Many training programmes for psychotherapists and counsellors include a mandatory personal therapy component – as well as learning about psychotherapeutic theories and techniques, and practising being a therapist, the trainee must also spend time in therapy themselves, in the role of a client. Indeed, the British Psychological Society’s own Division of Counselling Psychology stipulates that Counselling Psychology trainees must undertake 40 hours of personal therapy as part of obtaining their qualification.
What is it like for trainees to complete their own mandatory therapy? A new meta-synthesis in Counselling and Psychotherapy Research is the first to combine all previously published qualitative findings addressing this question. The trainees’ accounts suggest that the practice offers many benefits, but that it also has “hindering effects” that raise “serious ethical considerations”.
David Murphy and his colleagues at the University of Nottingham conducted a systematic review of the literature and found 16 relevant qualitative studies up to 2016, involving 139 psychologists, counsellors and psychotherapists in training who had undertaken compulsory personal psychotherapy as part of their course requirements. Most the studies involved interviews with the trainees about their experiences; the others were based on trainees’ written accounts.
Murphy and his team identified six themes in the trainees’ descriptions. Some were positive. The trainees talked about how therapy had helped their personal and professional development, for example raising their self-awareness, emotional resilience and confidence in their skills. Personal psychotherapy also offered them a powerful form of experiential learning in which they got to see for themselves how concepts like transference play out in therapy, and they obviously experienced what it is like to be a client. They also learned about “reflexivity” – how to reflect on themselves and the way their own “self material” contributes to the dynamics of therapy.
Another positive theme was therapeutic gains – some trainees saw their personal therapy as a form of “explicit stress management”; they said it helped them work through issues from their past; and also helped them to become their authentic selves, and accept their strengths and weaknesses.
But the remaining themes were more concerning. The first – Do no harm – referred to the fact that many trainees spoke of the stress and anguish that the therapy caused them, and the way it affected their personal relationships. In some cases this left them feeling unable to cope with their client work (in which they were the therapist). Another theme – “Justice” – summarises the burden that trainees felt the mandatory therapy imposed on them, in terms of time and expense, and the pressure of being assessed and of their lost autonomy.
Finally, under the theme “Integrity“, the researchers said some trainees talked about how their therapist was unprofessional, yet it was difficult to change them; that they felt coerced into therapy and that the mandatory nature of it prevented them from truly opening up – in fact there was a sense of some trainees simply jumping through hoops in a functional way to complete their course requirement.
Murphy and his team end their paper calling on regulatory and training institutions to consider the issues raised by their findings. Although the “hindering factors” they identified raise serious ethical issues, they believe that it may be possible to address them: “We envisage that programmes that attend to the points raised in this study will provide the best learning opportunities, compared with courses that do not regularly critically reflect upon, assess, and evaluate mandatory psychotherapy within the course.”