A Therapist’s Dilemma: Whether to Disclose or Not Disclose

October 16th, 2017   |  

One challenge that can arise for therapists is the decision whether to disclose personal tidbits of information as they become potentially relevant during treatment with the people we help. I recently provided consult to a colleague who brought this dilemma to light and gave me the opportunity to contemplate all of the aspects involved in deciding whether to share information in our work.

In this particular scenario, my colleague was conflicted about whether to disclose to a woman she was working with that they shared the same medical practice. Normally, this piece of information might be an insignificant coincidence; however, this specific case was more complicated. A large focus of what the woman was discussing in the session involved decisions she was making regarding one of the doctors in the practice as it related to the future of her health care. My colleague, her therapist, had strong opinions about this particular doctor due to a very negative personal experience she had. As she listened to the woman explain her situation, she felt conflicted over whether to speak up about the fact she knew this doctor or stay quiet and focus solely on the woman’s experience.

Both felt like no-win options. On the one hand, it felt awkward to take the focus off the woman’s experience by mentioning her own knowledge of the practice. On the other, she felt that simply listening and nodding without mentioning her familiarity with the doctor was like withholding a secret or being dishonest. And that felt like a threat to her credibility and to the therapeutic relationship.

As we contemplated her options, we discussed various questions, including: What if the two women ran into each other in the doctor’s office waiting room? What if the woman mentioned her therapist by name to the doctor and he revealed he knows her? If the woman somehow found out her therapist knew of this doctor all along with no mention, would she feel betrayed? Would it be a threat to their working effectively together?

I had a similar experience in the past in terms of feeling uncomfortable holding a “secret” from two people I was working with. I had a long-standing relationship with each individual. Well into my work with both, it became apparent the two had met and become friends. As the two talked about their budding relationship in their individual therapy sessions, I sat with the discomfort of being unable, due to confidentiality, to blurt out, “I know this person!”

Sometimes, obvious conflicts are apparent up front and we have the opportunity to inform an individual that, due to a conflict of interest, we are going to need to refer them to a colleague. But when coincidences and complications arise well into the course of treatment or are not obvious conflicts, our options and decisions as therapists become more complicated. We are often faced with navigating how to balance being transparent, open, and honest while adhering to boundaries, ethics, and legal codes.

When ethical or legal boundaries do not prohibit therapists from sharing information, appropriate self-disclosure can be incredibly useful in therapy. For one, sharing common experiences can strengthen the therapeutic relationship. Additionally, revealing limited personal information or mentioning mutual experiences can help make the therapist seem more “human” or “real,” which can increase the comfort level of the person seeking help.

When a therapist decides to disclose certain information, it’s important to keep in mind that the reason for doing so is to help support the person in therapy and advance the treatment. The therapist must ensure the disclosure is in the best interests of and for the benefit of the person they are helping and be careful not to turn the focus on the therapist.

A strong therapeutic alliance is one of the biggest factors in whether therapy is helpful, and some level of disclosure can help in developing this necessary rapport. Additionally, when therapists share that they personally relate to pain, struggle, or challenge, they can instill hope and help to reduce feelings of isolation or helplessness.

The key to disclosing lies in determining when it is appropriate. In line with most health care provider codes of ethics, the first obligation is to do no harm, so it’s paramount to think about the welfare of the individual in treatment and to contemplate all the ways they may be impacted by the decision to share or not share. In more complicated situations, it is important to seek outside consultation with other professionals or colleagues to ensure the therapist is looking at the situation from every angle and that personal needs, emotions, and biases are not clouding their judgment.

When a therapist decides to disclose certain information, it’s important to keep in mind that the reason for doing so is to help support the person in therapy and advance the treatment. The therapist must ensure the disclosure is in the best interests of and for the benefit of the person they are helping and be careful not to turn the focus on the therapist. The therapist should not disclose anything that may require the person they are helping to then be in a position of caring for the therapist. For example, it would not be appropriate to bring up unresolved grief or any other issues the therapist is wrestling with.

Disclosure is effective only when the person in therapy feels supported, understood, and validated, so care should be taken in the timing and delivery of the information. It is not helpful if the person feels the therapist is wasting valuable time with their own interjections or anecdotes, so therapists should consider whether disclosure can be summed up in a simple sentence or whether it would require a more in-depth explanation that takes up time and turns the focus away from the person’s experience.

Questions for Therapists to Consider Regarding Disclosure

Some questions therapists must ask themselves when deciding whether to share certain information include:

• Is the information clinically relevant?
• How will sharing the information affect the treatment?
• Will not sharing the information impede the therapeutic process?
• Does disclosing breach any lines of confidentiality?
• Does not disclosing violate any legal obligations?
• What is the intent of the disclosure?
• Is disclosing for the benefit of the person in therapy or the therapist?
• Does withholding or sharing the information cross any ethical boundaries?
• How might disclosing impact the person in therapy? Would it be helpful or harmful?
• How might disclosing impact the therapeutic relationship?

Apart from issues that involve clear legal or ethical guidelines, there is often no right or wrong answer as to whether disclosing certain information is appropriate or warranted. By considering the above questions, therapists may be better able to make decisions that are well thought out and upholding of their duty to act in the best interests of the people they help.