Self-Disclosure in Clinical Social Work

Clinical Social Work Journal Vol. 24, No. 4, Winter 1996

SELF-DISCLOSURE IN CLINICAL SOCIAL WORK

James C. Raines, ACSW

ABSTRACt. This article seeks to establish six guidelines for the use of self- disclosure in clinical social work. It examines the relationship between self-disclosure and countertransference, the timing of self-disclosure over the course of the therapeutic relationship, types of self-disclosure, the connection between assessment of the client and self-disclosure, and how self-disclosure is related to reality-testing. Objections to self-disclosure are also examined and clinical examples are used throughout.

KEY WORDS: self-disclosure; countertransference; communication.

A shor t - t ime a f te r wr i t ing an ar t icle on e m p a t h y , I b ecam e aware t h a t as I became more empath ic wi th m y clients, t h e y became more em- pa th ic w i th me. As I became more a t t u n e d to subt le changes in the i r affect ive s ta tes , t hey not only became b e t t e r a t iden t i fy ing fee l ing-s ta tes in themse lves , b u t also in others inc luding myself . A co m m o n example should i l lumine m y meaning:

A woman who I have seen in therapy for one year comes in, and after being seated, says to me, 'You don't look well today." I analyze this internally on two levels. On the transference level, I wonder if this is an allusion to some hostility toward me. On a reality level, I know that I suffer from allergies and currently have a sinus headache. How am I to respond? I decide to confirm her sense of reality and reply, "Yes, I have a headache today." I then listen carefully to see if there are further hints that her observation may contain some hos- tile elements as well.

Analysis. I h a d four possible responses to such a s t a t em en t : I could have r e m a i n e d s i len t (she did not technica l ly ask a quest ion) , I could have a n s w e r e d h e r w i th a ques t ion of m y own (e.g., "Do you w a n t to know i f I

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am well enough to help you today?"), I could have interpreted her statement (e.g,, ~You're worried that I'm not well today"), or I could have responded as I did.

On what basis did I make my decision? Retrospectively, there were five elements that I took under consideration: my theoretical understanding of the therapeutic relationship, the timing of the statement within the treatment frame, the type of disclosure, my working model of the client (Greenson, 1960), and my sense of whether the client was justified in her observation of my physical state. This paper seeks to explore each of these five elements as well as objections to self-disclosure and inductively state six general guidelines for self-disclosure.

Self-disclosure refers to the sharing of personal information by the social worker. It includes personal data, feelings, opinions, diagnoses, formulations, experiences, and even fantasies. In a broad definition, it must also include non-verbal disclosures or acting out by the therapist (Goldstein, 1994).

THEORETICAL UNDERSTANDINGS

Since the cognitive and behavioral perspectives have generally min- imized the importance of the therapeutic relationship (Bergin & Gar- field, 1994), this paper focuses on the two approaches which have em- phasized the relationship as a necessary part of the therapeutic process. These are the psychoanalytic schools and the humanist/existentialist schools.

Psychoanaly t ic Views

The traditional psychoanalytic view was that self-disclosure was a gratification of the client's wishes. Langs (1974) stated, "with the excep- tion of brief acknowledgement of technical errors, self-revelations by the therapist to the patient reflect countertransference problems" (p. 361). How one defines countertransference has tremendous implications for where one stands on the issue of self-disclosure. Freud first addressed the issue of countertransference in 1910:

We have begun to consider the "counter-transference" [geg- eniibertragung], which arises in the physician as a result of the patient's influence on his unconscious feelings, and have come to the point of requiring the physician to recognize and overcome this counter-transference in himself. Now that a larger number of people have come to practice psycho-analysis and mutually exchange their experiences, we have noticed that every analyst's achievement is limited by what his own complexes and resistances permit, and consequently we require that he should begin his practice with a self-analysis and

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should extend and deepen this constantly while making his observa- tions on his patients. Anyone who cannot succeed in this self-analysis may without more ado regard himself as unable to treat neurotics by analysis (p. 19, emphasis added).

The traditional approach saw countertransference as an unconscious reaction which was a negative impediment to the therapeutic process. Communication of this reaction was only to occur within the therapist's t ra ining analysis. The responsibility belonged totally to the therapist, who had to "recognize and overcome" this obstacle or get out of the business!

The classical view began to be challenged from two different direc- tions. The first challenge came from the British object relations school. In 1947, Winnicott wrote, "Hate in the Countertransference," in which he classified three types of countertransference phenomena. The first two could be considered types of subjective countertransference. There were the abnormal feelings and identifications which indicated that the analyst needed more analysis. Second, there were those personal tendencies which made each analyst unique, but did not hinder the therapy. To these he added "the truly objective countertransference," by which he meant "the analyst's love and hate in reaction to the actual personality of the patient, based on objective observation" (1947, p. 195). Heimann (1950) also agreed that "the analyst's emotional response to his [or her] patient within the analytic situation represents one of the most important tools for his [or her] work (p. 81). She also posited the notion of a predictable emotional response on the part of the therapist to the client. Second, she explained the dynamic process by the theory of projective identification, wherein clients project dystonic parts of their own personalities into the therapist, who then feels pressure to feel, think, and behave in ways similar to those projections. Racker (1957) argued that objectivity was an "infantile ideal" and proposed a more intersubjective approach.

The first distortion of truth in "the myth of the analytic situation ~ is that analysis is an interaction between a sick person and a healthy one. The truth is that it is an interaction between two personalities . . . . and each of these whole personalitiesmthat of the analy- sand and that of the analystmresponds to every event of the analytic situation (p. 162).

Racker then differentiated between two types of "direct countertransference." The first type were "concordant identifications" that were based on a resonance between the therapist and the client. The second type were "complementary identifications" that were produced by projective identification, during which the client treats the therapist as an internal

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(projected) object and the therapist identifies with this object. Together, they suggested "the acceptance of countertransference as the totality of the analyst 's psychological response to the patient" (p. 165).

Object relations theorists were far from unanimous on whether to disclose these responses to the client. Winnicott approved of communicating these feelings to the client.

A patient of mine, a very bad obsessional, was almost loathesome to me for some years. I felt bad about this until the analysis turned a corner and the patient became lovable, and then I realized that his unlikeableness had been an active symptom, unconsciously determined. It was indeed a wonderful day (much later on) when I could actually tell the patient that I and his friends had felt repelled by him, but that he had been too ill for us to let him know (p. 196).

He imaun (1950) disagreed, "I do not consider it r ight for the analyst to communicate his feelings to his [or her] patient. In my view, such hon- esty is more in the na ture of a confession and a burden to the pat ienC (p. 83). Racker (1957) took a moderate position:

It is probable that the purposes sought by communicating the countertransference might often (but not always) be better attained by other means. The principal other means is analysis of the patient's fantasies about the analyst's countertransference sufficient to show the patient the truth; and with this must also be analyzed the doubts, negations, and other defenses against the truth, intuitively perceived, until they have been overcome. But there are also situations in which communication of the countertransference is of value for the subsequent course of treatment. (p. 199).

The second challenge to the classical view came from the interpersonal school. Sullivan (1949) considered the chief method of analysis to be the "skill in participant observation of the :unfortunate pat terns of his own and the patient's living, in contrast to merely participating in such unfor tunate pat terns with the patient" (p. 12). He labeled these unfortu- na te pat terns "parataxic distortions," which included both t ransference and counter- t ransference phenomena. Fromm-Reichmann (1950) first addressed the issue of countertransference from an interpersonal perspective. She divided the responses of the therapis t into those of a private person and those of a professional person. She also proposed tha t "positive countertransference" enabled the analyst to have an empathic at t i tude toward the client.

Cohen (1952) defined countertrausference as an in terference in the communication process. 'W~/hen, in the pat ient-analyst relationship, anxiety is aroused in the analyst with the effect tha t communication between the two is interfered with by some alteration in the analyst's be-

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havior (verbal or otherwise), then countertransference is present" (p. 70). She then classified three types of countertransference responses. Situational problems occurred with the therapist's need for social recognition.

Unfortunately, some aspects of psychoanalytic training tend to rein- force the interpretation of the therapist as a magically powerful person. The admonition, for instance, to become a "mature character," while excellent advice, still carries with it a connotation of perfect adjustment and perhaps brings pressure to bear on the traineenot to recognize his [or her] immaturities or deficiencies (p. 73).

Unresolved neurotic influences were those that were attributable to the therapist's character structure. Communication of the patient's anxiety was a "mysterious phenomenon" that was considered closely related to empathy. It relied more on the prosody of speech than its actual content.

The interpersonalists were also divided on whether to disclose countertransference material to their clients. While Fromm-Reichmann did not take a stand on the issue of self-disclosure, her case examples reveal that she did disclose personal information to clients who had difficulty with reality-testing. Cohen felt that any decision about disclosing countertransference material was premature until we understood the phenomenon of affect transmission better.

In 1965, Kernberg summarized the psychoanalytic literature and described the "classical" definition of countertransference as "the unconscious reaction of the psychoanalyst to the patient's transference" and the two subsequent views as "totalistic" in that countertransference was ~the total emotional reaction of the psychoanalyst to the patient in the treatment situation" (1975, p. 49). Over the past 30 years, there has been a gradual loosening of the rules of abstinence within psychoanalysis. Eminent theorists such as Greenson, Langs, and Gill have adopted a more totalist perspective on countertransference. Unfor- tunately, this has not resulted in any substantial revision about therapists' use of self-disclosure.

Humanist/Existentialist Views

Outside of psychoanalysis, both the humanists (Perls, Rogers, Mas- low, Fromm & Bugental) and the existentialists (Becker, May, Frankl, & Yalom) embraced Buber's concept of an 'I-Thou" relationship as essential to the therapeutic process. Inherent to this kind of relationship was an appreciation for the humanity (or fallibility) of the therapist as not only unavoidable, but often the best method of cure. Yalom related this to self-disclosure:

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A therapist who is to know a patient must do more than observe and listen; he or she must fully experience the patient. But full experience of the other requires that one open oneself up to the other; if one engages the other in an open and honest fashion, one experiences the other as the other is responding to that engagement. There is no way around the conclusion that the therapist who is to relate to the patient must disclose himself or herself as a person. The effective therapist cannot remain detached, passive, and hidden. Therapist self- disclosure is integral to the therapeutic process (1980, p. 411).

What guidelines served for determining how much to reveal? May (1969) suggested tha t the Greek term, ~ a ~ (agape), a selfless love devoted to the welfare of the other, is the ethic tha t underlies the healing relationship. I t requires tha t any disclosure tha t does not come from a conscious and thoughtful desire to help the client be avoided. It im- plies self-restraint as the obverse of self-disclosure.

In my work with a socially limited middle-aged man, he lamented about whether he'd ever have a friend or whether he was destined to go through life having never had an intimate relationship. I told him that I was finding it difficult to share his pessimism and he asked why. I then revealed that my optimism was predicated on the care he elicited from me. He smiled and remarked that he thought he knew what I was saying. Several weeks later, he told me that he had been much less depressed and attributed his change in mood to my self- disclosure.

Analysis. Despite having had several therapists in the past, this man had never considered the therapeutic relationship as a real relationship with mutua l feelings involved. My sense tha t if I could care about him, then so could others was the only foundation for such a conclusion. The man had no experience of either a close friendship or a romantic relationship, not even within his family of origin. If the therapeutic relationship could not evoke genuine caring, then all hope really was lost. The f i rs t guidel ine t hen becomes t h a t any self-disclosure must lead to growth, it should deepen the capacity for insight and for relationship.

TIMING

It is tradit ionally considered appropriate to answer some questions from the client tha t occur at the beginning of the t r ea tment process. It is within the client's "right to know" certain facts about the social worker: the customary fee, type of degree and training, years of experience, and theoret ical orientat ion. Typically, these are handled matter-of-fact ly

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during the first session. Sometimes, however, the client wishes to know more personal details about the therapist.

Because of my seminary training, it has become quite common for me to receive referrals from other professionals who want me to see a religious client. It is not unusual for such clients to inquire about my religious background. Sometimes the questions are posed bluntly (e.g., "Are you born-again?"). My own practice is to answer these briefly and then inquire as to the meaning behind them from the client's perspective (e.g., "I consider myself a Christian, perhaps you can tell me what %orn again' means to you"). Such a response is based on the principle of the client's "right to know." Contrary to Strean (1978), a simple reply does not and should not preclude a full exploration of the question and may help to enable it. Typically, I hear that their faith is important to them and that they want to make sure that their faith will be treated respectfully.

What about personal questions which are raised during the middle phase of therapy? I remember explicitly addressing the issue of sexual orientation with my own therapist midway through my treatment.

"Sometimes I wonder if you're gay or not ~ I probed. My therapist 's eyebrows rose and he answered me with a question, ~Yhat makes you wonder? ". I then confessed my own attraction to him and he ex- plored how it felt to reveal such feelings. I articulated that it felt both uncomfortable as well as relieving. I then elaborated tha t even though I considered myself heterosexual, I frequently found that my closest male friendships were with gay males. I attributed this to my straight friends' difficulty with homophobia and their subsequent fear of closeness with another male. A few years later, a mutual col- league casually referred to my former therapist as a "middle-aged gay social worker, ~ a revelation that confirmed my earlier hunch.

Analysis. Without meaning to keep my therapist on a pedestal, I believe that he did well to keep his sexual orientation private. First, I had s i m - ply wondered aloud, not actually asked a question. Second, the t iming of my fantasy/observation occurred during a phase of the t reatment when intimacy was a key issue for me. In essence, I was really asking if I could be intimate with him and be sure that he would neither reject my need for closeness nor abuse my transferential feelings. Lastly, any self- disclosure on this point could have stalled further exploration by acti- vating my own (projected) homophobia!

Finally, it has sometimes been suggested that the therapis t dis- closes more during the termination phase in order to enable the therapist-patient relationship to "move toward a social relationship" (Weiner, 1983, p. 101). Such a view, however, demands that termination of the therapeutic aspect is truly final and never a hiatus. What does some-

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times change with the onset of the termination phase is a resolution of the client's former difficulties which previously prevented them from as- similating some therapist disclosures. This will be elaborated as we discuss the working model of the client. Thus, the second guideline of self- disclosure is that i f it occurs at the beginning of the engagement process, it is more likely to fall under the client's right to know.

This guideline is not an absolute rule. While giving a seminar on this topic, one trainee related how a new client repeatedly pressed her for self-disclosure. When the client wanted to know whether the trainee waxed her bikini line, the trainee set an appropriate limit and realized the client was looking for any excuse not to engage in the therapeutic relationship.

TYPES OF DISCLOSURE

Non-Verbal Disclosures

Non-verbal disclosures refer to those aspects about our person tha t it would be difficult to hide. How we decorate our office communicates something about ourselves. We may have plants or pictures of our family. How we dress expresses our personality. Females may wear a dress or slacks, males may sport facial hair. What kind of jewelry we wear is significant, especially wedding rings. Our style is evident in our degree of politeness, our warmth, and our attention to details (e.g., s tart ing and ending on time). There are also meta-communication clues such as our vocabulary, accent, volume, pitch, ra te of speech, use of humor, etc. Singer (1968) shows how even interpretations can be risky.

The more to the point and the more penetrating the interpretation, the more obvious it will be that the therapist is talking and understanding from the depth of his [or her] own psychological life . . . . It takes one to know one, and in his [or her] correct interpretation the therapist reveals that he [or she] is one (p. 369).

Thus, the idea tha t we can be blank screens is impossible, our personality exudes from everything we do or do not do! Jane t Rioch noted this long ago:

There is no such thing as an impersonal analyst, nor is the idea of the analyst's acting as a mirror anything more than the "neatest trick of the week." Whether intentionally or not, whether conscious of it or not, the analyst does express, day in or day out, subtle or overt evidences of his own personality in relationship to the patient (1943, pp. 48-49).

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Acting Out

By acting out, I refer to behavioral mistakes tha t are unconscious. Unconscious acts are difficult to recognize and represen t unresolved countertransference issues.

While working with a very attractive waitress a few years younger than myself, I would receive phone calls from her during which she frequently called me "honey." When I addressed this with her in sessions, she denied that there was any significance to it, alleging that she had simply "confused" me with her boyfriend! One night, after picking my wife up from work, we walked around and wandered into a restaurant and were seated for dinner. Suddenly the waitress ap- peared and remarked what a nice surprise it was to meet my wife. I had 'Torgotten" that this was the restaurant where she worked!

Analysis. While I had been in touch with my feelings of attraction and the romantic na ture of the transference, I had been ineffective at resolv- ing this during the therapy. My unconscious guilt led me to forget the waitress ' place of employment and to actively confront her with my mar- ried state. It was a blundering a t tempt to regain some control in the t rea tment process. Eventually, it did lead to a productive discussion of an "intimacy," which transcended sexuality (Rokach, 1986).

Clearly we are on firmer ground when we can identify such counter- t ransferent ia l clues before they occur (Cohen, 1952). We can usual ly guess tha t we are having such feelings by recognizing clues to our overinvolvement or underinvolvement. Overinvolvement refers to having overly permeable boundaries between the client and therapist . Underin- volvement refers to having overly rigid boundaries. In both, the result may also be negative or positive. (See Table 1.)

It is probably no accident tha t we often recognize (become conscious of) our counter t ransference through impulses to act inappropriately. Saari (1986) redefined countertransference as "the carrying out of action pa t te rns tha t the therapis t has not conceptualized or a t tuned to the t rea tment goals" (p. 47). The only amendment tha t might be added is tha t countertransference also includes the impulse to carry out those actions.

Verbal Self-Disclosures

One of the basic distinctions that can be made between the various types of verbal self-disclosures is between those disclosures about what is occurring between the participants during the here and now of the session versus those disclosures about the therapist 's life outside the therapeutic encounter (Wachtel, 1993).

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TABLE 1

Clues to C o u n t e r t r a n s f e r e n c e

O v e r l n v o l v e m e n t Negative �9 Therapis t has unreasonable dislike or even disgust for a client �9 Therapis t dreads sessions or arrives late (sometimes by extended

previous session) �9 Therapis t becomes argumentat ive or provocative

competes intellectually with the client has violent thoughts or dreams about the client

�9 Therapis t �9 Therapis t Positive �9 Therapis t �9 Therapis t �9 Therap is t �9 Therapis t

is overly emotional or sympathet ic to client regular ly provides ext ra t ime fantasizes bril l iant in terpre ta t ions is unusual ly sensitive to criticism from the client

�9 Therapis t has sexual thoughts or dreams about the client U n d e r i n v o l v e m e n t

Negative �9 Therapis t finds it difficult to empathize with the client �9 Therapis t finds it difficult to pay a t tent ion �9 Therapis t becomes drowsy or pre-occupied �9 In terpre ta t ions frequently miss thei r mark �9 Therapis t never thinks or dreams about the client Positive �9 Therapis t withholds empathy due to belief in client's s t rength �9 Therapis t refrains from interpre ta t ion to promote insight �9 Therapis t reflects or reframes client's questions without answering �9 Therapis t consistently uses more abstinence with the client �9 Therapis t never considers self-disclosure with this client

While working with an adolescent in special education who had been diagnosed as having an Attention Deficit Hyperactivity Disorder, a family session was held to discuss the possibility of medication. Un- fortunately, his mother was a Jehovah's Witness and his step-father was a recovering alcoholic who both refused to give this a moment's thought. They considered the problem a moral one and "Bullet" (his nickname) would just have to go into foster care if he didn't straighten up. Their son dared them to go through with it and denied having any feelings about his parents' rejection. I asked the parents to step outside for a moment while I spoke privately with their son. I asked him to look in my eyes, knowing that they had welled up with tears. He was then able to admit that underneath his anger, he also felt enormous pain and sadness.

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Analysis. This was a family who attempted to control feelings either through alcoholism or religious sanctity. While they recognized their son's hyperactive and destructive tendencies (as evidenced by the nickname), they refused to view the problem through a new heuristic. My hope was that by seeing a "softer side" to their son, they would be able to soften too. Since I was the only one in the room in touch with the sadness of this situation, my feelings were intensified because I was "containing" this feeling for the entire family. (It has been my experience that the intensity of the affect is proportional to the number of people in the family or group who have disowned and projected this feeling into the containing person.) I needed to reveal my feelings to move beyond a stalemate.

Thus, Basescu (1990) states a third guideline for self-disclosure: it is disclosures within the current relationship that are predominant "in importance, in relevance to the therapeutic work, and in frequency of occur- rence" (p. 55). If we believe that relationships are formative, then it

makes sense that what transpires within the therapeutic relationship can be transformative. Making the intersubjective process explicit can facilitate that transformation.

WORKING MODELS

Greenson (1960) described his working model of a patient as includ- ing "all I know about the patient: experiences, modes of behavior, memo- ries, fantasies, resistances, defenses, dreams, associations, etc." (p. 422). A normal part of the social work process is some assessment of the client's strengths and weaknesses. This is true regardless of one's theoretical orientation. In drive theory, the client's secondary processes and impulse control are under scrutiny. In ego psychology, the client's ego functions and defenses are routinely surveyed. In object relations theory, the client's ability to cathect Whole objects and quiet internal sabo- teurs is important. In self psychology, the client's ability to maintain a resilient self and avoid fragmentation is paramount.

The more positively we view the client's level of maturity, the more we can risk certain disclosures without worry that it will be an unbear- able burden to the client. On the other hand, less mature clients often have a strong need for concrete data about the therapist to ground them in reality and to view the social worker as a real person.

While working with a second-grade boy with Asperger's syndrome and an all-encompassing preoccupation with spectator sports, I inter- rupted him as he began to launch into another non-stop monologue about last night's game. I asked him to look at me and tell me if he thought I was really interested in the game. This served as a re-

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minder to previous self-disclosures I had made about my non-interest in spectator sports. Once he had been confronted with my individuality, I then used his interest in sports to discuss the personalities of the players.

Analysis. Since one of the characteristics of persons with Asperger's disorder is to treat people as if they were faceless replicas of themselves, I encouraged him to make eye-contact and consider my interests before performing a soliloquy. To the extent he can treat me as a real person with separate interests I have hope that he can begin to treat peers and family members as real people too. While I am willing to "entertain" his fascination with sports, my agenda remains the same: to help him see others as real persons with separate personalities and interests.

Gorkin (1987) stated that ~reasons for disclosing countertransfer- ences are most clearly applicable to those patients for whom a sense of basic trust, a sense of reality, and clear-cut differentiation of self and object boundaries is least firmly establishedmin short, those patients who are most disturbed" (p. 85). As Saari (1991) has observed, the creation of meaning is a shared achievement. Those who are least able to maintain a relationship have the greatest difficulty making sense of their world and need the therapist to be a genuine other to begin to create a meaningful existence. On the other end of the spectrum are those clients whose meaning systems have enough coherence and complexity (Saari, 1993) that they will not will not be adversely affected by a social worker's disclosure of individuality. Thus, the fourth guideline becomes: self-disclosure is most appropriate when the client is least able to obtain consensual validation of reality or when the client's identity is most able to allow the therapist his or her own individuality.

REALITY AND KNOWLEDGE

The shift in the therapeutic professions' understanding of countertransference cannot be separated from shifts in the philosophy of science, especially in the understanding of ontology and epistemology. How we understand the relationship between reality and knowledge has important implications for our praxis. Gradually, we have moved from positivism to a post-modern view.

Logical Positivism

Freud was a product of his time and like most of his contemporaries he believed in logical positivism, which assumed a reality 'out there' that could be known by 'objective' observers without contamination of the thing observed. Freud believed that therapists could be objective ob-

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servers of the reality of their patient's illness. His word for transference (iibertragung) was in fact a medical term which referred to the communication of disease, a spreading of the infection. The assumption behind it was that the healthy analyst was experiencing the pathology of the patient through the transference. Furthermore, since the therapist was simply an objective observer, every therapist would experience the client in the same way (providing they had been completely analyzed). The patient's "repetition compulsion" made analysts interchangeable!

Relativism

Others have given up the illusion of the pure helping t he impure in recognition tha t both therapist and client have a transference which they bring into the relationship (Balint, 1939; Reich, 1951). If we accept that both parties have a transference, then we must also argue that both have a countertransference, a response to the other's personality. Given that neither party has "immaculate perception" (von Bertalanffy, 1969), many persons have adopted a stance of relativism. This relativis- tic philosophy, however, has laid bare a fundamental question. How are we to know (the epistemological question) what is real (the ontological question)?

In a strange irony, both logical positivism and relativism share a common fault. They both lack a boundary between ontology and epistemology. The logical positivist assumes tha t since there mus t be a mind-independent reality then it must 'be knowable in a direct way. The relativist assumes that since all knowledge is socially constructed, then there is no mind-independent reality. Neither separates the ontological issue from the epistemological one.

Fallibilistic Realism

In 1983, Manicas and Secord posed a third alternative known as fallibilistic realism, which avoided the narrowness of logical positivism and the capriciousness of relativism. Also called critical realism, it re- tains a belief in real objects, but "admits that these are not directly and homogeneously presented to us in perceptual situations" (Flew, 1984, p. 81). Bhaskar (1989) renamed this perspective and elaborated:

Transcendental realism explicitly asserts the non-identity of the objects of the transitive and intransitive dimensions, of thought and being. And it relegates the notion of a correspondence between them to the status of a metaphor for the aim of adequating practice. It entails acceptance of (i) the principle of epistemic relativity, which states that all beliefs are socially produced, so that all knowledge is transient, and neither truth-values nor criteria of rationality exist

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outside historical time. But it entails the rejection of (ii) the doctrine of judgmental relativism, which maintains that all beliefs are equally valid, in the sense that there can be no rational grounds for prefer- ring one to another (pp. 23-24, emphasis in the original).

Thus, a fifth guideline for self-disclosure is that it must be justifiable on rational grounds, that it is not subject to the whim of the therapist. Some of these rational grounds may include the following: Does it lead to an improvement in the client's symptomatology? Does it improve the client's relationships with others? Is it congruent with t rea tment goals? Is it within the "average expectable environment" in terms of accepted technique? Is it based on a "shared reality," ie. does it make sense to at least two people involved with the case? Without the protection of these questions we would be in danger of practicing without principles.

OBJECTIONS

There are three common objections to the use of self-disclosure in therapy. It is alleged that self-disclosure changes the focus, interferes with the transference, or is simply unnecessary.

Change of Focus

One objection is tha t it changes the focus from the client and to the therapist . In so doing, it is not only a distraction bu t a repetition of a parenta l failure to at tend to the client's needs in an empathic and selfless way. Wachtel (1993), however, observed that:

unduly narrow restrictions on the grounds of a presumed need by the patient for his [or her] experience to be the exclusive focus can be problematic. The conception of the infant and young child as requiring absolute and selfless attention is altogether too precious and out of touch with the reality of life as it is lived by flesh and blood human beings (pp. 212-213, emphasis in the original).

These types of parental failures may also be instructive for the therapis t and ul t imately curative for the client. Winnicott (1965) wrote:

In the end the patient uses the analyst's failures, often quite small ones, perhaps manoeuvred by the pa t i en t . . , and we have to put up with being in a limited context misunderstood. The operative factor is that the patient now hates the analyst for the failure that origi- nally came as an environmental factor, outside the infant's area of omnipotent control but that is now staged in the transference. So in the end we succeed by failing--failing the patient's way (p. 258, emphasis in the original).

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This is not to imply tha t we try to fail or tha t we become careless. It does mean tha t we acknowledge our mistakes (to both ourselves and our clients), learn from them, and at tempt to make reparations.

Interference

Another objection is tha t self-disclosure interferes with the transference because the therapist is no longer a '%lank screen". If resolution of the transference is the essential element in the t rea tment (Gill, 1982), then it would seem to behoove the therapis t to facili tate this transference by being as opaque as possible. But is transference the only way to help people? Kohut (1984) discussed the importance of " t ransmuting internalizations" of the empathic therapist as a selfobject. In fact, he explicitly compared this to Alexander and French's (1946) "corrective emotional experience."

If an ill-disposed critic now gleefully told me that I have finally shown my true colors and, with this last statement, demonstrated that I both believe in the curative effect of the "corrective emotional experience" and equate such an experience with analysis, I could only reply: so be it (p. 78).

Thus, it seems that within the psychodynamic perspective there is more than one pa th up the mounta in of healing. Too exclusive a focus on t ransference negates the importance of the h u m a n dimension in the therapeut ic encounter and may even produce what Greenson and Wex- ler (1969) describe as "prolonged affective atherosclerosis ' . Further- more, it depends on an idea of the transference as "radically acontex- tual" (Wachtel, 1993).

Gill redefined his view of transference in 1983:

The definition would change from the customary one of transference as a distortion of reality defined by the analyst to a conception of a transference-countertransference transaction in which, from the dif- fering perspectives of patient and analyst, each has a view which has its plausibility (p. 234).

This would seem to point to a "totalist" conceptualization of the transference as both a distortion (from the past) as well as an appropriate response (to the present). It requires tha t we tease out both elements. This is parallel to the way in which the therapist in conjunction with a supervisor or consul tant teases out both the "homogenous" reactions (those which others would share) and the "idiosyncratic" reactions in the countertransference (Giovacchini, 1989).

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A female attorney entered treatment because she was afraid that she was going to be fired from her new job. She lost her old one for reasons that were still unclear to her because colleagues said she was good in the courtroom. In addition, she was experiencing marital troubles because her husband wasn't talking to her anymore. During our work, she would frequently criticize the wording of my interpretations. If I touched my moustache while speaking, she would ac- cuse me of prevaricating because she'd learned in law school that people frequently cover their mouths when committing perjury. I found myself becoming increasingly silent during our sessions. Fi- nally, she worried that she would know longer be able to afford my "exorbitant" fee once unemployed. I tried to reassure her that ~we will cross that bridge when we come to it." She objected, ~you couldn't even give me an 'if'!"

Analysis. This woman's razor sharp abilities at "cross"-examinat ion were obviously the source of her interpersonal problems. In addition to this, her appearance and demeanor reminded me of an in-law who also worked as an attorney. As I became aware of'~keeping my mouth shut," I carefully considered how much of my reaction was due to the effect of this client and how much was due to my own issues with my in-law. Once I had sorted this out, I was ready to respond.

This is the final guideline of self-disclosure. We never share our response to the current situation without first analyzing what (and how much) belongs to whom. This is the problem which faces object relations theorists (e.g., Grinberg, 1979), who assume tha t certain processes such as "projective counteridentification" operate in a "exclusive way to the intensi ty and quality of the patient's projective identification" (p. 234). In so doing, they make the same epistemological error as the classicists. Whereas the classicists believe tha t they can view the transference objectively, some object relationists believe tha t they can view the countertransference objectively. I t seems logical (and safer) to assume tha t both the intensi ty and quality of both the transference and the countertransference have rational and irrat ional elements. Tansey and Burke (1989) arrived at the same conclusion.

Whereas the classicist may be too quick to attribute an intense response to the therapist's exclusively private concerns, the totalist runs the risk of too readily concluding that the countertransference response to the patient constitutes a royal road to the patient's unconscious rather than a detour into his [or her] own (p. 28).

Unnecessary

A final objection to self-disclosure is t h a t it is unnecessary, the same resul t can be achieved in other ways. Reich (1960) s ta ted "the countertransference as such is not helpful but the readiness to acknowl-

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edge its existence and the ability to overcome it is" (p. 392). She distin- guished between two broad types of countertransference. Pe rmanen t at- t i tudes were conflict-laden characterological problems which indicated the therapis t needed more analysis. Acute manifestations were more sit- uationally determined and more easily repaired. In nei ther case was direct communication advisable, except when the analyst makes an obvious mistake.

We may be compelled to agree tha t it is simply a question of prefer- ence, but Wachtel (1993) notes tha t "persistent refusal to answer questions can generate what one might think of as 'surplus resistance, ' re- sulting from the patient's feeling warded off and e x p e r i e n c i n g . . , tha t the therapis t is playing a kind of cat and mouse game about answering his questions" (p. 227).

Near the beginning of my career as a social worker, I was working with a narcissistic adolescent whose parents were consistently un- available. His father was a compulsive gambler and his mother was severely depressed. One day he began our session by asking how old I was. I asked why he wanted to know and he refused to say until after he'd received his answer. I decided to trust him and revealed my age. He promptly replied that I wasn't old enough. "Old enough for what? ~ I demanded. He then shared his fantasy that I could marry his favorite teacher. I then finished the unspoken part of his wish, "and then adopt you." He smiled and confirmed my conclusion.

Analysis. At the base of his self-esteem problems, it was clear tha t this boy had difficulty with trust. In a sense, the real question he was asking was "Can I t rus t you?". Given the predicament, the only way I could respond to the unspoken question was by saying in effect "I am willing to t rus t you." He then disclosed a very private fantasy of having two concerned parents who t ruly regarded him as special. Could I have achieved the same result in another way? I didn't th ink so. Any "interpretation" of his question was likely to be experienced as another de- privation in a very deprived life. Perhaps one of the differences between social work and the other therapeutic professions is the degree to which we meet people who have suffered malignant deprivations and losses. It seems to me tha t only the provision of an authent ic person will suffice.

Why do we cling to an outmoded technique when our theory has changed? One answer may simply be habit. It has been four centuries since Copernicus corrected the Ptolemaic view of the solar system by positing the ear th revolves around the sun instead of vice versa. In spite of this, we continue to speak of "sunsets," when we would be more accu- rate to speak of "horizon-rises" against the background of the stat ionary s u n .

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James C. Raines, ACSW Loyola University Chicago School of Social Work 820 N. Michigan Ave. Chicago, IL 60611

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