Happy Chinese New Year (Gung Hay Fat Choy!). As you can see from the photo, I attended the New Year’s parade in San Francisco’s Chinatown this year. This disclosure introduces my topic for today, directed toward patients and would-be patients: Why do therapists disclose so little about ourselves? Why all the secrecy?
The standard answer goes as follows. Traditional psychodynamic psychotherapy, the kind that evolved from Freudian psychoanalysis, derives much of its healing power from observing and analyzing the transference. Transference is a complex concept, but for our purpose it can be understood as interpersonal attitudes and expectations learned early in life, that the patient unconsciously applies (“transfers”) to the therapist. These unconscious expectations can be positive, as in assuming the therapist will be loving, selfless, and perhaps superhuman, and/or negative, as in assuming the therapist will be withholding, competitive, or shaming. The nature of a patient’s transference reveals a great deal about how he or she sees others. ”Interpreting the transference” — making these unconscious assumptions conscious — frees the patient to treat self and other more realistically.
For this reason, anything in dynamic psychotherapy that promotes transference, and leaves it in its unperturbed natural state for observation, helps move the process along. This is where Freud’s “tabula rasa” or blank slate idea originates. The less known about the therapist, the more the patient fills in the blanks with transference. According to this view, it is more helpful to learn what the patient imagines about the therapist, than to correct the patient’s misperceptions or to share private details reciprocally.
However, there are several caveats that go with this idea. One is that not every patient in psychodynamic therapy handles frustration and delayed (or thwarted) gratification the same way. Some easily tolerate asking a question and not getting an answer, and enjoy exploring what their own minds come up with. At the other extreme are those who find the process insufferably insulting or humiliating, and cannot do this kind of work. In between are the majority who find therapist non-disclosure frustrating, but who can tolerate and work with it. In addition, patients (i.e., all of us) can shift day by day, or moment by moment, in our frustration tolerance and our willingness to “play” with our ideas and feelings in order to learn more about ourselves. A sensitive therapist recognizes this and responds accordingly.
An even more obvious caveat is that no therapist is truly a blank slate. If nothing else, patients know our race, gender, approximate age, and how we like to decorate the office. And let’s not kid ourselves, perceptive patients can soon guess or estimate details like socioeconomic status, regional dialects and accents, formality, conventionality, frustration tolerance, warmth, and a host of other therapist attributes. Moreover, we often reveal just by our look of recognition, or the lack of it, whether we are familiar with the book, movie, restaurant, cultural happening, or bit of street slang the patient just mentioned. And all this before the patient really gets curious and googles us.
The slate is far from blank. Still, therapists play what must seem like a sadistic guessing game to many patients: “You asked if I’m married [or gay, or have children, or watch 'The Sopranos']. What do you imagine about my home life?” I believe many times this exchange feels awkward and stilted for both parties, first, because the therapist does not explain the transference-based rationale behind the socially odd rejoinder, and second, because not answering also serves a boundary-setting function for the therapist, which is also not discussed. Often therapists themselves fail to distinguish these two aims.
I have supervised many beginning therapists who treat non-disclosure as a blindly followed rule about maintaining boundaries. Transference and even their own privacy are poorly articulated afterthoughts. (Conversely, I’ve met a few trainees who disclose freely in defiance of orthodoxy, and to make the therapist and patient “equal,” which they are not. Free and open disclosure by the therapist is compatible with perfectly good therapy — just not the psychodynamic variety that examines transference. It’s also not compatible with one’s own privacy, as discussed below.) With more experience, therapists pick and choose what to disclose, and the whole endeavor becomes less stilted and defensive on the part of the therapist, and more comprehensible to the patient. However, even very experienced therapists sometimes fail to explain to patients why they don’t answer personal questions directly. I see no harm, and much to gain, in offering a brief rationale.
The most important point about therapist self-disclosure is that the therapy is for the patient, not the therapist. Therapists who self-disclose because they like to tell stories or talk about themselves detract from the therapy they provide. They need another outlet (friends and family? a blog?). More subtle is disclosure aimed to make the patient like or respect the therapist. As a general guideline I disclose what I judge will benefit my patient, and not what I judge will not.
But there is a final point to be made about privacy. Being a patient in therapy feels — and is — vulnerable and exposing. It takes courage to bare one’s soul to someone who is initially a stranger; trust comes with time and must be earned. Efforts by either party to “even the playing field” through therapist self-disclosure cannot hasten this process or make it easier; the cost of such doomed effort is the therapist’s privacy. Many therapists have been in therapy ourselves, and that was when we were vulnerable. Good therapists owe their patients undivided attention, thoughtful reflection, concern, and empathy — but not an experience of false equality at the cost of their own privacy. I feel comfortable telling you I attended the Chinese New Year’s parade both because it won’t hamper our transference work if you happen to be my patient, and also because it isn’t very private. I consider both of these factors when a patient asks me a personal question.