Women counsellors' experiences of personal therapy: A thematic analysis

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Women counsellors' experiences of personal therapy:

A thematic analysis

Karen Ciclitira a , Fiona Starr a , Lisa Marzano b , Nicola Brunswick a & Ana Costa ca Middlesex University, Psychology, Hendonb University of Oxford, Department of Psychiatry, Warneford Hospital, Oxfordc Maudsley Hospital, Centre for Anxiety Disorders and Trauma, London, UK

Available online: 06 Jan 2012

To cite this article: Karen Ciclitira, Fiona Starr, Lisa Marzano, Nicola Brunswick & Ana Costa (2012): Women counsellors'experiences of personal therapy: A thematic analysis, Counselling and Psychotherapy Research: Linking research withpractice, 12:2, 136-145

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Women counsellors’ experiences of personal therapy: A thematicanalysis

KAREN CICLITIRA1*, FIONA STARR1, LISA MARZANO2, NICOLA BRUNSWICK1, &

ANA COSTA3

1Middlesex University, Psychology, Hendon, 2University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford,

and 3Maudsley Hospital, Centre for Anxiety Disorders and Trauma, London, UK

AbstractBackground: Following recent moves to relax the requirements for clinical mental health trainees to undergo personaltherapy, this qualitative project explored the effects of personal therapy on volunteer counsellors. Method: Interviews wereconducted with 19 volunteer counsellors at a women’s community centre, and the data were analysed using thematicanalysis. Findings: Emerging themes included the importance of personal therapy for trainee development, key elements ofpersonal therapy and the idea that personal therapy is ‘a double-edged sword’. Discussion: Allowing for evidentmethodological difficulties in evaluating the impact of personal therapy on trainees, this study suggests that closeconsideration should be given to the potentially adverse effects of reducing requirements for personal therapy in clinicaltrainings.

Keywords: personal therapy; qualitative research; volunteer; counsellors; thematic analysis

Introduction

Personal therapy is generally perceived as an invalu-

able component in the training of psychotherapists,

counselling psychologists and counsellors. Research

conducted over the past four decades shows that

most clinicians consider it indispensable to their

personal lives (Mahoney, 1997; Stevanovic &

Rupert, 2004) and professional development

(Buckley, Karasu, & Charles, 1981; Pope & Tabach-

nick, 1994; Williams, Coyle, & Lyons, 1999).

Historically, psychotherapists were expected to be

sufficiently aware of their own difficulties to prevent

them from adversely affecting their clinical work

(Macaskill, 1988).

Research into clinicians’ use of personal therapy in

Britain and elsewhere is extensive (e.g. Atkinson,

2006; Rizq & Target, 2008). In a US study, 85% of

727 mental health workers cited personal reasons for

seeking therapy, only 5% identified training as their

main reason for seeking therapy, and over 90%

reported positive outcomes from therapy (Bike,

Norcross, & Schatz, 2009). In a study of 4000

therapists from 14 countries, personal therapy was

consistently ranked among the top three positive

influences on professional development, along with

direct experience with clients and formal case super-

vision (Orlinsky, Botermans, & Rønnestad, 2001).

Psychologists in Britain and America report learn-

ing lasting lessons from their own therapy, including

better understanding of the importance of empathy,

transference and countertransference, and the need

for patience (Norcross, Dryden, & DeMichele,

1992; Norcross, Strausser-Kirtland, & Missar,

1988). Clinicians’ therapeutic experiences were felt

to validate the supposition that change is possible,

and to help them develop their clinical techniques

through modelling the good and bad practice of their

therapists (Grimmer & Tribe, 2001).

In six studies involving more than 1400 American

and nearly 1000 British clinicians, over 90%

reported experiencing considerable personal im-

provement, and over 75% strong professional devel-

opment as therapists: they experienced improvements

in self-esteem,work functioning, social life, emotional

expression, characterological conflicts, and symptom

*Corresponding author. Email: [email protected]

Counselling and Psychotherapy Research, June 2012; 12(2): 136!145

ISSN 1473-3145 print/1746-1405 online # 2012 British Association for Counselling and Psychotherapy

http://dx.doi.org/10.1080/14733145.2011.645050

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severity (Orlinsky, Norcross, Rønnestad, &Wiseman,

2005).

Should all clinicians have personal therapy?

A minority of clinicians have negative experiences of

personal therapy in training. These include the

discomfort of attending therapy, the difficulties of

receiving therapy from their teachers, undergoing

types of therapy inappropriate to their needs, and

experiencing poor or harmful therapy. Some report

stress due to the constraints on time or money that

personal therapy entails (McEwan & Duncan,

1993). Other studies have found a small negative

effect on client outcomes (see Bike et al., 2009).

While personal therapy used to be generally

considered a prerequisite for clinical work, therapists

who do not undergo personal therapy often claim to

have ways of dealing with stress and to be able to

resolve their problems independently. The impor-

tance of personal therapy varies according to theo-

retical orientation; behavioural and cognitive

therapists are less likely to enter therapy than

therapists from other theoretical orientations (Bike

et al., 2009), and it may be that personal therapy is

more congruent with some therapeutic trainings

than others (Atkinson, 2006).

Personal therapy requirements for UK clinicians

The British Association for Counselling and Psy-

chotherapy’s (BACP) requirement for a minimum of

40 hours of personal therapy for newly accredited

members was waived in 2005; but the Division of

Counselling Psychology still requires chartered

counselling psychologists to have completed 40

hours of personal therapy during training, on the

grounds that interpersonal skills and the use of the

self are important for the therapeutic process

(Grimmer & Tribe, 2001). Regulatory requirements

for counsellors and psychotherapists in the UK are

changing. The government has announced that the

Council for Healthcare Regulatory Excellence will

be the new regulatory body. It seems likely that

requirements for personal therapy will continue to

depend on individual clinical trainings.

Impact of therapy on clinical practice

The impact of personal therapy on clinical outcomes

is difficult to measure. Personal therapy is only one

factor that may affect a therapist’s professional

development and potential to affect clients’ out-

comes. Other factors, including clients’ resources

and the vicissitudes of the therapeutic relationship,

make it difficult to conceptualise how one could

reliably determine the specific impact of a therapist’s

personal therapy on clients’ outcomes (Orlinsky

et al., 2005).

Research into the impact of personal therapy on

clinical practice has examined therapists’ own eva-

luation of personal therapy (Wiseman & Shefler,

2001) and measured client outcomes (Macran &

Shapiro, 1998). Experimental outcome studies have

examined therapists’ responses to analogous ther-

apeutic situations (McDevitt, 1987; Strupp, 1955,

1973), and process studies have examined within-

session client-therapist interactions (Wheeler, 1991).

Qualitative methods continue to offer a useful

alternative to explore therapists’ own therapy, and

this study aims to explore the views and experiences

of counsellors from diverse orientations working in

the voluntary sector.

Method

Research was carried out at a community health

centre which provides a range of low-cost treatments

for women ! including low-fee therapy, once a week

for up to two years ! in the South East of England.

Female volunteer counsellors from diverse theoreti-

cal orientations provide long-term counselling at the

Centre. Approximately half of these counsellors

require the practice hours for their training require-

ments; others work at the centre post-qualification.

This service differs from most National Health

Service (NHS) mental health services, which gen-

erally offer only short-term cognitive behavioural

therapy (CBT) in a medical setting (Cooper, 2008).

This article focuses on research with the service-

providers (i.e. the counsellors).

Design

This study sought to explore counsellors’ views and

experiences using a qualitative approach, since this is

capable of providing a rich and complex under-

standing of data (Braun & Clarke, 2006). Thematic

analysis was chosen as being compatible with a

constructionist paradigm, whereby meaning is

viewed as co-created by interviewer and participant.

The value of qualitative methodologies for exploring

the meanings of therapeutic change is recognised

as being particularly appropriate when research

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questions are concerned with understanding pro-

cesses rather than outcomes (Rubin & Rubin, 1995;

Smith, 1996). This study was designed to address

desiderata for qualitative research outlined by

McLeod (2006) and Stiles (1993):

(1) Clarity and comprehensiveness, by giving suffi-

cient procedural detail.

(2) Adequacy of conceptualisation of data, by

acknowledging the provisional and open-ended

nature of the analysis.

(3) Credibility of researchers, through acknowled-

ging power differentials, and the researchers

meeting to consider difficulties and differences

throughout the research process.

(4) Sufficient contextualisation, by carrying out a

comprehensive literature review which enabled

the research to be historically and socially

located.

(5) Systematic consideration of competing inter-

pretations of data: the five researchers, with

differing views about the benefits of personal

therapy, systematically analysed the data indi-

vidually, in pairs, and again as a team.

(6) Experiential authenticity of the material, by

reporting participants’ rich and verbatim ac-

counts, offering participants copies of their

transcripts and asking two participants to com-

ment on the authenticity of the final draft. All

participants will have access to academic arti-

cles and reports resulting from this research.

Methodology

This study used qualitative methods to explore the

impact of personal therapy on clinical trainees. Most

research to date has not considered the role of

therapy in counsellors’ training, and relatively few

studies have used qualitative methods. One recent

study considered the impact of compulsory personal

therapy on counsellors’ personal and professional

development (van Haenisch, 2010).

Interview schedule

A semi-structured interview schedule was designed

following the biographical-interpretive approach of

Hollway and Jefferson (2000). Participants were

asked about the theoretical orientation of their

personal therapy and their clinical training, their

experience of long-term therapy, and how their own

therapy had impacted on their clinical practice.

Participants

Forty counsellors had worked at the Centre for more

than six months, and 19 of them volunteered to

participate. Their ages ranged from 32!63 years, and

their theoretical orientations varied (see Table I). All

19 had been in personal therapy between one and

three times, and the frequency per week varied

between one and five times. Length of time spent

in therapy ranged from 3!21 years (mean"4.7

years). When interviewed, 12 of the participants

were undergoing personal therapy, and six of these

were in training. These women worked as unpaid

volunteers; nine had an income of less than £25,000

per annum, and four earned less than £10,000.

In order to work as a volunteer at the Centre, all

trainee counsellors are required to be in weekly

therapy, and all (including those who are qualified)

must attend clinical supervision with one of the

Centre’s four low-fee supervisors. As the participants

were all working as counsellors, a distinction was not

made between psychotherapists, counsellors, and

counselling psychologists; all are referred to here as

‘counsellors’.

Ethics

Participants gave signed consent to participate, and

for anonymised extracts of interviews to be pub-

lished. Participants’ pseudonyms have been provided

for the purpose of citing excerpts from their inter-

views. A university ethics committee gave ethical

approval for this study.

Data collection

One-to-one interviews were carried out by three

of the researchers. These interviews were

audio-recorded and took between 33 and 73 min-

utes. Interviews were transcribed verbatim, with

words underlined to indicate vocal emphasis by

participants. All participants were offered the op-

portunity to amend their transcripts; three requested

to read their transcripts and one made minor

amendments. At the end of each interview, partici-

pants were asked what they thought about the

research project and about their experiences of the

research process.

Analysis

The main theoretical influences on the analysis

were qualitative theory (Braun & Clarke, 2006;

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McLeod, 2006) and clinical theory (e.g. Geller,

Norcross, & Orlinsky 2005; Roth & Fonagy, 2005).

At the first stage of analysis, interview transcripts

were read at least twice by three of the researchers.

The transcripts were coded line by line, sum-

marised, and a hierarchical structure of themes

was produced; this was compared across all tran-

scripts and cross-referenced to salient topics from

the literature. The main analysis focussed on the

themes that emerged from participants’ accounts,

and there was no attempt to fit these to any

predetermined framework (see Rizq & Target,

2008). The final stages of analysis involved all five

researchers reviewing the first stage of analysis,

analysing and comparing main themes, and further

analysing them into sub-themes. The researchers

discussed the process by which themes were derived

at various stages to ensure the analysis was

reasoned, logical and valid (McLeod, 2006) ! see

Table II for a summary of the coding frame. This

article focuses on a subset of the data, which

includes three themes relating to personal therapy:

personal and professional benefits of personal

therapy, challenges of personal therapy, and the

core ingredients of personal therapy.

Researchers

All five authors are academics; three are also

therapists, and two have been in personal therapy.

The authors acknowledge the dynamic interplay

between researchers and researched. The research-

ers’ beliefs relating to the processes of personal

therapy for clinicians were brought to the research

act; these need to be considered and acknowledged

(Bury, Raval, & Lyon, 2007).

Findings

Personal and professional benefits of therapy

When asked how their own therapy influenced their

work, all 19 participants claimed that it had profes-

sional benefits, using words such as ‘crucial’, ‘en-

ormously helpful’ and ‘immensely helpful’. Although

participants were not asked whether they considered

it important for their personal development, 14

spontaneously said they thought it was. Personal

benefits were either explicitly or implicitly enmeshed

with professional benefits.

Sandra explained how her therapy had helped her

to understand the psychoanalytic theoretical model,

Table I. Counsellors’ orientation of personal therapy and training.

Name Age Own personal therapy orientation Orientation of practice Ethnicity

Lisa 44 Gestalt Gestalt, person-centred, attachment Caribbean

Kathleen 32 Existential Existential British

Louise 42 Psychoanalytic Psychoanalytic British/

Spanish

Wanda 63 Psychoanalytic Person-centred, psychoanalytic, attachment British

Sarah 43 Attachment Attachment Swedish

Pippa 58 Integrative, psychosynthesis, attachment Person-centred/humanistic, psychoanalytic/

attachment

British

Doris 53 Psychoanalysis Psychodynamic Australian

Susan 57 Humanistic Humanistic, integrative British

Sandra 55 Psychodynamic Psychosynthesis British

Jane 57 Psychoanalytic Psychoanalytic, attachment Middle

Eastern

Gillian 61 Attachment/psychoanalytic Attachment British

Alison 51 Transpersonal, integrative, existential Person-centred British

Anne 45 Psychoanalytic Psychoanalytic British

Patricia 63 Psychoanalytic Psychoanalytic British

Wendy 43 Adlerian, attachment, psychoanalytic,

existential

Existential, person-centred German

Kim 39 Integrative Integrative Greek

Carmen 45 Psychodynamic Object relations, integrative British

Jenny 32 Psychoanalysis Psychoanalytic, integrative British/

Spanish

Linda 38 Integrative Integrative, psychodynamic, attachment British

Women counsellors’ experiences of personal therapy 139

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and had allowed her to separate her own issues from

those of her clients:

I had the space of the therapy and the supervision

to do the work of separating out what was mine

and what was the client’s . . .My personal issues

were resonating with my client’s issues . . . It helpedme theoretically, it helped me in my learning as

well. It was helping me personally, but it was also

helping me understand the model as well and how

to be a therapist.

Patricia claimed that the influence of her therapy was

‘immense’:

It’s absolutely to do with the separation that has to

happen . . . I’m either taking responsibility for

something which isn’t mine which is going to

paralyse me, or I’m giving somebody else respon-

sibility for my own stuff which is going to paralyse

them.

Alison said how she thought personal therapy should

be mandatory for all clinical trainees:

It is absolutely crucial . . . It’s absolutely essential

that I deal with all my stuff in order to be able to

accompany my clients, partly so they don’t trigger

stuff off in me . . . I need to be able to learn how to

put all my stuff back. So it is absolutely crucial and

I can’t understand about the BACP saying that

trainee therapists don’t have to do it, it is

completely nuts.

Jenny described how her personal therapy helped her

to listen and think:

If this room were me, and I piled it full of rubbish,

the more I clear out the more space there is in

there, and the more space that I have the better

the capacity to think about what’s going on with

my clients . . .Those little moments when your

mind just drifts just for a couple of seconds and

you think ‘Oh god what was it they just said that

was so, I don’t want to hear that bit, I don’t want

to go to that place in myself.’ So the clearer my

space is the more I can do, the more I can listen,

the more I can help people.

Linda thought her own therapy enabled her to be

more emotionally resilient in her clinical work:

Having been in therapy, and confronted and

worked through some extremely traumatic and

difficult things means that I know they are

survivable. And so I am less likely to shut a client

down or flee from their own sense of chaos,

disaster, collapse whatever.

Carmen discussed how her training, supervision,

and personal therapy all contributed to her develop-

ing her own style:

Table II. A summary of the coding frame.

Main themes Sub-themes Sub-themes

1. Personal and professional

benefits of therapy

Personal benefits Working through personal issues ! separation of the personal from the

professional

Emotional resilience

Personal journey

Professional benefits Applying theory to practice

Therapist as role model

Mandatory therapy ! issues and tensions

The ‘art’ of therapy

2. The challenges of personal Boundaries and difficulties Learning from therapists’ practice ! positive and negative

therapy Boundaries ! benefits and limitations

Constraints ! financial and time

Double-edged sword of therapy ! disturbance, pain, rewards and

endings

3. The core ingredients of

therapy

Therapeutic relationship,

orientation and skills

Therapeutic relationships: learning through relating ! unconscious

processes, therapeutic change and empathy

Learning aspects of theory and skills through live observation

How it feels to be a client

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It feels a little bit like when you learn to drive, and

your driving instructor has all these fixed things

like ‘mirror-signal-manoeuvre’, but then once

you’ve actually been driving for long enough you

do it your own way. You’ve worked out your own

style.

Some participants were emphatic about the impor-

tance of personal therapy. Doris noted:

I don’t think the training would have been nearly

as successful without the therapy . . . I can see what

analysis has done and the way it has totally

revolutionised my life.

One of the centre’s counselling co-ordinators em-

phasised the importance of personal therapy for

trainees:

What I’ve come to realise over time is that a key

factor in whether . . . they’re going to be a good

counsellor or not, is actually the amount of sort of

personal work they’ve done.

The challenges of personal therapy: boundaries and

difficulties

Five participants reported negative experiences such

as not getting on with their therapist, finding their

therapist unprofessional, or finding the process

frustrating. These experiences were, however, re-

ported as an aid to learning even when they were

anti-therapeutic, as Sarah’s comments indicate:

I think that she is arh very rigid, and not actually

very relational at all . . .Until I say, ‘Yes, you are

right, I am like that’, we’re not moving anywhere.

And since I’m not prepared to do that, so I think

she’s partly wrong at least . . . It’s one of those

times where you kind of learn from the negative

you know, so I’m being very wary of not being like

she is when I am the therapist . . . It’s all learning,it’s not pleasant in any kind of way but it is

teaching me I think good things.

Sarah also raised the challenges posed by personal

therapy being a training requirement as it could

make it difficult to change therapists:

Fingers crossed . . .The course has to make a

decision . . . as far as I understand; I will be given

the permission to, to finish.

Some therapists were thought to be ‘too rigid’, and

others too open about their personal lives. Pippa

raised the importance of boundaries in relation to

her new therapist:

She is very professional; she is a good role model

for me, because I’ve started supervising now. She

is very, very boundaried, and I had a very

unboundaried therapist for seven years, and I

knew so much about her.

Wendy had a more critical perspective about ther-

apeutic boundaries and the setting, having been a

client herself:

There’s one problem with counselling, which I

guess always happens with anything that becomes

institutionalised, regulated and all those

things . . . I can say all kinds of things and I could

cry or I could, you know but certain things I can’t

do. Like I can’t just take my clothes off or dance

around the room, or go into his kitchen and get a

bottle of beer, or even have a cigarette in the

session . . . certain things are just not possible and

however much we say ‘oh this is a space for you,

you can say anything’ it’s not true at all and it’s

very, very limited in what can happen, for good

reasons.

Undergoing personal therapy can create financial

strain and time constraints, particularly for unpaid

female volunteers who are also caregivers. Carmen

said:

I’m going twice a week and I find it a terrible

chore . . . I look after X (disabled child) for 40

hours a week, as well as these three placements. So

I think it’s the squeezing it in late in the evening

when you’re tired . . . It’s hugely useful and I

wouldn’t be without it, and I think it would be

unsafe to work without it.

Wendy noted being pleased to take a break from

therapy for financial reasons:

I had six months of no therapy, and I just couldn’t

get it together to sort it out and it seemed really

nice not to have to go, save some money.

Alison considered her therapy difficult but reward-

ing:

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It is very, very challenging, well I find it very

challenging. We’re doing very, very good work.

Sandra described her therapeutic ‘journey’ as painful

but also useful:

I really felt that I had done this kind of a journey

and I had gone into what I needed to go into, my

life’s journey and looked at things and then come

out again . . .The intense pain and agony, and then

I came back up into the adult place again.

Jenny was finishing six years of therapy and dis-

cussed how experiencing her own personal challenge

of ending long-term therapy was a learning experi-

ence:

We spent a long time working towards an ending,

and actually that in and of itself, at the time,

wasn’t something particularly I wanted to do. But

I realised in the end it was something that was

quite important for me. It was just a big part of my

process, it’s not my favourite thing, ending.

The core ingredients of therapy: therapeutic relationship,

orientation and skills

Participants described learning about the core in-

gredients of therapy from their own therapists. Jane

discussed how her own therapy had enhanced her

understanding about relating and change:

My experience with my therapist allowed me to

see how I do relationships, and allowed me to

understand how we can project, how we can

assume and how change is possible when that is

thought about together and understood.

Wendy was doing an existential training, and

described the different ingredients required for a

beneficial therapeutic experience: the therapist’s

personality, openness, theoretical orientation, ther-

apeutic skills, and techniques. Her new therapist

was existential like herself, and she felt was better

able to help her explore difficulties than was her

previous psychoanalytic therapist. She noted:

It’s really good, I am really happy. It is much

more disturbing and intense than the other one

(previous therapist). I think it was partly to do

with her, as well, not maybe just the relation-

ship, but it felt like I was telling her about

something which has already happened . . . I

always had the sense that she had a certain view

about what is a healthy way to live or what is a

good way to be, or how I should end up after

successful therapy.

Other participants talked about the educational

benefits of having had more than one clinician, and

one of a different theoretical orientation. Carmen

said:

I like the variety of having . . .different insights

from each of the counsellors that I have seen.

Sandra argued that trainee clinicians should experi-

ence the same orientation of therapy and also

undertake sessions of the same frequency as that

offered to their clients:

I can’t imagine being a therapist without having

the experience of being in therapy. I think you

must have the experience of the type of therapy

you are going into. What I’m saying is if you do

weekly then you must have weekly, if you do

fortnightly or twice a week or whatever. I think

you have to actually experience that.

Being a client allowed participants to observe what

kinds of interventions seemed more or less helpful.

Lisa explained:

I find myself observing her and being . . .counselled by her at the same time, to see how

she, she deals with me and reacts to me. And

sometimes I find myself just asking things to see

what she says . . .Because she’s Gestalt as well.

And I’m supposed to be Gestalt too.

Wendy thought it was important for her clinical work

to have had the experience of being a client:

If you are just the therapist and you never have the

client’s role, it’s quite easy not to realise the basic

little things that can be awkward or difficult for the

clients.

She went on to describe how a particular experience

had affected her own responses to clients:

And he’s (therapist) just sitting there watching me

settling down and it felt really uncomfortable. I’ve

got a couple of clients who always apologise for

that and I, until it happened to me, I . . .didn’tunderstand why you know what are they saying.

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Why don’t they just take their time? I’m quite

happy to sit there, but it’s because I was watching

them and um just things like that. Just to know

what it’s like to be in that role of silence.

Discussion

All 19 participants believed that their personal

therapy had professional benefits, and was an

integral part of their training. This concurs with

previous findings (Grimmer & Tribe, 2001; Orlinsky

& Rønnestad, 2005). Participants repeatedly noted

that therapy contributed to their professional devel-

opment, helped them deal with their own psycholo-

gical difficulties, and facilitated their ability to

distinguish clients’ issues from their own. However,

five participants also reported negative experiences

such as not getting on with their therapists. They

found their therapists either too rigid or too un-

boundaried, or the process emotionally and practi-

cally demanding. Other studies have drawn similar

conclusions (Grimmer & Tribe, 2001; Macaskill,

1988; Macaskill & Macaskill, 1992; Murphy, 2005).

Research has found that a good therapist!clientrelationship is one of the most important factors for

a successful client outcome (Roth & Fonagy, 2005).

One participant in this study (Patricia) said ‘the only

thing that matters is the kind of relationship you have

with somebody and not their theoretical model’.

Some participants suggested that their likes and

dislikes about their therapists were connected to

their therapists’ theoretical orientation: Wendy de-

scribed her psychoanalytic therapist as being like a

‘sphinx’, while Pippa preferred an attachment thera-

pist who was more boundaried than a psychosynth-

esis practitioner. In both cases the participants

preferred to be treated by a therapist trained in the

same theoretical model as themselves. In fact,

participants’ accounts of having more than one

therapist, and trying out therapists who used differ-

ent models, suggested that working with therapists

trained in the same orientation as themselves could

be of professional benefit for trainee clinicians.

Previous studies have suggested that by observing

the work of experienced therapists, therapist-patients

learn what might help or hinder their practice

(Norcross & Guy, 2005; Rizq & Target, 2008). In

this study participants also described how their

therapy had allowed them to experience for them-

selves the efficacy of specific therapeutic techniques,

and to model their own therapists. As in other

research, trainees who experienced therapeutic

incompetence did not think it invalidated therapy

itself (Grimmer & Tribe, 2001).

The view that personal therapy is effective for

clinicians is not novel (e.g. Orlinsky et al., 2001), but

there are many variables to be considered: the timing

of therapy, the motivation of a person to pursue

personal therapy, the mode(s) of intervention, the

theoretical orientation(s), the competence of the

therapist, and the therapeutic alliance (Roth &

Fonagy, 2005). The resulting dynamics are difficult

if not impossible to control, especially given hidden

contextual forces, life experiences, and the impreci-

sion of measurement criteria. Findings from this

study cannot be generalised, but may nonetheless

inform counsellor trainings and placements. This

topic is of particular interest at the current time

given the apparent reluctance of professional orga-

nisations such as the BACP and the British Psycho-

logical Society to insist or even recommend that

personal therapy should be mandatory for trainee

clinicians.

Without personal therapy, trainees may not con-

front in a systematic manner those areas of their own

personality which may be a potential source of

conflict in their work. These cannot be effectively

addressed by supervision alone. Furthermore, resis-

tance to enter into a process of self-exploration may

imply defensiveness detrimental to the therapeutic

process (Howell, 2009). It can be argued that

personal therapy improves the emotional functioning

of clinicians, allows a better understanding of

personal dynamics, interpersonal relationships, and

alleviates the emotional stresses inherent in the

practice of psychotherapy (see Orlinsky et al.,

2005). However, insistence for trainees to undertake

personal therapy, whether by a training organisation

or employer, can create resistance (Rizq & Target,

2008). Furthermore, this study highlighted the fact

that personal therapy can be a double-edged sword

for female volunteers. Research shows that unpaid

volunteers are generally women who often also have

the main household care-giving responsibilities (see

Bondi & Burman, 2001). Such women may need

personal therapy to deal with their own mental

health difficulties and to help them with their

professional development, but they may struggle to

find the time and money to do so.

Macaskill (1988) proposes that personal therapy is

only likely to have a significant impact on client

outcomes when therapists are put under emotional

pressure from working with clients with complex

disorders. However, it is questionable whether a

Women counsellors’ experiences of personal therapy 143

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connection between client outcomes and clinicians’

personal therapy or, for that matter, their super-

vision, is empirically verifiable (Mackey & Mackey,

1993). Studies into the effects of personal therapy

suffer from inevitable defects in sampling,

design and measurement (Ciclitira, Marzano,

Brunswick, Starr, & Berger, 2004).

The proliferation of CBT through the Improving

Access to Psychological Therapy (IAPT) scheme is

resulting in a significant reduction in requirements

for both supervision and personal therapy for

therapists (Department of Health/Mental Health

Programme/IAPT, 2008). The lack of empirical

evidence for the benefits of personal therapy for

trainees gives cause for concern in this evidence-

based assessment culture to which services and

training institutions are increasingly subject. The

fact that personal therapy is not mandatory for most

clinicians working in the NHS has uncertain con-

sequences for training undertaken and client out-

comes.

Acknowledgements

We would like to thank our participants and Sue

Berger. We gratefully acknowledge the support of

Middlesex University and the King’s Fund.

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Biographies

Karen Ciclitira is a practising psychotherapist

and a principal lecturer in psychology at Middlesex

University. Her research interests include clinical

research, evaluative- and practitioner-based research,

psychoanalysis, women’s health, gender, racism,

feminist research and qualitative methodologies.

Fiona Starr is a clinical psychologist and princi-

pal lecturer at Middlesex University. She works

clinically with adolescents, children and families.

She also carries out medico-legal work where there

are child protection concerns. Her research interests

include applied, clinical, evaluative- and practi-

tioner-based research.

Lisa Marzano is a postdoctoral researcher at the

Centre for Suicide Research, University of Oxford.

Her research interests include: suicide and self-harm

in prison, mental health provisions and understand-

ings in criminal justice settings, feminist methods and

theory in relation to women’s and men’s health, and

qualitative methodologies.

Nicola Brunswick has held post-doctoral posi-

tions at the Wellcome Department of Imaging

Neuroscience (UCL), the MRC Cognitive Develop-

ment Unit, and the Department of Epidemiology and

Public Health (UCL Medical School). Her research

interests include the cognitive neuropsychology of

language and specific learning difficulties, and health

psychology.

Ana Costa is a postdoctoral researcher at the

Maudsley Hospital. Her research interests include

eating disorders, body dysmorphic disorder, border-

line personality disorder, suicide, self-harm, and their

prevention and treatment. She has also worked as

a dialectical behavioural therapy psychotherapist,

dealing with individuals who self-harm.

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