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.

ii

Copyright 2017

by

Cynthia M. Bevly

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

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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

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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

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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

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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.

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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.

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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

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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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APPENDIX A

INTRODUCTION

31

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.

37

APPENDIX B

EXTENDED LITERATURE REVIEW

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.

57

APPENDIX C

EXTENDED METHODOLOGY

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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APPENDIX D

RESULTS

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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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APPENDIX E

EXTENDED DISCUSSION

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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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APPENDIX F

SUPPLEMENTAL MATERIALS

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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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APPENDIX G

SAND TRAY PICTURES

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Liz

Betty

121

Lynn

Thomas

122

Felicity

Michelle

123

Rose

Ashley

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Sophia

Eleanor

Jennifer

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