What impact does core training have on developing psychotherapists’ subsequent professional ethos?

by Anne Burke

Introduction

In April, 2008 I embarked on a Master’s Degree with the University of Sheffield and I was awarded my Master of Science Degree in November and graduated in January, 2012. In order to complete my Master’s Degree I had to complete four Modules and then go on to complete a piece of research, a topic of my own personal choice. The whole course took three years with the thesis taking a little under a year to complete. The research piece that I chose to do was to discover the impact of core training on the psychotherapist’s developing ethos. This idea flourished based on some of my own experiences in training and working as a psychotherapist throughout the last ten years, as well as being aware of other colleagues and listening to their experiences in their professional and personal journey. The other thing that highlighted the importance of this question for me was the impending question of Statutory Regulation and the focus on more academic training and what this might or could mean for the profession of psychotherapy.

I conducted 12 interviews and the participants were therapists who had varied experience. Some had just graduated, others were working towards accreditation and some had been working as psychotherapists, trainers and supervisors for many years. I tried to get people who had trained at as many different colleges as possible to give a good overall perspective on the experience of training.

The research project was broken down into three main chapters. Chapter One was a literature review of the papers that were relevant to this particular subject and it explored what kind of research to date has gone into designing training courses for psychotherapy. Another question explored here was how this training has impacted and continues to impact on students as they train and develop as professional psychotherapists. Chapter Two explored the methods used in the research and how these proved relevant in helping to support, discover and use, to the best of its potential, the vast information that each and every therapist provided so readily in this research project.

Chapter Three proved very interesting in that I explored two different theories of development: one was Erik Erikson’s Eight Psychosocial Stages of Development (Passer and Smith, 2001: 471) and the other was Kohlberg’s theory on Moral Reasoning (Gleitman, 1995:554). These theories were explored in the context of believing that development may not be confined to childhood stages; life is a continuous learning process and we may learn to address certain areas of each of these stages as we branch out into new ways of learning as an adult. I think this is relevant to the psychotherapy field in particular because it is not just a matter of learning the theory. It is also a journey of self-discovery, an opportunity to learn all about our thoughts, feelings, behaviours and belief systems and how they have been developed and influenced, with the opportunity to challenge these ways of behaving and thinking if we wish to do so; what might be described as developing a new sense of self.

This idea occurred to me, having being strongly influenced by two papers that I read: True and False Self in the Development of The Psychotherapist (Eckler-Hart, 1987) and Development Themes and Self-Efficacy for Career Counsellors (Marshall, 2000). Anton Eckler-Hart draws on Winnicott’s 1965 theory of the True and False Self and, in brief, talks about the journey of the student psychotherapist and their struggle to achieve a position of security within the context of their professional and personal identity:

Becoming a psychotherapist involves becoming more capable of dealing with the demands of the work; becoming more secure and able to use the self in relation to a patient in a spontaneous way. This is a difficult task in that it is those creative, spontaneous aspects of a person which are the ones which it is most dangerous to expose.

Eckler-Hart (1987:63)

Marshall (2000) explores the question of confidence and competence in her paper, asking the question “How do Trainees come to believe in their ability to be a counsellor?” She draws a comparison to Lerner’s 1986 concept of development, the three elements being “(1) development always implies change of some sort, (2) the change is organised systematically, and (3) the change involved succession over time” (Marshall, 2000: 2). These elements that she discusses are a common denominator in all aspects of change, regardless of theoretical or philosophical input.

What was the core piece of the Masters?

The core of this research project was to discover the impact of core training on the psychotherapist’s developing ethos. In the first part of the research I felt it was important to see what the whole aspect of training covers and what kind of research has gone into developing training courses for psychotherapists. It was interesting to see that to date there seems to be very little research, either documented or carried out, on the process of training and no research to date as to what the impact of this is on students or on therapeutic outcomes. In the context of Statutory Regulation with a more focused view on the academic side, it was interesting to read many papers that highlighted the importance of more experiential and relational aspects to the training. These papers were: Psychotherapy Training: Suggestions for Core Ingredients and Future Research (Boswell and Castonguay, 2007:378-383), Big Ideas for Psychotherapy Training (Fauth et al, 2007) and Implications of Psychotherapy Research for Psychotherapy Training (Piper, 2004).

Core issues highlighted

There were many core issues highlighted in the research. One such was the meaning of ethics and the importance of having an ethical framework. The writings of Tim Bond (2010) in Standards and Ethics for Counselling in Action and John Callender’s (1998) paper Ethics and aims in psychotherapy: a contribution from Kant had some very interesting perspectives on this piece. Callender’s paper discusses the concepts of free will, rationality and ethics and how they could be adapted to an ethical framework in psychotherapy.

Throughout the interviews certain themes were extremely prevalent. Among these were the personal therapy process within training and how important it was for the therapist to have this experience, the synopsis being that it gave students a greater understanding of their blind spots and their own process. Group Therapy was also noted as a very important part of the process in that it gave a chance to broaden the perspective of the therapy within the 46opportunity of a group experience. It was noted throughout the research that there needed to be a much greater emphasis on the whole area of ethics and ethos in training. Interviewees felt that a lot of what they had learned about ethics and ethos came after their training. This conclusion on experience and ethics may be understandable from an experiential point of view; however, many of the participants felt that there should be a training module dedicated to ethics and what is expected in the profession of psychotherapy.

Supervision was another theme that was given great emphasis. Noting again the important influence that trainers and supervisors have on their trainees, one participant described supervisors as the “gatekeepers” to the profession. Participants noted that often the student goes from trying to mimic their supervisors in the hopes that they “get it right” to being guided to develop their own style of working and a sense of what was referred to as their own “personal authority”.

Statutory regulation was discussed within the context of ethics and ethos and the drive towards more academic training. Where participants thought that statutory regulation was a good idea, there was also a fear that the relational aspect of therapy would be focused on less and that this could have a detrimental effect on what psychotherapy and counselling emphasises, namely, the therapeutic alliance and the therapeutic relationship. These are recognised as being important aspects of therapeutic change.

Theoretical influences

Erikson (Sugarman, 2001) and Kohlberg (Sugarman, 2001) were the theoretical influences that I was drawn to while analysing the data that had been researched. I also explored the existential perspective on what Emmy van Deurzen (2009) so aptly describes as the characteristics that we need as a psychotherapist.

Erik Erikson’s theory gave me the basis and understanding of psychosocial development from birth to late adulthood and I explored the potential connection of this development to the developmental stages of the psychotherapist within the context of training. Based on my own experience of training and therapy and having worked with many students over the years, I see the potential to regress back into the various different stages of development that we may have not fully moved through in our younger years, with the hopes of working through the development stage with a renewed self-confidence and strong sense of self.

Kohlberg’s theory on Moral Reasoning was one of great interest. As psychotherapists, we are bound to a code of ethics but these codes are guidelines and many dilemmas can arise within the therapeutic process and relationship that may at times not seem so black and white. What we depend on to guide and help us with the right decision at times like this may reflect on how developed our own sense of moral reasoning is, in other words, our own “personal authority”.

The characteristics that van Deurzen (2009) discusses in her book Psychotherapy and the Quest for Happiness reflect many things that the various therapists discussed in the interviews for this research. She talks about the demands that therapy will make on the therapist. To be able to contain these demands, the therapist needs to be strong in character in order to accept the challenges and explore them; this can only be achieved by maturity and self-reflection. Characteristics discussed throughout this book indicate that therapists need to be understanding, patient and flexible; they need a good knowledge of the “emotional palette”. There is a need to be able to manage and tolerate anxiety, despondency and have a good knowledge of life and what it means in order to hold steady when faced with its contradictions and paradoxes. It is also noted that therapists need to be ethical because of the powerful position that they hold with a vulnerable client and the potential for the abuse of this power if they do not have a good sense and understanding of professional ethos. Van Deurzen believes that therapy is a lifelong vocation with a willingness to continue to train and learn because that is the reality of life; to be continually developing and growing and that life brings, with these changes, new challenges all the time (2009: 169-170). I believe that Erikson’s and Kohlberg’s theories lay a good foundation for the characteristics that Van Deurzen believes are essential for the therapist who is working towards developing their own professional ethos.

This is a very brief synopsis of what the research thesis covered and if anyone is interested in getting a copy of it please email me at anneb@johnstowntherapy.com

Anne Burke MIACP, MIAHIP, MEAPA, is an accredited therapist who works in private practice at the Johnstown Therapy Centre in Dun Laoghaire. Anne works with individuals, couples and groups and provides workshops for CPD see www.johnstowntherapy.com for further details.

References

Bond T. (2010). Standards and Ethics for Counselling in Action (3rd Edition), London: Sage.
Boswell, J.F., Castonguay, L.G. (2007). ‘Psychotherapy Training: Suggestions for Core Ingredients and Future Research’. Psychotherapy: Theory, Research Practice Training 44 (4): 378-383.

Callender, J.S. (1998). ‘Ethics and aims in psychotherapy: a contribution from Kant’. Journal of Medical Ethics. 24: 274-278.
Deurzen van E. (2009). Psychotherapy and the Quest for Happiness, London: Sage.

Eckler-Hart, A. (1987). ‘True and False Self in The Development of The Psychotherapist’. Psychotherapy 24 (4): 683-692.
Fauth, J., Gates, S., Vinca, M.A., Boles, S., Hayes, J.A. (2007). ‘Big Ideas for Psychotherapy Training’. Psychotherapy: Theory, Research, Practice, Training. 44 (4): 384-391.

Gleitman H. (1995). Psychology, (4th edition), London: Norton.
Marhsall, A. (2000). Developmental Themes and Self-Efficacy for Career Counsellors. University of Victoria, British Columbia, Canada. http://www. contactpoint.ca/natcon-conat/2000/pdf/pdf-00-04.pdf
Passer, M.W., Smith, R.E. (2001). Psychology Frontiers and Applications, International Edition, New York: McGraw –Hill.
Piper, W.E. (2004). ‘Implication of Psychotherapy Research for Psychotherapy Training’. Canadian Journal of Psychiatry 49 (4): 221-229. Sugarman, L. (2001). Life-Span Development, Frameworks, Accounts and Strategies, (2nd Edition), East Sussex: Psychology Press Ltd.