This is an anonymous survey about the use of self disclosure by either a licensed psychotherapist, psychiatrist, counselor or social worker, or a student of psychotherapy, psychiatry, counseling or social work.
A Story
INSTRUCTIONS: Please read the story below. At the end of the story, you will find there are a series of questions written in blue. Please answer these questions. Do not worry about how you answer them, just write freely, as much as you are able to write.
Jeff Watters, a 40 year old Caucasian physician, is living with his wife in a suburban home they purchased several years ago. For the past two years, Jeff has been in therapy with Dr. Steven Knox, seeing him in his office. Dr. Knox is an integrative therapist, using humanistic, cognitive and psychodynamic techniques. Jeff initially came to see Dr. Knox for help with anxiety about his work situation, and arguments he was having with his wife. Recently their marriage has deteriorated to the point that they are talking about getting a divorce. Dr. Knox is 50 and went through a difficult divorce himself ten years earlier.
In the early phase of treatment Jeff and Dr. Knox were focused on his low self-confidence, problems he was having at work, and in his marriage. Currently, his wife has been more and more demanding, as increasingly she has been blaming Jeff for her own unhappiness. Jeff has found himself trying to please her and when his efforts fail, he feels responsible.
Recently, Jeff realized she had become emotionally abusive. He found that he wanted out of the marriage but he was having a difficult time leaving. Dr. Knox listened patiently. At some point, he told Jeff that he too had gone though a difficult divorce years earlier.
What do you think about Dr. Knox telling Jeff about his own divorce? What do you think he might have felt after disclosing this personal information? What effect do you think this intervention may have had on Jeff’s psychotherapy?
Write as much as you can in the space below.
In the following questionnaire, self-disclosure is defined as “verbalized personal revelations made by the therapist to the client” (Watkins, 1990, pp.478). This practice is distinguished from self-involving statements, which are comments made by the therapist regarding the therapy process (Edwards, 1994).
These are questions about self-disclosure. Please answer using the 1 to 5 response scale indicated.
Use the scale below to record how willing you would be to reveal information about yourself to the person(s) in each question. Select the number which best indicates the degree of self-disclosure at which you would be comfortable in the situation. Write the number you select on the line to the left of the question. In looking at the numbered scale, you will see that only the numbers at the far left and far right (1 and 6) have been described. You should, however, use any of the numbers which best represent your reaction to the situation. The numbers from 1 to 6 are to be understood as indicating gradually increasing degrees of willingness to disclose at a personal level in that situation.
Below is a list of situations. Imagine yourself in each of the situations and then indicate, using the numbered scale, the degree to which you would be willing to disclose. Please answer every question.
1 2 3 4 5 6 1. You are on a blind date.
1 2 3 4 5 6 2. You are having dinner at home with your family.
1 2 3 4 5 6 3. You are sightseeing with a tour group in Europe.
1 2 3 4 5 6 4. You are sitting next to a stranger on an airplane.
1 2 3 4 5 6 5. You are with the family of a friend.
1 2 3 4 5 6 6. You are in a coffee shop with some casual friends.
1 2 3 4 5 6 7. You are being introduced to a group of strangers.
1 2 3 4 5 6 8. You are a member of a psychotherapy group.
1 2 3 4 5 6 9. You are at a party with some friends.
1 2 3 4 5 6 10. You are in the library with a friend.
1 2 3 4 5 6 11. You have picked up a hitch-hiker while driving.
1 2 3 4 5 6 12. It's evening and you are alone with your partner in his/her house.
1 2 3 4 5 6 13. You are applying for a job as a public relations consultant.
1 2 3 4 5 6 14. You are in a discussion group on human sexuality.
1 2 3 4 5 6 15. You are at a restaurant with your date.
1 2 3 4 5 6 16. You are meeting your girl/boyfriend's parents for the first time.
1 2 3 4 5 6 17. You are eating alone and a stranger asks if s/he may join you.
1 2 3 4 5 6 18. You are taking a walk in a park with your partner.
1 2 3 4 5 6 19. You and a friend are driving to California.
1 2 3 4 5 6 20. You are on a picnic with friends.
Here are a number of characteristics that may or may not apply to you. For example, do you agree that you are someone who likes to spend time with others? Next to each statement, please indicate the extent to which you agree or disagree with that statement.
Below are five statements that you may agree or disgree with. Using the 1 - 7 scale below indicate your agreement with each item by placing the appropriate number on the line preceding that item. Please be open and honest in your responding.
General Information
How did you hear about this study?
Age
Gender
Degree: M.D./Ph.D. M.D. Ph.D. Psy.D. M.T.F. Social Work Other Mental Health Profession M.D. student Ph.D. student Psy.D. student M.T.F. student Social Work student Other Mental Health Profession student Other
What country were you born/raised in? (Click for choices) United States (USA) United Kingdom (Great Britain) Canada Australia --- Abu Dhabi (United Arab Emirates) Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire (Netherlands Antilles) Borneo (Indonesia) Bosnia-Herzegovina Botswana Brazil British Guiana (Guyana) British Honduras (Belize) British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Ceylon (Sri Lanka) Chad Channel Islands (Great Britain) Chile China Colombia Comoros Congo (Zaire) Corsica Costa Rica Cote d lvoire (Ivory Coast) Crete (Greece) Croatia Cuba Curacao (Netherlands Antilles) Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Dubai (United Arab Emirates) Ecuador Egypt El Salvador England (Great Britain) Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland Formosa (Taiwan) France France, Metropolitan (France) French Guiana French Polynesia Gabon Gambia Georgia, Republic of Germany Ghana Gibraltar Great Britain and Northern Ireland Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man (Great Britain) Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North Korea) Korea (South Korea) Kuwait Kyrgyzstan Labrador (Canada) Laos Latvia Lebanon Lesotho Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, Republic of Madagascar Maderia Islands Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Moldova Monaco (France) Mongolia Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Newfoundland (Canada) Nicaragua Niger Nigeria North Borneo (Malaysia) Northern Ireland (Great Britain) Norway Okinawa (Japan) Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Qatar Reunion Romania Russia Rwanda Saba (Netherlands Antilles) San Marino Sao Tome and Principe Saudi Arabia Scotland (Great Britain) Senegal Serbia-Montenegro Seychelles Siam (Thailand) Singapore Slovak Republic Slovenia Solomon Islands South Africa Spain Sri Lanka St. Christopher and Nevis St. Eustatius (Netherlands Antilles) St. Helena St. Lucia St. Maarten (Netherlands Antilles) St. Martin (Guadeloupe) St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tahiti (French Polynesia) Taiwan Tajikistan Tanzania Tasmania (Australia) Thailand Tibet (China) Togo Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales (Great Britain) Wallis and Futuna Islands Western Samoa Yemen Zambia Zimbabwe
In what country do you practice? (Click for choices) United States (USA) United Kingdom (Great Britain) Canada Australia --- Abu Dhabi (United Arab Emirates) Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire (Netherlands Antilles) Borneo (Indonesia) Bosnia-Herzegovina Botswana Brazil British Guiana (Guyana) British Honduras (Belize) British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Ceylon (Sri Lanka) Chad Channel Islands (Great Britain) Chile China Colombia Comoros Congo (Zaire) Corsica Costa Rica Cote d lvoire (Ivory Coast) Crete (Greece) Croatia Cuba Curacao (Netherlands Antilles) Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Dubai (United Arab Emirates) Ecuador Egypt El Salvador England (Great Britain) Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland Formosa (Taiwan) France France, Metropolitan (France) French Guiana French Polynesia Gabon Gambia Georgia, Republic of Germany Ghana Gibraltar Great Britain and Northern Ireland Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man (Great Britain) Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North Korea) Korea (South Korea) Kuwait Kyrgyzstan Labrador (Canada) Laos Latvia Lebanon Lesotho Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, Republic of Madagascar Maderia Islands Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Moldova Monaco (France) Mongolia Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Newfoundland (Canada) Nicaragua Niger Nigeria North Borneo (Malaysia) Northern Ireland (Great Britain) Norway Okinawa (Japan) Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Qatar Reunion Romania Russia Rwanda Saba (Netherlands Antilles) San Marino Sao Tome and Principe Saudi Arabia Scotland (Great Britain) Senegal Serbia-Montenegro Seychelles Siam (Thailand) Singapore Slovak Republic Slovenia Solomon Islands South Africa Spain Sri Lanka St. Christopher and Nevis St. Eustatius (Netherlands Antilles) St. Helena St. Lucia St. Maarten (Netherlands Antilles) St. Martin (Guadeloupe) St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tahiti (French Polynesia) Taiwan Tajikistan Tanzania Tasmania (Australia) Thailand Tibet (China) Togo Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales (Great Britain) Wallis and Futuna Islands Western Samoa Yemen Zambia Zimbabwe
If you practice in the US, in what specific region do you practice?
What ethnic/racial/cultural, and/or national background do you most identify with?
Where would you place your parents on the following spectrum for social class?
Where would you place yourself on the following spectrum for social class?
Number of years of formal education your mother or father (whichever is the highest) has completed:
Number of years of formal education you have completed:
What is your religious background, i.e. what religion did you grow up with?
What is your present religion if any?
Sexual orientation
What is your housing status?(please check the one that applies best to you)
In general would you describe your political views as
How would you describe your psychotherapy orientation? (check all that apply) Cognitive Behavioral Cognitive Behavioral Interpersonal Psychotherapy Psychoanalytic Psychodynamic Humanistic Existential Family Systems Feminist Narrative Dialectical Behavioral Therapy (DBT) Acceptance and Commitment Therapy (ACT) Control Mastery Eclectic Integrative Psychopharmacology ONLY Other
What kind of setting do you practice in? (check all that apply) private clinic inpatient hospital community mental health university other
As a professional, I: (check all that apply) prescribe psychoactive medications provide brief psychotherapy provide long-term psychotherapy provide group pychotherapy provide family/couple's psychotherapy provide both medications and some form of psychotherapy
If your frequency of self disclosure has changed, to what do you attribute this change?
Thank you for taking the time to complete this survey.
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