Understanding the Impact of Psychological Inflexibility on Client Non-Disclosure in Therapy

In the therapeutic setting, client disclosure of personal thoughts, feelings, and experiences is essential for effective treatment. However, many clients withhold critical information during therapy, which can impede progress and limit the effectiveness of the intervention. A study led by Kati Lear PhD and Jason Luoma PhD and Christina Chwyl PhD from Portland Psychotherapy delves into the factors influencing client non-disclosure, focusing on psychological inflexibility (PI) and internalized shame. 

The Role of Psychological Inflexibility and Shame 

Psychological inflexibility (PI) refers to the tendency to avoid or control uncomfortable internal experiences, even at the cost of one’s values and long-term goals. It is a central concept in Acceptance and Commitment Therapy (ACT) and has been linked to various adverse psychological outcomes. In contrast, internalized shame is the deep-seated belief that one is fundamentally flawed or unworthy, often leading to behaviors aimed at hiding perceived deficiencies from others. 

This study is the first to investigate the prospective impact of PI on client non-disclosure in outpatient therapy. Non-disclosure, in this context, refers to the intentional withholding of information relevant to therapy, such as distressing life experiences, psychological symptoms, or behaviors. The research also compares PI with internalized shame to determine which factor is more predictive of client non-disclosure. 

Key Findings from the Study 

The study's findings reveal that higher levels of PI at the beginning of therapy significantly predict greater likelihood of non-disclosure at a 15-week follow-up. Clients who scored higher on the Acceptance and Action Questionnaire-II (AAQ-II), a measure of PI, were more likely to withhold important information from their therapists. Specifically, threefold difference in the odds of non-disclosure between people high and low in psychological inflexibility. 

Interestingly, while internalized shame also predicted non-disclosure, its effect was not as robust as that of PI. When both PI and shame were included in the same predictive model, only PI remained a significant predictor. This suggests that while shame is an important factor in understanding client behavior, PI may play a more crucial role in determining whether clients will withhold information during therapy. 

The study also explored the reasons clients provided for not disclosing certain information. The most common reasons included feeling "too ashamed," fearing negative judgment, and finding the subject matter "too painful to talk about." These reasons align closely with the constructs of PI and shame, highlighting the emotional and cognitive barriers that prevent full disclosure in therapy. 

Implications for Clinical Practice 

The findings of this study have significant implications for therapists working with clients who may be at risk of non-disclosure. Identifying clients with high levels of PI early in the therapeutic process could help therapists address potential barriers to disclosure. For example, therapists might consider incorporating interventions aimed at increasing psychological flexibility, such as those used in ACT, to help clients become more open to discussing distressing topics. 

Moreover, the study underscores the importance of creating a therapeutic environment that reduces shame and fosters trust. Given that many clients fear judgment or rejection, therapists need to be mindful of how they approach sensitive topics. Techniques that emphasize acceptance and compassion, rather than confrontation, may encourage more honest communication. 

Future Directions and Research 

This study opens the door for further research on the role of PI in therapy. Future studies could explore whether targeted interventions that specifically address PI can reduce non-disclosure rates and improve therapeutic outcomes. Additionally, research could examine the interplay between PI and other relational factors, such as the therapeutic alliance, to gain a more comprehensive understanding of how these dynamics influence disclosure. 

The involvement of researchers from Portland Psychotherapy, including Kati Lear PhD and Jason Luoma PhD, highlights the clinic’s commitment to advancing the understanding of psychological processes that impact therapy. Their work contributes to a growing body of literature aimed at improving therapeutic practices and outcomes for clients. 

You can find an open access version of this article here.