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11.1 Self-Disclosure
Self-disclosure is a multidimensional skill that affects genetic counseling processes
and outcomes. Self-disclosures vary with respect to intimacy level, content, timing,
and length, disclosure of present experiences or past situations, their relative simi-
larity or dissimilarity to the patient’s experiences, counselor motivations for disclos-
ing, cultural considerations, whether the disclosure is patient-requested or
counselor-initiated, intentional versus unavoidable revelations, and counselor and
patient characteristics (McCarthy Veach 2011 ).
11.1.1 To Disclose or Not to Disclose?
Counselor self-disclosure is a controversial behavior. Within genetic counseling,
some authors (e.g., Kessler 1992 ) suggest caution in its use, arguing that self-
disclosure is highly directive (e.g., telling a patient what you would do if you were
in her or his situation, thereby implying what the patient should do). Some mental
health authors (e.g., Simone et al. 1998 ) caution that self-disclosure may reflect the
therapist’s unconscious needs (e.g., for intimacy), blur relationship boundaries (are
you my counselor or my friend?) (Audet 2011 ), shift focus from the patient (Audet
and Everall 2003 ; Dewane 2006 ), confuse patients about the nature of counseling
(Audet and Everall 2003 ), and even reverse roles such that the patient is caretaking
the counselor (Audet and Everall 2003 ; McCarthy Veach 2011 ).
As described in different disciplines, such as psychotherapy and genetic counsel-
ing, general reasons for using self-disclosure include to “respond to client requests
for disclosure (Peters et al. 2004 ; Thomas et al. 2006 ); help client feel s/he is not
alone; convey understanding of client’s situation; decrease client anxiety; build rap-
port/working alliance; normalize client’s feelings/reactions; encourage client and
instill hope; increase clinician’s credibility; build trust; suggest/model coping strate-
gies; encourage client disclosure; increase client awareness of alternative view-
points; provide a rationale for clinician-initiated topics; connect with clients whose
cultural background encourages such disclosure; encourage client to express emo-
tions; challenge the client; and prevent client idealization of the counselor (Henretty
and Levitt 2010 ; Peters et al. 2004 ; Simone et al. 1998 ; Thomas et al. 2006 )”
(McCarthy Veach 2011 , pp. 351–352).
Conversely, reasons for refraining from self-disclosure are to avoid blurring
boundaries, remain patient-centered, prevent the patient from becoming concerned
about the counselor’s welfare, avoid giving the patient information to manipulate
the counselor, and avoid counselor discomfort (Balcom et al. 2013 ; McCarthy Veach
2011 ). Additional reasons include to prevent undermining patient autonomy, and
viewing self-disclosure as generally not relevant/helpful to the patient (Thomas
et al. 2006 ). Balcom et al. ( 2013 ) investigated genetic counselor responses to prena-
tal patients’ requests for self-disclosure: “Particularly noteworthy, counselors
11 Counselor Self-Reference: Self-Disclosure andfiSelf-Involving Skills