Self-Disclosure as a Public Health Intervention

Abstract

In a recent therapy session, my 79-year-old patient with a stable psychotic disorder informed me of her socially distanced holiday in her typical blunted affect. She then repeatedly inquired about mine. I felt my stomach turn, a common experience for me when faced with personal inquiry. Responses to self-disclosure in the voices of my attendings came to mind ranging from the imaginative, “what did you picture my holiday was like?” to an emphasis on the therapeutic relationship, “what makes you curious about my experience now?” I have yet to suppress the thought that I should respond as a person, metaphorically removing my psychiatrist hat, or perhaps putting it on backwards. Surely, some inquiry is a social grace that warrants an authentic response. I am not the cold blank slate upon which patients reflect their emotions. As a resident psychiatrist, a new father, partner, and caregiver, I am increasingly aware of the fluidity of my identity as opposed to one separated into discrete roles. The emerging psychiatrist within me cannot help but interpose—what am I missing (in me, in her, or between us), by avoiding self-disclosure? I felt lonely and wondered if this reflected concern for her well-being given her isolation. Facing personal inquiry is a fork in the road of therapeutic approach that reveals conflict in my identity as an emerging therapist and physician.