by Ger Murphy
The Psychotherapy and Counselling professions have grown and developed greatly in Ireland over the past 15 years. This time has seen the development of professional standards for practitioner accreditation, the clarification of ethical and educational training standards and training recognition, and cross national equivalence. It may now be timely to consider how practitioners once educated and accredited to practise, can maintain themselves in “good enough condition to practise” as our ethical codes require us to be. Indeed we can ask what might constitute such a condition to practise. In this piece I will try to consider what psychotherapist on going professional development might entail in the hope of generating a timely debate in our profession on this issue.
This may be particularly relevant as continuing professional development (C.P.D.) will too need to be boundaried, recognised and accredited as a next step in the profession’s self regulation. I will also outline a C.P.D. structure, which has been used in recent years at the Institute of Creative Counselling & Psychotherapy. Firstly, we might consider why continuing professional development is necessary.
It is commonly accepted that to practise in any professional endeavour at a high level it is necessary to update oneself on current theoretical and clinical thinking. An example here would be the value for psychotherapists to develop a familiarity with recent development in models of psychotherapy integration and research findings on brain development as they affect and are affected by attachment patterns in early childhood. For example, see Wilber’s extensive writing on levels of consciousness and how different psychotherapies can be seen to address different levels of development.
However while such continuing professional development is essential to keep the practitioner’s conceptual framework open and growing, it is but one of the aspects of C.P.D. which is relevant to psychotherapists and counsellors. The personal affects of providing a therapeutic service to clients can be very powerful. Kottler discusses the occupational hazards of therapeutic practice and lists the following: “Sleepless nights, one-way intimacy, restraint, narcissistic fatigue, futility, isolation, conflict and money” Kottler (1991). In effect he says psychotherapists can be traumatised by concern.
Mc Cann and Pearlman (1990) outline how working with clients in a therapeutic setting can strongly affect the practitioner’s well being, specifically by undermining three core beliefs which they estimate as important for well being – those being related to
a) personal vulnerability
b) positive view of oneself
c) belief that the world is meaningful and orderly
All of these can be undermined by practice over time.
Further it is important to note that along with “compassion fatigue” and disturbed self belief patterns which can come about from prolonged practice, there are specific risks attached to working with severely traumatised client groups. Pearlman and Seakvitne (1995) define vicarious traumatisation as “the transformation in the inner experience of the therapist that comes about as a result of the empathic engagement with clients’ trauma material”. Therapists can experience enduring changes in their ways of experiencing self, others and the world. We then have a varied collection of needs, which C.P.D programmes may address. These vary from conceptual recharging to managing compassion fatigue, and from self belief maintenance to counteracting vicarious traumatisation.
C.P.D. programmes can offer a professional community environment, which supports and challenges the practitioner to reflect on their own well-being. As isolation is a particular hazard in the profession, developing a group climate of safety and self disclosure is key. Yalom in speaking of the value of support group for himself as a practitioner states: “What is essential is that the group offer a safe, trusting arena for the sharing of the stresses of personal and professional life”. A programme with a strong process group component is perhaps essential. It is also valuable for a programme to consider such issues as burn- out, self care strategies, addictions and the consideration of ongoing professional learning paths. I believe that a programme can also valuably engage the practitioner at a somatic as well as a verbal level, a place to move, dance and play, as well as speak together. The overall process can allow practitioners to periodically build awareness and reflect on what can be unconsciously accumulated over years of practice.
In facilitating such programmes, I have found the importance of practitioners finding a safe place to meet the grief, rage and fear that the continued exposure of the work seems to generate. Freud advised therapists to return to psychotherapy every five years because of frequent exposure to primitive repressed material, which he likened to dangerous exposure to X Rays. Such exposure can render psychotherapists flat, in affect, suspicious and closed. A good CPD programme can help engender hope, curiosity and expansion of personal boundary.
The particular C.P.D. programme offered at I.C.C.P. is of 5 days duration and takes place on one day per month over a five-month period. This programme was devised and facilitated by Colm O’ Doherty and myself at the Institute. The theoretical input takes the form of relevant papers on themes of practice, which are considered by the group. This is followed by a clinical supervisory discussion where participants present from their own practice related to core themes. The day proceeds to explore personal themes as they have been stimulated by the material of the day. Such exploration is undertaken both in discussion and by way of movement and related somatic exercises relevant to the theme.
The process is a powerful one, as the following quote from Mary Peyton M.I.A.H.I.P., a recent participant confirms:
“Letting the body speak, this body which is impacted upon every time I sit with another body. Allowing my body to tell me what I am like as a therapist, and what I ask of myself and then embodying what I could be like is just one of the many experiences that stands out for me. I have more compassion for myself and a deeper understanding of the many layers of my work and feel the need for this space to be available on and ongoing basis.”
Participants have the opportunity to engage with their own process, as it relates to themselves as practitioner, in the company of others and in the context of both clinical and conceptual material. The experience of participants would attest to the view that the C.P.D. experience is best served where in-depth personal process work can be done alongside clinical and theoretical material, thus allowing for the integration of the practitioner in their professional context. This avoids the professional risk of separating the practitioner into split off parts where they only converse with their colleagues about clinical and theoretical issues and contain the personal dimension for individual psychotherapy.
I trust that these thoughts may stimulate input from other trainers and practitioners as to their views of relevant content and structure for C.P.D., a developing element of ongoing training.
Ger Murphy works as an integrative psychotherapist using a somatic and object relations approach. He also works as a supervisor, organisational development consultant and trainer.Ger can be contacted at firstname.lastname@example.org
Kotter & Hazler (1997) What you never learned at Graduate School. U.S.A.:W.W. Norton & Co Inc.
Yalom, I.D. (2003) The Gift of Therapy. Reflections on being a Therapist. Piatkus
Wilber, K. No Boundary. U.S.A.: New Science Library.
Kottler J. (1991) On Being a Therapist. San Francisco: Jossey Bass
McCann, I. & Pearlmann, L. (1990) ‘Vicarious Traumatization: A Framework for understanding the psychological effects of working with Clients’ , Journal of
Traumatic Stress 3 131 – 149
Pearlmann L. & Baakvitne (1995) Trauma and the Therapist – Counter transference and vicarious traumatisation in therapy with incest survivors. New York: Norton.