July 19, 2012
Volume 3, Issue 27
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To Tell the Truth: Why and How Mental Health Professionals
Can and Should Self-Disclose Personal Psychiatric Histories
by Steve Harrington, MPA, J.D.
Among mental health professionals, self-disclosure of personal information has been a long-debated subject. Some believe this disclosure interferes with treatment. Other clinicians are open to the practice. Regardless of the preference, it is a controversial and complex issue that has potential benefits and potential dangers.
Over the last 10 years, people with lived experience of mental illness have entered the mental health workforce. Their success in quickly establishing meaningful therapeutic relationships has caught the attention of wary clinicians. As a result, more traditional mental health professionals are disclosing their psychiatric histories to the people they serve.
Barriers to widespread practice of self-disclosure include perceived ethical issues, self-perceptions about having a psychiatric condition, potential ramifications in the workplace and in social contexts, and uncertainty about why and how to disclose this information.
Why Disclose a Psychiatric History?
Mental health professionals are no different from the rest of the population. No one is immune to psychiatric conditions, and personal experience with such conditions may drive a considerable number of people to these professions.
Because psychiatric conditions are often “invisible” and there may be no obvious reason to disclose, a careful examination of the potential benefits and disadvantages is warranted. Corrigan and Lundin (2001) explained why practitioners may wish to self-disclose, including not having to worry about someone discovering a psychiatric history, finding people with a similar history who could help, promoting a sense of self-power, and providing living testimony that combats stigma.
For mental health professionals, an additional and important reason for considering self-disclosure is the opportunity to foster a positive therapeutic relationship with those they serve. Self-disclosure can remove or reduce power differentials and create a peer-to-peer relationship that benefits mental health treatment. Power differentials in therapeutic relationships can be especially problematic when one is serving a person with a traumatic history.
Self-disclosure does not automatically cast clinicians in the role of peer specialist. The peer specialist’s role is diverse and centered on the use of one’s recovery experience to inspire hope, provide encouragement, explore barriers, and identify resources with and for those served. Peer specialists accomplish these tasks through individual support, facilitating support groups, expressing empathy, building trusting relationships, and modeling recovery.
For peer specialists, self-disclosure is an expectation of employment. They are hired almost exclusively because of a past or current psychiatric condition. What is considered a detriment by most employers is thought to be an asset for peer specialists. Because they are expected to share their recovery experiences and related knowledge and skills, self-disclosure is vital and often incorporated into job descriptions. Peer specialist training addresses several points of consideration prior to self-disclosure: 1) Do not discuss specific medications, 2) Ensure the dialogue focuses more on the person served than on you as the peer specialist, 3) Tell your story of psychiatric challenges only when beneficial to the person served, 4) Explain the challenges you encountered early on, but focus heavily on the recovery process to inspire hope, and 5) Decide beforehand how much will be disclosed and what method will be used.
Despite roles distinct from other mental health professions, there is clear overlap of peer support with the potential benefits of self-disclosure. Mutuality can be the foundation for a trusting, supportive relationship. One study reported that supportive relationships were identified as “most helpful” for 90 percent of people with psychiatric conditions, outpacing traditional talk therapies (7 percent) and medications (3 percent).
Although self-disclosure has many potential benefits, it also has potential disadvantages. Corrigan and Lundin (2001) compiled a list of general concerns that included disapproval of the condition and/or disclosure, potential for gossip, and social exclusion. Other potential disadvantages are the loss of educational or recreational opportunities, personal attacks by others, lack of credibility, and anxiety related to hiding one’s psychiatric history or current mental health status.
A leading barrier is the fact that self-disclosure may have serious employment ramifications and cause negative reactions among employers and coworkers. One psychologist employed by a federal medical facility reported he had dealt with major depression in his adult life, an experience that helped him empathize with those he served. But he could not disclose this psychiatric condition, as he believed it would result in his termination. The federal government is exempt from the Americans with Disabilities Act of 1990, and employees may be discriminated against due to a psychiatric condition.
Additionally, clinicians often interpret their respective professions’ codes of ethics as barriers to self-disclosure, especially when disclosure involves sensitive information such as personal psychiatric experiences. An author who conducted a comprehensive review of ethical codes for mental health professionals found that although such codes include standards related to intimacy, there are no codified barriers to self-disclosing one’s personal psychiatric history and/or status in a therapeutic relationship.
The “rules” of self-disclosure have changed with changing times. Two changes that make self-disclosure among mental health professionals more appropriate are extensive reporting by news media on the true nature of psychiatric conditions and recovery, and the emergence of new treatment models that are not constrained by anonymity.
Although psychiatric nursing, psychology, and psychiatry professions have engaged in the debate regarding how and why to self-disclose psychiatric histories, the social work profession appears to struggle with this issue in professional literature. Whether people with such histories are capable of providing quality social work services remains a concern, despite a growing body of evidence that social workers experience clinical depression more often than the general population. The profession’s discrimination of social work students based on their psychiatric histories is well-documented.
When Is Self-Disclosure Appropriate?
Even the most ardent advocates of self-disclosure concede there are times when it is inappropriate to do so.
Because self-disclosure is very personal, no particular set of guidelines can determine when it is universally appropriate. Advice from other mental health professionals with considerable self-disclosure experience reveals a consistent theme: always consider the environment before disclosing. By “environment,” they mean the attitude of employers, coworkers, and those they serve. Disclosing in an unfriendly and potentially hostile environment can have devastating effects on the individual.
One case manager said she often discloses her psychiatric history spontaneously. For her, disclosure is dependent upon the apparent needs of those she serves, and most often arises in conversation about medication side effects. Disclosure occurs with the full knowledge and support of her employer and helps her establish credibility, especially regarding medication issues.
Psychiatrist Dan Fisher, Executive Director of the National Empowerment Center, readily discloses his experience with schizophrenia to a wide audience. As a public speaker, advocate, and writer, Dr. Fisher uses self-disclosure to combat the ignorance, prejudice, and discrimination often associated with psychiatric disorders.
I have been diagnosed with schizophrenia and major clinical depression. Through public speaking engagements, books, articles, and personal communication, I freely disclose my psychiatric history to encourage and inspire others on recovery journeys.
How Can and Should One Disclose?
Just as the decision to disclose is very personal, so is the chosen extent and method of disclosure.
One peer specialist instructor and program administrator emphasized the importance of practice through role plays or “rehearsing” with friends and family. She said it is often a matter of finding the right words when self-disclosing, and that trial and error is an effective way to refine one’s method for communicating a psychiatric history.
The use of humor can also be effective depending on the individual’s comfort level and personality. In the curricula reviewed, students were advised that humor must be used carefully and in a manner that does not denigrate, embarrass, or discomfit the person served. Self-deprecating humor seems to help initiate the practice.
Self-disclosure must be appropriately timed and evolve naturally in the relationship—often, the earlier the better. In several curricula, peer specialists are encouraged to consciously look for an appropriate opportunity to begin the self-disclosure process.
When initiated by a mental health professional at the appropriate time and in the right way, self-disclosure can reduce power differentials, validate others’ thoughts and feelings about a psychiatric condition, and inspire hope and motivation. It is a key element of the peer specialist practice and can play an important therapeutic role for other mental health professionals.
Steve Harrington is the Executive Director of the National Association of Peer Specialists and a postdoctoral fellow at Boston University’s Center for Psychiatric Rehabilitation. He is a person in recovery from schizophrenia and major depression.
Recovery Month PSAs Answer ‘Why Recovery’?
Two public service announcements (PSAs) posted on SAMHSA’s National Recovery Month Web site will be sent to more than 2,500 national television and radio stations this summer.
Watch or listen to “Own It” and “Pick Up the Pieces,” short informational clips that can be re-posted to generate interest in your community during Recovery Month this September and throughout the year. Read the guidelines for promoting recovery services through PSAs.
Misdiagnosing a consumer’s treatment preferences may seem less damaging than misdiagnosing his or her disease, but for the individual, the results can be just as extreme. Patients’ goals and interests often vary from what doctors infer. When they are well-informed, people make different choices about treatment.
“Patients’ Preferences Matter,” written by faculty at the Dartmouth Center for Health Care Delivery Science and published by The King’s Fund, challenges the National Health Service to end “silent misdiagnosis” and improve the UK’s health system by assessing and reporting on such cases.
Shaking Things Up
Part of the recovery process is discovering who you really are-an awareness that often emerges during new journeys, challenges, and self-reflection. Whether it’s a hobby, trip across the country, or simple change in your routine, trying something new can help you learn about yourself.
Thinking ahead may also offset the temptation to stray from your goals. Put your hopes and dreams to paper. No matter how complicated or simple they may seem, focusing on the things you want to accomplish will help keep your mind clear and your spirits high.
The RTP Resource Center Wants to Hear From
We invite practitioners to submit personal stories that describe how they became involved in recovery-
oriented work and how it has changed the way they practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit stories or other
recovery resources, please contact Stephanie Bernstein, MSW, at 877.584.8535,
or email firstname.lastname@example.org.
We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topics,
please contact the RTP Resource Center at
877.584.8535, or email email@example.com.
The views, opinions, and content of this Weekly Highlight are those of the authors, and do not necessarily reflect
the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.
1Although Corrigan and Lundin use the term “stigma,” the author acknowledges that other terms, including ignorance, prejudice, and discrimination, may be more accurate and acceptable to describe negative feelings, thoughts, and behaviors expressed by people who fail to understand the true nature of psychiatric conditions and recovery.