Therapist self-disclosure with children, adolescents, and their parents

Therapist Self-Disclosure with Children,Adolescents, and Their Parents

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Robert Gaines

William Alanson White Institute

Many therapists who work with children and adolescents make extensiveuse of self-disclosure. However, these interventions have received littleattention in the literature, and the basis for using them has not been wellestablished. A developmental/relational perspective on the therapeuticprocess provides a cogent foundation using therapist self-disclosure withchildren, adolescents, and their parents. Therapist self-disclosure facili-tates the negotiation of many important therapeutic tasks. Clinicians work-ing with children and adolescents almost always work concurrently withparents, yet the nature of this work has not been clearly conceptualized. Iadvance a collaborative model for parent work, highlighting the essentialrole of therapist self-disclosure. Extensive clinical examples of therapistself-disclosure with children, adolescents, and their parents are provided.© 2003 Wiley Periodicals, Inc. J Clin Psychol/In Session 59: 569–580,2003.

Keywords: therapist self-disclosure; children; adolescents; parents; relational,therapeutic tasks

Therapist self-disclosure with children, adolescents, and their parents presents a paradox.Personal experience, collegial communications, and simple reflection on the daily clini-cal work suggest that the child/adolescent therapist makes extensive use of him or herselfin clinical interactions. Whether it is convincingly playing an enraged, wounded lionwhile being tied up in a chair by a seven-year old, using one’s knowledge of baseballplayers to put a fourth grader at ease, or sharing some of one’s own adolescent socialdifficulties to help a highly anxious teenager feel like part of the human race, it is clearthat the child/adolescent therapist’s personality is often on display. However, this aspectof work with children and adolescents has received scant attention in the clinical litera-

Correspondence concerning this article should be addressed to: Robert Gaines, William Alanson White Insti-tute, 27 West 72nd Street, New York, NY 10023; e-mail: [email protected].

JCLP/In Session, Vol. 59(5), 569–580 (2003) © 2003 Wiley Periodicals, Inc.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.10163

ture. The only attempt at a systematic survey of practices with regard to self-disclosureindicated that therapists use less self-disclosure with children than with adults (Capo-bianco, 2002). How can we account for this?

In part, child/adolescent therapists, in their struggle for grown-up legitimacy, areafraid to innovate. Even as adult therapists have embraced more relational ways of think-ing and have experimented with expressive uses of their experience (Bollas, 1983; Ehren-berg, 1992; Renik, 1999), many child/adolescent therapists of a psychodynamic orientationhave remained mired in an old-fashioned model of Freudian orthodoxy. Neutrality, absti-nence, and anonymity remain ideals. Questions are parried with questions. Moments ofself-revelation are seen, at best, as lost opportunities to explore a child’s fantasies, or atworst, violations of the frame.

In addition, child/adolescent therapists have been stymied by the task of taking theconcept of therapist self-disclosure and making it relevant to the more action-packedexchange common with children. Many child/adolescent therapists make good use ofself-disclosure, but avoid presenting this part of their work because they are unsure of itstheoretical justification.

In what follows, I will briefly outline my approach to working with children, ado-lescents, and their parents, and then describe how use of therapist self-disclosure growsout of this way of thinking. I will give a number of illustrations of how therapist self-disclosure can be useful while also addressing some of the objections that are raisedabout therapist self-disclosure.

A Developmental/Relational Approach

I approach clinical work with children and adolescents from a relational psychoanalyticperspective, with an emphasis on developmental considerations (Gaines, 1995, 1997;Mitchell, 1988; Sullivan, 1953). From this point of view, therapist self-disclosure is anatural part of the therapeutic interaction. While the amount of explicit self-disclosurevaries considerably from case to case, openness towards and a readiness for an opendialogue is an essential part of the therapist’s basic stance.

The usefulness of therapist self-disclosure rests on several assumptions. First, from arelational or interpersonal point of view, therapist self-disclosure is not such a specialevent, not such a departure from business as usual. Relational thinkers have long main-tained that the idea of the blank screen, nonrevealing therapist was a myth. The therapistis inevitably a participant/observer in the therapeutic dyad (Sullivan, 1940). The patientaccurately registers, even if he or she does not consciously formulate, many aspects of thetherapist’s thoughts and feelings (Levenson, 1983).

Second, the patient is continuously changing in response to the nature of the thera-pist’s participation. From the relational point of view, it is limiting to consider as “dis-closure” only the therapist’s explicit declarative statements. We also must include whatthe therapist is exposing on all levels of communication. I will elaborate later on theimportance of this kind of “exposure” for work with children.

Third, a developmental point of view suggests revising some basic conceptions abouthow therapy works. The most central concerns the role of transference versus the realrelationship. Adults are assumed to have developed rather fixed personalities. The aim oftherapy is to elicit their characteristic maladaptive patterns in the transference relation-ship, and then to change these patterns via insight. Relative anonymity on the part of thetherapist is presumed to leave room for the patient’s transference reactions to emerge infull force. Children and adolescents, on the other hand, are less rigid. They are stillcapable, as Anna Freud (1965) pointed out, of developing new relationships in which

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their behavior and experience of self can change. Therapy with children and adolescentsis less about creating and resolving transference than it is about providing these newrelationships. Self-disclosure can help show the child that we are not like the “old objects,”and make way for new experience. In addition, all qualities that we associate with a goodrelationship, such as genuineness, empathy, respect, caring, and willingness to set limits,can be enhanced by tactful use of self-disclosure.

And fourth, another important developmental consideration is the tendency of chil-dren and adolescents to think and communicate more concretely than adults. Abstract orimpersonal communications can confuse or alienate them. Communication in a morepersonal mode, which inevitably involves some self-disclosure, is more effective. A cor-ollary of this is that children and adolescents are less able to understand that the therapistis playing a role, governed by certain rules (Gaines, 1995). Rather, they experience therelationship as real, and the therapist’s expressions or lack of expressions as his or hertrue feelings. In this context, a conversation without some therapist self-disclosure feelscold and rejecting.

Self-Disclosure with Children

Therapist self-disclosure with children is often misunderstood because of the inevitablecomparison to self-disclosure with adults. In particular, the intimate nature of the infor-mation sought by adults (Do you cheat on your spouse? Are you afraid of dying? Are yousexually attracted to me? Do you hate me?) makes the typical queries of children (Areyou married? Do you have children? Do you have a pet?) seem trivial. It is important tokeep two points in mind. First, the importance of personal information has to do withwhat it means to the child, not to us. Behind a simple question, such as whether we havechildren, may lie a deep concern the child has about how much we really care abouthim/her. Second, often it is not the content of the disclosure that matters but the willing-ness to open ourselves up to the child in the same way we are asking him or her to openup to us.

Another misunderstanding emanating from work with adults is that we tend to thinkof self-disclosure as the verbal revelation of discrete bits of information or feelings.Psychotherapy with children involves a wider range of nonverbal communication. Self-disclosure might, in a given instance, take shape in action, as when one forcefully preventsa child from breaking an office lamp. This might be more aptly termed self-exposure, andis a big part of work with children. Self-exposure with children also can come in the formof a mode of relating or participating. Examples include engaging in pretend play, par-ticipating in physical games, and competing without holding back. By responding toinitiatives in these areas, or making initiatives of his or her own, the therapist indicates awillingness to participate in these kinds of communicative interactions.

Therapist self-disclosure and exposure can enhance a number of therapeutic taskswith children. As illustrated next, these include engagement, scaffolding play, findingemotionally evocative language, identification of disavowed feelings, and modificationof self-judgments.

Engagement

Individuals of all ages need some help in becoming patients. This process of engagementwith children involves allaying initial anxieties and promoting therapeutic communica-tion. Therapist self-disclosure can facilitate this process.

Therapist Self-Disclosure with Children and Their Parents 571

C.G. was a fourth-grade boy, with two health care professional parents and twoacademically successful older brothers, who was referred for academic underachieve-ment. C.G. entered my room for his first session with a nervous smile. It was clear he wasreluctant to be there, and he readily acknowledged his trepidation. Being a patient meantsomething bad about him. These acknowledgments did not make him feel better. As Iasked him some questions about his life, his interest in baseball came up. I latched ontothis and shared with him my own interest in baseball. A spirited discussion of the currentperformance and future prospects of our local team ensued. My knowledge of and gen-uine interest in baseball were certainly apparent. C.G. enjoyed our exchange and began torelax.

This is a routine event in the psychotherapy of children of this age, but warrants aclose look. If I had simply asked a series of impersonal questions—What is your favoriteteam? Who is your favorite player?—it may not have had such a powerful effect. Bysharing my genuine excitement, I conveyed to this boy, who feared some threat to hisself-esteem in our encounter, that I value something that he thinks is important, that I findhis observations sharp and worthwhile, and that we can feel good talking together. Ofcourse, more difficult topics and feelings lie ahead, but now we have a common bond.

Moving from ordinary (reality oriented, conventional) to therapeutic (fantasy tinged,deeply personal) communication is another part of the engagement process. A beautifulexample of this is seen in a vignette reported by Buechler (2002). Early in her training,she was working with a three-year-old boy with severe nightmares. She felt it would behelpful to know what he was dreaming, but direct questions elicited no response. Shethen figured that if she asked him to make up a dream, it would probably bear consider-able resemblance to his real dreams. This request also elicited no response. Feeling dis-couraged, she tried something different. She suggested they play a game. She wouldmake up a dream to tell him, and then he would tell her one. To reinforce the game, shesuggested they lay down on the floor and then tell their dreams. Her patient respondedenthusiastically to this offer, and after listening to her dream, told one of his own. This isa prototypical example of mutuality, transposed to a child’s developmental level. Thetherapist goes first, and the patient is willing to follow.

Another example is the case of A.J., a depressed, anxious second-grade boy whoseparents are divorced. He has a younger sister whom he resents deeply. Bedwetting is asymptom that concerns him and his parents. He mentions this concern in his first ses-sion, but is able to say little about this behavior. Before his second session, I learn thathe has walked in his sleep and urinated on his little sister. At this second session, hebuilds a Lincoln Log fort, then another smaller building beside it, and finally an evensmaller building with only three walls. I suggest that this smallest building might be anouthouse, and he agrees. He says it is a good thing it opens away from the fort, so noone will see the soldiers peeing. I say it is also good because sometimes they like to peeon the ground. He laughs and says, yes but sometimes then the ground gets muddy. Isay yes, the soldiers like to have fun with peeing, sometimes they even like to put outfires by peeing on them. He laughs more excitedly and says that sometimes then theflame comes up the stream of pee and burns them, and boy does that hurt. This peeingtalk continues a bit further, and then we move on to other aspects of the soldiers’ lives.It is not clear just what has been revealed about A.J.’s fantasies and fears, but it is clearthat we have moved to a level of more personally revealing communication. How hasthis happened? Perhaps my fantasies have stimulated his. Moreover, I have disclosedthat I know, in a personal way and not a textbook way, that boys get excited aboutpeeing, that it makes them feel powerful. This has helped him feel freer to share whathe feels about peeing.


Scaffolding Play

Play is young children’s most effective modality for communicating their experience andfor coming to terms with it within themselves. However, not all children readily constructplay narratives or metaphors. Simply pointing to the available toys and inviting a child toplay is not always enough. For these children, a therapist’s exposure of his own playful-ness can create a scaffold on which these children can construct play.

J.P. was a kindergarten boy who had been raised in a most indulgent way until thearrival of a younger brother when he was three. At that point, he went into a narcissisticshock from which he had never recovered. He needed to have everything go his way,could not share or tolerate losing a game, and had multiple meltdowns every day. At theoutset of therapy, his mother was pregnant and due in three months. At the beginning oftherapy, J.P. did not play imaginatively. He asked to play chess, but altered the rules togive his pieces “special protection” and always won. This seemed an apt representation ofhow he wished life would be, but was more of a prerequisite for his participation than ametaphor that gradually expanded to reveal different aspects of his concerns.

To try to create a scaffold for more meaningful play, one day I picked up a mousepuppet and created a whiny, wounded, entitled character who was very angry because hehad a “younger brother problem.” J.P. looked at me like I was losing my mind. I picked upa smaller bear puppet to be the younger brother and staged a scene with the youngerbrother talking about getting Mom’s attention and the older brother beating him up. Despitehis initial reaction (and the not altogether flattering portrayal of my character), as I per-sisted, J.P. found him very appealing and wanted to play with him. Over the succeedingsessions, he and the mouse evolved a game. In his game, there was a house in which theyplayed that was surrounded by water. The mouse and his little brothers wanted to join theplay, and would attempt to swim to the island, which was surrounded by all the “danger-ous creatures” J.P. could find. As we discussed how much they wanted to join in, howspecial the goings on in the house were, the younger brothers met repeated gruesomedeaths in the water. The significant disclosure here is not my personal knowledge of thedynamics of sibling rivalry, but my willingness and desire to play. In creating my char-acter, I was telling him I wanted to and could go into this realm of pretend, which he wasavoiding.

Emotionally Evocative Language

To help children in psychotherapy, we must speak to them in a way that has emotionalimpact. Sometimes this requires dropping our impersonal, third-person style of speakingfor a more personal, intrinsically self-revealing style.

T.D. was a seventh-grade boy with a history of severe language impairment. Lan-guage acquisition had been an arduous effort, and while enormous progress had beenmade, difficulties with expression and comprehension remained. Before we ever met, Iknew that work on T.D.’s low self-esteem would be an important part of the treatment.Early on, I could see that to ward off awareness of his weak areas, he tended to downplayhow hard he worked to overcome them. When T.D. showed me how he could build ahouse of cards three stories high, I saw an opportunity to show him how remarkable hispatience and persistence could be. I thought that impersonal statements, such as “You areso patient” and “You must have worked so hard to learn how to do that” would be toeasily dismissed. Instead, I emphasized my personal reactions to make my communica-tion have more emotional impact. I said things like “I am so impressed with what youhave learned to do” and “I wish I knew how to do that.”


Identification of Disavowed Feelings

Discovery and reintegration of warded-off feelings is a major part of work with children.Children often do this through play, assigning the bad feelings or the role they fear orwish to avoid to the therapist. Sometimes, though, the child enacts this scenario ratherthan playing it out. The bad feelings are induced in the therapist, but not expressed. Astalemate ensues. The therapist can use disclosure of these feelings to bring them explic-itly into the interaction, where they can be explored. Unlike work with adults, where thisintervention requires direct verbalization, with children this is often done more easilythrough play. As in work with adults, the therapist must carefully process these feelingsand be sure they are not being used in a retaliatory way. In addition, the therapist, or hisproxy pretend character, must initially take ownership of these feelings for them to besafely introduced.

W.A. was a fourth-grade girl suffering from inhibitions, low self-esteem, over-weight, and withholding of feces. Her mother saw W.A. as the embodiment of everythingthe mother did not like in herself, and vastly preferred W.A.’s sister. In W.A.’s firstsession, she drew a picture of her mother. It came out looking like a witch. This sofrightened W.A. that she completely retreated from imaginative play and spent severalmonths playing chess. When she started to play again, she began building little housesand populating them with little people. As she worked, she would whisper to herself. Forweeks I would ask her to speak up, and she would speak more softly or not at all. I feltirritated, excluded, and wondered what I was doing wrong.

Finally, I got it. I was to be the rejected one, desperate to be included. I brought outmy mouse puppet and created a character, a little fellow who wanted to get in the house,who was angry and hurt that he was not allowed in. At first, A.W. just kept pushing themouse away. The more the mouse complained and schemed about how to get in, the moreinvolved the goings on in the house became, and the louder A.W. talked. Pretty soon therewere elaborate feasts and parties going on. The mouse begged, cajoled, ranted, and schemed.Eventually, he began being allowed in to clean up the crumbs. The mouse debated whetherthis was beneath his dignity, but could not resist temptation. This play continued to growand change over several months. The key element had been my expressing my feelings ofbeing left out and wanting to push my way in, so that A.W. could recognize them andbegin to explore them.

Modification of Self-Judgments

Another major task in the psychotherapy of children is the improvement of self-esteemby modifying overly rigid or excessively perfectionistic standards. Since children oftenexperience these attitudes in terms of idealization of adults, such as the therapist, self-disclosure of the therapist’s foibles, conflicts, and failures can be very helpful to thechild.

For example, R.B. was a young boy with low self-esteem. He expected himself to begood at everything, but unfortunately was saddled with a significant learning disability,short stature, and poor eye–hand coordination. He tended to bolster his self-esteem witha know-it-all attitude, which made it hard to make friends. Once he developed some trustin me, R.B. would frequently ask me if anything like the latest disappointment which hadjust befallen him had ever happened to me. I would always respond directly. If I hadn’thad that particular problem, I would talk about something similar.

I think this is probably the most frequent form of direct therapist self-disclosure withchildren. It can be overdone, in which case it loses some of its effectiveness, or even


becomes a sort of competition for the worse childhood (Bromfield, 1999). However, itsenormous impact should not be underestimated.

Barish (2000) reported a case which makes this point very colorfully. It was a several-years-long, successful treatment of a highly neurotic boy that featured detailed analysisof a phobia, including dream analysis. Toward the end of treatment, Barish asked the boywhat had been helpful, hoping to hear something about the fancy analysis. The boy’ssimple reply was, “Now I know everything you stink at.”

Self-Disclosure with Adolescents

In contrast to the world of play and activity in the consulting room with children, psy-chotherapy with adolescents begins to resemble work with adults in that the relationshiprides on a stream of verbal dialogue. Many a novice therapist who has thought that sinceyou can talk to a teenager like a grown up you can work with them in therapy the sameway has been rudely made aware this is not so. Adolescents occupy their own develop-mental space, and it is an intense, fast-moving place. Prominent among their transitions isa massive transformation in the adolescent’s relationship to the adult world. As a result,there will be great tensions and great possibilities in the relationship to the adult therapist.Negotiation of these tensions and activation of these possibilities can be significantlyaided by sensitive use of therapist self-disclosure. The therapist’s openness, accessibility,and genuine involvement in the adolescent’s life are central to escaping the adolescent’snegative projections and becoming a new person who can provide new relationship expe-riences (Gaines, 1999; Kantor, 1995).

Next, I will illustrate how I use self-disclosure with adolescents by discussing fourcommon clinical issues: initial wariness, differentiation from parents and identificationwith the therapist, promotion of constructive development, and development of a capac-ity for self-observation.

All of these issues can be seen in the case of Fred, a boy I began to see midwaythrough his ninth-grade year. Fred was the older of two children, with a younger brotherwho had severe learning disabilities and emotional problems and a very demanding youn-ger sister. Fred felt his life had been dominated by having to take a back seat in hisparents’, particularly his mother’s, attention, which was always on his brother. He felt hismother capitulated to his brother’s tantrums, and looked to Fred to make up for that bydoing with less or taking care of himself. As a result, Fred had very low self-esteem andwas seething with anger. The anger came out mainly in a sense of alienation and a passive–aggressive sabotaging of his parents’ hopes for academic success. Inwardly he felt needy,but struggled to ward this off because he regarded it as shameful and weak.

Initial Wariness

Like most adolescents, Fred was a reluctant patient, sent for therapy by his parents. At ourfirst meeting, Fred immediately declared that therapy was for people who are weak,which he was not. He would take care of his own problems by forgoing college, movingout of his home, and getting a job just as soon as he could graduate high school. I said itsounded to me like he was making some big commitments rather prematurely. I alsowondered how he was going to feel talking to me. He said that was not a problem; he wascomfortable talking to all kinds of people, and besides, he planned to come only a fewtimes to satisfy his parents. He acknowledged being very angry, which he attributed to hismother’s continual appeasement of his brother, often at his expense. I wondered aloud if


he felt I could help with that. He replied that I could help by talking to his mother, nothim. I indicated I planned to do that. He spoke briefly about a fear of death, but mainlyspoke nonstop about not wanting or needing treatment. He felt no one really wantedtherapy unless they were extremely desperate. He challengingly stated that he was sure Ihad never been in therapy. I matter-of-factly corrected this assumption, and added that Iprobably was in therapy much longer than he could imagine. At this point, some of thefight went out of Fred. He returned to his fear of death, which he said was more a fear ofabandonment. He spoke of his reluctance to become attached to anyone, which hardlymattered because he could not spend more than two days with anyone without fighting.When I suggested that I might be able to help him with that, he seemed genuinely sur-prised and mumbled something about possibly doing that. I thought this was significantprogress for a first session. Many things went on in this session. My validation of hisperception of the family dynamics was certainly helpful, but the real turning point wasmy disclosure about my therapy experience. Masked within Fred’s brash and provocativestatements had been a sincere and hopeful question, “Could he accept treatment and notbe an emotional weakling?” I think only a very personal response, such as that I gave,would have been convincing.

Differentiation and Identification

Finding new adults with whom to identify is an important task of adolescence. A therapistcan be such a person, especially when the therapist reveals enough of his or her values,interests, work habits, and relational style to give the adolescent something meaningfulwith which to identify.

Becoming such a person for an adolescent in treatment is not a straightforward prop-osition. At the outset, the therapist is often seen as an agent of the parents, carrying someof the bad parent attributes. To make room for a more positive relationship, therapistsdifferentiate themselves from the parents. Therapists of adolescents have tended to cloakthemselves in an unconventional, slightly anti-authority robe for just this purpose. How-ever, having achieved this differentiation, the therapist also must embody commitmentsand attitudes with some congruence and value in mainstream society, or else risk encour-aging acting out or unproductive nonconformity. Judicious use of therapist self-disclosure helps make the therapist “knowable” enough for the adolescent patient to puthim or her to such use.

For instance, at the outset with Fred I made every effort to show interest in his music,movies, and books; all things his parents scorned. I made connections between his inter-ests and my own, which I shared with him. What really turned a corner in differentiatingme from his parents was a particular piece of self-disclosure. Fred was quite interested inan African country. He had visited there with a youth group and planned to return on hisown. His parents rejected this interest, hurt that he was not interested in a country con-nected to his own ethnic/religious background. Fortuitously, I am interested in this samecountry and had even visited there myself, which I immediately shared with Fred. This, inhis eyes, stamped me as a different kind of adult. Having succeeded in differentiatingmyself, I then looked for opportunities to show another side. When opportunities arose,I spoke about the value I placed on education and the importance of hard work to reachone’s goals.

Promotion of Constructive Development

While Freudian theory of adolescence has emphasized a process of emancipation fromthe parents, relational developmental theory emphasizes that the adolescent/parent


relationship is being renegotiated, moving towards a more fluid and reciprocal connect-edness (Gaines, 1999). During this time, the adolescent still needs the parents. Adoles-cents need psychological permission from their parents to cease being children and becomeadults, and they require parental help in promoting their forward strivings. They needreflected back to them from their parents a vision of themselves as competent adults, andthey need concrete help in finding activities in which to actualize that vision (Gaines,1999). Adolescents in difficulty often do not get enough of this at home, and look for itfrom their therapists. Again, a more personal, self-revealing mode of interaction is thebest medium in which to convey this kind of vision and advice.

With Fred, one way this came up was when he began to express an interest indropping the language he was taking at school and studying the language of the countryhe was interested in outside of school (His school did not offer that language.) I explic-itly endorsed this move to him and convinced his parents to give it a try. I told Fred thatI could see that he was serious about his interest, and that pursuing what one was ex-cited about was always a good idea. Following up on this, when we were discussingbooks or political ideas, which was often, I regularly shared my view of Fred’s futurewith him. I told him I could see that he was going to love college and that I couldpicture him as a university professor some day, or perhaps a writer or journalist. Thiswas not disclosing facts about my life, but my personal fantasies about him and hisfuture, which clearly revealed a lot about me and about my feelings about him. Over thecourse of a year, Fred began to take his academic work seriously and produce someimpressive results.

Capacity for Self-Observation

One of the significant developmental achievements that we look to promote in psycho-therapy with adolescents is a capacity for self-observation. One of the great strengths ofa relational approach to psychotherapy is the way it fosters that capacity. In a relationalapproach, the emphasis is on the mutual analysis of the mutually created relationship. Insimpler words, the idea is that what happens between us is something to which we bothcontribute, and we can learn something by seeing how together we get into binds. Thisapproach is particularly effective with adolescents who are just learning how to observethemselves and their impact on others. This approach requires therapists to be self-disclosing about the nature of their participation. Often with adolescents, therapists mustgo first in taking responsibility for their behavior before adolescents can observe and owntheirs.

With Fred, early in our work he would sometimes get angry with me, feeling that Iwas taking his mother’s side. He felt I was being like his father, who often took aconciliatory approach, and wanted Fred to do the same. I thought Fred was taking hisview of his mother to an extreme, perhaps even holding onto it for some defensivepurposes. After several of these blowups, I thought more about what Fred was saying. Iacknowledged to him that I was afraid of the consequences of his anger, that he mightburn his bridges and be left alone, and that I was trying to take away his feeling as hisfather often did. At that, Fred observed that he responded to me and his father by be-coming more extreme, and maybe he liked that because it made him feel strong, wheninside he was tempted to give up any claims on his mother. Fred’s anger at his motherdid not go away after this, but it became easier for me to listen to. I began to realize thatit was only with me that it was safe to express these feelings and that he wasn’t going toact on them.


Self-Disclosure with Parents

Most contemporary therapists consider work with parents of children and adolescents tobe a crucial part of the therapeutic enterprise (Nevas & Farber, 2001). However, theexact nature of this work is elusive. It encompasses family therapy, parent counseling,brief individual therapy, and parent training, but is not exactly any of these. Parent workis a hybrid which awaits an adequate conceptual model. In my work, I find that thebest initial approach, and the one most sustainable over the long term, is to engage theparents as collaborators in the child’s treatment. Parents are not treated as pathologicalor pathogenic, but as competent partners who can assist my work with the child bymeans of their detailed observations and by using my understanding of their child tomake adjustments in their parenting practices. I try to appeal to their highest level offunctioning.

Therapist self-disclosure plays a key role in creating this collaborative relationship.Therapist self-disclosure is one of the most potent ways of creating more symmetry in therelationship. It is a powerful way of sending the message that both parties are on equalfooting.

Therapist self-disclosure to parents can come about through direct statements ormore indirectly through the way routine exchanges are handled. A colleague related to mea good example of the latter. This therapist was treating a late-adolescent girl and had notyet met the parents. An urgent matter had come up, and the therapist and mother had beentrying to reach each other on the telephone, to no avail. As she was getting ready to leavethe office, the therapist answered the phone—it was her patient’s mother. She told themother she was on her way out, and that the mother could call her later on her cell phone,but she might not get through because the therapist would be at her own daughter’svolleyball game, in a gymnasium with poor reception. If they didn’t speak then, thetherapist would call her later. Obviously, the therapist did not have to provide so muchdetail about her whereabouts. The information given was more like what one would tella friend or colleague. That, however, is the point. The provision of that kind of personaldetail sends the message, “We are partners working together” and “I will be accessible toyou in the way I hope you will be to me.”

Bringing one’s child to a therapist requires a great leap of faith. In my work, a majorgoal of my first interview, which I have with the parents without the child, is to shortenthat jump. A self-disclosing stance is an essential part of the process. I start the process byalways saying explicitly that our first meeting is both a chance for me to get to know themand their child, and for them to get to know me. Throughout initial interviews, I try to beopen and spontaneous in my reactions. If something is sad, I say so. If something isfunny, I laugh. If I think a child is being treated unfairly at school, I say so.

I try to be responsive to the parents’ questions. Two questions are most commonlyasked. The first is “Are you a parent?” I answer simply, “Yes.” Parents feel, and rightlyso, that this is a useful piece of information; that, all other things being equal, a therapistwho is a parent will be able to understand them and their child better. The second com-mon question is, “Do you have experience with this problem?” Again, I think this isimportant information for the parents to assess what I can do for their child. It is not aseasy a question to answer because we do not always have experience with the particularproblem as the parents define it. I believe that we need to be prepared to say what ourexperience is and how we think it is relevant and sufficient to work with that child. Forexample, I work with many children with chronic medical conditions. I am constantlybeing referred children with conditions that are new to me. When these parents ask if Ihave worked with a child like theirs, I explain that this condition is new to me (and I am


eager to learn about it from them and their child), but that I have worked with manychildren with other chronic conditions. This usually sets their mind at ease.

The great unvoiced concern of parents is: How will I feel about their child? Will I seeonly her problems or will I appreciate her special qualities? Will I see him as just anothercase, or will I prize him as they do? Accurate listening, empathic understanding, and acareful formulation of the child’s character, development, and difficulties in living go along way towards addressing these concerns, but not always far enough. Parents needto feel that you really “get” their child (and themselves, too) and are looking forward toworking with him. Truly personal responses are often necessary to convey this. I makea point of looking for the child and family’s strengths, and commenting in a direct andpersonal way. I may say, “He seems like a great kid” or “He sounds very interesting, Ican’t wait to meet him.” I am not advocating being disingenuous; sometimes the mostaffirming thing I can find to say is, “He sounds like quite a challenge, but I’m readyto try.”

Over the long haul of therapy, many types of therapist self-disclosure with parentscome up. Sometimes sharing something from the therapist’s own childhood, perhaps inconjunction with eliciting recall of similar situations from the parents, can help parentsbetter understand a difficulty their child is experiencing. At other times, sharing some-thing the therapist has experienced as a parent can be helpful. This type of disclosure isfairly risky, as it can easily come across as showing up the parents as inferior in theirparent skills, so I seldom use it. On the other hand, sharing reactions to teachers or otherschool personnel can be very useful in helping parents have confidence in their ownreactions. Sharing reactions to adolescents friendships also can be useful.

One last problem in working with parents that involves self-disclosure is the avoid-ance of parental meetings. It is well accepted that most premature or unsatisfactory ter-minations of child treatments come about because of a breakdown of the working alliancewith the parents. One of the common causes of such breakdowns is the tendency of sometherapists to avoid parental meetings. This avoidance can be due to fear of confrontingthe excuses parents may give for avoiding these meetings themselves, to feeling intimi-dated by particularly powerful parents, or a host of other reasons. But a common cause isfear of, distaste for, or inhibition about the self-disclosure they entail. Parents want toknow what is going on in the therapy and what the therapist is doing. This presents awonderful opportunity to educate the parents about the process of therapy and to ways,such as play, that children use to master their experience. However, it is a daunting task.

In discussing material with parents from a child’s sessions, several considerations ofconfidentiality arise. With younger children, I feel that the child’s privacy and need tofeel free in sessions is the guideline, not confidentiality in the strictest sense. Even so,there will be times when a young child’s secrets must be kept. As children get older, morematerial becomes private, but significant sharing with parents is still possible. With olderadolescents, strict confidentiality may need to be observed, though some flavor of whatthe therapist is doing can still be shared.

Clinical Issues and Summary

Therapist self-disclosure and exposure is a ubiquitous part of work with children, ado-lescents, and their parents. To date, it has not been explored systematically or in depth.The thoughtful use of therapist self-disclosure is an important tool for child and adoles-cent therapists. By virtue of their cognitive developmental and emotional needs, childrenand adolescents require a more personal, revealing mode of communication. Childrenand adolescents grow in therapy mainly through the relationship experience. They can


find in the therapist a “new object” only if the therapist makes himself sufficiently trans-parent and accessible. Work with parents is a unique clinical hybrid. The therapist’sopenness to being known by the parents promotes the kind of collaborative relationshipwe desire to achieve.

Select References/Recommended Readings

Barish, K. (2000, October). The child therapists’ generative use of self. Paper presented at theannual meeting of the Westchester Center for the Study of Psychoanalysis and Psychotherapy,White Plains, NY.

Bollas, C. (1983). Expressive uses of the countertransference: Notes to the patient from oneself.Contemporary Psychoanalysis, 19, 1–34.

Bromfield, R. (1999). Doing child and adolescent psychotherapy. Northvale, NJ: Aronson.

Buechler, S. (2002, October). Discussion of “Terror and trauma: An attachment theory perspec-tive.” (Paper by Peter Fonagy.) Paper presented at the William Alanson White Society Scien-tific Meeting, New York.

Capobianco, J. (2002). Therapist self-disclosure to child patients. Unpublished master’s thesis,Teachers College, Columbia University, New York.

Ehrenberg, D.B. (1992). The intimate edge. New York: Norton.

Freud, A. (1965). Normality and pathology in childhood: Assessments of development. New York:International Universities Press.

Gaines, R. (1995). The treatment of children. In M. Lionells, J. Fiscalini, C. Mann, & D.B. Stern(Eds.), Handbook of interpersonal psychoanalysis. Hillsdale, NJ: Analytic Press.

Gaines, R. (1997). Reply to Sugarman: More relational than otherwise. The Round Robin: News-letter of APA Division 39 Section I, 13, pp. 6, 13, 14.

Gaines, R. (1999). The interpersonal matrix of adolescent development and treatment. AdolescentPsychiatry, 27, 25– 47.

Kantor, S. (1995). Interpersonal treatment of adolescents. In M. Lionells, J. Fiscalini, C. Mann, &D.B. Ster (Eds.), Handbook of interpersonal psychoanalysis. Hillsdale, NJ: Analytic Press.

Levenson, E. (1983). The ambiguity of change. New York: Basic Books.

Mitchell, S. (1988). Relational concepts in psychoanalysis. Cambridge, MA: Harvard UniversityPress.

Nevas, D.B., & Farber, B.A. (2001). Parents’ attitudes toward their child’s therapist and therapy.Professional Psychology: Research and Practice, 32, 165–170.

Renik, O. (1999). Playing one’s cards face-up in analysis: An approach to the problem of self-disclosure. The Psychoanalytic Quarterly, 68, 521–539.

Sullivan, H.S. (1940). Conceptions of modern psychiatry. New York: Norton.

Sullivan, H.S. (1953). The interpersonal theory of psychiatry. New York: Norton.


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Therapist self-disclosure with children, adolescents, and their parents