by Colm O’Doherty
Training in Ireland
Having been involved in counselling training and in psychotherapy training since the mid 1970’s, I have seen great changes in the field over the years. There was not a single professional training course in either counselling or psychotherapy in Ireland at that time. Just to get a glimpse at how things have changed since then, I refer you to the two issues of “Inside Out” that have been published since the re-launch of the journal, and suggest you look at the lists of current courses!
Significant developments continue to take place in psychotherapy and counselling training in this country. Many of these are to do with the emergence of national and European standards for training. There have been, and continue to be, heated discussions and disagreements about these standards. All such discussions have been guided by the clear desire of those involved to improve the quality of training so that trainees would be better prepared for the work following graduation or qualification. But what about those who do not get through, those who get bad news rather than congratulations?
Not everybody who takes on the training reaches graduation. In fact, probably a sizable number of those who start do not complete their studies in this field. Considering that training usually lasts three or four years, and considering that each year some people choose not to continue, or are assessed as not ready or not suitable, then over the course of any training those leaving are certainly not an insignificant number.
Trainers give a lot of thought and consideration to preparing trainees for the work following the training. What about those trainees, who, for whatever reasons, cease their training? What attention do they receive and from whom? What is the responsibility of the trainers and the training schools in this regard? Does any responsibility lie elsewhere, outside the training schools, perhaps with the general body of psychotherapists? In this article I will limit myself to some reflections on that particular group of trainees who cease their training by virtue of being assessed as not ready or suitable to continue the training that they had begun. Are they a forgotten group, and by whom are they forgotten?
People who decide to join a psychotherapy or counselling training course do so with a wide variety of motivations, some conscious and some unconscious. Some people may want a chance to work outside the home, others may wish to further their career or start a second one. Some people may join training courses in order to engage in personal development or to “receive” therapy. Some may wish to train so as to be a resource in a work setting or neighbourhood. Some wish to meet like-minded people, and so on. There are very few, if any, who have a single stranded motivation and who do not have some personal agenda in taking on psychotherapy training. It is essential that we as trainers are open to such a variety of motivations and are able to take them into account in the course of the training. After all, we have our own personal agendas in being in the profession and in choosing to do training.
While most courses have an approach that allows for training in intellectual understanding, relational manner and competence in skills, there is also, in the integrative and humanistic modality (and in many other modalities), a focus on aspects of the person of the therapist. In the humanistic and integrative model we address such factors as the trainees’ personality, their level of self-awareness and personal development. We are now well familiar with the research findings which tell us that it is the quality of the therapeutic relationship that is the primary curative factor in therapy. Obviously that does not mean that a strong conceptual understanding of the psychological processes is not crucial, but rather that this conceptual understanding is in the service of the therapeutic relationship. Such relating depends profoundly on the personal qualities of the therapist. Qualities such as a willingness to be open and undefended, an ability to be in touch with their feelings, openness to being aware of their prejudices, their rough edges, is enormously important. Because these aspects are so personal, and are often related to a person’s sense of self-worth, they present a delicate area when it comes to critical feedback and assessment, whether this is given by another trainee, by colleagues, or by course trainers. While critical comment is generally not easy to receive. I think that it is often more painful to be critiqued about some personal limitation or blind spot, than to be told about an imbalance or inadequacy in an essay.
It may be that some might want to argue that assessment in this more personal area is not appropriate. I take the view, however, that this assessment is essential because of the responsibility the training body has to both the trainees and to the trainers, to the public and to the profession itself. While a certain level of vulnerability is present in any process of assessment, this is heightened when the process is focussed on the trainee’s more personal aspects. This can give rise to questions for the trainee, such as ‘is it my work or is it I who is being assessed?’ Can these aspects really be separated? As humanistic and integrative psychotherapists we must consider the relationship between the academic and the personal. And, of course, we must be cognizant of the subjectivity of any assessment, but a subjectivity informed by experience and the input of other trainers.
There can be so much room for “getting it wrong” from the assessors’ position, and there can be so much room for “getting it wrong” from the position of the trainee. Whether directly or indirectly through transference or counter-transference, the training setting can foster confusion and conflict in both trainers and trainees around a number of themes. Such extremely personal issues as power, judgement, authority, failure and shame, are most complex. It is vital that trainers, with the responsibility they carry, have a setting to address these matters in an on-going way. As for the trainees, they encounter these themes, often quite painfully, in their interactions with each other, with their trainers, and particularly in relation to being assessed. Difficulties can arise even with assessment of essays or presentations, but vulnerability is heightened when it comes to the assessment of the more personal aspects of the training. This is particularly relevant when it comes to being assessed on such issues as the trainees’ manner in group, their style of interacting, the nature and quality of their defenses, their attention to colleagues, their ability to contain and to reveal, their openness to being engaged with and the quality of their self-reflecting. Furthermore there is the way that trainees reveal themselves in their struggles, in their doubts and in their conflicts, to those people who have the responsibility of assessing their ability. How do they relate in various settings to trainers who are assessing them? How do they address their transference feelings towards their trainers? The way trainees respond or react to the potential risk of being faced with feelings of shame, anger, or fear, and how this is addressed by them, is revealing to both trainee and trainer.
Of course there can be criteria, and very specific criteria at that, on which assessment and feedback are based. It is indeed essential that there be such criteria and that these be clearly presented to the trainees and trainers alike. But where the assessment is negative, no amount of criteria can cover over the personal impact for those trainees who do not make it. Some accept this outcome, not without serious disappointment, with a sense of being let down and some anger. Many are helped in so doing by the on-going feedback they received during the course, by their own therapy, and by different processes within the training. Others who may feel unheard or misunderstood, can, over time, come to an understanding and acceptance of the outcome. They can, with much churning, integrate it into their life experience. Still others feel only hurt, betrayal and humiliation. They may feel punished, diminished, rejected and enraged, and bring these feelings with them on leaving the course. Even those who come to some acceptance of the outcome are not immune to these feelings. Often trainees have deeply invested themselves in the training, have made considerable sacrifices, personal, familial, financial and other, for the sake of the training. Such people, who have started the course with strong intent and enthusiasm, can end up leaving after a negative assessment with a deep sense of personal failure and with the sense of damage having been done to them. And while trainers can signal concern, in verbal and/or written form, about progress to trainees, sometimes it can be hard for trainees to really receive this, for all sorts of reasons.
An assessment which puts an end to the training can have an impact in some ways similar to that of receiving notice during therapy that one’s therapist is putting a premature close to the therapy. Trainees come up against, and engage with, raw and painful aspects of their relationships and their history in various aspects of the course. Such engagement is not merely confined to their personal therapy. An outcome which ends their training interferes with that personal process, almost always in a premature fashion. Moreover, in the setting of a training the impact can be all the greater because of the exposure and shame felt in the face of the trainers and the trainee’s peer group.
So some people who start out on a training course with strong personal and professional hopes leave with the bitter experience of being hurt, even devastated. Is this just one of the risks of the trade, part of the “collateral damage”? That, I think, is a rather cynical perspective. Maybe we have to accept that there will be casualties, that inevitably some trainees will receive bad news. But do we simply accept it and shrug our shoulders? Perhaps interviewing, screening processes, and assessment procedures need to be improved. Maybe all we can do is put safeguards into the system of training, and give adequate and substantial “warnings”, written and verbal, when they seem warranted. Even with all these steps, there will still be people who are assessed as not suitable or not ready to continue their training.
I am not for one moment suggesting any lessening of standards, any softening of assessment or any shrinking from responsibility. An assessment process is crucial to training. Trainees will be asked to face how others see them and will be challenged to discover their responses to such perspectives. But there are other challenges, and to people other than trainees. In the light of the hurt and rejection some trainees feel as they leave the course. I am left with some question. In relation to trainees and trainers, training schools and institutes, and also the counselling and psychotherapy professions, what responsibility do each of these have to address the damage the training can leave in its wake. Such damage affect not only the trainees, but may also affect the courses and the professions.
Does a conversation need to take place between trainers about the long shadow that training courses can cast? Could trainers listen to trainees, current and past, some who received good news and some who did not, in order to open up new possibilities? Might the pain of rejection experienced by some trainees be responded to in a way other than to recommend therapy? And what about those practicing counsellors and psychotherapists? How do we carry in our work the experience of success and failure, of good and bad news?
Colm O’Doherty is Director of Training in the Institute of Creative Counselling and Psychotherapy, Dun Laoghaire, where he works as an integrative psychotherapist in training, supervision and psychotherapy.