Chapter 11 1. Define self-disclosure in the helping relationship 2. Define immediacy in the helping relationship 3. Identify guidelines for appropriate self-disclosure by the nurse 4. Distinguish between helpful and nonhelpful disclosures in selected clinical scenarios 5. Participate in exercises to build skills in appropriate self-disclosure Self-disclosure is another interpersonal communication behavior that you can use to show your clients and colleagues that you understand them. It can facilitate movement toward a common goal (Grover, 2005). To bring your unique gifts to the creative process of developing a helping relationship is historically referred to as the “therapeutic use of self” (Varcarolis and Halter, 2010). Immediacy is a form of self-disclosure that can facilitate the helping relationship. By the end of this chapter you will understand what is meant by self-disclosure and appreciate how this skill can be used appropriately in your relationships with clients and colleagues. You will have a chance to enhance your self-disclosing skills in the exercises at the end of this chapter. Self-disclosures can take any number of forms: complaining, boasting, gossiping, expressing political or religious views, and sharing endearments, secrets, or dreams. In social relationships self-disclosures are traded back and forth until the partners establish a mutually agreed-upon plateau. Intimate relationships are characterized by more private revelations than those shared between superficial acquaintances. The give and take of self-disclosing can occur with or without formal spoken rules. A specific request for deeper closeness, or an observed withdrawal of the usual pattern of sharing, influences the relationship and readjusts the established level of intimacy. “Nursing is inherently characterized by the desire to be connected to others at a very basic level of human significance . . . in milestone events of birth, death, illness, and growth in the lives of those for whom we care” (Drew, 1997). Nurses are moved to offer self-disclosure where the need for connectedness “transcends theoretical connections. Sharing . . . for the sake of connection and to give the interaction life, meaning and depth” (Drew, 1997). An example of useful information to share with a client with chronic illness and his or her family members is chronic sorrow. A nurse daughter describes it as “a type of lurking presence that periodically engulfs the life of an individual experiencing chronic illness or disability . . . it is an intermittent, bearable sadness that is interspersed with periods of joy and satisfaction” (Rosenberg, 1998). To understand this experience as distinguished from the acute grief of traumatic injury or the chronic despair accompanying depression can be helpful in listening to clients’ shared experiences of lifestyle changes. Egan (2002) identifies situations in which immediacy might be helpful. The following are appropriate in the nurse–client relationship: 1. Tension—when you are feeling tension in the conversation with a client, try, “Let’s stop a moment so I can determine if you are comfortable with what we are discussing. It seems to me there is some tension between us.” 2. Trust—when it seems the client is not trusting in the relationship, try, “It seems to me you are hesitating to answer questions we need to discuss. Are you concerned that what you tell me will not be held in confidence?” It is important to note here that the client needs to understand how information shared will be used. If, for example, the client asks if you will promise not to discuss anything about to be revealed, it is important you let the client know that anything that reveals a danger to the client or to others cannot be kept confidential. This kind of question from a client might precede a client’s revealing ideas about suicide, information that must be shared for his or her safety. Often a client would be relieved to know you are concerned and that help is available. 3. Diversity—when there is diversity of culture, age, or gender between you and the client, and you sense that this might be impeding progress in your work with the client, try, “You have had more life experience than I have; is this getting in the way of my being able to help you?” Or a female nurse with a male client: “It seems to me that it is embarrassing for you to talk with a woman about these issues, is that right? . . . This is information we need to discuss for your health and we will get through it the best we can.” 4. Dependency—when the client is unable to make decisions and wants advice from the nurse, try, “It seems you want me to give you an answer or direction. I can give you information but the final decision has to be yours.” 5. Attraction—when the client is attempting to turn a professional relationship into a social relationship, try, “It is important that our relationship remain a professional one so you can get the best possible care.” If this issue persists, or if you find yourself attracted to a client, seek out support and counsel to meet your obligations to keep the relationship professional. Client–nurse relationships demand special considerations in the use of self-disclosure. A helping relationship is established for the benefit of the client; in other words, this is a client-centered relationship. It follows that anything you reveal about yourself—your thoughts, feelings, and experiences—should be revealed for the benefit of your clients. The focus of the relationship is the client. To continue to maintain healthy boundaries, a characteristic of a professional relationship, you must consider the why, what, when, and how of self-disclosing with your clients (Stuart, 2009). Because self-disclosure is a sharing of your personal self with your clients, it can deepen the bond between you. Although still within the parameters of a professional helping relationship, your self-disclosure lets your clients know that you are a normal human being and intend to lead the client into an exploration of deeper feelings (Dossey and Keegan, 2008). Such therapeutic self-disclosure may promote comfort, honesty, openness, and risk taking by the client but never burdens clients with your problems (Keltner et al, 1999). Bateson, a noted anthropologist, wrote a book of stories reflecting her experience in many cultures (Bateson, 1994). “Our species thinks in metaphor and learns through stories.” Human beings can join and communicate and learn in spite of profound differences. As we meet people we have never met before, in situations we’ve never faced, as we try to apply communication skills to real people in real crises, we must “improvise responsibly and with love.” This “quality of improvisation characterizes more and more lives today, lived in uncertainty, full of the inklings of alternatives.” Consider this as you struggle to choose communication techniques, to say just the right thing, to disclose just the right incident and amount of detail, to be helpful without being self-absorbed. “Rarely is it possible to study all the instructions to a game before beginning to play, or to memorize the manual before turning on the computer. . . . We can carry on the process of learning in everything we do. . . . Ambiguity is the warp of life, not something to be eliminated. . . . [We learn] to savor the vertigo of doing without answers or . . . making do . . . [as we face difficult situations]. We are called to join in a dance whose steps must be learned along the way, so it is important to attend and respond. Even in uncertainty, we are responsible for our steps.”
Self-disclosure
Self-disclosure in personal and professional relationships
Immediacy in the helping relationship
Guidelines for self-disclosing in the helping relationship
Why nurses should use self-disclosure with clients
When nurses should use self-disclosure with clients
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