The answer depends on the patient, her/his diagnosis, and the state of the relationship between us. No, in general, I am cautious about many of my thoughts and feelings as I treat them as speculative.
However, if what I am thinking or feeling is drawn into the interaction, especially if asked directly, then, yes I am transparent. I immediately pay close attention to how the patient reacts to this disclosure.
With some patients who grew up having to be exquisitely aware of a parent’s thoughts, feelings, and behavior to survive, I will be far more transparent than with other patients. Coming from a background where physical/psychological safety depended on the patient’s ability to know what’s going on, I have to be more active in helping that person tease out what they “know” and what is going on in me. I don’t want to do anything to increase the patient’s “paranoia” about me.
