Skip to main content Accessibility help

Culture and therapist self-disclosure

  • Peter Phiri (a1) (a2), Shanaya Rathod (a1), Mary Gobbi (a2), Hannah Carr (a1) and David Kingdon (a1) (a2)...


Cognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist’s reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists’ cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training.

Key learning aims

  1. (1)To develop a dialogue and practice with confidence when addressing issues of self-disclosure with diverse populations.
  2. (2)To appreciate the impact therapist self-disclosure has in early stages of engagement, in particular when working with patients from BME communities.
  3. (3)To understand the impact and role of self-disclosure as initiated by patients.
  4. (4)To increase therapist awareness on cultural differences in self-disclosure and develop ways to address this in therapy.
  5. (5)To challenge therapists to adapt psychological therapies to diverse cultures and be cognisant that ‘one size does not fit all’.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Culture and therapist self-disclosure
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Culture and therapist self-disclosure
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Culture and therapist self-disclosure
      Available formats


Corresponding author

*Corresponding author. Email:


Hide All
Derlega, V.J., & Berg, J.H. (1987). Self-Disclosure: Theory, Research and Therapy. New York and London, Plenum Press.
Farber, B. (2006). Self-Disclosure in Psychotherapy. New York, USA: Guilford Press.
Stricker, G., & Fisher, M. (1990). Self-Disclosure in the Therapeutic Relationship. New York, USA: Plenum.
Zur, O. (2007). Self-disclosure. In Boundaries in Psychotherapy: Ethical and Clinical Explorations, chapter 7, pp. 147165. Washington, DC, USA: APA Books.
Anderson, A., Elam, G., Solarin, I., Gerver, S., Fenton, K., & Easterbrook, P. (2009). Coping with HIV: Caribbean people in the United Kingdom. Qualitative Health Research, 19, 10601075.
Beck, J. S. (2007). Self-Disclosure in Therapy: Monday, 8 January 2007 at 8:59 pm and is filed under Cognitive Therapy, Judith S. Beck. Blog: available at: = (accessed 6 November 2010).
Berry, C., & Hayward, M. (2011). What can qualitative research tell us about service user perspectives of CBT for psychosis? A synthesis of current evidence. Behavioural and Cognitive Psychotherapy, 39, 487494.
Bhugra, D. (1997). Setting up psychiatric services: cross-cultural issues in planning and delivery. International Journal of Social Psychiatry, 43, 1628.
Bhui, K. (1997). London’s ethnic minorities and the provision of mental health services, pp. 143166. London’s Mental Health, London: King’s Fund Institute.
Bhui, K. (2002). Racism and Mental Health: Prejudice and Suffering. Jessica Kingsley Publishers.
Bitar, G. W., Kimball, T., Bermúdez, J. M., & Drew, C. (2014). Therapist self-disclosure and culturally competent care with Mexican-American court mandated clients: a phenomenological study. Contemporary Family Therapy, 36, 417425.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101.
Cantor-Graae, E., & Selten, P. (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry, 162, 1224.
Cashwell, C. S., Shcherbakova, J., & Cashwell, T. H. (2003). Effect of client and counsellor ethnicity on preference for counsellor disclosure. Journal of Counseling & Development, 81, 196201.
Cherbosque, J. (1987). Differential effects of counsellor self-disclosure statements on perception of the counsellor and willingness to disclose: a cross-cultural study. Psychotherapy: Theory, Research, Practice, Training, 24, 434437.
Corbin, J. (2017). ‘Grounded Theory’. Journal of Positive Psychology, 12, 301302.
Creswell, J. W. (2009). Research Design, Qualitative, Quantitative, and Mixed Method Approaches (3rd edn). Los Angeles, USA: Sage Publications.
Department of Health (2003). Delivering Race Equality: A Framework for Action. London, UK: Department of Health.
Department of Health (2005). Delivering Race Equality in Mental Health Care: an action plan for reform inside and outside services and the Government’s response to the independent inquiry into the death of David Bennett. Report no. 4393. London, UK: Department of Health.
Fearon, P., & Morgan, C. (2006). Environmental factors in schizophrenia: the role of migrant studies. Schizophrenia Bulletin, 32, 405408.
Fearon, P., Kirkbride, J. B., Morgan, C., Lloyd, T., Hutchinson, G., Tarrant, J., Fung, W. L., Holloway, J., Mallett, R., Harrison, G., Leff, J., Jones, P. B., & Murray, R. M. (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine, 36, 15411550.
Fisher, D. (1994). A psychiatrist’s gradual disclosure. New York State, Office of Mental Health, OMH News, 6, 16. Available at:
Fernando, S. (1988). Race and Culture in Psychiatry. Billing and Sons Ltd.
Forchuk, C. and Roberts, J. (1993). How to critique qualitative research articles. Canadian Journal of Nursing Research, 25, 4756.
Freedman, J., & Combs, G. (1996). Narrative Therapy: The Social Construction of Preferred Realities. New York, NY, USA: W.W. Norton & Co.
Freud, S. (1912). Recommendations to physicians practicing psycho-analysis. In Strachey, J. & Freud, A. (eds), The Standard Edition of the Complete Psychological Works of Sigmund Freud, volume XII (1911–1913): The Case of Schreber, Papers on Technique and Other Works (pp. 109120). London, UK: Hogarth Press, 1958.
Goldfried, M. R., Burckell, L. A., & Eubanks‐Carter, C. (2003). Therapist self‐disclosure in cognitive‐behavior therapy. Journal of Clinical Psychology, 59, 555568.
Goldsmith, L. P., Lewis, S. W., Dunn, G., & Bentall, R. P. (2015). Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis. Psychological Medicine, 45, 23652373. doi: 10.1017/S003329171500032X
Gondim, P. T. (2006). Self-Disclosure – Underpinnings and Applications. Available at: = (accessed 23 August 2009).
Haddock, G., Eisner, E., Boone, C., Davies, G., Coogan, C., & Barrowclough, C. (2014). An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia. Journal of Mental Health, 23, 162165. doi: 10.3109/09638237.2013.869571
Hays, P. A., & Iwamasa, G. Y. (2006). Culturally Responsive Cognitive Behaviour Therapy: Assessment, Practice and Supervision. Washington, DC, USA: American Psychological Association.
Healthcare Commission (2008). ‘Count Me In Census’. Results of the 2008 national census of inpatients in mental health and learning disability services in England and Wales. Published by 2008 Commission for Healthcare Audit and Inspection.
Henretty, J. R., & Levitt, H. M. (2010). The role of therapist self-disclosure in psychotherapy: a qualitative review. Clinical Psychology Review, 30, 6377.
Hsieh, H., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 12771288.
Hyman, I. (2008). Self-Disclosure and its Impact on Individuals who Receive Mental Health Services. HHS Publication No. (SMA)-08-4337. Rockville, MD, USA: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Available at:
Jackson, J. S., Neighbors, H. W., Torres, M., Martin, L. A., Williams, D. R., & Baser, R. (2007). Disentangling mental health disparities: use of mental health services and subjective satisfaction with treatment among Black Caribbean immigrants: results from the National Survey of American Life. American Journal of Public Health, 97, 6167.
Kaufman, S. E. (2016). The effects of therapist self-disclosure of a mental health condition on client perceptions of the therapist. PCOM Psychology Dissertations, 365. Doctoral Thesis, Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM
Keating, F. & Robertson, D. (2004). Fear, black people and mental illness: a vicious circle? Health and Social Care in the Community, 12, 439447.
Keating, F., Robertson, D., Francis, F., & McCulloch, A. (2002). Breaking the Circles of Fear: A Review of the Relationship between Mental Health Services and African and Caribbean Communities. Sainsbury Centre for Mental Health.
Keating, F. (2007). African and Caribbean men and mental health. Race Equality Foundation.
Kingdon, D. (2010). Oversimplification and exclusion of non-conforming studies can demonstrate absence of effect; a lynching party? Psychological Medicine, 40, 2527.
King, M., Nazroo, J., Weich, S., McKenzie, K., Bhui, K., Karlsen, S., Stansfeld, S., Tyrer, P., Blanchard, M., Lloyd, K., McManus, S., Sproston, K., & Erens, B. (2005). Psychotic symptoms in the general population of England: a comparison of ethnic groups (the EMPIRIC study). Social Psychiatry and Psychiatric Epidemiology, 40, 375381.
Kirkbride, J. B., Fearon, P., Morgan, C., Dazzan, P., Morgan, K., Tarrant, J., Lloyd, T., Holloway, J., Hutchinson, G., Leff, J., Mallet, R. M., Harrison, G., Murray, R. M., & Jones, P. B. (2006). On behalf of the AESOP Study Group. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP study. Archives of General Psychiatry, 63, 250258.
Kirkbride, J. B., Errazuriz, A., Croudace, T. J., Morgan, C., Jackson, D., Boydell, J., Murray, R. M., & Jones, P. B. (2012). Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PloS ONE, 7, e31660. doi: 10.1371/journal.pone.0031660
Kitzinger, J. (1995). Qualitative research: introducing focus groups. British Medical Journal, 311, 299302.
Krueger, R. A. (1994). Focus Groups: a Practical Guide for Applied Research (2nd edn). Los Angeles: Sage Publications.
Kvale, S. (1996). Interviews: An Introduction to Qualitative Research Interviewing. Los Angeles: Sage Publications.
Laungani, P. (2004). Asian Perspectives in Counselling and Psychotherapy. New York, USA: Brunner-Routledge.
Leininger, M. (1994) ‘Evaluation Criteria and Critique of Qualitative Research Studies’ in Morse, J.M. (ed.), Critical Issues in Qualitative Research Methods (pp. 95115). Thousand Oaks, USA: Sage Publications.
Lewins, A., & Silver, C. (2007). Using Software in Qualitative Research: A Step by Step Guide. Los Angeles: Sage Publications.
Levitt, H. M., Minami, T., Greenspan, S. B., Puckett, J. A., Henretty, J. R., Reich, C. M., & Berman, J. S. (2016). How therapist self-disclosure relates to alliance and outcomes: a naturalistic study. Counselling Psychology Quarterly, 29, 728.
Lombard, D. (2008). Healthcare Commission survey reveals increase in proportion of BME patients. Available at: (accessed February 2009).
Luft, J., & Ingham, H. (1955). The Johari window, a graphic model of interpersonal awareness. Western training laboratory in group development. Los Angeles: University of California.
Lynch, D., Laws, K. R., McKenna, P. J. (2009). Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychological Medicine, 40, 924. doi: 10.1017/S003329170900590X
Merton, R. K., Fiske, M. & Kendall, P. L. (1990). The Focused Interview: a Manual of Problems and Procedures (2nd edn). Collier MacMillan.
McCabe, R., & Priebe, S. (2004). Explanatory models of illness in schizophrenia: comparison of four ethnic groups. British Journal of Psychiatry, 185, 2530.
McCulloch, A., Ryrie, I., Williamson, T., & St John, T. (2005). Has the medical model a future? The Mental Health Review, 10, 715.
Morse, J., & Field, P. (1996). Nursing Research: The Application of Qualitative Approaches. Chapman & Hall.
Nazroo, J. Y. (1997). Ethnicity and Mental Health: Findings from a National Community Survey. Policy Studies Institute.
NICE (2014). Psychosis and Schizophrenia in Adults: Treatment and Management. NICE Clinical Guideline 178. London, UK: NICE. Available at:
NICE (2009). Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Adults in Primary and Secondary Care. NICE Clinical Guideline 82. London, UK: NICE.
Office for National Statistics (2001). Census of population. Available at:
Office for National Statistics (2011). Ethnicity and National Identity in England and Wales: 2011. Available at:
Parkman, S., Davis, D., Leese, M., Phelan, M., & Thornicroft, G. (1997). Ethnic differences in satisfaction with mental health services among representative people with psychosis in South London: PriSM Study 4. British Journal of Psychiatry, 171, 260264.
Patel, S. (2016). An exploration of South Asian clients’ experiences of therapist self-disclosure in individual therapy. Doctoral dissertation, City University of London.
Patel, V., & Andrade, C. (2003). Pharmacological treatment of severe psychiatric disorders in the developing world: lessons from India. CNS Drugs, 17, 10711080.
Patterson, C. H. (1985). The Therapeutic Relationship: Foundations for an Eclectic Psychotherapy. Thomson Brooks/Cole Publishing Co.
Patterson, C. H., & Hidore, S. (1997). Successful Psychotherapy: A Loving, Caring Relationship, pp. 111113. Jason-Aronson.
Phiri, P. (2012). Adapting cognitive behaviour therapy for psychosis for black and minority ethnic communities. Doctoral thesis, University of Southampton, Faculty of Medicine.
Pinto, R., Ashworth, M., & Jones, R. (2008). Schizophrenia in Black Caribbeans in the UK: an exploration of underlying causes of the high incidence rate. British Journal of General Practice, 58, 429434.
Pinto-Coelho, K. G., Hill, C. E., & Kivlighan, D. M. Jr (2016). Therapist self-disclosure in psychodynamic psychotherapy: a mixed methods investigation. Counselling Psychology Quarterly, 29, 2952.
Polit, F., & Hungler, P. (1999). Nursing Research: Principles and Methods (6th edn). Lippincott.
Rack, P. (1992). Race, Culture, and Mental Disorder. London, UK: Tavistock Publications.
Rathod, S., Kingdon, D., Smith, P., & Turkington, D. (2005). Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics – data on a previously published randomised controlled trial. Schizophrenia Research, 74, 211219.
Rathod, S., Naeem, F., Phiri, P., & Kingdon, D. (2008). Expansion of psychological therapies. British Journal of Psychiatry, 193, 256.
Rathod, S., Kingdon, D., Phiri, P., & Gobbi, M. (2010). Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users and health professionals views and opinions. Behavioural and Cognitive Psychotherapies, 38, 511533
Rathod, S., Phiri, P., Harris, S., Underwood, C., Thagadur, M., Padmanabi, U., & Kingdon, D. (2013). Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophrenia Research, 143, 319326.
Rathod, S.,Gega, L., Degnan, A., Pikard, J., Khan, T., Hussain, N., Munshi, T., & Naeem, F. (2017). The Current Status of Culturally Adapted Mental Health Interventions: A Practice-Focused Review of Meta - Analyses. Neuropsychiatric Disease and Treatment. Dove Medical Press.
Raleigh, V. S. (2000). Mental health in black and ethnic minorities: an epidemiological perspective. In Kaye, C., and Lingiah, T. (eds), Race, Culture and Ethnicity in Secure Psychiatric Practice. London and Philadelphia, Jessica Kingsley Publishers.
Richie, J., & Lewis, J. (2003). Qualitative Research Practice: A Guide for Social Science Students and Researchers. Los Angeles: Sage Publications.
Rowan, J. (2008). A triumph for the humanistic approach: a customer’s book review of Dimaggio et al. (2007). Psychotherapy of Personality Disorders: States of Mind and Interpersonal Cycles. Routledge. Available at: (accessed 5 May 2009).
Sharpley, M., Hutchinson, G., Murray, R.M., & McKenzie, K. (2001). ‘Understanding the excess of psychosis among African-Caribbean population in England’: review of current hypothesis. British Journal of Psychiatry, 178, 6068.
Simone, D. H., McCarthy, P., & Skay, C. (1998). An investigation of client and counsellor variables that influence likelihood of counsellor self-disclosure. Journal of Counselling and Development, 76, 174182.
Simons, L., Lathlean, J., & Squire, C. (2008). Shifting the focus: sequential methods of analysis with qualitative data. Qualitative Health Research, 18, 120132.
Smith, J., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory, Method and Research. London: Sage Publications.
Specialist Library for Ethnicity and Health (SLEH) (2009). Schizophrenia and ethnic minorities in Britain: an urgent need to improve the evidence base. Published by SLEH. Available at: = (accessed on 17 June 2009).
Spradley, J. P. (1980). Participant Observation. Fort Worth: Holt, Rinehart, and Winston.
Stewart, D. W., & Shamdasani, P. N. (1990). Focus Groups: Theory and Practice. Sage Publications.
Strong, R. S. (1978). Social psychological approach to psychotherapy research. In Garfied, L. & Bergin, A.E. (eds), Handbook of Psychotherapy and Behaviour Change (2nd edn), pp. 101136. Wiley.
Sue, D. W., & Sue, D. (2003). Counselling the Culturally Diverse: Theory and Practice (4th edn). Wiley.
Tseng, W.-S., Chang, S. C., & Nishjzono, M. (2005). Asian Culture and Psychotherapy: Implications for East and West. USA, University of Hawaii Press.
Velthorst, E., Koeter, M., van der Gaag, M., Nieman, D.H., Felt, A.K., Smit, F. et al. (2015). Adapted cognitive behavioural therapy required for targeting negative symptoms in schizophrenia: meta-analysis and meta-regression. Psychological Medicine, 45, 453465.
Willig, C. (2008). Introducing Qualitative Research in Psychology: Adventures in Theory and Method (2nd edn). Maidenhead: McGraw-Hill Open University Press.
Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behaviour therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34, 523537.
Zimmermann, G., Favrod, J., Trieu, V. H., & Pomini, V. (2005). The effect of cognitive behavioural treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research, 77, 19.


Related content

Powered by UNSILO

Culture and therapist self-disclosure

  • Peter Phiri (a1) (a2), Shanaya Rathod (a1), Mary Gobbi (a2), Hannah Carr (a1) and David Kingdon (a1) (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Culture and therapist self-disclosure

  • Peter Phiri (a1) (a2), Shanaya Rathod (a1), Mary Gobbi (a2), Hannah Carr (a1) and David Kingdon (a1) (a2)...
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *