Beyond Questioning- 'To Disclose, or Not to Disclose’.
Introduction
After publishing my previous blog post ‘To disclose, or not to disclose’, I was struck by several thoughtful reflections from readers. Two comments in particular on LinkedIn stayed with me.
The first commenter encouraged me to integrate wider systemic thinking into my conceptualisation of disclosure, asking- ‘How do institutions respond when clinicians speak? Are responses proportionate, compassionate, and fair?’
The second commenter questioned if disclosure is ever a choice, and suggested disclosures may be inevitable in the therapeutic relationship- ‘via the books, photos, and paintings in the therapy space or the appearance and punctuality of the therapist’.
Both of these reflections helpfully broadened my view and allowed me to think about the wider contributing factors to this complex process. Equally, they encouraged me to reflect on how I am viewing disclosure and wonder about the different types of disclosure that may co-exist. This is where we will focus today. This piece explores disclosure not simply as an individual act, but as something shaped through relational, systemic, and discursive processes.
What is disclosure?
When we think about ‘self-disclosure’, we often think about the decisions made in the therapy room by the practitioner and of course the client. Yet, there are many ways of viewing what disclosure is, what it does, and why. Disclosure can of course be an act of speaking about oneself and one’s experience. It may also be an unspoken act of revealing parts of oneself. This can, of course, be between two individuals, between an individual and system, between two systems, and so on. There are many types of disclosure that can co-occur, and yet this may not always be seen clearly by all of our therapeutic approaches.
As a care-experienced trainee clinical psychologist I am acutely aware that disclosure is rarely neutral. I reflected on my moments of self-disclosure in my journey to becoming a trainee clinical psychologist with Dr Marianne Trent on our podcast episode. Disclosure was never a neutral decision for me; it was one I made in order to benefit myself through getting on the right training course. In disclosing cleanly, I demonstrated a level of competence in both the ‘hidden’ (Gofton et al., 2006) and explicit curricula. Plus, clinical psychology needs diversity. So, in that sense, disclosure began to feel less like a choice and more like a requirement- something to be given in order to receive opportunity, revealing how systems may implicitly shape what is shared, why, and how.
Some psychotherapeutic approaches, namely classical psychoanalysis and Cognitive Behavioural Therapy (CBT) have careful theoretical approaches to the therapist initiating disclosure of themselves to their client (Miller et al., 2018). Other approaches, like Systemic Family Therapy (SFT) and humanistic approaches welcome this same phenomenon more warmly, theorising disclosure as part of the process (Roberts et al., 2005). The interesting thing to hold in mind here is not simply the difference in theoretical approach to disclosure we observe, but where this difference may come from.
Noticing this difference brings us back to the starting comment about systemic influences on disclosure. Looking into the application of CBT in the National Health Service (NHS) may help us to observe these systemic influences. CBT is an overrepresented therapeutic approach in the NHS for many reasons. It is outcome-driven and evidence-based which allows it to demonstrate its effectiveness and attract continued commissioning (Davies, 2021). It is structured and can be standardised, which makes it more possible to manage finite resources in the face of ever-increasing demand, and allows for clinicians and teams to clearly communicate that they are ‘managing risk’ where risk is part of standard CBT protocol. These systemic demands of being a service in the NHS- efficiency, accountability, and safeguarding- organically cultivate a more cautious approach to therapist self-disclosure (TSD). Not as a result of CBT theory alone, but a response to the context this theory sits within.
Dominant Discourse
So- ‘how do institutions respond when a clinician speaks?’. Well, that depends on what they say, how they say it in the given context, and what values the institution privileges. A layer that subsequently begins to subtly emerge in the discussion of the possibility of active TSD is that dominant narratives around this area will inevitably shape the landscape of disclosure.
This phenomenon could be understood through Social Representations Theory (Wagner et al., 1999) that might suggest that dominant narratives both create and are created by a shared understanding of what it means to be a ‘competent practitioner’ in the NHS context and may in turn relegate TSD to a ‘mute zone’- conceptually possible, but socially constrained. Equally, a Foucauldian-informed discourse perspective might suggest that TSD is never simply a matter of practitioner choice. Rather, types of disclosure are negotiated by shared discourse around professionalism, risk, and evidence-based practice in powerful networks, like the NHS, that shape what kinds of disclosures are possible, when, where, and how they may occur.
So, disclosure may indeed, in some contexts, only feel possible ‘via the books, photos, and paintings in the therapy space or the appearance and punctuality of the therapist’. In other contexts, it might also feel possible for this to co-occur with active TSD, depending on the dominant narratives and discourses around and how they assert their power on the practitioner, and how the client might reinforce this discourse in their encounters through their own disclosures. Perhaps the client side of this experience is something we can touch on at another time.
Disclosure as Transactional
These reflections remind us that disclosure is multilayered, relational, and systemic. Disclosure occurs in the negotiation between dominant and powerful discourses around professionalism, risk, and evidence-based practice, which shapes what kinds of disclosure feel possible.
In that sense, disclosure can become transactional. Something that is not simply performed by an individual alone, but a phenomenon that takes place between two entities. For example, I shared earlier how my journey to clinical training as a care-experienced practitioner was very much shaped by disclosures made in the transactions between me and my training course throughout the application process. That shows us that disclosure itself can be transactional. Something one may give in order to receive.
It can also show us that it is in the transaction that disclosure occurs, which returns us to the question of whether disclosure is, in some sense, inevitable. Staying with my example demonstrates that it was the space in between myself and my training course wherein the disclosures occurred, mutually. I disclosed parts of my identity, and this was received well enough to get me past written application to interview, then into the course. Throughout this process was an implicit and later explicit communication that my ability to disclose in a ‘contained’ manner was a strength. With that came disclosure from my course on their position on this- that it potentially aligned with their values, need for diversity, or rather more personal motivations. The motivations behind both our positions remain surmised, so in that sense inevitable transactional disclosures may not always have the same ability to ‘cleanly’ reveal, and the deciphering of these motivations is a valuable science belonging to psychodynamic approaches. What might that reveal about why psychodynamic approaches retain more cautious stances to active TSD?
Final reflection
What has become clear for me in writing this blog is not a single stable definition of disclosure, but the concept’s resistance to having one. Rather than fixing this ambiguity, this piece aims to sit alongside it, proposing that actually ‘disclosure’ may be better understood as a fluid and relational phenomenon. At points in this piece, I therefore intentionally resist offering fixed definitions to the concepts discussed in hope that this allows you the space to make sense of them in your own way. From this stance, the task is perhaps not for us to define, but to remain attentive to the ongoing processes that shape and reshape our definitions of these complex concepts across the contexts in which we practice.
References:
Davies, J. (2021). Sedated: How modern capitalism created our mental health crisis. Atlantic books.
Gofton, W., & Regehr, G. (2006). What we don't know we are teaching: unveiling the hidden curriculum. Clinical Orthopaedics and Related Research®, 449, 20-27. https://www.aoassn.org/wp-content/uploads/2020/12/whatwedon_tknowweareteaching.pdf
Miller, E., & McNaught, A. (2018). Exploring decision making around therapist self‐disclosure in cognitive behavioural therapy. Australian Psychologist, 53(1), 33-39. https://doi.org/10.1111/ap.12260
Roberts, J. (2005). Transparency and self‐disclosure 1 in family therapy: dangers and possibilities. Family process, 44(1), 45-63. https://www.researchgate.net/profile/Janine-Roberts-2/publication/7929251_Transparency_and_Self-Disclosure1_in_Family_Therapy_Dangers_and_Possibilities/links/5aeb85a4458515f59981dfc8/Transparency-and-Self-Disclosure1-in-Family-Therapy-Dangers-and-Possibilities.pdf
Wagner, W., Duveen, G., Farr, R., Jovchelovitch, S., Lorenzi‐Cioldi, F., Marková, I., & Rose, D. (1999). Theory and method of social representations. Asian journal of social psychology, 2(1), 95-125.https://dspace.stir.ac.uk/bitstream/1893/28148/1/Markova_Asian_Journal_of_Social_Psychology_1999.pdf
