Disclosure, HIV, and the Dialectic of Sameness and Difference

ABSTRACT

Generally a distinction is made between the disclosure of personal information and the disclosure of countertransference feelings to a patient. While this may be a necessary distinction to make in the interest of carrying on a coherent conversation on this question, I argue that there is sort of vanishing point where the difference between “facts” and “feelings” merges. What I wish to suggest here is that, to a certain and necessary degree, the context and the framing of the question of self-disclosure determines what we define as a disclosure. I propose that thinking about a dialectical relationship between sameness and difference is a particularly useful way into the question of self-disclosures in contemporary clinical work.

The question of disclosing personal information to patients became a pressing one for me when I found that in some cases if felt necessary to disclose my HIV seropositive status. Here is an example of a fact that is particularly laden with feelings, confounding the distinction between a factual and a countertransferential disclosure. As might be expected in considering the disclosure of personal medical information, I felt there were a variety of reasons to do so, each with a specific context.

In a long psychotherapy treatment with an HIV-negative man I found that tracking each of our senses of sameness and difference offered a way of understanding the changing meanings of the disclosure of my HIV seropositivity. But more importantly it became clear that it was the process of disclosure rather than the content that exerted the greatest influence on our work, ultimately contributing to a transformative experience for the patient.

KEYWORDS:

• AIDS
• countertransference
• dialectical thinking
• dichotomous thinking
• dynamic systems theory
• HIV positive
• mutuality
• self-disclosure
• sexual compulsion
• transference