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Therapist self-disclosure as an integrative intervention

Article  in  Journal of Psychotherapy Integration · March 2013

DOI: 10.1037/a0031783

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Sharon Ziv Beiman

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 Journal of Psychotherapy Integration © 2013 American Psychological Association
2013, Vol. 23, No. 1, 59 –74 1053-0479/13/$12.00 DOI: 10.1037/a0031783

Therapist Self-Disclosure As an Integrative Intervention

Sharon Ziv-Beiman
College for Academic Studies

This article advances an integrative conceptualization of therapist self-disclosure.

The first section reviews various theoretical positions regarding self-disclosure and
then proceeds to examine research and theory concerning the impact of self-
disclosure on patients’ perception of the therapist, its efficacy as evaluated by both
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

patient and therapist, and its impact on the therapeutic outcome. It is proposed that
This document is copyrighted by the American Psychological Association or one of its allied publishers.

the power of therapist self-disclosure derives from its integration of various

therapeutic dimensions, enabling it to simultaneously strengthen the therapeutic
relationship and advance diverse dimensions of therapeutic change. Illustrating this
claim clinically, it is suggested that an integrative conceptualization of self-
disclosure supplements previously discussed approaches to psychotherapy
integration.

Keywords: therapist self-disclosure, psychotherapy integration, therapy outcome, therapeutic

relationship

I am facing Naomi (age 34 years), one of my
favorite patients, who is always hoping that her
“knight in shining armor” will arrive to rescue
her “sleeping beauty.” Eight months into treat-
ment, we are stuck. I therefore take a calculated
risk and, my heart beating, say to her,
Most of my life I believed that only slim people are
eligible for membership in the society called “human-
ity.” My life would begin, I thought, only when I lost
sufficient weight to gain entrance into this exclusive
club. It took a lot of time—and pain—to realize that
such waiting is useless. Finally, I gave it up and ac-
cepted my size. This acceptance comes at a price,
however. Sometimes—fortunately not too often—I get
rejected because of my weight. On the other hand, I am
much less dependent upon external approval. Now I
spend much more time expressing myself, feeling joy.
I’m alive.
What prompted me to make this speech?
Why did I find it suitable and therapeutic to
share one of the most painful struggles of my
own life with Naomi? And why during this
particular session, at this specific point in the
treatment, with this patient? Although I con-
sider myself to be a relational—and integra-
tive—psychotherapist, I do not share the belief
Correspondence concerning this article should be ad-
dressed to Sharon Ziv-Beiman, School of Psychology, the
College for Academic Studies, Or Yehuda, Israel, P.O.
44217 Tel Aviv 61441. E-mail: Sharon_z@mla.ac.il
59
that this necessarily entails self-disclosure. Al-
though I am fascinated by the power of this
particular form of intervention, I also know
that—like other powerful interventions—it car-
ries serious risks. My experience has taught me,
however, that self-involving communications
tend to be broadly effective. This article thus
examines the integrative power of therapist self-
disclosure in deepening the therapeutic relation-
ship and initiating a gamut of changes with
respect to emotions, thought, motivation, be-
havior, and interpersonal relationships. In other
words, it posits that an intervention based on
self-disclosure is powerful because it is integra-
tive.
In order to ground this argument, I first
review the theoretical and empirical literature
relating to therapist self-disclosure. On the
basis of this literature, I then proceed to dem-
onstrate the potential therapist self-disclosure
exhibits in its ability to simultaneously ad-
vance the therapeutic relationship and a wide
range of therapeutic goals. My treatment with
Naomi constitutes the relevant case study. I
conclude by raising the possibility that con-
ceptualizing therapist self-disclosure as an in-
tervention capable of integrating a range of
therapeutic processes may lead to the expan-
sion of extant models of psychotherapy inte-
gration.
 60 ZIV-BEIMAN
Theory and Research Regarding
Self-Disclosure
Classical psychoanalysis imposed a taboo on
therapist self-disclosure, believing that the cre-
ation of an interpersonal void between analyst
and patient leads to the emergence of uncon-
scious conflicts and urges that the patient then
transferentially projects onto the analyst/
therapeutic alliance. The “three rules of thumb”
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a psychoanalyst is required to follow were thus
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set down as anonymity, equanimity,1 and absti-
nence (Freud, 1915; Goldstein, 1997). Although
Freud himself tended to ignore these rules in his
clinical work—as indicated by Lynn and Vail-
lant’s (1998) examination of 43 of his cases—
the movement he founded turned it into the
cornerstone of psychoanalytic technique
(Etchegoyen, 1991; Falzder & Barbant, 2000).
Even during Freud’s lifetime, some of his
colleagues and students defended the practice of
therapist self-disclosure. Ferenczi (1932/1988),
for example, argued that the psychoanalyst
should be open and share a mutual relationship
with her patients in order to ensure the challeng-
ing of hierarchies and free communication of
information—a particularly important ap-
proach, he asserted, in the treatment of child-
hood trauma, where the therapist’s anonymous
and neutral stand was quite likely to reenact the
original trauma rather than lead to recovery.
Racker (1953)—who also introduced avant-
garde ideas into early psychoanalysis—simi-
larly asserted that, despite its desirability, “ther-
apist objectivity” is not an achievable goal. For
him, the focus must lie on the degree to which
the therapist is willing to examine the impact of
the subjectivity she brings into the therapeutic
relationship.
Classical psychoanalysis’s immediate suc-
cessor— ego psychology—tends to concur with
its predecessor in propounding that the therapist
must personify anonymity, equanimity/neutral-
ity, and abstinence. This stance not only creates
the proper conditions under which the function
of the unconscious ego can be “analyzed” but
also serves to strengthen the ego and promote
individuation (Hartmann, 1964).
According to object relations theory, the ther-
apist’s inquiry of her own countertransference
experience can facilitate the identification and
conceptualization of the unconscious internal-
ized object relations patterns the patient brings
into the therapeutic present (Mitchell & Black,
1995). Contemporary object relations theorists,
such as Casement (1988), thus encourage dis-
closure of the therapist’s countertransference in
order to give the patient the opportunity of
discovering how the other experiences her
and/or learn about the parts of herself she en-
trusts to the therapist.
Self psychology (Kohut, 1971) views the
therapist as a self-object who puts her empathic
subjectivity at the service of an investigation of
the patient’s subjectivity, rather than as a sub-
ject seeking to engage in joint-construction and
mutual-influence processes with the patient.
Within this framework, self-disclosure forms a
legitimate psychoanalytic function primarily
when the therapist reveals her feelings toward
the patient/treatment in the context of the trans-
ference relations.
A major shift in the psychoanalytic attitude
toward therapist subjective participation was in-
troduced by the intersubjective (Stolorow,
Brandchaft, & Atwood, 1987) and relational
(Aron, 1996) schools, which highlight the inter-
subjective space within which the treatment
takes place. These theories assert that therapeu-
tic interpretations and transference relations are
constructs that arise from the meeting of two
subjects, the patient and the therapist, with the
therapist’s professional knowledge, personal
world, and cultural background having a direct
effect upon her work (Mitchell, 1988).
Scholars of an intersubjective persuasion dis-
cuss therapist self-disclosure in positive terms,
principally in the context of disclosure of coun-
tertransference (Bridges, 2001; Orange & Stol-
orow, 1998). Relational scholars emphasize that
exposure to subjective otherness is essential for
the foundation of the self (Aron, 1996; Benja-
min, 1988) and view therapist self-disclosure as
a form of intersubjective inquiry, which is part
and parcel of every treatment. This mutual in-
1
Over the years, the concept of equanimity has been
constructed and widely referred to and discussed in the
psychoanalytic literature as “neutrality” (e.g., Chused,
1982; Franklin, 1990 ; Glover, 1928; Hoffer, 1985;
Schachter, 1994). Kallner (2002) points out that, although
Freud himself never employed the term “neutrality,” it
gained currency due to James Strachey’s use of it to render
the German indifferenz. Rather than advising psychoana-
lysts to be neutral—such a requirement being unfeasible—
Freud posited that they must respond “equanimously” to
volatile or controversial issues raised by the patient.
 SELF-DISCLOSURE AS INTEGRATIVE
quiry enables the development of the patient as
a subject with awareness to the multiple self-
states that emerge from the dialogue with the
other within the context of a range of intersub-
jective dyads—including the therapeutic dyad
(Aron, 1996; Greenberg, 1995; Mitchell, 1997).
However, most of these scholars oppose general
recommendations on the usage of any therapeu-
tic intervention, including self-disclosure, be-
lieving that interventions should be evaluated in
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the context of the specific therapeutic dyad
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and the specific timing within the process. Oth-
ers claim that a transmuting therapeutic rela-
tionship facilitating change cannot arise without
the intentional disclosure of aspects of the ther-
apist as a real person (Billow, 2000; Bridges,
2001; Marcus, 1998; Renik, 1995), thus offer-
ing guidelines for the optimal employment of
therapist self-disclosure (e.g., K. A. Frank,
1997; Maroda, 1999; Renik, 1995).
Significantly, most contemporary psychoana-
lytic schools of thought—including those not
identified with the intersubjective and relational
schools—suggest that self-disclosure is inevita-
ble (Farber, 2006; Marcus, 1998; Singer, 1977).
Various proposals have thus been raised con-
cerning the optimal use of the therapist’s dis-
closure of her countertransference experiences
and the provision of facts relating to her life,
experiences, insights, and so forth (Bridges,
2001; Hanly, 1998; Wachtel, 1993).
Humanistic– experiential psychotherapy ac-
centuates the importance of therapist self-
disclosure in promoting an authentic therapeutic
bond, regarding the therapist’s genuineness—
which entails self-disclosure when appropri-
ate—as a central tool in facilitating the patient’s
growth and establishing an effective therapeutic
relationship (Bugental, 1987; Rogers, 1957).
Humanistic scholars maintain that therapist
self-disclosure allows the client to feel equal to
the therapist and to acknowledge that all human
beings suffer from weaknesses and unresolved
issues (Stricker & Fisher, 1990; M. H. Wil-
liams, 1997). Recently, several humanistic the-
orists have attempted to conceptualize and de-
fine the conditions under which therapists
should engage in self-disclosure—taking its di-
verse typologies into account (Geller, 2003).
The existential approach similarly views
therapist self-disclosure as a core therapeutic
technique (Hill & O’Brien, 1999; Traux &
Carkhuff, 1967), the therapist being encouraged
61
to disclose her manner of coping with existen-
tial questions in order to inspire the client to
deal with such issues and find her own authentic
answers. Herein, the therapist is conceived of as
a guide, coach, and model (Jourard, 1971;
Yalom, 2002).
Feministic approaches to psychotherapy pro-
mote profound self-examination on the therapist’s
part, complemented by wise use of self-disclosure
(Tabol & Walker, 2008). The revelation of per-
sonal opinions, values, and feelings— especially
with respect to political and social issues— helps
the patient choose a therapist and examine her
interventions within the context in which they
occur, as well as contributing to the distribution of
responsibility for change between therapist and
patient and deconstructing positions of power
within the therapeutic dyad (Simi & Mahalik,
1997).
The cognitive– behavioral approach regards
self-disclosure as a means for achieving a wide
array of therapeutic goals, including— but not
limited to—strengthening the therapeutic bond,
normalizing the patient’s experience of her dif-
ficulties, challenging negative interpretations of
emotions and behavior, enhancing positive ex-
pectations and motivation for change, and mod-
eling and reinforcing desired behaviors
(Dryden, 1990; Freeman, Fleming, & Pretzer,
1990; Goldfried, Burckell, & Eubanks-Carter,
2003). However, the difficulties therapists face
when considering whether to self-disclose are
also pointed out—such as the need for approval
from clients and the notion that therapists suffer
no psychological distress (Dryden, 1990).
Farber (2003) suggests that the increased in-
terest displayed in therapist self-disclosure in
both theoretical and applied research over the
past three decades reflects two general profes-
sional trends: (a) the transfer of focus from the
intrapersonal to the interpersonal, with distress,
pathology, and healing being viewed not only as
mainly internal individual experiences but also
as events rooted and conceptualized within the
interpersonal realm; and (b) the identification of
the therapeutic relationship as the primary
source of healing within the therapeutic pro-
cess—a commonly accepted and empirically
based idea bridging theoretical and applied per-
spectives.
These shifts have prompted a comprehensive
discussion of the implications of the therapist’s
ineluctable subjectivity within the therapeutic
 62 ZIV-BEIMAN
relationship—including issues relating to self-
disclosure. In addition to Farber (2003), other
authors (e.g., Bloomgarden & Mennuti, 2009;
Zur, Williams, Lehavot, & Knapp, 2009) have
recently drawn attention to various social and
cultural processes that—facilitated by the media
and Internet—also promote a disclosure-
endorsing environment.
This review indicates the manifestation of a
transition within the professional discourse
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with respect to therapist self-disclosure—the
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taboo that once ruled clinical practice, slowly
but steadily losing its grip. Although some
contemporary approaches argue that therapist
self-disclosure is unavoidable, and therefore
its ramifications must be addressed, others
acknowledge its value by conceptualizing it
as a therapeutic technique that contributes to
both the therapeutic relationship and a range
of therapeutic goals. These trends highlight
the need to classify the various forms of ther-
apist self-disclosure and to examine the influ-
ence it exerts.
What Is Self-Disclosure? Theory- And
Research-Based Classifications
Prominent psychotherapy theorists and re-
searchers have repeatedly voiced their concern
over the vague use of the term “self-disclosure”
in the literature (Hill & Knox, 2002; Knox &
Hill, 2003; Watkins, 1990). In a review of over
200 studies, Watkins (1990) identified four cen-
tral therapist self-disclosure axes: (a) disclosure
of positive versus negative experiences; (b)
sharing an opinion (whether positive or nega-
tive) about the patient or her behavior versus
providing personal information; (c) conveyance
of demographic data versus divulgence of inti-
mate details; and (d) communication of emo-
tional reactions similar to those of the patient
versus dissimilar reactions.
A decade later, Hill and Knox (2002) re-
peated the same exercise, proposing seven sub-
categories of disclosure:
1. Biographical facts relating to the thera-
pist’s life and professional training.
2. Feelings—including the use of emotional
terms in the therapist’s description of her
subjective experiences.
3. Insights into past experiences exemplify-
ing what the therapist has learned about
herself.
4. Strategies the therapist has found effective
in dealing with specific issues.
5. Approval and legitimization of the patient
in the specific therapeutic context.
6. Challenges to the patient’s thought pro-
cess or behavior via examples from the
therapist’s life.
7. Immediate thoughts or feelings toward the
patient/therapeutic relationship and
process.
One of the most comprehensive distinctions
proposed in this context relates to immediate
versus nonimmediate therapist self-disclosure
(Audet, 2004). Immediate disclosure consists of
the articulation of self-involving feelings and
the display of negative and positive attitudes
toward the patient/therapeutic process, as well
as information regarding the therapist’s educa-
tion and professional approach. Nonimmediate
disclosure pertains to the therapist’s experi-
ences outside the treatment—including bio-
graphical details, personal insights, coping
strategies, and so forth.
Immediate therapist disclosure is gaining in-
creasing legitimacy in light of the claims made
for its beneficial effect. This trend reflects
changes in theory and research that posit the
centrality of a positive and intimate therapeutic
bond as a favorable predictor of therapy out-
come (Lambert, 1991; Norcross & Goldfried,
1992), as well as conceptualizing the therapeu-
tic relationship as a major arena of change
(Aron, 1996).
Nonimmediate therapist disclosure, on the
other hand, remains controversial, continuing to
be viewed as threatening fundamental therapeu-
tic principles. Particular reservations are raised
regarding therapist-initiated disclosure un-
prompted by a direct request from the patient or
in those cases when the disclosure is incommen-
surate with the subjects brought up by the pa-
tient. Findings nonetheless indicate that patients
also experience the latter type of disclosures as
beneficial (Hill & Knox, 2002).
Is Self-Disclosure a Good Thing?
Basic research. Interest in self-disclosure
extends beyond the realm of psychotherapy to
other disciplines and areas. Jourard’s (1971)
 SELF-DISCLOSURE AS INTEGRATIVE
studies—which have significantly contributed
to the growing body of research on the topic—
suggest that self-disclosure in interpersonal re-
lations both establishes closeness with others
and leads to a better understanding of the self.
Significant evidence also exists that self-
disclosure in interpersonal interactions encour-
ages the participants to further open themselves
up (Farber, 2006; Watkins, 1990). According to
other studies, self-disclosure has a positive ef-
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fect on physical health (Locke & Colligan,
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1986; Pennebaker, 1989), functioning as a
source of catharsis and relief for the disclosing
party (Stiles, 1987, 1995). Although the signif-
icance of self-disclosure as a key factor leading
to psychological relief has yet to be formally
established, current findings indicate that it fos-
ters general mental well-being (Bareket-Bojmel
& Shahar, 2011; Pennebaker, Zech, & Rimé,
2001; Zech & Rimé, 2005).
Frequency of therapist self-disclosure.
The various definitions and modes of measuring
therapist self-disclosure make it difficult to gain
a clear estimate of the frequency with which
such interventions occur in therapy. Although
Hill et al. (1988) found that self-disclosure con-
stitutes merely 1% of the therapist’s interven-
tions in a given session, other studies (e.g.,
Anderson & Mandell, 1989; Edwards & Mur-
dock, 1994; Mathews, 1988; Pope, Tabachnick,
& Keith-Spiegel, 1987) attest to a wider use of
self-disclosure by therapists. Nevertheless,
other therapeutic interventions—such as mirror-
ing or interpretation—appear to be far more
frequent than self-disclosing communications.
Ramsdell and Ramsdell’s (1993) survey—
designed to estimate the frequency of nonim-
mediate self-disclosure from the patient’s per-
spective—indicated that 58% of patients re-
ported therapist disclosure of personal details at
least once, with 6% claiming to have experi-
enced the phenomenon at least 10 times across
the entire treatment.
The degree/frequency of immediate disclo-
sure appears much more difficult to ascertain.
These interventions are usually viewed by ther-
apists and patients alike as part and parcel of the
therapeutic dialogue, and therefore are custom-
arily omitted from self-disclosure reports. How-
ever, it is presumed that such disclosures occur
in therapeutic dialogues at a higher frequency
than has been reported (Farber, 2006).
63
Disclosure content. A number of studies
have examined the content of self-disclosure,
with findings demonstrating the most common
subjects to be the therapist’s theoretical ap-
proach, beliefs about treatment efficacy, apolo-
gies for alleged professional mistakes, state-
ments expressing respect for the patient, views
regarding child rearing, emotions similar to
those expressed by the patient, and stress-
coping strategies. Topics that therapists appear
reluctant to disclose include dreams, sexual at-
traction toward the patient (Davies, 1994), and
personal problems (Berg-Cross, 1984; Edwards
& Murdock, 1994; Lane, Farber, & Geller,
2001; Robitschek & McCarthy, 1991).
The rationale behind self-disclosure.
Watkins (1990) proposes four models for ex-
plaining the rationale behind the use of self-
disclosure: mutuality, modeling, reinforcement,
and social exchange. The mutuality hypothesis
suggests that one party’s disclosure induces dis-
closure by the other—an assertion supported by
research results (Cozby, 1973; Strassberg,
Roback, D’Antonio, & Gabel, 1977; Watkins,
1990). The modeling hypothesis maintains that
patients learn to open up and expose themselves
in therapy by imitating the therapist’s disclosure
(Mann & Murphy, 1975). The reinforcement
model proposes that therapists employ self-
disclosing interventions in order to reinforce
patient self-disclosure (Mann & Murphy, 1975).
Finally, the social exchange model views the
reinforcing nature of the therapist and patient’s
mutual sharing as serving as a beneficial norm
guiding the therapeutic interaction (Fisher,
1990; Giovacchini, 1972). Other reasons ad-
duced for self-disclosure include demonstration,
strengthening the therapeutic alliance, suggest-
ing alternative modes of thought and action,
validating the patient’s perception of reality,
and granting a sense of normality and univer-
sality to the patient’s experiences (Edwards &
Murdock, 1994; Geller & Farber, 1997; Lane et
al., 2001; Simon, 1990). The cumulative re-
search clearly demonstrates that therapists fre-
quently make personal communications in order
to encourage patients to do the same (Knox &
Hill, 2003).
Self-disclosure and the therapist’s theoret-
ical approach. Of all the factors affecting the
therapist’s use of self-disclosure, that which ap-
pears to have garnered greatest attention in the
literature is associated with the therapist’s the-
 64 ZIV-BEIMAN
oretical framework (Farber, 2006; Simon,
1990). Studies identify the greatest willingness
to disclose among humanistic therapists and the
lowest among psychodynamic therapists (Bi-
anco, 2007; Cowan, Hansen, & O’Toole, 2010;
Edwards & Murdock, 1994). The findings of a
relatively recent study (Vandernoot, 2007),
however, suggest that, despite psychodynamic
therapists’ reluctance to make nonimmediate
disclosures, no relation appears to exist between
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their theoretical approach and the frequency
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with which they employ immediate disclosures.
Significantly, irrespective of theoretical ap-
proaches, many more therapists currently ap-
pear to be adopting a flexible approach to im-
mediate self-disclosure, thereby enabling them
to expand their therapeutic repertoire within the
context of the specific clinical situation (Bloom-
garden & Mennuti, 2009; Johnston & Farber,
1996).
Self-disclosure and patient psychopathology.
Findings concerning the relationship between
the nature/severity of patients’ psychopathology
and the degree of self-disclosure on the thera-
pists’ part are inconclusive. One theory suggests
that therapists tend to make more disclosures to
clients who exhibit difficulty in forming a rela-
tionship and those who commence treatment
with particularly high degrees of disturbance
(Hill & Knox, 2002). Other findings, such as
those from a recent experimental study (Kelly &
Rodriguez, 2007), actually report a negative
correlation between the severity of patient
symptoms and the degree of therapist self-
disclosure. The sparse research available points
to a greater tendency toward therapist self-
disclosure when treating patients diagnosed
with adjustment disorders, anxiety disorders,
mood disorders, and posttraumatic stress disor-
der and a less pronounced inclination to disclose
to those diagnosed as suffering from personality
disorders, behavior disorders, impulse control
disorders, and psychotic disorders (Mathews,
1989; Simone, McCarthy, & Skay, 1998).
The effect of disclosure on patients’ per-
ception of the therapist. Reviews of the ex-
isting quantitative research into the relation
between therapist self-disclosure and therapist-
perception variables indicate that inconsistent
conceptualizations of self-disclosure make
comparison among studies problematic. One
finding that repeatedly emerges, however, is
that the therapist’s self-disclosure contributes to
her being perceived as warmer and more per-
sonable, particularly when the information di-
vulged resembles the patient’s experience. At
the same time, disclosing therapists tend to be
perceived as less professional (Henretty & Lev-
itt, 2010; Vandernoot, 2007).
Qualitative studies regarding therapist self-
disclosure demonstrate mixed reactions to the
therapist’s use of disclosure (Wells, 1994). Self-
involving communications—that is, immediate
disclosures—appear to foster the patient’s per-
ception of the therapist as open, involved, hu-
mane, and “imperfect” while not affecting her
perceived professionalism. Disclosures relating
to similarities between therapist and patient
were found to deepen the patient’s self-
exploration and exert a normalizing effect. Fre-
quent disclosures, on the other hand, were found
to harm the therapeutic relationship, displacing
the focus onto the therapist and reducing the
patient’s involvement in the treatment (Audet,
2004).
The perceived efficacy of therapist
self-disclosure. One of the most significant
findings to emerge is that whereas therapists
evaluate self-disclosing interventions as being
only marginally efficacious (Hill et el., 1988),
patients tend to perceive it as highly beneficial
(Hill et al., 1988; Lane et al., 2001). Hill, Ma-
halik, and Thompson (1989) found that the dis-
closures experienced as most effective by both
therapist and patient were characterized by
emotional involvement and affirmation of the
patient’s experience by the therapist. An in-
triguing study (Curtis, Field, Knaan-Kostman,
& Mannix, 2004) exploring the experiences of
psychoanalysts in their own analyses, indicated
that whereas nonimmediate (factual) self-
disclosure was not associated with perceived
therapeutic change, immediate disclosure (feel-
ings) was perceived as being linked to change.
Another study (Kim et al., 2003), however, sug-
gested that self-disclosure of the therapist’s cop-
ing strategies was regarded as more effective
than self-disclosure of affirmation, facts, and
feelings. Disclosure interventions were also
rated as more beneficial the more intimate the
participants perceived them to be.
The effect of disclosure on indices of treat-
ment outcome. Studies investigating the ef-
fect of therapist self-disclosure on treatment
efficacy have yielded contradictory findings.
Five studies (Beutler & Mitchell, 1981; Coady,
 SELF-DISCLOSURE AS INTEGRATIVE
1991; Hill et al., 1988; Kushner, Bordin, &
Ryan, 1979; K. E. Williams & Chambless,
1990) employing a correlative design found no
relation between the frequency of therapist self-
disclosure and treatment outcomes as rated ac-
cording to the judgment of clients, therapists, or
external observers. Furthermore, a study of cog-
nitive– behavioral therapy with children (Bras-
well, Kendall, Braith, Carey, & Vye, 1985)
yielded a negative correlation between the num-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ber of therapist self-disclosures and the degree
This document is copyrighted by the American Psychological Association or one of its allied publishers.
of patient improvement—as rated by the thera-
pists. In an intriguing experimental study, Bar-
rett and Berman (2001) examined the effects of
self-disclosure on treatment outcomes. Al-
though patients exposed to greater levels of
disclosure manifested greater symptom allevia-
tion and more affection for the therapist than
those experiencing lesser levels, the former
practice led neither to a higher frequency of
patient disclosures nor to greater levels of inti-
macy. Kelly and Rodriguez’s (2007) more re-
cent empirical study, on the other hand, dem-
onstrated no significant relation between fre-
quency of therapist self-disclosure and
symptomatic change or therapist/patient ratings
of the therapeutic alliance—although the self-
disclosure index adopted herein was based ex-
clusively on therapist reports and related solely
to nonimmediate (factual) self-disclosure.
Among other factors, the lack of significant
results in this study may derive from the fact
that immediate disclosures tend to produce
more positive effects on treatment outcome than
nonimmediate ones.2
Clinical recommendations. A number of
research reviews that have summarized the find-
ings in the research literature (Farber, 2006;
Henretty & Levitt, 2010; Hill & Knox, 2002;
Watkins, 1990) have also proposed a set of
recommendations for optimizing the therapeutic
influence of therapist self-disclosure. These in-
clude the use of low to mild frequency of self-
disclosing interventions, the better efficacy of
immediate self-disclosure compared with non-
immediate ones, moderate level of intimacy and
a minimum of detail as characterizing optimal
disclosures, the importance of timing and return
of the focus to the patient as promptly as pos-
sible, and the accompaniment of disclosure by
an exploration of the patient’s reactions to the
intervention. If these criteria are followed, ther-
apist self-disclosure possesses the potential, it is
65
claimed, to serve as a powerful therapeutic in-
tervention. The accumulating wealth of theoret-
ical material and research findings regarding
therapist self-disclosure led an American Psy-
chological Association task force on empiri-
cally supported therapy relationships to include
this intervention under the category of “prom-
ising and probably effective” therapeutic ele-
ments (Ackerman et al., 2001).
In summary, although the literature fre-
quently views therapist self-disclosure as a
breach of the therapeutic contract (Audet &
Everall, 2003; Barnett, 1998; Epstein, 1994),
and additional research is required to find solu-
tions for the methodological problems that
plague the field, the following findings are rel-
evant:
1. Therapist self-disclosure is widely used.
2. Its therapeutic value is conceptualized ac-
cording to a range of therapeutic theories.
3. Immediate disclosure is strongly estab-
lished as beneficial to the therapeutic alli-
ance and serves to advance a range of
therapeutic goals.
4. Despite being theoretically conceptualized
and frequently evaluated as therapeutic by
patients, nonimmediate therapist self-
disclosure remains a controversial tech-
nique.
5. Moderate use of therapist self-disclosure
demonstrably contributes to the therapeu-
tic alliance.
6. Additional research is required to deepen
our understanding of the therapeutic influ-
2
Numerous methodological problems plague research on
self-disclosure and cast doubt on the various findings that
point to its contribution to the therapeutic relationship and
treatment outcomes (Anderson & Mandell, 1989; Watkins,
1990; Weiner, 1983). These include the fact that different
definitions of self-disclosure make comparison between the
various studies difficult (Henretty & Levitt, 2010; Hill &
Knox, 2002; Vandernoot, 2007; Watkins, 1990); the num-
ber of participants in most studies is too small to yield
significant results (Audet, 2004; Watkins, 1990); most of
the existent studies rely on non-naturalistic and therapy-like
settings or surveys, leading to a serious lack of experimental
research in the field (Henretty & Levitt, 2010; Sloan, 2007;
Vandernoot, 2007; Watkins, 1990); the lack of qualitative
research based on actual therapeutic session protocols pre-
cludes analysis of the circumstances under which therapist
self-disclosure can yield an optimal influence (Audet,
2004).
 66 ZIV-BEIMAN
ence of therapist self-disclosure on ther-
apy outcomes.
Therapist Self-Disclosure as an Integrative
Intervention
Here, I would like to draw attention to an
aspect of psychotherapy integration that has not
been clearly conceptualized within contempo-
rary models of integration—namely, the inte-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
grative potential of the therapeutic intervention.
I propose that the strength of therapist self-
disclosure as a therapeutic intervention—as in-
dicated in the previous section—lies in its inte-
grative power. It is, I would argue, the ability of
self-disclosing interventions to simultaneously
promote multiple therapeutic goals while also
fostering the therapeutic relationship, which
proves its prospect as a beneficial therapeutic
tool.
My case study is taken from my clinical work
with Naomi. Naomi began therapy with the
hope of overcoming her difficulties in forming
meaningful romantic relationships, describing
herself as being “frozen” and enclosed in a
“bubble.” Professionally successful and sur-
rounded by friends, she reported a deep sense of
detachment from her life. When she was 17, her
father collapsed and died of cardiac arrest. Her
reaction to her father’s death, she said, was
characterized by detachment and restricted ex-
pression of emotions— despite her feeling that
she had been his beloved daughter. Shortly after
his demise, in fact, she had already replaced him
as the family’s “manager.”
Naomi has never experienced a full and sat-
isfying romantic relationship. She terminated
two relationships with married men when she
felt that the limitations they placed on her had
become restrictive. At the beginning of the
treatment, we focused on the feeling of “freez-
ing” that pervades her life and on her belief that
a romantic relationship will initiate the longed-
for “thaw.” I suggested that the treatment—and
perhaps a “good enough” relationship with
me— could form the basis for her liberation
from the “inner bubble” of the interminable wait
for the yearned-for “knight in shining armor.”
This formulation related to her dissociation
from her feelings—particularly, emotions to-
ward others— deriving from the cumulative
traumas she had experienced and from her un-
conscious efforts to avoid experiencing aban-
donment again.
A few months into therapy, a promising
“knight” appeared on the scene. I was worried
by the rapidity with which the relationship ad-
vanced, endeavoring to convey my concern that
speedy developments do not necessarily indi-
cate “Mr. Right,” but was unable to dent her
enthusiasm. When the “knight” abruptly disen-
gaged himself, she was devastated. Even her
repressions—which, up until this point, had
helped her deal with her longings and yearnings
for her father—failed her, her agony, tears, and
anger erupting forcefully. “I want my Daddy
now!” she vociferated in our sessions. The sup-
port I offered her during this severe breakdown
was supplemented by medication. I suggested to
her that this experience opened up feelings she
had bottled up inside her for a long time and
that, once she had recovered, our task would be
to ensure that she continues to feel, finding the
courage to live irrespective of whether she finds
a romantic partner. Naomi became entrenched,
claiming that if she agreed to live her life with-
out such a hope, this would merely prove how
deficient she is, not worthy of being part of
humankind.
Naomi was devastated, enraged, and lonely.
Convinced that no one understood her, it was
very difficult to communicate with her. At this
point, I made an assessment that a nonimmedi-
ate self-disclosure on my part might communi-
cate to her that I am very concerned about her
suffering, deeply involved in the therapeutic
process, and completely committed to working
with her to find relief and achieve personal
development—at the same time as conveying
my comprehension of her core unconscious
conflicts and anxieties and how they construct
her emotions, thoughts, and behavior. I esti-
mated that such a step would contribute simul-
taneously to the therapeutic alliance as well as
to Naomi’s ability to own and reflect on her pain
and to develop insight regarding the complexity
involved in her view of the only way to achieve
happiness and find acceptance within society.
I was also influenced by Benjamin’s (1988)
concept of the intersubjective—a Winnicott-
derived idea that maintains that the subject must
intimately meet and recognize other subjects in
order to identify what s/he has in common with
them and where they differ, thereby gaining
ownership of the subjective experience. I was,
 SELF-DISCLOSURE AS INTEGRATIVE
of course, concerned that my self-disclosure
might shift the focus from her inner world to
mine, causing her to experience me as manipu-
lating her into accepting my view rather than
merely offering an alternative perspective, or
lead her to believe that my coping abilities are
better than hers. Weighing all these aspects, I
eventually decided to make the nonimmediate
disclosure, countering the risk of making her
feel embarrassed, abandoned, or inferior by at-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
tempting to be very sensitive and receptive to
This document is copyrighted by the American Psychological Association or one of its allied publishers.
her reactions, monitoring them closely and dis-
cussing with her how the intervention affected
her.
I then shared with Naomi that twice, during
my own therapy, I had chosen life—with no
warranties assured. At the beginning of my
treatment, I had struggled with the feeling that if
I did not lose weight my life would be pointless.
Only after I made an unconditional commitment
to living with my excess weight did my life
truly begin. The second incident related to a
difficult romantic separation I experienced at
the age of 26, when I decided to buy a house
and start a family without a spouse. I added that,
although I did eventually find a partner, I now
know that I would have lived a full life even if
I had not met him and that I will still be able to
live a full life even if we separate in the future.
I clarified that I was not suggesting that she
follow my specific example but that I wanted to
share with her how important it sometimes is to
step outside our “shell” (bubble) and live to the
full—in spite of the pain attendant on being
“different.”
Both Naomi and I noted, retrospectively, that
this nonimmediate disclosure was a milestone
in the therapeutic process, directly facilitating
therapeutic change. It is important to note that,
being aware of the controversial aspects of this
technique, I carefully examined Naomi’s per-
ception of my self-disclosure. She was prepared
to reflect on it, emphasizing that she felt more
open and accepting after I had made it. As the
therapy progressed, both of us continued to re-
late to this intervention on numerous occasions
as we processed and analyzed issues of depen-
dency versus autonomy, fear of abandonment,
and painful defenses. It was evident that each of
us felt that it had evened out the playing field
between the ostensibly healthy, married thera-
pist with a family and the lonely, abandoned
patient. It also reinforced Naomi’s belief in my
67
capacity to understand suffering and “devi-
ance”—as well as her conviction that I was
involved and emotionally invested in the treat-
ment (Aron, 1996; Audet, 2004; Edwards &
Murdock, 1994; Geller & Farber, 1997; Hill &
O’Brien, 1999).
The self-disclosure further appeared to have
enabled Naomi to investigate her self-experi-
ence and to develop her ability to feel herself as
a subjective agent within a mutual dyad by
recognizing the differences and similarities be-
tween us. In line with the relational approach,
making my inner experience accessible to her
gave her the opportunity to extend her subjec-
tive self-experience by mutually engaging with
me as a subject (Aron, 1996; Benjamin, 1988).
It also facilitated her insight that her preoccu-
pation with the need of finding a romantic part-
ner defends her—via the mechanism of reaction
formation—against discovering the extent to
which she is afraid of intimacy and her dread of
being abandoned once again (Hill & O’Brien,
1999). The self-disclosure may have helped to
promote this insight by offering a softer and
more indirect form of interpretation. In her
words, “I was so surprised and moved. Sud-
denly I could see that all my life I have been
torn between being detached and independent
and feeling totally dependent, painful and help-
less—like an egg: hard on the outside but very
soft and fragile inside.” The nonimmediate self-
disclosure also assisted in revealing to Naomi
modes of action and coping, which enable self-
expression and personal development without
the necessity of a romantic context. Such mod-
eling also afforded Naomi the opportunity of
exploring the notion I proposed in an experi-
ence-near sense while translating it into opera-
tive actions appropriate to her experience on
both cognitive and behavioral levels (Dryden,
1990; Hill & O’Brien, 1999).
These indications suggest that my disclosure
to Naomi at this precise point in the therapy
process was therapeutically influential precisely
due to its integrative ability to simultaneously
advance the therapeutic alliance, the therapeutic
work of patient empowerment, the expansion of
Naomi’s inner world, and the promotion of in-
sight and cognitive and behavioral change.
In order to conceptualize the integrative
value of therapist self-disclosure as a therapeu-
tic technique, we may adduce the distinction
between “nonspecific factors”—primarily rep-
 68 ZIV-BEIMAN
resenting influences stemming from the thera-
peutic relationship—and “active technique,”
namely, interventions whose principal focus lies
on actively promoting change on the basis of
theoretical conceptualizations of personality
and pathology (Lambert, 2005). This analysis
implies that the disclosure enabled the enhance-
ment of many dimensions considered to be
“nonspecific factors”—such as Naomi’s trust in
me, the degree to which she felt that I was
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
engaged in the therapeutic process, and the bal-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ancing of the power play between us. It also
appears to have exerted an influence as an active
technique, encouraging insight, cognitive
change, behavioral change, and a change in the
experience of self and others.
I thus suggest that the conceptualization of
therapist self-disclosure as an integrative inter-
vention whose contribution lies in acting simul-
taneously via various therapeutic channels can
help clarify findings in the research literature
relating to the powerful role this intervention
appears to play in the clinical process. One of
the direct clinical implications of this assertion
suggests that therapists might consider using
self-disclosure when seeking to move concur-
rently toward different therapeutic goals requir-
ing multiple—and potentially antithetical—
therapeutic channels. For example, a therapist
looking to challenge the patient’s perceptions or
cognitions and create insight, while concur-
rently strengthening the therapeutic alliance,
might find that employing self-disclosure can
integrate work on two of these different and
seemingly conflicting therapeutic dimensions
while balancing the tension between challeng-
ing the patient and supporting her.
Requiring extensive research in order to
prove its validity, a fruitful avenue to follow
would be a study investigating patients’ reac-
tions to therapist self-disclosure and the ef-
fects the latter may demonstrate. Methods are
already available to facilitate such research.
Hill et al.’s (1988) Client Reactions System—
which constitutes a scale rating of possible
patient reactions to therapeutic interven-
tions—yields five categories: (a) support, (b)
therapeutic work, (c) challenging, (d) nega-
tive reaction, and (e) lack of reaction. This
evidence-based model may enable examina-
tion of the hypothesis that self-disclosure can
simultaneously promote different therapeutic
goals and the therapeutic relationship, while
optimizing the balance between supporting
the patient and challenging her.
The Integrative Influence of Therapeutic
Interventions as an Additional Model of
Integration
The current literature suggests four basic
models for conceptualizing psychotherapy inte-
gration (Gold & Stricker, 2006; Norcross,
2005):
1. Technical eclecticism, which seeks to “im-
prove our ability to select the best treatment for
the person and the problem . . . guided primarily
by data on what has worked best for others in
the past” (Norcross, 2005, p. 8). Choice of treat-
ment, according to this view, derives from ac-
cumulated data regarding therapeutic interven-
tions that have proved effective for patients with
similar personal characteristics suffering from
similar symptoms and problems (Beutler, Con-
soli, & Lane, 2005; Lazarus, 2005; Lazarus,
Beutler, & Norcross, 1992).
2. Theoretical integration, which aims at
combining a number (few or several) of psy-
chotherapeutic models in order to create a better
understanding of personality, psychopathology,
and causes of distress, on the one hand, and
foster new directions in theory, research, and
practice, on the other. Examples include Wach-
tel’s (1977, 1987, 1997) cyclical psychodynam-
ics, Ryle’s (1990, 2005) cognitive analytic ther-
apy, and Shahar’s (2010) poetics, pragmatics,
and schematics model.
3. The “common factors” approach, which
seeks to identify the core elements shared by
various theories in order to map the therapeutic
processes that bring about change, irrespective
of theoretical framework (J. D. Frank & Frank,
1993; Garfield, 1980, 1992; Hubble, Duncan &
Miller, 1999; Miller, Duncan, & Hubble, 2005).
4. Assimilative integration, which promotes
adoption of a specific therapeutic approach as a
base into which it is possible to assimilate in-
terventions from other modalities (Messer,
1992). Proponents of this model claim that it
offers a clear and coherent form of treatment
because, although based on a specific approach,
it also allows for flexibility. Examples include
Stricker and Gold’s assimilative psychody-
namic therapy (see Stricker, 2006), Castonguay
et al.’s (2004) cognitive– behavioral assimila-
tive therapy, and the multisystemic therapy
 SELF-DISCLOSURE AS INTEGRATIVE
model (Henggeler, Schoenwald, Rowland, &
Cunningham, 2002).
As Stricker (2010) points out, the fact that
these four models evince a substantial measure
of overlap—together with the emergence of
other viable conceptualizations—indicates the
possibility of reducing them to two principal
categories: theory-driven versus technical-
driven models. An alternative route is to sup-
plement them with an additional category relat-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ing to client-directed approaches, which focus
This document is copyrighted by the American Psychological Association or one of its allied publishers.
on client preferences and an ongoing dialogue
between client and therapist concerning appro-
priate interventions (Duncan, Sparks, & Miller,
2006; Miller et al., 2005). Other significant pro-
posals for additional categories include integra-
tion of theory, practice, and research; integra-
tion of psychotherapy and pharmacological
treatments; integration of individual and couple/
family therapy; and integrative models for treat-
ing specific psychopathological phenomena
(Goldfried, 2010; Norcross, 2005; Stricker,
2010).
In line with the claim that the power of ther-
apist self-disclosure derives from its ability to
help consolidate the therapeutic relationship,
while concurrently advancing a variety of ther-
apeutic goals, it is possible that the effective-
ness of other forms of intervention might also
be a function of the extent to which they simul-
taneously influence various therapeutic dimen-
sions. It is thus plausible to suggest that the
psychotherapeutic efficacy of an interpretation,
for instance, devolves from the extent to which
it synchronically addresses behavioral, cogni-
tive, emotional, and interpersonal aspects at the
same time as relating to the past, present, and
here-and-now levels of the issue under explora-
tion. This view is based on the assumption that
the contents and structure of the interpretation
must include a wide range of components capa-
ble of facilitating simultaneous change via var-
ious therapeutic channels and levels.
To exemplify, let us examine the following
interpretation I offered Naomi:
I believe that the deep loneliness and despair you feel,
which is very present in our meetings—together with
your selective and critical attitude toward others, your
tightly planned schedule, and the influence you attri-
bute to other people’s opinions about your life—all
serve to protect you from being hurt again by others
close to you whom you fear will let you down or
abandon you. Perhaps this is the reason why you tend
to give yourself totally and without any caution to
69
someone inappropriate. Such relationships afford you
the opportunity to express your need for a deep relation
with the other at the same time as substantiating your
inner belief that, although you appear to have found the
perfect partner, he will either disappoint you or disap-
pear as your dad did. In this way, you defend yourself
from engaging in possible but complex, real, and frus-
trating relations, which might in the end in fact turn out
to be long term, deep, and dependable. This inner mode
inhibits you from grasping hold of life, which is our
therapeutic mission.
This intervention simultaneously addresses a
variety of therapeutic goals and aspects: the
therapeutic alliance; cognitive, behavioral, ex-
periential, and interpersonal patterns; and Nao-
mi’s emotional experience in the here and now,
past, present, and future.
Obviously, intensive research is necessary in
order to examine the proposal that the therapeutic
effectiveness of different therapeutic interven-
tions—such as therapist self-disclosure and inter-
pretation— derives from their integrative function.
In line with Stricker’s (2010) proposal of refining
the classification and conceptualization of models
of psychotherapy integration, I would like to sug-
gest the “intervention as integration” model as a
candidate. Importantly, I do not construe self-
disclosure or interpretation as a therapeutic mo-
dality in its own right but rather as an intervention
that makes an integrative impact—this potentially
constituting the underlying explanation of the
power of its influence. I posit that, if this hypoth-
esis is validated by further research, it may pave
the way for constructing an additional kind or
model of psychotherapy integration—namely, the
integrative influence of therapeutic interventions.
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Received July 11, 2012
Revision received September 29, 2012
Accepted December 20, 2012 䡲