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Trainee clinical psychologists’experience of mandatory personalpsychotherapy in the context ofprofessional trainingGavin Iveya & Corné Waldeckb

a Department of Psychology, Victoria University, Melbourne,Australiab Weskoppies Psychiatric Hospital, Pretoria, South AfricaPublished online: 09 Sep 2013.

To cite this article: Gavin Ivey & Corné Waldeck (2014) Trainee clinical psychologists’ experienceof mandatory personal psychotherapy in the context of professional training, Asia Pacific Journal ofCounselling and Psychotherapy, 5:1, 87-98, DOI: 10.1080/21507686.2013.833525

To link to this article: http://dx.doi.org/10.1080/21507686.2013.833525

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Asia Pacific Journal of Counselling and Psychotherapy, 2014Vol. 5, No. 1, 87–98, http://dx.doi.org/10.1080/21507686.2013.833525

Trainee clinical psychologists’ experience of mandatory personalpsychotherapy in the context of professional training

Gavin Iveya* and Corné Waldeckb

aDepartment of Psychology, Victoria University, Melbourne, Australia; bWeskoppies PsychiatricHospital, Pretoria, South Africa

(Received 27 June 2013; final version received 7 August 2013)

The professional and personal impact of mandatory personal therapy (MPT) on clinicalpsychologists in training was explored through qualitative analysis of interviews withnine intern clinical psychologists. Participants’ reported initial resistance to treatment,but subsequently came to own and value their therapy as an indispensable professionalresource. MPT reduces expectations of clinical supervision, while clinical training andpersonal therapy were viewed as reciprocally enhancing components of professionalgrowth. Participants believed that they benefitted personally from their treatment andthat the compulsory nature of the therapy did not compromise its positive effects. Whileproviding containment and support during the personally challenging clinical training,MPT is itself emotionally taxing, financially stressing, and affects personal relationshipsin complex ways.

Keywords: mandatory personal therapy; clinical psychology training; thematicanalysis

How personal therapy impacts on the professional development, personal well-being andclinical effectiveness of psychotherapy practitioners has long interested researchers. Therecent surge in survey research devoted to the topic attests to its ongoing fascination (Bike,Norcross, & Schatz, 2009; Norcross & Connor, 2005; Orlinski, Norcross, Ronnestad, &Wiseman, 2005; Orlinski, Schofield, Schroder, & Kazantzis, 2011).

While widely recommended, personal therapy is not an international requirement inthe professional training of psychologists, despite the fact that psychotherapy comprisesthe bulk of clinical and counselling psychologists’ professional activity. It is thus useful toinvestigate contexts in which trainee psychologists are required to receive psychotherapy intandem with their professional instruction and clinical work. Large-scale surveys are usefulin establishing broad trends, but qualitative studies are needed to produce rich descriptionsof participants’ experiences of personal therapy. In the decade 2001–2011, no fewer thannine qualitative studies were published (Bellows, 2007; Grimmer & Tribe, 2001; Kumari,2011; Moller, Timms, & Alilovic, 2009; Murphy, 2005; Oteiza, 2010; Rizq & Target, 2008;Von Haenisch, 2011).

It is worth noting that only two of the above studies focused on psychotherapy duringtraining, and only one (Kumari, 2011) used interviews to gather experiential data from

*Corresponding author. Email: gavin.ivey@vu.edu.au

© 2013 Taylor & Francis

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88 G. Ivey and C. Waldeck

trainee psychologists. Given the relative paucity of focused qualitative studies, we soughtto investigate the personal experience of a sample of trainee clinical psychologists whoundertook mandatory personal therapy (MPT) as a part of their postgraduate training. Theaim was to explore how they perceived and experienced this compulsory therapy and whatimpact they believed it had on their professional development and personal lives.

Our study contributes to the literature by identifying significant themes either missingor inadequately explored in previous studies, and by paying attention to the complexity andtensions emerging in participants’ accounts of their experience.

Research design and procedure

Participants had received broadly psychodynamic training at a single university and wererequired to undergo personal psychotherapy for the duration of their two-year postgraduatecourse. This university is the only one in the researchers’ country (South Africa) to requirepersonal therapy, hence the reliance on participants from that institution.

Following approval from the university Human Research Ethics Committee, open-ended, in-depth, recorded individual interviews were conducted with nine trainee clinicalpsychologists in the internship year of their training. Seven participants were female, twowere male, and all had undergone once weekly compulsory personal therapy for at least oneyear. The therapy was of the non-reporting kind, i.e. there was no communication betweenfaculty staff and the therapists about trainees’ therapeutic progress.

The study was inductive in that the focus was on participants spontaneously emergingaccounts of their experience. The interviews were largely unstructured, with participantssimply asked to discuss their experience of MPT and its impact on their professionaldevelopment and personal lives.

Thematic analysis (Braun & Clarke, 2006) was used to identify themes salient to theexperience of mandatory therapy and its perceived impact on participants’ personal andprofessional life. This approach was chosen because of its flexibility and utility in access-ing latent themes in participants’ explicitly intended meanings (Braun & Clarke, 2006).This openness to semantic latency meant that our analysis placed emphasis on the com-plexity of participants’ accounts (Morrow, 2005) and on their multivocality (Tracy, 2010),i.e. the multiple ‘voices’ or perspectives introduced by individual participants in their inter-views. Finally, the refined themes, illustrated with interview extracts, were compared anddialogued with the relevant literature, enabling the researchers to identify commonalties,consistencies and anomalies between published findings and our own.

All interviews were conducted by CW, who had also recently undergone clinicalpsychology training at the same university. The interviewer did not know any of the par-ticipants, however, as she had completed her training in an earlier cohort. Given that bothresearchers were associated with the clinical programme in question (CW a former stu-dent and GI an academic staff member), we needed to ensure that any shared or individualbiases we had regarding mandatory therapy did not skew our data collection or interpreta-tion (Drisko, 1997). To this end we articulated and interrogated our assumptions, whetherbased on personal experience or literature we had read, and strove for awareness of how ourpersonal viewpoints could incline us to overlook, emphasize or misrepresent participants’experience (Holloway, 2007; Tracy, 2010). To bolster the credibility of our analysis, theResults section of the study was emailed to all participants as a form of member checking.They were asked whether they found the results credible and an accurate representation oftheir experience (Elliott, Fischer, & Rennie, 1999).

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Asia Pacific Journal of Counselling and Psychotherapy 89

Results

Our analysis identified six main themes: the ethical challenges of MPT; evolving attitudestowards MPT; the influence of MPT on professional development; the personal impact ofMPT; mutual influence of MPT and clinical training; and the relationship between personaltherapy and supervision.

This paper focuses on exploring themes, tensions and complexities missing or under-developed in the published literature, and accentuates participants’ experience of therapyas obligatory and concurrent with training. Relevant themes and sub-themes are discussedunder the headings below, with participant quotes illustrating the themes.

The ethical challenges of MPT

Participants identified a tension between the requirement that they be in their own therapyand the national Professional Psychology Board’s ethical code, which states that psy-chotherapy clients should be aware of the voluntary nature of participation and freely andwithout undue influence give their consent. Three participants raised this issue, with onevoicing ethical objections to MPT: ‘Ethically, you shouldn’t be made to do therapy. In termsof the ethical stuff, it was initially difficult to get my head around the fact that it was partof our course’ (P9). However, the same participant later stated:

If you do have an issue with going into therapy and you’re training in clinical psychology, thenthat does, I suppose, tell people a lot about you. If you’re not prepared to practice what youpreach it’s telling.

While ostensibly objecting to compulsory therapy on ethical grounds, this participant wasclearly wrestling with an internal ethical conflict, insisting that it is unethical to imposetherapy on trainees while simultaneously claiming that personal therapy while training is‘necessary’ and that abstaining from it is hypocritical – not ‘practising what you preach’.

This clearly unresolved tension can be contrasted with the perspective of other partici-pants, who averred that the mandatory status of the therapy was appealing to a higher orderethical principle, one that did not feature in the Board’s ethical code document:

You need to know what it feels like to be a patient. You need to know how damn hard it issometimes to be a patient. How can you sit with someone if you don’t know what it feels liketo be in their place?

Implicit here is the claim that a depth of empathy for patients’ suffering, which arguablymay only be gained by being a patient oneself, is a higher ethical imperative than traineeautonomy, because the former is a sine qua non for helping others therapeutically.

While the above ethical conflict involved the competing principles of trainee autonomyand beneficence – doing what is arguably in the best interests of one’s clients – someparticipants raised different ethical aspects. Having noted the external pressure to be in herown treatment, one participant went on to say: ‘I felt my own internal kind of pressure towork really hard in therapy, because I felt that embarking on this profession I owe it tomyself to use the space as much as I possibly could’ (P3).

Here responsibility to self assumes ethical primacy, but the ethical accountability is toa professional self , rather than to personal self-development.

Another ethical issue raised by participants concerned their feeling that they had notbeen sufficiently informed about the rationale for MPT and had not been given the spaceto discuss their responses to it: ‘I do think it was valuable, I just don’t think we were given

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enough time initially in terms of talking about what it means to be in therapy. We needed abit more time and explanation so that we could understand’ (P1).

The implication here is that, while consenting to the course requirement of personaltherapy, participants felt that the status of their consent was not properly informed givenperceived insufficient information and opportunity for discussion.

It can be seen from these sub-themes that there are a range of complex ethical issuesgenerated by the mandatory status of the personal therapy (see Ivey, in press; for a com-prehensive discussion of the ethics of MPT). However, eight of the nine participantsconsidered the requirement to be necessary, while one considered it ‘desirable’. This sup-ports research findings that participants who have undertaken personal therapy themselvesare more likely to favour MPT as a training requirement (Kumari, 2011; Pope & Tabachnik,1994).

The evolving experience of MPT

What the published literature on MPT has not adequately explored is the evolution thattakes place in trainees’ relationship with their therapy process. Two distinct stages inparticipants’ experience of MPT were evident in our study, beginning with considerablereluctance and the initial perception that something unpleasant was being imposed. Mostparticipants indicated that they initially did not feel a need for personal therapy and wouldnot have considered it without external pressure: ‘If it wasn’t necessary for the course,I would not have chosen to do it. Now I see the importance of having done it, you know.It’s an important aspect of becoming a psychologist’ (P1).

In this initial stage some experienced the requirement to be in treatment in a ratherpersecutory way: ‘All of us thought that maybe it was a personal attack on us as opposed tohelping us grow’ (P4). However, a few participants were retrospectively able to reinterprettheir initial resentment at being ‘forced’ into therapy: ‘Therapy is a painful process, youknow; maybe it suited us to resent the fact that the university was forcing us to go. Yourresistance to go, maybe the university offered a nice place to project your resistance’ (P2).

Some participants experienced being ‘pushed’ into therapy in a different way, sayingthat they felt grateful because they needed this external pressure to override their resistanceto seeking personal therapy: ‘I would have messed around a lot more; it did give me thatpush to be there’ (P3).

Four of the participants reported a significant difference between their initial andlater experience of personal therapy. They described commencing therapy as ‘hard’,‘uncomfortable’, and negatively associated with their training and assessment. They alsoacknowledged initial suspicions that their therapy was being monitored and evaluated bythe training institution.

The second stage in the process began with participants gradually establishing a semi-permeable boundary between the training and personal therapy, thereby enabling them topersonalize and claim the process as something for themselves, rather than viewing it as anunwelcome course obligation: ‘Initially it was very hard, quite uncomfortable, but I startedto feel more comfortable with going and it’s become something for me, rather than “Oh,this is what I have to do for the course.”’

Unlike some other studies (Kumari, 2011; Rizq & Target, 2008) in which trainees iden-tify simply ‘going through the motions’ as a risk of MPT, all of our participants reportedan evolving personal investment in their therapy over time. Our results suggest that themandatory status of the therapy does not negatively influence what trainees get out of theprocess.

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Asia Pacific Journal of Counselling and Psychotherapy 91

Impact of personal therapy on professional development

Consistent with recently published qualitative findings, all participants indicated thattheir personal therapy had contributed significantly to their professional development andhad benefitted their clinical training. Six participants referred to how their experiencesenhanced their understanding of the processes and dynamics of psychotherapy, specificallyexperiences of transference, interpretation, termination, and therapy technique. These find-ings corroborate previous findings that personal therapy complements professional trainingby providing a vehicle for cognitive and emotional understanding of the therapeutic pro-cess and the dynamics of psychotherapy (Grimmer & Tribe, 2001; Kumari, 2011; Mackey& Mackey, 1994; Moller et al., 2009; Von Haenisch, 2011). Our participants reported thefollowing benefits.

Firstly, they identified how their vulnerability as patients garnered greater sensitivityand appreciation for the position of their own patients. Seven participants reported thatpersonal therapy made them more empathic: ‘You become more sensitive to what the expe-rience is like when you are a client. I think it is good to be reminded what it feels like to bein the other chair and to experience that – I think it’s crucial’ (P1).

Participant 7 reported a better understanding of his patients’ ambivalence towardstherapy:

I know what it feels like to be thinking ‘I don’t really wanna be here right now!’ and I thinkthat’s such a valuable thing to know for our patients’ [sake]. Understanding that ambivalencein myself helps me to understand the ambivalence in my patients and to be able to bring it upin sessions.

Secondly, the increased self-understanding derived from personal therapy was reported toindirectly benefit professional competence: ‘[It] has helped me to know my issues, to knowmyself more and to grow as a person. I think growing as a person and knowing what getsat you, makes you a better psychologist’ (P6). Three participants also mentioned that theirtherapy fostered insight into the nature of their identity as psychologists and why they chosepsychology as a career. Increased insight, it appears, is a consistent benefit for trainees inpersonal treatment.

A third sub-theme of the impact of personal therapy on professional development wasa greater awareness of countertransference process (Bike et al., 2009; Kumari, 2011).Four of the participants felt their own treatment helped them recognize and managecountertransference with their clients. Participant 6 explained:

Sometimes I would have a strong countertransference response, and I think if I wasn’t intherapy I could have just thought ‘Maybe it’s to do with the patient’. At times I did, but I havesince realized ‘Hold on, I think this may be more my stuff than the patient’s stuff,’ you know.

This supports MacDevitt’s (1987) research findings that personal therapy promotes coun-tertransference awareness by increasing therapists’ ‘readiness or preference for turning toself-awareness as a resource in conducting psychotherapy’ (p. 700).

However, while personal therapy helps many trainees to differentiate their own issuesfrom those of their patients, one participant described how preoccupation with a personalissue in therapy had the opposite effect:

Sometimes when I was working through a particular issue I would go in and I would be think-ing along the lines of my therapy about what was happening in the patient’s life. And I thinkit could confound it sometimes; there were these issues coming out raw and fast in me and Iwas starting to identify them in my patient, when in fact they were mine. (P2)

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Fourthly, modelling, or the ‘identificatory learning process’ (Thomä, 1993, p. 6), hasalways been a part of the function of the training analysis. A number of studies have high-lighted identification with therapists as being a key aspect of personal therapy (Bellows,2007; Grimmer & Tribe, 2001; Oteiza, 2010; Rizq & Target, 2008). This was borneout in our study: seven participants mentioned adopting their therapists as professionalrole models, commenting that they found themselves studying and imitating their thera-pists. Participants reported internalizing various aspects of their therapists, including theirmannerisms, phrasing, and techniques:

A few of us once discussed how we almost borrowed lines from our therapists, you know.It sort of gave us permission to phrase things a certain way. So we were having a first-handexperience of watching a therapist in action and I learnt a lot from my therapist. (P2)

Another participant expressed this modelling experience as follows: ‘He was comfortablein his chair, comfortable in his skin, there were things that I really wanted to internalize, toemulate as a therapist.’

In contrast, one participant described how her own treatment elicited a self-criticalprofessional comparison with her therapist:

When I watched my therapist in action I would feel absolutely inadequate in my own therapywith my patients. I would feel completely inexperienced, not having said the right thing at theright time; so it sort of made me feel less competent compared with his absolute competence.(P2)

Here the perceived competence differential between trainee and therapist, at least initially,was too great to use for identification purposes. However, absent from our sample wasreference to dis-identification with therapists, based on negative experiences of therapistinterventions (Rizq & Target, 2008; Von Haenisch, 2011).

Exactly what trainees in therapy internalize and how they utilize these professionalidentifications in their role as therapists has not been properly documented. Two of our par-ticipants identified therapist deviations from ‘strict’ psychodynamic practice as significant.Participant 2 explained that her treatment served as a practical example of a more flexibleapproach towards the therapeutic frame: ‘Sometimes my therapist absolutely adhered tothe frame and I experienced how containing that was, but he had his own personality andin some ways it gave me permission to try little things that didn’t adhere to the frame.’

This trainee implicitly addresses a containing-constraining tension in her relationshipwith perceived technical orthodoxy. Evidently, her therapist’s flexibility implicitly sanc-tioned a more personalized relationship with the ‘ground rules’ of the therapy setting,which allowed her to experiment with these without feeling professional guilt.

Another participant was critical of her ‘strict’ psychodynamic training while observingof her therapist: ‘She showed me that you can be very adaptable – you don’t have to bestrict and work in a strict dynamic way’ (P4). This participant’s training is portrayed asconstraining and her identification with her therapist ‘authorizes’ her opposition to its per-ceived restrictiveness. This illustrates that, while identification with one’s therapist is oftenhelpful in the establishment of a professional therapeutic self, it is potentially problematicwhen the therapist behaves – or is seen to behave – in ways that contradict or deviate fromwhat students learn in their training (Macran, Stiles, & Smith, 1999).

In contrast, one participant terminated treatment with a humanistically oriented ther-apist in order to pursue a more strict psychodynamic therapy: ‘Doing such an intensivelypsychodynamic course and knowing that this is how I want to work one day, um, I felt that I

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Asia Pacific Journal of Counselling and Psychotherapy 93

needed to experience it myself firsthand’ (P7). These data extracts indicate the importanceof matching trainees’ therapies with the training orientation of the relevant course.

Self-insight and personal growth

All the participants in this study credited personal therapy with self-discovery and generalpersonal growth. This resonates with previous research that found that personal ther-apy led to personal growth, self-awareness, increased reflexivity, positive self-regard, andclarification of the role played by the therapist’s own issues.

Participants explained that therapy helped them to explore and work through conflictsoriginating in their past, leading to a personal growth:

Sometimes you have things [happen] as you grow up and, you know, they pass, but you neverreally work through them, or really have space to explore them all that much. Having had thespace to do that has helped me to know my issues, to know myself more and to grow as aperson. (P6)

Relationship between clinical training and therapy

Participants discussed the reciprocal effects of experiencing and simultaneously learningabout the process of therapy, and reflected on how these two experiences inform and enricheach other. Six referred to how their experiences of therapy enhanced their understandingof the processes and dynamics of psychotherapy. They specifically referred to their expe-riences of transference, interpretation, termination, and therapy technique, thus endorsingprevious studies that found that personal therapy complements professional training byproviding a vehicle for cognitive and emotional understanding of the therapeutic processand treatment dynamics (Grimmer & Tribe, 2001; Kumari, 2011; Moller et al., 2009; VonHaenisch, 2011).

Most participants observed that personal therapy helped enliven and ‘solidify the the-ory’ (P1) and ground it in participants’ lived experience: ‘You know it was alive . . . a lotof the theory, for me, came alive in my own therapy. I can’t imagine my training withoutit’ (P2).

Interestingly, our findings suggest that not only does personal therapy influence train-ing, but clinical training also influences the experience of personal therapy. One participantnoted, ‘The training has magnified the therapy and I’ve been able to get so much more outof it’ (P3). Another said that ‘because you are learning the techniques and that kind of stuff,I found that I could use the [personal] therapy space more effectively than I had before’(P9).

A number of participants, commenting on the containing and supportive functionof personal therapy, noted that it helped them deal with the emotional turbulence and‘unravelledness’ (P2) induced by the pressures and emotional demands of their training.Participant 1 described being

carried through the year because we had someone to go and speak to every week. It was avery, very tough year. I think it throws most people into some kind of spin and I think that thetherapy is also just basically a very supportive place, a place where you could go with that.

These observations corroborate the findings of previous studies highlighting the supportivefunction of personal therapy (Moller et al., 2009; Von Haenisch, 2011). One participant,however, noted an interesting reversal of this container-contained dynamic, whereby theemotional content of the therapy was contained by the training. She described how her

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clinical training helped her overcome resistance that would otherwise have led to her drop-ping out of therapy prematurely: ‘At times it did feel quite unbearable, you know, but I hada sense that, because I was training, I need to push through this – the course helped mecontinue, and want to continue, with therapy’ (P5).

These descriptions can be conceptualized as integrative experiences whereby therapymakes clinical theory salient and, for its part, clinical theory illuminates and heightensappreciation of personal therapy.

Interpersonal impact of therapy

Seven participants reported that personal therapy impacted on their relationships withsignificant others, precipitating crises in romantic relationships, temporarily alienatingpartners and resulting in the renegotiation of boundaries in families of origin. While thesechanges were retrospectively described as positive by all participants, at the time the impacton the relationships was not always so, putting pressure on family, partners and friends toadapt to trainees increased self-reflectiveness and personal change: ‘It’s difficult to livewith somebody and all of a sudden see them changing. It did impact on quite a bit on our[marital] relationship, sometimes he wouldn’t understand . . . ’ (P6).

Of course, the same may be said of any in relationship in which one partner enters psy-chotherapy, whether this is voluntary or mandatory. Sometimes, however, the mandatorynature of the therapy has an unpredictable impact on trainees’ partners:

My partner felt that that I was now talking to someone and not him about these intimacies; Ithink he felt quite cut out sometimes. What relieved him was the compulsory nature of it: ‘Shehas to do it, so it’s not cheating to go and tell someone other than me.’ I think that relievedhim. (P2)

In the case of this participant, the fact that the therapy was a requirement clearly amelio-rated the partner’s experience of exclusion and jealousy, which would not have been thecase had the therapy been voluntary.

The change that therapy facilitates in trainees can also have a positive systemic impacton their family of origin. This was highlighted by one female participant:

My father was very protective, but now it’s almost as though they [parents] have grown withme. We are sort of separating that enmeshed relationship and the boundaries are becomingclearer, which is brilliant; and scary as well because it’s not something we’ve been throughbefore. (P4)

An interesting interpersonal theme, not noted in any of the published literature, isMPT’s contribution to trainee group cohesion and the validation of members’ experience.Participants mentioned that they would talk among themselves about their therapy pro-cess, using their shared experiences to process emotional difficulties with their treatment,validate their experience, and bond with classmates:

It was nice, sitting together and talking about our therapy experience. We’d talk about ourtherapists, and sometimes we’d hate them. We were all going through the same thing, thesame developmental pattern. That was very nice, having someone who can see your growthand validate that experience, go with you through that experience. (P4)

Problematic aspects of MPT concurrent with training

Participants reported some difficulty is coming to terms with the simultaneous demandsof the training and the emotional toll of therapy. Words used to describe their experience

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included ‘overwhelmed’, ‘challenging’, ‘stressful’, and ‘demanding’. Both the therapy andthe course were described as ‘hard work’. Participants referred to the vulnerability andemotional exposure that comes with having therapy and how this made it difficult toweather the demands of training and the expectation that they be ‘emotionally together’for their patients. This is consistent with published reports of how personal therapy maynegatively impact course participation (Moller et al., 2009).

However, trainees’ status as neophyte psychologists also introduces a level of complex-ity into their personal treatment. Participant 1 commented, ‘There is the added dimensionof learning about therapy, trying to understand it, being a trainee, what that means, andtaking that to therapy, which I think does complicate it to some extent’. The nature of thecomplexity is captured well in the paradoxical words of another participant, who stated:‘I think therapy in training is also just therapy. It does what therapy does’, before goingon to say:

Therapists who work with trainees should be trained to work with trainees, ‘cause I thinkthere is something different, I think it holds a different kind of challenge. I think I was quite adifficult patient because I didn’t know what I wanted, and it was something that a lot of peoplein class were talking about as well. (P2)

The complexity participants identified concerned the initial absence of a presenting prob-lem, together with hyper-awareness of the therapeutic process and the simultaneousexperience of being both a patient and a therapist-in-training. This often results in a split-ting of one’s attention, which can compromise the emotional immediacy of the encounterat the same time as it adds another level of critical appreciation of the process.

Consistent with other studies (Kumari, 2011; Moller et al., 2009; Rizq & Target, 2008),many participants noted that MPT contributed to financial hardship. Given the full-timenature of the training, which precluded working to generate an income, five of the partici-pants discussed the financial costs of treatment and how it affected them. They experiencedit as an added stressor and a disadvantage of personal therapy, even though they paidreduced fees as a concession to their trainee status.

At the same time, participants were able to juxtapose the stressful and supportiveaspects of MPT. Participant 5 said ‘It was a strain, but I wouldn’t trade it for not hav-ing the therapy, definitely not’. It seems that the tension between experiencing personaltherapy as both emotionally demanding and supportive is a necessary one, at least insofaras the therapy is appropriately challenging. Our participants felt that what they gained fromMPT far outweighed the negative aspects.

Relationship between personal therapy and supervision

Clinical supervision and personal therapy are frequently cited as the most influential com-ponents of practitioners’ professional development, but the relationship between the twois seldom mentioned in the literature. Participants spontaneously raised this issue andreflected upon their need to clearly distinguish and separate therapy and supervision: ‘Ifelt glad that it didn’t have a supervisory element. I felt like that was my space. I didn’treally want the two to get confused’ (P7).

When participants did discuss their therapeutic work in their therapy they were appre-ciative when their therapists brought the discussion back to them: ‘He was quite clearlyjust my therapist. Stuff I took about what I was experiencing with my patients, what I wasdoing with patients in therapy, he related it directly back to me’ (P2).

It is sometimes argued that MPT is unnecessary because trainees’ professional devel-opment needs are adequately met through other means, typically clinical supervision

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(Atkinson, 2006). However, a number of participants expressed the sentiment that super-vision alone was not adequate to their support needs while training: ‘I didn’t feel that oursupervisors and lecturers were going to be able to give us that kind of support. And I sup-pose for them it’s reassuring, the knowledge that you have someone out there to work with’(P9). In this regard, MPT both reduces trainees’ expectations of supervision and takes thepressure of supervisors to contain the personal impact of the clinical training.

Clinical supervisors’ primary ethical commitment is to the well-being of the trainees’patients, while simultaneously focusing on trainee skill development. This ordering of pri-orities, however, can make trainees feel resentful. One participant contrasted the supportshe obtained in her therapy with her experience of supervision:

Supervision wasn’t very containing, because all they want to know is that you’re doing whatyou’ve been taught to do, and to make sure you are going the right way with the patient, but itdoesn’t really deal with what is evolving in you. (P4)

This illustrates the inherent limitation of clinical supervision and emphasizes that supervi-sion cannot substitute for personal therapy in training.

Discussion and conclusion

Our study contributes to the extant published research by highlighting the ethical dilemmasof MPT, showing the stages that trainees may go through in their relationship to their man-dated treatment, and illuminating the reciprocal interaction between clinical instruction andMPT. Regarding the latter, what stands out clearly in our findings is the mutually enhanc-ing relationship between participants’ personal therapy and the other components of theirclinical learning. Personal therapy animates the more theoretical and didactic aspects ofclinical training, while learning about psychological disorders and psychotherapy enrichestrainees’ experience of their own therapy process. What is also clear is that, while clinicalsupervision is essential to trainee professional’s development, it cannot substitute for theexperiential learning and personal support found in trainees’ own psychotherapy.

Our participants highlight the complex interpersonal impact of MPT and the para-doxical nature of what it means to be learning to facilitate, in the role of therapist, thevery process that one is undergoing in the role of patient. In their influential model oftherapist development, Skovholt and Ronnestad (1992) identified ‘continuous professionalreflection’, particularly reflection prompted by intense interpersonal experiences, as beingcentral to trainee therapists’ professional evolution. This is borne out by our participants’reports of how their personal therapy relationships both supported and challenged them,prompting a process of self-exploration that rippled through and enriched their overallexperience of clinical training.

Skovholt and Ronnestad (1992) also note the importance of ‘identification learning’ inthe early stages of therapy training. They point out that the modelling role provided by thetrainee’s own therapist constitutes ‘a rich experience because the interpersonal encounterprovides both imitation and identification components’ (p. 39). This notion was stronglysupported by participants’ accounts of how their experience of their own therapists mod-elled a professional stance for them at a stage when they felt insecure about whom and howto be in relation to their patients.

Based on their own experiences, our participants favoured MPT for all trainee psy-chologists. However, what our findings highlight is the dynamic nature of participants’perceptions of their own therapy and the difficult process of coming to claim a perceivedimposition as a personally worthwhile endeavour. We were also struck by the ethical

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debates that the MPT course requirement elicited among participants, prompting GI tointerrogate the ethics of MPT in a separate paper (Ivey, in press). Participants did notsimply accept that receiving their own treatment was an ethical imperative; in private dis-cussions with one another they wrestled with different ethical positions before concludingthat it would hypocritical and ethically problematic to practice psychotherapy without hav-ing had personal experience of receiving it. These findings, we would argue, undermine theclaim that MPT is ‘neither intellectually nor ethically coherent’ (Atkinson, 2006, p. 408).

Participants’ struggles to accommodate to and claim MPT as something personallybeneficial, however, has implications for improvements in how mandatory therapy is intro-duced to trainees and how trainees are prepared for this arduous component of theireducation. Firstly, there should be no cutting short the discussion that faculty should havewith trainees about the nature of personal therapy, the reasons for it, and the complex andpowerful feelings it stirs up. Secondly, ethical issues related to MPT should be directlyraised and addressed, as it is the sometimes unethical implementation of MPT that is thesource of trainees’ distress (Ivey, in press). Thirdly, trainees should be prepared for what ismost challenging or difficult about MPT and assisted in thinking about how they may bestmanage these stressful aspects.

There are two notable limitations of this study; firstly, the small sample size, whichrestricts the diversity of participant experience. A bigger sample would possibly yield agreater variety of idiosyncratic perspectives and a more nuanced analysis. A second limi-tation is the fact that our data were obtained from participants who had all undergone thesame psychodynamic clinical training at a single university. It may thus be argued that thiscontextual specificity limits the applicability of our findings. In this regard, it would beuseful to compare clinical psychology trainee experiences of MPT at different institutions,particularly those emphasizing different therapeutic orientations.

Despite these limitations, our findings provide substantive evidence that trainee clinicalpsychologists experience their personal therapy to be a deeply transformational learningexperience, and that the mandatory status of this therapy does not seem to detract fromeither its personal or professional usefulness. What should be reassuring to trainee psy-chologists contemplating the daunting prospect of their own treatment experience is thatpersonal therapy, whether voluntary or mandatory, is regarded as an indispensable part ofprofessional development by those trainees who have experienced it.

Notes on contributorsDr Gavin Ivey is Associate Professor and Coordinator of Clinical Psychology Programs at VictoriaUniversity, Melbourne, Australia. He was formerly the Coordinator of the Doctoral PsychologyProgram at University of the Witwatersrand, Johannesburg, South Africa, where this research wasconducted. Email: gavin.ivey@vu.edu.au.

Corné Waldeck is a clinical psychologist and graduate of University of the Witwatersrand. She worksat Weskoppies Psychiatric Hospital in Pretoria, South Africa. Email: corne.waldeck@gmail.com.

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