Self-disclosure in relationships: the social relations model

Self-Disclosure

COMING OUT of ONE'S SHELL

Self-Disclosure Communication

Self-disclosure refers to both the conscious and unconscious revelation of one's thoughts, feelings, experiences and other personal matters (Sprecher 1987). Self-disclosure begins from the time one person meets another. It continues as their relationship develops. As two persons get to know each other, they tend to reveal themselves more and more. But if one of them refuses to open up, the other tends to do the same. In counseling, the patient needs to self-disclose or open up. The therapist listens and helps the patient see things in different angles. The therapist's interpretation enables the patient to better assess his options. This, in turn, provides him with greater sense of power to make better decisions in his life (Sprecher).

The Social Relations Model Degree method of study revealed that self-disclosure was strongly influenced by individual differences and by relationship effects (Levesque et al. 2002). According to test results, persons prefer to disclose to particular individuals. When a relationship is established, disclosure proceeds with perceived intimacy. It was also strongly mutual. The Social Relations Model is used to study self-disclosure. Self-disclosure theory is vital in the development of personal relationships, relational intimacy and relationship dissolution. Findings of existing researches on friendship and self-disclosure showed differences between male-to-male friendships and female-to-female friendships in self-disclosure and perceived intimacy (Levesque et al.).

Another method is the Social Relations Model or SRM (Levesque et al. 2002). It uses three components, namely the actor or the discloser, the partner or the disclosure recipient, and the relationship. The actor effect deals with individual differences in the tendency to disclose, while the partner effect, on the tendency to become the recipient of the disclosure. SRM also distinguishes between individual and dryadic or relational level reciprocity. A study used SRM in analyzing relationships, including self-disclosure, among 16 groups of well-acquainted roommates of a small residential college. Consistent with the results of earlier studies, findings of this study showed that persons tend to disclose at similar levels among all group members. They also tended to disclose in order to accommodate the demands of dryadic relationships. This meant that persons adjust the level of what they disclose about themselves to fit their unique relationships. The pattern of self-disclosure among men compared with that of women. Disclosure of intimate information also depended on the uniqueness of the relationship (Levesque et al.).

The evidence drawn from individual tendencies towards generalized reciprocity suggested the importance of self-disclosure to group maintenance (Levesque et al. 2002). Individuals living together in a group should preserve group function in order to do so. The study also showed that gender was not obstacle in self-disclosure. Men and women both generally tended to disclose personal information according to the level of relationship. However, married women tended to disclose personal information than unmarried women. It is the opposite in the case of men. Unmarried men shared more intimate personal information than married men among themselves. Researchers theorized that the tendencies depended on how they structured their friendships or relationships. Boys also tended to interact more strongly with large groups, while girls preferred small group interaction. Hence, men's friendships were more group-focused, while women's friendships were more relational. Overall, women thought more about relationships than did men (Levesque et al.).

Self-Disclosure Among Health Care Providers

The lack of a guarantee from immunity to prosecution has discouraged healthcare providers from voluntary disclosure of information (Mustokoff et al. 2000). They would be more inclined to yield improprieties if the Department of Justice and the Department of Health and Human Services of the Office of the Inspector General would guarantee full amnesty to the healthcare companies. The two government agencies responded to this need and offered incentives for full disclosure by the companies. The current policy offering the incentives has, however, not offered or provided automatic amnesty from prosecution. Neither did it provide a consistent standard for determining when criminal prosecution was warranted (Mustokoff et al.).

The two agencies conducted a pilot voluntary-disclosure program, which did not contain amnesty provisions, from 1995 to 1997 (Mustokoff et al. 2000). Only 11 healthcare entities participated. Of the 11, only seven of them were accepted into the Operation Restore Trust program of the two agencies. Other healthcare providers were believed to have refused participation for fear of getting disclosed and prosecuted. A guidance memorandum for U.S. attorneys on the use of the False Claims Act, published on June 3, 1998, emphasized the importance of suing healthcare providers in a fair manner. A 12-month review of the impact of the guidance conducted by the U.S. General Auditing Office in 1998 and 1999 found it to run against the DOJ's enforcement practices. The OIG's 1998 voluntary discloser protocol also failed to motivate the provider to voluntarily disclose its problem. Instead, it refused to set a firm commitment on how a given disclosure problem was to be resolved. The OIG's last protocol merely asked providers and their counsel to hope for the best rather than provide clear incentives to participate in its disclosure initiative. OIG Inspector General June Gibbs Brown said that the new protocol attracted the participation of more health care providers than the original Operation Restore Trust program did. He said that 55 providers participated and 50 of them were accepted into the voluntary-disclosure program. He attributed the community's reluctance to the possibility or likelihood of civil and criminal charges for defrauding the Medicare program. She, however, failed to offer any reassurance or incentive to override the reluctance. There was no offer of immunity from prosecution or amnesty. Instead, she stressed that the OIG held the right to impose sanctions, such as penalties and program exclusion. The only offer she made was that the OIG might not choose to impose a corporate integrity agreement and, instead forgo the exclusion remedy in the event of self-disclosure. Furthermore, those who participated could not withhold any information. They would provide a detailed description of the violation; perform a self-audit, using the OIG's strict guidelines; and fully cooperate with the OIG in its investigation of the information they would provide (Mustokoff et al.).

Model Self-Disclosure Amnesty Programs

Tax Amnesty Program

The DOJ and the OIG could learn from the examples set by successful government amnesty programs on tax, environmental and antitrust law (Mustokoff et al. 2000). The tax amnesty program is the oldest and clearest example. While it does not expressly offer immunity from prosecution, its offer of prosecutorial restrain for many decades has encouraged taxpayers to voluntarily disclose potential legal violations. It maintains an informal policy of withholding a recommendation of criminal prosecution under specific conditions. Through its tax amnesty program, the Internal Revenue Service has expressed its dedication not to prosecute ordinary people who only make mistakes in their income tax returns. It had no intention of changing this practice. It stressed that its voluntary disclosure policy was neither an amnesty nor a grant of immunity from prosecution. Rather, it was an exercise of prosecutorial discretion, which did not constitute a legal right on taxpayers. It has been effective and popular. The 1993 report said that more than 140,000 taxpayers participated in its voluntary-disclosure program. The tax amnesty policy was refined in 1996 by including voluntary discretion among other factors to determine a recommendation for prosecution. The disclosure had to be timely and voluntary. It had to precede a probable inquiry by the IRS or an audit. It was not available to taxpayers who self-disclosed only because the IRS probably already knew of their anomaly. The benefits of this program can now be enjoyed by both taxpayers and the government. It lets the government raise revenue without the need to increase tax rates and compliance by taxpayers. Tax evaders pay delinquent taxes and the interest due. The government, on the other hand, avoids the cost and burden of criminal prosecution and imposing civil penalties (Mustokoff et al.).

Environmental Amnesty Program

The amnesty policy of this program, like the tax amnesty model, does not provide an absolute guarantee of amnesty (Mustokoff et al. 2000). But unlike this previous model, it expressly shields one from prosecution, as long as the criteria for participation are met. The objective of this amnesty policy of the Environmental Protection Agency or EPA is to enhance the protection of human health and the environment. This is by encouraging regulated entities to voluntarily discover, disclose, correct and prevent violations of federal environment requirements. As incentives, the program eliminates or reduces penalties; does not refer the case for criminal prosecution; and will not use the audit report as basis for further civil or criminal action. In order to qualify for the incentives, the violation must be discovered through a completely voluntary compliance program; revealed in writing within 10 days and corrected within 60; not first discovered through some regulatory action or a whistle-blower initiative; not part of a series of repeat violations; not causing serious damage on the environment or violating a court order; and not resulting from corporate concealment or condoning environmental violations. The EPA conducted a study on the effectiveness of the amnesty program after three years of implementation on May 17, 1999. It found that, during the study period, 455 entities had revealed violations of 1,850 facilities and that the rate of disclosure had also gone up. The EPA also noted that the amnesty policy was most beneficial in four major areas. These were overall benefit to human health and the environment, prompt disclosure and correction of violations, improvements in corporate compliance policies and programs, and increased awareness of new environmental issues. The EPA took special note of how the policy encouraged prompt disclosure and correction of violations. Those who disclosed said that the program encouraged them to prove their auditing and reporting procedures. Most of them reported improving corporate programs in the form of a broader scope of corporate compliance activities; greater diligence, thoroughness and frequency of auditing processes; and greater timeliness of internal and external reporting of violations (Mustokoff et al.).

Antitrust Amnesty Program

Promulgated on August 10, 1993, this policy considered the DOJ's most successful amnesty program (Mustokoff et al. 2000). It draws its success from an absolute guarantee of amnesty from criminal prosecution for disclosing directors, officers and employees of the company. The disclosure is shielded from criminal liability if he is the first to report the violation; promptly and effectively ends the violation; reports the violation spontaneously and completely, and cooperates with Antitrust. The disclosure has to be a true corporate act rather than an isolated or individual act. The discloser makes appropriate restitution. He did not coerce another participant into the violation and is not its leader or instigator (Mustokoff et al.).

Before 1992, the DOJ held discretionary authority under the Antitrust Division's self-disclosure policy to exercise leniency, rather than amnesty, to a discloser (Mustokoff et al. 2000). In the 14 years of implementation, only 17 companies applied for leniency and only 10 were granted it. Under the present policy, leniency applications grew 12 times. The revenues accruing from enforcement activities exceeded $200 million in the first year alone. It evidenced that full amnesty would promote voluntary disclosure of antitrust activity. Besides generating enforcement revenues, amnesty agreements effectively put an end to the collusion. This immediately benefited the government by correcting the legal violation (Mustokoff et al.).

Responsive Healthcare Amnesty Model

Successful healthcare fraud enforcement can be effected, gleaning from these specific models (Mustokoff et al. 2000). They provide evidence that voluntary disclosure program will be effective if they offer some guarantee of amnesty to disclosers and on condition. It needs to be guided by clear, uniform and truly enforced standards. These models suggest that an effective voluntary disclosure program for healthcare providers could make the same guarantee of amnesty from civil liabilities and criminal prosecution and on certain conditions. The violation was discovered voluntarily and independently of auditing or whistle-blowing; was disclosed promptly; and came out of appropriate self-disclosure and in full cooperation with the OIG's investigation of the violation. The entity would also repay in full, including overpayments and interest, within the time set by the OIG and operate an OIG-approved compliance plan to prevent recurrence. The shared experiences of the government agencies involved in these proven self-disclosure amnesty programs may prove applicable to healthcare providers who will self-disclose. The correction of violations is perceived to produce considerable positive effects. One is that it will encourage prompt disclosure and correction of the violation. This will lead agents to go after the worst violators. By eliminating the risk, which would ordinarily accompany the act of disclosure, the development and use of more compliant programs can be enhanced. It can also identify types and perpetrators of abuse, increase enforcement revenues and decrease enforcement costs. Most of all, it will establish a desirable environment of greater cooperation and trust between the government and healthcare providers (Mustokoff et al.).

Physician's Self-Disclosure and Patient Satisfaction recent non-randomized study of surgeons found that their occasional self-disclosure made the patients perceive their warmth and friendliness and resulted in patient satisfaction (Beach et al. 2005). Physician self-disclosure may or may not conduce to trust and rapport. Some may even consider it inappropriate as it crosses professional boundaries between physician and patient. A study conducted on patient satisfaction involved 59 primary care physicians and 65 surgeons and audio-taped statements by patients who made 1,265 office visits. The patients were surveyed with questions on their overall satisfaction, whether they would recommend their doctor to others, how well he knew them and his qualities as a person. Other studies revealed the occurrence of self-disclosure at 17% of primary care visits and 14% of surgical visits. In these cases, 71% of physicians self-disclosed to patients at least once. Surveyed patients rated primary physicians as much less warm and friendly when they self-disclosed to patients. Fewer patients were satisfied with the visit when primary care physicians self-disclosed. But the study found that surgeons' self-disclosure elicited patients' high level of warmth and friendliness at 60% and reassurance or comfort at 59%. The overall finding was that patients described their visit as very satisfactory at 88% (Beach et al.).

Self-Disclosure by Bereaved Parents

Bereaved-civilian interactions proceed from "differing cultural identities and rules for communication (Hastings 2000). Self-disclosure is vital at the time of bereavement when communication by the parent in order to heal his or her broken identity. The death or loss of a child is an intensely crushing experience for a parent. Its effects also reverberate. At this time, life no longer seems to make sense. A study conducted on bereaved parents found that they considered the death of their child the greatest trauma of their lives. The death threatened the ordered nature of their world. Many of the respondents perceived of God, Who once seemed close, now seemed distance and impotent. Their failure to protect their child from death was a challenge to their competence. Their inability to integrate the death into social reality created distance between them and the rest of the family and friends. Bereaved parents need to rebuild a crumbling world and live in a new one in relative comfort. Relationship development and enhancement, reciprocity, social control, self-clarification and expression or catharsis were obstacles to self-disclosure (Hastings).

Bridging an intercultural gap between the bereaved parent and civilians requires the appropriate communication skills (Hastings 2000). There are such things as face threats in communication about loss or death. The civilian or outsider may not know how to respond or fear saying the wrong thing. The deceased child should not be discussed. If the bereaved parent discloses, she may feel she would burden the civilian with her problems connected with her bereavement. This translates into a constraint to self-disclosure, which could otherwise contribute to reconstructing her damaged identity. Not every parent wants to self-disclose about her experience of loss. Yet self-disclosure is precisely the key to rebuilding a new identity for her. Self-disclosure helps reorganize a world in shambles by bringing the pieces together again. A new identity needs to first acknowledge the loss and then build itself on that loss. Civilians can help make this happen. If the bereaved parent expresses the desire to self-disclose, the civilian should display the willingness to listen. A phone call or card on the child's birthday or death anniversary is another way of helping the parent. If the bereaved parent wants to commemorate the death in some way, the civilian can cooperate in the activity. It may be a dedication ceremony or a book collection with the child's name stamped on the books. As good communications require, the civilian must be flexible. If the bereaved parent does not wish to talk about it, the civilian must respect the desire. But if she wants to, that should also be respected (Hastings).

Current Western cultural identity is not generally supportive of those who grieve and make communication in the time of bereavement difficult (Hastings 2000). However, it is precisely at this time that the bereaved must communicate and self-disclose in order to rebuild their shattered identity and universe. Future studies should discover how civilians can effectively communicate with them and in a way, which will not affect or violate their cultural belief of the self. The bereaved parents should also be helped in finding parallel ways of communicating with civilians as effectively and within the context of cultural constraints. Studies on basic interpersonal communications showed that even those who acknowledge cultural diversity issues included discussion and communication with the bereaved (Hastings).

Parental bereavement is only one of the many forms of loss (Hastings 2000). Studies on communication with different kinds of sufferers have grown voluminously. But there persists a dearth of comforting messages for those in a state of grief over the loss of a child. Cultural environments and changing identities affect these life-altering experiences. The necessity of self-disclosure is critically wanting during this period where it is most crucially needed (Hastings).

Self-disclosure is, therefore, that act of sharing one's personal and inner realities with another person. It occurs most often when the discloser has developed a close relationship with the recipient of the disclosure. Females generally disclose more than males. Companies are most likely to disclose confidential information when there is less or no threat of prosecution and when amnesty or security is guaranteed. Patients respond better to self-disclosing surgeons. The people of Northern Ireland open up more to those of the same culture and religious affiliation. And bereaved parents are least likely to self-disclose at the time of their bereavement just when it is most critically needed to rebuild their shattered identity and universe.