If authenticity is a journey, maybe a process, then self-disclosure is one tool in its development. I've wrestled with these concepts over the years. Somewhere it was mentioned that a person can go for years without revealing their true nature to the therapist. Being genuine is something we value. It is also true I am flawed.

The residency at Wright State valued dynamic approaches to psychotherapy. Consistent with that was the edict that we do not disclose to our patients. At the very least we were admonished to decide, for whom is this self-disclosure, and will it benefit or gratify patient or myself? Our instruction included that advice-giving was unnecessary and unrefined. Instead, I became acquainted with asking "sideways questions" (this phrase came from a patient, I didn't conceive of it myself) to search for the truth, doctor and patient together.

With this background I was invited to serve on a panel of psychiatrists discussing the issue of psychiatrist self-disclosure at two APA Annual Meetings. I was the panel member chosen for NOT disclosing. At the other end of the spectrum, one of our moderators declared to the audience that he freely self-disclosed, to his boss and administration, to colleagues and even sometimes patients. Waiting for my turn to speak on stage, I wondered what the payoff was for this distinguished and successful psychiatric physician to reveal what he told other people.

Before that, there were several years of volunteering to serve on a panel moderated by Drs. Leah Dickstein and Michael Myers.  Among my colleagues on this panel were two ladies who were maintained long term on antipsychotic medicine, and they spoke openly of recognizing their delusions as they occurred. By the by both these doctors are brilliant. One other psychiatrist panelist was recovering from cocaine addiction, and her presentation was the most memorable for me. Because it brought about a hopeful and encouraging message despite the humbling acceptance that she, like the rest of us, had struggles.

When I was much younger, I listened to dialogues between my parents: from time to time my father was faced with the increasing corporatization of medical practice, expected to stab peers in the back to pursue career advancement. I liked my mother's discourse, mostly because she did not pretend to have the answer but rather, she enjoined my dad to think. For himself. Every one of their decisions reflected who my parents were.

You might have guessed I deliberately will not offer definitive advice on whether it is better to self-disclose or not. If we agree that authenticity is the goal, then what is best is to be true to the person we are inside.

(a short footnote) In the carceral environment where I work, a psychiatrist should never self-disclose in my opinion.