The Impact of Therapist Self-Disclosure on Client-Perceived Working Alliance amongst Psychiatrist Inpatients

Abstract

Working alliance has been shown to predict positive psychotherapy treatment outcomes. Past research focuses on therapist characteristics that correlate with working alliance after multiple therapy sessions (e.g., warmth, trustworthy) rather than employing experimental designs examining specific techniques that quickly improve working alliance. Specific techniques that have been empirically shown to improve working alliance quickly may be particularly beneficial today in the age of managed care wherein clinicians often face constraints limiting the amount of time they can spend with clients. Therapist self-disclosure (TSD) of information about a clinician’s personal life, when used appropriately, may have the potential to quickly improve working alliance. Prior research has demonstrated a positive relationship between TSD and working alliance; however, most studies examining TSD are methodologically unsound. The present study employed a methodologically rigorous design in which psychiatric inpatients participated in a highly structured assessment as part of standard intake procedures. After the intake interview, participants completed a baseline working alliance measure, which was followed by the clinician making one personal TSD statement to half of the participants. Shortly after the TSD statement (or non-TSD statement for the control group), participants completed a second working alliance questionnaire. As hypothesized, participants in the TSD group exhibited significantly higher scores than controls on the Bond subscale of the post-manipulation working alliance measure, and paranoia was negatively correlated with baseline working alliance. Contrary to what was expected, paranoia did not moderate the effects of TSD on working alliance. Implications for clinical applications and future research directions are discussed.