Brendan J Dunlop, Clinical Psychologist in training
Mental health practitioners have long known the importance of the therapeutic relationship (the professional, safe and confidential relationship that exists between practitioner and service user) for effective mental health care delivery. In fact, we know that the therapeutic relationship is one of the key drivers for change, regardless of the therapeutic modality being delivered (Ardito and Rabellino, 2011).
Because the therapeutic relationship is so important, it makes sense to pay attention to the nuances of this dynamic. For some service users, being able to ‘see’ their mental health practitioner as a human being, akin in ways to them, and fallible as well to the messy world we find ourselves in, can be incredibly powerful for this relationship (Lovell et al., 2020). The process of doing this, where appropriate and in the service user’s best interests, is usually referred to as self-disclosure. However, due in part to historical narratives of ‘us’ (the psychologically well) versus ‘them’ (the psychologically unwell), and the dominance of specific therapeutic modalities, self-disclosure within mental health care is an area that many practitioners feel uncomfortable, unprepared or unsupported in managing (Dunlop et al., 2021).
This short blog presents a novel framework, grounded in international research, for helping guide practitioners that wish to consider or use self-disclosure in their work with service users. It is called the Sharing Lived Experiences Framework, or SLEF for short (Dunlop et al., 2021), and has been co-created by academics, clinicians, service users and peer support workers. This framework guides the practitioner through a series of questions and reflective prompts, and is split into six areas. These six areas aim to help the practitioner consider how prepared they might feel to disclose, how comfortable, competent and confident they feel, how relevant their disclosure is to the topic at hand and the relationship in general, and how they can use supervision to reflect and learn from this process. The SLEF is intended as a tool that can be used both in individual supervision, but also as a self-guided self-reflective tool.
Self-disclosure is always a personal choice. The SLEF recognises that not all practitioners will feel comfortable disclosing. Indeed, there is a broad range of disclosures that a practitioner could make, that have varying ‘levels of comfort’. For example, telling a service user that your favourite colour is blue may feel more comfortable than disclosing that you have also experienced anxiety in your life. The act of disclosure, and the process of managing this, still arguably needs careful consideration. The SLEF is therefore suitably broad in the questions that it poses, to enable it to be applicable to a majority of disclosures.
Until now, no comprehensive framework has existed to allow practitioners to navigate this area. Preliminary data from staff training sessions found that staff confidence and competence in managing and using self-disclosure with service users increased after training on the SLEF. I would invite colleagues to think about how this framework could work within your services, and I invite feedback on how this could be developed further for specific populations and groups.
You can interact with Brendan through twitter, or he is directly contactable through his university email account:
You can access the paper that this framework is based on at the following link: https://doi.org/10.1080/02650533.2021.1922367
The framework itself is provided in pdf form below.
Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology, 2, 270. https://doi.org/10.3389/fpsyg.2011.00270
Dunlop, B. J., Woods, B., Lovell, J., O’Connell, A., Rawcliffe-Foo, S. & Hinsby, K. (2021). Sharing Lived Experiences Framework (SLEF): a framework for mental health practitioners when making disclosure decisions. Journal of Social Work Practice. https://doi.org/10.1080/02650533.2021.1922367
Lovell, J., O’Connell, A., & Webber, M. M. (2020). Sharing Lived Experience in Mental health Services. In L. B. Joubert, & M. Webber. (Eds), The Routledge Handbook of Social Work Practice Research (pp. 368–381). Routledge.