Just how much self-disclosure is too much?

I found myself asking that question after reading the recent p. 1 article in the New York Times about Marsha Linehan, Ph.D., the creator of dialectical behavior therapy ("Expert on Mental Illness Reveals Her Own Fight," June 23, 2011).

In the article, the author described Dr. Linehan’s reasoning for coming out recently as a former patient with severe mental illness "before an audience of friends, families, and doctors" at the Institute of Living in Hartford, Conn. – the same institution in which she had been hospitalized for more than 2 years while in her late teens and early 20s. She is now 68.

Dr. Linehan’s decision must not have been taken lightly. After what must have been a tremendous amount of thoughtful consideration, she concluded that the disclosure was necessary for herself, her patients, and the field. We now know that it was personal experience that informed the creation of DBT – an effective, evidence-based treatment for severely suicidal people and those who suffer from borderline personality disorder.

Each mental health provider practices in a unique way, informed by personal experience. That experience includes not only formal training and practice experience, but life experience beginning with family of origin and continuing with community, education, friendships, romantic relationships – all that happens over a lifetime. It is our job to know what we bring into the room and to be aware that the experience of the patient sitting with us may be similar to our own, but it may be completely different. We have to do our best to understand the person sitting with us, even though, more often than not, it cannot be from first-hand experience. What we do is aim to understand the themes and behaviors that we are treating and employ a method of treatment that works.

Every now and then, I find myself sitting with a patient and asking myself, Would it help this person to know that I have been there? That I know from personal, not just professional, experience what they are feeling?

My instinct, driven by my desire to help, is to want to disclose to them that I have been where they are. However, my brain, my training, my skills, and my sincere desire to do right by my patients remind me that self-revelation is not necessary.

Some of my patients have told me that they see me as someone who has a "great" life. I am successful professionally and personally; I am physically and mentally healthy, balanced, and happy. I don’t appear to be someone who knows first hand about mental struggles. Of course, that is their perception – call it transference, if you wish – and for those who have said such things to me, their belief may be that "a healthy person can help me to become healthy." I make a note to myself that this is likely modeling, which can be a very helpful, effective part of treatment. On the other hand, might a patient believe that someone who has been there might be better able to help them?