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Openness in therapy: the essentials are often left unsaid

SCIENCE

Although self-disclosure is crucial for the success of therapy, patients often do not address important issues. The openness of the therapist can also be helpful.

It is essential for any psychotherapy that the client speaks openly and honestly about his feelings, thoughts, memories, experiences and problems. Even so, most clients do not reveal every secret by a long way. An estimated two-thirds of clients who undergo long-term psychotherapy leave something essential unsaid. "Some of the most hidden topics include sexual experiences, feelings and fantasies," says psychologist Barry Farber of Teachers College at Columbia University, who, together with colleagues, has conducted two studies on self-disclosure and has also reviewed relevant literature.
Uncomfortable to report negative feelings
Above all, the subject of masturbation and interest in pornographic books, magazines, films and videos are absolutely taboo. Fantasies relating to the therapist's sexuality or to intimacies between client and therapist are also rarely expressed. Affairs, affairs, loss of virginity, violence, abuse, rape, use of drugs and medication, fantasized crimes and other most intimate topics are also kept secret. Contrary to expectations, money and financial matters are not taboo subjects.
There are several reasons for keeping clients secret or silent. For example, clients fear that the therapist will not want to hear about their negative feelings. They feel uncomfortable reporting that they feel misunderstood, scared, confused, or helpless. Instead, if they only report positive reactions, they hope to please the therapist and be accepted by him. Silence is caused by fear, apprehension, shame and guilt. It is often very painful for clients to share something that they are guilty of, that casts a bad light on them, or that they feel embarrassed about. It also prevents you from being overwhelmed by fears, stress, and unpleasant and disturbing memories. Another reason clients don't tell is because they don't think it's important. "Most clients have one or two basic conflicts in their lives that they want to deal extensively with," explains Farber. Everything else seems irrelevant to them. However, this rating can also be an expression of resistance. Recognizing this is in turn the task of the therapist.
But there are also topics that clients address very often. This includes, for example, the feelings they have about themselves. Most of the time it is negative feelings like disappointment, despair and frustration. The clients speak
about what they don't like about themselves,
are concerned about them and what they consider to be an obstacle. Relationships with others are also often addressed. Here it is mainly negative aspects, such as disappointment in others, character defects on the part of parents and partners as well as anger and feelings of revenge.
While some studies show that women in therapy reveal more and different things about themselves than men, Farber assumes a tie based on his own research. However, women are more likely to withhold sexual experiences and thoughts, for example. Men are more silent about experiences of violence. Women are more likely to talk about feelings of disappointment and despair, whereas men are more likely to talk about feelings of disappointment and despair.
address issues of concern to you. A taboo subject, especially for women, is their interest in pornography and their sexual fantasies about the therapist. Women also have great problems revealing their sexual experiences, their experiences with menstruation and premenstrual syndrome. The fear of not being able to have children is also reluctantly admitted.
"Stranger-on-the-train phenomenon"
There are several factors that make it easier for clients to open up in therapy. First of all, this includes the “stranger-on-train phenomenon”. That means: It is easier for us to entrust secrets to a complete stranger than to someone close to us. Clients sometimes see their therapist as a stranger whose opinion or feelings they do not need to consider. Second, it creates relief and relief to reveal oneself. Third, it helps clients if they don't have to go into too much detail. Research has shown that clients respond more readily when they are asked to agree to general statements. Fourth, the quality of the therapeutic relationship plays a role. A trusting relationship creates an atmosphere in which the willingness of clients to reveal themselves is encouraged. The same applies to the duration of therapy. The longer a therapy lasts, the more clients reveal about themselves. The degree of shame also plays a role. Clients who are ashamed speak less about something that is bothering them. The importance of a topic also influences openness. However, it cannot be taken for granted that clients always speak in detail about what is important to them. For the therapy to be successful, however, it is essential that important topics are also discussed. Because if clients can talk about topics that are important to them, they are more likely to notice the progress of the therapy and rate the therapy as successful.
It is very rare for therapists to reveal themselves to clients. This is due, among other things, to the theoretical positions of the therapy schools. Classical psychoanalysis takes the view that the client must express every thought. The therapist, on the other hand, must remain neutral, anonymous and closed off. Because the more the client knows about the therapist, the more blurred the transference becomes. Progressive advocates of psychoanalysis, however, claim that complete neutrality is not possible. The furnishings in the practice or the clothing alone reveal something about the therapist. Psychoanalysts should reveal their feelings, as this is essential for an authentic analysis.
Other schools of therapy have less strict views. In humanistically oriented therapies, the therapist's self-revelation is seen as an asset. It shows the client that the therapist is caring and makes the therapeutic process less mysterious. The authenticity and authenticity of the therapist also promote openness, familiarity, trust, self-image and change processes in the client. Self-revelation makes the therapist appear more human and real. Therapy schools with an existentialist orientation are less clear about the openness of the therapist. For example, the therapist should rely on personal experiences when interpreting, but should not reveal them to the client. Therapies with a cognitive-behavioristic approach consider the therapist's self-disclosure to be a profitable intervention. They assume that openness strengthens working alliances, promotes change, improves client motivation, and increases the effectiveness of techniques. In addition, the therapist can serve as a model for roles, problem solving and coping techniques. So there is a wide range of opinions. However, they all agree on one thing: self-disclosure by the therapist is one of the rarest interventions, but one with great influence.
Rethinking required
Most therapists are trained to reveal as little about themselves as possible. "In view of the many profitable effects of the
However, there should be a rethink on this point, ”say the two American psychologists Sarah Knox and Clara Hill, who conduct several research papers on self-
have evaluated revelation. you
advise therapists to face each other
Open to clients, but thoughtful and
irregular. The right level of openness has to be found. Just
Appropriate content should be disclosed, for example on professional background or similar experiences or reactions. Therapists shouldn't reveal things that are too personal and intimate. The revelations should have something to do with that
have what concerns the client.
Revelations should be made spontaneously, then they will be understood as a normal part of the interaction. Therapists should ask clients how their revelations affect them. Dr. phil. Marion Sonnenmoser

Journal of Clinical Psychology. In session: Self-disclosure. 2003; 59: 5: 525-635.

Barry A. Farber, Program in Clinical Psychology, 525 West 120th Street, Teachers College, Columbia University, New York, NY 10027, [email protected]

Sarah Knox, Department of Counseling and Educational Psychology, School of Education, Marquette University, Milwaukee, WI 53210-1881, [email protected]
Openness in therapy: the essentials are often left unsaid

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