Therapist Self-Disclosure

“I sit here and tell you all this stuff about me and you can’t even tell me that.”

I’ve heard some version of that sentence enough times that I can feel it coming. It’s usually a teenager, though not always — adults in outpatient ask constantly, they just take the refusal more politely. What teenagers do is push.

This one had spent thirty minutes on something he hadn’t told anybody. Who he was using with. What the house was like when his dad had been drinking. The thing he did that he hadn’t decided yet whether to be ashamed of. Then he asked whether I’d ever used, and I told him I wasn’t going to answer that, and he was annoyed, and he was right to be.

That’s where I want to start, because most of us were trained to hold the line and move on, and moving on is a flawed response to a fair objection.

What I Say

“Have you ever used?”

At a prior agency, I’d guess close to every client I had asked me some version of that. It’s the most common question in addiction work.

Here’s what I say, and it hasn’t changed much in sixteen years:

Everyone asks me that. It’s a very common question, and I’m not going to answer it — but I want to tell you why, because the reason is more useful than the answer.

Some of you are hoping I say yes. That I’ve used, that I’m in recovery, that I’ve been where you are. If I said that, some of you would feel like you could finally talk to someone who gets it, and some of you would feel let down, because you wanted proof that a person can live a whole life without going near this, and now I’m just one more who did.

Some of you are hoping I say no. Then I’m a model, something to aim at. And some of you would resent that, because who am I to sit in this chair and talk to you about something I’ve never lived.

There’s no version of this where the answer just lands. Whichever one I give, I’ve handed you a job you didn’t ask for.

Most clients take that. Not happily, but they take it — or at least very few have argued with it in front of me, which isn’t the same as knowing what they thought on the drive home.

I’m giving you that script because it’s what I often say, not because it’s the answer. It’s the defensive play. It protects the relationship from an answer that could go either way, and what it costs is that some clients would probably have been better served by hearing something true about me, and I don’t get to find out which ones. Use it if it fits your setting. Just use it knowing that.

When They Push

The script isn’t the end of the conversation. It buys me the conversation actually worth having.

When a client pushes past it, they’re telling me something, and what they’re telling me varies more than I used to think.

Sometimes it’s about the imbalance. They just said something out loud that cost them, and they’ve noticed how one-sided this arrangement is. Sometimes it’s closer to I need to know you can understand where I’m coming from, which isn’t a challenge, it’s a request. Sometimes it’s curiosity. Sometimes it’s a test of whether I’ll be straight with them about anything. Often enough it’s more than one at once, and I don’t get to know in advance which.

The difference I’d stand behind isn’t in the reasons, and it’s smaller than I used to think it was. Adults push too. Teenagers are just more willing to make it a power struggle — to say it out loud, to make me sit in it, to not let it go at the point where I’d like them to. I don’t mind that. When it gets said out loud I know what’s in the room.

So I don’t defend the boundary. Defending it treats the objection as an obstacle, and it isn’t one.

When it’s the imbalance, what I do instead is validate the question. This is uncomfortable, and you want me to know it’s uncomfortable. That’s fair. You just told me something you don’t tell people, and you’re allowed to be annoyed about how this works. I don’t take it lightly, what you handed me — sitting on this side of it is a privilege, and most people in your life don’t get what I just got.

That conversation gives me something to work with, which twenty more minutes on whether I’ve smoked weed never would.

When someone needs to know I can understand where they’re coming from, I’d rather meet the request than argue about its terms. It sounds like you want me to identify with this so you can feel safe being honest in here. That makes sense. You’d want someone who can recognize what you’ve lived and put themselves in it.

Then the question I’m actually after: why is that need so loud right now? Who was supposed to understand you and didn’t? Is it that the only people who ever got it were people who’d been through the same thing?

Most of the time that’s enough, because the need was never about my history.

And Sometimes I Answer

Sometimes it isn’t enough. They keep pushing, and the redirect starts to feel like I’m managing them rather than talking to them.

At that point I may just answer. I’ve done it a handful of times in sixteen years — told a client outright that I’m not in recovery, that I haven’t had a substance use disorder — and we moved along. Nothing happened that I could see.

Though look at what I actually gave them, because it isn’t an answer to the question. You can have used and never developed a substance use disorder. You can have used plenty and have nothing to be in recovery from. What I handed those clients was the thing underneath the question — whether I’ve lived addiction from the inside — while leaving the literal question alone. A client could reasonably point out that I still hadn’t answered them, and I’d have to concede that.

The reason I’ll do it isn’t complicated. A client who walks out early is a worse outcome than a disclosure that goes badly. In the population I’ve worked with, someone who leaves because they decided I was withholding may not come back to treatment at all, not to me and not to anyone. Against that, the risk of telling them one true thing about myself is small. I’m risking a relationship. They’re risking considerably more.

That’s harm reduction applied to myself instead of to them. Keep the person in the room.

The only hard limit is content that would put weight on them. I’m not telling a client I was assaulted or anything else that leaves them holding something of mine. That isn’t a disclosure, it’s a transfer.

And those few times don’t prove what they look like they prove. Nothing bad happened, but they weren’t random. Every one came at the end of a sequence — the script, the redirect, working out what the client was really after, a judgment about whether this person at this point could hold it, and then the least loaded true thing available. I’m not in recovery asks very little compared to what the other answer would have asked. So what the absence of catastrophe tells you is that the process in front of it works. It doesn’t tell you disclosure is safe.

What I Was Told

My first job was residential. The training on this was blunt and it started early.
Don’t tell clients what car you drive, because they might damage it. Don’t give out details that could be used to find you. And there were stories — there are always stories — about the staff member who disclosed something personal while trying to comfort a client and watched it come back at them. I remember the shape of those stories better than the details. They were told to make sure we could handle the population, and they worked.

Then I did my alcohol and drug counseling certificate, where the same instruction arrived with more nuance and the same conclusion. Then grad school, where it was confirmed again. Very little disclosure, ever. When in doubt, less.

Three institutions across several years, all landing in the same place. There was other material in there — grad school covered more ground than the certificate had, and some of it pointed elsewhere — but caution is what came through as practice.

Because there is an argument. There’s a whole tradition — feminist therapy, and parts of multicultural counseling — that has held since the seventies that disclosure can be a legitimate and valuable part of the work, with ethics code language describing how to use it well rather than how to avoid it. That reached me eventually, mostly through practice and through people, and more as something admirable than as something I was being trained to do. By then I’d built years on one side of a debate I hadn’t understood was live.

The part that bothers me now is what those residential rules were actually about. Physical safety in a locked setting with acutely dysregulated people. They were probably correct. But the same instruction followed me into outpatient work with a fifteen-year-old asking whether I’ve ever smoked weed, which is a clinical judgment problem rather than a safety one, and needs a different rule. Nobody separated them, so I applied the strict one to everything.

That’s defensive practice. I push back on it in other places — not because I like the friction, but because when a decision gets made to protect the clinician, the client stops being the first priority, and sometimes they’re worse off for it. Hospitalizing someone because their risk makes me uncomfortable rather than because it will help them. Diagnosing out of worry instead of evidence. Documenting for a chart reviewer rather than the next clinician who’ll have this person in front of them.

On this one I went along.

What It Cost

A blank slate isn’t blank. It reads as whatever the default is, and the default is the dominant culture. Which means the instruction is priced differently depending on who follows it — free for some of us, expensive for others. I gave up things I didn’t register as losses until recently, and there were probably clients I could have reached who needed the part of me I was leaving at the door. That’s a bigger subject than this blog and I’ll take it on properly another time.

Three Kinds

The distinction that matters is what kind of thing you’re disclosing, not how much of it.
Start with the ambient kind. I’m married. I have two kids. My husband and I bicker. My kids matter more to me than anything and I still get frustrated with them and still want to be a great mom, and those sit next to each other permanently. There are no good kids and bad kids — there are kids, making decisions that are sometimes short on judgment, same as everyone. Anything findable with a decent search, I’ll generally just say. None of that asks the client to do anything except notice that a person is sitting across from them. Whether I like coffee is not a boundary crisis.

Then there’s the kind aimed at whatever’s on the table. I have an allergy to alcohol; it showed up after I had my kids and I can’t drink. I bring it out when someone has lost access to something — a client with pancreatitis told never again, someone pregnant or just past it working out what happens now, someone in recovery who has finally landed on the fact that one is not a number available to them. What I’m offering there is the practical problem of being the person not drinking in a room where everybody else is, plus the plain acknowledgment that this part is bad and I’m not going to pretend otherwise. Same species: a session on communication with a grieving couple, and I mention that my husband’s number one complaint about me is the same thing. Five seconds, aimed at the material, gone.

And then the hard kind. Recovery status. Mental illness. Neurodivergence. Orientation. What they share isn’t that they’re personal — my marriage is personal. It’s that they carry stigma.

That’s the criterion. A client can hold the fact of my alcohol allergy forever and it costs me nothing, because nobody thinks less of a person who can’t drink. A substance use disorder is not in that category, and neither is mental illness, or neurodivergence, or being gay. Each arrives with something attached, the client decides what to do with it, and some of them will think less of me while others won’t come back. Neither group tells me.

That’s also where the highest payoff sits, so rather than give you a rule I’d rather show you my reasoning on one.

The times I’ve told a client I take psychiatric medication, the setup was consistent. They were already on something or seriously considering it. They were carrying shame about that — either their own, or enough of what gets said about psychotropics that they’d absorbed it. And we’d worked together long enough that they had some regard for me. So the disclosure did one narrow thing: you clearly don’t think less of me for this, so consider extending yourself the same.

What I noticed afterward was behavioral rather than emotional, and I’d rather report what I saw than guess at what they felt. People became more willing to consider a medication they’d been refusing. More willing to advocate for themselves with a prescriber — to walk in with questions instead of accepting whatever they were handed. I have no access to what happened internally, but I could watch what they did next.
The whole thing only works because the subject is stigmatized, which is the same reason it’s dangerous.

The Test

So here’s what I’d tell you to do, and then the reason it isn’t enough.

Before you disclose or refuse, ask what’s driving it. Am I doing this because it’s best for this client, or because I’m afraid? Afraid of how it’ll land, of what they’ll do with it, of what a supervisor would say, of being the clinician who overshared. That question has served me everywhere else in my practice. It’s how I’ve caught myself about to hospitalize someone for my comfort rather than their safety.

It doesn’t work here, and it took me a long time to understand why.

In every other area, protecting myself and protecting the client eventually come apart. If I hospitalize someone unnecessarily, I’m safer and they’re worse off, and if I look honestly I can see the split. That’s what makes the question answerable.

Disclosure doesn’t split. Withholding protects the client from a risk and protects me from stigma, from what colleagues think, from career damage. Both point the same direction, every time. So when I decline and tell myself it’s clinical, there’s no way to check, and not because I haven’t thought about it hard enough — the domain simply doesn’t offer the comparison the test depends on.

Sixteen years and I don’t have a rule, which I’ve stopped treating as a failure of reasoning and started treating as a property of the problem.

What I have instead of a rule is a reason, and it’s a narrow one. In community mental health I watched one number more closely than any other, which was how many people left in the first month. My clients weren’t shopping around. Someone who left after a bad first impression frequently left treatment altogether rather than finding somebody else. An answer that pulls some people closer while pushing others out is a poor trade when the ones pushed out have nowhere to go.

That isn’t a principle I’d hand you. It’s arithmetic that came out of a particular setting with a particular population, and if you’re somewhere else your arithmetic will look different.

Which is why I’ve kept the script and stopped being certain about it. I still use it, almost word for word, and I still think naming the trap is more honest than either answer would be. What I can’t do anymore is claim it’s purely clinical. Refusing to answer is a form of neutrality, and neutrality is what I was trained into — so I can’t rule out that I find my own reasoning persuasive partly because it lets me keep doing what I was taught, in language that sounds like judgment rather than caution.

Both things seem true to me. It’s a good move and it’s also a well-argued version of the instruction I absorbed at twenty-three.

Somebody Else In The Room

And there’s a second reason the test isn’t enough, which is more uncomfortable, because it’s about the quality of the judgment itself.

When Pinto-Coelho and colleagues interviewed thirteen experienced therapists about disclosures that went well and disclosures that went badly, a pattern showed up in the failures. The unsuccessful ones typically started from a countertransference reaction. The intention was almost always to provide support. And the content usually involved the therapist believing they had something in common with the client when they didn’t.
That’s worth sitting with. The failures didn’t come from clinicians being careless or self-indulgent. They came from wanting to help someone and misreading what they shared with them — which is exactly what it feels like from the inside when you’re about to do it well.

So trusting your gut is not the available answer to the rule having been defensive. Your gut is unreliable here in a specific, documented way.

And if you’re early in this, it’s harder still, in a way that isn’t a knock on you. Telling the difference between this serves the client and this serves me is a skill, and it develops late. At twenty-three I would have started talking and not known where to stop, and the session would have quietly become mine. That’s what year two is rather than a character flaw, which means a fair amount of what looks like principled restraint in newer clinicians is really an accurate read of their own execution — and if that’s you, that read is worth trusting for now. Not permanently. For now.

What I’d actually do is build the habit of asking before you need it. After an interpretation — how did that land? After a redirect — was that useful, or did I take us sideways? After a hard session — that was a lot, where are you with it? None of that is uncomfortable, because nothing of yours is on the table. Do it until it’s just how you work. Then, on the day you disclose something that matters, you’re not inventing a new behavior while feeling exposed. You’re doing the thing you always do.

This matters more than it sounds. Clinicians are poor at detecting when something has gone wrong with a client, and clients rarely bring it up spontaneously. Spontaneously is the operative word — nobody has found that clients won’t tell you when you actually ask them.

Then put it on someone else’s radar, and watch how you bring it, because the framing shapes what you get back. Was it okay that I disclosed X invites a ruling, and an overworked supervisor will hand you the cheapest one available, which is usually some version of don’t do it again. I disclosed X, it landed oddly, help me figure out what happened invites analysis. Same event, harder to answer with a prohibition.

That’s easier advice to give than to take, and I know it. If your supervisor signs off on your hours, reframing her question isn’t a free move, and you know your situation better than I do. Do what’s safe for you. But pay attention to what you’re getting back, because if it’s only ever prohibitions, that isn’t supervision. It’s risk management with a nicer name.

And if you’re reading this because you already answered something and you’ve been turning it over since — that’s where most people find this question, not in the tidy version where you decide in advance. You probably can’t determine whether it went badly. You’d need information you don’t have and aren’t going to get. What you can look at is narrower: did it take the session away from them, did it leave them holding something of yours, did it come back to them and how quickly. Those you can actually see. The rest is guessing, and guessing hard about it for weeks becomes its own problem rather than a solution to the first one.

Somebody Else In The Room

What I’d stop doing is treating this as the binary school handed us. Disclose and you’ve made it about yourself; withhold and you’re being professional. That isn’t the shape of it. You can be authentic in the room without making the hour yours, and a fair number of clients need to see that before they’ll hand you anything real.

Notice too that we mostly decide this without consulting anyone. Some clients want a person across from them and some genuinely don’t, and rather than find out which we assume — and having assumed, you end up either blank and interchangeable or filed under quirky. There’s a lot of room between those, and the way into it is asking rather than guessing.

So try it. Cautiously, and on your own terms. Keep it to a few sentences. Check whether it’s serving them or serving you, knowing you won’t always be able to tell. Bring it to supervision afterward, framed so you get analysis rather than a ruling. And pay attention to what happens next, because that’s how you find your own flow with it — which is the part nobody can hand you, including me.

I’m still working mine out. Sixteen years in.

This is post #35 in the New Clinician Survival Kit Series — a collection of honest, non-cheerful blogs about the parts of this work that don’t show up in grad school. If you’ve been feeling something and can’t quite name it, this series is probably where you’ll find the words.

Until Next Week | The Underrated Superhero