Queer Identity: Considerations on Self-Disclosure and the Therapeutic Alliance
Julio J. Fonseca
Gay people in the pre-war years, then, did not speak of coming out of what we call the “gay closet” but rather of coming out into what they called “homosexual society” or the “gay world, a world neither so small, nor so isolated, nor, often so hidden as “closet” implies. —George Chauncey (Chauncey, 2008)
I am a career changer, having left a well-established 27-year career to return to pursue a PsyD in Clinical Professional Psychology. As likely surmised by the title and topic of this column and corner, I am an openly queer (my ideology), gay (my orientation) man who is cisgender and Latinx. A quick Google search of my name reveals quite a bit about me and many of my identity factors. For example, in my last role, I worked in communities using my lived experience openly living with HIV and my sobriety journey in leadership development for people living with HIV. New Clients could easily find all this information, adding a potential layer of nuance to my clinical work. I have rehearsed the inevitable ‘“Are you gay? Do you have a husband?” What about what happens with you and your wife? Do you plan on having kids?”’. I will share more about my thoughts on how I plan to respond.
As an emerging clinician who started the second year of my program and has been seeing Clients since July 2024, I have discussed the importance of the therapeutic alliance and ways to nurture it in clinical practice and supervisory meetings. One less defined or “prescribed” way of developing trust is using self-disclosure as an intervention.
Therapist Self-Disclosure: Theoretical Views
Therapist Self-Disclosure (TSD) intentionally shares personal information, feelings, or experiences with Clients (Johnsen & Ding, 2021). Different theories have different views on the appropriateness of self-disclosure. For the sake of brevity, I will share two theoretical views here, with additional insights featured in the referenced research. Classical psychoanalysis posited that self-disclosure had the potential to undermine the pure vision of the theory. The three rules of thumb upheld the notion of the “interpersonal void” between analyst and Client: anonymity, equanimity, and abstinence (Freud, 1915).
The Cognitive Behavioral Therapy (CBT) approach sees self-disclosure as a tool to accomplish therapeutic objectives such as strengthening the therapeutic alliance, normalizing the Client’s experience of their struggles, challenging negative interpretations of emotions and behaviors, fostering positive expectations and motivation for change, and modeling and reinforcing desired behaviors. TSD is, at times, not as readily discussed, which can perpetuate the idea that self-disclosure is still taboo or not an appropriate intervention (Ziv-Beiman, 2013). What is the emerging research, and how can we support our colleagues in fostering this discussion?
Types of Disclosure
What exactly is self-disclosure? Watkins (1990), in a review of over 200 research studies, identified four main types, or categories, of therapist self-disclosure, were identified as:
- Positive vs. Negative Experiences – Sharing personal experiences that are either positive or negative.
- Opinions vs. Personal Information – Expressing views about the Client or their behavior versus revealing personal information about the therapist.
- Demographic Data vs. Intimate Details: Provide general demographic information (like age or background) rather than sharing more private, intimate details.
- Similar vs. Dissimilar Emotional Reactions – Sharing emotional reactions like the Client’s feelings versus responses that differ from the client.
Additional research-based classifications from Hill and Knox (2002) divided disclosure into seven more detailed sub-categories.
- Biographical facts relating to the therapist’s life and professional training.
- Feelings—including emotional terms in the therapist’s description of their subjective experiences.
- Insights into past experiences exemplify what the therapist has learned about themselves.
- Strategies the therapist has found effective in dealing with specific issues.
- Approval and legitimization of the client in the specific therapeutic context.
- Challenges to the client’s thought process or behavior via examples from the therapist’s life.
- Immediate thoughts or feelings toward the client/therapeutic relationship and process.
Of note, there are two distinct types related to the timing of the intervention’s disclosure: immediate and nonimmediate therapist disclosure. Immediate disclosure involves articulating feelings and reactions to the session’s content and details about the professional background. Non-immediate disclosure is when the therapist shares personal experiences outside therapy, such as personal insights or coping strategies. Immediate self-disclosure has demonstrative and measurable research demonstrating that it can improve outcomes and bolster the therapeutic alliance. At the same time, non-immediate disclosure remains unsettled as it can be seen as going outside of the core principles of therapy (Ziv-Beiman, 2013, p. 62).
Disclosure of Identity with Clients: Impacts Based on Client Identity
In society, heterosexuality is generally assumed to be the dominant or default orientation, and thus, LGBTQ+ providers have more nuanced needs in considering self-disclosure. How do LGBTQ+ providers not only create a space of safety for clients who identify as part of the LGBTQ+ community but also for clients who do not identify and may have assumptions about their therapist’s identity?
Research from Lea, Jones, and Huws (2010) demonstrated that therapist disclosure of sexuality can significantly impact the therapeutic relationship, especially in contexts involving gay clients and psychologists. This study examines the experiences and challenges of gay male psychologists (no clients were surveyed) disclosing their sexual orientation to gay male clients. This study uses Interpretative Phenomenological Analysis (IPA) to examine how therapist self-disclosure (TSD) influences the therapeutic relationship, focusing on how it helps reduce feelings of isolation and fosters a warm, supportive environment for clients.
Six themes emerged from the research: being gay in a straight world, disclosure and the therapeutic agenda, contexts of disclosure, other ways of knowing (assumption of identity, other interpersonal cues, disclosure of sexuality as a big deal, and the invisible curriculum, or heterosexism (Lea et al., 2010, pp. 63-66). Participants believed that sharing their sexual orientation could benefit clients, especially by normalizing and affirming their experiences. Disclosure was viewed as particularly therapeutic for gay clients, who often felt isolated or misunderstood in heteronormative settings.
The research also pointed to challenges with non-disclosure. Some participants chose not to disclose in specific scenarios, such as when working with clients who were questioning their sexuality, to avoid influencing clients’ self-exploration. Therapists also grappled with the potential to be perceived as ” biased witnesses,” potentially diminishing the authenticity of client insights. Participants called for greater visibility of LGBT issues in clinical training and emphasized the importance of making thoughtful, client-centered disclosure decisions. It is essential to note the limitations of this research as it was gay-male-focused, and other LGBTQ+ communities should be researched similarly and expansively.
There is ample research regarding how therapist self-disclosure can strengthen the therapeutic relationship, yet little research has focused on sexual orientation disclosure by sexual minority counselors with heterosexual clients. According to Carroll, Gauler, Relph, and Hutchinson (2011), counselor self-disclosure concerning sexual orientation may influence client perceptions and therapeutic outcomes with research specific to working with heterosexual clients.
Two hundred Thirty-eight heterosexual college students in psychology took part in the study. They were randomly placed into one of eight groups, which differed based on the counselor’s gender, sexual orientation (gay/lesbian or heterosexual), and whether the counselor disclosed their sexual orientation. Each participant read a brief description of a counselor, including basic information about them, followed by a sample transcript from a counseling session. In some groups, the counselor shared their sexual orientation openly; in others, they made a more neutral statement that did not reveal their orientation. After reading, participants rated the counselors on qualities like trustworthiness, expertise, and attractiveness on the Counselor Rating Form-Short Version (CRF-S; Corrigan and Schmidt in Journal of Counseling Psychology, 30:64–75, 1983).
This was done to see how self-disclosure of the counselor’s sexual orientation influenced participants’ perceptions. The researchers looked at the differences in ratings across the groups, mainly focusing on trustworthiness. They found that counselors who openly shared their gay or lesbian orientation were seen as more trustworthy than those who did not disclose this information, potentially because participants viewed disclosure as a sign of honesty and courage. There were no significant effects on ratings of expertness and attractiveness, suggesting that disclosure primarily influences trustworthiness rather than other counselor attributes. This study underscores the need for additional research on client-centered attitudes regarding the impact of disclosure, such as gender roles and cultural norms around self-disclosure in counseling. Carroll, Gauler, Relph, and Hutchinson (2011) authors call for more nuanced training in counselor education regarding self-disclosure and sexual orientation, aiming to foster more inclusive and effective therapeutic environments.
Considerations and Possible Drawbacks of Therapist Self-Disclosure
Therapist self-disclosure can have an enriching effect on the client’s therapeutic experience. There is potential for deepening the therapeutic alliance, which can foster a sense of trust and emotional safety. Therapists can model authenticity and vulnerability, encouraging clients to do the same and engage more deeply in self-discovery. Instead of focusing separately on building trust, helping clients rethink negative thoughts, and validating feelings, self-disclosure can achieve all these together. It helps create a trusting relationship while encouraging clients to think more positively and make healthier choices. This approach helps therapists connect deeply with clients quickly and supports lasting improvements in their thoughts and behaviors.
There are considerations as to the possible drawbacks of self-disclosure. TSD can shift the focus away from the client, creating opportunities to collude with the client or joining in a way that may foster avoidance of goal-oriented work. Oversharing may create a blurring of boundaries that could confuse the therapist/client relationship (Hill & Knox, 2002). Additionally, clients may feel uncomfortable holding the content shared, which could dilute trust and the alliance, especially if the client feels the therapist is sharing for personal reasons rather than therapeutic ones (Hill & Knox, 2002; Satterly, 2006). For some clients, a therapist’s self-disclosure could shift the perceived power dynamics, making the therapist seem more relatable but possibly undermining the client’s autonomy or projecting personal biases onto the client (Satterly, 2006).
These considerations highlight that the LGBTQ+ therapist needs to engage in thoughtful consideration to avoid potential misinterpretation and disruptions to the client-therapist dynamic.
Summary
The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him. —Sigmund Freud (Freud, 1958)
Lived and open LGBTQ+ identity can be a significant draw for potential clients. For others, it could hinder work. When is it the right time to make the move to disclose openly? The most important question we as providers can ask ourselves before self-disclosing is, “Is this for the benefit of the client?” Are we joining, or are we offering an experience that may be unique to their journey to wellness? In my recent work as a co-leader for an LGBTQ+ Process Group, an open identity is an excellent foundation for safety and camaraderie. Personal, intimate, or other details need not be shared. When I get the inevitable question, I think I would start my answer with, “What would it mean to you if I were?”
References
Chauncey, G. (2008). Gay New York: Gender, urban culture, and the making of the gay male world, 1890-1940. Hachette UK.
Freud, S. (1915). Observations on transference-love (Further recommendations on the technique of psychoanalysis III). In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud, Volume 7 (pp. 157–171). London: Hogarth Press.
Freud, S. (1958). Recommendations to physicians practicing psycho-analysis. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 12). London: Hogarth Press.
Lea, J., Jones, R., & Huws, J. C. (2010). Gay psychologists and gay clients: Exploring therapist disclosure of sexuality in the therapeutic closet. Psychology of Sexualities Review, 1(1), 59-73.https://doi.org/10.53841/bpssex.2010.1.1.59
Johnsen, C., & Ding, H. T. (2021). Therapist self-disclosure: Let’s tackle the elephant In the room. Clinical Child Psychology and Psychiatry, 26(2), 443-450.
Satterly, B. A. (2006). Counselor self-disclosure from a gay male perspective. Families in Society, 87(2).
Watkins, C.E. (1990). The effects of counselor self-disclosure: A research review. The Counseling Psychologist, pp. 18, 477–500.doi:10.1177/0011000090183009 https://doi.org/10.1177/1359104521994178
Ziv-Beiman, S. (2013). Therapist self-disclosure as an integrative intervention. Journal of Psychotherapy Integration, 23(1), 59-74. https://doi.org/10.1037/a0031783
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