Self-Disclosure Coming Out of One\'s

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.).

Patterns of Self-Disclosure in Northern Ireland

Self-disclosure has been grabbing attention since the pioneering studies made by Jourard so that gathered data on the subject have become voluminous (Hargie 2001). But the areas of adolescence and religion have been largely unexplored. Northern Ireland is divided between Catholics and Protestants and between Nationalists and Unionists. As a result of this division, children of one religion never get to meet children of the other religion. People worship in different churches. They live and socialize in their own homogenous communities. They play their own sports and engage in their own cultural activities. Almost all Protestants in many part of Northern Ireland attend "State" or "controlled schools." Meantime, Catholic attended "maintained" schools. Young Protestants and Catholics differed in their attitude towards disclosure. A growing tendency to integrate children from the two denominations together for their education has also remained at a 2% low (Hargie).

A series of investigations was conducted to address these and other issues, including gender and patterns of self-disclosure (Hargie 2001). The general finding of the investigations was that self-disclosure increases as people age. They self-disclosed least during adolescence as this is the stage of development when the personality is still forming. It is the time of self-search, when they find self-disclosing most difficult. One of the studies on adolescent friendships revealed that 66% of the girls wanted to just talk with other girls more than did boys of their age at 60%. The girls got involved in personal and supportive discussions while the boys had little or no such intimate involvement. The girls self-disclosed on family problems and personal experiences. Boys, on the other hand, revealed only non-confidential or personal matters, such as school events or grades (Hargie).

Another study in the series said that female adolescents made more emotional disclosure to parents and peers than male adolescents (Hargie 2001). Younger adolescents also disclosed more than older ones to their peers. Still another study was made on gender differences in self-disclosure to four targets. These targets were mother, father, best female friend and best male friend. The subjects were more inclined to open up to mothers and best female friends than to fathers and best male friends. This meant that female targets were favored as recipients of disclosure as they are perceived to be more empathic and understanding than male targets. In one study concerning revealing secrets, the researchers found gender differences as a main factor. Girls expressed greater willingness to divulge family secrets than boys. Boys, on the other hand, were more willing to reveal secrets about moral offenses and possessions (Hargie).

One early study found that people would disclose to parents and friends of both genders, regardless of religion (Hardie 2001). Jewish people also tended to be disclosers more than those of other denominations, such as Baptists, Catholics and Methodists. Researchers attributed this to the Jewish culture rather than their religion. Jewish families are closely-knit. Still another study discovered that males were more likely to disclose to a person not wearing a habit. On the other hand, women were more prone to open up to a religious wearing a habit, like a nun or priest. Thus, it was the impact of clothing, rather than religious affiliation, which elicited more self-disclosure. A comparative study on clients and counselors who said they were devout Christian, Jew or another denomination. Jewish clients disclosed much less to Christian counselors. Researchers, therefore, concluded that the counselor's disclosure of religion would not enhance client disclosure but even reduce or inhibit it (Hardie).

Researcher Greer suggested that Catholics were more disclosing or "open" than Protestants because of their practice of confession (Hardie 2001). A study of Protestant and Catholic female undergraduates in Northern Ireland showed the difference in their level of disclosure was negligible. The Catholic female would, however, disclose more to another Catholic female than would a Catholic to a Protestant, a Protestant to another Protestant or a Protestant to a Catholic. The study also suggested that education influenced or minimized the effect of religious affiliation on the tendency to self-disclose. A large part of the research initiative provided evidence that females disclosed more and the recipients of greater amounts of disclosure than other parties or targets. Females tended to disclose more to other females. Males tended to disclose to other males least. People of opposite sexes would disclose to one another at in-between rates. The researchers explained the opposite-sex pairings as a kind of "reciprocity effect." This meant that females would disclose at a level high enough for males to reciprocate the level. On the other hand, males would disclose at a low level and influence females to do the same. This tendency derived from a hypothesis, whereby females were more trusting and, at the same time, perceived as the more trustworthy, than males (Hardie).

Levels of self-disclosure were found to be affected or mediated by their relationship to the target or recipient of disclosure (Hardie 2001). Women would open up to best friends than would men. The pattern went on the reverse towards a stranger. Males would disclose more to strangers than would females, especially if the stranger was of the opposite sex. A sample of 70 males and 67 female psychology students for study revealed that males would more intimately disclose to new female acquaintances than would females. The finding was connected with the traditional role identity assigned to males and expectation of their initiating relationships with females. After the initial phase, the tendency would reverse when a relationship was established (Hargie).