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- Relationship status (e.g., if you wear a wedding ring, you may be perceived as
someone who understands the conflict a couple is experiencing). - Physical appearance (e.g., if your physical characteristics suggest you have a
genetic condition, this might make some patients reluctant to discuss termination
of an affected pregnancy). Being obviously pregnant may evoke any number of
reactions from patients (e.g., Clark 2010 , 2012 ; Menezes 2012 ). Balcom et al.
( 2013 ) found that patient requests for self-disclosure increase when the counselor
is pregnant. The most prevalent questions asked are “When are you due?,” “How
do you do this job while being pregnant?,” and “How is your pregnancy going?”
This type of indirect disclosure is not something you can or necessarily should
try to control or manipulate. It is important, however, to reflect upon what your
characteristics and actions may convey to the patients. Depending on the given situ-
ation and circumstances, you may need to directly discuss your unintentional dis-
closures (McCarthy Veach 2011 ).
There are other types of indirect disclosures, however, that you can control. For
example: - Office decorations [e.g., pictures of your children may lead some patients to
perceive you as understanding about pregnancy but perhaps less about pregnancy
loss; the presence of LGBT-friendly literature in your office may reflect your
openness and comfort with patients who self-identify as LGBT (VandenLangenberg
et al. 2012 )]. - Accessories/jewelry (e.g., expensive jewelry and clothes may cause a patient
with fewer resources to think you would not be able to relate to their circum-
stances or situation; religious jewelry may cause a patient to draw conclusions
about your attitudes or beliefs that may or may not be accurate).
In contrast to indirect self-disclosure, direct self-disclosure refers to inten-
tional communications about yourself. You may sometimes deliberately choose to
reveal information about yourself, and sometimes your disclosures will be in
response to patient questions (e.g., “Have you ever worked with patients who
have a genetic condition like mine?”). Direct disclosures are the primary focus of
this chapter.
11.1.3 Self-Disclosure Intimacy Levels
Self-disclosures vary along a continuum from low, to moderate, to high intimacy. In
Table 11.1 we describe and illustrate different levels of disclosure intimacy.
Generally speaking, sharing information about one’s personal experiences (e.g.,
history of infertility) is higher in intimacy than sharing information about one’s
professional experiences (e.g., what other patients you’ve counseled have felt or
done).
11 Counselor Self-Reference: Self-Disclosure andfiSelf-Involving Skills