Psychotherapy © 2011 American Psychological Association

2011, Vol. 48, No. 4, 342–348 0033-3204/11/$12.00 DOI: 10.1037/a0025909

Directions for Research on Self-Disclosure and Immediacy: Moderation,

Mediation, and the Inverted U

Charles J. Gelso and Beatriz Palma

University of Maryland

The psychotherapist’s use of self-disclosure (SD) and immediacy has been a controversial topic over the
decades. In this article, some ingredients are described that will help advance knowledge in the area of
the therapist SD and immediacy. More than has been the case, researchers in this area should construct
clear definitions of the SD/immediacy variables being investigated, and make sure that their operation-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

alizations are consistent with these definitions. In addition, it is argued that if the field is to advance, at
This document is copyrighted by the American Psychological Association or one of its allied publishers.

this point in time researchers need to examine “who, what, when, and where” questions, making use of
in-principle moderation, that is, the study of which SD/immediacy responses are most effective with what
patients, suffering from what problems and disorders, when offered by which therapists doing what kinds
of psychotherapy? In addition, the study of mediation is suggested, as is researchers’ taking into account
the operation of the inverted U when studying the frequency, intensity, or duration of SD/immediacy.

Keywords: psychotherapist self-disclosure, immediacy, moderation, mediation, inverted U

For over half a century, theoreticians and researchers have been
curious about how much psychotherapists could and should reveal
about themselves to their patients. This interest emerged from an
historical background in which virtually all therapist self-
revelations were viewed as unhelpful at best and, more likely,
symptomatic of a psychotherapist’s unresolved conflicts. This
historical context was, of course, the psychoanalysis of the first
half of the 20th century, and the accepted view about therapists’
self-disclosure (SD) was powerfully established by Freud’s com-
ments on the topic. Freud (1912) proposed that an analyst’s SD
might seem to be helpful because “One confidence repays another,
and anyone demanding intimate revelations from another, must be
prepared to make them himself” (p. 330). However, Freud went on
to say that such disclosure actually was harmful in that it strength-
ened resistances (including transference resistances) to making
unconscious processes conscious. Freud (1912, p. 331) thus con-
cluded:
“Therefore I do not hesitate to condemn this kind of technique
as incorrect. The physician should be impenetrable to the patient,
and, like a mirror, reflect nothing but what is shown to him.”
As psychoanalytic theories branched out from classical Freudian
theory, and at the same time, as nonanalytic theories emerged in
the middle of the 20th Century, the door to therapist’s SD gradu-
ally inched open. The humanistic theories such as Carl Rogers’
client-centered therapy and Fritz Perls’ Gestalt therapy that grew
to maturity in the 1950s and 1960s appeared to open the door even
wider. Perhaps, the major theoretician who pushed the door open
the rest of the way in the 1950s and 1960s was Sidney Jourard
Charles J. Gelso and Beatriz Palma, Department of Psychology, Uni-
versity of Maryland, College Park.
Correspondence regarding this article should be addressed to Charles J.
Gelso, Department of Psychology, University of Maryland, College Park,
MD 20472. E-mail: cgelso@umd.edu
(1964, 1968; Jourard & Lasakow, 1958). Jourard believed that
human relations and positive mental health were greatly facilitated
by people revealing themselves to one another. His writing and
research on SD had a major impact on mental health practitioners,
perhaps because it both reflected and contributed to the emerging
ethos of the 1960s. This was a point in time, at least in the United
States, in which being open and honest, and sharing one’s feelings
and thoughts openly, were elevated almost to the level of a moral
imperative, and this imperative displayed itself in the psychother-
apies that became popular at that time (including encounter groups,
T groups, marathon groups, primal therapy, etc.). It also showed
itself in the changes that were happening in psychoanalysis, in the
beginnings of the now-powerful relational movement. When, for
example, the prominent psychoanalyst, Owen Renik (1999) pro-
posed that analysts and therapists “play with their cards face up,”
he was reflecting a relational position on therapist SD that grew
out of the 1960s and is now firmly established in psychoanalysis.
We have been focusing on the therapist’s SD. However, as
clearly seen in the articles in this special section by Khurgin-Bott
and Farber (this issue, pp. 330 –335), Knox, Edwards, Hess, and
Hill (this issue, pp. 336 –341), and Yeh and Hayes (this issue, pp.
322–329), the topic certainly transcends psychotherapists. It is
highly pertinent to patients of psychotherapists, to psychotherapy
supervisors and supervisees, and perhaps to all people in both
intimate as well as nonintimate relationships. We have focused on
psychotherapists because we believe the topic of SD is the most
controversial and complex for them. However, this is not to say
that therapists are the most important group to explore, or that
there are not great complexities and ambiguities regarding how
much others (e.g., patients, people in close relationships) could and
should disclose. As Farber (2006) says in the most extensive and
penetrating analysis of SD to date, there is always a tension
between the wish/need to reveal and the wish/need to contain,
suppress, or repress. In the present article, we focus mostly on SD,
and its close theoretical cousin, immediacy, within the context of

342
 SPECIAL SECTION: SELF-DISCLOSURE AND IMMEDIACY
psychotherapy. Our emphasis is largely on the therapist’s use of
SD and immediacy because, as noted, this has been the greatest
source of controversy and confusion over the years. Although most
patients surely experience the tension between disclosing and
holding back, most agree that patient disclosure is not only desir-
able for effective therapy, but also necessary. Views about the
therapist’s disclosures are another matter.
Our intent is to provide guidelines that might help advance this
area of inquiry and facilitate sound practice. At the same time, we
want to acknowledge that major works have been produced in
recent years, for example, the aforementioned book by Farber
(2006), key works by Hill and her collaborators (e.g., Hill, 2009;
Hill & Knox, 2002; Hill et al, 2008; Kasper, Hill, & Kivlighan,
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2008; Knox & Hill, 2003), and an extensive review of empirical
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studies by Henretty and Levitt (2010). We shall draw heavily on
these important pieces throughout this article.
Self-Disclosure and Immediacy: Two Sides of the
Same Coin?
When considering the ways in which, and extent to which, one
may reveal oneself to another, a continuum may be readily con-
structed. The defining features of this continuum are degree of
intimacy within a communication and the extent to which the
communicator involves the other in the message. At one end of the
continuum may reside the psychotherapist’s communications of
information and facts about him/herself. Included are demograph-
ics such as marital status, when one’s degree was earned, and so
on. Generally nonintimate pieces of information are included at
this end of the continuum. At the other end exist the more person-
ally and interpersonally involving communications, such as the
feelings or thoughts evoked in the psychotherapist by his or her
patient’s behaviors in the psychotherapy hour. The former (com-
munication of facts and information) has traditionally been labeled
therapist’s SD, whereas the latter (communication by the therapist
of feelings and/or thoughts evoked in him/her by the patient) has
been termed immediacy. Throughout this continuum exist varying
degrees of intimacy and of involvement of the patient in the
therapist’s communications.
Although such a continuum makes theoretical sense to us, it also
appears that there are distinctive processes within this continuum
that require clear definition. Such definitional work is important
because the SD/immediacy literature has been marred by perhaps
too many differing (and often conflicting) definitions, as well as
ambiguity of definitions, as shall be exemplified subsequently (see
Farber, 2006; Henretty & Levitt, 2010; Hill & Knox, 2002).
Defining Self-Disclosure and Immediacy
Many definitions of SD and distinctions between types of SD
have been offered over the years (e.g., Bridges, 2001; DeForest &
Stone, 1980; Egan, 1994; McCarthy & Betz, 1978; Watkins &
Schneider, 1989). Hill and her collaborators (e.g., Hill, 2009; Hill
& Knox, 2002; Knox & Hill, 2003) and Farber (2006), in drawing
upon and synthesizing previous and current work in the area of SD,
have provided useful and up-to-date conceptualizations of SD. Hill
and Knox define SD as “therapist statements that reveal something
personal about the therapist” (2002, p. 255). Similarly, Farber
(2006) tells us that “. . . in its broadest sense, ‘self-disclosure’ can
343
refer to any behavior, verbal or nonverbal, that reveals information
about a person” (p. 133). He also points out that the study of
therapist SD has considered mostly therapist purposeful and verbal
SD.
Importantly, Farber (2006) specifies that therapists’ intentional
SDs can be divided into two types: factual and self-involving.
Factual (one end of our continuum presented earlier) includes facts
or information about the therapist, and may be further divided by
length of time discussing these, amount of information, degree of
“personalness,” positive or negative, past or present, and so forth
self-involving disclosures, on the other hand (the other end of our
continuum), focus on the therapist’s immediate or past feelings or
experiences in response to the patient’s experiences or feelings.
Farber suggests that these may be further divided into responses to
the patient’s immediate statements, responses to the patient in
general, and expressions of the therapist’s reactions that are dif-
ferent from the patient’s experience. Farber notes that this second
kind of SD is also often referred to as “immediacy” or “counter-
transference disclosures.”
Farber (2006) points out that, unfortunately, much of the re-
search in the SD area has been unclear about which type of
disclosure is being studied. This is an important failure in the
literature because type of disclosure may indeed relate to how SD
is associated with other relevant variables, with treatment process,
and with treatment outcome. In an effort to further clarify impor-
tant distinctions, Knox and Hill (2003) classified therapist SD into
seven subtypes, which Hill (2009) subsequently reduced to three
types: Disclosures of feelings (e.g., “When I was in a similar
situation, I felt very angry”), disclosures of insight (e.g., “While
growing up, I got into a lot of trouble. Later on I realized that was
the only way that my very successful and busy parents could focus
on me. I wonder if that was your experience.”), and disclosure of
strategies (e.g., “Whenever I give an important presentation, I
practice it out loud a few times, as a way of being more familiar
with it and to detect any needed changes”). Such refinements seem
important at this stage of research on therapist SD. Still, we do not
know yet if the classification systems can be reliably applied. It
may be that a different number of subtypes and/or different sub-
types represent a more reliable fit to the data than those proposed
by Hill and thus are preferable.
Like the term SD, immediacy has also been a source of consid-
erable ambiguity. As noted in the above paragraph, Farber (2006)
views immediacy as one type of SD. Hill (2009) defines immedi-
acy as the therapist’s disclosures within a session of “immediate
feelings about the client, her- or himself in relation to the client, or
the therapeutic relationship” (p. 255). However, even cursory
examination of the literature reveals that some therapist responses
to patients that are coded as immediacy responses do not neces-
sarily include therapists’ disclosure of their own feelings. For
example, in their important qualitative study of immediacy,
Kasper, Hill, and Kivlighan (2008) classified as therapist imme-
diacy therapist responses that encouraged patient expression of
immediate feelings and inquired about the patient’s reactions.
Some of these responses did not include the therapist’s immediate
feelings about the client, himself in relation to the client, or the
therapeutic relationship. Therapist responses such as “you keep
looking at your watch. I wonder if you are eager to leave” (Hill,
2009, p. 256) or “how are you feeling about me right now,” surely
focus on the here-and-now, but they do not imply the therapist’s
 344 GELSO AND PALMA
feelings. This begs the question of whether the therapist’s feelings
must be included in an expression for it to be considered an
immediacy response. We address this question subsequently. In
addition, we would want to include under the immediacy umbrella
therapist reactions in addition to feelings, for example, therapist
thoughts.
As was the case for SD, Hill (2009) has proposed a more
specific and refined classification of therapist immediacy. She
suggests four subtypes: (1) inquiries about the relationship (ther-
apist invites patient to share feelings about their relationship); (2)
therapists’ verbal expressions of their reactions to the patient, (3)
making the covert overt, and (4) drawing parallels to outside
relationships. It should be noted that the last two types seem to be
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ways in which the therapist probes for immediacy, more than
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disclosing his or her personal thoughts and feelings. As indicated
for SD, this more specific breakdown appears useful, but further
work is needed to determine its reliability.
When studying immediacy, it is important to distinguish be-
tween immediacy itself and what has been termed an immediacy
event. In their qualitative studies, for example, Hill and her col-
laborators (Hill et al, 2008; Kasper et al., 2008) defined an imme-
diacy event very broadly as “any talk about the relationship”
(Kasper et al., 2008, p. 302) and more specifically as events that
“began when one participant initiated a discussion about the im-
mediate relationship and ended when the discussion shifted to
another topic not related to the immediate relationship” (Hill et al.,
2008, p. 286). Left unclear here is whether both parties had to
participate verbally in the event for it to be considered an event.
Further Observations and Suggestions
As indicated, Hill and Knox (2002) define SD as “therapist
statements that reveal something personal about the therapist” (p.
255). We believe this definition to represent a helpful combination
of generality and precision. However, to this definition we would
add nonverbal forms of self-revelation. Although, as Farber (2006)
points out, the study of SD has been largely of verbal behavior, the
nonverbal arena is one in which much disclosure occurs, and this
is a likely topic for future SD research.
As knowledge unfolds in a given area, greater specificity of
constructs must occur if the area of investigation is to flourish.
Such is the case with conceptions of SD. Thus, the previously
mentioned Knox and Hill’s (2003) division of SD into the seven
types and Hill’s (2009) later classification into the three types
noted earlier represents the increasing specificity that is called for.
Such specificity allows researchers to assess if the relation of SD
to other phenomena is dependent upon type of SD. Again, how-
ever, researchers need to study such classification systems to
determine if they are reliable and if they map well onto the
phenomena being studied.
As with SD, we consider immediacy to include both verbal and
nonverbal expressions; but with immediacy these expressions re-
flect one’s experiencing in the moment, as expressed in the mo-
ment. As with SD, we include nonverbals because they can be as
revealing as verbal statements, for example, a smile may clearly
express to the client the therapist’s pleasure in what the client is
expressing in the moment. A key part of this conception is the
therapist’s overt expression in the moment, as it is this expression
(verbal or nonverbal) that distinguishes immediacy from simply
experiencing in the moment. It is the expression that allows for the
interpersonal element to take shape. In addition, we would suggest
that there can be two types of immediacy: (1) Being in the
here-and-now, which may not include therapist SD, for example,
“You seem sad. What are you feeling now?” or “What is your
laugh trying to tell us?” and (2) Relational immediacy, which
refers to the therapeutic relationship, and involves the therapist’s
inclusion of the patient in the therapist’s relational comments, for
example, “I feel anxiety as you tell me about you and your father;
is this what you feel?” or “I feel closer to you as you reveal your
pain about this loss.”
In keeping with these conceptions of SD and immediacy, it can
be seen that not all SDs are immediate, although SDs occurring in
the here-and-now moment are of course immediate. Furthermore,
not all immediacy must involve SD. A therapist’s response may
focus on the patient’s here-and-now experience, and in this sense
be immediate, without any SD at all.
It may be worth repeating here that, despite the fact that our
focus is on the psychotherapist’s SD and immediacy, the concepts
and definitions in this section may be applied to all relationships.
Further, in the psychotherapy context, there are essentially four
participants to whom our comments apply, that is, psychotherapist,
patient, psychotherapy supervisor, and psychotherapy supervisee.
Farber (2006) offers a penetrating analysis of SD phenomenon
considering all of these perspectives. In this special section, Knox
et al. (this issue) remind us of the central role that supervisors’ SD
has in therapist training.
Should immediacy be considered to be one type of SD, and thus
should immediacy and SD exist on a continuum, as earlier de-
scribed? Because not all immediacy involves SD and not all SD
involves immediacy, we think it best that the two constructs be
viewed as separate, although surely related. At the same time, this
degree of definitional nuance is not vital to our understanding of
these constructs. What is vital is that each investigator provide a
clear working definition of SD and immediacy, that the definitions
are logically consistent with each other and with the operations of
the research, and that the definitions be drawn from the existing
work that has been done on SD and immediacy. These require-
ments should facilitate the development of a cohesive body of
knowledge, one that builds upon itself. However, as we have
clarified, these requirements have too often not been met in re-
search on SD and immediacy. (Note that in the remainder of the
paper, we use the term SD/immediacy when our comments apply
to both constructs.)
Moderators, Mediators, and the Inverted U
We have stated that as knowledge advances in a given area,
greater specificity is evidenced in the constructs that are investi-
gated. These constructs are usually part of a developing theory,
which itself becomes more specified and nuanced (Gelso, 2006).
At the most rudimentary level, research in a given area examines
the relation between two variables at a time, construed in a linear
and additive manner. We believe that research on SD and imme-
diacy is at this level, as is evident from the extensive review of
research by Henretty and Levitt (2010), as well as from Farber’s
(2006) far-reaching analysis. However, as knowledge advances,
investigators become interested in more complex relationships
 SPECIAL SECTION: SELF-DISCLOSURE AND IMMEDIACY
among variables. As a key part of this, among other things,
moderation becomes of greater and greater interest.
Moderation
In the conceptual (rather than statistical) sense, moderation
implies that the relation between two or more variables is partly or
fully dependent on one or more other variables. For example, one
may theorize that the relation between the frequency of therapists’
SD and treatment success depends on a third variable, patient
open-mindedness. We may speculate that for more open-minded
patients, frequency of SD is positively related to treatment success,
whereas for more closed-minded patients, frequency of therapist
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SD is negatively related to success. This three-variable situation
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may be extended conceptually to X variables, but the main point is
when investigators begin to theorize about and examine modera-
tion (aka, interaction effects), this is a signal that knowledge is
becoming more advanced in an area.
The moderation or interaction question is reflected in Gordon
Paul’s (1967, p. 111, italics in original) now famous statement of
what we needed to be examining at the time in psychotherapy
research in general: “What treatment, by whom, is most effective
for this individual with that specific problem, and under which set
of circumstances?” Note that when any two of the focal points
(pronouns) in this question are combined, this conceptually ad-
dresses moderation or interaction effects. For example, what treat-
ment works best with whom? Or what treatment works with what
specific problems?
In surveying the research scene over 30 years ago, the first
author (Gelso, 1979) referred to this as the “who, what, when, and
where” question. The spirit of this question was that investigators
needed to be examining interaction effects, and doing so was what
was needed to advance our then meager understanding of psycho-
therapy outcomes. Currently, this is what is greatly needed in the
SD/immediacy area. Farber (2006) tells us, for example, that we
have not yet tackled the question of what disclosures are effec-
tive with whom. Researchers need to be tackling this question
more than they have, and they need to be slowly pecking away at
the “who, what, when, where” question, piece by piece. Paul’s
famous question may be extrapolated to the area of therapist
SD/immediacy as roughly “which SD/immediacy responses are
most effective with what patients, suffering from what problems
and disorders, when offered by which therapists doing what kinds
of psychotherapy.”
Moderation may be important in the study of SD/immediacy in
at least two ways. First, SD/immediacy may be examined as a
moderator. For example, one might study whether the therapist’s
use of immediacy moderates the relation between type of patient
personality disorder and treatment outcome. We might theorize
that when the patient has a histrionic personality disorder, the use
of immediacy is positively associated with treatment outcome,
whereas with patients suffering from paranoid personality disor-
ders, the use of immediacy is actually negatively related to out-
come.
What may be even more useful at this point in time is the
examination of variables that moderate the relation of SD/
immediacy as an independent variable (IV) or predictor with one
or more dependent or criterion variables. To exemplify, we shall
extend the conceptually two-variable study by Yeh and Hayes (this
345
issue), published in this special section. Yeh and Hayes examined
the relation of the therapist countertransference disclosure of more
versus less resolved countertransference issues to several depen-
dent variables (DVs). This study extended prior research (Myers &
Hayes, 2006) by focusing on additional DVs. As hypothesized,
therapists’ disclosing personal issues that were more resolved had
a positive effect on several DVs. Regarding moderation, one could
readily see this line of work being extended by examining factors
that would interact with (moderate the effect of) the therapist’s
countertransference disclosure of resolved issues in affecting cer-
tain DVs. It may be that certain client variables would moderate
the influence of degree of resolution of problems therapists dis-
closed, for example, clients’ degree of disturbance, type of disor-
der, personality variables. Such research would further chip away
at the “who, what, when, where” question by focusing on what
patient types would respond best or worst to therapists’ sharing
more and less resolved disclosures.
We have noted that our reference to moderation or interaction is
in a conceptual rather than a statistical sense. Part of this concep-
tual view is an “in principle” one. That is, in addressing parts of the
“who, what, when, where” question, not all studies need to include
an examination of moderators or interactions. Instead, given stud-
ies may examine an aspect or part of moderation, with the intent of
looking at other parts in future investigations. For example, it
would be in keeping with our call for studies that “in principle”
examine moderation if a given study focused on the effect of two
types of SD with patients who have avoidant attachment styles, if
the investigator is also interested in increasing knowledge of or
implications for differing attachment styles. This would be espe-
cially so if the investigator then studies, for example, the effect of
these two types of SD on patients who anxious attachment styles.
The net result of the two studies would then be the effect of two
types of SDs with patients exhibiting avoidant attachment styles
and those with anxious attachment styles. This gets at the “which
type of SD with what kind of patient” question, although the
investigator has not statistically studied moderation or interaction
effects. Although less elegant, because of the practical difficulties
that investigators face when conducting complex experiments,
especially in the field, this approach is a legitimate, “in-principle”
way of addressing questions of moderation.
In their recent review of empirical findings regarding SD, Hen-
retty and Levitt (2010) addressed to the “who, what, when, where”
question, although they modified the specific question to “to
whom, what, when, why, and how.” Based on empirical findings,
as well as theoretical views, Henretty and Levitt extended the
clinical guidelines for therapist SD/immediacy that had been of-
fered by Farber (2006) and Hill and Knox (2002). We present a
summary of Henretty and Levitt’s clinical guidelines in the fol-
lowing paragraphs. It should be noted that Henretty and Levitt
considered immediacy to be one of two types of therapist SD.
Similar to Farber (2006), Henretty and Levitt examined empirical
and theoretical findings for both self-disclosing disclosures and
self-involving disclosures. The latter captures much of what we
term immediacy.
To whom. It is best to consider self-disclosing when there
exists a positive relationship and/or strong working alliance. Also,
it is wise to self-disclose when therapists and patients are from the
same small community (e.g., LGBT), and the patient is likely to
learn about his or her therapist outside of therapy anyway. Also,
 346 GELSO AND PALMA
SDs should be avoided with patients diagnosed with personality
disorders, who have poor boundaries, weak ego strength, or who
focus on the needs of others rather than their own needs. Therapists
should be aware of patients who feel uncomfortable with or
burdened by their therapists’ SDs.
What. Therapists should consider disclosing demographic
information, feelings/thoughts about the relationship and/or the
client, therapy mistakes, past struggles that are relevant and have
been successfully resolved, and similarities with the client. How-
ever, special caution should be exercised about disclosing past
struggles with disorders or addictions, even when successfully
resolved. It is also important to consider being explicit about
values, especially when therapist values are at odds with client
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values, so that there is no a subtle conversion of the client’s values.
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When. Although authors believe that stage of therapy is
central for SD, authors’ practices and opinions are not consistent.
However, therapists might consider greater SD at the beginning of
psychotherapy to inform patients about treatment, relieve patients’
apprehensions, and build the relationship. Although therapists of-
ten use SD in the early stage, some caution that in this stage it is
better to limit SDs to lower levels of intimacy.
After the early stage, some therapists increase SDs, whereas
others decrease disclosures. Most seem to agree that SDs ought to
increase during the termination stage in order to encourage separ-
ateness by showing the realness of the therapist; debrief, discuss,
and demystify the process; and celebrate what has been accom-
plished, and to reciprocate tender feelings expressed by the patient.
Why. Therapists should have a clear rationale for SDs. Ra-
tionales often given by therapists are ethical obligation, to promote
patients’ SD and self-exploration, to foster the therapeutic rela-
tionship, and to be a model for the patient. It is crucial that
therapists not disclose to control or manipulate, attack the patient,
gratify the patients when not therapeutically appropriate, empha-
size dissimilarities between patient and therapist unless this is
needed for treatment, and to satisfy the therapists’ own needs.
How. Therapists should use SD infrequently and with delib-
eration, assessing their own comfort level and feelings about the
disclosure, and considering the effects the SD will have on the
patient. Also, it is important to determine what patients are com-
municating, especially when they ask therapists to disclose. In
such cases, therapists need to explore the reasons and the meaning
of the possible answers with patients before actually disclosing.
SDs also must be carefully worded, providing only the information
that is needed for the therapeutic process. Finally, therapists should
be responsive to patients before, during, and after SD, and return
the focus to the patient right after the SD.
A Perspective on Guidelines
Although these guidelines may be useful for practice and re-
search, we believe that they also have some serious limitations. For
one, many of them seem based on agreement among authors rather
than sound empirical evidence. Shared opinion may be one ele-
ment of science, but it is insufficient. Second, although in spirit we
believe Henretty and Levitt’s (2010) guidelines capture some of
the complexity of SD, many of the recommendations may not
sufficiently take into account the complex interactions that need to
be examined as this area of inquiry progresses. For example, one
of the recommendations is that SD (including immediacy) not be
used with patients diagnosed with personality disorders. This rec-
ommendation, in principle, is based on the view that whether or
not one suffers from a personality disorder moderates the effect of
SD on treatment process and outcome. However, there are many
kinds of personality disorders, and it is highly likely that for some,
SD/immediacy actually fosters the therapeutic relationship, as well
as treatment outcome. Thus, Kuutmann and Hilsenroth (2011)
found that psychodynamic therapists’ focus on the immediate
relationship actually benefitted patients with certain kinds of per-
sonality pathology. Dynamically oriented therapists tended to fo-
cus more on the immediate therapeutic relationship with patients
exhibiting a cold/distant interpersonal style along with low self-
esteem, and these patients improved to a greater extent when
therapists focused on the relationship early in psychotherapy. In
terms of moderation or interaction effects, it appears that type of
personality pathology may influence the effects of the therapist’s
use of immediacy on the therapeutic relationship and treatment
progress. Because interaction or moderation effects quality main
effects, this Kuutmann and Hilsenroth finding importantly quali-
fies Henretty and Levitt’s (2010) suggestion that SD/immediacy
not be used with patients who have diagnosed personality disor-
ders. Instead, it appears that the use of immediacy may be bene-
ficial to patients suffering from certain personality disorders, but
harmful to those suffering from other disorders. The point here is
that as knowledge advances, we need to be examining more and
more refined interaction or moderation effects.
Perhaps, the most serious limitation of the guidelines is that they
naturally reflect the limited empirical knowledge we now have
about therapist SD. Stated simply, there are a multitude of topics
still to be studied in the area of SD/immediacy. For example, Yeh
and Hayes (this issue), in this special section, suggest the study of
factors such as timing of disclosures and patient readiness for
disclosures in relation to resolved countertransference disclosures.
A study of supervisors’ SD by Knox et al. (this issue) highlights
the importance of studying antecedents of SD. This could easily be
extended to the psychotherapy hour. Finally, Khurgin-Bott and
Farber’s (this issue) investigation underscores that disclosure to a
significant other might boost the therapeutic work.
Self-Disclosure, Immediacy, and Mediation
In discussing the “who, what, when, where” question, we have
sought to capture the complexities of psychotherapists’ use of
SD/immediacy, and the view that research must address these
complexities more than it has if SD/immediacy is to flourish as a
scientific construct. Our in-principle focus was on moderator or
interaction effects as a way of capturing this complexity. Another
way to capture the complexity is through the study of mediation
(e.g., Baron & Kenny, 1986; Frazier, Tix, & Barron, 2004). In the
conceptual sense, mediation occurs when the effect of one variable
(independent or predictor variable) on another (dependent or cri-
terion variable) occurs through a third variable (mediator). Medi-
ation can be full or partial. When it is full mediation, the effect of
the IV on the DV is completely accounted for by the mediator. In
other words, the entire effect of the IV on the DV occurs through
its direct effect on the mediator, which in turn affects the DV. In
partial mediation, some of the effect of the IV and the DV is direct,
rather than through its effect on the mediator.
 SPECIAL SECTION: SELF-DISCLOSURE AND IMMEDIACY
We would offer that examination of mediation has great signif-
icance for SD/immediacy research. One can readily see many
situations in the SD/immediacy area where mediation is a key to
understanding relationships. For example, Ain and Gelso (2011)
recently found that in long-term psychotherapy dyads, both ther-
apist and patient ratings of the strength of what is termed the
therapist-patient real or personal relationship was associated sub-
stantially with both therapist and patient ratings of treatment
progress. This relationship held up even when therapists rated real
relationship and patients rated progress, and vice versa (when
source of ratings was crossed). It was also found that the degree to
which patients’ rated their therapists’ SDs as relevant was associ-
ated with strength of the real relationship. These findings beg the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
question of whether the strength of the real relationship could have
This document is copyrighted by the American Psychological Association or one of its allied publishers.
mediated the relation of SD relevance to treatment progress. The-
oretically, it would make sense that the therapist’s use of highly
relevant SDs would strengthen the real relationship, which in turn
would contribute directly to treatment progress. Our central point
is that causal paths such as this are likely very common in the area
of therapist SD/immediacy, but they have been very rarely, if ever,
studied. The study of mediation would capture some of the rich
and complex relations among SD/immediacy and other psycho-
therapy variables.
The Inverted U in Life and Psychotherapy
One can readily think of numerous aspects of life in which
things are good up to a certain point, and beyond that point, they
become too much. In the scientific study of human behavior, it
appears that so often the dose-effect relation is not completely
linear, that is, the frequency, intensity, or duration of variables are
positively related to other variables up to a certain point, after
which the relation becomes nonexistent or negative. In the area of
psychotherapy, psychoanalytic clinicians have long known and
theorized that some small amount of interpretation can be posi-
tively related to treatment progress, whereas frequent interpreta-
tions can be harmful, or at least not helpful.
We believe that the idea of the inverted U has substantial
applicability to the study of SD/immediacy. In part, it would serve
as an antidote for researchers’ tendency to examine simply the
linear relation between frequency of SD/immediacy and psycho-
therapy process/outcome. After reviewing the theoretical and em-
pirical literature on SD, Henretty and Levitt (2010) viewed the
focus on frequency of SD as one of the main problems in this area
of research. In doing so, these reviewers were echoing the lament
by Hill and Knox (2002), who stated that “There is no compelling
reason to believe that more disclosures should lead to better
outcome. It may even be that therapist SD yields its positive effects
because it typically occurs so infrequently” (p. 416).
The problem of frequency when studied in a linear manner was
brought home in Hill’s (1989) classic study of the use of tech-
niques by eight master therapists doing brief psychotherapy with
eight cases. Hill found that although therapist SD and immediacy
were one of the least used techniques, clients rated these tech-
niques as the most helpful, and SD/immediacy was followed by
greater client self-exploration than were other techniques. Because
SD was so helpful, it would be tempting to conclude that therapists
should have used this technique more than they did. After all, if a
technique is highly effective, it would seem that using it more
347
frequently is called for. However, Hill offered that SD/immediacy
may have been so effective because, among other things, it was so
infrequently used. Well-timed and infrequent usage, like good
interpretation, may have enhanced the power of the technique.
This is a striking example of the inverted U operating in the area
of SD/immediacy. That is, other things being equal, it seems likely
that SD/immediacy is helpful up to a certain point, beyond which
increasing doses are less helpful.
In sum, although we suggest that the study of frequency, inten-
sity, and duration of SD/immediacy is reasonable at this point in
time, it would appear important that these phenomena be studied
so that inverted U phenomenon can be captured. Thus, researchers
should be looking for the optimal amount (or intensity, or duration)
of SD/immediacy in relation to other phenomena. In addition, it
may be best to study frequency, intensity, and duration in con-
junction with other key indices, for example, timing, relevance,
content, and clinical appropriateness of the SD/immediacy that is
employed.
Conclusion
We have focused on the need for research in the area of
SD/immediacy to develop and consistently use clearer definitions
of SD/immediacy than has been the case, to take care that opera-
tionalizations are consistent with definitions, and to capture the
complexity of therapists’ usage of this technique more than it has.
Examination of the “who, what, when, where question” will help
move the field forward, especially when that question is construed
conceptually as focusing on moderator or interaction effects, for
example, what disclosures with whom, what frequency of SDs
with what disorders, and so forth. In addition, the study of SD/
immediacy in the context of mediation will take the field a step
closer to capturing the complexity of this phenomenon. Future
studies should also take nonlinearity, or the inverted U, into
account when examining frequency of SD.
The question of what topics within SD/immediacy should now
be studied have not been addressed in this article. Numerous
questions and contents await empirical scrutiny in this area. Fur-
thermore, we believe individual investigators are the best judges of
specific topics to study related to SD/immediacy. The reader is
referred to the excellent review by Henretty and Levitt (2010) for
an examination of the contents of what has been studied to date.
Although our emphasis has been on what at face value appear to be
quantitative ways of advancing the study of SD/immediacy, our
actual focus has been on moderation, mediation, and the inverted
U in a conceptual sense. This implies that qualitative research may
also address moderation, mediation, and the inverted U. Indeed,
qualitative research (e.g., Hill et al., 2008; Kasper et al., 2008) may
be an ideal counterpoint to quantitative research in the exploration
of these phenomena. Regardless of the specific research ap-
proaches (e.g., experimental, correlational, qualitative) and statis-
tical techniques that are used by investigators, knowledge in the
area of the psychotherapist’s use of SD and immediacy will only
advance significantly if investigators employ, more than they have,
carefully constructed definitions, and operationalizations that are
consistent with those definitions. As well, at this point, addressing
who, what, when, and where questions through the in-principle
examination of moderation and mediation, while taking the in-
verted U into account, will help advance knowledge even further.
 348 GELSO AND PALMA
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Received September 6, 2011
Accepted September 7, 2011 䡲