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Using spiritual self-disclosure in psychotherapy.

The purpose of this article is to outline a series of recommendations to aid therapists in developing and integrating spiritual self-disclosure into the therapeutic process. The authors introduce six categories of spiritual self-disclosure by adapting Well's (1994) and Kottler's (2003) categories of self-disclosure. Arguments for and against therapist self-disclosure are offered, along with underlying assumptions inherent to the use of self-disclosures that incorporate spiritual themes. Assumptions and recommendations for therapists that may facilitate clinically relevant, culturally sensitive, and ethical implementation of spiritual self-disclosure are offered. Case examples highlighting how therapists can integrate spiritual self-disclosures into clinical practice are also provided.

**********

Self-disclosure can be broadly defined as "statements that reveal something personal about the therapist" (Hill & Knox, 2001). The disclosure of personal information by therapists in the course of their work with clients has been a topic of serious deliberation deliberation n. the act of considering, discussing, and, hopefully, reaching a conclusion, such as a jury's discussions, voting and decision-making.


DELIBERATION, contracts, crimes.
 among psychotherapists (e.g., Hill & Knox, 2002; Knox, Hess, Petersen, & Hill, 1997). Furthermore, when, what, and how much to disclose has been the subject of additional debate, as well as whether self-disclosure is appropriate at all. Many therapists agree, however, that self-disclosure can be a powerful intervention if used properly (Kottler, 2003).

Despite the on-going debate among clinicians over therapist self-disclosure, there is a striking dearth of literature on therapeutic disclosures that are spiritual in nature. Spiritual self-disclosure has been defined as a spiritual intervention in which the therapist shares "aspects of his or her own spiritual experience" (Richards & Bergin, 2005, p. 287) with the client. To date, the literature has previously addressed spiritual self-disclosure only in abstract, non-precise terms, and most often as a vague intervention strategy (e.g., Richards & Bergin, 2005). Thus, the purpose of this article is to integrate spirituality into the discussion surrounding therapist self-disclosure and to provide recommendations for the clinically relevant, culturally sensitive, and, ethical use of spiritual self-disclosure. Our goal for this article is to demonstrate how therapists might utilize spiritual self-disclosure to normalize normalize

to convert a set of data by, for example, converting them to logarithms or reciprocals so that their previous non-normal distribution is converted to a normal one.
 client experience, offer encouragement, provide modeling, or convey a message or information without imposing their beliefs on clients.

ARGUMENTS FOR AND AGAINST SELF-DISCLOSURE

Arguments have been made both for and against the practice of therapist self-disclosure. One of the most salient arguments in favor of therapist self-disclosure postulates that this practice humanized therapists and increases the intimacy of the therapeutic interaction (Kramer, 2000). Guy (1987) addressed therapist self-disclosure within the context of significant events in the life of the psychotherapist psy·cho·ther·a·pist
n.
An individual, such as a psychiatrist, psychologist, psychiatric nurse, or psychiatric social worker, who practices psychotherapy.
 (e. g., marriage, divorce, retirement), stating:

Regardless of the theoretical orientation employed, patients need to know that the therapist is alive, vulnerable, and affected by life events, and yet able to survive and live a meaningful life. If this is not the case, there is no reason to hope that the labors of the psychotherapist, and participation in psychotherapy psychotherapy, treatment of mental and emotional disorders using psychological methods. Psychotherapy, thus, does not include physiological interventions, such as drug therapy or electroconvulsive therapy, although it may be used in combination with such methods. , will result in the desired change. (p. 195)

Therapists are models of interpersonal interaction and clients often respond to therapist self-disclosure with increased disclosure of their own experiences (e. g, Kottler, 2003). Further, appropriate self-disclosure may serve to: (a) convey respect and facilitate the therapeutic relationship, (b) provide feedback about the impact of the client on others, (d) expand the repertoire of experience and possibilities for clients, (e) reassure clients or normalize their experiences, and (f) facilitate hope. Kramer (2000) argued that therapist self-disclosure also serves to decrease client transference TRANSFERENCE, Scotch law. The name of an action by which a suit, which was pending at the time the parties died, is transferred from the deceased to his representatives, in the same condition in which it stood formerly. . That is, the more clients actually know about their therapists (e.g., therapists' thoughts, feelings) the less he or she is likely to project onto therapists, helping to avoid potential hindrances to the therapeutic alliance. Moreover, therapists who self-disclose are consistently rated by clients as more helpful in both quantitative and qualitative studies (e.g., Hill, et al., 1988; Knox, Hess, Petersen, & Hill, 1997).

Kramer (2000) and Kottler (2003) also enumerated This term is often used in law as equivalent to mentioned specifically, designated, or expressly named or granted; as in speaking of enumerated governmental powers, items of property, or articles in a tariff schedule.  several arguments against using self-disclosure in therapy. First, it is possible that therapists will use disclosure inappropriately or for the wrong motivations. For example, therapists may disclose to meet their own needs (psychological, emotional, to be their own needs (psychological, emotional, to be liked, etc.), manipulate or control clients, or defend their own actions of behaviors. Self-disclosures may also shift the focus of therapy onto the therapist, thus marginalizing the clients' needs. There is a possibility that therapists' disclosure may also exacerbate clients' symptomology, especially those with poor boundaries (e.g., client diagnosed with borderline personality disorder bor·der·line personality disorder
n.
A personality disorder marked by a long-standing pattern of instability in interpersonal relationships, behavior, mood, and self-image that can interfere with social or occupational functioning or cause extreme
). The main argument against self-disclosure in psychotherapy is that it has the potential to harm the client if done improperly or insensitively in·sen·si·tive  
adj.
1. Not physically sensitive; numb.

2.
a. Lacking in sensitivity to the feelings or circumstances of others; unfeeling.

b.
.

It is important to note that not all psychotherapeutic psy·cho·ther·a·py  
n. pl. psy·cho·ther·a·pies
The treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being
 modalities Modalities
The factors and circumstances that cause a patient's symptoms to improve or worsen, including weather, time of day, effects of food, and similar factors.
 would encourage self-disclosure as a therapeutic tool. Contemporary psychodynamically oriented o·ri·ent  
n.
1. Orient The countries of Asia, especially of eastern Asia.

2.
a. The luster characteristic of a pearl of high quality.

b. A pearl having exceptional luster.

3.
 therapists, for example, generally do not self-disclose in order to maintain a therapeutic frame that fosters exploration of the client's internal world. Self-disclosure can be experienced by the client as an implicit message that the therapy is also about the therapist, which is generally the concern about self-disclosure in contemporary psychodynamic therapy Psychodynamic therapy
A therapeutic approach that assumes dysfunctional or unwanted behavior is caused by unconscious, internal conflicts and focuses on gaining insight into these motivations.

Mentioned in: Cognitive-Behavioral Therapy
. However, there is an increasing emphasis in relational psychoanalysis Relational psychoanalysis is a school of psychoanalysis in the United States that emphasizes the role of real and imagined relationships with others in mental disorder and psychotherapy.  and attachment-based psychoanalytic therapy psychoanalytic therapy
n.
See psychoanalysis.
 on the therapist disclosing the impact the client has on the therapist (e.g., Stern et al., 1998). This fosters attachment, and is very different than disclosing content about the therapist's life or background.

ASSUMPTIONS AND RECOMMENDATIONS

Before using spiritual self-disclosure, therapists should consider several underpinning un·der·pin·ning  
n.
1. Material or masonry used to support a structure, such as a wall.

2. A support or foundation. Often used in the plural.

3. Informal The human legs. Often used in the plural.
 assumptions associated with this intervention. In the following, we outline assumptions that are intended to give therapists insight into possible limits and applications of spiritual self-disclosure in counseling and psychotherapy. Recommendations and examples for how therapists might attend to the highlighted assumptions are also addressed.

First, therapists should consult their governing ethical codes Noun 1. ethical code - a system of principles governing morality and acceptable conduct
ethic

system of rules, system - a complex of methods or rules governing behavior; "they have to operate under a system they oppose"; "that language has a complex system
 and guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks.
 to assist in determining appropriate uses of spiritual self-disclosure. Tan (1994) identified a series of potential pitfalls in religiously-oriented psychotherapy, the first of which is the danger of imposing therapists' religious beliefs or values on clients, thus reducing clients' freedom of choice. The issue of the sharing and imposing therapists' spiritual and religious values is explicitly addressed by various professional codes of ethics (e.g., American Counseling Association The American Counseling Association (ACA) is a non-profit, professional organization that is dedicated to the counseling profession. ACA is the world's second largest association exclusively representing professional counselors. , 2005; American Psychological Association The American Psychological Association (APA) is a professional organization representing psychology in the US. Description and history
The association has around 150,000 members and an annual budget of around $70m.
, 2002) and should not be done to manipulate or coerce clients. Therapists may find it helpful to utilize an ethical decision-making model (e.g., Chapelle, 2000). A number of authors (e.g., Chappelle, 2000; McMinn, 1996; Richards & Bergin 2005. Tan, 1994) have suggested guidelines and principles in making ethical decisions Real life ethical decisions are studied in sociology and political science and psychology using very different methods than descriptive ethics in ethics (philosophy). Not ethics proper  with regard to the use of spirituality in therapy. Therapists should also consult their agency or practice setting guidelines and policies before implementing spiritual self-disclosure. Obtaining informed consent for using spiritually oriented interventions, including spiritual self-disclosure, could also be obtained to ensure adherence to ethical principles (Hathaway & Ripley, in press). It is also recommended that therapists seek out training, supervision or consultation for addressing spirituality in counseling and psychotherapy (Worthington, et al., in press).

Second, therapists should only use spiritual self-disclosure if clinically relevant. Kottler (2003) noted that there are certain clients for whom therapist self-disclosure is most often contraindicated: (a) clients who may be inclined to use the information against the therapist in some way, (b) clients with personality disorders Personality Disorders Definition

Personality disorders are a group of mental disturbances defined by the fourth edition, text revision (2000) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
 or Axis II Axis II Psychiatry A dimension used with DSM-IV, which includes personality disorders: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, dependent, obsessive-compulsive, personality “NOS” and mental retardation.  leanings, (c) clients who might be inclined to readily adopt therapists' characteristics or who have poor identity formation, (d) clients who tend to focus on the needs of others rather than their own needs, (e), clients who fear closeness with therapists or intimacy in general, (f) clients who are self absorbed, (g) clients aversive aversive /aver·sive/ (ah-ver´siv) characterized by or giving rise to avoidance; noxious.

a·ver·sive
adj.
 to discussing emotional latent material or intense emotions. Similarly, caution should be taken when working with psychotic psychotic /psy·chot·ic/ (si-kot´ik)
1. pertaining to, characterized by, or caused by psychosis.

2. a person exhibiting psychosis.


psy·chot·ic
adj.
 clients who may incorporate religious themes into their hallucinations Hallucinations Definition

Hallucinations are false or distorted sensory experiences that appear to be real perceptions. These sensory impressions are generated by the mind rather than by any external stimuli, and may be seen, heard, felt, and even
 or delusions Delusions Definition

A delusion is an unshakable belief in something untrue. These irrational beliefs defy normal reasoning, and remain firm even when overwhelming proof is presented to dispute them.
. It may therefore be useful for therapists to listen, focusing on client experiences, symptoms, and diagnostic criteria, for either client indicators (e.g., discusses positive religious coping religious coping,
n means of dealing with stress (which may be a consequence of illness) that are religious. These include prayer, congregational support, pastoral care, and religious faith.
 strategies) or contra-indicators (e.g., reports atheistic a·the·is·tic   also a·the·is·ti·cal
adj.
1. Relating to or characteristic of atheism or atheists.

2. Inclined to atheism.



a
 worldview world·view  
n. In both senses also called Weltanschauung.
1. The overall perspective from which one sees and interprets the world.

2. A collection of beliefs about life and the universe held by an individual or a group.
) for using spiritual self-disclosure.

Third, cultural sensitivity needs to be displayed when integrating spiritual self-disclosure into treatment. Some clients, such as non-religious clients or clients who prefer to discuss the sacred with a spiritual leader may be less interested in discussing spiritual issues in counseling and psychotherapy. Still, researchers have found that many religiously and spiritually committed clients wish to discuss spiritual matters in the course of treatment. Further, researchers have found that matching client and therapist based on their religious and spiritual backgrounds or traditions enhances the efficacy of spiritually oriented interventions (Post & Wade, in press). In health related studies, discussing spiritual matters has been found to improve mental, physical, and spiritual health outcomes (e.g., Kristeler, Rhodes, Cripe, & Sheets, 2005). Assessment tools such as the ADDRESSING model could also potentially be used to help therapists determine the cultural significance of clients religious and spiritual beliefs (Zinnbauer & Barrett, in press).

Fourth, it may be inappropriate for therapists to disclose spiritual information about themselves to clients who are hostile toward religion and spirituality, may have had negative experiences with religious and spiritual leaders or organizations, or are psychotic and may incorporate religious themes into their hallucinations or delusions. Using psychological tools such as the spiritual genogram, which can be used to examine clients ' spiritual experiences and relational patterns across generations, is one way therapists might identify such potential problematic negative attitudes toward or experience with spirituality (Frame, in press). If negative patterns or experiences are reported, therapists need to make sure that a strong therapeutic alliance is established before using spiritual self-disclosure, and once again, only if the client is open to this from of spiritually oriented intervention.

Fifth, therapists must decide whether they will disclose experiences that occur within the therapy session or experiences and information from outside the therapy session. Some have asserted that therapist disclosure about immediate feelings and thoughts in session are appropriate and that disclosures about therapists' outside experiences and life are inappropriate as they distract from clients' experience (Wachtel, 1993). Others have found that disclosure about personal, outside experiences of the therapist were of major value and use to clients. For example, Knox, Hess, Petersen, and Hill (1997) found that "personal non immediate information" (p.279) about therapists' lives were rated as most valuable by clients. This may require that therapists engage in self-awareness activities to help determine their comfort level with, and ability to effectively use spiritual self-disclosure. For example, therapists might seek out peer consultation or attempt to journal about topic (Frame, in press). Therapists might also turn to their theoretical orientation for guidance, as certain approaches appear to more readily utilize immediacy im·me·di·a·cy  
n. pl. im·me·di·a·cies
1. The condition or quality of being immediate.

2. Lack of an intervening or mediating agency; directness: the immediacy of live television coverage.
 than others (e.g., interpersonal approaches).

Sixth, there are several questions therapists can ask themselves when deciding whether a disclosure would be appropriate (Kottler, 2003): (a) What do I hope this will accomplish?; (b) To what extent am I attempting to meet my own needs?; (c) Is this the right time?; (d) How will the client personalize per·son·al·ize  
tr.v. per·son·al·ized, per·son·al·iz·ing, per·son·al·iz·es
1. To take (a general remark or characterization) in a personal manner.

2. To attribute human or personal qualities to; personify.
 what I share about myself?; and (e) How can I put the focus back on the client? Table 1 offers a sample set of questions related to the various dimensions of therapist spiritual self-disclosure that may assist the therapist in deciding whether this kind of intervention is an appropriate therapeutic activity with a particular client at a specific point in therapy.

Seventh, therapists must be aware that self-disclosure may also be nonverbal non·ver·bal  
adj.
1. Being other than verbal; not involving words: nonverbal communication.

2. Involving little use of language: a nonverbal intelligence test.
 and can be intentionally in·ten·tion·al  
adj.
1. Done deliberately; intended: an intentional slight. See Synonyms at voluntary.

2. Having to do with intention.
 or unintentionally communicated through tone and facial expressions facial expression,
n the use of the facial muscles to communicate or to convey mood.
. Therapists might consider receiving informed consent to either audio or videotape videotape

Magnetic tape used to record visual images and sound, or the recording itself. There are two types of videotape recorders, the transverse (or quad) and the helical.
 sessions that can later be reviewed to listen for or watch for nonverbal communication nonverbal communication 'Body language', see there  around spiritual issues. Likewise, self-disclosure may occur through clothing, jewelry jewelry, personal adornments worn for ornament or utility, to show rank or wealth, or to follow superstitious custom or fashion.

The most universal forms of jewelry are the necklace, bracelet, ring, pin, and earring.
, pictures on the wall, and books on the shelf. Spiritual self-disclosure may also occur due to iconography iconography (ī'kŏnŏg`rəfē) [Gr.,=image-drawing] or iconology [Gr.,=image-study], in art history, the study and interpretation of figural representations, either individual or symbolic, religious or secular; , religious literature, posters, and affiliations indicated on professional and educational diplomas. It could benefit therapists to have a colleague provide feedback on how they perceive the implicit or explicit messages being conveyed the implicit or explicit messages being conveyed by office or personal artifacts artifacts

see specimen artifacts.
 and symbols. This is not to say that one approach (i.e., implicit or explicit) is better than the other, rather, the point is that therapists should be intentional in how they portray their surroundings (Leach, Aten Hernandez, & Wade, 2009).
TABLE 1.
Considerations in Deciding Whether Therapist Self-disclosure is an
Appropriate Intervention

              Client's          Therapist             Therapeutic
             Well-being       Considerations         Relationship

Context    * Has informed    * How is           * What is the practice
Variables  consent           self-disclosure    setting and the type of
           regarding the     viewed within the  relationship that
           use of spiritual  predominant        clients and therapists
           interventions     theoretical        typically establish in
           been obtained?    orientation of     this context?
                             the therapist and
                             the practice
                             context?

                                                * How does this setting
                                                view the use of
                                                spiritual
                                                interventions?

Content    * Is therapist    * What is the      * Will the specific
Issues     spiritual         therapist's        content described in
           self-disclosure   degree of          the self-disclosure
           compatible with   exposure to        strengthen the
           the client's      various spiritual  relationship or
           goals in          experiences,       create distance?
           therapy?          expressions, and
                             systems?

           * Is there        * What is the
           specific content  therapist's level
           in the            of training/
           disclosure that   supervision and
           may trigger       competency in the
           negative          use of spiritual
           reactions by the  interventions and
           client?           use of
                             self-disclosure?

Process    * Will the        * How healthy is   * How will the power
Variables  spiritual         the therapist's    differential endemic to
           self-disclosure   own spirituality?  therapy place pressure
           likely move the                      on the client to copy
           client forward                       the therapist rather
           in his/her                           than pursue his/her
           growth process                       own spiritual journey?
           or will it
           produce
           unhealthy
           reactions such
           as shame and
           guilt?

           * How will        * Does the         * Will the modified
           spiritual         therapist feel     relationship that
           self-disclosure   safe in            may emerge from
           at this point*    disclosing         sharing spiritual
           aid the           personal           experiences be
           therapeutic       information?       beneficial to the
           process?                             therapeutic process?

                             * What unresolved
                             issues might the
                             therapist have
                             that would
                             motivate this
                             disclosure with
                             this particular
                             client, at this
                             time, in this
                             context? Does the
                             therapist utilize
                             supervision that
                             would affirm
                             appropriate
                             spiritual
                             interventions?

                             * How will the
                             spiritual self-
                             disclosure be
                             documented in
                             clinical records?


SPIRITUAL SELF-DISCLOSURE IN PSYCHOTHERAPY

Wells (1994) and Kottler (2003) proposed that therapist self-disclosures could be divided into six categories (e.g., personal experiences). In the following, these categories have been used as template and adapted to highlight how spirituality can be integrated into therapist self-disclosure. It should be noted that these classifications of self-disclosure are not as distinct and orthogonal At right angles. The term is used to describe electronic signals that appear at 90 degree angles to each other. It is also widely used to describe conditions that are contradictory, or opposite, rather than in parallel or in sync with each other.  as their descriptions may insinuate in·sin·u·ate  
v. in·sin·u·at·ed, in·sin·u·at·ing, in·sin·u·ates

v.tr.
1. To introduce or otherwise convey (a thought, for example) gradually and insidiously. See Synonyms at suggest.

2.
, as they often overlap and occur simultaneously. For example, a therapist may disclose a personal struggle (mistake and experience), then describe how he or she felt (feelings), and how the faith community was used (personal data, experience, and opinion).

Moreover, Tan (1996) and Hall and Hall (1997) describe a continuum for integrating spirituality with implicit (e.g., therapist prays silently for a client) and explicit (e.g., therapist prays our loud with a client) anchors. Spiritual self-disclosures may also fall on such a continuum, as disclosures may vary in the degree to which they are implicit or explicit. For example, some therapists may feel uncomfortable disclosing personal spiritual information to clients choosing instead to share relevant non-personal examples, such as sharing a quote from a sacred writing (thus displaying a more implicit type of disclosure). Overall, we encourages therapists to draw from and utilize spiritual self-disclosures across the afore-mentioned continuum. However, the majority of case examples that we offer in the following section are more explicit in nature, which was done to make the types of spiritual self-disclosure more salient for clinical application. Also described below are a series of recommendations of guide therapists' use of spiritual self-disclosure.

1. Therapists use self-disclosure to communicate personal spiritual data. Therapists may disclose personal data of a spiritual nature such as the therapist's religion, denominational de·nom·i·na·tion  
n.
1. A large group of religious congregations united under a common faith and name and organized under a single administrative and legal hierarchy.

2.
 affiliation, any theistic the·ism  
n.
Belief in the existence of a god or gods, especially belief in a personal God as creator and ruler of the world.



the
 training, or significant spiritual experiences. This may be done implicitly by displaying spiritually-oriented wall decorations or by wearing religiously meaningful jewelry. It can be communicated explicitly by verbally sharing the name of the religious denomination For other senses of this word, see denomination.
A religious denomination (also simply denomination) is a subgroup within a religion that operates under a common name, tradition, and identity.
 he or she attends along with his or her church or synagogue synagogue (sĭn`əgŏg) [Gr.,=assembly], in Judaism, a place of assembly for worship, education, and communal affairs. The origins of the institution are unclear. One tradition dates it to the Babylonian exile of the 6th cent. B.C.  of choice. Clients often want to know something about the person with whom they are talking, and spiritual information about their therapist may be important information to those who are highly religious and spiritual. Morrow mor·row  
n.
1. The following day: resolved to set out on the morrow.

2. The time immediately subsequent to a particular event.

3. Archaic The morning.
, Worthington, and McCullough (1993) found that the way in which a therapist responds to a client's religious values is more important to clients that the actual religious affiliation of the therapist, thus illuminating il·lu·mi·nate  
v. il·lu·mi·nat·ed, il·lu·mi·nat·ing, il·lu·mi·nates

v.tr.
1. To provide or brighten with light.

2. To decorate or hang with lights.

3.
 the potential impact of a therapist's religiously-oriented disclosures. Chesner and Baumeister (1985) found a positive correlation Noun 1. positive correlation - a correlation in which large values of one variable are associated with large values of the other and small with small; the correlation coefficient is between 0 and +1
direct correlation
 between intimacy and disclosure when the client and therapist were of the same religion, but this was not significantly larger than the intimacy of therapeutic relationships in which the therapist did not disclose his or her religious affiliation. Therefore, therapists should be aware of the potentially positive and negative consequences of disclosing spiritual information about themselves and how such information may impact their work.

Case example. A highly anxious client from a very conservative religious background reluctantly entered therapy with considerable suspicion regarding the process of therapy, the role of spiritually in therapy, and the ability of the therapist to help. The intensity of her anxiety was considerably diminished when her therapist disclosed that she shared a similar religious background, and that the therapist understood her concerns about how God would be included in the therapeutic process. The use of familiar religious language and concepts, based in a common religious heritage, served to reduce initial anxiety so that they could work more effectively on her anxiety disorder anxiety disorder
n.
Any of various psychiatric disorders in which anxiety is either the primary disturbance or is the result of confronting a feared situation or object.
.

2. Therapist incorporate self-disclosure to communicate personal feelings about God or the divine. Therapists may explicitly reveal to clients how they feel or have felt toward God, as well as they feel or have felt toward God, as well as his or her perceptions about what God may be feeling toward the client. Therapists may also share a time when they were disappointed or angry with God. More implicitly, therapists could facilitate a conversation about how God interacted with a person in the Bible with a situation similar to the clients, or discuss a Psalm or Proverb proverb, short statement of wisdom or advice that has passed into general use. More homely than aphorisms, proverbs generally refer to common experience and are often expressed in metaphor, alliteration, or rhyme, e.g. . Emotions are inherently ethereal ethereal /ethe·re·al/ (e-ther´e-il)
1. pertaining to, prepared with, containing, or resembling ether.

2. evanescent; delicate.


e·the·re·al
adj.
1.
 and can be spiritual in nature and it may argued that to disclose one's emotional experience is to disclose a distinctly spiritual experience. As a caution, Knox, Hess, Petersen, and Hill (1977) reported that some participants experienced a negative reaction when their therapists disclosed negative emotions negative emotion Any adverse emotion–eg, anger, envy, cynicism, sarcasm, etc. Cf Positive emotion. . However, this did not detract from detract from
verb 1. lessen, reduce, diminish, lower, take away from, derogate, devaluate << OPPOSITE enhance

verb 2.
 participants' overall positive evaluation of therapist self-disclosure.

Case example. During the process of therapy a client discussed a deep sadness and frustration regarding how distant he felt from God. Such feelings are not unfamiliar in spiritual writings but were so disturbing to the client that he questioned many of his religious beliefs and was about "to give up on God." While some counselors might not enter into this discussion and would refer this client to a spiritual director or clergyperson, the therapist chose to self-disclose a time in her own life when she felt that God was very remote. The therapist described how she had moved beyond this period in her life by intentionally reconnecting with other believers from her faith tradition which opened up a sense of connection not only with others but with God. The theological dichotomy di·chot·o·my  
n. pl. di·chot·o·mies
1. Division into two usually contradictory parts or opinions: "the dichotomy of the one and the many" Louis Auchincloss.
 of the transcendence and immanence immanence (ĭm`ənəns) [Lat.,=dwelling in], in metaphysics, the presence within the natural world of a spiritual or cosmic principle, especially of the Deity. It is contrasted with transcendence.  of God, informed the counselor's ability to appropriately disclose her own experience of the ebb and flow the alternate ebb and flood of the tide; often used figuratively.

See also: Ebb
 of spiritual life.

3. Therapist utilize self-disclosure to communicate professional opinions. Many highly religious and spiritual clients may be interested in their therapist's perspective on medication, self-help books, popular remedies, lifestyle choices, cultural fads, specific denominations or churches, etc. They may seek their therapists' guidance when searching for religious readings or in finding a clergyperson to be involved in their treatment or to whom they can take theological questions. Therapists may explicitly offer suggestions and opinions or more implicitly guide the client in finding the resources themselves, perhaps suggesting only where to go to find information that would help the client make his or her own choice. Therapy training emphasizes the need for therapists to be careful regarding giving their opinions to clients and how disclosure of such information can affect the client's treatment and the therapeutic relationship. For example, Hanson (2005) found that clients perceptions of the helpfulness of therapist self-disclosure was mediated me·di·ate  
v. me·di·at·ed, me·di·at·ing, me·di·ates

v.tr.
1. To resolve or settle (differences) by working with all the conflicting parties:
 by the skill with which the therapist handled the disclosure, and the therapeutic relationship was found to be the variable most affected by appropriate and inappropriate disclosure. Spiritual self-disclosure can be even more powerful considering it adds spiritual authority to the already powerful intervention of therapist disclosure of personal and professional values.

Case example. Bibliotherapy bibliotherapy /bib·lio·ther·a·py/ (bib?le-o-ther´ah-pe) the reading of selected books as part of the treatment of mental disorders or for mental health.

bib·li·o·ther·a·py
n.
 appears to have considerable merit, however when recommendations for spiritual reading are given, the therapist has even greater influence on client values. A client struggling with compulsive com·pul·sive
adj.
Caused or conditioned by compulsion or obsession.

n.
A person with behavior patterns governed by a compulsion.



compulsive

the state of being subject to compulsion.
 eating patterns asked his therapist about a diet plan program that was recommended by his church. Framed within a religious perspective, this book prescribed pre·scribe  
v. pre·scribed, pre·scrib·ing, pre·scribes

v.tr.
1. To set down as a rule or guide; enjoin. See Synonyms at dictate.

2. To order the use of (a medicine or other treatment).
 what the therapist considered to be radical weight control strategies, and made excessive claims of success, all apparently derived from, and supported by, religious authority. While endorsing appropriate therapeutic strategies to deal with the compulsive eating, the therapist recommended that the client carefully evaluate the religious claims and views of God implied in the approach. In doing so the therapist used her professional opinion and spiritual awareness to guide the client in his physical and spiritual growth process.

4. Therapists include self-disclosure to communicate spiritual metaphors. Therapists may choose to disclose their view of the sacred through discussing religious or spiritual imagery or symbolic descriptions. Using self-disclosure to communicate spiritual metaphors can increase clients' understanding of abstract and complex concepts, ideas, and emotions (Lyddon, Clay, & Sparks, 2001). Much of one's spiritual experience involves faith, imagination, and wish-fulfillment, all of which are facets of spiritual experience clinicians may choose to disclose to clients. While some would argue that therapist disclosures should always be void of fantasies of any type (Fisher, 2004), other have pointed to the potential therapeutic power of deeper therapist disclosures, especially when the therapeutic alliance is strong (Myers & Hays, 2006). Therapists may choose to explicitly disclose their personal wishes and metaphors, or they may disclose more implicitly by drawing from Biblical or literary metaphor.

Case example. Within the context of a longer-term therapeutic relationship, the therapist asked the client's permission to share a fantasy he had of the client. With the client's consent he described how in the midst Adv. 1. in the midst - the middle or central part or point; "in the midst of the forest"; "could he walk out in the midst of his piece?"
midmost
 of all the transition in careers and relationships that the client was experiencing, he saw the client (a Christian) walking a path in the tropical jungle that was rough but had been cleared. Ahead of him on the path was Jesus clearing the foliage from the pathway. The biblical image of God going before us was explored as a way of helping the client come to terms with the fear that was overwhelming him in his current life transitions.

5. Therapists employ self-disclosure to communicate spiritual experiences. Some therapies may have had significant personal experiences with God or persons in their faith community that they believe could be beneficial for clients if shared. James (1902/1936) called these numinous nu·mi·nous  
adj.
1. Of or relating to a numen; supernatural.

2. Filled with or characterized by a sense of a supernatural presence: a numinous place.

3.
 experiences which are characterized by a sense of connection with something or someone beyond the self. Examples may include a conversion experience, a moment of calling or clarity, or an instance of emotional or physical well-being. The disclosure of spiritual experiences reveals how the therapist has related to God, self, and others. Richards and Bergin (2005), along with professional codes of ethics (e.g., ACA ACA - Application Control Architecture , 2005; APA (All Points Addressable) Refers to an array (bitmapped screen, matrix, etc.) in which all bits or cells can be individually manipulated.

APA - Application Portability Architecture
, 2002), note that it is unethical unethical

said of conduct not conforming with professional ethics.
 for therapists to impose their religious values on clients by attempting to persuade them to adopt certain beliefs. Therefore, therapists may wish to disclose experiences more implicitly by depersonalizing the experiences disclosed. Talking about an experience of a friend or Biblical character, for example, Therapists must be aware of the power differential inherent in the therapeutic process and never communicate their spiritual experiences as normative nor·ma·tive  
adj.
Of, relating to, or prescribing a norm or standard: normative grammar.



nor
, exemplary, or do so with the goal of manipulating a client's choice.

Case example. Specific religious systems emphasize particular types of versions of religious experience and it is often helpful for the therapist to have some insider knowledge of how such experiences are described. For instance, charismatic and Pentecostal Christians might describe the experience of "being filled with the Holy Spirit," and various groups within this faith tradition might describe the evidences of such an experience differently. A client from such a tradition expressed considerable concern regarding whether she truly was "filled." Rather than entering into biblical and theological discussion regarding this, the therapist shared his experience of "being filled" that differed from the client's but effectively revealed that spiritual experiences are often unique and personal. While therapist self- disclosure of specific spiritual experiences may not often be indicated, it is possible that a therapist describing a variation or form of a spiritual experience may serve to normalize a client's experience and help the client reduce concern about whether he or she fits a particular religious framework.

6. Therapists may use self-disclosure to communicate spiritual mistakes. Therapists may reveal their mistakes, poor decisions, or other actions for which there exists struggle or disappointment. Some clients feel alienated al·ien·ate  
tr.v. al·ien·at·ed, al·ien·at·ing, al·ien·ates
1. To cause to become unfriendly or hostile; estrange: alienate a friend; alienate potential supporters by taking extreme positions.
 from God because of their mistakes and imperfections, and such disclosures from therapists can serve to normalize clients' experience. The disclosure of therapist mistakes can help humanize hu·man·ize  
tr.v. hu·man·ized, hu·man·iz·ing, hu·man·iz·es
1. To portray or endow with human characteristics or attributes; make human: humanized the puppets with great skill.

2.
 the therapist and spark discussions about grace, repentance, confession and forgiveness. Therapist disclosure has been found to enhance the therapeutic alliance and normalize clients' experiences, thus making them better able to process mistakes and failures (Hanson, 2005). Some therapists may be uncomfortable disclosing their mistakes to clients and may choose to more implicitly disclose the mistakes of people they have known in the past or highlight the mistakes of Biblical persons, which may also serve to normalize the client's experience.

Case example. Many religious systems utilize rituals to help people move beyond their mistakes and sins. For example, a therapist used a brief description of how a simple confession ritual was part of his own process of moving beyond a broken relationship for which he had felt responsible. This disclosure became the impetus for exploration in therapy of how the client could develop a ritual or process of coming to terms with the car accident he had caused.

NEGATIVE CASE EXAMPLE

We began the article with the proposition that spiritual self-disclosure can be a useful intervention if integrated in a clinically relevant, culturally sensitive, and ethical manner. Moreover, we also stressed that caution needs to be taken to avoid the possible mishandling of spiritual self-disclosures in counseling and psychotherapy. Though we outlined possible shortcomings A shortcoming is a character flaw.

Shortcomings may also be:
  • Shortcomings (SATC episode), an episode of the television series Sex and the City
 of spiritual self-disclosure, up to this point, the case examples provided have highlighted positive ways that spiritual self-disclosures might be integrated into treatment. Before concluding, an example of inappropriate spiritual self-disclosure is offered to further stress to readers the need for careful consideration when using this intervention.

The following case example highlights several misuses of spiritual disclosure. At the core of this negative case example is the therapist's imposition of her own spiritual experience onto the client thereby detracting from the client's growth process, exhibiting a lack of sensitivity to the client's own spiritual values, which ultimately damaged the therapeutic relationship.

Case example. A highly depressed and potentially suicidal su·i·cid·al
adj.
1. Of or relating to suicide.

2. Likely to attempt suicide.
 woman expresses her desire to hear from the therapist what keeps her going in life. As a person of faith, the therapist, out of her own anxiety and need to help at a critical time in the client's life, discloses her post-partum depression a few years earlier. She describes for the client a series of intentional spiritual activities that were extremely helpful in her own healing process. These included meeting with another young mother from her congregation for mutual prayer, asking for a blessing from her religious leader, and practicing a set of guided imagery Guided Imagery Definition

Guided imagery is the use of relaxation and mental visualization to improve mood and/or physical well-being.
Purpose
 exercises involving specific religious content and themes. While the client initially felt relieved that even her therapist had experienced serious depression, the client's social network and religious context were not nearly as supportive as the therapist's, which intensified in·ten·si·fy  
v. in·ten·si·fied, in·ten·si·fy·ing, in·ten·si·fies

v.tr.
1. To make intense or more intense:
 concerns regarding the hopelessness of her own situation and her life. Soon after she terminated therapy complaining to her next therapist that this self-disclosure was destructive for her in that it did not help her grow, did not acknowledge the differences in life circumstances and religious contexts between her and the therapist, and damaged her trust in the therapist.

CONCLUSION

The issues of spirituality in therapy and the use of self-disclosure have been the subject of both debate and investigation in the field of psychology, yet the practice of spiritual self-disclosure has received very little attention in the literature. Many therapists are sensitive to how religious and spiritual issues impact their clients' lives, but through the practice of spiritual self-disclosure, the religious or spiritual experiences of the therapist may also become a tool to foster client growth and change. As the overarching o·ver·arch·ing  
adj.
1. Forming an arch overhead or above: overarching branches.

2. Extending over or throughout: "I am not sure whether the missing ingredient . . .
 ethical guideline guideline Medtalk A series of recommendations by a body of experts in a particular discipline. See Cancer screening guidelines, Cardiac profile guidelines, Gatekeeper guidelines, Harvard guidelines, Transfusion guidelines.  of therapy is to do not harm, therapists are encouraged to weigh several ethical, clinical, and cultural matters before disclosing spiritual aspects of themselves to clients, as well as to consider the potentially positive benefits of such disclosures.

A limitation of the types of spiritual self-disclosure provided is that they were adapted from domains of non-spiritual disclosure. There may be other types of spiritual self-disclosure yet to be described. More research is needed in this area, and both qualitative and quantitative methodologies could be employed to further clarify the types of spiritual self-disclosure and to determine its effect on the therapeutic process. Qualitative investigations could be used to understand the decision-making process therapists currently use when considering self-disclosure or to study clients' perception of the affect of their therapist's spiritual self-disclosure on their therapeutic work. Quantitative research Quantitative research

Use of advanced econometric and mathematical valuation models to identify the firms with the best possible prospectives. Antithesis of qualitative research.
 methods could be utilized to illuminate il·lu·mi·nate  
v. il·lu·mi·nat·ed, il·lu·mi·nat·ing, il·lu·mi·nates

v.tr.
1. To provide or brighten with light.

2. To decorate or hang with lights.

3.
 such issues as the frequency of spiritual self-disclosure and its impact on measurable therapeutic outcomes. In sum, it is hoped that this article will stimulate therapists and researchers to further investigate and consider the nature and clinical implications of spiritual self-disclosure within the therapeutic context.

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A physician specializing in the diagnosis and treatment of cancer

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AUTHORS

DENNEY, RYAN M. Address: 1606 North IH 35 Apt. 11 San Marcos San Marcos (săn mär`kəs).

1 City (1990 pop. 38,974), San Diego co., S Calif., a northern suburb of San Diego; settled 1880s, inc. 1963.
, TX 78666. Title: Doctoral Candidate, The University of Southern Mississippi. Degree: M.A. Research interests include spirituality and posttraumatic posttraumatic /posttrau·mat·ic/ (post?traw-mat´ik) occurring as a result of or after injury.

post·trau·mat·ic
adj.
Following or resulting from injury or trauma.
 growth.

ATEN, JAMIE, D. Address: 118 College Drive #5025 Hattiesburg, MS 39406. Title: Assistant Professor, The University of Southern Mississippi. Degree: Ph.D. Specializations: Spirituality, supervision, rural psychology, and qualitative methods.

GINGRICH, FRED, C. Address: 6399 South Santa Fe Santa Fe, city, Argentina
Santa Fe, city (1991 pop. 341,000), capital of Santa Fe prov., NE Argentina, a river port near the Paraná, with which it is connected by canal.
 Drive Littleton, CO 80120. Title: Associate Professor of Counseling. Degree: Ph.D., Denver Seminary Denver Seminary is an evangelical post-graduate institution that offers a wide range of degrees not typically associated with seminaries. The school prides itself in its rigorous academics that are combined with a steady dose of spiritual formation.

Founded in 1950, Dr.
. Specialization: Marital and premarital counseling, counselor, supervision, and cross-cultural counseling.

Please address correspondence to Ryan M. Denney, MA, 1606 North IH 35, Ap. 11, San Marcos, TX 78666. Email: rdenney 1980@yahoo .com.

RYAN M. DENNEY AND JAMIE D. ATEN

The University of Southern Mississippi

FRED C. GINGRICH

Denver Seminary
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Publication:Journal of Psychology and Theology
Date:Dec 22, 2008
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