The Impact of Training on the Practice of Psychotherapy and Counselling – a Practitioner’s Reflections

by Geraldine Grindley

Over the decade there have been many changes in psychotherapy in Ireland. Among these changes has been an increase in the number of institutions offering training in counselling and psychotherapy, with a resulting increase in the number of trainees attending for psychotherapy and supervision. As developments in psychotherapy in Europe continue to impact on the profession here, and as the pressure to achieve Statutory Recognition mounts, I have become more and more aware of the need to resist a subtle erosion of the beliefs and values which I hold as a psychotherapist.

The recent development of training in counselling and psychotherapy at degree level, and the accreditation of training courses in counselling and psychotherapy by various third level institutions is one of the factors in bringing about some of these changes. By offering a university degree instead of what used to be a professional training, these courses are attracting a different kind of student, and creating a different learning environment. The academic education which is now on offer attracts undergraduate students, as opposed to the professional training which attracted trainees at a post-graduate level or equivalent. While this may not have been true for courses in counselling recognised by IACP, it has been, by and large, for some time, the case for those applying for accreditation to IAHIP and the European Association for Psychotherapy.

In the past, to a large extent, trainees applying for training in psychotherapy were people who were making a deliberate decision to change career from some other profession – e.g. teaching, nursing, psychology, social work, community work, etc. On the whole, trainees had every intention of practising as psychotherapists when they graduated. They also tended to be mature people with considerable life experience. Many training schools provided clients on the basis of low-cost therapy, and trainees generally were supervised on their work.  While it was usually a requirement of the training courses that the trainees were in one-to-one therapy, those who went on to graduate usually continued to work on their own processes in therapy, with occasional breaks, for the duration of their practice. The emphasis in such training courses was on experiential learning, personal development, and a basic theoretical knowledge of at least one core model of therapy.

With the advent of the new training courses, offering a third level academic qualification in “counselling and psychotherapy”, conditions began to change. The first change I noticed was the age profile of the trainees, many of whom were in their early twenties. The second change was that classes seemed to be much larger, and run more along the lines of a university undergraduate course, with lots of lectures, and theoretical input, but considerably less skills training, and even less on personal development.  Much emphasis seemed to be placed on a type of dissertation, to be completed before graduation, and in some cases, quite unrelated to practice. Furthermore, a strong element of quantitative requirements was involved, with students needing to complete hours of client work, supervision and therapy in order to complete the course. No longer were clients provided by the training institution. Now, in many cases, students were required to find their own clients. Some institutions offered a “placement”, and many of these placements seem to be in Family Centres, where the experience of the trainees was much more akin to social work than to counselling or therapy. Most trainees were required to have outside supervision on these placements.

While the content of these courses seems to be related to Client Centred Counselling or Therapy, lectures on psychoanalysis, psychiatry, psychiatric illness and psychotropic medicine are given. In cases where some form of group experience is offered, compulsory attendance at group analytic therapy is part of at least one course. Other courses contain no element of group therapy whatsoever. Some students, training to work in a humanistic way with clients, have no experience, even in their own therapy of that way of working, attending an analyst for one-to-one work.

James T. Hansen (2005) writing in American Counselling Association’s Journal of Counselling and Development, argues that counsellor training has contributed to the devaluation of inner subjective experience – the unique way in which clients experience the world – by developing generic training programmes. While it is understandable that the profession must develop programmes of education, the way in which those programmes are designed can impact on the very nature of the practice. He reminds his readers that counselling has its origins in psychological humanism, which placed the highest value on the individual and his/her inner experience. Humanism, Hansen claims, emphasised “the encountering of the whole person of the client, unlike the prevalent theories of the time that reduced clients to unconscious processes (i.e. psychoanalysis) or stimulus-response contingencies (i.e. behaviourism)” (Hansen,2005). However, he agrees that this stance, “while in keeping with the values of the counselling profession, presented tremendous and virtually insurmountable problems for counsellor education. Teaching students about clients seems to require that clients be reduced to various categories”(ibid). His plea to colleagues, contained in the title of his paper, is to reclaim the essence of the profession.

Humanistic psychotherapy is a non-pathologising model, which places the highest value on the uniqueness of each client and of the human potential for self-actualisation.  Rogers believed that it was the personality of the psychotherapist and their attitudinal qualities, such as self-acceptance, sensitivity and authenticity, among others were of paramount importance in the therapeutic relationship, and that in fact training contributed little to the effectiveness of the therapist. (Rogers, 1961).

However, as in all other professions, it was perceived that there was a need to regulate the profession and to set standards that are measurable and achievable in a training programme. This led to the development of core training in relational techniques, which implies, to some extent, that there is one correct way to deal with all clients, which of course is a complete denial of the valuing of the uniqueness of the person and of inner subjective experience.

I am not arguing against training for psychotherapists. However, I think that it is essential that the profession reflects on the implications of training design and the impact that training may have on our practice. Dialogue between professionals practising in the field and training institutions engaged in the development and implementation of courses is essential if we are to avoid the creation of an Ivory Tower mentality in Third Level institutions involved, and if we are to preserve the very nature of humanistic psychotherapy.

Professional training in psychotherapy and counselling includes the imparting of knowledge, by theoretical inputs, lectures, reading and research; the learning of skills, which is achieved by experiential methods, practice, observation, role-play, video tapes,  etc; and the development of attitudes, which is much more difficult, and takes much more time and requires a very broad range of psycho-educational interventions. Attitudes such as sensitivity, self-awareness, self- acceptance, congruence and authenticity are not easy to “teach”. They are achieved through deep personal therapy, individual and group, reflection, life experience, maturity and exposure to a variety of different situations. Some training courses offer opportunities to trainees to develop such attitudes; others concentrate almost exclusively on the knowledge and skills components of training. The impact of this change on the practice of psychotherapy could be enormous.

Working as a psychotherapist and supervisor with trainees from such programmes, I have been concerned at the lack of awareness on the part of some trainees about the nature of psychotherapy, and their inadequate information about the contract involved, or about the implications of attending therapy, and the possible impact that it can have on lives and relationships. This in no way reflects on the trainees, but rather raises questions about the kind of education that they are receiving.

In relation to supervision which I have been engaged in for about 15 years now, I see my role as educative, formative, supportive and normative, based on material brought to supervision by the trainee from his/her client work (Hawkins and Shohet, 2000).  With trainees, the educative and formative often take priority. However, I have noticed that trainees from some courses who present for supervision are required to do so whether they are working with clients or not! This seems to alter my definition of supervision. It was being altered in other ways too. I noticed on the report form that I was required to complete in respect of some trainees that I was being asked to verify the number of hours of client work the trainee had done. This seems to me to be a function of the training school rather than the function of the outside supervisor. I also have a problem as a supervisor with being asked to give my supervisee a percentage mark as a way of evaluating their work over a period of two years.

Nor does it seem to me to be the supervisor’s job to help a trainee get clients. I believe that this is the responsibility of the training school. But I have to admit, so desperate was I that my supervisee and I would have some material to work on, I often got involved in helping the trainee to look for clients, giving names and addresses of possible placements. This certainly distorts the practice of supervision.

Some trainees are in placements which could by no stretch of the imagination be described as counselling or therapy placements. Others have placements in addiction centres, and eating disorder clinics, or in centres where psychiatric patients with severe psychiatric disorders are clients. It seems to me to be unfair to both clients and trainees to expect them to work in such extreme conditions, or in placements that require very specific training, when they have little or no experience and a foundation training in general skills.

Supervision is also problematical when the trainee is expected to practice in a humanistic way with clients, and to have that work supervised in a humanistic way, and when, at the same time, the trainee is being taught psychodynamic methods or exposed only to analytical ways of thinking about the work. If supervisees have had no experience of humanistic therapy, and are not being taught it on their course, it makes supervision in that mode extremely difficult. Again, I do not see this as a reflection on either the trainee or the training school, but rather as a consequence of designing a course to comply with academic criteria as opposed to designing a professional training to form practitioners.

Looking back over this year, it seems more apt to describe what we are being asked to do with trainees as one-to-one tuition. It is certainly not supervision, as I have always understood the term. I believe that it could only be helpful to open up a dialogue between the training schools and their potential supervisors to clarify some of these issues, and indeed I, and others, have attempted to do this in the past few years without great success.

In view of all this, as an individual and group psychotherapist, and as a supervisor, I have to consider carefully the implications of accepting into my practice trainees from such courses, so that I do not compromise my own ethical standards or erode my professional standards. As a trainer, I have a commitment to contributing to the professional development of trainee psychotherapists and counsellors in the best way that I can.

The collaboration of experienced practitioners and trainers can only enhance the standard and excellence of training. I hope that the training institutions will be open to a creative and constructive dialogue, with the aim of building the profession and providing a solid basis for the development of the next generation of therapists and counsellors. The development of a clear vision of the role of the therapist and the supervisor in the on-going training of new practitioners is important if experienced therapists are to work with trainees. A clear contract between outside therapists and supervisors with the training institution and with the trainee, taking into account the needs and ethics of both parties, would provide a more supportive environment for the on-going development of the profession.

Geraldine Grindley is a psychotherapist, supervisor and trainer working in private practice and is currently serving on the Governing Body of IAHIP

References:

Hansen, J. T. (2005) The Devaluation of Inner Subjective Experience by the Counselling Profession: A Pleas to Reclaim the Essence of the Profession. Journal of Counselling and Development American Counselling Association pp. 406-415

Hawkins, P. and Shohet, R.(2000) Supervision in the Helping Professions UK: Open University Press

Rogers, C. (1961) On Becoming a Person: A Therapist’s View of Psychotherapy Boston: Houghton Mifflin

Rogers, C. (1980) A Way of Being New York: Houghton Mifflin