Disclosure and nondisclosure of physical health issues in psychodynamic psychotherapy

In this exploratory study, 54 adult clients seen by 11 therapists in open-ended individual psychodynamic psychotherapy reported about disclosure and nondisclosure of physical health issues (PHI) within psychotherapy. Although clients reported at intake that they had moderately severe PHI, they discussed these issues in therapy only in 12% of sessions, and clients initiated the discussion about these issues nearly 75% of the time. The most frequently disclosed PHI were sleep, weight, illness, and pain. Clients were more likely to disclose if PHI were distressing, related to their mental health, relevant to the psychotherapy process, a priority, and if there was enough time in therapy for discussion. At the client level for disclosed PHI, depth of discussion was associated with client-rated alliance; clients who generally rated the alliance high were those who disclosed about the PHI, initiated the PHI discussion, and were not distressed by the PHI. At the session level, clients rated the alliance higher when they were distressed by the PHI but did not discuss it in depth. For nondisclosed PHI, clients reported a higher alliance if they generally and in particular sessions were not distressed about the PHI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).