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PubMed2004

What do physicians tell patients about themselves? A qualitative analysis of physician self-disclosure.

OBJECTIVE: Physician self-disclosure (PSD) has been alternatively described as a boundary violation or a means to foster trust and rapport with patients. We analyzed a series of physician self-disclosure statements to inform the current controversy. DESIGN: Qualitative analysis of all PSD statements identified using the Roter Interaction Analysis System (RIAS) during 1,265 audiotaped office visits. SETTING AND PARTICIPANTS: One hundred twenty-four physicians and 1,265 of their patients. MAIN RESULTS: Some form of PSD occurred in 195/1,265 (15.4%) of routine office visits. In some visits, disclosure occurred more than once; thus, there were 242 PSD statements available for analysis. PSD statements fell into the following categories: reassurance (n = 71), counseling (n = 60), rapport building (n = 55), casual (n = 31), intimate (n = 14), and extended narratives (n = 11). Reassurance disclosures indicated the physician had the same experience as the patient ("I've used quite a bit of that medicine myself"). Counseling disclosures seemed intended to guide action ("I just got my flu shot"). Rapport-building disclosures were either humorous anecdotes or statements of empathy ("I know I'd be nervous, too"). Casual disclosures were short statements that had little obvious connection to the patient's condition ("I wish I could sleep sitting up"). Intimate disclosures refer to private revelations ("I cried a lot with my divorce, too") and extended narratives were extremely long and had no relation to the patient's condition. CONCLUSIONS: Physician self-disclosure encompasses complex and varied communication behaviors. Self-disclosing statements that are self-preoccupied or intimate are rare. When debating whether physicians ought to reveal their personal experiences to patients, it is important for researchers to be more specific about the types of statements physicians should or should not make.

Counseling↗
PubMed1982

The interactive effects of counselor gender, physical attractiveness and status on client self-disclosure.

Investigated client self-disclosure and client perception of counselors (as expressed in counselor evaluations) as a function of the sex, attractiveness and status of the counselor, and the sex of the client. Counselor gender and attractiveness were established by means of stimulus photographs; counselor status was defined in terms of education and experience. Ss (160 college students) first rated their counselors on intelligence and empathy; they then completed Jourard's Self-Disclosure Questionnaire while role-playing clients in therapy. A four-factor between-Ss analysis of disclosure scores revealed that clients disclosed more of themselves to male than to female counselors when the counselors were high in either status or attractiveness. Results supported the hypothesis that the effect of counselor gender on client disclosure depends on an interaction of counselor gender with other counselor variables.

Adult↗
PubMed1996

[The relationship between self-esteem and self-disclosure of negative information].

Although self-disclosure after a negative experience may be good for our adjustment, we also feel hesitant to do so. This study investigated the relationship between self-esteem and hesitancy to disclose negative information about one's self. One hundred and fifty-five undergraduates imagined self-disclosure to a friend of high or low intimacy. They then answered a questionnaire concerning hesitancy to self-disclose negative information to friends, as well as expected negative consequences of such self-disclosure. Main results were: (1) Low intimacy strongly affected the hesitancy. (2) Factor analysis of the negative consequences found three factors: interpersonal and intra-personal negative-effect, and no positive expectation. (3) Hesitancy of high self-esteem students was most affected by the interpersonal factor. Impression management may be the reason. (4) On the other hand, low students tended to feel hurt after negative self-disclosure. Theirs was affected by the intra-personal and no positive expectation factors. Defensiveness may be the reason. The results were discussed from the viewpoint of adjustment when people have had a negative experience.

Adult↗
PubMed2002

The problem of self-disclosure in psychoanalysis.

The problem of self-disclosure is explored in relation to currently shifting paradigms of the nature of the analytic relation and analytic interaction. Relational and intersubjective perspectives emphasize the role of self-disclosure as not merely allowable, but as an essential facilitating aspect of the analytic dialogue, in keeping with the role of the analyst as a contributing partner in the process. At the opposite extreme, advocates of classical anonymity stress the importance of neutrality and abstinence. The paper seeks to chart a course between unconstrained self-disclosure and absolute anonymity, both of which foster misalliances. Self-disclosure is seen as at times contributory to the analytic process, and at times deleterious. The decision whether to self-disclose, what to disclose, and when and how, should be guided by the analyst's perspective on neutrality, conceived as a mental stance in which the analyst assesses and decides what, at any given point, seems to contribute to the analytic process and the patient's therapeutic benefit. The major risk in self-disclosure is the tendency to draw the analytic interaction into the real relation between analyst and patient, thus diminishing or distorting the therapeutic alliance, mitigating transference expression, and compromising therapeutic effectiveness.

Countertransference↗
PubMed1976

Self-disclosure in friendship.

An experimental investigation of the influence of self-disclosure on friendship was conducted by manipulating the level of self-disclosure. 65 same-sex pairs were randomly assigned to one of three treatment conditions, intimate self-disclosure, nonintimate self-disclosure and control (no disclosure); the treatment conditions were independently verified by judges' ratings. One member of each pair was randomly selected as the confederate or first speaker and was provided with a list of 7 conversation topics. There were no lists provided in the control condition. The dependent variable, level of friendship as measured by the Acquaintance Description Form (Wright, 1969), was rated before and after Ss engaged in self-disclosure, and the influence of the experimental conditions on friendship scores was assessed by analyses of covariance. The results showed that the general level of friendship increased as a function of intimate and nonintimate self-disclosure; however, intimate disclosure produced greater increases in friendship than nonintimate disclosure. The unique influence of self-disclosure on male friendship patterns is discussed.

Female↗
PubMed2004

Is physician self-disclosure related to patient evaluation of office visits?

CONTEXT: Physician self-disclosure has been viewed either positively or negatively, but little is known about how patients respond to physician self-disclosure. OBJECTIVE: To explore the possible relationship of physician self-disclosure to patient satisfaction. DESIGN: Routine office visits were audiotaped and coded for physician self-disclosure using the Roter Interaction Analysis System (RIAS). Physician self-disclosure was defined as a statement describing the physician's personal experience that has medical and/or emotional relevance for the patient. We stratified our analysis by physician specialty and compared patient satisfaction following visits in which physician self-disclosure did or did not occur. PARTICIPANTS: Patients (N= 1,265) who visited 59 primary care physicians and 65 surgeons. MAIN OUTCOME MEASURE: Patient satisfaction following the visit. RESULTS: Physician self-disclosure occurred in 17% (102/589) of primary care visits and 14% (93/676) of surgical visits. Following visits in which a primary care physician self-disclosed, fewer patients reported feelings of warmth/friendliness (37% vs 52%; P =.008) and reassurance/comfort (42% vs 55%; P =.027), and fewer reported being very satisfied with the visit (74% vs 83%; P =.031). Following visits in which a surgeon self-disclosed, more patients reported feelings of warmth/friendliness (60% vs 45%; P =.009) and reassurance/comfort (59% vs 47%; P=.044), and more reported being very satisfied with the visit (88% vs 75%; P =.007). After adjustment for patient characteristics, length of the visit, and other physician communication behaviors, primary care patients remained less satisfied (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.24 to 0.81) and surgical patients more satisfied (AOR, 2.22; 95% CI, 1.12 to 4.50) after visits in which the physician self-disclosed. CONCLUSIONS: Physician self-disclosure is significantly associated with higher patient satisfaction ratings for surgical visits and lower patient satisfaction ratings for primary care visits. Further study is needed to explore these intriguing findings and to define the circumstances under which physician self-disclosure is either well or poorly received.

Female↗
PubMed2005

Formation of and adherence to a self-disclosure norm in an online chat.

To understand how a norm of self-disclosure forms and is adhered to in a synchronous computer-mediated discussion, participants discussed the stigma of mental illness. The transcripts of the discussion were coded for the number of self-disclosures, the number of statements supportive of self-disclosure, and the number of statements supportive of non-self-disclosure. The results showed that the number of self-disclosing statements increased over time, although not in a linear fashion, as did the number of statements supportive of self-disclosure. However, the number of statements supportive of non-self-disclosures decreased over time. These results suggest that once a norm of self-disclosure forms, it is reinforced by statements supportive of self-disclosures but not of non-self-disclosures. The results are discussed in the context of self-disclosure reciprocity and the social identity model of deindividuation effects (SIDE).

Adaptation, Psychological↗
PubMed2001

Reexamination of therapist self-disclosure.

In mental health practice, a commonly held view is that therapist self-disclosure should be discouraged and its dangers closely monitored. Changes in medicine, mental health care, and society demand reexamination of these beliefs. In some clinical situations, considerable benefit may stem from therapist self-disclosure. Although the dangers of boundary violations are genuine, self-disclosure may be underused or misused because it lacks a framework. It is useful to consider the benefits of self-disclosure in the context of treatment type, treatment setting, and patient characteristics. Self-disclosure can contribute to the effectiveness of peer models. Self-disclosure is often used in cognitive-behavioral therapy and social skills training and might be useful in psychopharmacologic and supportive treatments. The unavoidable self-disclosure that occurs in non-office-based settings provides opportunities for therapeutic deliberate self-disclosure. Children and individuals who have a diminished capacity for abstract thought may benefit from more direct answers to questions related to self-disclosure. The role of self-disclosure in mental health care should be reexamined.

Humans↗
PubMed1994

Getting to know you: how own age and other's age relate to self-disclosure.

In this study, we compared self-disclosures made in ten same-aged (young-young) and ten mixed-aged (young-old) conversational dyads. We developed a scoring scheme to code get-acquainted conversations on amount, type, valence, and intimacy of self-disclosure (S-Ds). Overall, young women produced more S-Ds with same-aged than with older partners. Young women devoted marginally fewer of their self-disclosures to statements about the past than did older women. Younger and older women's S-Ds about the present and the past were not significantly different in how negative, positive, or intimate they were. The intimacy and negativity of disclosures made by the dyad members were more closely correlated in young-young than in young-old dyads. Young participants' affective reports following the conversations did not differ as a function of partner age, but did correlate with aspects of their partners' self-disclosures. Findings offer a contrast to the stereotype that older adults dominate conversations with intimate, negative disclosures about the past.

Adult↗
PubMed2004

The therapist's use of self-disclosure in a relational therapy approach for eating disorders.

One of the critical aspects of Relational Therapy (RT) that distinguishes it from other treatments for eating disorders is the therapist's use of self-disclosure. Self-disclosure is one way the therapist authentically represents her- or himself in the therapeutic relationship to foster relational movement and growth. This article makes use of an initial clinical vignette to compare and contrast the use of therapist self-disclosure within an RT approach with views of therapist self-disclosure from other psychotherapy traditions. Advantages are discussed for using therapist disclosure with eating disordered patients. Criteria are outlined to help the RT therapist decide when to disclose. Additional clinical vignettes show different types of therapist self-disclosure, their therapeutic purposes, and their relational impact. The article ends with implications for future research, training, and practice related to the use of self-disclosure in the treatment of eating disordered patients.

Journal Article↗
PubMed1978

Self-disclosure in relation to psychotherapist expertise and ethnicity.

The self-disclosure styles of Mexican Americans and their possible role in the limited participation of Mexican Americans in mental health services were explored. Ninety-four Mexican American and 93 Anglo American junior college students listened to one of four therapist introductions, then responded to questionnaires designed to measure self disclosure and self acceptance. Both groups indicated a substantial willingness to disclose about themselves to therapists. Mexican Americans proved lower in self-disclosure scores than Anglo Americans. Mexican Americans were found to disclose less to Mexican American therapists than did Anglo Americans to Anglo American therapists. Sex differences in self-disclosure were negligible. Both Mexican Americans and Anglo Americans scored in the direction of high self-acceptance. The findings held for comparable socioeconomic levels.

Educational Status↗
PubMed1998

Development of the Marital Self-disclosure Questionnaire (MSDQ).

This research describes the development of the Marital Self-Disclosure Questionnaire (MSDQ), a brief, self-report measure of the quantity and quality of marital self-disclosure. Consisting of 40 true-false items, the MSDQ provides a global index of marital self-disclosure as well as assesses four facets of self-disclosure between spouses: Relationship, Sex, Money, and Imbalance. Results indicate that the MSDQ scales are reliable, and preliminary data suggest that the MSDQ may have validity for distinguishing among groups hypothesized to differ in terms of marital distress and self-disclosure. Further evaluation of the MSDQ for its clinical and research utility appears to be warranted.

Adult↗
PubMed1992

[Self-disclosure and loneliness].

This study examined the relationship between self-disclosure and loneliness. The self-disclosure questionnaire (ESDQ) and the loneliness scale (LSO, consists of two subscales, U-scale and E-scale) were administered to 114 female subjects (junior college students). Results show that self-disclosure scores were negatively related to the U-scale of loneliness (whether or not they believe in mutual sympathy among human beings), but not to the E-scale of loneliness (whether or not they are conscious of individuality of each individual). The results suggest that we have to specify the quality of loneliness in question, when we examine the relationship between self-disclosure and loneliness.

Adult↗
PubMedDate not supplied

Effects of alcohol and expectancy on self-disclosure and anxiety in male and female social drinkers.

To study the effects of alcohol consumption and expectancy on self-disclosure and self-reported anxiety during a social interaction, 32 male and 32 female social drinkers were assigned to one of four groups comprising a 2 x 2 factorial balanced-placebo design. Alcohol expectancy reduced the intimacy level of self-disclosure but not the amount of self-disclosure. Alcohol consumption had no effect. Thus, in contrast to the common view that alcohol functions as a "social lubricant," it served to inhibit social interaction. There was a three-way interaction among alcohol consumption, expectancy, and gender of subjects, such that the largest increase in anxiety was reported by male subjects who expected but did not receive alcohol. Thus, the previously reported inverse relationship between anxiety and self-disclosure was not confirmed, and alcohol's effect on anxiety seems unrelated to its effect on self-disclosure.

Adult↗
PubMed1995

Patterns of self-disclosure across social support networks: elderly, middle-aged, and young adults.

Self-disclosure has generally been examined as a unidimensional construct which relates to intimacy in developing relationships. Self-disclosure also serves many functions in established relationships, such as with close friends and family. Moreover, the functions served by self-disclosure may vary depending upon the adults' gender and stage in the life-span. In this study, such issues are examined with regard to elderly, middle-aged, and young adults' use of four functions of self-disclosure: self-expression, self-clarification, social control, and social validation. Findings support the claim that greater intergenerational distance is related to less self-disclosure among members of a social network. Further, elderly adults self-disclose more often to family than to friends, while young adults self-disclose to friends more often than to family. Implications for self-disclosure within the areas of gender, social support, and social comparison are discussed, and the appropriateness of adults' disclosure patterns within a framework of life stages is considered.

Adult↗
PubMed1976

The influence of interviewer self-disclosure and verbal reinforcement on personality tests.

The effects of prior interview experiences on subsequent test responding were examined by comparing the influence of three interviewer behaviors: interviewer self-disclosure, interviewer verbal reinforcement of self-referent statements, and direct instructions to be self-disclosive. Performance was contrasted with a control interview condition characterized by no interviewer self-disclosure or self-referent reinforcement and with a no-interview condition. Responses on measures of self-disclosure and anxiety indicated that female Ss tended to be more self-disclosive than males in general, but were relatively uninfluenced by experimental condition. For male Ss, verbal reinforcement increased self-disclosure relative to the interviewer seld-disclosure condition. Interviewer self-disclosure was shown to result in more favorable perceptions of the self and the interviewer, particularly for males, and greater social evaluative anxiety for females. Both these factors are discussed as possibly counteracting the modelling effects of interviewer self-disclosure. An interpretation of the results in terms of interactions between S sex, interviewer sex, and experimental condition is proposed and implications for related research discussed.

Anxiety↗
PubMed1983

Effect of therapist expectations and need for approval on self-disclosure.

Previous therapy analogue studies of self-disclosure have treated Ss as a homogeneous group without examining possibly relevant S variables. In the present study, 68 female students identified as high or low in need for approval listened to a tape-recorded interview between a high self-disclosing therapist and a female client under one of two therapist expectation conditions: Clear expectation of high self-disclosure vs. ambiguous expectation. Ss then indicated on the Jourard Self-Disclosure Questionnaire the degrees to which they would be willing to disclose to the therapist. It was predicted that high need for approval Ss would disclose most under the clear expectation condition, while low need for approval Ss would not be affected by the therapist expectation. A significant Need Approval X Therapist expectation interaction supported this prediction. Further analysis indicated that items for the Work, Money, and Personality subsections of the disclosure questionnaire contributed most to the interaction. Implications for differential treatment of high need for approval Ss who were entering therapy were discussed.

Adult↗