A systematic review of literature and meta-synthesis of evidence for mandatory personal therapy in counselling and psychotherapy education: a report on progress

1
A systematic review of literature and
meta-synthesis of evidence for mandatory personal
therapy in counselling and psychotherapy
education a report on progress

• David Murphy, Emma Castledine, Harriet Barnett,
  Lily Enescu, Nisha Irfan

Friday, May 15, 2015
1
Event Name and Venue
2
Introduction

• Aim To provide an overview of the project so far
• set the study in context
• introduce our methodology
• provide outline of our preliminary synthesis of
  evidence on mandatory personal therapy within
  counselling/psychotherapy education

Friday, May 15, 2015
Event Name and Venue
2
3
Historical Overview
Stanley W. Jackson (2001) wounded healer does not
refer to an impaired physician...or someone
who is the victim of burnout instead it
refers to the inner woundedness of a
healer...suffering and vulnerability which
contribute to the capacity to heal...experiences
have left the lingering effects...in the form of
lessons learned that later serve constructive
purposes in the form of attitudes and
sensitivities that recurrently serve them

• Chiron the
• wounded
• healer

4
Damaged, deficient, dangerous?
No one who, like me, conjures up the most evil
of those half-tamed demons that inhabit the human
breast, and seeks to wrestle with them, can
expect to come through unscathed Freud, S.
(1905) Dora An analysis of a case of hysteria
5
Historical Overview
Freud (1937) in Analysis Terminable and
Interminable asks But where and how is the
poor wretch to acquire the ideal qualification
which he will need in this profession? The answer
is in an analysis of himself, with which his
preparation for this future activity begins (p.
246)

• What grounds are there to mandate a personal
  therapy?

6
Historical Overview
Fromm-Reichmann (1949 p. 42) And so it is
that, because of the interrelatedness between the
psychiatrists and the patients interpersonal
processes and because of the interpersonal
character of the psychotherapeutic process
itself, any attempt at intensive psychotherapy is
fraught with danger, hence unacceptable, where
not preceded by the future psychiatrists
personal analysis

• Can we justify mandatory personal therapy on the
  grounds of ethics?

7
Why might psychotherapists access therapy?

1. improve emotional and mental functioning
2. provide more complete understanding of
   interpersonal dynamics
3. alleviate stress of therapy work
4. socialisation to profession
5. place therapist in role of client
6. observe clinical practice

• In training the goal is
• to alter the nature of subsequent therapeutic
  work in ways that enhance its effectiveness
• (Norcross et al.,1988 36)

8
Influence of Evidenced Based Practices

• Norcross (2005) - as we move towards training
  therapists in manual guided therapies
• Professional training that addresses only or
  primarily the techniques of psychotherapy quickly
  becomes arid, disembodied, and decontextualized
  (p. 840)
• Decades of research points to both the therapy
  relationship and the person of the therapist
  account for as much variance in outcome as
  particular treatment method
• Implication for Dodo Bird...C-B Therapists not
  yet having training therapy by matter of routine
  - might they become more effective than other
  approaches if they do?

9
Pluralistic Landscape

• BACP - removed the requirement in approx 2002...
• Atkinson (2006) suggests the BACP could not
  maintain a position of mandatory personal therapy
  for all therapists in training because it would
  be neither intellectually nor ethically
  coherent
• UKCP - require training therapy for virtually all
  approaches in the same modality, duration and
  frequency of the type they intend to offer.
• BPS - Counselling Psychologists 40 hours minimum
  requirement

10
Research aim/question

• To carry out a systematic review of the evidence
  for mandatory personal therapy within
  counselling/psychotherapy education.
• Having identified the evidence to conduct a
  meta-synthesis of the findings...

11
Method

• Systematic review and meta-synthesis

12
Search criteria for inclusion and exclusion
13
Search strategy
14
(No Transcript)
15
16 x qualitative studies were assessed using the
Quality in Qualitative Evaluation framework.
Currently using this framework and working
towards some inter-rater reliability - work not
yet complete. Generally studies seem to be of
reasonable quality
16
Overview of the Studies
N of studies Dates of studies N Methods Sample Demographic Sample professions Theoretical orientation of sample Theoretical orientation of therapists sessions/ hrs
16 Qualitative studies (5 Quant) Conducted between 2001- 2013 12 independent samples Total N139 Participants Mean 11.5 participants per study 16 Qualitative (inc 4 x Mixed method) 3 x Grounded Theory 8 x IPA 4 x Thematic Analysis 1 x Autoethnography 117female 22 male 5 x samples reported info on ethnicity 82 partpts 61White British 3Asian/Asian British 2African Caribbean 2Black/Black British 2Brit/Spanish 1Australian, British Indian, Caribbean, German, Greek, Indian, Middle Eastern, Swedish, Other, White Other/European, Trainee Couns Psychs, Clin. Psychs, Counsellors, Volunteer Counsellors, Music Therapy Students, Psychologists, Experienced and senior Couns. Psychs Attachment CBT Existential Gestalt Humanistic Integrative Music Therapy Person-Centred Psychoanalytic Psychodynamic Attachment CBT Eclectic Existential Gestalt Humanistic Integrative Music Therapy Person-Centred Psychoanalytic Psychodynamic PsychosynthesisTranspersonal TA Jungian 22 Modal 40hrs

17
We divided the 16 x qualitative studies within
the research team to identify themes within the
studies Initially 73 themes were identified by
two researchers this was reduced to 45 themes
through further analysis and discussion and
collapsing similar themes into a single
theme Further analysis showed that themes
gathered around a single theme of
constructive-limiting effects This single
construct/theme has six sub themes
18
Development
1. Identifying with self, increased insight /self
awareness
2a. Professional benefits/kudos
3. Pers. Dev journey
21. Confidence in skills
8. exp. learn empathy
5. Emotional dev
13. Validation of interventions
14. Stress management
2b. Theory to prac
18. Understanding Counter- transference
6. Modelling
19. Managing boundaries
4. Working through
9. Learn to support
20. Tolerate ambivalence
22. Reflexivity
10. exp learn
11. Increased self-esteem
16. Supports/informal supervision
12. Authenticity/self acceptance
17. Distinguish therapy supervision
7. Exp. learn by being a client
23. Relationship, trust,
15. Provides support
Pedagogy/Exp. Learning
Therapeutic
19
Non-maleficence
4. Emotional pain, disturbance, difficulty
5. Increase stress and anxiety
8. Internal pressures impact client work
12. Personal issues starting to affect client work
17. Impact on course participation
22. Disappointment, frustration, anger toward
therapist
6. A demanding aspect of training?
11. Feeling of being assessed
13. Difference in competence, power, therapist
critical
15. Impact on personal relationships
7. Ethical challenges
3. Therapist as negative role model
1. Financial burden/constraint
10. Feeling resentment at coerced into therapy
2. Time burden/constraint
9. Students lack of input to decision on
accessing therapy
19. Repetitive discussion of issues
18. No recognition of prior therapy hours
20. Suspicious of therapist, lack of trust,
concern for safety
15. Mandatory element impact therapy
relationship/inauthentic
21. Difficulty to discuss issues. Express anger
Justice
Trustworthy/Fidelity
20
Summary and conclusions

• Generally, an area with relatively little
  research has been conducted
• The majority of research is qualitative and the
  quality is acceptable/reasonably good
• Studies have used a range of different approaches
• People that have been required to undergo
  mandatory personal training therapy report mixed
  responses on the experience
• Three emerging themes reflecting positive
  experience development, therapeutic, pedagogical
• Three emerging themes reflecting negative
  consequences non-maleficence, justice,
  trustworthy/fidelity
• Negative themes raised a serious question about
  the ethical justification of mandating training
  therapy
• (re)position mandatory therapy as a pedagogical
  device rather than emphasising the therapeutic
  need
• Further research, both qualitative and
  quantitative, is required

21
Questions?
22
References

• Freud, S. (1937). Analysis Terminable and
  Interminable. International Journal of
  Psycho-Analysis, 18, 373-405.
• Jackson, S. W. (2001). The wounded healer.
  Bulletin of the History of Medicine, 75 (1),
  1-36.
• Norcross, J. C., (2005). The psychotherapists
  own psychotherapy. American Psychologist, 60(8),
  840-850.