311distracting (Audet and Everall 2003 ; McCarthy Veach 2011 ), and cause patients to
experience your disclosures as oversharing (Balcom et al. 2013 ).
Be purposeful and relevant. Your self-disclosure should pertain to the session
goals and should be expressed in a way that makes its relevance obvious to the
patient (Audet and Everall 2003 ; Henretty and Levitt 2010 ).
Keep more personal disclosures non-immediate. It’s generally less risky to dis-
close information from your past experiences rather than from your current experi-
ences (McCarthy Veach 2011 ). For example, patients might be distressed to learn
you currently are undergoing BRCA testing, but they might benefit from learning
that you underwent testing 5 years ago.
Be prepared. Bonovitz ( 2006 ) asserts “We personally reveal much more about
ourselves on those occasions when we are thrown into a situation unprepared”
(p. 295). Therefore, it’s a good idea to reflect in advance about the sorts of informa-
tion you would never disclose to patients and the reasons why you would not dis-
close, as well as the sorts of information you might share and why.
Relatedly, remember that although you are required to maintain patient confiden-
tiality, your patients are not under the same imperative (Sweezy 2005 ). Patients can
reveal anything that they care to, and with anyone. So, “...be aware of choices and
possible consequences before this question [of whether to self-disclose] arises in
session” (Sweezy 2005 , p. 90). When thinking about topics that you might disclose,
you should consider how you would feel if patients passed this information along to
others. Furthermore, patients vary in how sensitive and nonjudgmental they will
be about your situation.
Know your own reactions. You should anticipate how you will feel as you dis-
close certain information and generally avoid topics that would cause you to be
highly emotional, such as information that would make you quite distressed, anx-
ious, or angry.
Assess what a patient is really asking and respond accordingly. Thomas et al.’s
( 2006 ) genetic counselor participants perceived patients’ motivations for requesting
self-disclosure as to seek guidance about a decision, out of respect for the counselor
and her/his expertise and trustworthiness, to seek validation, to build the relation-
ship/establish a connection with the counselor, to determine whether the counselor
can understand them/their situation, and to avoid responsibility for their decision
and its outcomes.
It’s always a good idea to consider the possible motivation for a patient’s ques-
tion and to ask about it in a noncritical/nondefensive way. For example, a patient
might ask a genetic counseling student, “How old are you?” The question could
simply be a desire to know more about the student. It might also be an indirect way
for the patient to ask if the student is experienced enough to meet her or his needs.
It is not uncommon for patients to ask students a lot of questions about their training
(e.g., How long is your program?, When are you going to graduate?, Where do you
hope to get a job?, Why did you choose genetic counseling?, etc.). Consider that a
patient may just genuinely be interested in getting to know more about you or about
11.1 Self-Disclosure