Psychoanalytic Social Work

ISSN: 1522-8878 (Print) 1522-9033 (Online) Journal homepage: http://www.tandfonline.com/loi/wpsw20

Self-Disclosure and Vulnerability

Karen Maroda PhD

To cite this article: Karen Maroda PhD (2003) Self-Disclosure and Vulnerability, Psychoanalytic
Social Work, 10:2, 43-52, DOI: 10.1300/J032v10n02_04

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Published online: 25 Sep 2008.

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Countertransference
in Psychoanalytic Treatment
and Supervision
Karen Maroda

[Editor’s note: This article is a review of Herbert Strean (2002) Contro-

versies on Countertransference, Northvale, NJ: Jason Aronson, 269
pages, $40.00]

Herbert Strean was a man who knew how to listen. I didn’t know him
personally, but having read his work, I have been impressed with his ca-
pacity for empathy, his ability to really hear the people he worked with,
and his own ability to change when what he heard did not jibe with what
he had been taught. Trained in classical Freudian psychoanalysis, Strean
began his professional transformation early in his career. One of his first
papers (1959) was titled “The Use of the Patient as Consultant.” In this
paper he talked about how his training left him ill-prepared for dealing
with very disturbed patients, finally throwing up his hands and simply

Karen Maroda, PhD, is a faculty member of the Medical College of Wisconsin and the
Minnesota Institute for Contemporary Psychoanalytic Studies, and maintains a private
practice in Milwaukee, Wisconsin.
She is an editorial board member of several prominent journals, including Contem-
porary Psychoanalysis and Psychoanalytic Psychology, and the author of numerous
publications, including two books, The Power of Countertransference (1991) and Se-
duction, Surrender and Transformation: Emotional Engagement in the Analytic Pro-
cess (1999).
Psychoanalytic Social Work, Vol. 10(2) 2003
http://www.haworthpress.com/store/product.asp?sku=J032
 2003 by The Haworth Press, Inc. All rights reserved.
10.1300/J032v10n02_04 43
 44 PSYCHOANALYTIC SOCIAL WORK

asking them what they needed from him. Dr. Strean never stopped learn-
ing, never stopped changing, and never stopped writing.
He was known for his sense of humor. He took the art of psychoanal-
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ysis and psychotherapy very seriously, always searching for a way to do

it better. But he did not appear to take himself too seriously. As we
know, the capacity for humor is dependent on an observing ego, and
Strean seems to have been constantly stepping back to look at what he
was doing and how his patients and students were responding. He was
the consummate teacher, yet apparently remained the consummate stu-
dent as well.
How fitting that his last book is devoted to the teaching process. I
think it unfortunate that this book is titled Controversies on Counter-
transference because, from my perspective, that is not really what the
book is about. It is more about the countertransferential entanglements
that embroil both the therapeutic and the supervisory relationships.
Strean proposed throughout this volume that self-disclosure of the
countertransference is the key to grid-locked treatments and grid-locked
supervisory relationships. Disclosure of the countertransference is a
topic of great interest to me (Maroda, 1991, 1994, 1999), which is why I
was asked to write this review essay. I appreciate the acknowledgement
of my work by Strean and applaud his efforts to pursue the notion of dis-
closure in the supervisory relationship, which I have not done. I regret
that he passed away before we could have a dialogue on some of the is-
sues he discusses in this book.
My first question to Strean would have been about the title. We all
want our books to have the largest audience possible. Why not title the
book more accurately so that it would immediately be considered as a
text in graduate schools and psychoanalytic institutes, where it would
be put to its best use? Why use a title that implies an in-depth discussion
of the disparate attitudes regarding countertransference and its clinical
applications when the book does not contain this? I deliberately chose a
title for this essay that more directly reflects the book’s contents in
hopes of drawing the attention of those who teach and supervise. I think
Controversies on Countertransference is an excellent basic text for
anyone in an analytic or psychodynamic training program and hope that
the book will come to be known and used in this way.
I wish I could tell the potential reader that this is all new material by
Strean, but it is not. He is the major contributor, writing every chapter,
followed by commentaries by discussants, all of whom are experienced
analytic teachers and supervisors. Most of the chapters were written by
Strean in the last few years. But they have all appeared previously as
 Karen Maroda 45

journal contributions. Speaking of which, whatever happened to the no-

tion of Collected Papers? Does it seem too egotistical in our narcissis-
tic-phobic analytic culture? Can you only have collected papers after
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you have died? It seems to me that collecting related papers from nu-
merous journals and publishing them in book form is a good idea. And
many analytic books are, in fact, exactly that. It is rare to find a book
that is comprised of entirely original material, perhaps because most
writers seem to prefer to quote journal articles over books, and also
have easier access to them. Much of the best material in books has been
previously published in major journals. And there is a good reason for
this phenomenon. With so many books being published and so few li-
braries having the monies to purchase them all, it is far easier to obtain a
copy of a journal article than a book, unless one is willing to purchase it.
Better to save your best ideas for journal articles and include them in a
book later.
So Strean’s latest volume is not filled with new material, but it is
filled with valuable material that has been neatly collected, with the
aforementioned added discussion at the end of each chapter. These dis-
cussions serve to broaden the range of opinions offered and, presum-
ably, to provoke the reader to his or her own appraisal. The added
dialogue is one feature of the book that makes it a good teaching tool.
The dialogue format encourages the reader to think for himself about
the issues and mentally engage in assessing their merit. Used in a class-
room or study group, it lends itself to lively participation by students or
candidates.
The first chapter provides a brief, highly readable introduction to the
topic of countertransference and the arguments for self-disclosure. A
student looking for in-depth knowledge of the subject would have to
look further, but Strean adequately covers the basics and points the in-
quisitive reader in the right directions to learn more.
In the second chapter Strean makes a statement with which it is hard
to disagree. He says that “candidates quite frequently tended to misuse the-
oretical concepts to provide a rationale for many of their counter-
transference enactments and counterresistances” (p. 43). This chapter
describes how the supervisee’s defensiveness can expand exponentially
through the phenomenon of parallel process. If the supervisor is also de-
fensive it can become impossible to determine whose psychodynamics
are dominating not only the supervisory relationship, but also the ther-
apy one. The two discussants on this chapter echo Strean’s thoughts on
the subject.
 46 PSYCHOANALYTIC SOCIAL WORK

Throughout this volume Strean aims to de-mythologize the supervi-

sory experience, pointing out the pitfalls of supervisor and supervisee
assuming omniscience on the supervisor’s part. I think Strean was right
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in saying that even though the two-person approach has radically

changed the way we look at the relationship between analyst and patient,
there has not been a corresponding shift in our view of supervision.
Many supervisors, particularly if they have made a name for themselves
in the field, collude with their awe-struck students in sustaining the be-
lief that the supervisor knows all and does everything perfectly. Not all
students are so deferent, of course.
One subject Strean does not discuss is that many analytic candidates
are painfully aware of their supervisor’s flaws and narcissism, but feel
compelled to play along so that there are no impediments to their gradu-
ation. In either case, everyone loses when the supervisory relationship
is swayed in the direction of imitating and pleasing the supervisor rather
than examining how each member of the triad contributes to what is
happening in the sessions. In all fairness, I want to point out that not all
supervisors fall into one of these categories, yet all of us certainly do at
times. And the challenges of supervision are substantial. It is quite diffi-
cult enough to make some sense of the transference-countertransference
process in the therapy relationship. Adding the third dimension through
supervision can provide a more objective view that can enlighten the
supervisee, provide an overlay of distracting pet theories, distractions
and misdirections, and everything in-between. After forty years as an
analytic teacher and supervisor, Strean was keenly aware and apprecia-
tive of these complexities.
Strean objected to the infantalizing culture of analytic institutes and
strove to create a more egalitarian, open relationship with both his pa-
tients and his supervisees. In his own practice he found the answer to re-
solving impasses was almost always a self-disclosure on his part. Strean
experimented and discovered that the simple act of telling the patient
that you are stumped and frustrated can open things up. His conviction
that therapist self-disclosure was invaluable in therapy led to his use of
it in supervision. Not surprisingly, he found it worked just as well there.
When the supervision seemed to be going nowhere, Strean self-
disclosed. He gives many clinical examples in the book that illustrate
how he did this.
The third chapter takes the discussion a step further by discussing
parallel process and the evolution of the supervisory experience. Strean
says that in spite of what we now know and accept about subjectivity
and influence, vestiges of the supervisor as all-knowing remain. He
 Karen Maroda 47

says it is all too common for both candidate and supervisor to maintain
secrets that undermine the patient’s treatment.
Discussant Jerrold Brandell agrees with Strean’s main points, but
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adds that Strean may be underestimating the value of implementing an

ongoing intersubjective approach that involves more regular collabora-
tion and communication between supervisor and supervisee. He says
doing so can minimize the perfection seeking of both parties. More im-
portantly, Brandell makes the excellent point that an atmosphere of
openness and honesty naturally reduces the need of all parties to force
certain thoughts and feelings out of awareness. He agrees with Strean’s
point that contributions to impasses are often largely unconscious. But I
agree with Brandell’s implication that the degree of repression by all
parties in the relationship, ergo the likelihood of impasse, can be re-
duced through setting a tone of mutual emotional honesty. Extensive re-
pression and impasses may be common, but do they really have to occur
as frequently as they do? Brandell thinks not.
Stanley Teitelbaum also provided a commentary on Chapter 3 and,
like Brandell, added a new dimension to the discussion. He says that su-
pervisors contribute heavily to the frequency of impasses and that this
reality deserves more attention than it gets. He notes that it is too easy to
blame the supervisee in the way that we used to blame the patient when
things were not going well. He candidly reports that many treatments
not only do not end well, many therapists, and presumably supervisors,
are oblivious to the patient’s dissatisfaction. Citing a recent study where
both patient and therapist were interviewed following termination he
says,

Their findings indicated that therapists significantly underestimated

the role of dissatisfaction with treatment and the therapist as a cen-
tral factor in patients’ decision to terminate. These authors maintain
that therapists tend to have limited awareness of the real reasons
governing their patients’ decision to end treatment. (p. 101)

These results have obvious implications for the supervisory process. He

further states that even supervisors who are aware of the realities of par-
allel process may overuse the concept, effectively badgering their
supervisees by moving too quickly and too often to identify it, thereby
creating a defensive reaction in the supervisee.
Chapter 4 focuses on actual disclosure of the countertransference and
Strean gives many instructive examples. The chapter serves as a good
learning tool, but the discussion by Martha Stark that follows adds much
 48 PSYCHOANALYTIC SOCIAL WORK

more depth and complexity to the issue of self-disclosure. Like Brandell,

she points out that Strean makes a powerful and persuasive argument
for the use of self-disclosure, but questions his almost exclusive use of it
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for resolving impasses. She echoes Brandell’s thoughts that an ongoing

collaborative relationship might have actually prevented some of the
impasses. Stark refers to one of the case examples given by Strean to
support her theory. She recalls the patient named Bella saying to Strean,
“If you had told me earlier in the game that you were furious with me,
we could have had a better dialogue.” Stark says,

In essence, Bella is suggesting that had Strean been more comfort-

able with a two-person, interactive model from the beginning, then
perhaps they could have had a more meaningful, more mutual ex-
change from that point forward. (p. 148)

Stark dares to suggest what few people ever address, that Strean has a
pattern of provoking certain responses in patients, observable in the
clinical material he provides. Stark says,

With respect to Strean, it would be important for him to consider why

some of his patients experience him as weak and ineffectual and as
someone who can be mocked and treated contemptuously. (p. 150)

I think Stark’s argument has much to say for it and I admire her cour-
age in being willing to state it. She confronts us with another oft-
ignored issue, the therapist’s re-creation of his or her past within the
treatment. I have commented on this previously and also placed it in the
context of countertransference dominance (Maroda, 1991) and mutual
projective identification (Maroda, 1999). I have found that if I read sev-
eral case examples presented by any clinician I can clearly see a pattern
of that person stimulating similar feelings in most of his or her patients.
Likewise, therapists seem to have repetitive patterns of counter-
transference feelings across patients. Some therapists are consistently
bored or depressed, others are overstimulated and overwhelmed, still
others are perpetually annoyed, have rescue fantasies, or are sexually
aroused. I might add that the match no doubt plays a large part in this
phenomenon as well. There has to be a certain shared emotional make-up
or early experience that allows any analyst-patient pair to attach to each
other, regress together, and stay in the relationship. And I think that is
why our pathology does not necessarily interfere with the treatment. If
 Karen Maroda 49

our patients do well and stay with us, we probably are providing the
right environment for them to re-create their pasts.
It is easier, of course, to identify these patterns in others. But I have
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often emphasized that trainees can be taught to look for these patterns,
which gives them permission to be imperfect and also helps them to
make therapeutic use of their vulnerabilities. Knowing, for example,
that I tend to feel unappreciated helps me to keep it in perspective when
this feeling arises in response to one of my patients. I know that when-
ever I feel this way it has as much, or more, to do with me than it does
with them. And sometimes I may actually encourage my patients to take
me for granted so that I can have this experience. Stark rightly identifies
this as one of the critical issues related to therapist self-examination and
to training and supervision.
Chapter 5 is perfectly placed, since Strean continues the evolution of
his subject matter to discuss the added complexities created by the su-
pervisory third. He says,

Just as the therapist has to decide with the client when and how to
support her, when and what to clarify or interpret, the supervisor
has to determine with the supervisee what will be most beneficial
to the supervisee at a particular time with a particular patient.
Not only does the supervisor have to deal with her counter-trans-
ference reactions to the supervisee but she also has to cope with her
countertransference toward the supervisee’s client. (p. 163)

Strean again emphasizes the value of self-disclosure for breaking im-

passes in supervision, noting how sharing his own vulnerabilities seems
to have the same powerful impact in supervision that it does in treat-
ment. Discussant Gildo Consolini agrees. He says, “ . . . I can safely say
that dissatisfaction with the supervisory process and situation is com-
mon” (p. 187). Again we see the parallel. Patients are not nearly as
happy with their treatments as their therapists believe they are, and
supervisees are equally mixed about their supervisory experiences.
Strean and Consolini think greater emotional honesty, and a willingness
on the part of therapists and their supervisors to make themselves vul-
nerable, can help this situation. So do I.
Chapter 6 presents Strean’s observations regarding the frequency
with which analytic candidates flounder shortly after graduation. He be-
lieves they commonly suffer from a crisis in confidence regarding their
abilities, and even their choice of profession. He attributes this to the
aforementioned infantalization of candidates at most analytic institutes
 50 PSYCHOANALYTIC SOCIAL WORK

and discussants James Hull and Angelo Smaldino agree with him.
Smaldino adds that institutes promote a degree of conformity that is not
productive.
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The final chapter of this book is really an extensive case study of a

man who literally would not reveal his name to Strean until the 217th
session. It is impossible to read this fascinating study of a rather para-
noid individual without being amazed at Strean’s capacity for empathy
and his patience. His description of his painstaking work with this pa-
tient is a noteworthy classic. Following on the heels of the previous
chapters devoted to the therapeutic and supervisory processes, this case
was no doubt intended as an example of what can be achieved. But I
think it would have been much more effective if Strean had added com-
mentary linking it to the previous chapters. Elaborations on his counter-
transference and on how the treatment ended (since it was originally
published in 1984) and what he did well or would have done differently
would have greatly enhanced the use of this case history.
I stated earlier in this essay that the title, Controversies on Counter-
transference, is really a misnomer in spite of being attached to a good
teaching tool. Had the book actually addressed some of the controversy
surrounding the therapeutic use of countertransference, it would have
included some of the arguments against disclosure, which I will briefly
summarize here. They are:
1. self-disclosure is not well-defined,
2. there is no consensus on when and how to use it,
3. there is no consensus on what makes it therapeutic,
4. it can result in the therapist interfering with the patient’s narrative
flow, and/or restricting his or her associations for fear of upsetting
the therapist,
5. it can be used extensively by the therapist for his or her own nar-
cissistic gratification rather than to help the patient, and
6. it can be inaccurate or incomplete, in that it presumes the thera-
pist’s ability to accurately identify exactly what he or she is feel-
ing at any point in time.
I do not intend to take on the task of rebutting each of these argu-
ments, and I think any reasonable person would have to admit that any
intervention could be used non-therapeutically, including self-disclo-
sure. I am more interested in continuing the discussion begun by Strean
about the therapeutic value of self-disclosure. It is important that we un-
derstand what makes it therapeutic if we are to use it well. When you
read Strean’s case material you can sense that he knew how to use it,
 Karen Maroda 51

that his vast clinical experience and willingness to listen to his patients
and supervisees helped him to know when it was absolutely necessary
for him to self-disclose. You can tell he had reached a point when he
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knew that nothing else would do. I think if he had lived longer he would
have ultimately come to the conclusion discussed by Brandell and
Stark, that it could be used therapeutically before the point where noth-
ing else would do.
But what is it exactly about self-disclosure that can make it so thera-
peutic? What gives it that impasse-shattering power in both therapy and
supervision? Time does not permit a discussion of when and how to use
it, but I began this task in The Power of Countertransference (1991),
which Strean references. For the purposes of this essay I am more con-
cerned with Strean’s conviction that works extremely well. What is the
therapeutic action of self-disclosure? Strean quotes Gorkin, who pro-
vides a list of important reasons for disclosing, such as confirming the
patient’s reality. I refer the reader to Gorkin (1987) for the others.
Strean uses the word ‘vulnerability’ more than anyone else I have
read on countertransference, and I think he intuitively understood what
the therapeutic action of self-disclosure was. He knew he couldn’t just
say the words. He repeatedly talks about making himself vulnerable to
his patients and his supervisees. His disclosures were acts of surrender,
not merely the relating of information. They were sincere, emotional,
and immediate. They were sometimes scary. Strean was a courageous
man who was willing to risk being hurt and humiliated by his patients.
But it does not seem that he often was. He bared his throat and they were
moved to their own vulnerability more often than they were moved to
attack. In fact, his critical, angry patients seem to do a complete reversal
of attitude when he makes himself vulnerable.
If you look at self-disclosure this way, any arguments about the limits
of the analyst’s self-knowledge become superfluous. It is not complete
accuracy that matters. In fact, there are times when it may not matter at
all. From my own clinical experience, I am convinced that the act of sur-
render itself is much more important than what is said. And I do not
mean to downplay the importance of providing emotional feedback for
many patients as a therapeutic tool. But I am equally impressed by how
often the feedback itself is not what the patient focuses on. Rather it is
the analyst’s willingness to make himself vulnerable, as Strean does. It
is his ability to be emotionally present, to show his patients respect by
being honest with them, rather than placating or ignoring them, that
stimulates them and opens them to new experience.
 52 PSYCHOANALYTIC SOCIAL WORK

Strean was a man of conviction, and he was clearly convinced of the

value of self-disclosure in therapy and supervision. He did not want to
be perceived by his students as all-knowing. He wanted them to under-
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stand how imperfect we all are, and how many mistakes we make in a
given day. I imagine he hoped that this final book would influence oth-
ers to practice and supervise differently. I hope it does.

REFERENCES
Gorkin, M. (1987). The Uses of Countertransference. Northvale, NJ: Aronson.
Maroda, K. (1991). The Power of Countertransference: Innovations in Analytic Tech-
nique. Wiley: Chichester.
Maroda, K. (1994). The Power of Countertransference (Softcover). Northvale, NJ:
Aronson.
Maroda, K. (1999). Seduction, Surrender and Transformation: Emotional Engagement
in the Analytic Process. Hillsdale, NJ: The Analytic Press.
Strean, H. (1959). The use of the patient as consultant. Psychoanalysis and the Psycho-
analytic Review, 46: 53-63.