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 (917) 742-2624 during business hours or email me.

Developing Realistic Expectations About Your Family of Origin

In my prior articles, I discuss "emotional neglect" and how unmet childhood needs often cause problems for adults.  In this article, I'll be focusing on how adults, who had unmet childhood emotional needs, often have unrealistic expectations about their family of origin, and how therapy can help them to develop more realistic expectations and heal emotionally.

See my articles: 

What is Childhood Emotional Neglect?

What is the Connection Between Childhood Emotional Neglect and Problems in Adult Relationships, 

Developing Realistic Expectations About Your Family of Origin

The Effect of Unmet Child Emotional Needs
As I mentioned in my earlier articles, without help in therapy, unmet emotional needs from childhood usually carry over into adulthood.

If they haven't worked this issue out in therapy, most people are unaware of the effect of these unmet needs.   They're also usually unaware of how they might still hold out hope that their parents or siblings might change and, finally, give them the love and nurturing they didn't give them when they were children.

From a psychotherapist's point of view, this makes psychological sense:  Just because someone is an adult doesn't mean that s/he doesn't still carry that strong wish to finally get what was their birth right as a child.

As most people would agree, every child deserves to be loved and nurtured.

Of course, there's no such thing as a "perfect family" and every parent makes mistakes.  Fortunately, parents don't have to be "perfect."

Due to most children's inherent resilience, parents just need to be "good enough" to provide their children with the a relatively stable, loving home.

But, as we know, for a variety of reasons, this doesn't always happen in every family, especially in families that are chaotic or dysfunctional.  Among the many reasons for this is that, often, the parents of these children weren't nurtured themselves, so they don't know how to nurture their own children.

Whatever the underlying cause might be, unless there are mitigating factors, children who have significant unmet emotional needs usually grow with these same needs.

Developing Realistic Expectations About Your Family of Origin

This doesn't mean that someone who grew up under these circumstances is doomed for the rest of his or her life to be emotionally unfulfilled.  On the contrary, people often find nurturing friendships and romantic relationships if they're discerning and choose healthy relationships.  These relationships help to mitigate what they didn't get when they were children.

Also, there are times when parents and siblings, who were once unloving, can and do change so that familial relationships can be repaired.

But this isn't always the case:  Many people who lived in an unloving family environment continue to perpetuate this in their relationships by choosing unhealthy friendships and relationships, and parents and siblings often don't change, especially if they haven't worked out their personal issues in therapy.

    See my articles:  

Falling In Love With "Mr. Wrong" Over and Over Again

The Connection Between Obsessive Love as an Adult and Unmet Childhood Emotional Needs

Letting Go of Unhealthy Relationships

Choosing Healthier Romantic Relationships).

What Happens When Family Members Don't Change to Become Who You Want Them to Be?
When dysfunctional family relationships don't change, the person who grew up feeling unloved can still yearn to gain the love s/he never got from the family.  In many cases, people in these circumstances still hope, against all odds, that they can change a parent or sibling(s).

Developing Realistic Expectations About Your Family of Origin

Does this mean that they should stop trying to repair their family relationships?  No, not necessarily.  After all, people do repair family relationships later in life all the time.

Developing Realistic Expectations About Your Family of Origin

The problem arises when someone doesn't accept the reality of the current situation and continues to have unrealistic expectations of his or her family, even after repeated attempts to change the family dynamic.

Unrealistic Expectations Are Often Unconscious
The person in this situation often doesn't even realize that s/he has unrealistic expectations because this yearning can be unconscious.

So, how do these unconscious, unrealistic expectations come to light?

In many cases, these expectations come to light when someone airs his or her grievances about family members.

S/he might say something like, "Can you believe that my dad let me down again?" or "After all that I've done for my sister, she still won't do even this small favor for me?" or "Why is my mom still nasty to me on the phone?"

A close empathic friend might commiserate with this person about the unfairness of the situation.  Anyone would agree that it's disappointing to be hurt or let down by a family member, especially if there's a lifelong history of this.

But an attuned psychotherapist will hear something more.

An Empathically Attuned Psychotherapist Hears the Underlying Unconscious Wish
A psychotherapist also will hear something more, which is the underlying issue that the client, who has lived all of his or her life being disappointed by family members, seems to still expect different behavior from family members who have been consistently disappointing (see my article:  The Psychotherapist's Empathic Attunement to Unconscious Communication in the Therapy Session).

Many therapists, who do ego states therapy, will also realize that there is an aspect of this client's personality, usually the child self with unmet emotional needs, who is still hurt and continues to have unrealistic expectations.

Ego States Therapy and the Inner Child (or Child Aspect of the Adult)
This type of therapy is called ego states therapy because it recognizes that we all have many different aspects of self, and certain situations elicit different aspects.

So, even though someone is an adult, s/he can still experience a situation, in part, as his or her child self (see my article:  Untreated Emotional Trauma is a Serious Issue: Overcoming an Impasse in Trauma Therapy for an explanation of ego states therapy).

Ego States Therapy and the Inner Child

As I've mentioned in other articles, ego states therapy (as called "parts work") has nothing to do with multiply personalities or dissociative identity disorder.

These different aspects of self are a part of everyone, but most people don't recognize this because these aspects often remain just under the surface.

Therapists who are trained in ego state therapy are attuned to the various states that come to the surface in therapy sessions.

So that if I hear a client, who came from a chaotic and unloving environment as a child tell me, as an adult, that "it's unfair" that a parent or sibling is continuing to behave in the same dysfunctional way he or she always has, I listen to see if there is a child state under the surface that needs psychological help.

Listening to a client in this way helps therapists to be more attuned and empathic to what's going on with the client.  Equally important, it alerts the ego state therapist that the client needs psychoeducation about ego states and the child state needs to be treated.

Due to the popularity and accessibility of John Bradshaw's books (Healing the Shame That Binds You and Healing the Child Within), many people know about their "inner child."  His books have provided much-needed psychoeducation for people who grew up in unloving dysfunctional homes.

So, whether we call this aspect of self the "inner child" or the child aspect of self, we're talking about the same phenomenon.

Over the years, I've had many clients who have told me that these books have helped them to understand their shame, emotional longing and family dynamics.  Knowing that this is a phenomenon that is experienced by many people helps to normalize how they feel and helps to decrease their shame.

Mind-Body Oriented Psychotherapy and the Unconscious Mind
As I've mentioned in other articles, often regular talk therapy isn't enough to heal certain emotional problems.  Clients might gain an intellectual understanding about the issue, but talk therapy might not be enough to actually change the problem on an emotional level (see my article:  When Talk Therapy Isn't Enough).

In my article, Mind-Body Psychotherapy: The Body is a Window Into the Unconscious Mind, I explain how certain experiential mind-body oriented types of therapy, like EMDR, Somatic Experiencing and clinical hypnosis help to resolve psychological problems when talk therapy might not be adequate.

Ego states therapy, which explores and heals the various states, including the child state, can be used in combination with any of the experiential types of therapy.

Mind-Body Psychotherapy:  The Body is a Window Into the Unconscious Mind

Although there are no quick fixes, experiential mind-body oriented therapy can often help with psychological healing much faster than regular talk therapy.

As I usually like to point out, I am psychoanalytically trained and I have seen the value of both psychodynamic and cognitive behavioral therapy (CBT).  But I also know that every therapy has certain limitations.

The limitation with CBT talk therapy is that CBT often stays on the surface without a transformative  effect for the client.  And psychoanalysis or psychodynamic psychotherapy can be transformative, but it can also take a long time (see my article:  Experiential Therapy Helps to Achieve Emotional Breakthroughs).

There are many ways that experiential mind-body oriented psychotherapy, like EMDR, Somatic Experiencing and clinical hypnosis and ego states therapy can help when an adult has a child aspect that, understandably, wants a parent or sibling to be different (see my articles:  What is EMDR?, How Does EMDR Work - Part 1, How Does EMDR Work - Part 2,  Overcoming Emotional Trauma With Somatic Experiencing,  Somatic Experiencing: Overcoming the Freeze Response and Clinical Hypnosis and Hypnoprojectives to Overcome Emotional Problems).

Getting Help in Therapy
It can be very hurtful and frustrating to hold to hope against all odds that a family member will change to be the attuned, loving person that you want him or her to be.

Letting go of these types of unrealistic expectations can be very difficult without doing work in therapy to heal the child self in you that still yearns to be loved and nurtured.

Getting Help in Therapy

In my experience as a psychotherapist, a mind-body oriented therapy is usually the best type of therapy to help with this healing process.

Rather than continuing to suffer with unrealistic expectations from family members who show no signs of changing, the best course of action is to focus on yourself and heal the emotional wounds that are keeping you stuck.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, ego states 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 (917) 742-2624 during business hours or email me.