Therapist self-disclosure of sexual orientation revisited: Considerations with a case example

Abstract Background Self-disclosure of sexual orientation is a topic that requires nuance and thoughfulness by therapists who work in direct client care roles. While all therapists must contend with their sexual orientation when relating to clients, lesbian, gay, and bisexual therapists often encounter a more complex calculus with regard to when, why and how they might disclose their sexual orientation to clients and manage unintentional disclosures. Case A 14-year-old girl was admitted to the inpatient psychiatric unit with a diagnosis of Conversion disorder and intractable psychogenic nonepileptic seizures. In her initial interview in the inpatient unit, in an attempt to help the client open up, a gay male medical student spontaneously disclosed his sexual orientation. Outcome The student’s disclosure led to a fruitful discussion about the client’s reticence to bring up sexual attractions toward girls to her parents, whom she feared may reject her. The client then asked the medical student to assist in coming out to her parents during her inpatient stay. Over the course of her seven-day stay on the inpatient unit, the client had no further episodes and was discharged home. Discussion Disclosure of sexual orientation can benefit the therapeutic alliance, facilitate trust and reciprocity and improve client perceptions of the therapist’s trustworthiness and empathy. However, due to a lack of recognition, training and supervision surrounding this important topic, lesbian, gay and bisexual therapists are often left with only their intuition to guide them. We discuss clinical considerations for use of therapist self-disclosure of sexual orientation in terms of setting, manner and timing and elaborate a discussion about the potential impact of such a disclosure on both the client and the therapist.