Shirah Vollmer MD

The Musings of Dr. Vollmer

Self Disclosure

Posted by Dr. Vollmer on April 29, 2015

Should I answer the question about where am I going on vacation? Should I attempt to explore where their fantasy tells them I am going? Should I tell my patients when I take off for a death in the family or should I say I need to change the appointment and remain vague? These are the questions that therapists struggle with, for which there is no answer, but only questions about technique which need to be bantered around to determine the course of action, knowing that the answer depends on the patient, the therapist, and the current issues in the therapy room. Orthodox Freudian analysts were clear that no question could be answered directly. Every question or concern for the therapist was, in their reality, a reflection of the patient’s narcissism. For example, if the patient says “I am sorry you were sick,” the Freudian analyst would respond, “yes, I am sure you were sorry because you worried that I could  not show up for you,” thereby turning a casual demonstration of concern into a self-centered question, where this is a false dichotomy because both can be true. Similarly, one can elicit the fantasized vacation and then disclose the actual vacation by saying, “I will answer that question, but first tell me where you imagine me on vacation.” More contemporary therapists easily disclose their marital status, their children and their current struggles, perhaps to the detriment of patient care. Too much self disclosure can subtly coerce the patient into being the caretaker, a role familiar to many patients, and in so doing, this recreates the early traumatic experience of not being listened to. Yet, too little self-disclosure can create a discomfort and distance which diminishes the patient’s trust in the therapist. To disclose where I go on vacation often has the unintended benefit of having the patient feel that he/she has “joined me” on vacation  and therefore feels less abandoned. Joy, a fictional patient, tells me that when I tell her where I am going on vacation, she looks at the map with great anticipation for me and my adventures. Joy tells me that if I did not answer where I am going on vacation she would worry that I am not safe. When I give her a specific location, then when she hears the news of a disaster, she immediately knows whether I am in the vicinity or not, and this helps her anxiety tremendously. I did not know, until Joy told me, how important my self disclosure was to her. Joy went so far as to tell me what restaurants I should go to and what sites I should see, based on her internet research, which I found very helpful and thoughtful. At the same time, I was aware that I needed to listen to Joy to hear how she felt, not just about my self disclosure, but about me telling her that I would be out of contact. She coped by helping me “get ready” for my trip, but at the same time, she feared that she might need me while I am away, and that caused her stress. For Joy, self disclosure was critical to her well-being, but it did not erase the uncertainty that I was giving her. I learned from Joy, that for her, telling her where I was going on vacation was important. As for my next patient, it is not so clear.

2 Responses to “Self Disclosure”

  1. Shelly said

    Why is it narcissistic to be concerned about the therapist? You talked in a past blog about the patient-therapist “relationship” but in this blog you call concern for the therapist narcissistic. This makes no sense. If being concerned about the patient is narcissistic, then it’s not a real relationship at all. It’s only one sided. In essence, therapists insist that the patients tell them everything that’s on their minds in a free manner, but if the patients express any concern in any way about the therapist, they are at risk for being called narcissistic. Is that fair?

    • Oh, I have not been clear. The idea is that all interactions involve both a caring component and a narcissistic component, but most of us only think about ourselves as caring people. Selfish people tend to deny their selfishness. In in-depth psychotherapy, one has the opportunity to explore the idea that concern for another also involves the worry that if your friend is sick, there is also concern that you will lose that friend, in addition to being concerned for the friend’s welfare. Acknowledging the complexity of the feeling of concern is the point of an exploratory dialogue in which motivations are more complicated than they seem. This example illustrates the complexity of caring for other people and embracing that complexity as a way to see interactions in multiple dimensions. Thanks.

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