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Saturday, April 4, 2015

Psychotherapy Blog: Should Psychotherapists Be Required to Attend Their Own Personal Therapy?

Many people are surprised to discover that psychotherapists aren't required to attend their own personal therapy (as of this writing).  It would seem to be a "no brainer" that psychotherapists, who provide psychotherapy services to clients, would benefit on many levels from having the experience of being in therapy, especially at the beginning of their mental health career when professional inexperience and a lack of insight about how their own issues could affect their work and lead to clinical and ethical mistakes with clients (see my article:  The Benefits of Therapy).

Should Psychotherapists Be Required to Attend Their Own Personal Therapy?

While psychotherapists are required to have a certain amount of clinical supervision to get their license, as of this writing, unless a clinician with a graduate degree goes on for additional postgraduate psychoanalytic training, they're not required to be in their own therapy.

In my opinion, this is not only unfortunate for their clients, it's also a mistake for clinicians, who also might be getting poor clinical supervision, especially if they're practicing in a social service setting.

When I completed my graduate school training and became certified, I knew that the clinical training that I received in graduate school was inadequate to begin seeing therapy clients, so I trained for four additional years at a psychoanalytic institute starting in 1996 where I was required to be in my own three-time a week therapy.

The list of approved therapists that I was given had a minimum of 15 years of postgraduate clinical experience, so they were seasoned professionals who had experience as psychotherapists to therapists in training.

While I enjoyed the rigor of my classes, my individual and group supervision, and seeing clients at the center, the experience of being in my own therapy was, by far, the best part of my training.

Not only did my own analysis help me to work through personal issues, it also helped me to distinguish my own personal issues from the clients' issues.

While, at first glance, it might seem like it should be obvious for a therapist to distinguish his or her personal issues from the client's, therapists, like anyone else, have unconscious emotional blind spots.  So, it's very easy to inadvertently allow countertransference issues to get in the way of clinical work.

With fewer clinicians going on for postgraduate training these days, I'm very concerned about what this means for the field and for prospective therapy clients, especially for new clinicians who are getting inadequate or poor quality clinical supervision.

Even in cases where clinicians might be getting good clinical supervision, supervision isn't the same as being in your own personal therapy.

Should Psychotherapists Be Required to Attend Their Own Personal Therapy?

Clinical supervisors are usually careful about maintaining a boundary where they don't discuss in detail a clinician's personal history with regard to how it might relate to the clinical work.  So, many relevant issues that could be affecting the work wouldn't be explored.

To illustrate some of the possible pitfalls of therapists not attending their own personal therapy, I've included a fictionalized vignette below:

Ann
After Ann completed her graduate school training, she began working at a social service agency for low income clients.  This was the same social service agency where she did her second internship where she received supervision for her individual and group work with clients.

As a full time employee, she was supervised by a different clinical supervisor, who also supervised 20 other clinicians.

Whereas Ann had a small caseload as an intern, she was given a much larger caseload as a full time clinician.  She was also expected to work more independently as compared to when she was an intern.  In addition, she was expected to keep up with a lot of required paperwork.

Within a short period of time, Ann realized that she was in over her head.  But, whereas when she was an intern, she had easy access to her clinical supervisor for questions and problems, her current supervisor was often tied up trying to handle whatever clinical crises arose on a daily basis.

Should Psychotherapists Be Required to Attend Their Own Personal Therapy?

Ann's coworkers were also overwhelmed with their own caseloads, so they also had limited time to help her with problems that came up with Ann's clients.

When Ann had an opportunity to meet with her supervisor, she discovered that the emphasis was on getting paperwork done and not on clinical issues.

The agency was audited by a number of entities and would be sanctioned heavily if the cases weren't properly documented.  So, Ann's supervisor informed her that they had already been sanctioned hundreds of thousands of dollars in the past for missing paperwork.  She warned Ann to do whatever she needed to do to get the paperwork done before the auditors arrived the following week.  If this meant that Ann had to stay on her own time to complete the paperwork, so be it.

When Ann attempted to talk more in-depth about clinical issues, she felt that her supervisor only provided her with minimal assistance and she was often left on her own to handle problems.

Working long unpaid hours and plagued by doubts and insecurities, Ann went home exhausted but she was often too anxious to fall asleep.  So by the time she came to work the next morning, she was feeling irritable as well as anxious.

Ann and her colleagues talked sometimes on those days when they actually took a lunch break, but these times were few and far between.  So she was often felt alone with her anxiety.

Within a few months, Ann felt like she was burning out.  She was determined to stay at the social service agency long enough to meet the requirements to get her license, and then she hoped to open her own private practice.

As soon as she became licensed, she set up a private practice office and gave notice to her employer.  With brand new business cards and a well furnished office in a central Manhattan location, she went to her office and waited for clients to come.  But no one did.

After a few months of paying a high rent but not seeing any clients, Ann wasn't sure what she was doing wrong, so she decided to participate in peer supervision where she learned the basics of setting up a private practice and how to try to get clients.

Colleagues from the group referred a few clients to Ann.  One of the clients was involved in an emotionally abusive relationship, and Ann felt herself becoming annoyed, judgmental and impatient with this client.

Should Psychotherapists Be Required to Attend Their Own Personal Therapy?

As she talked about this client in peer supervision, one of the more experienced therapists told Ann that she thought Ann's countertransference towards this client was getting in the way of her clinical work.

She suggested that Ann hire an individual clinical supervisor.  In addition, since she knew that Ann had never been in her own therapy, she also suggested that Ann get into her own personal therapy because it seemed like the client's issues were triggering personal issues in Ann.

At first, Ann was surprised and a little offended that this senior therapist would suggest that she get into her own therapy.  She agreed that she could benefit from individual supervision, especially since the quality of supervision she received from her former employer was so poor.  But she didn't think that anything was getting triggered in her personally.

At that point, her biggest concern was that her small income from her private practice wasn't even covering the rent.  How could she afford to hire an individual supervisor as well as be in her own therapy?

Ann chose Mary, a supervisor who was recommended by several senior clinicians in her peer supervision group, and met with her an hour every week for clinical assistance.

Within a short time, Mary could see that there was something about Ann's client, who was in an emotionally abusive relationship, that was affecting Ann on a personal level.

Distinguishing individual supervision from personal therapy, Mary told Ann that it was obvious to her that Ann was getting emotionally triggered by this client and this was why Ann was so impatient, judgmental and irritable around this client.

She spoke to Ann about this in terms of countertransference, and recommended that if Ann was going to continue to do this work, she needed to be in her own therapy so she could distinguish her own issues from the client's.

Ann respected Mary's clinical expertise so, reluctantly, she followed her advice, and she was able to find a therapist who provided sliding scale therapy.

Within a short time, Ann realized in her own therapy that her client reminded her of her mother, who was emotionally abused by Ann's father.  She also realized that her reaction to this client was based on her own unconscious unresolved feelings towards her mother.

Rather than do this client any more harm, Ann decided to refer the client to a more experienced therapist who had worked with many similar cases.

Ann also realized that while, on paper, she was qualified to be a licensed therapist, she had a lot of personal clinical work to do, so she decided to disband her private practice and take a job doing administrative work until she did her own clinical work in her personal therapy.

Should Psychotherapists Be Required to Attend Their  Own Personal Therapy?

After a couple of years in her personal therapy where she worked through many of her own unresolved issues, both she and her therapist agreed that she was in a much better position to consider starting a private practice again.

Conclusion:  Psychotherapists Should Have the Experience of Being in Their Own Therapy
Licensing requirements for therapists vary from state to state.  Most states require a certain amount of clinical experience and clinical supervision.  Although it might seem like basic commonsense for therapists to have their own personal therapy, most states don't require this for licensure.

The fictionalized vignette above demonstrates some of the pitfalls when a therapist hasn't been in his or her own therapy.

Here are some reasons why personal therapy is beneficial for therapists and, in my opinion, should be required for licensure:

Therapists who have been in their own therapy:
  • tend to have a more empathic understanding of what it's like for their clients to be in therapy
  • tend to be more attuned to the client's needs
  • usually work through their own personal issues so that they don't impose these issues on their clients
  • usually have a better understanding of their clients' transference and their own countertransference issues 
  • are less likely to have an attitude that therapy is for "other people," but they don't need it
  • have a place where they can deal with the unique stressors of being a therapist
  • often gain a better understanding of their clients in therapy than in individual supervision
  • usually learn to be a better therapist from their own therapist 

Even though personal therapy isn't a requirement for therapists to become licensed, this isn't to say that many therapists don't seek out their own therapy.  Many therapists do opt to go to personal therapy because they know that they and their clients will benefit from it.

Getting Help in Therapy
As a consumer, who might be considering attending therapy, it's important for you to be informed.

Many therapists have the same degrees (LCSWs, Ph.Ds, MDs, etc), but you can't tell from their degree alone whether they went on for additional postgraduate training or if they've ever been in their own therapy.

When you're choosing a psychotherapist, it's important to ask the right questions (see my article:  How to Choose a Psychotherapist).

You can't assume that just because a therapist has a shingle outside his or her door that s/he has worked out his or her own personal history.

During the consultation, you can ask the therapist about the type of training that s/he did as well as if s/he had the experience of personal therapy.

While it wouldn't be appropriate to ask detailed questions about the nature his or her own personal therapy or what issues s/he worked on, if the therapist isn't comfortable answering basic questions about this, I would look elsewhere.

I would be very wary of seeing a therapist who has never been in personal therapy.

When choosing a therapist, you owe it to yourself to make the best possible choice.

The therapist's professional training, licensure, experience and personal therapy do make a difference in the quality of care that you'll receive, so be an informed consumer and make good choices.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.

















































































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