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Articles: 

Psychologists' ethical use of self-disclosure about highly charged issues & 
How are tabletop role-playing games being used in therapy? {Below}

Psychologists' ethical use of self-disclosure 

about highly charged issues

By Linda K. Knauss, Ph.D., ABPP

and Jeanne Slattery, Ph.D.

Like our clients, we have been responding to COVID-19, the Dobbs decision, racial and political unrest, gun violence, concerns about climate change, the war in Ukraine, inflation, and voting rights. Sometimes our clients bring these issues up in our work, or we consider whether we should do so.

    

    What "difficult things" have you been asked? What are you worrying about being asked? What disclosures have you made that you felt were inappropriate?

    When deciding how to handle these difficult issues, we often must decide whether and how to self-disclose and how much. Self-disclosure often has a dirty name, with many people believing that self-disclosure is an ethical violation. Early psychoanalytic theories, for example, suggested that self-disclosure would interfere with transference and countertransference. Risk management workshops outlined the risks and discouraged self-disclosure, although the internet increases the probability that therapist self-disclosure will occur anyway.  Nonetheless, self-disclosure can be a powerful therapeutic technique of great value when used appropriately and in the service of the client’s treatment.

    Self-disclosure takes many forms. Benign self-disclosures are part of everyday life and include natural or routine disclosures such as accent, expressed gender, a readily recognizable disability, or office décor.

    Deliberate self-disclosure refers to the intentional disclosure by the clinician of personal information. This includes marital status, parenthood, age, religion, sexual orientation, pronouns, vacation destination, and family photographs. Deliberate self-disclosure also includes information intentionally posted online, such as photos of participation in a political rally.

    Unavoidable self-disclosure is often part of life in a small community. Small communities also exist within large metropolitan areas, such as college campuses, religious groups, or LGBTQ+ communities. This form of self-disclosure is often spontaneous, such as facial expressions revealing personal attitudes or values.

    Accidental self-disclosure occurs when a client unexpectedly witnesses the therapist in a public place, such as at a protest or a locker room.   

    Inappropriate self-disclosures are those that primarily benefit the clinician. An example may be a clinician discussing a recent loss, but it may become an ethical violation when a therapist expresses a sexual attraction to a client. In contrast, appropriate self-disclosures are intentionally used with a sound clinical rationale for the client's welfare. Therapists sharing that they also have served in the military, have a child with diabetes, or experienced discrimination may help a client feel better understood.

    Laws and political changes influence our actions in therapy, including our discussion of politically sensitive issues (e.g., abortion and gender-affirming care). Psychologists practicing in more than one state must know the rules in each state and the consequences of ignoring them.


     Questions to consider regarding self-disclosure:

        * Who is this for, me or my client?

        *  What would be beneficial for my client?

        *  Will my self-disclosure be helpful or reassuring?

        *  Will my self-disclosure interfere with treatment goals?

        *  What are other potential costs?

        *  Can self-disclosure be prevented?

        * What would be the costs of preventing self-disclosure?

    Consider whether and why you decided to discuss George Floyd’s murder or the Dobbs decision with clients. Perhaps you self-disclosed your own feelings during that discussion. Your client’s perspective and goals might have influenced whether and how you discussed this case and shared your opinions. Self-disclosure may also be useful to encourage discussion of a different perspective. A psychologist working with a client with active war-related flashbacks disclosed her own anxiety about guns to admit the possibility of bias when discussing whether he should be carrying a gun, especially now.

    In some cases, self-disclosures about election results may have been made impulsively, while in others, disclosures may have been useful for normalizing a client’s stress or sense of outrage. With the opportunity to self-reflect, you could consider what would benefit your client and what would be helpful or reassuring. For example, you may have considered how sharing your pronouns would interfere with or enhance treatment goals or have other potential costs or benefits. Sometimes self-disclosure cannot be prevented, as when your office manager raises concerns about the election in your client’s earshot.

    While self-disclosure may have costs, not disclosing may also have costs, leaving a client wondering what is safe to discuss in session. It also models overly rigid boundaries and fails to demonstrate how self-disclosure can be used well. For all cases of potential self-disclosure, however, especially those about politically sensitive issues, whether one should self-disclose depends on several factors that can be identified through consultation or periods of self-reflection. As described above, these factors include an analysis of the client, the client’s goals, needs, and context.

 

Reference available from author

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psychologists' ethical use of self disclosure

Linda K. Knauss, Ph.D., ABPP, is a Professor at Widener University’s Institute for Graduate Clinical Psychology. She is a past chair of the APA’s Ethics Committee. She has authored several book chapters and journal articles on ethics and teaches many continuing education workshops on ethical issues.

Her email address is: lkknauss@gmail.com

    Jeanne Slattery, Ph.D., is a Professor of Psychology at Pennsylvania Western University. She has written three books on therapy, numerous articles and chapters on meaning-making and ethics, and has presented many continuing education workshops on ethics. She recently served as president of the Pennsylvania Psychological Association.

Her email address is: jslattery176@gmail.com.

How are tabletop role-playing games being used in therapy?

By Megan A. Connell, Psy.D.

tabletop role playing games for therapy

     Therapists desire to have effective outcomes in their work. One known method of increasing treatment outcomes is connecting with clients through their culture and interests or establishing strong rapport. In an effort to help meet clients where there are more and more therapists are finding ways to bring niche interests into the therapy office.

     

     One such tool is Tabletop Role-Playing Games (TTRPG), such as Dungeons & Dragons (D&D). TTRPGs are narrative-based games where one player acts as the narrator of the story, often called the Game Master (GM), and the other players take on the role of the main characters of the story, called a Player Character (PC).

    In most Tabletop Role-Playing Games, the players will explore three main themes: exploration, role-play, and combat.

    Exploration refers to the players having their characters interact with the game's world. This can be studying the history of a location to solve a mystery or going through the wilderness to see what they might find.

    Role-playing is when the players speak in character to one another or non-player characters (NPC) that the Game Master (GM) controls.

    Combat is when the players need to overcome a challenge, which might be fighting a dragon, disarming a trap, or escaping a temple that is collapsing.

    Each individual meeting of a Tabletop Role-playing Game (TTRPG) is called a session. The entire story is called a campaign. Campaigns can last as long as a single session or go on for years. As a campaign progresses, the Player Characters (PCs) will gain experience and learn new abilities as their characters become more powerful. Most campaigns have a central tension that the players need to solve, and when it is resolved, the campaign will come to a close.

    There are many different styles of TTRPGs. Many, like D&D, utilize a fantasy sword and sorcery setting, while others, such as Kids on Bikes, allow players to play in a 1980s-type setting reminiscent of Stranger Things. There are also games set in a cyberpunk world, zombie horror settings, or

a world of superheroes. The genera of the story is incredibly diverse,

as are the different rule sets. This allows most people to find a style of TTRPG

that fits into at least one of their personal interests.

    Therapists worldwide have found that these games seem to be an effective tool for group

therapy, referred to as applied gaming. A typical applied TTRPG will have the clinician

act as the GM while the clients create characters that will engage with the story. Each player will

have a sheet of paper with information about their character’s abilities and skills called the

character sheet.

    The creation of characters seems to be central to why TTRPGs are an effective tool in therapy. The character is an extension of the player but is not the player themselves. This distance seems to help the player, not the consequences of their player’s actions, in a way that does not trigger typical ego defenses. Thus, mistakes do not feel like an attack on the player’s skills and abilities.

    Role-playing is nothing new to therapy. It can be difficult to get people to engage in role-play, though. This seems to be in large part due to social anxiety. Much of the hesitation to role-play seems to dissipate when the person has a character sheet to help guide them in their role-play.

     The applied GM can use role-play in their game to help their clients/players practice therapeutic outcomes. For example, if the group is learning social skills, an exploration encounter of having the group attend a formal banquet might allow for opportunities to practice the skills they are learning.

    Another effective piece of role-playing in Tabletop Role-Playing Games (TTRPGs) is that time can be paused. For example, a player attending the above-mentioned banquet might be in the midst of a conversation with non-player characters (NPCs) if they do not know what to say. The player can ask the rest of the group for their feedback. The applied GM might even pause the gameplay to help the group talk through how to think of solutions for the presented problem.

    Though TTRPGs are being used globally as a therapy tool, as of this article's writing, there is limited research on the topic. TTRPGs are now used in therapy in a way that has much in common with creative arts therapy, play therapy, and psychodrama. So, while there is not yet sufficient research on specifically using TTRPGs, there is evidence to suggest that they could be at least as effective as other creative tools in therapy.

    For more information on using TTRPGs in therapy, I co-authored an article entitled "The Rise of the Use of TTRPGs and RPGs in Therapeutic Endeavors" published (https://savvysciencepublisher.com/jms/index.php/jppr/article/view/891).

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Megan A. Connell, Psy.D., is a board-certified psychologist and former US Army psychologist. She authored the book Tabletop Role-Playing Therapy: A Guide for the Clinician Game Master through Norton Publishing. She works at Health Quest Innovative Therapeutics, a group practice she co-founded.

More information can be found at www.HQPsych.com or www.MeganPsyD.com 

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