Dissertations and Theses
Date of Award
2024
Document Type
Dissertation
Department
Psychology
First Advisor
Elliot Jurist
Second Advisor
Sarah O'Neill
Third Advisor
Diana Puñales
Keywords
therapist self-disclosure, LGBTQ, therapeutic alliance, minority stress, psychotherapy outcome, loneliness
Abstract
Therapist self-disclosure (TSD) is a controversial clinical intervention whose benefits and drawbacks remain contested. Notably, no prior research has differentiated explicitly between self-disclosures related to the therapist’s core identities and those peripheral to identity, and qualitative studies suggest that identity-focused therapist self-disclosure (TSD-I) may be beneficial when therapist and patient share at least one marginalized identity. LGBTQ+ people, who experience significant health disparities and utilize psychotherapy more than their heterosexual and cisgender counterparts, could benefit particularly from TSD-I. The mental and physical health challenges facing LGBTQ+ individuals are predominantly explained through minority stress theory, which suggests that societal prejudice and discrimination contribute to heightened levels of rejection sensitivity, internalized LGBTQ+-negativity, and loneliness in the LGBTQ+ individual, which lead to deleterious health outcomes.
Objective: This longitudinal study investigates the effects of TSD-I on patient psychological functioning in therapy dyads matched by LGBTQ+ status. It explores two potential pathways through which TSD-I may affect patient psychological functioning: the therapeutic alliance (assessed as the “real relationship” between patient and therapist) and minority stress level. This study also qualitatively analyzes participant written reflections to understand the meaning that LGBTQ+ patients make of TSD-I.
Method: A sample of 198 LGBTQ+ individuals, each receiving psychotherapy from an openly LGBTQ+ therapist, was recruited via therapist outreach, ads placed on social media sites and e-mail listservs, and posted flyers. Participants completed surveys at three time points, spaced on average eight weeks apart, measuring frequency and optimality of TSD (both identity-focused and general [GD]), minority stress processes, and psychological health. Path analysis was used to examine longitudinal mediation models. Emergent themes related to the therapeutic impact of TSD-I were identified using Interpretive Phenomenological Analysis (IPA) methodology.
Results: As hypothesized, longitudinal results revealed a significant indirect relation between TSD-I optimality at baseline and patient psychological functioning at T3, through real relationship and minority stress at T2. This indirect relationship remained significant after controlling for GD optimality, but only through the combined effects of both mediators and not each individually. Further, only TSD-I and not GD optimality at baseline significantly predicted better patient psychological functioning at T3 through the individual mediating pathway of minority stress at T2. Thematic analysis revealed that TSD-I can reduce loneliness, normalize life experience, and instill hope, among thirteen emergent themes, but also that it carries therapeutic risks.
Discussion: This study reveals that LGBTQ+ therapists do tend to disclose about their identities to their LGBTQ+ patients, that LGBTQ+ patients tend to rate disclosures as highly optimal, and that TSD-I appears to impact a patient’s minority stress in ways that that GD does not. The path analyses suggest that TSD-I can be a beneficial therapeutic intervention but clinicians are wise to approach it with caution, as the optimality of self-disclosure appears to influence treatment dynamics and patient mental health.
Keywords: Therapist self-disclosure, identity, sexual and gender minorities, LGBTQ, therapeutic alliance, real relationship, minority stress, internalized LGBTQ+-negativity, rejection sensitivity, loneliness, psychotherapy, psychopathology.
Recommended Citation
Neff, Brian Thomas, "Identity-Focused Therapist Self-Disclosure in Matched Sexual/Gender Minority Dyads: A Longitudinal Therapy Process-Outcome Study" (2024). CUNY Academic Works.
https://academicworks.cuny.edu/cc_etds_theses/1169