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APPROVED: Elizabeth Prosek, Major Professor Amanda Giordano, Committee Member Natalya Lindo, Committee Member Jan Holden, Chair of the Department of
Counseling and Higher Education Bertina Hildreth Combes, Interim Dean
of the College of Education Victor Prybutok, Vice Provost of the
Toulouse Graduate School
A PHENOMENOLOGICAL EXPLORATION OF COUNSELORS’ EXPERIENCES
IN PERSONAL THERAPY
Cynthia M. Bevly, M.S.
Dissertation Prepared for the Degree of
DOCTOR OF PHILOSOPHY
UNIVERSITY OF NORTH TEXAS
May 2017
Bevly, Cynthia M. A Phenomenological Exploration of Counselors’ Experiences
in Personal Therapy. Doctor of Philosophy (Counseling), May 2017, 135 pp., 2 tables, 2
figures, references, 79 titles.
Professional counselors may choose to increase self-awareness and/or engage
in self-care through the use of personal therapy. In particular, counselors may feel
reluctant to pursue personal therapy due to stigma related to their professional identity.
To date, researchers have paid limited attention to the unique concerns of counselors in
personal therapy.
The purpose of this phenomenological study was to explore counselors’
experiences and decision-making in seeking personal therapy. I addressed the following
questions: What contributes to counselors’ decision to seek personal therapy? How do
counselors make meaning of their experiences in utilizing personal therapy?
Participants included 13 licensed professional counselors who had attended personal
therapy with a licensed mental health professional in the past three years.
I identified six emergent themes through adapted classic phenomenological
analysis: presenting concerns, therapist attributes, intrapersonal growth, interpersonal
growth, therapeutic factors, and challenges. Participants reported positive changes in
personality and relationships, as well as several barriers specifically related to their
counselor identity. Findings inform mental health professionals and the field of
counselor education and supervision about the personal and professional needs of
counselors. Limitations and future research directions are discussed.
iii
ACKNOWLEDGEMENTS
First, I have to thank God for giving me the strength and wisdom to carry on even
when I felt so discouraged. To Dr. Elizabeth Prosek, my mentor since the beginning of
my master’s program and the only person besides me who will read this entire
dissertation. We have really seen each other grow and change over the past five years.
I am so grateful for you and our relationship. I never imagined being where I am today,
and I owe much of that to you. Thank you for seeing my potential and believing me,
even when I couldn’t do that for myself. I hope we are forever friends. To Dr. Amanda
Giordano, thank you for your words of affirmation. I felt like I could always come to you
for support, guidance, and kind words. You have been so instrumental in my career. To
Dr. Natalya Lindo, for your constant care that always put me at ease. Every time I talk to
you, I walk away thinking and feeling that everything will be okay. Thank you for your
uplifting spirit. To my amazing research team that stayed with me through all of my
flaws and hiccups. Because of my team, I never felt alone in this journey. To my
beloved Alex, I love you more than I could ever find a way to say. You have saved me
from myself so many times. There is no doubt in my mind that I would not have made it
without you. Thank you to my cohort, I am forever changed by your love and
acceptance of me. To the rest of my family and friends (Mom, Tio, Tia, Melissa, and
Dad), thank you for being there for me through all of my rough patches. To my clients,
you are the reason I do what I do. “…when we risk ourselves as persons in the
relationship, when we experience the other person as person in his/her own right, only
then is there a meeting at a depth that dissolves the pain of aloneness…” – Carl Rogers
iv
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS ..............................................................................................iii LIST OF TABLES AND FIGURES ................................................................................. v A PHENOMENOLOGICAL EXPLORATON OF COUNSELORS’ EXPERIENCES IN PERSONAL THERAPY .................................................................................................. 1
Introduction .......................................................................................................... 1 Methods ............................................................................................................... 4 Results .............................................................................................................. 11 Discussion ......................................................................................................... 20 References ........................................................................................................ 26
APPENDIX A. INTRODUCTION .................................................................................. 30 APPENDIX B. EXTENDED LITERATURE REVIEW .................................................... 37 APPENDIX C. EXTENDED METHODOLOGY ............................................................. 57 APPENDIX D. RESULTS ............................................................................................. 74 APPENDIX E. EXTENDED DISCUSSION ................................................................... 95 APPENDIX F. SUPPLEMENTAL MATERIALS .......................................................... 110 APPENDIX G. SAND TRAY PICTURES .................................................................... 119 COMPREHENSIVE REFERENCE LIST .................................................................... 125
v
LIST OF TABLES AND FIGURES
Page
Table 1. Participant Demographics ................................................................................. 5
Figure 1. Coding graphic ............................................................................................... 11
Table C.1. Participants of the Study .............................................................................. 61
Figure D.1. Flow of themes ........................................................................................... 75
1
A PHENOMENOLOCIGAL EXPLORATION OF COUNSELORS’ EXPERIENCES IN
PERSONAL THERAPY
Self-awareness is a fundamental part of the counseling profession. Not only do
professional counselors seek to increase the self-awareness and personal growth of
their clients, but counselor educators and researchers call upon counselors and
counselor trainees to increase their own self-awareness as well (Council for
Accreditation of Counseling and Related Programs [CACREP], 2016; Hansen, 2009).
Additionally, counselor educators often recommend self-growth experiences such as
personal counseling to increase counselor trainees’ self-awareness (Gladding, 2008;
Remley & Herlihy, 2010). Several scholars defined counselor self-awareness as the
mindfulness of thoughts, feelings, and behaviors in the self and in the counseling
relationship (Oden, Miner-Holden, & Balkin, 2009; Richards, Campenni, & Muse-Burke,
2010; Williams, 2008). Pompeo and Levitt (2014) asserted that self-awareness
parallels awareness of personal values and enables counselors to explore best
practices in counseling. They also stated that counselor self-awareness relates to
awareness of the counseling relationship and that such awareness is helpful to client
satisfaction and growth (Pompeo & Levitt, 2014). Therefore, counselor self-awareness
can benefit both counselors and their clients.
Several researchers have examined the clinical implications of counselor self-
awareness, including professional competence, client treatment outcomes, and
wellness (Hays, 2008; Richards et al., 2010; Williams, 2008). For example, Evans,
Levitt, Henning, and Burkholder (2012) emphasized the significance of counselor self-
awareness in the ethical decision-making process, stating that counselors’ sense of self
2
is crucial in understanding how personal values intertwine with clients and their
concerns. Self-awareness can assist counselors in ethical decision-making as well as
facilitate beneficence and nonmaleficence in providing counseling services (Evans et
al., 2012). Additionally, many researchers have investigated the importance of self-
awareness as a characteristic of counselors who can competently work with culturally
diverse clients (Arredondo et al., 1996; Cartwright, Daniels, & Zhang, 2008; Sue & Sue,
2013). Furthermore, Killian (2008) discovered that mental health professionals’ self-
awareness of emotional and physical distress helped to identify burnout and
compassion fatigue when working with difficult caseloads. Thus, some evidence of the
clinical impact of counselor self-awareness exists in the literature.
Counselors can gain self-awareness in a variety of different ways, including
personal therapy. Mearns and Cooper (2005) stated that the term therapy loosely
signifies the receiving of mental health services from any licensed mental health
professional that holds a license to practice. Additionally, I will use the word therapist in
reference to researchers who did not specify the type of the mental health professional
(e.g., counselor, psychologist, social worker) who serviced the participants in their
study. Several scholars have found that therapists who completed their own personal
therapy experienced increased professional development. For example, Oden et al.
(2009) found that counselor trainees who completed a personal therapy requirement
perceived a noticeable increase in awareness of client interactions. Furthermore, other
researchers have noted the impact of therapy on therapists’ personal growth; Linley and
Joseph (2007) found that therapists who have received personal therapy or currently
receive personal therapy reported increased wellness and self-awareness (Linley &
3
Joseph, 2007). Therefore, previous scholars have supported the positive impact of
personal therapy for therapists.
Some therapists may seek personal therapy due to mental health concerns
(Rake & Paley, 2009). Therefore, it is worth exploring the needs of this unique
population. In a national survey, Lawson (2007) found that almost a third of participating
counselors reported compassion fatigue, burnout, and vicarious traumatization. Other
investigators have reported that therapists’ most frequently cited presenting concerns
were resolving personal problems (Orlinsky, Schofield, Schroder, & Kazantzis, 2011).
Among counselor trainees, Christopher and Maris (2010) stated that stress can affect
their effectiveness by decreasing their ability to attend, concentrate, and make
decisions. Furthermore, Prosek, Holm, and Daly (2013) found that counselor trainees
presented with elevated levels of anxiety and depression. Hence, counselors are at risk
for mental health concerns related to occupational and personal stressors. The
psychological needs of counselors coupled with the emphasis on gaining self-
awareness highlight the necessity for counselors’ personal therapy.
Self-awareness is an important component of counselor development due to the
personal nature of the profession (Hansen, 2009). Personal therapy is one way to
enhance counselor self-awareness (Mearns & Cooper, 2005). Additionally, counselors
may experience a variety of mental health concerns including compassion fatigue,
interpersonal conflict, depression, and anxiety (Lawson, 2007; Orlinsky et al., 2011;
Prosek et al., 2013). Therefore, some counselors are in need of personal therapy to
support their professional development as well as to attend to their personal concerns.
4
Researchers have primarily focused on the perceived outcomes of personal therapy,
including personal growth and professional development (Bellows, 2007; Daw &
Joseph, 2007; Oteiza, 2010; Rake & Paley, 2009). However, scarce research exists
regarding counselors’ decision-making process in seeking personal therapy. Thus, if
counselors could benefit from personal therapy, and if little knowledge exists regarding
how counselors decide to seek personal therapy, professional counselors, counselor
educators, counselor supervisors, and other mental health providers have limited
information regarding how to facilitate that decision-making process. The purpose of this
study is to explore professional counselors’ experiences and perceived outcomes in
seeking personal therapy. The following questions will guide my inquiry:
1. What contributes to counselors’ decision to seek personal therapy?
2. How do professional counselors make meaning of their experiences in utilizing
personal therapy?
Method
Hays and Singh (2012) stated that phenomenologists seek to understand the
distinctive characteristics of human behavior and first-person experience. I strive to
understand how counselors make meaning of their experiences in personal therapy.
Because I aim to describe the lived experiences, or essence (Moustakas, 1994), of
counselors receiving personal therapy, phenomenology appropriately answers the
research question based on its traditions (Wertz, 2005). Consistent with
phenomenology, I used Miles, Huberman, and Saldaña’s (2014) adaptation of classic
data analysis, as well as an inductive-deductive approach to analyze the data.
Participants
5
The population for this study included individuals who are Licensed Professional
Counselors (LPCs) in a large state in the southwestern United States and have utilized
individual counseling services with a licensed mental health therapist. Participants can
have current or past personal therapy experiences within the last three years. In an
unpublished dissertation similar to the current study, Yaites (2015) recruited participants
who had received counseling services within the last three years in a phenomenological
exploration of African Americans in counseling. I aimed for a sample size of 15
participants based on Creswell’s (2013) recommendation of 5 to 25 relatively
homogeneous participants for a phenomenological study. Therefore, I recruited 13
participants based on saturation of data. I used purposive sampling to select
participants for this phenomenological study (Hays & Singh, 2012). I asked participants
to choose pseudonyms in an effort to protect their anonymity and confidentiality. More
information about participants is listed in Table 1.
Table 1 Participants of the Study
Participant Age Race/Ethnicity Gender Religious/Spiritual Affiliation
Sexual Orientation
Alma 37 Latina Woman Christian Heterosexual Amy 30 Latina Woman Christian Heterosexual Ashley 29 Multiracial Woman Spiritual Heterosexual Betty 55 White Woman None Heterosexual Elenore 30 Multiracial Woman Christian Queer Felicity 44 White Woman Christian Heterosexual Jennifer 40 White Woman Christian Heterosexual Liz 35 White Woman Pagan Bisexual Lynn 48 White Woman Christian Heterosexual Michelle 37 White Woman Christian Heterosexual Rose 30 White Woman Christian Heterosexual Sophia 35 White Woman None Heterosexual Thomas 34 White Man None Heterosexual
6
Procedures
I obtained Institutional Review Board approval before participant recruitment to
approve all forms of and procedures for this study. I recruited participants through email,
word of mouth, and networking with LPCs in a 50-mile radius of a large southwestern
state in the United States. To attend to diversity, I intentionally recruited from locations
that varied in racial and economic make-up. I also recruited participants through
personal contacts and professional counseling organizations.
After reviewing initial demographic surveys, I contacted potential participants via
phone or email to explain the study and assess their eligibility to participate in the
interviews and sand tray sessions. I recruited 13 individuals to continue in the study
based on their responses to my initial phone contact. I excluded participants who
reported holding expired LPC licenses, experienced therapy more than three years ago,
and described personal therapy from an individual without a license in a mental health
profession from the study. If eligible for the study, I scheduled to meet with participants
face-to-face in their professional counseling office at their convenience in order to
conduct the interviews and sand tray sessions. Although participants read and
acknowledged the informed consent before completing the online demographic form, I
readdressed informed consent before beginning individual interviews and sand tray
activity. Participants then identified a pseudonym to use for the remainder of the study.
Data Sources
To determine eligibility, potential participant members completed a Qualtrics
survey, an online initial screening tool that included questions about number of sessions
completed, length of time since termination (if applicable), age, gender, racial and ethnic
7
identification, sexual orientation, religious/spiritual identity, number of years as an LPC,
disability status, licensure of therapist, therapist demographic information, and whether
or not their counseling training program required personal therapy. The online
demographic survey also included information about informed consent and
confidentiality.
I audio recorded 60 minute interviews using a digital audio recording device. I
used a semi-structured interview protocol to guide the interview that consisted of six
open-ended questions to assist me in understanding the experiences of professional
counselors who have engaged in their own personal therapy: a) please tell me about
your experience in personal therapy in as much detail as you feel comfortable sharing,
b) what outcomes did you experience as a result of personal therapy?, c) how, if at all,
has personal therapy affected your personal growth?, d) how, if at all, has personal
therapy affected your own clinical work? e) describe the experience of being both a
client and a counselor, f) is there anything else that you would like to share?.
Furthermore, Hays and Singh (2012) stated that “visual methods, in general,
provide participants with an opportunity to express themselves in a nonverbal manner
that may access deeper aspects of their understanding and/or experience of a
phenomenon” (p. 278). After the semi-structured interviews, I invited participants to
create their personal therapy experience in the sand tray using the figures and materials
provided; this method is consistent with Measham and Rousseau (2010) who used sand
tray as a method of data collection for understanding the experiences of children with
trauma. I prompted participants to explain their sand tray and continued audio recording
their description. I also took digital photos of participants’ sand trays.
8
Data Analysis
Miles, Huberman, and Saldaña (2014) offered procedural steps for conducting
the adaptation of classic data analysis. I utilized four research partners and a
supervising researcher in order to increase trustworthiness of the study. I am a 26-year-
old Latina woman completing a doctoral degree in counseling. All four of the research
team members are women in their early 20s completing a master’s degree in
counseling; three identified as White and one identified as Asian. The supervising
researcher is a White woman in her 30s and an assistant professor at a CACREP-
accredited counselor education program with experience conducting, facilitating, and
mentoring doctoral student researchers in qualitative research. After I completed all
interviews and sand tray sessions, I sent recordings to a professional transcriptionist to
transcribe each interview and sand tray session verbatim. I reviewed recorded
transcripts to listen to participants’ tone and verify accuracy. Consistent with qualitative
research and phenomenological procedures, the research team conducted data
analysis according to an adaptation of classic analysis.
To develop preliminary codes, the research team summarized notes of our
reactions to the interview material of the first three transcripts. We then compared and
contrasted the key phrases developed in the previous step and grouped them into
categories. My team and I then facilitated reduction of the data as we combined similar
phrases and merged overlapping categories. My team and I continued to merge
categories and reformulate the category headings. From this process, my team and I
developed preliminary themes based on the data.
9
In order to develop initial codes, my team and I established agreement by
independently applying the preliminary codes to a subset of three interviews. My team
and I meet weekly in order to discuss inconsistencies and points of agreement, adjust
the preliminary codes, and reapply it to the data subset. We continued to discuss any
remaining discrepancies and concerns until we reached a mean agreement of 86% to
90% (Creswell, 2013). The research team reached a mean agreement of 95.1%. We
then finalized the codes to use in our coding manual.
In final coding, my research team and I applied the final coding manual to each of
the interviews and sand tray explanations. We used the same coding manual for both
the interviews and sand trays. The same research team member coded both the
interview and sand tray explanation for the same participant. I coded all 13 interviews
and sand tray explanations; all four members coded the first three interviews and sand
tray explanations. Two members coded interviews and sand tray explanations four
through eight, and the other two members coded interviews and sand tray explanations
nine through 13. We revised the codebook on four occasions and recoded previously
analyzed transcripts with the updated codebook. Once we completed final coding, I
performed member checks with the participants. In this process, I emailed all
participants a summary of the identified themes and inquired if the summary portrays an
accurate representation of the experience. Moreover, it provided an opportunity for
participants to bring my attention to an area of their experience that is not accounted for
in the themes. Nine out of 13 participants responded and informed me that no
adjustments were necessary because the summary adequately captured their
experiences. The remaining four participants did not respond to my follow-up email.
10
Establishing Trustworthiness
To develop trustworthiness in qualitative research, Lincoln and Guba (1985)
presented four criteria: credibility, dependability, confirmability, and transferability. I
established credibility in this study through the use of research partners in debriefing,
researcher reflexivity, and participant checks. I utilized researcher partners in debriefing
and data analysis steps in order to strengthen the development of the coding manual. In
relation to researcher reflexivity, I bracketed my experiences by reflecting on my biases
and assumptions as a professional counselor who experienced personal therapy
through journaling and discussing my assumptions with my supervisor and research
team. My research team and I also engaged in bracketing through journaling and
discussing assumptions based on previous research and personal experience. Most
notably, the members reported benefits including increased awareness, higher
functioning in relationships, and increased self-esteem because of their own personal
therapy and expected participants to report similar outcomes. Additionally, I conducted
participant checks to confirm themes found by the research team (Lincoln & Guba,
1985).
I demonstrated transferability by openly and honestly providing information about
myself, the proposed study’s context, participants, and study methods. My transparency
can facilitate application of research findings and procedures in the current study.
Moreover, dependability refers to the ability of the study to be consistent across time,
researchers, and analysis techniques (Lincoln & Guba, 1985). I achieved dependability
through documenting each task I completed for the study by keeping an audit trail. This
process may allow others to replicate my study. Lastly, confirmability is based on an
11
acknowledgement that I, as the primary researcher, cannot be truly objective (Cope,
2014). It is important that I remain as objective as possible throughout the study. I
utilized multiple methods of data sources, or triangulation to facilitate increased
confirmability. In this study, I triangulated the findings using participant checks,
consultation with the supervising researcher, and research team consensus.
Results
The research team identified six major themes and 11 sub-themes.
Figure 1. Coding graphic.
12
Participants shared their decision-making process leading to the initiation of
personal therapy, including motivations for seeking therapy. Presenting concerns
included participants' thoughts and feelings prior to engaging in personal therapy, as
well as the two sub-themes of mental health concerns and life transitions.
...I would say that generally, um, I feel pretty confident dealing with the daily stressors and, you know, life is hard at times and goes up and down and marrying and having kids and there's just always stuff going on, but I would say those were the times when it was like I was put, I was pulled to my end, um, and so the, the depression, it was like I needed something else more than just the regular support from family and friends and then the miscarriages. It was like I felt so isolated, um, and then with my dad dying it was like I, gosh, this is ...It was like both of them dying so close together...(Michelle)
...it was stress it's- me feeling like, overwhelmed and probably getting like more snappy or short with my family, which is feeling like, over-taxed, over-done. Being like, I need to go. I need to just dump some of this stuff. Yeah, I feel like I can't balance all the junk everybody throws at me all day, first, and then combine that with family life. (Sophia)
And some of that was related to, um, eh, like as a result of the divorce. I've moved 3 times in the past, like sold a house and moved out of it or kind of moved into storage while in that house in order to be able to stage it and sell it. Then out of the house into an apartment, out the apartment into a rent house. And so there's been a lot of upheaval for me and for my child. (Lynn)
For some participants (n = 10), life transitions overlapped with their mental health
concerns, such as a career change triggering anxiety. However, the remaining three
participants cited either mental health concerns or life transitions as a reason for
initiating personal therapy. All participants differentiated their experience of internal
mental health distress and external life stressors.
Theme 2: Therapist Attributes
As participants reflected on the different feelings and thought process they
experienced during the initiation of personal therapy, they also shared different
attributes they looked for in a therapist. Two sub-themes emerged: practicality and
Theme 1: Presenting Concerns
13
quality. Practicality involved factors such as location and affordability. Quality consisted
of therapist credentials, training, experience and specialty areas. All participants shared
factors related to both sub-themes.
So I was like "Okay. Well I know this person, I know this person, I know this one. Oh. I don't know this person, okay. Let's see if they have an opening." So, that kind of ended up being, and I wanted someone that was close to my work because it's easier for me just to go straight from work considering working at a hospital, um, I can work ridiculously long hours. Sometimes, you know, twelve hour days...So I needed someone in [city withheld], and I needed someone I didn't know. (Laughs) And they took my insurance. (Liz) I'm very intentional on their education. Even like when I have family and friends that ask me, "Hey, I need a therapist," um, I will like, just, you know, like on [therapist finder website], I'll get their zip code and I'll tell them to put in whatever search criteria they want, like insurance or whatever and I go through and I look at where they went to school and I look at what their license is and I weed out a lot of people just based on that. (Rose) I just wanted, I really wanted somebody who was, um, not an intern and not a grad student. I need somebody who was fully licensed. Um, I was looking for somebody who’d done their own work. I would, I wouldn’t really know, but I, I can kind of tell. I was looking for somebody who had done their own work, their own process, um, and somebody who’d work with therapists. Um, and so the first therapist that I found, she’d been a, a therapist for about twelve years. Um, she had a successful private practice on her own... (Alma)
Some participants (n = 8) prioritized affordability and location over other
attributes, other participants (n = 5) emphasized education, specialty area, and
recommendations as their way of selecting therapists. Each participant highlighted their
need for accessibility and fit into their hectic schedules and personal lives. Participants
described these factors as a method of narrowing down the pool of possible therapists.
Theme 3: Intrapersonal Growth
All participants identified various internal and external changes that took place in
personal therapy, and how it affected life outside of the relationship with their therapist.
14
Participants discussed the occurrence of these outcomes as they happened during
and/or after their personal therapy experience. All participants expressed changes in
thoughts related to self that were associated with increased perspective. Participants
specifically reported internal changes such as awareness, mindfulness, and a sense
purpose as outcomes of receiving personal therapy. Twelve out of 13 participants
described these cognitive changes as a positive experience. One participant described
the experience as distressing due to the increased awareness of unpleasant knowledge
of self and others.
Um, I think a lot of self-awareness in the sense of, like, why I function the way I function and, um, an understanding of why, like, not only the why, but, like, what I was needing, and so, like, and what I was seeking. And so, um, just a greater understanding of those pieces that I really had no, uh, no awareness of before that. And so, I had a little awareness of it, I should say. I probably knew a little bit, but I don't think I trusted myself in, like, seeing that, trust in myself and, like, um, trust in my intuition, and trust in my decision making. (Jennifer) Um, and the biggest thing for me was redefining my idea of confidence and self-esteem, self-worth, that kind of thing. Um, I was able to get to a place where I accepted who I am, where I am, what's going on with me, um, versus some idea of attaining confidence or attaining self-worth or self-esteem, that I'm enough where I'm at. Um, so, as I said, it's like a lot of work on grounding, checking in, tuning in. That was really so beneficial in, in the outcome for me that on a daily basis I'm able to check in, tune in, see where I'm at, um, pour more into me if I need to. Um, so I'm very much so I believe, uh, much farther than I was when I started on that self-awareness and, and growth in helping myself. (Amy) Um, well I know, a lot of time, even when I started at the hospital, I always kind of felt like an impostor. In my field. I felt like it was, I felt like someone was gonna find me out that I'm really just faking all of this, and I really don't know what I'm doing. And it's, and it's also helped me find purpose, which has really helped with the knowing that I can't have children. You know. I have children. I have all these patients, and some of them are, some of them come in and out, and I see, you know, once a month, and some of them I see every six months and...it's kind of like you know, I can help them. I can make a difference. I can matter. I can leave my footprint. Which really has helped with the knowing that you know, I can't leave a legacy through children, I can leave a legacy though work. (Liz)
15
All participants described emotional changes within themselves related to
regulation, stability, and expression as a result of personal therapy. Participants
reported a decrease in distressing emotion, increased attunement to their emotional
well-being, and an increased ability to express emotions in a healthier manner.
Additionally, participants experienced less negative feelings towards themselves.
…like I, uh, back then, like, I, I was just, I was, uh, hiding from a lot of pain. I was hiding a lot of pain. So now, that I've, I've been able to work through that in therapy, I'm just more emotionally attuned in general. (Thomas) Well like, for, I, I would've told you at the beginning that I don't get angry. I'm not an angry person. I never get angry. Well, I just never felt it. Um, so I've learned to recognize, "Yeah, actually there's a bunch of anger stacked in here."…Uh, so, uh releasing anger in a grounded way means that you're breathing and you're uh, present…you're present and you're, you're connected, and you're not out of control. (Betty) um, I'm also able to know what's, what is my emotion and what is other people's emotions because sometimes I struggle. I will feel what other people are, other people are having. Like, if they're high stress or high anxiety then mine starts to ramp up too, and so, um, I've been able to really recognize, "Okay, that's not my stress. That's their stress," and kind of protect myself in that way. (Ashley)
All participants explained the overlap between cognitive and emotional
intrapersonal growth; they described that one naturally flowed into the other. However,
the experiences were also distinct regarding changes in thought and changes in feeling.
Furthermore, participants expressed how this intrapersonal growth that occurred as a
result of personal therapy carried over into other relationships in their lives. Participants
shared that these internal benefits influenced external factors in their lives. Thus, the
theme of intrapersonal growth led into the third theme, interpersonal growth.
Theme 4: Interpersonal Growth
16
All participants shared changes in relationships and depth of social connection,
both in personal relationships and professional relationships with clients. Participants
reflected on how their growth affected relationships with romantic partners, family,
friends, and clients. Thus, the two-sub themes of personal relationships and
professional relationships arose in the data. Personal relationship growth included
increased empathy, awareness, and boundary flexibility in relationships with friends,
romantic partners, and family members. More specifically, participants shared that
personal therapy allowed them to recognize, connect, and emotionally attune to others’
thoughts and feelings. Additionally, participants reported learning to relax their
boundaries by allowing people to know them more deeply and accept help during times
of need. Conversely, participants (n = 7) also described that they were able to increase
their boundaries to protect themselves and their time as a result of personal therapy.
I believe that it helped me connect with people on a deeper level. Because it's, uh, it's hard to empathize or connect with someone if you're, you can't feel yourself. 'Cause if you can't feel yourself, you can't feel what they're feeling either. So, uh, like with my kids, you know, I would be able to, uh, first of all, set firmer boundaries with them. And they would take me more seriously. And uh, I'll then also be able to connect more. And in another area I was able to learn to ask for help. Um, instead of trying to always be, take care of things and handle things by myself, and to, to actually feel safe enough to ask for help. (Betty) ...a greater sense of comfort and ease with intimacy in relationships. So um like, being vulnerable and um ... not being as afraid of like interp- like conflict within a relationship, and um feeling more secure in the fact that like, if I have conflict in relationship um that I would be, I would be able to work it out with them. And conflict in relationship doesn't necessarily mean that like the relationship is over, or um you know. (Eleanor)
...you know, I could empathize, I could play the role of counselor and do my job, but I wasn't doing it, like for real for real, like I was falling out of the, you know, like, what I really needed to be doing, and now, like, I'm able to sit with clients, and you know, every now and then my mind, like, wanders to "oh, I gotta to do this or that," but, like, I'm quick, you know, I become aware of it more quickly, and I'm able to feel deeply with clients, like I, I have sessions all the time now, where
17
I'm like tearing up with my clients, and just like feeling so moved by them. And also, I cry more in my personal life, and, and, and professional life…(Thomas)
Twelve out of 13 participants experienced their interpersonal growth as helpful in
alleviating their presenting concerns. The remaining participant described the
interpersonal growth as tense and uncomfortable. All participants explained that their
interpersonal growth in personal relationships was connected to interpersonal growth in
professional relationships with their clients. For example, increased boundaries with
family extended to increased boundaries with clients. Participants shared that the
relationship with their therapist acted as a surrogate for relationships with other people
in their lives. Thus, the next theme represents factors in the therapeutic relationship.
Theme 5: Therapeutic Factors
All participants reported avenues of healing within the context of the therapeutic
alliance that lead to the changes in self and in relationships. Participants reflected on
how engaging in the relationship with their therapist facilitated their intrapersonal and
interpersonal growth. This theme included four sub-themes: nurturing, vulnerability,
normalization, and transference. Seven out of 13 participants described their therapist
as nurturing or felt nurtured throughout the process of personal therapy. Participants
reported that nurturing meant feeling safe with, trusting of, and cared for by their
therapist. This atmosphere of nurturing helped participants foster the courage to take
risks without fear of judgment or criticism.
Um, I felt prized, and loved, and a hundred percent accepted. And, like, nothing was abnormal or weird or, like, what I shared. Or, her response was always super supportive...My schedule was really odd, and so she made it work for my schedule. So, sometimes we met at 7:30 in the morning. Which I really appreciate. Sometimes we met at 8:00, sometimes we met at 2:00 in the afternoon...and I never felt like that was a burden to, she never made it sound like I was burdening her...and I'm super appreciative for that (Jennifer)
18
Participants also reported feeling vulnerable as the client and described the
feeling of opening themselves to the presence and feedback of another as
uncomfortable but also growth inducing. Participants described this level of vulnerability
as it related to their counselor identity. Participants explained that they were most
accustomed to structuring the session and managing the time and felt more comfortable
in the therapeutic relationship in the role of counselor. As the client, participants
experienced a new kind of vulnerability that led to intrapersonal and interpersonal
growth due to the reversed power differential.
Uh, but in the, when I'm the client it's like, "I don't know where we're going, I don't know what's gonna come up." It's kind of scary sometimes. Like you know? He's the guy with the flashlight, and I don't know where he's, what's gonna happen sometimes. Like what's going to get uncovered, or what's gonna I'm suddenly gonna become aware of or feel, or something. So it's a little scary. (Betty) All participants reported that their therapist, in different ways, normalized their
experience. Many participants (n = 12) believed something was atypical or flawed about
their personhood for needing personal therapy. Receiving help triggered feelings of
stigma, self-rejection, or self-criticism. Thus, a large part of participants’ healing process
was feeling normalized by the therapist.
…there's even been times when I've asked her, like, "do I, do I fit a diagnosis? Like, what's wrong with me?" You know, there's even been times when I've kind of demanded from her, like "what, what's the deal? I've been seeing you for two years, tell me what's wrong with me." And she won't do it. She’d, she will not do it, and she's just like "no, that's not what I do." And so that's helped me immensely. She's like "everything you've told me, every, everything fits." And it's helped me to see it that way…people that are in the mental health field want to know what's wrong with them, and how to fix it…sometimes I think diagnosis may be helpful a little bit, but, like, usually no, especially with trauma…it may sound crazy at first to someone who's never heard about it before, but then when you learn what they've been through, it makes perfect sense. (Thomas)
19
Several participants (n = 9) shared that healing occurred as a result of
therapeutic transference in the relationship with their therapist. Participants reported
perceiving the therapist as significant relationship in their life, sometimes describing
their therapists as a maternal or paternal presence. At times, the therapists themselves
were the healing catalyst, acting as substitute for redirecting emotional wounds.
…she probably was the age of my mom at the time and so I felt very nurtured by her in a way that, like I always wanted to be nurtured by mom but it hadn't happened like that...I mean, there was that transference kind of feeling that was happening but it was very positive, um, and she was very, very, just very warm, and I feel like that was, that relationship, that was so healing and allowed me to process through more things, feeling supported and encouraged by someone who is kinda like my mom but not my mom, almost like I was able to, it was like a reparative thing within the relationship. (Michelle) This sub-theme also encompassed feelings of attachment. In many cases,
participants’ early attachment figures were either emotionally or physically unavailable
or harmful. Participants explained that their therapists acted as a healthy attachment
figure and described this aspect of the relationship as reparative. Some participants
shared feeling re-parented by their therapist.
Theme 6: Challenges
Eleven out of 13 participants reported challenges related to the initiation of
personal therapy; two participants shared that personal therapy was a purely positive
experience without negative or uncomfortable feelings. Additionally, the same 11 out of
13 participants described challenges during the course of therapy that inhibited their
healing process. These challenges included three sub-themes: finances, stigma, and
role adjustment.
Oh, right. Okay. Oh yeah, you need about a stack of uh, 50,000 of these [dollar bills]. After all that money, he's not in network. So it was expensive. (Betty)
20
Um, yes, that there is a stigma like that if you need to go see someone that you're somehow like inadequate to deal with your own stuff, um, or that you're crazy or that you're really far gone, like only people who are really far gone need to do that or, um, but I still think it's a pride thing, you know? (Michelle) It's weird and it's distracting as a client because you're like, I know what's she's doing. Why is she doing that? Huh. Like it's, it's a good, it's a good place to run to if you don't want to go where they're trying to take you, you can go into your analytical, left brain logical mode. Oh, I know exactly, you know, and you feel like an expert. You know what they're doing. They're not pulling it over on you. It's a good way to run inside therapy. (Rose)
Five out of 13 participants discussed the idea of stigma and reported feeling the
general stigma towards mental health counseling plus additional stigma due to their
counselor status. The remaining participants (n = 9) explained that they did not
personally feel stigmatized, but were aware of the stigma that existed in regards to
counselors who receive personal therapy. All participants shared that they would attend
personal therapy longer or more frequently if not for financial barriers. Additionally, each
participant described the difficulty of experiencing the identity of both client and
counselor.
Discussion
The results of the current study are both similar and contradictory to previous
literature. For example, many researchers have demonstrated evidence of counselor
burnout and compassion fatigue (Deighton, Gurris, & Traue, 2007; Lawson, 2007;
Richards, Campenni, & Muse-burke, 2010; Thompson, Amatea, & Thompson, 2014).
Participants in the current study described feeling burned out and lacking in empathy as
motivations to seek personal therapy. Additionally, Killian (2008) outlined behavioral
symptoms of burnout and compassion fatigue, including mood changes, sleep
disturbances, becoming easily distracted, and increased difficulty concentrating. Many
21
participants in this study shared similar symptoms when discussing thoughts and
feelings in the decision-making process to initiate personal therapy, as well as when
describing their mental health concerns. Therefore, it is important to assess counselors
for levels of burnout and compassion fatigue in addition to raising awareness of signs
and symptoms.
The sub-theme of stigma in participant voices within the current study is
consistent with the existing literature. Norcross (2010) stated that counselors might feel
reluctant to seek personal therapy because of the assumption that as clients they might
appear as flawed or less capable as helpers. Participants described the general stigma
and personal shame in seeking mental health treatment. Furthermore, participants
differentiated between general stigma regarding mental health and stigma specific to
counselors. Based on this finding, counselors may experience greater stigma than the
general population when seeking personal therapy.
Aligned with the concept of professional growth, many researchers have
emphasized that personal therapy was an educational and/or training experience for
therapists and added to their professional repertoire of knowledge and skills (Ciclitira et
al., 2012; Daw & Joseph, 2007; Rizq & Target, 2008). However, these findings are not
congruent with the experiences of participants in the present study. Although
participants reported enhanced professional growth in terms of boundaries with clients
and professional advocacy outside of the therapeutic relationship, participants shared
that the intellectual aspect of personal therapy within the relationship served as a barrier
to the healing process. All participants expressed a desire or intent to release
themselves of their counselor identity while experiencing the client role. Thus, some
22
counselors may not see personal therapy as a means for education or professional role-
modeling and instead find those aspects as distracting to the experience.
Implications
The participants in this study sought personal therapy from licensed professional
counselors (n = 11) and psychologists (n = 2). However, participants did not mention
seeking a particular therapist orientation, field, or license. Therefore, a variety of mental
health professionals may service professional counselors and may benefit from the
implications from this study. Participants often emphasized the struggle in assuming the
client role, as they were most comfortable with the typical power differential in their
professional work. The therapeutic relationship is hierarchical due to its one-sided
nature; the therapist, privileged with specific training and expertise, possess the ability
to harm or help the client, who is vulnerable, distressed, and seeking a specific service
(Chang & Berk, 2009). This phenomenon was especially salient in the participant voices
of this study; vulnerability and role adjustment were crucial themes of their experience.
It may behoove clinicians to maintain awareness of this possibility or discuss it within
personal therapy. Chang and Berk (2009) also suggested the use of self-disclosure,
greater transparency about the therapy process, and facilitative questioning directly
related to therapist responses (e.g., What comes up for you as you process what I just
said?) as ways to balance the power differential in the therapeutic relationship.
Stigma emerged prominently in the current data and previous literature.
Additionally, counselors in this study experienced another layer of stigma related to their
professional identity. Participants indicated that as counselors, it felt shameful to need
professional help. Indeed, participant voices echoed the concept in the literature that
23
therapists must be exceptionally mentally healthy in order to provide mental health
services (Norcross, 2010). Clinicians may consider normalizing these thoughts and
feelings. Carpetto (2008) defined normalization as the therapist’s use of indirect or
direct statements that reframe client problems as contextual responses to the difficulties
of life. Therapists use normalization to de-pathologize client concerns and convey
implicit acceptance of the person of client (Carpetto, 2008). Varying degrees of
normalization skills include psychoeducation, reframing, and self-disclosure (Carpetto,
2008).
Counselor educators and supervisors have the opportunity to decrease stigma
among counselors and counselor trainees. Given that stigma was a central theme within
the current study, counselor educators may consider allocating time to discuss personal
therapy as means of self-care and burnout prevention, as well as a way to increase self-
awareness. Knaak, Modgill, and Patten (2014) reported that the most effective anti-
stigma interventions incorporate social contact, education, personal testimonies, the
teaching of skills, and myth-busting. Counselor educators and supervisors may consider
sharing important research on the topic of counselors in personal therapy, including
challenges and benefits of personal therapy. Counselor educators could invite guest
speakers to their classes, including professional counselors who see therapists or
professional counselors who have received personal therapy, to speak on their
experiences.
Implications for Future Research
Although participants reported feeling burned out and low on compassion, future
researchers may consider assessing burnout and compassion fatigue of counselors in
24
personal therapy through quantitative assessments, such as the Professional Quality of
Life Scale (Stamm, 2005). Researchers could conduct pre- and post-tests before and
after personal therapy to provide quantitative results in the efficacy personal therapy as
a form of burnout and compassion fatigue intervention. Additionally, future investigators
could quantitatively measure client treatment outcomes among counselors who
received personal therapy as another way to empirically validate the professional
interpersonal growth found in this study.
Moreover, qualitative researchers could explore the experiences of counselors
who provide mental health treatment to therapists to reveal more about this
phenomenon. Methods such as grounded theory, phenomenology, and interpretive
phenomenological analysis could delve more deeply into providing best practice for
counselors who seek therapy. Furthermore, participants in this study shared their
experience of personal therapy in a single interview; researchers may collect richer data
through the use of longitudinal studies that examine participants’ experiences in
personal therapy over time.
Limitations
The current study included many strengths, such as the rigor I followed and
trustworthiness I demonstrated. However, some limitations exist. I used a single-
interview design, thus limiting the amount of extended field experience with participants.
Participants may have offered more intimate and sensitive information after spending
more time in the interviewing process. Due to the sensitive nature of the topic of the
study, I worked to establish trust and build rapport with my participants through the use
of introductory questions at the beginning of my interview. Furthermore, the interviews
25
took place in one geographical area; participants from other locations across the United
States may have provided a more diverse perspective.
Despite plans to recruit a sample that was diverse in terms of age, gender, ethnic
identification, sexual orientation, religious/spiritual orientation, participants in this study
were similar to each other. Only one participant identified as a man, and the majority of
participants (n = 9) were White. Additionally, 11 participants identified as heterosexual
and eight identified as Christian. It would be beneficial to know more information about
the experience of counselors who identify as men, counselors of color, LGBTQIA+
counselors, and counselors from other religious and/or spiritual orientations. Other
limitations include the absence of voices of counselors ordered to receive mandated
counseling. I believe I received many interested participants who have experienced less
stigma; counselors who volunteered to participate in a study regarding this topic may
not be representative of their peers who undergo personal therapy for remediation
purposes. I attempted to rectify the above limitations through networking with licensed
professional counselors who worked in a variety of counseling settings.
Conclusion
Counselors face many challenges in their clinical work, including the need for
self-awareness and occupational stressors (Mearns & Cooper, 2005; Moller et al., 2009;
Orlinsky et al., 2011; Orlinsky, 2013; Oteiza, 2010; Rake & Paley, 2009; Rizq & Target,
2008). The current phenomenological study served to provide an understanding of the
lived experiences of counselors who utilize personal therapy. Motivations and deciding
factors to seek personal therapy consisted of presenting concerns and therapist
attributes. Outcomes of personal therapy involved intrapersonal growth, interpersonal
26
growth, therapeutic factors, and challenges. This study is not without limitations and
cannot be generalized to the population of professional counselors due to my small
sample size. However, this study does give voice to the counselors involved in this
study and their experiences in seeking personal therapy. I carried out many steps to
ensure the trustworthiness of this study. It is my hope that this study is the beginning of
a movement to significantly decrease stigma about seeking personal therapy, especially
among counselors.
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A Phenomenological Exploration of Counselors’ Experiences in Personal Therapy
Self-awareness is a fundamental part of the counseling profession. Not only do
professional counselors seek to increase the self-awareness and personal growth of
their clients, but counselor educators and researchers call upon counselors and
counselor trainees to increase their own self-awareness as well (Council for
Accreditation of Counseling and Related Programs [CACREP], 2016; Hansen, 2009).
Additionally, counselor educators often recommend self-growth experiences such as
personal counseling to increase counselor trainees’ self-awareness (Gladding, 2008;
Remley & Herlihy, 2010). Several scholars defined counselor self-awareness as the
mindfulness of thoughts, feelings, and behaviors in the self and in the counseling
relationship (Oden, Miner-Holden, & Balkin, 2009; Richards, Campenni, & Muse-Burke,
2010; Williams, 2008). Pompeo and Levitt (2014) asserted that self-awareness
parallels awareness of personal values and enables counselors to explore best
practices in counseling. They also stated that counselor self-awareness relates to
awareness of the counseling relationship and that such awareness is helpful to client
satisfaction and growth (Pompeo & Levitt, 2014). Therefore, counselor self-awareness
can benefit both counselors and their clients.
Several researchers have examined the impact of counselor self-awareness on
clinical implications, including professional competence, client treatment outcomes, and
wellness (Hays, 2008; Richards et al., 2010; Williams, 2008). For example, Evans,
Levitt, Henning, and Burkholder (2012) emphasized the significance of counselor self-
awareness in the ethical decision-making process, stating that counselors’ sense of self
is crucial in understanding how personal values intertwine with clients and their
32
concerns. Self-awareness can assist counselors in ethical decision-making as well as
facilitate beneficence and nonmaleficence in providing counseling services (Evans et
al., 2012). Additionally, many researchers have investigated the importance of self-
awareness as a characteristic of counselors who can competently work with culturally
diverse clients (Arredondo et al., 1996; Cartwright, Daniels, & Zhang, 2008; Sue & Sue,
2013). Furthermore, Killian (2008) discovered that mental health professionals’ self-
awareness of emotional and physical distress helped to identify burnout and
compassion fatigue when working with difficult caseloads. Thus, some evidence of the
clinical impact of counselor self-awareness exists in the literature.
Counselors can gain self-awareness in a variety of different ways, including
personal therapy. Mearns and Cooper (2005) stated that the term therapy loosely
signifies the receiving of mental health services from any licensed mental health
professional that holds a license to practice. Additionally, I will use the word therapist in
reference to researchers who did not specify the type of the mental health professional
(e.g., counselor, psychologist, social worker) who serviced the participants in their
study. Several scholars have found that therapists who completed their own personal
therapy experienced increased professional development; for example, Oden et al.
(2009) found that counselor trainees who completed a personal therapy requirement
perceived a noticeable increase in awareness of client interactions. Furthermore, other
researchers have noted the impact of therapy on therapists’ personal growth; Linley and
Joseph (2007) found that therapists who have received personal therapy or currently
receive personal therapy reported increased wellness and self-awareness (Linley &
33
Joseph, 2007). Therefore, previous scholars have supported the impact of personal
therapy for therapists.
Some therapists may seek personal therapy due to mental health concerns
(Rake & Paley, 2009). Therefore, it is worth exploring the needs of this unique
population. In a national survey, Lawson (2007) found that almost a third of participating
counselors reported compassion fatigue, burnout, and vicarious traumatization. Other
investigators have reported that therapists’ most frequently cited presenting concerns
were resolving personal problems (Orlinsky, Schofield, Schroder, & Kazantzis, 2011).
Among counselor trainees, Christopher and Maris (2010) stated that stress can affect
their effectiveness by decreasing their ability to attend, concentrate, and make
decisions. Furthermore, Prosek, Holm, and Daly (2013) found that counselor trainees
presented with elevated levels of anxiety and depression. Hence, counselors are at risk
for mental health concerns related to occupational and personal stressors. The
psychological needs of counselors coupled with the emphasis on gaining self-
awareness highlight the necessity for counselors’ personal therapy.
Statement of the Problem
Self-awareness is an important component of counselor development due to the
personal nature of the profession (Hansen, 2009). Personal therapy is one way to
enhance counselor self-awareness (Mearns & Cooper, 2005). Additionally, counselors
may experience a variety of mental health concerns including compassion fatigue,
interpersonal conflict, depression, and anxiety (Lawson, 2007; Orlinsky et al., 2011;
Prosek et al., 2013). Therefore, some counselors are in need of personal therapy to
support their professional development as well as to attend to their personal concerns.
34
Furthermore, researchers have primarily focused on the perceived outcomes of
personal therapy, including personal growth and professional development (Bellows,
2007; Daw & Joseph, 2007; Oteiza, 2010; Rake & Paley, 2009). However, scarce
research exists regarding counselors’ decision-making process in seeking personal
therapy. Thus, if counselors could benefit from personal therapy, and if little knowledge
exists regarding how counselors decide to seek personal therapy, professional
counselors, counselor educators, counselor supervisors, and other mental health
providers have limited information in how to facilitate that decision-making process.
Purpose and Significance of the Study
The purpose of this study is to explore professional counselors’ experiences and
perceived outcomes in seeking personal therapy. The following questions will guide my
inquiry:
1. What contributes to counselors’ decision to seek personal therapy?
2. How do professional counselors make meaning of their experiences in utilizing
personal therapy?
As a result of this study, I seek to better understand how professional counselors
experience and make meaning of their decisions to attend personal therapy. It is my
hope that others can use the results of this study to give voice to professional
counselors’ experiences and outcomes in the utilization of personal therapy. This
understanding may help counselor educators, counselor supervisors, and other mental
health professionals better meet professional counselors’ unique needs and
experiences by providing information or assistance in the decision-making process of
utilizing personal therapy.
35
Definition of Terms
I will use the following terms frequently throughout the study. For the purposes of
this study, I have operationally defined the following terms:
Professional Counselor
This term will be defined by an individual fully licensed to practice professional
counseling in the state where he or she lives: “licensed professional counselors (LPCs)
are master’s-degreed mental health service providers, trained to work with individuals,
families, and groups in treating mental, behavioral, and emotional problems and
disorders” (American Counseling Association, 2011, p. 1).
Therapist
This term will be defined by any mental health professional that holds a license to
practice and administer mental health services (Mearns & Cooper, 2005).
Personal Therapy
This term will be defined by services provided by an individual therapist fully
licensed to practice professional mental health therapy in the state of residence,
including licensed psychologists, licensed social workers, licensed counseling
psychologists, and licensed professional counselors.
Self-awareness
This term will be defined by the mindfulness of thoughts, feelings, and behaviors
in the self and in relationship with others (Oden et al., 2009; Richards et al., 2010;
Williams, 2008).
Conclusion
36
In order to understand the experiences of professional counselors who choose to
utilize personal therapy, it is important to address issues related to the counseling
profession that may impact professional counselors’ experiences in personal therapy. In
Appendix B, a comprehensive review of the literature will provide readers with
information about the professional identity of counselors, current mental health needs of
professional counselors, and existing experiences of professional counselors in
personal therapy. In Appendix C, I provide an extended discussion on my methodology,
including research questions and recruitment, procedures, analysis, and how I
demonstrated trustworthiness and rigor in this study. Appendix D will contain a section
on the results of this study and Appendix E will contain an extended discussion, as well
as limitations of the study. In Appendix F, I provide the supplemental materials
necessary for my procedures.
38
In this section, I provide a rationale for the current study. Counselors’
developmental processes can influence the decision to seek personal therapy (Remley
& Herlihy, 2010). Furthermore, researchers have found this unique population to have
several prevalent mental health concerns (Lawson, 2007). Lastly, counselors, counselor
supervisors, and counselor educators may lack knowledge and understanding in how to
support professional counselors’ decision-making process and perceived outcomes in
personal therapy within the United States. I will discuss this limited awareness and how
my proposed study intends to meet this research need.
Professional Development
Self-awareness is an inherent part of the counseling profession, including the
training process. Counselor trainees can increase their self-awareness in a variety of
different ways. Experiential learning, role plays, recordings of sessions, and self-
reflection can foster self-awareness (Hawley, 2006; Paladino, Barrio Minton, & Kern,
2011). Furthermore, supervision in clinical courses such as practicum and internship is
another opportunity for personal development and growth (Dryden & Thorne, 2008).
Aside from classroom experiences, researchers supported that two extra-curricular
activities associated with self-awareness are experiential growth groups and personal
therapy (Paladino et al., 2011). The experiential growth group usually consists of
several hours of group work, where trainees can explore their own behaviors and
develop awareness of how they impact others (Ieva, Ohrt, Swank, & Young, 2009;
Robson & Robson, 2008). A second path towards self-awareness for trainees is
personal therapy. Personal therapy may involve internal searching and working through
39
conflicts aiming at change (Malikiosi-Loizos, 2013). Training program developers may
require experiential growth groups and/or personal therapy (CACREP, 2016).
Therapist-Trainee Development
Generally, it is widely accepted to require personal therapy for therapist trainees
as a part of their education programs (Dryden & Throne, 2008). This practice occurs
across multiple disciplines, including psychologists, counseling psychologists, and
counselors. However, Malikiosi-Loizos (2013) debated whether therapist trainees
should attend mandated personal therapy because of financial constraints, lack of time,
belief that it is unnecessary, fear of exposure, and difficulty in finding the right therapist.
Malikiosi-Loizos (2013) also posited that personal therapy may lead to therapist
distraction and negatively impact their clients. Furthermore, Norcross et al. (2008) found
that therapist trainees cited affordability, lack of information about available services,
difficulties in transportation, and fear of exposure as reasons for not seeking personal
therapy However, Atkinson (2006) argued that personal therapy is an essential part of
training for future therapists, emphasizing that counselors need a substantial level of
personal awareness, psychological maturation, and adjustment in order to help clients
with that very process. Therefore, differing viewpoints on personal therapy for therapist
trainees exist in the literature.
Despite conflicting opinions, it is important to understand the rationale for
personal therapy as a part of counselor development. Personal therapy serves two
purposes for training: increasing knowledge and comprehension of the counseling
process and promoting self-awareness (Malikiosi-Loizos, 2013). Malikioski-Loizos
(2013) further argued that counseling in practice requires a significant level of self-
40
awareness in order to connect skills and knowledge of personal and interpersonal
dynamics in the context of the therapeutic relationship. The need for an increased level
of self-awareness requires many therapist trainees to complete personal therapy in
order to meet the mandates of their training programs. For some, it is a requirement for
accreditation in various professional associations. In the United Kingdom, the Division of
Counselling Psychology of the British Psychological Society stated counseling
psychology trainees must complete at least 40 hours of personal therapy (Rizq &
Target, 2008). The European Federation of Psychologists’ Associations necessitated at
least 100 hours of personal therapy or personal development as part of future
psychotherapists’ training (European Federation of Psychologists’ Associations, n.d.). In
Greece, postgraduate counseling psychology students need to complete 40 hours of
personal development work as part of their training and self-awareness process with the
goal of sensitizing them to the thoughts, feelings, and expectations a client might have
during the therapeutic process (Malikiosi-Loizos, 2013). Clearly, developers of
counseling programs view self-awareness through personal therapy as a critical part of
becoming a therapist.
Professional Therapist Development
Although there is considerable discussion regarding self-awareness through
personal therapy among counselor trainees, there is a scarcity of literature regarding
self-awareness and personal therapy for professional counselors, despite the fact that
personal therapy can benefit counselors and other mental health practitioners at any
age, developmental level, and with any years of experience (Norcross, 2010). In
addition to the many factors that influence counseling skills, Norcross (2010) asserted
41
that personal therapy is the most crucial because of the importance of self-awareness.
Moreover, Norcross (2010) emphasized that the self-awareness fostered in personal
therapy can provide vital insight into sources of countertransference, relationship
dynamics, and emotional boundaries with clients.
Aligned with the idea that self-awareness is essential, Mearns and Cooper (2005)
argued that therapists are most effective when they are familiar with their deepest
selves, committed to genuineness and transparency, self-aware, and self-accepting.
They also argued that therapists can achieve this level of development through personal
therapy (Mearns & Cooper, 2005). Additionally, in a text consisting of extensive
qualitative research from three doctoral dissertations and an additional research study
conducted over a seven-year period on the same 10 master therapists, Skovholt and
Jennings (2004) found that the participants own personal therapy facilitated the traits of
self-awareness, reflection, non-defensiveness, and openness to feedback. Moreover,
Rønnestad and Skovholt (2012) stated that a working understanding of personal
feelings and behaviors might increase counselors’ awareness of their individual biases,
personal issues, and blind spots, and how these factors might appear in clinical work.
Thus, personal therapy may facilitate continued counselor development and impact
clinical work due to the power of self-awareness.
Although self-awareness is a prevalent concept in the counseling literature, there
are other noteworthy internal attributes of the therapist affected by personal therapy.
Some theorists believe that experiencing the role of a client can increase professional
counselors’ empathy because it provides actual knowledge of the client experience,
including successes, frustrations, and challenges (Norcross, 2015). Additionally,
42
experience of the client role can allow counselors to look beyond their own counselor
identity perspective and embrace the perception of the client (Norcross, 2010).
Counselors may also experience the general effectiveness of counseling just as any
other client would. For example, Kumari (2011) found that counselors who experience
personal therapy as a client are less likely to report anxiety related to clinical practice.
Furthermore, Everson (2014) stated that because counselors have experienced their
own struggle personal therapy, they may possess greater respect for each client’s
unique pacing and process.
Various researchers have supported the notion that experience as a client could
affect counselors’ clinical practice. Norcross (2009) conducted a phenomenological
study examining therapists’ uncertainty in clinical work. Through the analysis of semi-
structured interviews, Norcross (2009) discovered that therapists’ experiences with
uncertainty in their personal therapy facilitated a higher tolerance for uncertainty with
clients. Therapists’ reported that remaining in uncertainty inhibited premature
counseling responses on their part and allowed new possibilities in the counseling
relationship to emerge that would not have otherwise. Thus, personal therapy may help
counselors stay grounded in the unpredictability of clinical work. Although many
potential clinical implications exist in counselors undergoing personal therapy, it is worth
exploring other reasons counselors seek personal therapy besides personal growth.
Mental Health Needs of Counselors
Some literature exists demonstrating therapists’ need for personal therapy.
Several researchers investigated prevalence and presenting concerns of therapists who
utilize personal therapy. Orlinsky, Schofield, Schroder, and Kazantzis (2011)
43
administered an online questionnaire to 3,995 psychologists, counselors, social
workers, and psychiatrists in six different countries that inquired about experiences in
personal therapy. Almost 87% of therapists surveyed cited engagement in personal
therapy at least once. Orlinsky et al. (2011) found that the highest prevalence of
personal therapy was among those who identified themselves as counselors, rather
than psychologists, social workers, or psychiatrists. Similarly, Bike, Norcross, and
Schatz (2009) mailed questionnaires and received responses from 727
psychotherapists (counselors, psychologists, and social workers) in the United States.
The authors found that 85% sought therapy at least once and that the most frequent
presenting concerns were couple distress (20%), depression (13%), need for self-
understanding (12%), and anxiety/stress (10%). More recently, Orlinsky (2013)
surveyed 11,154 therapists and found almost 80% had received personal therapy and
that the most frequently occurring reasons for seeking therapy were personal problems,
personal growth, and for training purposes. Therefore, high prevalence rates of
therapists seeking personal therapy exist; many of these therapists present to therapy
with personal and interpersonal concerns.
Not all therapists prefer to seek personal therapy. Norcross, Bike, Evans, and
Schatz (2008) mailed questionnaires to and received responses from 119
psychologists, counselors, and social workers in the United States who had never
sought personal therapy. Non-therapy seekers, compared to therapy seekers,
expressed less positive attitudes toward its value as a necessity for clinical work and
professional development. When asked about their reasons to not seek personal
therapy, the researchers found that 27.9% of non-therapy seekers reported dealing with
44
stress in other ways, 25.5% of participants reported receiving sufficient support from
friends and family, 23.7% of participants reported that they believed their coping
strategies were effective, and 22.9% of participants reported resolving the problem
before therapy was needed (Norcross et al., 2008). Thus, there is a percentage of
therapists who are not receiving personal therapy. However, researchers suggested
that mental health professionals are more likely to experience wellness concerns given
the nature of their work (Lawson, 2007; Lawson, & Myers, 2011; Sprang, Clark, & Whitt-
Woosley, 2007; Thompson, 2014).
Burnout and Compassion Fatigue
Figley (1995) described burnout or compassion fatigue as the psychological
stress of working with difficult clients. Burnout/compassion fatigue can have a variety of
implications for therapists. For example, Deighton, Gurris, and Traue (2007) found in a
sample of 100 therapists working with torture survivors, higher levels of
burnout/compassion fatigue were associated with more resistance to process and work
through client trauma. Additionally, Killian (2008) surveyed 104 mental health clinicians
and discovered burnout/compassion fatigue led to mood changes, sleep disturbances,
becoming easily distracted, and increased difficulty concentrating. Therefore, important
clinical implications exist when addressing burnout and compassion fatigue in
counselors.
Due to the ramifications of burnout and compassion fatigue, it is worth exploring
its prevalence and characteristics among counselors. Lawson (2007) mailed survey
packets and received responses from 501 professional counselors, finding that
community agency counselors reported that more than half of their clients are trauma
45
survivors, and that an average of more than one third of clients across all settings are
trauma survivors. The percentage of high-risk (suicidal, self-injurious, or otherwise
dangerous) clients across settings was 15%. Fourteen percent of counselors reported
clinically low levels of compassion satisfaction, or the positive feelings associated with
helping clients. Five percent of counselors reported clinically high levels of burnout.
Eleven percent of counselors reported clinically high levels of compassion fatigue and
vicarious traumatization (Lawson, 2007). Based on these results, Lawson (2007)
asserted that counselors’ wellness is challenged and may be at higher risk for
impairment. In a more recent study, Thompson, Amatea, and Thompson (2014)
conducted an online questionnaire with 231 mental health counselors and found that
negative perceptions of working conditions, such as inadequate financial compensation,
lower quality of supervision, lack of clinical preparedness to serve the types of clients on
their caseload, or fewer years of clinical experience, were positively associated with
burnout and compassion fatigue.
Furthermore, Lawson and Myers (2011) discovered counselors with larger
percentages of trauma survivors among their clients seemed to be more at risk for
burnout, and those with more high-risk clients on their caseloads were at higher risk for
burnout and reaped less satisfaction from their work. Sprang et al. (2007) revealed that
mental health professionals who were female, younger, had less clinical experience,
and had a higher percentage of clients with post-traumatic stress were more likely to
present with higher levels of burnout and compassion fatigue, and lower levels of
compassion satisfaction. Therefore, certain populations of counselors are more likely to
experience burnout and compassion fatigue.
46
Many researchers have demonstrated that counselors who engage in self-care
practices are less likely to experience burnout and compassion fatigue. Richards,
Campenni, and Muse-burke (2010) described personal therapy as a form of
psychological self-care and suggested counselors seek personal therapy because they
spend a significant amount of time providing services to others. Some outdated
literature exists regarding the effects of counseling on burnout and compassion fatigue.
Macran, Stiles, and Smith (1999) conducted qualitative interviews among therapists with
burnout and compassion fatigue and found that personal therapy alleviated symptoms
of distress and impairment, enhanced empathy for clients, increased self-awareness of
one’s boundaries and limitations, and supported the development of other types of self-
care skills. Therefore, personal therapy may serve as a self-care strategy for
counselors. Additionally, standard C.2.g. of the ACA (2014) Code of Ethics stated,
“counselors are alert to the signs of impairment from their own physical, mental or
emotional problems and refrain from offering or providing professional services when
such impairment is likely to harm a client or others. They seek assistance for problems
that reach the level of professional impairment” (p. 9). Thus, counselors have an ethical
responsibility to remedy burnout and compassion fatigue and may choose personal
therapy as their means. However, some barriers exist in fostering self-awareness
through personal therapy to protect against impairment.
The current climate in the counseling profession is that some counselors seek
personal therapy as a reactive measure in difficult circumstances (Norcross, 2010). In
counselor education, personal therapy is often a part of the remediation process
(McAdams & Foster, 2007). Some counselor trainees may feel stigmatized during the
47
remediation process (Rosenberg, Getzelman, Arcinue, & Oren, 2005) and might
unconsciously internalize a negative bias towards personal therapy. Troff (2007) found
that stigma accounted for part of the variance of help-seeking behaviors of counselor
trainees. Wilson, Weatherhead, and Davies (2015) also reported that stigma was a
significant issue for psychologist trainees who sought personal therapy. The authors
interviewed 10 psychologist trainees and used narrative analysis to interpret findings;
participants in their study believed they were clinical psychologists and thus experts
who did not need therapy (Wilson et al., 2015). Additionally, participants reflected on the
dichotomous boundary of therapist and client and how this idea protected mental health
professionals from considering themselves in the client’s position. Similarly, Richards
(2010) discussed the dichotomy of “us” and “them” within mental health services and
how it implies individuals seeking mental health support are different or abnormal.
Norcross (2010) stated that counselors might feel reluctant to seek personal
therapy because of the assumption that as clients they might appear to be flawed or
less capable as helpers. This bias also mirrors general stigma of seeking mental health
services (Lannin, Vogel, Brenner, Abraham, & Heath, 2016; Turner, Jensen-Doss, &
Heffer, 2015). Norcross (2010) believed increased personal therapy for counselors
could benefit clients and the profession overall and decrease the stigma of help-
seeking. Hence, although self-awareness is a highly-valued trait in counselor trainees
and professional counselors, fostering this quality through personal therapy is not
always as equally valued.
Based on the literature, mental health professionals are seeking personal therapy
for a variety of reasons, including occupational stress and interpersonal problems
48
(Orlinsky, 2013; Sprang et al., 2007). Many researchers demonstrated that this
population has a unique set of mental health needs due to the emotional tax of their
clinical work (Lawson, 2007; Lawson, & Myers, 2011; Sprang, Clark, & Whitt-Woosley,
2007; Thompson, 2014). It may behoove professional counselors to utilize personal
therapy as a support for their mental health concerns. Some researchers have
qualitatively explored therapists’ experiences in personal therapy to better understand
this distinctive phenomenon.
Counselors Experiences in Personal Therapy
Many scholars have studied the impact of personal therapy on counselor trainees
and professional European counselors. Additionally, personal therapy is often a
program requirement for trainees in counselor education. Because behaviors and
attitudes cultivated during counselor training may continue in professional counselors’
careers (Norcross, 2010), it is important to explore counselor trainees’ experiences in
personal therapy in order to fully understand professional counselors’ experiences in
personal therapy.
Therapist Trainees
In a qualitative study, Everson (2014) conducted interviews with eleven master's-
and doctoral-level psychologist trainees who utilized personal therapy. Participants had
mostly positive experiences in therapy, feeling that it had a beneficial influence on their
functioning personally, academically, and clinically. They viewed their academic
programs as being supportive of personal therapy for trainees. Nearly all participants
felt strongly that personal therapy is an integral part of graduate training, asserting that
programs should encourage such therapy for their trainees. Therefore, the psychologist
49
trainees in this study found their personal therapy as personally and professionally
beneficial.
Kumari (2011) focused on therapist trainees in the United Kingdom. The author
conducted semi-structured interviews with eight counseling psychologist trainees. The
author found the major themes of experiential learning, personal development, stress,
and new found belief in the essentiality of personal therapy. Participants reported that
the therapeutic relationship, first-hand experience of techniques, and knowing how it
feels to be the client contributed to the learning experience. Furthermore, within the
theme of personal development, participants discussed gaining insight, self-awareness,
and knowledge that personal development is a lifelong process. Participants also
reported that financial cost of therapy, pressure of mandated therapy as training
requirement, and disruption of their own clinical work were all stressors of personal
therapy. Lastly, participants acknowledged that although personal therapy was required
for their training program, it was an essential part of becoming therapist (Kumari, 2011).
Thus, although personal therapy was stressful, participants in this study experienced
positive outcomes as a result of personal therapy.
Moller, Timms, and Alilovic (2009) explored thoughts and feelings of individuals
beginning their counseling psychology, clinical psychology, and counseling programs
regarding mandated personal therapy during training. The authors analyzed data from
open-ended questionnaires using inductive thematic analysis. Moller et al. (2009) found
that participants believed the requirement of personal therapy helped them to be better
practitioners and that personal therapy cost them time and emotional resources. Thus,
50
although these participants experienced professional benefits of personal therapy, they
also considered the drawbacks of the process.
Researchers have also studied personal therapy among therapists using
quantitative methods. Prosek, Holm, and Daly (2013) conducted pre-post analyses of
mental health outcomes for counselor trainees required to attend 10 sessions of
counseling. They found that counselor trainees experienced a significant decrease in
overall mental health stress, anxiety, and depression after completion of counseling
(Prosek et al., 2013). Although, Prosek et al. (2013) measured mental health outcomes,
the researchers did not investigate counselor trainees’ perceptions of the experience or
satisfaction with the requirement. Among a similar population of counseling students
mandated to counseling as part of a program requirement, Oden et al. (2009)
investigated the students’ perceptions of how the experience influenced professional
characteristics, such as self-awareness. The participants reported a significant increase
in self-awareness regarding their interactions with their own clients, and 92% of
participants supported required counseling for mental health professional trainees
(Oden et al., 2009). In alignment with the counseling value of self-awareness, these
authors provided support for the impact of required counseling in increasing perceived
self-awareness for trainees. Therefore overall, therapist trainees experience mostly
positive outcomes of their own personal therapy, although the process is not without its
challenges. However, in several of the studies presented, therapist trainees were
required to attend the therapy as part of training. It behooves researchers to consider
the experiences of professionals attending therapy, post-training.
Professional Therapists
51
The recent literature is sparse regarding the experiences of professional
counselors’ experiences in personal therapy. However, researchers have found several
frequently occurring themes in the qualitative and quantitative investigation of
professional therapists’ experiences in personal therapy. Wigg, Cushway, and Neal
(2011) conducted a comprehensive literature review on the topic of therapists’, including
psychologists, social workers, and counselors, personal therapy found two major
themes: personal reflection and professional reflection. Personal reflections encouraged
personal growth and development to take place. Professional reflections included
consideration of the professional self (Wigg et al., 2011).
Personal reflection. Many scholars have documented the personal effects of
therapy for therapists. Oteiza (2010) conducted a phenomenological investigation of 10
European therapists’ experiences of personal therapy using the transcripts of semi-
structured interviews. In some European countries, psychotherapists are mandated to
receive 40 hours of personal therapy to maintain licensure (Kumari, 2011). Therefore,
Oteiza (2010) sought to explore psychotherapists’ experiences of this process. The
researcher did not specify the credentials or type of psychotherapist (e.g., counseling
psychologist, psychologist). In regards to the experiences of personal therapy,
participants in the study reported that personal therapy was challenging but growth
producing. More specifically, participants discussed increased awareness of their own
struggles, acceptance of their fallibility, and appreciation of the ebb and flow of therapy
(Oteiza, 2010). Therefore, European psychotherapists experienced several beneficial
personal outcomes of therapy. However, this study is limited to therapists in Europe and
not specific to counselors.
52
Similar to phenomenology, Daw and Joseph (2007) conducted an interpretive
phenomenological analysis (IPA) to explore the experiences of European therapists in
personal therapy. These researchers examined clinical psychologists, counselors,
psychotherapists, and counseling psychologists. The authors surveyed 48 participants
via mail, asking them to complete a questionnaire that inquired about demographics and
motivations for therapy, as well as open-ended questions about their experiences.
Participants reported that personal therapy helped them gain insight into their own
vulnerabilities and promoted change and growth. Additionally, participants stated they
utilized personal therapy as a form of self-care to feel supported during times of stress.
Overall, Daw and Joseph (2007) found that participants recognized the value of
personal therapy as a form of self-care and personal development. Therefore, the
mental health clinicians in this study reported personal benefits from their own therapy.
Other researchers have also used IPA to understand the experiences of
counselors in personal therapy. Rake and Paley (2009) conducted semi-structured
interviews with eight therapists in the United Kingdom and did not specify their
credentials. These investigators analyzed the data and found that in terms of personal
influence, participants described emotional impact of exploring concerns such as
trauma, relationship difficulties, and bereavement as deeply distressing and yet
ultimately helpful. Participants reported personal therapy helped them realize that strong
emotional reactions were tolerable, allowed them to know themselves better, and
facilitated increased emotional resilience when working with their own clients (Rake &
Paley, 2009).
53
Rizq and Target (2008) also used an IPA to explore the experiences of therapists
in personal therapy with nine counseling psychologists. Participants reported that
personal therapy provided them a space for an intense experience, including
attachment to the therapist, increased authenticity, and psychological safety. Moreover,
Bellows (2007) conducted semi-structured interviews with 20 psychotherapists that
reported a psychoanalytic theoretical orientation. This researcher did not specify the
type of qualitative data analysis she used. Participants reported their therapy
relationships promoted psychological change and improved their interpersonal
relationships. Additionally, participants discussed gaining self-acceptance of personal
imperfection and improved their clinical work by increasing empathy for how difficult
change is for clients. Participants reported that their therapists’ acceptance of their
fallibility facilitated a decrease in perfectionistic traits (Bellows, 2007).
Ciclitira, Starr, Marzano, Brunswick, and Costa (2012) conducted a
phenomenological study with nineteen European, female counselors using semi-
structured interviews. Participants described working through personal issues and
increasing emotional resilience during personal therapy. When participants discussed
the challenges of personal therapy, learning from the therapist in both positive and
negative ways, experiencing financial and time constraints, and living through the pain
and upset of working through personal issues all emerged as themes (Ciclitira et al.,
2012). Thus, in the literature overall, professional therapists, counselors included, have
experienced personal growth and change in a positive direction. However, some
drawbacks include financial constraints, emotional distress, and feeling stigmatized
54
(Norcross, 2010; Norcross et al., 2008). It is important to also explore the perceived
professional benefits of therapists’ experiences in personal therapy.
Professional reflection. Many participants in the studies who described benefits
to their personhood as a result of their own therapy also discussed the professional
advantages that arose out of their time in personal therapy. For example, Daw and
Joseph (2007) found that professional therapists reported how personal therapy
deepened their understanding of the therapeutic process in terms of boundaries,
techniques, and procedures. Additionally, participants reported valuing personal therapy
in professional practice as a form of experiential learning as the client (Daw & Joseph,
2007).
In regards to personal therapy as an educational experience, Rake and Paley
(2009) used IPA to understand eight therapists’ perspectives and found that participants
reported modeling themselves after their therapist or learning about technical aspects of
a therapeutic approach. Participants described the experience of linking theoretical
knowledge with an actual experience of the same therapeutic approach as significant.
Additionally, participants discussed some negative aspects of therapy such as
disagreeing with the therapist or perceiving the therapist to respond too harshly;
however, they tended to view this as an inevitable part of the process. This awareness
helped participants determine what they would do differently as therapists (Rake &
Paley, 2009). Therefore, based on these participants’ experiences, personal therapy
can potentially have far reaching clinical implications.
Rizq and Target (2008) found that European counselor participants in their study
reported that personal therapy provided them with professional learning in seeing the
55
therapist as a role model as well as the professional significance of self-reflection.
Additionally, participants discussed how personal therapy increased awareness of the
client role and helped them feel more connected to clients’ experiences in general.
Similarly, Bellows (2007) reported that therapists valued their own former therapists as
professional role models; identification with a therapist whom they viewed as competent
and professionally similar helped develop their own professional identity. In another
study, Ciclitira et al. (2012) found that professional benefits of personal therapy included
seeing the therapist as a role model. Moreover, participants reported engaging in the
therapeutic relationship, learning aspects of theory and skills through live observation,
and experiencing what it is like to be a client as core ingredients of therapy (Ciclitira et
al., 2012). Thus, in addition to the impact on clinical practice, therapists in personal
therapy experienced educational benefits as well.
Conclusion
Overall, many researchers have supported the importance of self-awareness in
counselor training and practice (Dryden & Thorne, 2008; Malikiosi-Loizos, 2013). In
addition to this need, counselors and other therapists have mental health concerns,
such as stress, compassion fatigue/burnout, and interpersonal problems (Lawson,
2007; Thompson, 2014). Therapist trainees mandated to personal therapy as a training
requirement have overall reported increased self-awareness and education regarding
the therapeutic relationship (Oden et al., 2009) but also that personal therapy was
emotionally taxing and financially constraining (Moller et al., 2009).
Scholarly investigators have studied counseling psychologists, psychologists,
and social workers’ experiences in personal therapy and found mostly positive benefits,
56
such as alleviation of occupational stress and personal growth (Bellows, 2007; Ciclitira
et al., 2012). Furthermore, researchers have explored the experiences of professional
counselors’ experiences in personal therapy in European countries such as the United
Kingdom and Spain, also reporting positive changes in personal relationships and
professional relationships with clients (Daw & Joseph, 2007; Oteiza, 2010; Rake &
Paley, 2009). Similar to therapist trainees, the negative impact of personal therapy for
therapists includes financial constraints, therapist fit, and increased distress that
hindered effectiveness with clients (Norcross et al., 2008).
Therefore, professional counselors, counselor supervisors, and counselor
educators have little understanding of professional counselors’ experience in personal
therapy within the United States, as well as their decision-making process leading to the
utilization of personal therapy. Due to this limited awareness, I have designed the
present study to provide research that may support professional counselors’ in this
process. I will outline the research methodology I will utilize to employ this study,
phenomenology.
58
Extended Methodology
Qualitative approaches differ from quantitative methods in that qualitative inquiry
utilizes different philosophical assumptions, approaches to analysis, and methods of
collecting data. Creswell (2013) asserted that although quantitative and qualitative
processes are similar, qualitative procedures rely on text and image data, have unique
steps in data analysis, and draw on different strategies of inquiry. Researchers
employing qualitative investigation typically seek to holistically understand meaning.
More specifically, the goal of a phenomenological approach is to capture the
experiences and meaning making from the perspective of the participants (Creswell,
2013).
I have selected phenomenology as my methodology and will begin this chapter
with information regarding how this analysis relates to the purpose of the proposed
study and research questions. Next, I will explain information about selection of
participants and include details about how I obtained my sample of participants. I will
include a description of procedures, identify how I attended to trustworthiness and
ethical concerns, and explain the analysis process I will utilize in the study. I will
conclude this chapter with a description of the limitations of this study.
Research Questions
In order to develop a more in depth understanding of professional counselors’
experiences when seeking personal therapy services, I designed this study to address
the following questions:
1. What contributes to counselors’ decision to seek personal therapy?
59
2. How do professional counselors make meaning of their experiences in utilizing
personal therapy?
Phenomenology
Hays and Singh (2012) stated that phenomenologists seek to understand the
distinctive characteristics of human behavior and first-person experience. I strive to
understand how counselors make meaning of their experiences in personal therapy.
Because I aim to describe the lived experiences, or essence (Moustakas, 1994), of
counselors receiving personal therapy, phenomenology appropriately answers the
research question based on its traditions (Wertz, 2005).
Consistent with phenomenology, I used Miles, Huberman, and Saldaña’s (2014)
adaptation of classic data analysis, as well as an inductive-deductive approach to
analyze the data. Additionally, my research team and I engaged in Moustakas’ (1994)
process of epoche in order to approach the study free of our beliefs, personal and
professional experiences, and existing knowledge. Researchers openly reflect on their
assumptions and biases in order to view the phenomenon through the eyes of the
participants during the process of epoche. I selected this approach because my
research questions are exploratory, open, and aimed at participants’ understanding of
their experiences in seeking personal therapy services. I will explain the research
design and analysis of adapted classic data analysis in a later section.
Participants
The population for this study included individuals who are Licensed Professional
Counselors (LPCs) in a large state in the southwestern United States and have utilized
individual counseling services with a licensed mental health therapist. Participants can
60
have current or past personal therapy experiences within the last three years. In an
unpublished dissertation similar to the current study, Yaites (2015) recruited participants
who had received counseling services within the last three years in a phenomenological
exploration of African Americans in counseling. I did not require a specific number of
sessions because time in counseling is a highly-individualized process; what one
person resolves in several years may take another person six sessions (Mearns &
Cooper, 2005). I aimed for a sample size of 15 participants based on Creswell’s (2013)
recommendation of 5 to 25 relatively homogeneous participants for a phenomenological
study. Furthermore, saturation is important concept to note. In phenomenological
research, researchers do not aim for generalizability in the sample; instead, they focus
more on sample adequacy and less on sample size (O'Reilly & Parker, 2012). In
regards to adequate samples, phenomenologists seek to reach saturation, meaning
they have achieved depth as well as breadth of information related to the phenomenon
under investigation (Bowen, 2008). Therefore, I aimed for 15 interviews and completed
13 based on saturation of data.
I used purposive sampling to select participants for this phenomenological study
(Hays & Singh, 2012). Hays and Singh (2012) defined purposive sampling as selecting
participants that researchers believe will produce the best understanding of the
phenomenon they aim to study. Although the requirement to identify as an LPC in the
same state and to have current or past experience with personal therapy services lends
to a homogenous sample, I attempted to increase the diversity of participant
demographics including age, socioeconomic status, racial and ethnic identity, gender,
sexual orientation, number of years with full licensure, and religious or spiritual identity
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by recruiting from a wide variety of counseling settings. I asked participants to choose
pseudonyms in an effort to protect their anonymity and confidentiality. See Table C.1 for
details about the participants of the study. I reported demographic variables using the
words participants used in their initial demographic survey. I will include details about
data sources in the next section.
Table C.1
Participants of the Study
Participant Age Race/Ethnicity Gender Religious/Spiritual Affiliation
Sexual Orientation
Alma 37 Latina Woman Christian Heterosexual Amy 30 Latina Woman Christian Heterosexual Ashley 29 Multiracial Woman Spiritual Heterosexual Betty 55 White Woman None Heterosexual Elenore 30 Multiracial Woman Christian Queer Felicity 44 White Woman Christian Heterosexual Jennifer 40 White Woman Christian Heterosexual Liz 35 White Woman Pagan Bisexual Lynn 48 White Woman Christian Heterosexual Michelle 37 White Woman Christian Heterosexual Rose 30 White Woman Christian Heterosexual Sophia 35 White Woman None Heterosexual Thomas 34 White Man None Heterosexual
Data Sources
To determine eligibility, potential participant members completed a Qualtrics
survey, an online initial screening tool that includes questions about number of sessions
completed, length of time since termination (if applicable), age, gender, racial and ethnic
identification, sexual orientation, religious/spiritual identity, number of years as an LPC,
disability status, licensure of therapist, therapist demographic information, and whether
or not their counseling training program required personal therapy. The online
demographic survey also included information about informed consent and
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confidentiality. I included a copy of the screening survey and informed consent in
Appendix F.
One method of data collection consisted of face-to-face, semi-structured
individual interviews. I chose semi-structured interviews because of their effectiveness
in working with small sample sizes (Wertz, 2005). Also, Creswell (2013) reported that
semi-structured interviews are useful for studying specific situations or experiences and
helpful in understanding perceptions and insights of participants. Furthermore, another
method of data collection included the use of participant sand trays. Hays and Singh
(2012) noted the advantages of using visual methods to understand participants’
experiences, including added richness and depth of the participants’ voices. I will
provide more detailed information about the interview protocol and sand tray activity in
procedures.
Procedures
I obtained University of North Texas Institutional Review Board approval before
participant recruitment to approve all forms of participant recruitment for this study.
Additionally, all members of the research team attained a certificate for Protection of
Human Subjects training. Regarding confidentiality, I protected participants’
demographic information through the use of a password protected excel sheet that only
my supervising researcher and I accessed. I requested that a professional
transcriptionist de-identify audio recordings of participants’ interviews and sand tray
experiences. During the data analysis portion of the study, my research team worked
with de-identified transcripts that did not have any of the participants’ personal
information; only my supervising researcher and I had access to personally identifiable
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data during the process. I also informed participants that I would maintain their
confidentiality in any publications or presentations regarding the study through use of
pseudonyms and omission of personally identifiable information.
I recruited participants through email, word of mouth, and networking with LPCs
in a 50-mile radius of a large southwestern state in the United States. To attend to
diversity, I intentionally recruited from different locations around the area that varied in
racial and economic make-up. I also recruited participants through personal contacts
and professional counseling organizations. I included a copy of the email I used for
recruitment to LPCs in Appendix F.
After reviewing initial demographic surveys, I contacted potential participants via
phone or email to explain the study and assess their eligibility to participate in the
interviews and sand tray sessions. I recruited 13 individuals to continue in the study
based on their responses to my initial phone contact. I excluded participants holding
expired LPC licenses, reporting past therapy over three years ago, and describing
personal therapy from an individual without a license in a mental health profession from
the study. If eligible for the study, I scheduled to meet with participants face-to-face in
their professional counseling office at their convenience in order to conduct the
interviews and sand tray sessions. Although participants read and acknowledged the
informed consent before completing the demographic form, I readdressed informed
consent before beginning individual interviews and sand tray activity. I explained the
purpose and procedures of the study, acknowledged risks and benefits, discussed
confidentiality, reminded participants of their freedom to withdraw from the study at any
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point in time, and allowed participants to ask me any questions regarding their
involvement in the study.
Data Collection
I drove to the LPCs office locations for their convenience and ease of access to
audio record 60 minute interviews using a digital audio recording device. I used a semi-
structured interview protocol to guide the interview that consisted of six open-ended
questions to assist me in understanding the experiences of professional counselors who
have engaged in their own personal therapy. I derived the interview questions based on
a review of the literature and also to allow participants to comprehensively explore their
experiences in personal therapy. According to Galletta (2013), researchers draw from
extant literature to formulate interview questions that will help answer the study’s
research question. Rabionet (2011) also stated reviewing the literature is one of the
soundest methods to develop a first draft of an interview protocol. Therefore, I included
a table details the interview questions I created based on specific studies from the
literature in Appendix F.
I exercised caution to not lead the participants to conclusions, a practice
consistent with Moustakas’ (1994) phenomenological interview procedures. In the
beginning of the interview, I spent time building rapport with participants and to create
an atmosphere that encouraged trust, openness, and self-disclosure (Moustakas,
1994). Building rapport consisted of introducing and telling participants about myself,
asking the participants about themselves or their counseling practice, and explaining the
objectives for the interview process (Dunden & Ryan, 2012). I included the entire
interview protocol in Appendix F.
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Hays and Singh (2012) stated that “visual methods, in general, provide
participants with an opportunity to express themselves in a nonverbal manner that may
access deeper aspects of their understanding and/or experience of a phenomenon” (p.
278). Additionally, using multiple sources of data helps to strengthen data triangulation,
thus increasing trustworthiness of this study (Creswell, 2013). Linzmayer and Halpenny
(2013) described the qualitative data source of sand tray as collections of figures, and
other materials, that research participants can select and place in a sand tray to
illustrate their responses to researcher’s questions. After the semi-structured interviews,
I invited participants to create their personal therapy experience in the sand tray using
the figures and materials provided; this method is consistent with Measham and
Rousseau (2010) who used sand tray as a method of data collection for understanding
the experiences of children with trauma. I prompted participants to explain their sand
tray and continued audio recording their description. I also took digital photos of
participants’ sand trays. I included the sand tray activity protocol in Appendix F.
Data Analysis
Miles, Huberman, and Saldaña (2014) offered procedural steps for conducting
the adaptation of classic data analysis. I will provide a detailed outline of research
protocol I used in this study. I will include information about the research team, data
analysis steps, and steps I took to ensure validity was demonstrated throughout the
study in this section.
Research team. Wertz (2005) recommended using multiple methods of verifying
data sources to demonstrate confirmability in qualitative research, a process called
investigator triangulation. I utilized four research partners and a supervising researcher
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in order to increase trustworthiness of the study. I selected four master’s level
counseling students based on their previous experience with research; three of the
members had experience with phenomenological research specifically. All four of the
research team members are women in their early 20s; three identified as White and one
identified as Asian. The supervising researcher is an assistant professor at a CACREP-
accredited counselor education program and had experience conducting, facilitating,
and mentoring doctoral student researchers in qualitative research.
After I completed all interviews and sand tray sessions, I sent recordings to a
professional transcriptionist to transcribe each interview and sand tray session verbatim.
I transferred each transcription to a secure password protected USB drive and deleted
audio recordings from the software after I completed data analysis. I reviewed recorded
transcriptions to listen to participants’ tone and verify transcriptions. Consistent with
qualitative research and phenomenological procedures, the research team conducted
data analysis according to an adaptation of classic analysis. I analyzed data through the
following steps: epoche, initial coding, and final coding.
Epoche requires that the researcher abstain from incorporating their own
explanations, hypotheses, and conceptualizations of the subject matter (Wertz, 2005).
Investigators must set aside prior assumptions in order to gain access the essence of
participants’ experiences. The investigator, through process of epoche, explores the
subject matter as it exists independent of a priori knowledge. Moustakas (1994) stated
that researchers return to phenomena as they are lived, in contrast to beginning with
hypotheses.
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Researchers using phenomenology do not assume that prior knowledge is false;
they only suspend preconceived notions for the sake finding the essence of the
phenomenon (Wertz, 2005). Epoche helps researchers to see the world from the
participants’ perspective as it is lived, precisely as it is encountered (Wertz, 2005).
Investigators must actively seek to become aware of their own biases and assumptions
through an intentional reflective process. We demonstrated epoche by journaling and
discussing our biases and assumptions regarding the present study throughout data
analysis.
Bracketing. Hays and Singh (2012) stated that researchers engage in bracketing
when they become aware of their inherent biases and assumptions and set them aside
to avoid influencing the research process. Implicit biases and assumptions could
interfere with the data collection process, including my emotional involvement with the
topic of interest. I am keenly aware of my own personal biases in planning to conduct
the study. I have participated and currently participate in my own personal therapy for
nearly three years and believe it is one of the most profound and meaningful
experiences of my life. I wholeheartedly believe I am a more developed person and
counselor. I have witnessed my growth in my interpersonal relationships, as well as in
my relationships with my clients. Therefore, my personal bias is that personal therapy is
highly beneficial and influential for counselors.
I consulted with my research team as I examined my experiences, reactions, and
any assumptions or biases that could interfere with the coding process during data
analysis. My research team members held me accountable for my responses to the
research process (Creswell, 2013). The four other members of the research team also
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engaged in the examination of their experiences, reactions, and assumptions or biases
during analysis. Most notably, the members reported benefits including increased
awareness, higher functioning in relationships, and increased self-esteem as a result of
their own personal therapy and expected participants to report similar outcomes. I also
utilized my research team for the purpose of engaging in critical discussion during the
analysis process in order to develop a trustworthy study. Furthermore, I kept a journal to
document the research team members and my bracketing throughout the study. I wrote
mostly of the connection and validation I experienced in interviewing participants and
how mindful I was not to insert my own experiences into theirs, especially regarding the
overlapping roles of client and counselor as well as feelings of vulnerability.
Prior to initial coding, the research team completed several tasks in order to
develop the preliminary coding manual: taking notes, summarizing notes, playing with
words, and making comparisons (Miles, Huberman, & Saldaña, 2014). Taking notes
involved the research team as well as my own independent analysis of a subset of the
first three interviews and sand tray explanation transcripts. We divided the transcripts
into ten line segments and wrote notes in the margins. My research team and I noted
our initial reactions to the material.
Summarizing notes involved discussion between myself and my team regarding
our reactions to the interview material. We compared and contrasted our margin notes
and highlighted shared perspectives and inconsistent viewpoints in a summary sheet. In
order to achieve the task of playing with words, my team and I generated metaphors
based on our summary sheet. We developed phrases that represented our
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interpretation of the participants’ interview responses. Creswell (2013) stated that this
process is a preliminary stage in code development.
During the making comparisons task, my team and I compared and contrasted
the key phrases developed in the previous step and grouped them into categories. My
team and I then facilitated reduction of the data as we combined similar phrases and
merged overlapping categories. Hays and Singh (2012) asserted the importance of
sieving the data in order to eliminate redundancy. My team and I continued to merge
categories and reformate the category headings. From this process, my team and I
developed preliminary themes based on the data.
In order to develop initial codes, my team and I established agreement by
independently applying the preliminary codes to a subset of three interviews. My team
and I meet weekly in order to discuss inconsistencies and points of agreement, adjust
the preliminary codes, and reapply it to the data subset. We continued to discuss any
remaining discrepancies and concerns until we reached a mean agreement of 86% to
90% (Creswell, 2013). The research team reached a mean agreement of 95.1%. We
then finalized the codes to use in our coding manual.
In final coding, my research team and I applied the final coding manual to each of
the interviews and sand tray explanations. We used the same coding manual for both
the interviews and sand trays. The same research team member coded both the
interview and sand tray explanation for the same participant. I coded all 13 interviews
and sand tray explanations; all four members coded the first three interviews and sand
tray explanations. Two members coded interviews and sand tray explanations four
through eight, and the other two members coded interviews and sand tray explanations
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nine through 13. My research team’s finalized codes will include the meaning and depth
of participants’ experiences in personal therapy. However, it is important to remain
flexible in the process of coding (Clancy, 2013). Researchers review their codebook
throughout the process to determine if the inconsistencies are due to coding error by the
team members, such as misinterpreting terminology or guidelines (Creswell, 2014).
Other inconsistencies may arise because of issues with code definitions, such as
ambiguous or overlapping inclusion criteria (Creswell, 2014). If necessary, researchers
may still recode during final coding to maintain consistency with the revised definitions
(Creswell, 2013, 2014). When recoding occurred, we reviewed previously analyzed
transcripts with the updated codebook on four occasions. Once we completed final
coding, I performed member checks with the participants. In this process, I emailed all
participants a summary of the identified themes and inquired if the summary portrays an
accurate representation of the experience. Moreover, it provided an opportunity for
participants to bring my attention to an area of their experience that is not accounted for
in the themes. Nine out of 13 participants responded and informed me that no
adjustments were necessary because the summary adequately captured their
experiences.
Establishing trustworthiness. Quantitative and qualitative research differ in
methodologic approach; the perspectives of quantitative research are reliability and
validity, and the perspectives of qualitative research are credibility and trustworthiness
(Cope, 2014). To develop trustworthiness in qualitative research, Lincoln and Guba
(1985) presented four criteria: credibility, dependability, confirmability, and
transferability. These aspects of trustworthiness help to increase the scientific rigor of
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this research method. I will describe how I plan to use credibility, transferability,
dependability, and confirmability the proposed study to establish trustworthiness and
rigor.
Credibility refers to internal consistency (Cope, 2014). I established credibility in
this study through the use of research partners in debriefing, researcher reflexivity, and
participant checks. I utilized researcher partners in debriefing and data analysis steps in
order to strengthen the development of the coding manual. In relation to researcher
reflexivity, I bracketed my experiences by reflecting on my biases and assumptions as a
professional counselor who experienced personal therapy through journaling and
discussing my assumptions with my supervisor and research team. My assumptions are
related to personal experience in my own counseling. My research team and I also
engaged in bracketing through journaling and discussing assumptions based on
previous research and personal experience. Additionally, I conducted participant checks
to confirm themes found by the research team (Lincoln & Guba, 1985).
Transferability refers to the extent to which readers can apply the findings of the
study to their own experiences (Cope, 2014). I demonstrated transferability by openly
and honestly providing information about myself, the proposed study’s context,
participants, and study methods. My transparency can facilitate application of research
findings and procedures in the current study. Moreover, dependability refers to the
ability of the study to be consistent across time, researchers, and analysis techniques
(Lincoln & Guba, 1985). I achieved dependability through documenting each task I
completed for the study by keeping an audit trail. This process may allow others to
replicate my study. Also, I included an in-depth description of my methodology to
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increase dependability of the study. The in-depth description includes information about
sample size, data collection, and data analysis that my research team used.
Lastly, confirmability is based on an acknowledgement that I, as the primary
researcher, cannot be truly objective (Cope, 2014). It is important that I remain as
objective as possible throughout the study. I utilized multiple methods of data sources,
or triangulation to facilitate increased confirmability. In this study, I triangulated the
findings using participant checks, consultation with the supervising researcher, and
research team consensus.
Limitations
Several limitations exist in the current study. Most notably is the small sample
size that is restricted to one geographical location of a large metroplex in the Southwest
region of the United States. This factor limits generalizability in my study (Creswell,
2013). Additionally, transcribed semi-structured interviews and sand tray sessions are
currently the only data sources I used during analysis; I could use other forms of data in
future research studies, such as focus groups (Miles et al., 2014). Furthermore, I utilized
a single-interview design for this study, thus limiting the amount of prolonged and varied
field experience spent with participants.
Moreover, neutrality is an important consideration in qualitative research and is a
potential limitation in the proposed study. I have discussed a strong personal bias
throughout the proposed study. I am a counselor who received personal therapy and
experienced many positive benefits as a result. It is important that findings of the
research are a result of participants and not researcher bias, motivation, and
perspective. I attempted to address this potential threat by utilizing my supervising
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researcher and research partners throughout the study. I thoughtfully bracketed my
assumptions that personal therapy will have beneficial outcomes for professional
counselors; however, the fact that I have experienced the phenomenon under
investigation is an important limitation to note. Additionally, I am not able to control for
the therapy services received; participants’ experiences may vary widely due to
therapist type (e.g. counselor, psychologist, social worker), theoretical orientation, and
training. Other limitations may include recruiting interested participants who have
experienced positive benefits; those who respond to an open call for participation
regarding this topic may not be representative of their peers. I attempted to remedy the
above limitations through networking with licensed professional counselors who work in
a variety of counseling settings.
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In this appendix, I present the results of a phenomenology exploring counselors'
experiences personal therapy. We, four research team members and myself, conducted
an adapted classic data analysis that Miles, Huberman, and Saldana (2014)
recommended. We identified six major themes and 11 sub-themes from participant
transcripts and sand tray explanations (see Appendix G). Figure D.1 is a visual
representation of the identified themes and sub-themes.
Figure D.1 Flow of themes.
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Theme 1: Presenting Concerns
Participants shared their decision-making process leading to the initiation of
personal therapy, including motivations for seeking therapy. Presenting concerns
included participants' thoughts and feelings prior to engaging in personal therapy, as
well as the two sub-themes of mental health concerns and life transitions. Participants
described the initiation of personal therapy as a significant part of their experience of
personal therapy as a whole.
Sub-theme 1a: Mental Health Concerns
Participants (n = 11) reflected on a wide range of mental health concerns,
including grief, trauma, anxiety, depression, emotional dysregulation, and relational
stressors that factored into their decision to seek personal therapy. Some participants
shared past issues that occurred in a different developmental stage in life and some
participants’ distress stemmed from current circumstances. Participants differed in the
intensity of their mental health concerns.
...I would say that generally, um, I feel pretty confident dealing with the daily stressors and, you know, life is hard at times and goes up and down and marrying and having kids and there's just always stuff going on, but I would say those were the times when it was like I was put, I was pulled to my end, um, and so the, the depression, it was like I needed something else more than just the regular support from family and friends and then the miscarriages. It was like I felt so isolated, um, and then with my dad dying it was like I, gosh, this is ...It was like both of them dying so close together...(Michelle)
...it was stress it's- me feeling like, overwhelmed and probably getting like more snappy or short with my family, which is feeling like, over-taxed, over-done. Being like, I need to go. I need to just dump some of this stuff. Yeah, I feel like I can't balance all the junk everybody throws at me all day, first, and then combine that with family life. (Sophia)
And I-I wasn't sleeping well, and, um, I-I was always stressed out, and I know that I had said it earlier, but I was just, I was crying a lot. Um, kind of like a little bit of depression. But I didn't really recognize it as depression. I was having a lot
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of anxiety as well. And, um, so that, that was, um, what was going on then. It's changed as I've, as the years have gone by, but in that particular moment when I started to go it was, um, based on not feeling really worthy or competent. Um, and some relationships, like, friendships, and things like that in the, in the moment, um, that I was struggling with, and not feeling, um, I'm trying to think of, like, how, not feeling cared for, or loved, or liked, and I knew that was mostly it was all from me. Just the really not liking myself too. So it was, it was a mix of all of that. (Ashley)
Overall, participants expressed that the severity of their mental health concerns
was beyond their typical means of coping. All participants reported that they needed
something more outside themselves or their support systems to alleviate their concerns.
Thus, the intensity of their presenting concerns coupled with the effect on various areas
of their life motivated participants to initiate personal therapy services.
Sub-theme 1b: Life Transitions
Seven out of 13 participants reported a significant life transition that motivated
them to seek therapy. These precipitating events included changes in relationships,
career, or location. The adjustment caused enough disequilibrium to motivate
participants to seek personal therapy.
So I literally had a newborn and was nursing when I grabbed and got my degree, um, and then started my new job... Um, and so that's when I really like hit the pavement running like, Okay, I need a therapist, because if not, I'm not going to survive in this career. (Alma) And some of that was related to, um, eh, like as a result of the divorce. I've moved 3 times in the past, like sold a house and moved out of it or kind of moved into storage while in that house in order to be able to stage it and sell it. Then out of the house into an apartment, out the apartment into a rent house. And so there's been a lot of upheaval for me and for my child. (Lynn) Um, I had quit my job. Well, I had been out of a job for a year…Um, I think I was, this is the wrong wording, but, like, at a crossroads, like, even with my family, and I think it was invading, like, my perceptions of my family, and- I was slowly changing…and, um, and that was impacting relationships in my family, and my relationships with people in my family. (Jennifer)
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For some participants (n = 10), life transitions overlapped with their mental health
concerns, such as a career change triggering anxiety. However, the remaining three
participants cited either mental health concerns or life transitions as a reason for
initiating personal therapy. All participants differentiated their experience of internal
mental health distress and external life stressors.
Theme 2: Therapist Attributes
As participants reflected on the different feelings and thought process they
experienced during the initiation of personal therapy, they also shared different
attributes they looked for in a therapist. Two sub-themes emerged: practicality and
quality. Practicality involved factors such as location and affordability. Quality consisted
of therapist credentials, training, experience and specialty areas. All participants shared
factors related to both sub-themes.
Sub-theme 2a: Practicality
All participants described their personal and professional lives as demanding of
their time. Participants shared that choosing a therapist was based on feasibility and
ease of access, including financially and geographically. Some participants (n = 5)
reported using their health insurance while the remainder (n = 8) utilized private pay.
So I was like "Okay. Well I know this person, I know this person, I know this one. Oh. I don't know this person, okay. Let's see if they have an opening." So, that kind of ended up being, and I wanted someone that was close to my work because it's easier for me just to go straight from work considering working at a hospital, um, I can work ridiculously long hours. Sometimes, you know, twelve hour days...So I needed someone in [city withheld], and I needed someone I didn't know. (Laughs) And they took my insurance. (Liz)
But- and that was the more recent one…I had to go through an [employee assistant program] and so, thinking you [have] like a list of five or six…(Sophia)
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Participants explained that they could not initiate personal therapy if the therapist
was not easily accessible or affordable. Although participants recognized their need to
attend personal therapy, the decision to contact a therapist was delayed if personal
therapy did not fit into their lives in a practical way. Participants’ thoughts and feelings in
regards to this sub-theme were those of conflict, knowing that their own personal,
financial, and practical needs were all important.
Um, just I felt very resistant to even just making the phone call and yet knew that I needed to. And so it was very just inner conflict of, "this is the right thing to do, this is right for me personally but also for me professionally and I really really hate it and I don't want to do it." And so there was this push and pull. And I just more or less white knuckled it and I was like, "I'm just going to do it." But it was, you know just making the phone call, I was very anxious, setting at the appointment I was very anxious, um, the whole process just been very anxious. (Felicity)
Sub-theme 2b: Quality
In addition to practicality, participants (n = 13) also expressed that therapist
quality was an important factor in deciding to seek personal therapy. Participants cited
therapist training, education, recommendation, and specialty as essential deciding
factors in pursuing personal therapy. Participants differed in their standards and criteria,
although they were all related to the quality of services the therapist could provide.
I'm very intentional on their education. Even like when I have family and friends that ask me, "Hey, I need a therapist," um, I will like, just, you know, like on [therapist finder website], I'll get their zip code and I'll tell them to put in whatever search criteria they want, like insurance or whatever and I go through and I look at where they went to school and I look at what their license is and I weed out a lot of people just based on that. (Rose)
Um I found my therapist through one of my friends who had already been seeing the same therapist and she like highly recommended him and had um had really good results. She's also a counselor as well. Um and so, and he had seen, from what she had shared with me, that he saw multiple counselors that I also was familiar with. Um and so I decided to go with him, or give him a call because of other people who knew him and trusted him. (Eleanor)
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I just wanted, I really wanted somebody who was, um, not an intern and not a grad student. I need somebody who was fully licensed. Um, I was looking for somebody who’d done their own work. I would, I wouldn’t really know, but I, I can kind of tell. I was looking for somebody who had done their own work, their own process, um, and somebody who’d work with therapists. Um, and so the first therapist that I found, she’d been a, a therapist for about twelve years. Um, she had a successful private practice on her own... (Alma)
Some participants (n = 8) prioritized affordability and location over other
attributes, other participants (n = 5) emphasized education, specialty area, and
recommendations as their way of selecting therapists. Each participant highlighted their
need for accessibility and fit into their hectic schedules and personal lives. Participants
described these factors as a method of narrowing down the pool of possible therapists.
All participants experienced varying degrees of presenting concerns that
motivated the initiation of personal therapy services. Additionally, participants reported
the process of finding a therapist as well as the specific attributes of potential therapists
as important deciding factors to initiate personal therapy services. Participants
described these two themes as critical when deciding to initiate personal therapy.
Theme 3: Intrapersonal Growth
All participants identified various internal and external changes that took place in
personal therapy, and how it affected life outside of the relationship with their therapist.
Participants discussed the occurrence of these outcomes as they happened during
and/or after their personal therapy experience. The research team separated the first
major theme of intrapersonal growth into two different sub-themes: cognitive and
emotional.
Sub-theme 3a: Cognitive
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All participants expressed changes in thoughts related to self that were
associated with increased perspective. Participants specifically reported internal
changes such as awareness, mindfulness, and a sense purpose as outcomes of
receiving personal therapy. Twelve out of 13 participants described these cognitive
changes as a positive experience. One participant described the experience as
distressing due to the increased awareness of unpleasant knowledge of self and others.
Um, I think a lot of self-awareness in the sense of, like, why I function the way I function and, um, an understanding of why, like, not only the why, but, like, what I was needing, and so, like, and what I was seeking. And so, um, just a greater understanding of those pieces that I really had no, uh, no awareness of before that. And so, I had a little awareness of it, I should say. I probably knew a little bit, but I don't think I trusted myself in, like, seeing that, trust in myself and, like, um, trust in my intuition, and trust in my decision making. (Jennifer) Um, and the biggest thing for me was redefining my idea of confidence and self-esteem, self-worth, that kind of thing. Um, I was able to get to a place where I accepted who I am, where I am, what's going on with me, um, versus some idea of attaining confidence or attaining self-worth or self-esteem, that I'm enough where I'm at. Um, so, as I said, it's like a lot of work on grounding, checking in, tuning in. That was really so beneficial in, in the outcome for me that on a daily basis I'm able to check in, tune in, see where I'm at, um, pour more into me if I need to. Um, so I'm very much so I believe, uh, much farther than I was when I started on that self-awareness and, and growth in helping myself. (Amy)
Um, well I know, a lot of time, even when I started at the hospital, I always kind of felt like an impostor. In my field. I felt like it was, I felt like someone was gonna find me out that I'm really just faking all of this, and I really don't know what I'm doing. And it's, and it's also helped me find purpose, which has really helped with the knowing that I can't have children. You know. I have children. I have all these patients, and some of them are, some of them come in and out, and I see, you know, once a month, and some of them I see every six months and...it's kind of like you know, I can help them. I can make a difference. I can matter. I can leave my footprint. Which really has helped with the knowing that you know, I can't leave a legacy through children, I can leave a legacy though work. (Liz)
Sub-theme 3b: Emotional
All participants described emotional changes within themselves related to
regulation, stability, and expression as a result of personal therapy. Participants
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reported a decrease in distressing emotion, increased attunement to their emotional
well-being, and an increased ability to express emotions in a healthier manner.
Additionally, participants experienced less negative feelings towards themselves.
…like I, uh, back then, like, I, I was just, I was, uh, hiding from a lot of pain. I was hiding a lot of pain. So now, that I've, I've been able to work through that in therapy, I'm just more emotionally attuned in general. (Thomas)
Well like, for, I, I would've told you at the beginning that I don't get angry. I'm not an angry person. I never get angry. Well, I just never felt it. Um, so I've learned to recognize, "Yeah, actually there's a bunch of anger stacked in here."…Uh, so, uh releasing anger in a grounded way means that you're breathing and you're uh, present…you're present and you're, you're connected, and you're not out of control. (Betty) um, I'm also able to know what's, what is my emotion and what is other people's emotions because sometimes I struggle. I will feel what other people are, other people are having. Like, if they're high stress or high anxiety then mine starts to ramp up too, and so, um, I've been able to really recognize, "Okay, that's not my stress. That's their stress," and kind of protect myself in that way. (Ashley)
All participants explained the overlap between cognitive and emotional
intrapersonal growth; they described that one naturally flowed into the other. However,
the experiences were also distinct regarding changes in thought and changes in feeling.
Furthermore, participants expressed how this intrapersonal growth that occurred as a
result of personal therapy carried over into other relationships in their lives. Participants
shared that these internal benefits influenced external factors in their lives. Thus, the
theme of intrapersonal growth led into the third theme, interpersonal growth.
Theme 4: Interpersonal Growth
All participants shared changes in relationships and depth of social connection,
both in personal relationships and professional relationships with clients. Participants
reflected on how their growth affected relationships with romantic partners, family,
friends, and clients. Thus, the two-sub themes of personal relationships and
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professional relationships arose in the data. Participants reported these interpersonal
changes as constructive.
Sub-theme 4a: Personal Relationships
Personal relationship growth included increased empathy, awareness, and
boundary flexibility in relationships with friends, romantic partners, and family members.
More specifically, participants shared that personal therapy allowed them to recognize,
connect, and emotionally attune to others’ thoughts and feelings. Additionally,
participants reported learning to relax their boundaries by allowing people to know them
more deeply and accept help during times of need. Conversely, participants (n = 7) also
described that they were able to increase their boundaries to protect themselves and
their time as a result of personal therapy.
I believe that it helped me connect with people on a deeper level. Because it's, uh, it's hard to empathize or connect with someone if you're, you can't feel yourself. 'Cause if you can't feel yourself, you can't feel what they're feeling either. So, uh, like with my kids, you know, I would be able to, uh, first of all, set firmer boundaries with them. And they would take me more seriously. And uh, I'll then also be able to connect more. And in another area I was able to learn to ask for help. Um, instead of trying to always be, take care of things and handle things by myself, and to, to actually feel safe enough to ask for help. (Betty)
...a greater sense of comfort and ease with intimacy in relationships. So um like, being vulnerable and um ... not being as afraid of like interp- like conflict within a relationship, and um feeling more secure in the fact that like, if I have conflict in relationship um that I would be, I would be able to work it out with them. And conflict in relationship doesn't necessarily mean that like the relationship is over, or um you know. (Eleanor) Participants expressed similar themes in their professional relationships, but
made a clear distinction that personal therapy strengthened their personal relationships
with romantic partners, family members and friends. It is important to note that although
participants believed this growth to be beneficial, it did not necessarily alleviate
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relationship concerns. Some participants (n = 6) described that significant others in their
life reacted with uncertainty or negativity towards participants’ growth in this area.
and then it also helped me to start reaching out more, to build more relationships with people, and it also changed the kind of people I was attracted to, which wasn’t always the best experience. Like, for friends, partners, whatever. Um ... people that were able to, to uh, uh, provide what I was needing, that, you know, that I wasn't getting before. So it's ... it's really helped me to grow in my relationships, but sometimes that causes friction in the relationships I had before therapy… (Thomas)
Sub-theme 4b: Professional Relationships
Similar to the sub-theme of personal relationships, this sub-theme represents the
growth in professional relationships, specifically with clients or other professionals.
Participants reported improved counseling skills, such as presence, warmth, empathy,
and relational awareness. Additionally, all participants reported using their own personal
therapy experience as a way to normalize the counseling process for their clients. Some
participants (n = 9) expressed professionally advocating for mental health services to
clients, other mental health professionals, friends, and family by referencing their own
personal therapy experience.
...you know, I could empathize, I could play the role of counselor and do my job, but I wasn't doing it, like for real for real, like I was falling out of the, you know, like, what I really needed to be doing, and now, like, I'm able to sit with clients, and you know, every now and then my mind, like, wanders to "oh, I gotta to do this or that," but, like, I'm quick, you know, I become aware of it more quickly, and I'm able to feel deeply with clients, like I, I have sessions all the time now, where I'm like tearing up with my clients, and just like feeling so moved by them. And also, I cry more in my personal life, and, and, and professional life…(Thomas)
Um, and then I definitely talk to my friends like if they bring up like, "I don't know. Maybe I should take my child to see a counselor. Do you have a recommendation since they can't see you?" Um, and I, I always talk about my experience in counseling, too, with them because I feel like it lightens that load
for them, that stigma that I think most of us in this culture carry around, like those people do (Michelle)
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I would think it has more to do with how I am to be, like, to sit with, with clients. Like, I think it's probably changed more of that than anything technical or anything like that. I think I'm probably easier to sit with…just less rigidity, more accepting. Probably. I think it helps them accept themselves more. And I think that I model more effectively if you don't know what to do, it's okay. That we can just sit here and be within, hold in the, it's okay not talking. So I think that helps a lot. (Rose)
Participants also shared that personal therapy enabled themselves to be more
genuine with clients. All participants described feeling more authentic in their
professional relationships and expressed that this enhanced the therapeutic relationship
with their clients. Participants reported feeling grateful for the experience and how it
enhanced their clinical work, although the degree to which this change occurred varied
among each participant.
Twelve out of 13 participants experienced their interpersonal growth as helpful in
alleviating their presenting concerns. The remaining participant described the
interpersonal growth as tense and uncomfortable. All participants explained that their
interpersonal growth in personal relationships was connected to interpersonal growth in
professional relationships with their clients. For example, increased boundaries with
family extended to increased boundaries with clients. Participants shared that the
relationship with their therapist acted as a surrogate for relationships with other people
in their lives. Thus, the next theme represents factors in the therapeutic relationship.
Theme 5: Therapeutic Factors
All participants reported avenues of healing within the context of the therapeutic
alliance that lead to the changes in self and in relationships. Participants reflected on
how engaging in the relationship with their therapist facilitated their intrapersonal and
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interpersonal growth. This theme included four sub-themes: nurturing, vulnerability,
normalization, and transference.
Sub-theme 5a: Nurturing
Seven out of 13 participants described their therapist as nurturing or felt nurtured
throughout the process of personal therapy. Participants reported that nurturing meant
feeling safe with, trusting of, and cared for by their therapist. This atmosphere of
nurturing helped participants foster the courage to take risks without fear of judgment or
criticism.
Um it's actually been really good. Um she's been very just gentle and patient with my process. Um, I did talk to her in the first session just that I'd had a bad experience um and she wanted me to talk more about that then and I said, "No I'm not ready." And she was, you know, she respected that... (Felicity)
but it's like that one place where I can say exactly what I want, and I don't have to censor for kids, or there- they're public and or there's clients around here ... and just like, whatever the hell I wanted and now I think... I don't know, it's just so relaxed. Or if I cried, because I don't- I don't take enough time for self-care. I know that. And so sometimes that's the only way I'll do it, is if I schedule it and pay for it. (Sophia)
And like I ... I it's dif- it is difficult to put into words- Like how powerful the experience of like the relationship is. Um, just feeling accepted, feeling loved, feeling cared for, feeling, seen, heard, understood. All those fun feel-good words. Um which is interesting, like, like parenting...Um and most of all he sat with me. You know like, he held space. (Eleanor) Um, I felt prized, and loved, and a hundred percent accepted. And, like, nothing was abnormal or weird or, like, what I shared. Or, her response was always super supportive...My schedule was really odd, and so she made it work for my schedule. So, sometimes we met at 7:30 in the morning. Which I really appreciate. Sometimes we met at 8:00, sometimes we met at 2:00 in the afternoon...and I never felt like that was a burden to, she never made it sound like I was burdening her...and I'm super appreciative for that (Jennifer) Participants discussed the necessity and gratitude of having a space to express
their most genuine self and know that their therapist would nurture them throughout the
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process. More specifically, participants described caring for others the majority of their
day, including at work and at home. Thus, having this time and space was both cathartic
and healing.
Sub-theme 5b: Vulnerability
Participants reported feeling vulnerable as the client and described the feeling of
opening themselves to the presence and feedback of another as uncomfortable but also
growth inducing. Participants described this level of vulnerability as it related to their
counselor identity. Participants explained that they were most accustomed to structuring
the session and managing the time and felt more comfortable in the therapeutic
relationship in the role of counselor. As the client, participants experienced a new kind
of vulnerability that led to intrapersonal and interpersonal growth due to the reversed
power differential.
Um, I think over here definitely I do a lot, uh, self-reflection, and looking at, at my, uh, self. Um, and, you know, I put this [sand tray figure] here. I was thinking of these two [sand trays figures] being vulnerable. Um, such a vulnerable, so vulnerable, um, being in your own counseling, and it's scary, um, you know, fearful, and what's going to come up. Is it going to stop? Doing this in front of somebody else. Um, and so that just kinda felt right for me depicting it that way. (Amy)
Uh, but in the, when I'm the client it's like, "I don't know where we're going, I don't know what's gonna come up." It's kind of scary sometimes. Like you know? He's the guy with the flashlight, and I don't know where he's, what's gonna happen sometimes. Like what's going to get uncovered, or what's gonna I'm suddenly gonna become aware of or feel, or something. So it's a little scary. (Betty) Yeah there's nothing, nothing negative in there. Like ever. Sometimes it's difficult, sometimes it's hard, sometimes it's provocative but I've never walked away from a counseling session wishing that I hadn't gone. (laughs) (Lynn)
Sub-theme 5c: Normalization
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All participants reported that their therapist, in different ways, normalized their
experience. Many participants (n = 12) believed something was atypical or flawed about
their personhood for needing personal therapy. Receiving help triggered feelings of
stigma, self-rejection, or self-criticism. Thus, a large part of participants’ healing process
was feeling normalized by the therapist.
She would bring in research that was related to what I was experiencing or she would also talk about [researcher name], and the research that she found, uh, related to shame, and low self-worth, and things like that. Um, and I think kind of hearing that and realizing that that was a, a thing, that other people experience this. And I know that they do because I'm, I'm a counselor too, but, um, I think it helped to normalize that. Um, and I think it, it was helpful too when she would bring in research because I think there is that academic piece, to me, where, um, I've realized, "Okay, so people are studying this. This is not just something I'm making up in my head." (Ashley) …there's even been times when I've asked her, like, "do I, do I fit a diagnosis? Like, what's wrong with me?" You know, there's even been times when I've kind of demanded from her, like "what, what's the deal? I've been seeing you for two years, tell me what's wrong with me." And she won't do it. She’d, she will not do it, and she's just like "no, that's not what I do." And so that's helped me immensely. She's like "everything you've told me, every, everything fits." And it's helped me to see it that way…people that are in the mental health field want to know what's wrong with them, and how to fix it…sometimes I think diagnosis may be helpful a little bit, but, like, usually no, especially with trauma…it may sound crazy at first to someone who's never heard about it before, but then when you learn what they've been through, it makes perfect sense. (Thomas) I guess just, (sighs) I guess normalizing. Having somebody normalize it for me. Like I will never forget. Okay. The best thing my original therapist told me back when I was in undergrad when I was first seeking therapy, um, I remember she saying, that was a normal reaction for an abnormal situation. And that really hit home, cause you know. I thought I was weird. I though I was reacting to it. I shouldn't be doing this. I should, and she was like "No." It's normal. (Liz)
Participants described their presenting concerns as distressing; the therapeutic
relationship helped to normalize feelings of isolation or shame. Participants also stated
that this normalization also extended to their own clinical work with clients, as
mentioned earlier in the sub-theme of professional advocacy. As their therapists
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normalized participants’ experiences, participants were able to do the same with clients
and other life events.
Sub-theme 5d: Transference
Several participants (n = 9) shared that healing occurred as a result of
therapeutic transference in the relationship with their therapist. Participants reported
perceiving the therapist as significant relationship in their life, sometimes describing
their therapists as a maternal or paternal presence. At times, the therapists themselves
were the healing catalyst, acting as substitute for redirecting emotional wounds.
…she probably was the age of my mom at the time and so I felt very nurtured by her in a way that, like I always wanted to be nurtured by mom but it hadn't happened like that...I mean, there was that transference kind of feeling that was happening but it was very positive, um, and she was very, very, just very warm, and I feel like that was, that relationship, that was so healing and allowed me to process through more things, feeling supported and encouraged by someone who is kinda like my mom but not my mom, almost like I was able to, it was like a reparative thing within the relationship. (Michelle) …what I learned in the relationship was it increased my sense of um, my own internal security. Like I guess attachment security. I guess would be the best way to say it. Um, because I just developed this sense that he would be there. I could um take a, take an, a leave of absence if you will or step out of therapy for a little bit. I could come back a few months later, and I would still be welcomed back. And like- Um, all of the things that like developed in my family of origin, like I was working it out in relationship with him. Um, so it was more of like a both, and, right. He made interpretations and insight, but also who he was and how he treated me facilitated change. You know? Like whether it was over the phone or whether I could step out of therapy or step back in…(Eleanor) Yeah. That's me. (crying) Before. Mm. So of course this person is trapped. Scary things. So she can't move or breathe, or feel alive. So finally she meets this guy. He's the guide. So um, she's on this path here. And uh, this, this guide is here going down the path with her…Um, so he held her little child, held a space for her. And helped her. And helped her see things about herself. (Betty) This theme also encompassed feelings of attachment. In many cases,
participants’ early attachment figures were either emotionally or physically unavailable
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or harmful. Participants explained that their therapists acted as a healthy attachment
figure and described this aspect of the relationship as reparative. Some participants
shared feeling re-parented by their therapist.
Participants reported the experiences as specifically resulting from the
relationship with their therapist, citing these factors as the mechanism for change.
Participants also noted how aspects of the therapeutic relationship translated into other
areas of their life. However, participants further described that these factors were not
always positive or pleasant. In the following sub-theme, participants identified the
challenges in experiencing some of these therapeutic factors.
Theme 6: Challenges
Eleven out of 13 participants reported challenges related to the initiation of
personal therapy; two participants shared that personal therapy was a purely positive
experience without negative or uncomfortable feelings. Additionally, the same 11 out of
13 participants described challenges during the course of therapy that inhibited their
healing process. These challenges included three sub-themes: finances, stigma, and
role adjustment.
Sub-theme 6a: Finances
Although participants acknowledge the need for personal therapy and attempted
to select an affordable therapist, finances were an obstacle during the course of
personal therapy. Participants indicated that they would attend more sessions for longer
periods of time if they had the financial means. Feelings of conflict were common within
this theme.
Oh, right. Okay. Oh yeah, you need about a stack of uh, 50,000 of these [dollar bills]. After all that money, he's not in network. So it was expensive. (Betty)
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I mean, I guess if it was ... I would go every week. (Laughs). It's just a little bit expensive to do that. (Michelle)
Um and then I kind of thought I was done and then I realized it was like, "Okay I have to add the money aspect, because every time that just like ugh" um because I am perpetually broke. And so I added the money like off to the side just like it's not really part of the process but it's this thing that exists that I can't erase. (Felicity).
All participants expressed concerns related to the financial obstacle of pursuing
personal therapy. There were no differences in the participants’ description among
those who utilized insurance versus those who used private pay. Additionally, all
participants found a way to engage in personal therapy despite financial limitations;
however, some participants’ length of treatment was shorter than they desired or
needed.
Sub-theme 6b: Stigma
All participants were aware of the general stigma that accompanies mental health
treatment. Additionally, participants expressed knowledge that counselors face an
additional type of stigma due to working in the mental health field. Although not all
participants personally felt stigmatized, each individual recognized its presence among
society and other mental health professionals.
Um, yes, that there is a stigma like that if you need to go see someone that you're somehow like inadequate to deal with your own stuff, um, or that you're crazy or that you're really far gone, like only people who are really far gone need to do that or, um, but I still think it's a pride thing, you know? (Michelle) Um, I'm trying to think, because I remember, because I remember sitting across from my therapist, and like when you tell them what you do for a living in it's kind of you know (coughs), also when you're sitting across from them it's like I know I'm supposed to be doing X, Y, and Z. And I know I should be doing this, and I know I need to be doing this, and if I just didn't I wouldn't need to see you, but I'm not doing it, and I don't know why I'm not doing it. (Liz)
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I think sometimes I, I stigmatize myself like going, "Okay, you're a counselor, like you should be able to figure this out for yourself." But that's more of the criticism that comes from within me not from anybody else. (Felicity)
But, that's, I grew up in a family where you just figured things out, and so, like, that was not my go to was to seek out help, or seek out guidance at all, so it was just, I mean, you can ask for a little help, but, like, something that big you would never ask for help on. That was something that you're supposed to observe, figure out, intuitively know how to do, and I wasn't doing any of those things. And so, um, or, I wasn't perceiving that I was doing any of those things, um, or I couldn't hear. If I was doing it, I wasn't hearing, like, the messages I needed to, which was hard. And so, um, but I think just, like, deep down inside, and I knew I needed to go for a while…(Jennifer)
This sub-theme also encompassed feelings of shame in seeking personal
therapy. Participants described shame as more of an internal felt sense rather than the
external nature of stigma.
Um, I know that sometimes I-I have still felt a little timid is sharing that I go to counseling…I think that there's still a fear of, "I wonder what other people would think of me” …as a counselor. Because sometimes I have felt that that means, "Oh, you don't have your, your crap together if you have to go to counseling,"…And that I should be, um, able to, to have this all figured, and to know what to do and how to handle conflict, and how to, um, you know…that’s the shame part. I think I had thought I, that I would have this idea that others would think that I have nothing figured out, and that I'm a mess, or a-a wreck, if I have to go personal counseling…From friends I get some stigma. They've kind of been like, "Are you okay? Why are you going to counseling?" Just because they don't understand that's it's not all extreme…(Ashley)
In addition to societal views of mental health for counselors, participants also stated
they received stigma from family members and friends.
Sub-theme 6c: Role Adjustment
All participants expressed difficulty in the duality of identities as counselor and
client. Balancing both roles was a challenge. Furthermore, participants reflected on the
struggle in allowing themselves to fully embrace the client role. Participants described
their counselor identity as a barrier in truly receiving the therapeutic value of their
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experience. Participants often intellectualized or analyzed the process from a counselor
perspective, rather than experience personal therapy as a client.
Um, well, and the only, you know, another thing is, sometimes if I'm working on something really intense, it's a little, it's harder to come. That's why I schedule my sessions like on Monday. And I don't have to be here 'till Wednesdays. 'Cause I need 24 hours at least to process sometimes. (Betty) It's weird. Because, um, I don't know. Sometimes I'm like, (sighs) maybe transferring, like, like what I experience as a counselor to her, or what, or what I experience as a client to my clients...like, if I'm sitting there in session with her, and I'm like, I, I'll be like "oh, she's reflecting feeling right now," like "oh, I see what she's doing there." Um, she's, she's just going by the book, you know, sometimes. Um, but it still helps...And then, sometimes, with a client, I'm like, I'm like wondering about, like, um, I don't know, like I said, I've, I've looked for her not paying attention sometimes, you know, and I, er, I'll just wonder about things. And then when I'm in the counselor role, I'm like "I wonder if my client, like, feels the way I do, when I'm sitting in session," I wonder if they know what I'm doing or if they notice me doing the same thing over time. (Thomas) It's weird and it's distracting as a client because you're like, I know what's she's doing. Why is she doing that? Huh. Like it's, it's a good, it's a good place to run to if you don't want to go where they're trying to take you, you can go into your analytical, left brain logical mode. Oh, I know exactly, you know, and you feel like an expert. You know what they're doing. They're not pulling it over on you. It's a good way to run inside therapy. (Rose)
Participants stated it required intentional effort to become the client throughout
their personal therapy experience. Participants explained that they were able to
experience the healing benefit of personal therapy once they stepped away from their
counselor identity during the session. Some participants stated it was helpful when their
therapist helped increase their awareness of this process.
Participants shared numerous challenges in personal therapy. Five out of 13
participants discussed the idea of stigma and reported feeling the general of stigma
towards mental health counseling plus additional stigma due to their counselor status.
The remaining participants (n = 9) explained that they did not personally feel
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stigmatized, but were aware of the stigma that existed in regards to counselors who
receive personal therapy. All participants shared that they would attend personal
therapy longer or more frequently if not for financial barriers. Additionally, each
participant described the difficulty of experiencing the identity of both client and
counselor.
Summary
Participants in this study shared intimate and detailed accounts of their
experiences and decision-making regarding seeking personal therapy. In this chapter, I
provided details about the six major themes and 11 sub-themes that the research team
identified from interviews with the participants. The findings of this study suggest
potential implications for clinical practice, implications for counselor education and
supervision, and future research. I provide detailed discussion on these points in the
next chapter.
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Researchers have asserted the need for self-awareness in counselor training
and practice (Dryden & Thorne, 2008; Malikiosi-Loizos, 2013). In addition to self-
awareness, counselors and other therapists expressed experiencing mental health
concerns, such as stress, compassion fatigue/burnout, and interpersonal problems
(Lawson, 2007; Thompson, 2014). Counseling psychologists, psychologists, and social
workers’ reported mostly positive benefits in their personal therapy experiences, such
as alleviation of occupational stress and personal growth (Bellows, 2007; Ciclitira et al.,
2012). Furthermore, researchers have explored the experiences of professional
counselors’ experiences in personal therapy in European countries such as the United
Kingdom and Spain, also reporting positive changes in personal relationships and
professional relationships with clients (Daw & Joseph, 2007; Oteiza, 2010; Rake &
Paley, 2009). However, many mental health professionals have reported feeling
stigmatized in seeking personal therapy (Norcross et al., 2008).
I designed a phenomenological study to explore professional counselors
decision-making and experiences in seeking personal therapy. Participants were all
individuals who identified as licensed professional counselors and had received, or were
currently receiving, counseling from a licensed mental health professional. I conducted
semi-structured interviews with participants (N = 13) and analyzed the data, along with
four research team members, according to recommendations for adapted classic data
analysis (Miles, Huberman, & Saladana, 2014). Six major themes emerged from the
data analysis: presenting concerns, therapist attributes, intrapersonal growth,
interpersonal growth, and challenges. Several important findings appeared from this
study that may help licensed mental health professionals better meet the unique needs
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and experiences of professional counselors. In the following sections, I discuss findings
within the context of existing literature regarding presenting concerns, burnout and
compassion fatigue, and outcomes of personal therapy. I then discuss implications for
clinical practice, counselor education, and future research. Finally, I conclude with
limitations of this study.
Findings and Existing Literature
The findings of this study both contradict and support several important findings
in the existing literature regarding counselor demographics and counselors who seek
personal therapy. In the current study, participants’ themes surrounded the exploration
of counselors’ decision-making process and lived experiences in personal therapy.
Thus, how one came to personal therapy and how one experienced personal therapy is
a relevant to the implications of the findings.
Presenting Concerns
Participants in this study discussed how their presenting concerns impacted their
decision to pursue personal therapy. Participants cited relationship distress, grief,
trauma, depression, anxiety, and childhood stressors as reasons for seeking personal
therapy. This finding is similar to Bike, Norcross, and Schatz (2009), who indicated that
the counselors, psychologists, and social workers in their study reported couple
distress, depression, need for self-understanding, and anxiety/stress as presenting
concerns when attending personal therapy. Additionally, Orlinsky (2013) found that the
most frequently occurring reasons for seeking therapy were personal problems,
personal growth, and for training purposes in a sample of 11,154 mental health
professionals. It is interesting to note that none of the participants in the current study
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sought therapy for training purposes; however, criteria for participation in this study
required full licensure. Orlinsky (2013) did not specify whether the therapists in the
sample were trainees, interns, or fully licensed professionals. Thus, attending personal
therapy for training purposes may not be a common presenting concern of professional
counselors.
Another important consideration is the finding that life transitions were significant
motivators for participants in this study to seek personal therapy; this finding is unique
and does not appear elsewhere in the literature. However, core values of the counseling
profession include environmental factors and holistic approaches (Remley, & Herlihy,
2010). Thus, due to the fact that my sample exclusively included licensed professional
counselors, life transitions may be a unique concern of counselors as they have
embraced a developmental perspective on human functioning and behavior.
Burnout and Compassion Fatigue
The literature is replete with evidence of counselor burnout and compassion
fatigue (Deighton, Gurris, & Traue, 2007; Lawson, 2007; Richards, Campenni, & Muse-
burke, 2010; Thompson, Amatea, & Thompson, 2014). Participants (n = 7) in the current
study described feeling burned out and lacking in empathy as motivations to seek
personal therapy. Additionally, Killian (2008) outlined behavioral symptoms of burnout
and compassion fatigue, including mood changes, sleep disturbances, becoming easily
distracted, and increased difficulty concentrating. Six out of 13 participants in this study
shared similar symptoms when discussing thoughts and feelings in the decision-making
process to initiate personal therapy, as well as when describing their mental health
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concerns. Therefore, it is important to assess counselors for levels of burnout and
compassion fatigue in addition to raising awareness of signs and symptoms.
Researchers have identified risk factors for burn out and compassion fatigue in
counselors. For example, Lawson and Myers (2011) discovered counselors with larger
percentages of trauma survivors among their clients seemed to be more at risk for
burnout; similarly, Sprang et al. (2007) revealed that mental health professionals who
were female, were younger, had less clinical experience, and had a higher percentage
of clients with post-traumatic stress were more likely to present with higher levels of
burnout and compassion fatigue. Four participants in this study identified as a woman,
younger in age, and newly licensed, and reported feeling burned out and lacking
empathy when deciding to seek personal therapy. Therefore, certain populations of
counselors may be at risk for burnout and compassion fatigue.
Although some counselors may choose to engage in personal therapy to address
burn out and compassion fatigue, little research exists related to how personal therapy
actually alleviates burnout or compassion fatigue. Participants in the current study
explained that personal therapy helped decrease mental health concerns and increase
empathy towards others due to feeling nurtured, vulnerable, and normalized by their
therapists; three participants described personal therapy as their form of self-care. This
finding is similar to Macran, Stiles, and Smith (1999) who found that personal therapy
alleviated symptoms of distress and impairment, enhanced empathy for clients,
increased self-awareness of one’s boundaries and limitations, and supported the
development of other types of self-care skills. Thus, personal therapy may be a critical
resource for counselors who experience burnout and/or compassion fatigue.
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Experiences in Personal Therapy
Within the present study, the sub-theme of stigma in participant voices is
consistent with the existing literature. Norcross (2010) stated that counselors might feel
reluctant to seek personal therapy because of the assumption that as clients they might
appear as flawed or less capable as helpers. Participants described the general stigma
and personal shame in seeking mental health treatment. Furthermore, participants
differentiated between general stigma regarding mental health and stigma specific to
counselors. Based on this finding, counselors may experience greater stigma than the
general population when seeking personal therapy.
These findings represent professional counselors within the United States;
however, many scholars have documented the personal effects of other types of
therapists in their own therapy and revealed similar findings. Oteiza (2010) interviewed
10 European therapists and found that personal therapy increased awareness of their
own struggles, acceptance of their fallibility, and appreciation of the ebb and flow of
therapy. Daw and Joseph (2007) also investigated the experiences of European
therapists in personal therapy; participants reported that personal therapy helped them
gain insight into their own vulnerabilities and promoted change and growth. Moreover,
Bellows (2007) conducted semi-structured interviews with 20 psychotherapists and
found that personal therapy relationships promoted psychological change, improved
their interpersonal relationships, and increased self-acceptance of personal
imperfection. Although the participants in the current study are culturally different than
the participants in the literature, comparable findings such as vulnerability, self-
acceptance, and increased awareness emerged from the data.
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In the literature, not all personal therapy experiences are positive. Rake and
Paley (2009) conducted semi-structured interviews with eight therapists in the United
Kingdom; participants described emotional impact of exploring concerns such as
trauma, relationship difficulties, and bereavement as deeply distressing and yet
ultimately helpful. Ciclitira et al. (2012) conducted a phenomenological study with 19
European, female counselors and discovered that participants learned from the
therapist in both positive and negative ways, experienced financial and time constraints,
and lived through the pain and upset of working through personal issues (Ciclitira et al.,
2012). This mirrors the experiences of participants in the current study, specifically
related to the theme of challenges, including the sub-themes of finances and role
adjustment. Participants in this study described the challenges and uncomfortable and
unpleasant but still growth inducing. Hence, this finding echoes the literature in that
although personal therapy is not may not be an enjoyable experience, it may still be
beneficial.
Participants in this study explored the therapeutic relationship and how it
contributed to the change process, represented by theme of therapeutic factors. Within
this theme, participants expressed that the sub-themes of nurturing, vulnerability,
normalization, and transference were healing and produced changed. This finding is
similar to Rizq and Target (2008), who interviewed nine counseling psychologists and
found that personal therapy provided a space for an intense experience, including
attachment to the therapist, increased authenticity, and psychological safety. Thus,
relationship with the therapist is a crucial element in the outcomes of personal therapy,
especially related to attachment and safety.
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The sub-theme of professional interpersonal growth is congruent with findings in
the literature. Participants in this study described that personal therapy enhanced their
counseling skills, including empathy and boundary setting, and increased their
professional advocacy. Similarly, Daw and Joseph (2007) found that professional
therapists reported how personal therapy deepened their understanding of the
therapeutic process in terms of boundaries, techniques, and procedures. Furthermore,
Rizq and Target (2008) found that therapists’ personal therapy increased awareness of
the client role and helped them feel more connected to clients’ experiences in general
(Rizq & Target, 2008). Hence, counselors may experience growth related to
professional relationships as a result of personal therapy.
Aligned with the concept of professional growth, many researchers have
emphasized that personal therapy was an educational and/or training experience for
therapists and added to their professional repertoire of knowledge and skills (Ciclitira et
al., 2012; Daw & Joseph, 2007; Rizq & Target, 2008). However, these findings are not
congruent with the experiences of participants in the present study. Although
participants reported enhanced professional growth in terms of boundaries with clients
and professional advocacy outside of the therapeutic relationship, participants shared
that the intellectual aspect of personal therapy within the relationship served as a barrier
to the healing process. All participants expressed a desire or intent to release
themselves of their counselor identity while experiencing the counselor role. Thus, some
counselors may not see personal therapy as a means for education or professional role-
modeling and instead find those aspects as distracting to the experience.
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Several themes emerged from this study not found in current literature. Although
researchers have reported intrapersonal growth and interpersonal professional growth
(Bellows, 2007; Orlinsky et al., 2011; Orlinsky, 2013; Oteiza, 2010; Rake & Paley, 2009;
Rizq & Target, 2008), the sub-theme of interpersonal growth in personal relationships is
an important concept that did not appear in these studies regarding therapists in
personal therapy. Participants in the present study discussed that personal therapy
fostered more awareness, empathy, and boundary flexibility in relationships with
romantic partners, family members, and friends. Therefore, counselors and other mental
health professionals may be unaware of this potential benefit. Furthermore, the themes
of therapist attribute did not emerge from any existing data in the literature. Although
Bellows (2007) stated that participants in the study reacted negatively when therapists
were harsh or rushed the process, little is known about what therapist attributes are
involved with counselors’ decision making process. Thus, factors such as therapist
education, specialty, recommendation, fee, and location could contribute to counselors’
selection process.
Implications
Participant voices shed light on a variety of considerations for counselors
experiencing personal therapy. These findings may lead to numerous implications within
the mental health field, especially related to counseling. I describe implications for
clinicians, counselor educators, counselor supervisors, and future researchers in the
following section.
Clinical Implications
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The participants in this study sought personal therapy from licensed professional
counselors (n = 11) and psychologists (n = 2). However, participants did not mention
seeking a particular therapist orientation, field, or license. Therefore, a variety of mental
health professionals may service professional counselors and may benefit from the
implications from this study. Participants often emphasized the struggle in assuming the
client role, as they were most comfortable with the typical power differential in their
professional work. The therapeutic relationship is hierarchical due to its one-sided
nature; the therapist, privileged with specific training and expertise, possess the ability
to harm or help the client, who is vulnerable, distressed, and seeking a specific service
(Chang & Berk, 2009). This phenomenon was especially salient in the participant voices
of this study; vulnerability and role adjustment were crucial themes of their experience.
It may behoove clinicians to maintain awareness of this possibility or discuss it within
personal therapy. Chang and Berk (2009) also suggested the use of self-disclosure,
greater transparency about the therapy process, and facilitative questioning directly
related to therapist responses (e.g., What comes up for you as your process what I just
said?) as ways to balance the power differential in the therapeutic relationship.
Stigma emerged prominently in the current data and previous literature.
Additionally, counselors in this study experienced another layer of stigma related to their
professional identity. Participants indicated that as counselors, it felt shameful to need
professional help. Indeed, participant voices echoed the concept in the literature that
therapists must be exceptionally mentally healthy in order to provide mental health
services (Norcross, 2010). Clinicians may consider normalizing these thoughts and
feelings. Carpetto (2008) defined normalization as the therapist’s use of indirect or
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direct statements that reframe client problems as contextual responses to the difficulties
of life. Therapists use normalization to de-pathologize client concerns and convey
implicit acceptance of the person of client (Carpetto, 2008). Varying degrees of
normalization skills include psychoeducation, reframing, and self-disclosure (Carpetto,
2008).
Implications for Counselor Education and Supervision
Counselor educators have many opportunities to impact the education and
knowledge of counselor trainees. Norcross (2010) stated that professional therapists
often maintain a similar professional identity cultivated during their training program.
Additionally, twelve out of 13 participants completed required counseling for their
training programs. Hence, early intervention during counselor training programs may
increase resources for future professional counselors.
All participants expressed an increased self-awareness as a result of personal
therapy. Scholars maintain that self-awareness is an essential aspect of counselor
development (Remley & Herlihy, 2010). Counselor trainees can foster self-awareness
through experiential learning, role plays, recordings of sessions, self-reflection, and
supervision (Dryden & Thorne, 2008; Hawley, 2006; Paladino, Barrio Minton, & Kern,
2011). In light of the current findings, counselor educators and supervisors can suggest
or recommend personal therapy to counselor trainees needing additional development
of self-awareness. Furthermore, counselor educators often address self-care, burnout,
and compassion fatigue throughout counselor preparation (Roach & Young, 2007).
Counselor educators and supervisors could recommend personal therapy as a form of
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self-care or burnout and compassion fatigue prevention and intervention by informing
counselor trainees or interns of the existing research related to such topics.
Counselor educators and supervisors have the opportunity to decrease stigma
among counselors and counselor trainees. Given that stigma was a central theme within
the current study, counselor educators may consider allocating time to discuss personal
therapy as means of self-care and burnout prevention, as well as a way to increase self-
awareness. Knaak, Modgill, and Patten (2014) reported that the most effective anti-
stigma interventions incorporate social contact, education, personal testimonies, the
teaching of skills, and myth-busting. Counselor educators and supervisors may consider
sharing important research on the topic of counselors in personal therapy, including
challenges and benefits of personal therapy. Counselor educators could invite guest
speakers to their classes, including professional counselors who see therapists or
professional counselors who have received personal therapy, to speak on their
experiences. Regarding skills, counselor educators and supervisors can assist
counselor trainees in searching for therapists, choosing criteria, and informing trainees
of important credentials, training, certifications, and specialty areas.
Implications for Future Research
Although participants reported feeling burned out and low on compassion, future
researchers may consider assessing burnout and compassion fatigue of counselors in
personal therapy through quantitative assessments, such as the Professional Quality of
Life Scale (Stamm, 2005). Researchers could conduct pre- and post-tests before and
after personal therapy to provide quantitative results in the efficacy personal therapy as
a form of burnout and compassion fatigue intervention. Additionally, future investigators
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could quantitatively measure client treatment outcomes among counselors who
received personal therapy as another way to empirically validate the professional
interpersonal growth found in this study.
Moreover, qualitative researchers could explore the experiences of counselors
who provide mental health treatment to therapists to reveal more about this
phenomenon. Methods such as grounded theory, phenomenology, and interpretive
phenomenological analysis could delve more deeply into providing best practice for
counselors who seek therapy. Furthermore, participants in this study shared their
experience of personal therapy in a single interview; researchers may collect richer data
through the use of longitudinal studies that examine participants’ experiences in
personal therapy over time.
Limitations
The current study included many strengths, such as the rigor I followed and
trustworthiness I demonstrated. However, some limitations exist. I used a single-
interview design, thus limiting the amount of extended field experience with participants.
Participants may have offered more intimate and sensitive information after spending
more time in the interviewing process. Due to the sensitive nature of the topic of the
study, I worked to establish trust and build rapport with my participants through the use
of introductory questions at the beginning of my interview. Furthermore, the interviews
took place in one geographical area; participants from other locations across the United
States may have provided a more diverse perspective.
Remaining neutral and free from bias is a potential limitation in this study,
although it is an important consideration in qualitative research (Creswell, 2014). In
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order to ensure findings of the research are a result of participants and not researcher
bias, motivation, and perspective, I utilized my supervising researcher and research
partners throughout the study in peer debriefing, as well as participating in researcher
reflexivity throughout the study. To account for reflexivity, I utilized a personal journal.
Despite plans to recruit a sample that was diverse in terms of age, gender, ethnic
identification, sexual orientation, religious/spiritual orientation, participants in this study
were similar to each other. Only one participant identified as a man, and the majority of
participants (n = 9) were White. Additionally, 11 participants identified as heterosexual
and eight identified as Christian. My sample echoes the overall lack of diversity among
professional counselors; the National Board for Certified Counselors (2010) reported
that the majority of its registered counselors were White women. However, it would be
beneficial to know more information about the experience of counselors who identify as
men, counselors of color, LGBTQIA+ counselors, and counselors from other religious
and/or spiritual orientations. Other limitations include the absence of voices of
counselors ordered to receive mandated counseling. I believe I received many
interested participants who have experienced less stigma; counselors who volunteered
to participate in a study regarding this topic may not be representative of their peers
who undergo personal therapy for remediation purposes. I attempted to rectify the
above limitations through networking with licensed professional counselors who worked
in a variety of counseling settings.
Conclusion
Counselors face many challenges in their clinical work, including the need for
self-awareness and occupational stressors (Mearns & Cooper, 2005; Moller et al., 2009;
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Orlinsky et al., 2011; Orlinsky, 2013; Oteiza, 2010; Rake & Paley, 2009; Rizq & Target,
2008). Limited information is available to counselors, counselor educators, and
counselor supervisors regarding decision making and considerations when professional
counselors choose to engage in personal therapy. The current phenomenological study
served to provide an understanding of the lived experiences of counselors who utilize
personal therapy. The counselors who participated in this study provided intimate and
detailed accounts of their concerns and difficult moments in their lives, and how they
benefitted from using personal therapy as a resource. Motivations and deciding factors
to seek personal therapy consisted of presenting concerns and therapist attributes.
Outcomes of personal therapy involved intrapersonal growth, interpersonal growth,
therapeutic factors, and challenges.
This study is not without limitations and cannot be generalized to the population
of professional counselors due to my small sample size. However, this study does give
voice to the counselors involved in this study and their experiences in seeking personal
therapy. I carried out many steps to ensure the trustworthiness of this study. It is my
hope that this study is the beginning of a movement to significantly decrease stigma
about seeking personal therapy, especially among counselors.
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Participant Recruitment Letter
Hello, My name is Cynthia Bevly and I am a doctoral candidate in the Counseling Program at the University of North Texas. I am recruiting licensed professional counselors to participate in a study regarding their experiences in their own personal therapy (IRB #16-306). Your participation could help counselors, counselor educators, and counselor supervisors understand the experiences of professional counselors who choose to seek personal therapy.
Your participation will consist of taking an online demographic survey that may take about 5-15 minutes. In order to participate, you must meet the following requirements:
1. You are a fully licensed professional counselor in Texas 2. You are at least 18 years old. 3. You are currently in counseling or have undergone counseling with a licensed mental health professional (e.g., counselor, psychologist, social worker) in the past three years.
All surveys are completely confidential and will only be viewed by myself and my supervising researcher; your IP address will not be collected. After completing the survey, I may contact you to participate in a 60-minute interview and 30-minute sand tray activity. Please click the link below to begin: (survey link) Thank you for your time and consideration, Cynthia M. Bevly, M.S., LPC-Intern
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University of North Texas Institutional Review Board
Informed Consent Notice
Before agreeing to participate in this research study, it is important that you read and understand the following explanation of the purpose, benefits and risks of the study and how it will be conducted. Title of Study: A phenomenological exploration of counselors’ experiences in personal therapy. Student Investigator: Cynthia M. Bevly, University of North Texas (UNT) Department of Counseling and Higher Education. Supervising Investigator: Dr. Elizabeth A. Prosek. Purpose of the Study: You are being asked to participate in a research study that involves sharing your experiences in seeking personal therapy. Study Procedures: First, you will be asked to complete a brief electronic questionnaire regarding your demographics and counseling experiences. Active license as licensed professional counselor, 18 years of age, and prior therapy with a licensed therapist within the past three years are the eligibility requirements for the study. If you are eligible, you may be invited to participate in a 60-minute individual interview and 30-minute sand tray activity. This interview can take place face-to-face if you live within the Dallas/Fort Worth Metroplex at your office or my office located on the University of North Texas’ campus. After the initial interview, you may be contacted with follow-up questions and/or to verify the accuracy of your experiences. The estimated length of time for participation for follow-up questions is 30 minutes. Foreseeable Risks: Some participants may experience discomfort sharing experiences that may be considered private. You will be in control of the interview and can decide whether and how much to share. Otherwise, no foreseeable risks are involved in this study. Benefits to the Subjects or Others: The researchers expect that you will have an opportunity to reflect on your decision to seek counseling in a meaningful way, but you may not experience direct benefit from participating in this study. Results of the study may help mental health professionals better understand how professional counselors experience and make meaning of their personal therapy. Other researchers may use this understanding to help support counselors in accessing mental health services and to further research. Compensation for Participants: There is no direct compensation for participating in the study.
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Procedures for Maintaining Confidentiality of Research Records: Interested participants will complete an online demographic survey. Your participation in this online survey involves risks to confidentiality similar to an individual's everyday use of the Internet. Researchers will download the information and keep it on a password protected excel sheet that will only be accessed by the supervising and student investigators. Once final participants are recruited, interviews and sand tray sessions will take place via face-to-face interviews. The student investigator will audio record these interviews and keep them locked in a HIPAA compliant file. Additionally, the student investigator will take a digital photograph of the completed sand tray that will not contain any identifiable data; the photographs will also be locked in a HIPPA compliant file. The audio recordings will be de-identified and assigned a number and pseudonym before being transcribed by a professional transcriptionist and analyzed by a research team. Only the student investigator and her supervisor will have access to the original recordings. The researchers will destroy the recordings once they complete data analysis. The de-identified transcriptions will be kept on the student researcher’s password protected computer in a location separate from your demographic information. The confidentiality of your individual information will be maintained in any publications or presentations regarding this study. Questions about the Study: If you have any questions about the study, you may contact Cynthia Bevly at cynthia.bevly@unt.edu or Dr. Elizabeth Prosek at elizabeth.prosek@unt.edu. Review for the Protection of Participants: This research study has been reviewed and approved by the UNT Institutional Review Board (IRB). The UNT IRB can be contacted at (940) 565-4643 with any questions regarding the rights of research subjects. Research Participants’ Rights: Your participation in the demographic survey confirms that you have read all of the above and that you confirm all of the following:
• Cynthia Bevly or Elizabeth Prosek have explained the study to you and you have had an opportunity to contact her with any questions about the study. You have been informed of the possible benefits and the potential risks of the study.
• You understand that you do not have to take part in this study, and your refusal to participate or your decision to withdraw will involve no penalty or loss of rights or benefits. The study personnel may choose to stop your participation at any time.
• You understand why the study is being conducted and how it will be performed.
• You understand your rights as a research participant and you voluntarily consent to participate in this study.
• You understand you may print a copy of this form for your records.
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Semi-Structured Interview Protocol Grand tour question: Please tell me about your experience in personal therapy in as much detail as you feel comfortable sharing. Follow up:
- What motivated you to seek personal therapy? - What was happening in your life at the time? - How did you go about selecting a therapist? - Can you tell me about what your internal process (thoughts/feelings) was like
leading up to your decision to seek personal therapy? 2. What outcomes did you experience as a result of personal therapy? 3. How, if at all, has personal therapy affected your personal growth? 4. How, if at all, has personal therapy affected your own clinical work? 5. Describe the experience of being both a client and a counselor.
- Some literature suggests that counselors feel stigmatized when seeking personal therapy. What do you make of this? How is that similar or different for you?
6. Is there anything else that you would like to share?
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Literature Support in Development of Interview Protocol
Question Literature Support
Please tell me about your experience in personal therapy in as much detail as you feel comfortable sharing.
(Bellows, 2007; Bike et al., 2009; Ciclitira et al., 2012; Daw & Joseph, 2007; Everson, 2014; King, 2011; Kumari, 2011; Lawson & Myers, 2011; Lawson, 2007; Linley & Joseph, 2007; Mearns & Cooper, 2005; Moller et al., 2009; Norcross et al., 2008; Oden et al., 2009; Orlinsky et al., 2011; Orlinsky, 2013; Oteiza, 2010; Prosek et al., 2013; Rake & Paley, 2009; Rizq & Target, 2008; Rønnestad & Skovholt, 2012; Sprang et al., 2007; Thompson, 2014; Troff, 2007; Wigg et al., 2011)
What was happening in your life at the time?
(Lawson & Myers, 2011; Lawson, 2007; Orlinsky, 2013; Spring et al., 2007; Thompson et al., 2014; Troff, 2007)
How did you go about selecting a therapist?
(Bellows, 2007; Orlinsky et al., 2011; Wigg et al., 2011)
What motivated you to seek personal therapy?
(Norcross et al., 2008; Orlinsky et al., 2011; Orlinsky, 2013; Oteiza, 2010; Rake & Paley, 2009; Rizq & Target, 2008; Sprang et al., 2007; Thompson, 2014; Troff, 2007)
Can you tell me about what your internal process (thoughts/feelings) was like leading up to your decision to seek personal therapy?
(Everson, 2014; Oteiza, 2010; Prosek et al., 2013; Rake & Paley, 2009; Rizq & Target, 2008; Rønnestad & Skovholt, 2012; Sprang et al., 2007; Thompson, 2014; Troff, 2007)
What outcomes did you experience as a result of personal therapy?
(Bellows, 2007; Mearns & Cooper, 2005; Moller et al., 2009; Norcross et al., 2008; Orlinsky et al., 2011; Orlinsky, 2013; Oteiza, 2010; Wigg et al., 2011)
How, if at all, has personal therapy affected your personal growth?
(Mearns & Cooper, 2005; Moller et al., 2009; Orlinsky et al., 2011; Orlinsky, 2013; Oteiza, 2010; Rake & Paley, 2009; Rizq & Target, 2008)
How, if at all, has personal therapy affected your own clinical work?
(Mearns & Cooper, 2005; Oden et al., 2009; Ronnestad & Skovholt, 2012)
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Describe the experience of being both a client and a counselor.
(Bellows, 2007; Orlinsky et al., 2011; Orlinsky, 2013; Oteiza, 2010; Rake & Paley, 2009; Rizq & Target, 2008)
Some literature suggests that counselors feel stigmatized when seeking personal therapy. What do you make of this? How is that similar or different for you?
(Norcross et al., 2008; Orlinsky et al., 2011; Thompson, 2014; Wigg et al., 2011)
Is there anything else that you would like to share?
(Creswell, 2013)
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Sand Tray Activity Protocol
Ground Tour Question:
Sand trays are another way people can express themselves without using words. I would like for you to create your personal therapy experience in the sand tray using the figures and materials.
Follow up:
- Tell me about your sand tray. - Can you elaborate more on this part?
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Initial Screening Questionnaire
Thank you for responding to the invitation to participate in A Phenomenological Exploration of Counselors’ Experiences in Personal Therapy. The following survey includes a number of questions regarding your counseling experience and how you identify culturally. I will utilize your responses to help select participants for my study. Please answer the questions to the best of your ability. You may skip any items you are not comfortable answering.
Do you currently hold full licensure as an LPC in the state of Texas? How long have you had your full LPC license? To what theory of counseling do you adhere? Have you ever seen a licensed professional therapist/psychotherapist for personal therapy? What type of licensure did the therapist have? Please provide the number of counseling sessions you participated in with your therapist Estimated date of last counseling session (if no longer attending sessions) Did your counselor training program require personal therapy? Name (First, Last) What is your gender? How do you describe your race/ethnicity? What is your age? What is your relationship status? What is your sexual orientation? What, if any, is your religious or spiritual affiliation? Please list any disabilities you have so that I can make the appropriate accommodations. Please provide the most preferred way to contact you (phone or email). Thank you for taking the time to fill out this questionnaire. Cynthia Bevly will contact you to follow-up and discuss next steps for participation in the study.
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