Self-Disclosure (aka Jumping on the Band Wagon)

So one of my favorite blogs on my blog roll, Vicarious Therapy, was talking about disclosure. She referenced Dr. Shock's post on the same topic. I read them both and found myself thinking about the topic in some depth.

It's ironic. For as much as I fear people and dealing with them under most circumstances, I want to know all about them. I want to know why they act the way they act, what they think about and why. I suppose I could be called a gossip in that I love to listen about anything and everything to do with other people's lives, especially the behind-the-scenes stuff. Though unlike most gossips, I don't like to spread what I hear and certainly have no malicious intent. I just want to know. Everything. I'm sure that colors my perspective on this subject...

When it comes to disclosure, more is better to my mind. I want to know it. But I recognize times when it is less than helpful. I also recognize when it is practically vital. But it can't be an easy call to make for the practitioner.

Aqua talked about the information her pdoc shared with her about his health. His health directly impacts her therapy process in both an objective (cancelled appointments and necessary contingency plans) and a subjective (obviously not feeling well, potential for feelings of abandonment and betrayal) way. So it would have been a poor judgment call to withhold that information.

I had a similar (on a MUCH smaller scale) situation with my psychiatrist. He cancelled an appointment on me at probably the single most inopportune time possible. I was in an extremely fragile state of mind, under tremendous stress and slightly psychotic. When I got the cancellation message, I could only assume it was for one of a couple of worst-case scenarios: he was golfing with his buddies, he hates me so much he didn't feel like dealing with me, or he was dying in a hospital somewhere. (Did I mention that I get a melodramatic when I'm psychotic - more so than usual?) I was fit to be tied. I was trying to figure out where I could get another psychiatrist that could monitor my VNS implant and that my insurance would accept. But when I called his office back, the receptionist told me that he had gone in for an emergency root canal. (OUCH!! Been there, done that - cancel everything! Those suck.) And that smoothed over my worries about why he had cancelled. If no explanation had been forthcoming, I likely would have continued to assume the worst to the point that I accepted it as fact. (I do that when I get psychotic - things I imagine become, in my mind, things that actually happened.) And I would have bailed. Score one for self-disclosure!

On the other hand...

The Shrink and I got into a discussion once about The Flying Spaghetti Monster and it came out in the discussion that he holds some very different religious beliefs than I do. Now he wasn't pushy or judgmental or preachy or disrespectful in any way. And it was practically an off-the-clock discussion - you know, the kind that occur as you are walking out the door at the end of the appointment and that contain no therapeutic value at all. But because of my past history of clashes with people from other religions condemning me for my beliefs, his views made an impression on me. The net result is that I have not brought up any of the confusion I have about my spirituality or the longing I have for the church I grew up in. I haven't deliberately withheld information or gone into my Artful Dodger routine to keep from talking about it, but I have purposely not steered the conversation that direction to address those concerns, because I know his religion is so very different from mine. And this is despite the fact that I am proof positive that he would not judge me or condemn me or lecture me or pressure me or anything other than support me in such a conversation. It is just that the issue of spirituality is a sore spot for me and, in keeping with my zero-conflict tendencies, I haven't been comfortable talking about it now. Self-disclosure takes a hit - ooo, that one packed a punch, Ladies and Gentlemen!

Flipping back to the other side, I often get bits of self-disclosure from our family pediatrician. We have a very close working relationship with her as we have been with her from the very start for both of us. My oldest son, who is about to turn 13, was the very first newborn in her practice. She has seen us through ups and downs and sideways and diagonally-s from bipolar hospitalizations to broken arms to well-baby visits and sports physicals. We adore her and have generally followed the major events of her life... changing practices, new partners, marriage, moving, and two kids. So last month I had Kid-3 into her office to discuss (read: beg for help about) his encopresis. Things had gone poorly at the specialist and for a variety of reasons, we would not be able to return to him but things were getting worse with Kid-3. The Pediatrician (who is officially my idol!) listened and examined and discussed and planned, including me all the way. I felt much more comfortable and more in control. Then she mentions that her son takes the same medicine she is recommending for Kid-3 (Miralax, btw - it's a wonder drug!) for the exact same problem Kid-3 has! Relief flooded my mind. If even our wonderful pediatrician has this problem with her son, this is highly unlikely to be my fault for being a bad mommy. AND... her son is doing wonderfully on it.Wow! TG... Ladies and GentleHobbits, self-disclosure us rallying with a vengeance.

Back to self-disclosure from The Shrink... I get little pieces of information from him frequently. Nothing huge, just tidbits. His son is into acting, singing and writing, much like my daughter is (and in a limited way I am) so we swapped stories about supporting vs pushing and helping vs crushing. His youngest two kids fight in much the same way as my youngest two do. He read that Stephen King book and liked this part for this reason (which miraculously tied into the point he was trying to make at the time! LOL) All those little things he tells me strengthens my feeling of trust with him. It makes me feel like even successful people have little issues. And when he relates something he's done to something I've done, sometimes it's easier to be objective about it. Of course, The Shrink, when he chooses to share like that, is short and to the point and with few details - it's not all about him. Ding! Ding! Ding! Another point to self-disclosure!

On the other hand, my infinite curiosity, especially regarding people I care about, tends to leave me wanting more. I hoard the bits of information he has shared, using them to fill in my mental picture of him. I don't deal too well with one or even two dimensional people. No one is like that - everyone is complex and layered. Sometimes it's just a matter of discovering the layers underneath. The Shrink puts forth his best foot in nearly all of his stories, leaving me wondering where his faults lie. The day I overheard him talking with a colleague in the hallway (DUDE! It echoes! Keep your voice down! LOL) expressing some pretty strong self-doubt over something unidentified, was a gold star day in my book. The Shrink is human after all. (And the crowd goes wild!) The point is, when he gives an inch, I want a mile. I completely respect boundaries so I don't push it or pry for details or look for ways to get him talking about himself, but I do crave the knowledge. I would have to put this on the "cons" side of the board for self-disclosure, though barely.

All in all, from my point of view, I favor selective self-disclosure. I love hearing anything and everything my doctors want to share. I like working with people, not with Robot MDs. I don't want to take up other people's time though. And I don't want them to share anything too personal or that makes them feel awkward. And they better be careful about sharing belief systems because, with my zero-conflict people-pleasing tendencies, I will worry if mine don't match theirs.

This, of course, is just from my point of view and I neither think nor expect that this holds true for other patients. I say again, I don't envy doctors who must decide such things on the fly.