Journal2011 - I5 - Gestalt Journal

ISSN 1756-7599
2011
Issue 5
European Journal for

Qualitative Research in
Psychotherapy
Published by the European Centre for Psychotherapeutic Studies
www.eurocps.eu/researchjournal
2 European Journal for Qualitative Research in Psychotherapy
Editorial: Celebrating new voices

Linda Finlay, The Open University, UK
Email: linda@lindafinlay.co.uk
The articles in this issue are diverse in terms of their focus, style and substance. The authors, too, come
from different fields of psychotherapy and they vary in their experience. What links the papers is that
all the authors are all relatively new voices in our academic/research/writing world. For most, indeed,
this is their first ever published paper.
In the first article, Kate Evans, a recently graduated psychotherapeutic counsellor, utilises a literature
review to reflect insightfully on Writers Block and the shame of exposure attached to academic writing. While she shows her experience and ease as a writer, her growing edge is finding an academicresearcher voice. This is her first experience of doing a sustained literature review.
The next three contributions are trainees at the Scarborough Psychotherapy Training Institute (UK).
All of them are discovering new voices as both relational therapists and researchers. Their papers show,
in different ways, the transformative potential of relational-centred research and how the research process of witnessing anothers experience impacts on both participants and researchers. Helen Germaine,
training to become an integrative psychotherapist, sensitively explores the lived experience of being
a single mother in the 1960s, an experience which resulted in a painful permanent rupture between
the participant and her mother. Vivien Sabel, also an integrative psychotherapy trainee, explores one
womans experience of life after childbirth. Her account well highlights the ambivalent reactions of the
new mother who may well be undergoing some level of post-natal depression. Alex Adamson, a gestalt
therapy trainee, draws evocatively on metaphors to explore the personal meanings of his participants
tattoos and the way they intertwine with her life story.
Next comes a contribution from Tami Avis, a recent recipient of a doctoral award as a counselling psychologist, who is also finding her voice as a researcher and academic. Tami gives us a glimpse of her
wider doctoral research using phenomenological methodology to explore the financial burden and mixed
responses of both trainees and therapists about the training requirement to have mandatory therapy.
The last two contributions explore the impact of different therapeutic environments. Lydia Noor, an
experienced integrative psychotherapist, provides an account of her inspiring therapeutic work with
young people in schools. As she celebrates the way the students have found a voice, she too claims her
own. Finally, Usha Srinath and Vijendra Kumar describe their fascinating work in a therapeutic community in India. They outline how new therapists are nurtured in supervision to find their place and
voice the challenges of their work.
In this issue, I invite you, the reader, to celebrate these new voices and their readiness to share their
diverse practices and interests with us.
Published by the European Centre for Psychotherapeutic Studies 3
Writers Block: a reflective literature review

Kate Evans, Scarborough Psychotherapy Training Institute, UK
Email: http://www.writingourselveswell.co.uk/
Abstract
For a significant proportion of therapists, the mere thought of writing up research academically and then
perhaps striving to publish any writings is anxiety provoking. These therapists may be suffering from
Writers Block a process, I suggest, that gets in the way of meaningful and relevant research being
completed by practitioners which could help inform and develop our way of working. Through this
review of the literature on Writers Block, intertwined by personal reflections on my own experience, I
aim to explore possible causes and offer some tentative solutions.
Introduction
Finlay and Evans (2009) suggest that there is a chasm between research and clinical-practice in psychotherapy and counselling because some therapists lack the confidence to embark on enquiries which
would further the skills and knowledge base of the profession. My article takes as its premise that what
holds a significant proportion of therapists back is the mere thought of writing up their project, especially the production of a published piece which would allow others to benefit from what they have
done (Boice and Jones, 1984). I am suggesting that they are suffering from Writers Block and this is
getting in the way of meaningful and relevant research being completed by practitioners which could
help inform and develop our way of working.
Quatyman (1971) describes the misery of Writers Block:
There are many things that are important to me that I would like to express and share in writing
and somehow, through the years, I have failed to do so. In my feeling, it is like a stone wall that
I cannot penetrate. And this is a particularly frustrating and painful experience. (1971, p.53)
However, he too emphasises that this is not just an individuals loss, there is also:
The enormous waste of the creative experiences and energies of thousands of psychotherapists[causing]inestimable damage to psychotherapeutic progress in general through the
failure, on the part of blocked psychotherapists, to communicate in writing their vital new
ideas, developments and discoveries. (1971, p.54)
This theme is taken up by Finlay (2011 forthcoming) when she says that the lack of published research
from certain quarters of the profession spearheads policy with pernicious effects: cheaper, quick-fix
behavioural answers are favoured rather than longer-term explorations of existential struggle.
So Writers Block is real, it has negative consequences for the person suffering it, as well as for professional development and, ultimately, society. Through this review of the literature on Writers Block,
intertwined by reflections on my own experience, I aim to explore possible causes and offer some tentative solutions.
Personally speaking
Interesting that as I begin an article about Writers Block, I am struck by my own version of it. That
nagging voice which says, What have I got to say? And then adds the turn of the screw, Will it be
good enough? Which translates neatly into, Will I be good enough, ever?
I am used to these lurches which sometimes set me off kilter when I sit down to write. I have grafted to
diminish them and their effects and have strategies to endeavour to circumvent them. (Pause, as I notice
I have actually typed circumvent me at the end of the last sentence, which is perhaps equally so.) More
about my tactics later, suffice to note, I am not immune to the affliction we have called Writers Block.
I know that I am not alone. I was a writer before I ever embarked on becoming a counsellor or ever
defined myself as a researcher. Many a time I have encountered people who appeared to have the desire
to write a story, a memoir, a poem, and who never got going on it or who started and did not complete.
During my counselling training, colleagues talked about the difficulty they had with essays. They had
the content in their heads, yet were unable to transfer it onto paper. One said she had to nail herself
down to get it done, which not only struck me as being incredibly painful, but also made me think of
someone being crucified. More recently, I have heard fellow therapists talk eruditely and compellingly
about the research they are doing, then witnessed them struggling with even the idea of writing an article.
While drafting and researching this piece, I found myself wearing two hats, that of counsellor and that
of writer. For me, the two are complementary and rub along fine in my way of being. On the other hand,
I am aware of what it took for me to come out as a writer and that many of my colleagues see being
a writer as something alien to them. This has led me to consider how significant is how significant the
identity of being a writer is within an exploration.
Some possible causes

Johnstone (1983) continues with the idea that the condition is serious in the very title of her article: The
Writers Hell; stating that Writers Blocks can be accompanied by agonizing feelings of incompetence, anxiety, paralysis or self-doubt (1983, p.155). In her review of the literature she identifies four
elements to the problem:
the cognitive
the affective
the environmental
the physical restrictions on the writers hand.
She spends very little time on the fourth, except to wonder whether a corporeal seizing up may also have
an emotional or psychological root.
In the cognitive approach, Johnstone is joined by Huston (1998) who describes it as a right brain-left
brain conflict, where the creative need to explore, take flight and have permission to be wrong, clashes
with a need for rules, logic and technique. Huston links this with the unattainable expectation to be
perfect first time.
I have come across this with participants in the writing groups I facilitate, a particularly over-concern
with how the words and ideas initially appear on the paper. I have described this as trying to drive forwards in reverse gear. I encourage messiness through free writing (Evans 2009; Goldberg 1986), using
the image of the potter getting the clay out onto the wheel. The words we are throwing any old how onto
the paper are the raw materials, the crafting comes later.
Delving into the affective sphere, Quaytman (1971, p.56) talks about the anxieties attached to the belief
in the irreversibility of the printed word. Johnstone (1983) cites the real or perceived expectations of
others; the fear; the shame; and the guilt (of getting it wrong, of putting oneself forwards, of not being
good enough) especially when tackling subjects considered taboo in the writers childhood. She states:
Like apprehension that ones writing is never good enough, a guilty sense that one is appropriating an unearned authority may also diminish incentive and some confidence in some
writers. A writing block prompted by apprehension or guilt may appear as perfectionism or
premature editing, or it may lead to avoiding writing altogether procrastinating. The writer
who fears he sic doesnt know enough yet may protect himself against fear of not knowing
enough or having enough to say by drawing out preparations taking more and more notes,
for example until a research project has so grown in scope that the writer feels inadequate to
taking it on. (1983, pp.159-160)
Jones (1975, p.415) also tackles procrastination caused by grandiosity and discounting.
The grandiose expectations function as a Be perfect driver analogous to an automatic hydraulic lift which constantly raises demands. As long as the individual procrastinates, the vaguely
described project grows. While the project multiplies itself, the potential writer feels smaller
and smaller, i.e. he (sic) discounts his or her adequacy.
Finally, Johnstone tackles the environmental factors which may be at play. As Schiff (1985) also suggests, there is the immediate physical setting in which the writing is taking place. Is it comfortable?
Does it feel safe? Can the writer make changes to it if they please? Johnstone also comments on sociocultural conditions, for instance, considering how the demands of child-rearing, domestic roles and
the a scarcity of role models sometimes lessen both aspiration and productivity. In addition, Boice and
Jones (1984) observe that certain exclusionary factors in the reviewing and publishing procedure might
put certain writers off, especially minority and female academicians. They note particularly the Matthew Effect (Matt. 25:29 For unto everyone that hath, more shall be given, or the tendency for those
who are already established to reap more citations and recognition from others who publish associated
work. (1984, p.571). However, Kaufman (2002) suggests that the internal variables the cognitive and
affective as detailed above - are more important than the external, and Boice and Jones appear to back
up that point of view.
Switching hats, I find story tellers and poets paralleling some of the above when they talk about Writers
Block. Bolton (1999) lists many of the same undermining thought processes as Johnstone. She suggests
beginner writers will be hampered by downgrading and rubbishing their thoughts:
Only the big thinkers philosophers, mystics etc. or those with literary genius have the right
to express themselves in writing, we think. You imagine that writing should have a proper form
and contain only sensible, thought-out ideas in logical progression. This is what we were taught
at school or college. The ghosts of those teachers are still at our elbows, criticising. (1999,
p.34)
In an interview, novelist (the late) Beryl Bainbridge is described as having writers block (Taylor 2003,
p.14). The article quotes Bainbridge: I cant go on to the next line until the previous one is perfect.
And Taylor comments, She seems rather proud of this fact, as though such a level of perfectionism is
a virtue.
Bainbridge wrote a score or more of books, so she had obviously made this method work for her.
However, in my opinion, this level of perfectionism is far from a virtue in creative writing, more the
slayer of it.
Too close for comfort

An issue involving affect, not mentioned by Johnstone, is: What if the material being considered is emotionally impactful for the writer, perhaps because it is close to them personally? Poet Penelope Shuttle
(2007) talks about feeling blocked when she was bereaved. In her case,
Time and therapy got me out of it. I started to write again slowly, at first writing bad, cathartic,
unpublishable poems. Now Im writing steadily again. Poetry is a healing process. (2007, p.28)
Researchers are often drawn to subjects because of their own experiences (Finlay and Evans 2009).
Furthermore, therapists turning to research, with their capacity for attunement and empathy, are surely
likely to be touched by what they explore, especially if choosing a relational, qualitative methodology.
And in being impacted, there is, in my experience, concerns around doing justice to our research subjects and not betraying their trust (Evans, 2010).
Writing is, as Quatyman (1971, p.55) suggests, a special type of ego activity which stirs up feelings of
threat at a much deeper unconscious level. So the emotional connection and, perhaps, distress, shaken
up by our research is likely to be heightened in the act of writing down. Maybe, it is not so surprising
many of my colleagues avoid that step.
I am a writer
Huston (1998) advises that not being able to identify oneself as a writer what she calls the imposter
syndrome is a block to getting on and doing it. On the other hand, defining oneself as a writer may
also be fraught and give rise to a mass of mixed feelings.
There was something daring for me about beginning to call myself a writer. Theres a certain amount
of arrogance in thinking that anyone might want to read what I have scrawled down, as well as the expectations of others to contend with oh how many novels have you published? was the frequently
received response to my tentative admission. And then there was the shame of having to admit, well,
none, and the uncomprehending look which to me said, So by what right do you say you are a writer?
Atwood (2003, pp.13,23) describes her own conversion to what she calls the dark art thus:
I wrote a poem in my head and then I wrote it down, and after that writing was the only thing I
wanted to do. I wasnt old enough to be at all self-conscious about what had just happened
to me. If Id read more about writers lives, or indeed anything at all about them, I would have
concealed the shameful transformation that had just taken place in me. Instead I announced
it, much to the shock of the group of girls with whom I ate my paper-bag lunches in the highschool cafeteria. One of them has since told me that she thought I was very brave to just come
out with something like that; she thought I had a lot of nerve. In truth I was simply ignorant.
A lot of people do have a book in them But this is not the same as being a writer. Or,
to put it in a more sinister way: everyone can dig a hole in a cemetery, but not everyone is a
grave-digger. The latter takes a good deal more stamina and persistence. It is also, because of
the nature of the activity, a deeply symbolic role. As a grave-digger, you are not just a person
who excavates. You carry upon your shoulders the weight of other peoples projections, of their
fears and fantasies and anxieties and superstitions
Accepting the mantle of writer is not, therefore, a straightforward process. It may, in itself, be blocking,
if it is accompanied by too many expectations our own, and those perceived in, or received from, others.
Shame
Writing, however, academic it might be, is inherently revealing of our selves, it is exposing (Quatyman 1971, p.56). We are holding a part of who we are up for public scrutiny and giving others (who
may never have put their words on the line) the power to shoot us down. This is more frightening and
potentially damaging if we have a lot to lose, for instance in terms of professional reputation, or if the
subject matter is close to our hearts.
To be on show, and, therefore, open to the (supposed or real) judgement of others, also increases the
potential for shame.
To feel shame is to feel seen in a painfully diminished sense. This feeling of exposure constitutes an essential aspect of shame. Whether all eyes are upon me or only my own, I feel deficient in some vital way as a human being. And in the midst of shame, an urgent need to escape
or hide may come upon us. (Kaufman, 1992, p.xxi)
Kaufman (1992) and others (such as DeYoung 2003, Yontef 1993) suggest that shame is created through
a process of negative re-enforcements during childhood. This becomes so internalized that the desperately painful feeling of self-consciousness, of wanting to evaporate, feels normal. By then, an individual
will expect any notice given to them to be inevitably critical. Praise is not possible. And any given will
often be misinterpreted to fit with the shame imperative.
After internalization, exposure itself takes on a much more devastating meaning. Exposure now
means exposure of ones inherent defectiveness as a human being. To be seen is to be seen as
irreparably and unspeakably bad. (Kaufman, 1992, p.75)
Furthermore, Kaufman (1992, p.32) describes our (contemporary Anglo-American) culture as a
shame-based culture created by the injunctions to succeed and be popular and conform. We have
already seen how the be perfect imperative is a block to writing and this, according to Kaufman, is
ingrained in the very fabric of our culture. She goes on:
Being different from others becomes shameful. To avoid shame, one must avoid being different,
or seen as different. The awareness of difference itself translates into feeling lesser, deficient.
(1992, p.32)
As we have already said, writing something down is being seen, it is making ourselves visible, literally
in black on white. And, I would want to add, writing something meaningful, something that comes from
what is uniquely ourself, is risking revealing our difference.
In some ways, it is a viciously circling and self-fulfilling process. The fewer therapists who do write,
the more different are those who dare to put pen to paper - or fingertip to keyboard - and, therefore, the
more potentially shaming the experience for them.
Tackling Writers Block

The creative process
Csikszentmihalyi (1996) identifies a number of aspects which are necessary for someone to be a writer
talent, skills, motivation. Motivation is developed and maintained because writers are able to submerge themselves into what Csikszentmihalyi describes as flow. Flow is associated with pleasure, it
is a state of absorption in which real time has little meaning. Writers keep going by connecting with
their task as an enjoyable, playful, flow activity, perhaps not words normally associated with academia.
Sue Spencer (personal communication) in a personal email to me described how becoming too fixed
on the end product rather than becoming thrilled by the process, had prevented her from finishing her
PhD thesis.
Creative writers perhaps unlike academic ones - are often very aware of their creativity and its rhythms.
And generally there is a tide to it all, which is sometimes full and sometimes way out over the horizon.
In a letter, the writer Joseph Conrad put it rather dramatically:
I sit down religiously every morning, I sit down for eight hours, and the sitting down is all. In
the course of that working day of eight hours I write three sentences which I erase before leaving the table in despair. After such crises of despair I doze for hours, still held conscious
that there is that story that I am unable to write. Then I wake up, try again, and at last go to bed
completely done up. So the days pass and nothing is done. I never mean to be slow. The stuff
comes out at its own rate. The worst is that while Im powerless to produce, my imagination
is extremely active; whole paragraphs, whole pages, whole chapters pass through my mind.
(cited in Olsen 1978, pp.153-154)
Unhappily for Conrad, he died some sixty years before Moustakas came up with his interrelated phases
for heuristic inquiry which I relate to the creative process, especially his points (2) immersion and (3)
incubation. Immersion is, Living the question, sleeping it, dreaming it, fully engaging with it. And
incubation is, Allowing an inner, unconscious, intuitive working of material (Barber, 2002, p.83).
Both these phases may be times when writing is impossible or possibly manifests itself in a less than
coherent and logical manner.
There also seems to be the need for fallow periods following episodes of creative output. As one philosopher, Ovid, put it: Take rest; a field that has rested gives a bountiful crop. As a therapist, I have
begun to associate this idea with the Gestalt Cycle, the moment of satisfaction and withdrawal which
comes after experiencing full contact and from which a new desire to create will emerge (Clarkson
1989). This also fits with my understanding of writing as a creative act which brings me more fully in
contact with my self/selves and with the world around me. After this hiatus, rest and a moving away is
required. As when the fire burns brightly, we enjoy the heat and then seek the coolness.
The problem is to recognise when our incapacity to write is to do with being in an immersion, incubation or withdrawal phase and when it is to do with deflection, avoidance or introjection, or any of
the other disturbances to the cycle (Clarkson 1989). I would say that this knowledge only comes
from self-understanding and self-monitoring, but it is useful, or even crucial, to anyone struggling with
Writers Block.
Cures?
Huston (1998) divides the condition into three. For mild blockage she suggests, for instance: assess
the appropriateness of your expectations; give yourself permission to be imperfect; break down the
work into manageable tasks. For moderate blockage: address imposter syndrome; try visioning;
take a break, seek laughter and relaxation (1998, p.94). In general, she offers, in my opinion, some
useful tips, though her treatment for recalcitrant blockage involving, cognitive restructuring and
a system of negative consequences sounds quite frankly terrifying. And she does make it all appear
rather too easy.
For me, its not about finding a cure. Its about working with my creativity and exploring its strengths
and vulnerabilities. I invite would-be writers to exercise their writing muscles little and often with free
writing; find the joy and playfulness in writing; and explore (through writing or another creative activity
like art or drama) their critical voices and creative ebb and flow. And above all, not to try and get it right
or be perfect, but allow for messiness and incoherence. I still have a persistent critical voice, though I
am through writing - turning it into a critical guide, there when I need it, yet not over-whelming. And
actually it is tough and needs continual attention.
Most of all, writing is about keeping at it. As Balzac says (Olsen, 1978, p.151):
The solution of the problem can be found only through incessant and sustained work true
artists, true poets, generate and give birth today, tomorrow, ever. From this habit of labor results
a ceaseless comprehension of difficulties which keep them in communion with the muse and
her creative forces.
Or as the more contemporary writer, Anne Enright, puts it: The way to write a book is actually to write
a book. A pen is useful, typing is also good. Keep putting words on the page.
It appears to me that trying to write an article (let alone a book) without tuning into your messy, unruly
creative process is like trying to run a marathon without training or a warm-up. My mission is to bring
the pleasure and play-fullness back into writing for therapists. This is the key, in my opinion, to being
able to reach into ourselves and find the Words to Say It (Cardinal 1993).
References
Atwood, M. (2003) Negotiating with the Dead. London: Virago.
Barber, P. (2002) Gestalt a prime medium for holistic research and whole person education. British
Gestalt Journal, Vol 11 (2), 78-90.
Boice, J. and Jones, F. (1984) Why Academicians Dont Write. Journal of Higher Education, Vol
55(5),567-582.
Bolton, G. (1999) The Therapeutic Potential of Creative Writing, Writing Myself. London: Jessica
Kingsley Publishers.
Cardinal, M. (1993) The Words to Say It: an autobiographical novel. (translated by Pat Goodheart)
London: The Womens Press.
Clarkson, P. (1989) Gestalt Counselling in Action. London: Sage Publications.
Csikszentmihalyi, M. (1996) Creativity Flow and the Psychology of Discovery and Invention. New
York: Harper Perennial.
DeYoung, P. (2003) Relational Psychotherapy: a primer. New York: Brunner-Routledge.
Evans, K. (2009) Rhythm n Blues. Groupwork, Vol 19(3), 27-38.
Evans, K (2010) Why Research?. Lapidus Quarterly, www.lapidus.org.uk
Finlay, L. and Evans, K. (2009) Relational-centred Research for Psychotherapists Exploring Meanings
and Experience. Chichester, West Sussex: Wiley-Blackwell.
Finlay, L. (Forthcoming) Research: an Existential Predicament for our Profession? In Madison G. and
Barnett L. (Eds) Existential psychotherapy: vibrancy, legacy and dialogue. London: Routledge.
Goldberg, N. (1986) Writing Down the Bones: Freeing the Writer Within. Boston: Shambhala.
Huston, P. (1998) Resolving Writers Block, Canadian Family Physician, Vol 44, January, 92-97.
Johnstone, A. (1983), The Writers Hell: Approaches to Writers Block, Journal of Teaching Writing,
Vol 2(2), Fall 155-165.
Jones, AC. (1975) Grandiosity Blocks Writing Projects, Transactional Analysis Journal, Vol 5(4), October, 415.
Kaufman, G. (1992) Shame, the Power of Caring, Third Edition. Rochester, Vermont: Schenkman
Books.
Kaufman, J. (2002) Dissecting the Golden Goose: Components of Studying Creative Writers, Creativity
Research Journal, Vol 14 (1), January, 27-40.
Olsen, T. (1978), Silences, New York: Delacorte Press/Seymour Lawrence.
Quaytman, W. (1971) Psychotherapists Writing Block, Journal of Contemporary Psychotherapy, Vol
4(1), 53-57.
Schiff, J. (1985) Toward a Human Geography: thoughts about in-class writing environments, Journal
of Teaching Writing, Vol 4(2), Fall,162-169.
Shuttle, P. (2007) Making a Poem, Mslexia, JanFebMar, 28.

Spencer, S. (personal communication) From an email dated 6th December 2010.
Taylor, D. (2003) Beryl Bainbridge talks to Debbie Taylor, Mslexia, OctNovDec, 14-16.
Yontef, G. (1993) Awareness, Dialogue and Process, essays on gestalt therapy. Gouldsboro, ME: The
Gestalt Journal Press.
Lived Experience of a Permanent Rupture

Between Mother and Daughter
Helen Germaine, Scarborough Psychotherapy Training Institute, UK
Email: helengermaine@hotmail.com
Abstract
This research explores the lived experience of the rupture in the relationship between Jenny (a pseudonym) - an 18 year old, pregnant, unmarried, young woman in Britain in 1968 - and her mother. In a
relational-centred research interview, Jenny shares her experience proceeding the rupture, the narrative
point of the rupture itself and the occurring experience of her relationship after the rupture. Phenomenological analysis reveals Jennys experience is one of shame and guilt in relation to her mother. She
feels exposed, humiliated and at fault. Jenny misses a shared sense of pride with her mother and instead experiences rejection not only of herself, but also through the new life she has created. She develops a number of ways to protect herself from her own painful internal experience. Notably she protects
her mother from criticism by taking responsibility for her mothers feelings and behaviours. Yet there
is a sense of a desperate internal confusion of experience as Jenny continually returns the question of
the why of her mothers behaviour. The pain of rejection and isolation is felt deeply by Jenny within
the relationship rupture with her mother. She feels her own deep sadness and loss as interwoven into
her mothers.
Introduction
In 1950s and 60s Britain there was a considerable stigma attached to having a baby out of wedlock.
There was a lack of information for women regarding their rights. Women were coerced into giving up
their children for adoption or into having pregnancies terminated, so as not to bring shame on the family.
A requirement of my training, as a trainee Integrative Psychotherapist, is to engage in research practice - the initial impetus for this paper. The research topic of this paper was chosen in part because it
touches my own experience and weaves itself into my own story. I have also recently become a mother
out of wedlock; I have a two year old daughter. When I told my mother the news that I was pregnant,
Jenny was sitting right next to me. When my mother stood up, approached me and embraced me with
exuberance and joy, I noticed Jennys tears. Later she shared a momentary glimpse of how different her
experience had been with her own mother. This initial insight sparked my curiosity and my interest in
this research topic germinated.
The aim of this paper is to provide: A phenomenological exploration of one womans experience of the
permanent rupture in her relationship with her mother.
Methodology
A phenomenologically-orientated, relational-centred approach was adopted (Finlay and Evans, 2009).
In addition to the explicit aim to explore my participants lived experience, my chosen methodology
values the relationship dynamics between researcher and participant. The data collected from the research encounter is viewed as emerging out of the intersubjective space between researcher and participant (Finlay and Evans, 2009).
Data collection and analysis

An unstructured audio-recorded interview lasting over one hour was initially undertaken to gather the
data. The interview took place informally seated on the floor in the participants living room. An attempt was made to allow as much space as possible for the participant to articulate and share her experience. I started the interview by asking Jenny what her relationship was like with her mother before she
became pregnant, which I hoped would help lead her into her narrative. Thereafter, I tried to respond
empathetically to my participant, asking open questions where possible and attempting to share the
impact her story was having on me.
A simplified variant of the phenomenological analysis method developed by Wertz (1983) was adopted
for the analysis of the data collected. Initially the interview was transcribed by myself and the recording listened to several times in an effort to get inside the participants experience. During the analysis
I aimed to empathise with the participants subjective experience whilst also being aware of my own
embodied responses to the data. Through immersing myself in my participants lived experience in this
way, I aimed to not only deepen my understanding of her experience but also to bring meanings into
focus and unearth meanings, which may be hidden. As I became more familiar with the data, I was able
to extract and examine themes. The participants own words have been used in the findings to assist in
illuminating the participants personal experience and to illustrate her narrative. In light of the relational
approach to this research, it is recognised that self reflection and reflexivity are important part of the
research process (Finlay and Evans, 2009). My aim therefore has been to hold and express an awareness of the co-creation of the research and how the relationship itself may have impacted my findings.
Ethics
The research participant in this paper is a 60 year old white British woman. She is known to me and
as such there have been particular ethical considerations to take into account. Particular care has been
taken to protect her anonymity; all names and place names have been altered, both within this article
and within the initial transcript. Specific attention has been given to data storage and the original audio
recording erased on completion of this research.
Informed consent was obtained from the participant at the initial stages of the research process and issues and assurances surrounding confidentiality were clearly defined and discussed between us. My
aim has been to involve and to share with her at key stages throughout the process. Because of our
existing relationship and the level of trust between myself and Jenny, I felt it necessary to gain some
additional consent. Therefore, the main themes which I identified within the data have been shared
and further consent has been gained in relation to submitting this paper for publication. The point of
sharing, however, was for moral reasons rather than as an exercise in participant validation (Finlay and
Evans, 2009).
The initial aim of the agreement was for us to explore the participants experience of being in a relationship with an individual with mental health difficulties. However, when we sat down together to begin
the interview, the participant expressed her concern at being able to give me what I needed for the purposes of the research. We floundered for a moment. It became apparent that the participant felt that she
was embedded her experience with the individual and was finding her experience difficult to grasp hold
of. Interestingly, I had held back on suggesting the title of this paper to her as I felt unsure as to whether
she would be willing to explore the subject matter. This initial falter between us gave me an opportunity
to propose the topic which is presented here. The subject was readily agreed to by the participant. A discussion of the co-creation of this occurrence and possible meanings can be found in the section entitled
Reflexive Considerations within this article.
Findings
I have chosen to focus selectively on what seems to be three particularly strong themes to emerge out
of Jennys experience. Within the first section I explore the experiencing of Shame and Pride. I follow
in the next section with the theme of Why?, which seems inextricably linked to Jennys attempts to
understand herself and events from her mothers perspective. In the third theme I explore Jennys felt
experiences of Isolation and Belonging.
Shame and Pride

Jenny feels both shocked and frightened on discovering herself to be pregnant. The following extract
from the transcript is a starting point of Jennys narrative experience of the rupture in the relationship
between herself and her mother. It is from this point that Jennys experience unfolds. I feel Jennys
anxiety in the re-telling of this part of her story, the pace of her voice quickens, her experience slips in
and out of being vivid and intricate to chunks being lost:
Oh definitely. I was really worried about telling them that I was having a baby. You
know and Jack [her boyfriend] just came round one night, you know cos obviously he
didnt leave me to tell them on our own and er [sic].. I can remember it clearly, I think
my dad was there, I cant remember to be fair but my mum was there definitely. And
she was one evening you know and you build up to it you know, youre sat there and
you know everythings on your mind and youre talking about other things and erm
you know. She was ironing and she finished doing that and you know, we said... And er
the reaction that she gave wasnt one that erm I expected at all I dont think. Well its
quite a long time ago so I cant really remember but she she just leapt up and hit me, I
didnt expect that.
There is an impression of Jenny being trapped, caught in between the experiences of belonging and
isolation. The words he didnt leave me to tell them on our own substituting the word my for our
further illuminates a felt sense of isolation. The phrases youre on your own now and youve made
your bed, now lie in it come to my mind. Jennys felt sense of isolation is more fully explored later
in this paper. The two words we said in this part of her re-telling of her narrative are spoken like a
full stop; they hold a sense of the shame of Jennys experience. I would come to understand that in this
moment, after the we said and the initial physical attack on Jenny, all her known ways of relating to
her mother ceased to exist. She says of this moment your whole worlds collapsing isnt it, when that
happens. Jenny tells me how she feels about being pregnant in relation to her mother and those people
around her:
She made me feel ashamed... It was guilt Helen I think, you know because youd done
something that you shouldnt have done. That, that, was, was in the way and everybody
could see that youd done it you know [laughs]... and even though I had a wedding ring
on by that time. I can remember travelling on the bus and [positions ring hand on knee]
you know, wanting to show it... It was it was probably just how I was made to feel,
what was going on in there [points to self] and what was happening outside as well you
know, from the family and how I was made, certainly made to feel, certainly made to
feel like that you know.
Jenny grapples with feelings of shame, attempting to decipher the origin. The shame seems to generate
from both inside and outside of herself. Jenny carries her shame in her pregnant body, it being both the
source and the vessel of her shame. A shame which is embodied and made visible. There is a sense of
feeling exposed: and everybody could see that youd done it. There is also a feeling of being trapped
by shame, it seeming to invade her from the environment, serving to make her feel vulnerable, selfconscious and marginalised. Jenny defends herself from her environment with her wedding ring, by
deliberately showing it she attempts to legitimize her own felt pride in being pregnant.
It is important for Jenny to position her narrative historically and culturally from the outset and she
continually reframes her experience in that way:
Well she was quite ashamed at the doctors I think, when we went to the doctors. The
doctors at that time were... well this one was well.. certainly wasnt all that understanding either. It was just a general attitude at that time that was probably changing. I mean
it would be 1968 you know 69 and erm people say like you know the swinging 60s
dont they [smiles] and they think it was all change then but it may have been that in
more, you know, in the bigger cities and things but it certainly hadnt spread to the
outskirts.
Jenny grounds the events of her narrative in a particular time and place, which helps her to make some
sense of her experience. It is important for Jenny to keep herself safe from her own painful unmet needs.
External references offer an explanation for her internal experiences and provide a justification for
her mothers actions. She expresses some of the joy and the sadness of having given birth to her baby
daughter; the pride and the longing to share this new life; this new part of herself:
Well I was sad, yer yer very sad yer, cos you sit there and you want, you know you want
people to have a look youve had a baby. Its lovely laughs] you know and for somebody not to come and take part in that pleasure you know for it to be your neighbour
that comes to the hospital to see you, you know good for her really if I think about it,
you know good for her.
Jenny misses the experience of her own pride being reflected in her mothers face; the shared experience
of pride. Instead she feels her mothers rejection, not only of herself but also through the new life she
has produced - a new part of her. Jenny substitutes the words my mother for somebody which again
can be interpreted as a method of protection, a way of keeping herself safe. By making her mother a
somebody, Jenny is able to guard against the pain of the rejection of her mother.
I did not set out as such to focus on the analysis of the language in the data, however, I found that deeper
into the analysis process I was able to gain further insights by specifically looking at some of the words
Jenny uses and their underlying meanings. Here she expresses her ability to talk about the relationship
rupture:
I suppose Im talking now and I have been able to talk about it to you know to the children since, when theyve, when theyve asked, if theyve asked. But at one time I was
never spoken about [sic], I would never speak about it.
Jenny uses the word I in place of it and I think there is some significance in that. In doing so a parallel
is drawn between what had never been spoken about in the past I was never spoken about and what
is not spoken about in the present. She experiences her mothers shame in relation to her and carries the
shame with her into the present. With her shame she carries guilt at somehow being wrong or bad.
In the experiencing of guilt Jenny holds on to her feelings of responsibility for the relationship rupture.
Jennys experiencing of guilt can be seen as an attitude towards herself in assuming responsibility for
a break in confluence and an attempt to repair an unbearable fracture in their relationship. What is prevented or avoided by the assumption of guilt however, is any actual contact between them (Perls et al,
1951).
Why? - A safer place to be

It is very important for Jenny to make some personal sense of the rupture between herself and her
mother; some private sense which grants her some control over her experience. Jenny is consumed with
the why? of her mothers behaviour, continually searching for some logical or rational to explanation
for her mothers rejection which might ease her internal experience:
We got married in a registry office, was the day of the wedding you know we went to
hairdressers and things like that but even that wasnt a really pleasurable experience
because me mum just spent the whole time in tears in the hairdressers. [laughs] While
she was er you know, having her hair done and then, you know and we were going, but
I did try and see it from her point of view because you know, you probably do have
hopes and expectations for your children and I used to think you know, Im the only
one and she maybe wanted you know, the big white wedding.
The pain and loss of Jennys abandonment comes in and out of focus as the question of why? is turned
over and over. Jenny attempts to rationalize and justify her mothers behaviour, reaching for explanations such as the possibility of her being menopausal and her hopes for the big white wedding being thwarted. The rationalizations collide with her feelings of being utterly alone and frightened, which
in turn catapult her back to the relative solace of the why? of her mothers reactions: Why did she
abandon me when I needed her most? She knows for certain that she could not behave in the same way
towards her own children:
Yer definitely and through, I think through your life you were [trying to understand]
and then you as you have children of your own, you just realize theres more to being
a mum than being a mum when things go right and you know, you step up to the mark
when things go wrong for your children dont you. And you would support them come
hell or high water really, whatever they did.
The knowledge of her strong convictions and attachment towards her own children makes her mothers
actions even more frighteningly painful and utterly bewildering. She thus continually checks out her
own beliefs and experience with her own children against her experience with her mother. Jennys rationalizing brings her to the conclusion that she herself must be wrong. Jenny talks about her mother:
You know shed come up through the war and knew me dad in the war so theres... she
had a lot more experience of life obviously than I did. You know I was the only one, and
thinking back on it, I would have thought she would have been a bit more understanding, as Ive grown and had my children. I couldnt have tret them like, like she tret me.
But you know when I was 19, I was at fault, [laughs] thats how I felt, [upset] I felt
really guilty. Really guilty. Really guilty.
During the analysis I looked at what I saw as the rhythm of the three themes, I found that Jenny continually comes back to working out what might be happening for her mother. Often punctuating beginnings
and endings of chunks of narrative with the why of her mother. There feels to be a relative sense of
safety for Jenny in the not knowing what drives her mothers feelings. I have an image in my mind of
Jenny crossing a river as she tries to make sense of her experience: She moves from the safety of the
why at one side of the river bank to the other. Stepping out and balancing on stepping stones of shame
and then guilt then jumping further onto isolation and teetering on rejection before hurling herself ahead
onto the safety of the next river bank of why.
Erm but then I had Laura and erm she didnt even come to see me. [crying pause] One
of the neighbours came to see me... in the hospital and she said you know I cant understand how your mums being and I couldnt really. I tried you know all the things I
could think of to erm to understand and try and understand her. Trying to understand
why she was treating you know, why she was treating me like that. I mean I could understand that she was shocked and upset but you know, you think that people are going
to come to terms with it... I never, I mean I often think if Id have just argued with her
and said you know, pull yourself together what do you think... Erm and I just you know,
I just wonder if Id have reacted differently instead of just being I dont know...
The why is an important place of safety for Jenny because no definite conclusions can be drawn.
There, she is removed from the pain of her unmet needs, from the pain of abandonment and isolation,
it is perhaps also a place to fantasize. In the past the why place may have been somewhere to hold
some hope that the rupture was repairable. In the present the why enables Jenny to fold in and out of
protecting her mother, there is an unwillingness to interpret her mother actions. For Jenny her mothers
imagined reality acts to distract her from her own felt experience. Ultimately, it seems that Jenny feels
responsible for her mothers feelings and actions towards her, adding to her already heavy burden of
shame and guilt.
Isolation and Belonging

The themes of isolation and rejection and seem to jostle with their counterparts belonging and acceptance within Jennys experience. In this section I hope to draw out some of the complexity and ambiguity of Jennys attempts to make meaning out of her experience. In struggling to express her mothers
reaction at the point of rupture, Jenny says:
Yer yer no, yer yer no no [crying] but anyway you know thats what happened and erm
she more or less said that I had to get out of the house or she would go. [crying] Sorry...
Or she would leave you know. and erm me dad. No, no, not that she would go sorry.
She said that I had to leave. And me dad obviously was there because he said no if she
goes, I go, you see.
In the initial statement before it is restructured, Jenny says her mother would go...would leave. That is
exactly Jennys experience, her mother rejected her, leaving her isolated; she withdrew herself, she left.
I mean Jack [her boyfriend] said you know, you can come to our house and stuff like
that but I mean, I wouldnt have wanted to do that and er you know, you want to be at
home dont you.
There is the sense of Jenny being trapped somewhere between isolation and belonging not fully accepting either.
Yer so I was trying all the time, I was trying really to justify I think how she was and
how she was reacting. Erm I used to... I used to catch a couple of buses when I was
pregnant to go and see me mum and dad and erm she would never speak me when I got
there. She just used to put her head behind the newspaper [crying] and that was it. Just
chatted to me dad while she just sat there and you know, pretended to read the paper.
And one night Id got back and erm, Id gone for the bus and Id just missed the bus
so that meant Id miss the bus from the town as well. And when I got back I got back
on the door and me dad had gone to bed, just gone to bed, and me mum said oh theres
your daughter. Theres your daughter not hers you know. Erm erm, ooh sorry Helen I
can talk about this sometimes and and it dunt it dunt really affect me and you know,
it just depends you know how your feeling.
The pain of being disowned by her mother in such an implicit manner touches me deeply. As I engage
with this part of Jennys experience over and over by listening to the recording I feel a resonance
through my own empathic somatic experiencing. I feel a kind of pressured haziness in the front of my
head as Jenny talks of her mothers failure to acknowledge her and a twist and squeeze in my stomach
together with nausea as I enter into Jennys experience of rejection and disownment by her mother.
Jennys mothers anger, which has gone unsaid, becomes missed contact with her daughter and feels
deliberate and brutal. I have an image of Jennys mothers anger as a red ball which she throws to Jenny:
Throwing it hard and fast towards her feet causing Jenny to jump, whilst also being impossible to catch
hold of. As Jennys mother retreats the ball is left for Jenny to pick up, hold, examine and carry. I sense
Jennys confusion, isolation and fear in bringing herself to her mother over and over only to me missed,
dismissed, ignored and rejected. I have an impression of Jenny holding conflicting senses of herself; simultaneously conspicuous and invisible in the face of her mother. I have a sense of Jenny feeling wrong;
feeling being wrong in her world.
As I reflect on my own experiences of expressing and holding onto anger, I wonder about Jennys experiencing of it. I consider whether expressing anger might feel like an incredibly dangerous option for
Jenny. She says:
I never, I mean I often think, if Id have just argued with her and said you know pull
yourself together, what do you think. But Im not, I dont like any form of aggression
really I dont Like that, you know I dont like to argue. Erm and I just you know, I just
wonder if Id have reacted differently instead of just being I dont know, I cant think
of the word.
Jennys words, again, are a striking illustration of her requirement to take responsibility for the relationship. There feels to be no solidity or firmness of ground on which for Jenny to stand to express her
anger, there feels to be a constant tug towards the Other. I wonder also, whether an expression of anger
from Jenny might have the potential to be used by her mother to legitimize her abandonment; to provide
something for her mother to hang her feelings of rejection on. I have a sense of Jenny feeling frozen,
waiting, holding on, holding in, scared. Perhaps not challenging her mother, again, becomes the safer
option and offers a greater imagined potential for reunion. As I begin to gain a greater depth of understanding of Jennys experience I have a greater sense of Jennys requirement to disengage with any
feelings of anger towards her mother. As I allow myself to be immersed in Jennys experience, I notice
I begin to feel very flat and I start to feel myself shutting down, exhausted as though I dont belong to
myself. I imagine myself to be two-dimensional; flimsy like grey cardboard.
Not only does Jenny experience abandonment and rejection by her mother, she also experiences herself
as coming between her parents. It is possible that she experiences feelings of guilt relating to her fathers
support for her. Accepting her fathers support may well necessitate Jenny in experiencing herself as
rejecting of her mother, something which indeed may be her mothers intention - in or out of awareness.
Jennys being-ness is directly used as a tool in a two-pronged attack in her mothers passive aggression,
aimed at both Jenny and her father.
Later in the interview Jenny expresses feelings of both gratitude and responsibility relating to her father
and her parents subsequent break-up. An underlying theme of responsibility becomes visible once
again; she experiences herself as being responsible not only for her mothers behaviour towards her, but
also for maintaining her parents relationship:
Ive definitely thanked him you know for the support, you know its not gone unsaid,
you know its been said. But it must have been quite difficult you know and I mean their
relationship split up in the end and so you blame yourself for that as well you know, I
did you know I blamed myself that that happened.
In the next part of Jennys narrative experience she shifts from the why? to expressing some sadness
for her mothers own lost experience, to feeling rejection and isolation, to expressing her ambivalence
about the support she did receive. In feeling supported by her grandparents and godparents she also
grasps what was missing for her. She says of her mother:
She loved children you know, when we were growing up we used to live down a terrace and there was lots of children, they were always you know, around and things
like that. And I just think you know, she missed out on so much you know. And I used
to see people you know, friends sort of shopping with their mums and things and Id
be on my own [crying]... Everybody else from my family was really supportive you
know, grandma granddad erm godparents and you know, people that were close but you
know... Then I tried to think well theyre not first hand are they, theyre not like your
mum are they, it doesnt really effect other people as much as maybe your immediate
family.
Jennys own felt experience is entwined with a need to take responsibility for her mothers. When Jenny
says then I tried to think well theyre not first-hand are they, theyre not like your mum are they, it
doesnt really affect other people as much as maybe your immediate family, the sentence feels ambiguous. Again the themes of isolation and belonging are revealed. Jenny seems to reason her mothers
rejection as being a measure of her close connection to her. A love inverted perhaps. For Jenny it seems,
she could only be genuinely rejected by her mother because it is only to her that she truly belongs.
Therefore it is the significance of the relationship that directly catapults Jenny into feelings of isolation
and rejection and crucially fuels her feelings of responsibility for the rupture.
Later Jenny talks about the loss of something precious its something missing isnt it, theres something you know, theres something missing that was quite precious really [crying]. Her mothers love
and support cannot be replicated or replaced. Jenny feels her own loss - a part of herself that is missing.
Reflexive Considerations
My own experience of pregnancy whilst being in an unmarried relationship has been very different
from that of Jennys. I experienced no stigma around my unmarried status and felt no requirement or
pressure to legitimise my pregnancy through marriage. Forty years on from Jennys experience and there
has been a societal shift in Britain; tolerance of changing attitudes towards what constitutes relationship and family is more widely held. Of course this generalised collective observation does not account
for individual experience; it merely recognises a historical and cultural backdrop. My own mother was
accepting, supportive and celebratory of my pregnancy and the subsequent birth of my baby daughter.
Still, both Jenny and my experiences at times converge and weave themselves together. At the time I
told my mother the news of my pregnancy, I wondered about Jenny being present and her close physical
proximity to me. After sharing in her phenomenological experience over the course of this research, I
now recognize the likelihood of Jennys own painful experience being evoked at the time of my disclosure. What also becomes apparent is the possibility that I unknowingly played her role in a re-enactment
of the scene of point of rupture from her own story. On the surface the two scenes are incredibly
similar. It is conceivable that at the time, my feeling of Jennys very close proximity accounts for Jenny
stepping into the role of my protector: Poised to protect me in the present and her 18 year old self of the
past. Poised to protect? Or poised for once again for my/her whole world to collapse. When I gave my
mother the news of my pregnancy, my mother leapt up and approached me, not with an attack but with
a loving embrace. It is also possible that in this way Jenny was able to re-experience aspects of her own
scene with a different outcome. On reflection I am caught by the profundity of us both having shared
the experiencing of each others same moment.
The co-creation of the re-negotiation of the research topic during the initial undertaking of my interview with Jenny, had some intriguing parallels with what I would go on to understand about Jennys
experiencing of the relationship rupture with her mother. Jennys need to make sense of her internal
experiences, led to feelings of responsibility for her mother. The original subject matter relating to her
being in a relationship with an individual suffering with mental health difficulties, would have undoubtedly directed Jenny towards experiencing some ambivalent feelings. Unable to grasp her experience
of the subject, she expressed not only her requirement to reflect on her experience but also feelings of
responsibility for providing for me. Unwittingly - and with my own agenda - this falter in proceedings
presented me with the opportunity to bring forward my preferred topic, thus providing us both with a
more desirable outcome. It seems that we were both caught up in parallel processes of protection and
responsibility. Jennys requirement to take responsibility for my needs whilst protecting herself, or
possibly both/all of us (including the third party) from her ambivalent feelings, parallels her process to
protect and take responsibility for her mothers feelings. Meanwhile I was also concerned with protecting Jenny by holding back the potentially distressing subject matter of her relationship rupture with
her mother. This reflects my own process of taking responsibility for others feelings. Interestingly and
paradoxically, it was the same subject matter that I initially endeavoured to protect her from that was
finally used to (on some level) protect Jenny from her difficult feelings in the moment.
During the interview I felt my own anger and frustration towards Jennys mother and I felt my impatience in relation to Jennys reasonable stance towards her. I felt a pull to ask Jenny about her anger, to
somehow bring it into her awareness. Around the same time as the interview taking place, I was working on some of my own unexpressed anger in my own therapy and training. It is conceivable therefore,
that my own emerging awareness at the time was seeping through into the relational process. Perhaps
I had a need - an excitement - which was just on the peripheries of my awareness, to share this new
consciousness with my participant. This coupled with my inexperience in doing this type of analysis,
I believe, added to the process and led me to challenge some of Jennys resistances at the time of the
interview:
Helen: It sounds like you have some anger, that you can say; no mum you were actually wrong.
Here I am verbalizing the anger I feel beneath Jennys words but it is also my own anger and frustration
at Jennys mother and also directed towards Jenny. In some way perhaps I need to hear Jennys anger;
it feels too unbearable for me to hold alone. Jennys reaction is to retreat into her sadness and pain; she
begins to talk about developing a thicker skin, which protects her from being hurt again.
At another point during the interview I begin to verbalize my own anger, which also feels to be on
Jennys behalf. Her need to protect her mother by taking responsibility for her feelings resonates deeply
with my own strong requirement for my own similar process. My frustration therefore, and what I find
intolerable, is held in finding my own process in Jenny and it being so vividly mirrored back to me:
Helen: And I hear that you were doing a lot of that [trying to understand your mother] but I
dont hear that she was doing any understanding.
My intervention causes Jenny, unsurprisingly given her well established pattern, to revert back to protecting her mother from this outside attack. Her response being: Well I dont know we can speak for
other people can we. Which puts her mother out of reach not only from outside attack, but also from
Jennys own relational experiencing of her. Jenny continues:
I think when youre younger your mum and dad are just your mum and dad you dont
always look at them as people and personalities.
With this statement from Jenny I seem to be instantly released from this mesh of processes that I feel
tangled in. I am thrown back in to Jennys experience of being an 18 year old girl, who desperately
needs the support of her mother. I sense her holding the unbearability of being abandoned by her when
she needed her most. I see clearly Jennys need to keep her mother safe. I have a new sense of Jennys
need to protect that part of herself that is desperate to belong and be accepted by her mother.
Conclusion
Whilst this paper may well have resonances for individuals and also perhaps in a broader context of
relationship rupture, my intention here has been to examine and express one womans lived experience
of a ruptured relationship with her mother.
Aspects of Jennys lived experience appear interwoven, but there are of course many alternative avenues of exploration and expansion. The themes I have chosen to examine are a reflection of the subjective and intersubjective nature of this research.
I believe that assuming a phenomenological and relational stance to this research process has helped
me to solidify my belief and understanding that relationship is central to our understanding of ourselves
and others. I feel that this research process has fed both into and out of my training as an Integrative
Psychotherapist, which mirrors the same value placed of the relationship between therapist and client.
The experience of the research encounter itself has impacted me deeply and I have found myself greatly
enriched by the process. Much of Jennys requirement to take responsibility in relationship resonates
with me. I have found myself in touch with my own excruciating urge to make myself right for the
Other. I have sensed my own panic and loss of self in the face of angry silence. The intersubjective
experiencing of Jennys narrative experience has led me to encounter my own feelings of gaining momentary and relative peace with myself only when my perception confirms that the Other is at peace
with me. I also appreciate and find a greater level of empathy and patience for myself in relation to my
capacity for desensitisation from my own feelings of anger.
Engagement in interpretative analysis has been challenging. I have found however, that the opportunity
for distance and reflection has enabled me to deepen my experience of embodied empathy, facilitating
the unearthing of multi-layered meanings and understandings (Finlay and Evans, 2009). My aim has
been to be both reflective and empathic. I have realised that this pattern of involvement and retreat mirrors a familiar relational process - potentially healthy and contactful. However, it also throws up echoes
of my own history whereby I could find my own intersubjective sharing of experience lost or essentially
stolen (Stern, 1985). This insight has highlighted for me the significance of the requirement for mutuality and humility throughout the research process. More explicitly: a recognition of the mutual impact
of the research encounter and an acknowledgement on the part of the researcher that interpretations are
always tentative and emergent (Finlay and Evans, 2009).
My understanding of Jennys experience of rupture in relation to her mother has enabled me to embrace
a broader and richer understanding of her in my own continuing relationship with her. I have a respect,
a deep appreciation and an admiration for her, having transformed the potential continuing cycle of intergenerational relationship patterns within her relationships with her own children and grandchildren.
To summarize: Jennys experience is one of shame and guilt in relation to her mother. She feels exposed
and humiliated; she experiences a feeling of being in the wrong that she is at fault. Jenny experiences
the shame of her pregnancy to be both internal and external. She feels her shame to be visible almost
tangible. Jenny misses a shared sense of pride with her mother and instead experiences rejection not
only of herself, but also through the new life she has created.
Jenny develops a number of ways to protect herself from her own painful internal experience. Notably
she protects her mother from criticism by taking responsibility for her mothers feelings and behaviours. She experiences feeling not only responsible for the relationship rupture itself but also for her
mothers behaviour towards her, as well as for the subsequent rupture in her parents relationship. Jenny
establishes a pattern of rationalizations and justifications about her mothers experience which again
serves as a successful strategy in distancing herself from her own felt experience. There is a sense of a
desperate internal confusion of experience as Jenny continually returns the question of the why of her
mothers behaviour.
The pain of rejection and isolation is felt deeply by Jenny within the relationship rupture with her
mother. She feels her own deep sadness and loss as interwoven into her mothers: she missed out on
so much. Their loss has the potential to momentarily fuse; they share the same loss. Jenny carries the
loss with her, her children feel the loss of their mothers mother.
In the present Jenny now stands where her mother once stood, her own children have had children - she
is now a grandmother. Our stories overlap and I stand where she once was, an unmarried mother with a
baby daughter. As Jenny expresses it: there is something missing that was quite precious really.
References
Finlay, L. and Evans, K (2009) Relational-centred Research for Psychotherapists: Exploring Meanings
and experience. Chichester, Sussex: Wiley Blackwell.
Perls, F., Hefferline, R. F. and Goodman, P. (1951) Gestalt Therapy: Excitement and Growth in the Human Personality. London: Souvenir Press.
Stern, D. N. (1985) The Interpersonal World of the Infant. New York: Basic Books.
Life After Delivery: a phenomenological enquiry into one womans experience

Vivien Sabel, Scarborough Psychotherapy Training Institute, UK
Email: viviensabel@btinternet.com
Being a parent is a true adventure. As you sail through the smooth
times,youll feel as if youre floating down a river on a warm sunny
day,unable to wipe the smile from your face.And as you struggle through
the harder times, it is as if you are climbing a mountain,physically and
emotionally exhausted, yet youll find relief and reward at the top.
Dr. Yehudi Gordon (2002) Birth and Beyond
Abstract
The massive shifts in emotions and upheaval of social roles women are likely to experience following
the birth of a child have been well documented. And yet, it is still not possible to predict how each individual woman will respond. This research explores one womans experience using a phenomenological, relational-centred research approach. My aim was to try to witness and give voice to her unique,
special and particular experience of life after delivery in a relatively unstructured interview. Analysis
revealed four emergent themes: Protection-Desertion; Contact-Isolation; Belonging-Shame; and Anxiety-Ambivalence. Throughout the interview there was a sense that Kate wished to be seen as the same
as other mothers, rather than as a mother-with-deficits. She goes to some lengths to hide herself from
her family and professionals to give them no reason to doubt her ability.
Introduction
This research explores one womans experience following childbirth. The massive shifts in emotions
and upheaval of social roles women are likely to experience have been well documented. And yet, it is
still not possible to predict how each individual woman will respond.
As a psychotherapist, I am interested in the subjects of pregnancy, pregnancy and loss, infant communication and Post-natal Depression including mood changes after the birth of our infants and our
miscarried infants. I also considered the value of understanding more about the above topics; for me
personally, the more I learn in relation to these areas the better informed my work and research will be.
As a woman and mother myself, I am interested in how being pregnant (and experiencing hormonal
shifts involved 1 ) impacts upon us and those around us, particularly how it affects our capacity to relate
to our infant(s) and those around us. I had considered focusing my research around pregnancy and loss,
but I felt I was not ready or emotionally prepared to embark upon this journey. I therefore chose a more
general focus concerning life after delivery.
Following my personal experience of child birth, and the early stages of infancy with my own daughter,
I knew I felt different but found it difficult to express what was different about how I was feeling. I
have met many women through my psychotherapy practice and many women friends/colleagues and
have discussed mood, emotions and feelings during (and post) pregnancy.
Post-natal/post-partum depression is a common, potentially life-threatening and disabling condition.
It is estimated to affect 10% to 15% of women, and its prevalence ranges from 5% to more than 20%
(OHara and Swain, 1996) while nearly three-quarters of new mums feel down shortly after birth (e.g.
they may experience baby blues with associated feelings of sadness, mood swings, anxiety and/or
loss of appetite). If all of the women above shared similar feelings in relation to mood, feelings and
emotions why do some of us get diagnosed with post-natal depression and others do not? It seems the
length of time we experience these feelings forms part of the diagnosis procedure (see, for instance,
the Edinburgh Postnatal Depression Scale -EPDS). Do some of us slip through the net? Are some of
us afraid to express what we are really feeling? If so, what are we afraid of? Is it possible for us to find
the words to express how we are feeling? Or is it too difficult to find the words to express what we are
feeling when we really dont know what it is that we are feeling? These were some of the questions I
held in mind, prior to embarking upon this research.
As a result of a chance meeting in a local supermarket and discussing my research project I found my
co-researcher - Kate (a pseudonym). I asked Kate ( a person Ive known for 4-5 years) if she knew of
anyone who had experienced post-natal/post-partum depression, as I was seeking to interview them, to
find out about their personal experience of themselves post the birth of their children. I was also curious
as to how other people may have experienced the mother post birth. In addition, I had wanted to find
out a little about how a mother might be supported by her local community midwife/health visitor and
any other professionals involved. I had also suggested that it would be useful to hear the voice of the
mother in the research, in the hope that she would be able to provide us with ideas which may help other
mothers. Although I knew Kate, I was surprised when she said, Well, if you want to do this then call
me. In knowing Kate, I knew she had experienced some separation anxiety, (a term offered to Kate
from her GP with reference to her presentation at a GP consultation following the birth of both of her
children), but I was surprised that she wanted to offer herself as a participant/co-researcher, as I have
always found her to be a very private person. Kate declared she wanted to do this if highlighting her
struggle helped others and prove useful. As Kate said she wanted to do the research, and it may
help or support others, we could therefore describe Kates telling of her story as a quest story (Frank,
1998 cited in Finlay and Evans 2009) from which something can be learned and passed onto others.
Methodology
As part of my course work, my assignment topic was to explore, by relatively unstructured, in-depth
interview some aspects of another individuals personal experience. I aimed to explore this interview
dialogue with a phenomenological eye.
Phenomenology is the study of phenomena; their nature and meanings. The phenomenological researcher aims to provide a rich, resonant, textured description of the lived experience (Finlay, 2006).
With qualitative analysis I am aiming to understand the implicit and explicit meaning through carefully
examining the data unpack both the explicit and hidden meanings through iteratively examining the
data (Finlay and Evans 2009). My research methodology maybe best described as phenomenologicallyorientated, using an interpretive reflexive, relational approach (Finlay and Evans, 2009). In my analysis
I have also used inferential thinking. I wish to remind the reader, my research is only offering my tentative interpretation of the data. Any one analysis can only be presented as one perspective with many
possible interpretations (Finlay and Evans 2009).
Data Collection and Analysis

The aim of the interview was to explore with Kate her own personal lived experiences of life after delivery; that is, her experience of herself, and how she perceived others experienced her, after the birth
of her second baby. Kate experienced a similar set of feelings, emotions and experiences post the birth
of her first child. Although Kate was not formally diagnosed with post-natal depression she appeared
to have experienced many of the symptoms. Kate recognised this and our focus really became how she
and others experienced her undiagnosed Post-natal Depression.
In order to gather this information, Kate and I agreed to meet in a setting of her choice (Kates home)
to undertake an in-depth interview (one hour), to explore Kates experiences, recording them digitally,
for further analysis.
Even though we had spent some time prior to interview, agreeing the subject matter, the expectations,
the focus of the interview, and matters in relation to disclosure and confidentiality, we discussed this
further at the beginning of our interview on the recording. I utilised the first few minutes of the recording, to further clarify, in support of anxiety reduction and to confirm matters in relation to consent and
anonymity. During the pre-interview discussions, and general conversations weve had over time, I
know I gathered additional information from Kate and this information may have found itself in the
interview. That we have been friends will also have influenced my understandings.
I started the interview by enquiring how Kate was feeling and if she was Okay. I then checked out
matters in relation to consent and clarified these with her. In order to minimise anxiety I also confirmed
Kates anonymity. I said, just to confirm that Im really happy that if youre not happy with this recording in any way that we dont use it. In support of Kate, I wanted to be as open as possible.
As suggested in the introduction I have approached this from a phenomenological perspective. My aim,
in relation to my method has been to dwell with the data to examine it and progressively deepen my
understandings of her meanings, in the hope that you, the reader, can hear the voice of my co-researcher Kate. This process required time and consideration. I visited the data on nine separate occasions. I listened to the recording and read the transcript simultaneously and reviewed them both individually. Here
I looked beneath the words of Kate, utilising reflexivity, inferential analysis and intuition, to uncover
potential hidden meanings. Alongside listening to the data I had made references to Kates non-verbal
utterances. I perceive these as valuable in terms of analysis and I make reference to these in my findings.
Each reflective visit uncovered some different meanings, and areas for potential exploration. Through
this reflection process I was able to select and create a few figural themes which I have attempted to
illustrate in my findings.
Ethical matters
I clarified the subject matter with Kate and confirmed her interest was still present. We discussed anonymity and confirmed that we would not be using her real name. I suggested to Kate that it was a matter
of choice in relation to her level of disclosure on the recording. In preparation for the interview and in
support of Kate we also spoke about how disclosing personal experiences, feelings and thoughts have
the potential to be emotionally unsettling (Finlay and Evans, 2009).
In the spirit of being collaborative, I invited Kate to have access to all of the research components at all
stages. I suggested she might want to read and comment upon the recording, the transcript, the analysis
and the finished project. Offering Kate access to the research at all stages, raised questions in relation to
authorial control. I suggested that it was fine for Kate to disagree with my interpretations and that I was
happy to include any of her comments, disagreements in analysis and in all or any part of the project.
However, it was agreed that I would have authorial control. Kate agreed to access this research as much
or as little as she liked. I pointed out to her that she was able to withdraw from the research at any point.
After the interview I offered space for Kate to debrief and, in the spirit of offering support, I have made
contact with her on three separate occasions (face-to-face and by telephone).

Both Kate and myself share the experience of motherhood. Given that the experience of labour and life
after delivery varies so greatly between women, it is not surprising that our experiences have been different. Kate has rarely spoken about her feelings and has not discussed her involvement in this research
with anyone, including her husband. I felt privileged and honoured Kate wanted to share her story with
me, in support of others, and feel I have been mindful and respectful of this prior to interview, during
and subsequently.
Findings
Four interconnected themes seemed to emerge and be particularly figural: Protection-Desertion; Contact-Isolation; Belonging-Shame; Anxiety-Ambivalence. These are described in more detail and illustrated by quotations from mainly Kate, but also I draw on our dialogue to illustrate the relational
context.
Protection - Desertion
One of the most dominant themes to emerge in Kates narrative was in reference to the need to protect.
Kate mentions, on at least fifteen separate occasions, the theme of protection. She speaks poignantly of
her need to protect her children, her family, her friends, herself from the depth of her feelings. She also
refers to the need for protection from the outside world. Kate makes reference to, and comments upon,
her own protective qualities and those of her father.
Kate: Everybody adored him (William, Kates baby). And then.......then I dont know, I just
didnt want to go outside, I didnt want to take him out in the pushchair, just didnt like people
stopping me and looking at him. Things like that and then. I think I was just over-protective of
him.
In the quotation above, the theme of protection emerges powerfully. Kate talks of protecting William
from the outside world. Yet Kate also appears to go to great lengths to protect her family and friends
from the true depth of her experiences. Her methods to protect include wearing a mask, hiding the
truth by telling little white lies, and omitting facts in relation to how she felt to family members and
professionals.
By being unable to speak her real truth, Kate fulfils her role as protector. Herein, she protects herself
from her own reality, and others from her feelings and experiences. Kate attempts to hide both the depth
and content of her feelings from both the outside world and from her internal world. Kate appears defended against allowing herself to experience her reality. Kate speaks of not talking about her experiences but in doing so she does not protect herself or others (her health visitor and her family members)
from her lived experience.
Kate: Friends and family had their concerns, but I kept it too myself, from everybody really,
just put on a front and....which was hard in one way, but quite OK in another. It made you feel
better at the end of it.
I wonder if underlying the need to protect could be an internalised sense of shame where she feels
exposed and seen in a painfully diminished way(?) Shame is as fundamental to human existence as
anxiety yet its nature is far more elusive (Kaufman, 1992). In Kates withdrawal from society, and her
family to some extent, I began to wonder what lay beneath her withdrawal. I also became aware of how
her strategy to protect herself from having true contact with others seemed, ironically, to result in Kate
experiencing a sense of desertion.
Dwelling with and analysing this data, it seems to me that the themes of protection and desertion are
interconnected. Kate seems to experience strong feelings in relation to being both protected and deserted by the health Visitor. Kate describes how supportive her Health Visitor was for a bit and how
the support offered by the Health Visitor just fizzled out. The dialogue below seems to support Kates
felt sense of desertion, in relation to the Health Visitor.
Kate: It would have made a difference, yes, like you say, just to check in, you know, even if I
could have just said, you know, yes Im OK, thanks for phoning but......but then she did want
me to get help and she, you know, tried to encourage me to go to Toddler Groups and things,
and she went along with me to two, so, you know, she was very good for a bit, and then it just
fizzled out.
Kate focuses upon the changes in the health care provision of mothers and infants after leaving hospital
and being discharged from care. She says both verbally and non-verbally that she is appalled by the
changes in the system for mothers and babies. This allows us to further see her sense of desertion. In
Kates non-verbal body and facial utterances, she appears to recoil in disgust. She scrunches her face,
leans back and her whole body appears very rejecting of the new system. Here, I feel Kate is experiencing a sense of rejection, desertion or abandonment. Kate says, instead of meeting with one named
Health Visitor or Mid-wife, the system has now changed. The system is now set up as a drop-in centre.
She describes her feelings in relation to the changes in the system and her visit to a drop-in centre in
the following way:
Kate: Yes I do, I think its appalling. You dont even have your own Health Visitors now, you
just go to these clinics and you just see random....random Health Visitors now.
Kate surprised and shocked me with her news regarding changes in the post-birth system. Both Kate
and I, following the birth of our first children (like other mothers from this period) were written to and
invited to our local GP Practice to meet with our Mid-wife for all follow-on tests and checks. Now there
is an expectation upon the mothers or primary caregivers to attend local drop-in centres (when and if
they feel like it or indeed they are able), placing the onus and responsibility only on the primary caregivers. The new system appears to offer primary caregivers less active support. Kate once again, appears to
experience a felt sense of desertion in a system that seems to promote self-referral. It seems Kate rejects
this system and the way the system is set-up.
Kate: Yes, like drop-in centres. You literally get a clipboard with a number on and so....its
not....
Vivien: Wow, Im really shocked!
Kate: Yes, its like going to a meat counter. Getting your ticket.....
There are other issues in relation to desertion or abandonment. I wonder if Kate abandoned her own
needs as she sought to protect her baby William? Having read the transcript I feel there is a huge shamebased level of anxiety. Throughout the interview I felt Kate wanted to experience herself as a good
mother yet she seems to feel confused about her own identity and who she has become. In some ways
Kate seems estranged from her self. This appears to compound a deeper sense of self-desertion. As I
re-write this now I feel the theme of rejection sits closely next to the themes of desertion and abandonment. Kate appears to experience others and the system as rejecting and she rejects her true feelings and
masks them to protect others.
Contact - Isolation
As expectant mothers we look forward to the arrival of our infants, to the contact we might share. Kates
experience was also one of isolation however. The themes of isolation, of being alone, and contact are
powerful in the utterances of Kate. I see something of a dance between Kates apparent need for contact
and her lack of capacity to have her needs met, which seemingly results in a felt sense of isolation and
abandonment. I also note in the dialogue Kates struggle to allow others (both family and strangers) to
have contact with William her baby. In such an ambivalent process she seems to isolate both her true
self and William.
Kate begins to explore her feelings in relation to taking William out of the house she speaks of not liking
all the fuss of everybody...coming near him (William) or anything. She talks specifically of not wanting William to have contact with interfering old people whom Kate describes as: just, dirty hands,
you know, [old people] dont wash their hands after theyve been to the toilet.....and just wanting to
touch my baby, I thought, it was.....no dont touch my baby please. In such utterances, I am reminded
of how Post Natal Illness (a UK based website) describes and outlines many (but not all) of the symptoms of Post Natal Depression on their website www.pni.org.uk. They speak about obsessiveness as
one of the symptoms. For instance, Kate refers to her need to ensure cleanliness in relation to William.
Kate: And then, even up until about a couple of months ago, just not wanting to take William
swimming, you know, anywhere would just freak me out completely. My Health Visitor was
really supportive, she wanted me to get, you know, help further down the line because I think
she could just read me like a book, but I just refused it all.
Kate: Yes...but then on other days Id be like, oh why cant she just phone me, just to phone,
just to say, are you alright? Even if I could lie and say yes Im absolutely fine, just getting that
phone call, would have been nice, but it was always me just phoning her sometimes.
Kate and I discuss contact. She says she wouldnt make contact with the Health Visitor even though
this was encouraged although she also acknowledges that a little bit of contact from the Health Visitor would have made a difference. Kate feels the Health Visitors contact fizzled out because Kate
didnt make any contact with her. Kate surmised that in the absence of making contact with the Health
Visitor she probably thought, you know, she is (Kate) fine, so Ill let her get on with it.
Whilst Kate felt like she did after the birth of her children, it seems she was able to recognise the Health
Visitors attempts to encourage contact. However, Kate was unable to reach out to find the contact solutions offered by the Health Visitor. The lack of contact seemingly resulted in Kate feeling isolation.
Kate also appeared to want to ensure isolation for both her and William in avoiding contact with others
in putting Williams needs first, however, she experienced a lack of contact with herself. Kate appears
to isolate herself from all, avoiding contact with the outside world and in depth contact with her family
and friends. I wonder how her lack of contact fuelled her experience of isolation?
Shame Belonging
Kate: But in....you know, when I was probably at my worst, you know, I just wanted to go.
Vivien: What does that mean?
Kate: I know thats really weird, just like a few thoughts in my head, just go, sometimes I used
to think hed be better off.....not without me, but I used to think you know, why cant he have a
mummy that can be proud of him and take him out and,......and I, you know, I just couldnt do
it inside. But you know, hes such a mummys boy so hes not missed out on anything. I think
hes probably gained more because hes had such a one-to-one with me, and hes a sociable little
boy, its unbelievable. And all the way through, sort of like the last six months, you know, the
Health Visitor has been saying hes such a sociable boy, you know, he needs to be out there, he
needs to communicate, he needs to get on with other people, you know, people will adore him,
you know.....yes, she was right.
Here Kate seems to be describing another symptom of Post-natal Depression.2 With her describing
wanting to go and in wishing he could have a mummy that can be proud of him, I felt deeply sad.
I can clearly recall my sense of sadness, as I type this. I felt Kates sense of not being good enough.
Kates desire to withdraw and hide allowed me to consider the potential presence of shame. In considering the above quote Kate appears to oscillate between wanting to belong and wanting to avoid belonging. She wants to be part of the mothering community and have William experience this fully. However
Kate also appears to want to run away from this role and community. Is this connected with feelings
of shame?, I wondered. Kate touches upon her contact with the Health Visitor. In the interview, Kate
speaks of how she is encouraged to take William out but she explains I just couldnt do it. Following
on from this statement I experience a defensive quality. In considering Kates defence I wondered again
about the presence of shame and the need to talk about not missing out and probably gaining more.
Kate says, hes not missed out on anything. I think hes probably gained more by having such a one-toone with me. Here, I experience a sense of Kate wanting William to experience her and himself as the
same as others - to be the same as others again an inferential sense of belonging appears to be present
here. Kate appears to want to belong; belong in her role as a mother. She seems to hear from others she
does belong but she doesnt seem to experience a deep sense of belonging internally. The feelings of
not being good enough seem to overshadow her felt sense of belonging. Her logical mind knows all
about belonging but her shame about her feelings appear to block her contact with her sense of belonging. Kate also makes an effort to belong to the mothering community by visiting her local drop in
centre. Here she attempts to belong to this community.
Anxiety-Ambivalence
Kate: I felt quite safe inside, you know, to get on with everything inside, it was more of going
out, getting panicky and things like that.
Vivien: When you say panicky, I wonder if you could tell us what that means to you?
Kate: Well when I went to the doctors and they said it was like panic attacks, because I literally......like somebody was like sat on my chest, I couldnt breathe and just wanted to exit wherever I was, like, you know.
Here Kate describes her feelings of high anxiety and panic attacks. Further on in this discussion Kate
says, Yes, I was really anxious. Kate recognises her anxiety when she experienced panic attacks and
she was able to own her feelings of anxiousness in relation to these attacks throughout the interview.
Her acceptance and understanding of her feelings here are clear.
Just seconds after the above dialogue, I go on to ask Kate about more about some of the other feelings
and emotions Kate experiences:
Vivien: Right. OK. So what else was going on for you? Tell me a little bit about some of the
other feelings and emotions that you were experiencing at the time.
Kate: Gosh this is really hard.
Vivien: Is it?
Kate: Yes, really hard.
Vivien: Is it hard to take yourself back there? Or is it....?
Kate: I dont know. I think it is because......I dont know, I think its just because of the situation really.
At this point I recall feeling a little lost in our discussion. I felt unable to grasp what was really hard.
There seemed to be a felt sense of the difficulty from both of us but I was unable to understand what
the difficulty was associated with. Kate seemed to be unable to make contact with the difficulty ,
while I was unable to extract any meaning from Kates non-verbal utterances at this time. On reflection, there could well have been some parallel process in action here. Some uncomfortable experiences
I had encountered from my past had found themselves present in the interview space and this affected
my capacity to be present in the interview. It is important for me as a relational-centred researcher to
recognise the presence of unconscious processes and how they may affect my interactions with others.
They will of course have steered the way in which I will have conducted the interview. I cannot separate
my own history from myself as a researcher I can only acknowledge the presence of such unconscious
processes. From my perspective, the presence of ambivalence here had avoidant and anxious qualities.
Was this the same or different for Kate?
A few moments later I try to explore what hard or really hard meant to Kate. Kate says This is. During this part of the interview I continued to feel lost and begin to wonder what Kate was experiencing.
I was then offered information from Kates non-verbal utterances.
Vivien: Are you anxious? Because your foots.....
Kate: Sorry.
Vivien: No, dont apologise, its just your foot is tapping and Im wondering whats going on
in your body?
Kate: I dont know.
Here I experienced an interconnectedness in terms of anxiety and ambivalence, both in the words of
Kate and in our processes. Kates non-verbal utterances of foot tapping, and some apparent wriggling
in what seemed like mild discomfort, suggested something of Kates anxiety. Her verbal utterances held
an avoidant quality. Throughout this interview, Kate spoke of masking and hiding her truth. I began to
feel Kates ambivalence and wondered whether she was still unable to find the words to express her true
feelings and as a result she (and I) experienced some avoidance and ambivalence. This felt-sense tapped
into some of my embodied feelings post- pregnancies. Here there was both an interpersonal quality and
a deeply embodied intra-personal experience. Had I felt ambivalence and anxiety following my pregnancies and losses? Had this been present in both the there and then and the here and now? I know
that this section of this research paper has been the hardest part to write. I know I have been avoidant in
the writing of it. I also know that in considering the writing of it I had felt some anxiety, a need to avoid
and some ambivalence.
Reflections
This paper has attempted to describe some of the subjective meanings of the experience of life after
delivery, focusing on one womans experience Kate. Four emergent themes form the basis for exploration: Protection-Desertion; Contact-Isolation; Belonging-Shame; and Anxiety-Ambivalence.
There was throughout our dialogue a sense that Kate wished to be seen as the same as others. An element of cultural shame appeared to present in this. It was as if Kate wanted to mask her true self and
put on a brave face so that she is seen to be like any other mother - not as a lesser mother or one with
differences (which could be perceived as deficits). She goes to great lengths to hide herself from her
family and professionals to give them no reason to doubt this.
Beyond these four themes, there are further possible themes on the horizon, such as rejection, confusion and complexity, and avoidance leading to feelings of indifference and ambivalence. I also noted a
theme of reassurance and self-sufficiency. These other themes would be worthy of further exploration
in future research.
It is important to note the possible presence of unconscious processes throughout the interview and the
subsequent writing of this research. In all the elements of this research I have the shadow of a parallel
process. I cannot ignore (and wouldnt wish to) the presence of Kates embodied experiences and those
of myself. As a researcher I wish to embrace their presence in order to deepen my understanding of the
other. I wish to separate out and untangle and in doing so experience the depth of my co-researchers
experience. I experience in the dialogue a wonderful sense of confidence growth in Kate, and identified
by the Health Visitor. Kate said that the Health Visitor noticed she looked amazing and that she had
turned a corner. Kate said the Health Visitor said, Im so proud of you. During the interview I recall
I was particularly moved by Kate relaying these words.
While much of what Kate shared with me suggests that she may well have experienced some post-natal
depression, I have not specifically focused on this. My aim was to try to witness and give voice to her
unique, special and particular experience of life after delivery. Of course, another mothers experience
will be different and there is a limit to how much these findings can generalise more widely. That said I
believe many mothers will identify with elements of Kates experience and how it is easy to feel generally shamed, low, abandoned and isolated. I believe it would help mothers to hear of others experience
in order to normalise their own experience of these more negative emotions. Further phenomenological research recognising the value of exploring ambivalence of life after delivery would be useful.
I asked Kate what she hoped would come as a result of this research, with reference to supporting others
with similar experiences. Kate said, I hope that maybe somebody recognises it, even just reading it
and recognising it and thinking that youre not alone. I have certainly recognised part of my experiences in Kates story and I would like her to know she is not alone in her struggle.
Acknowledgements
In the writing of this analysis and in conclusion, I would like to formally thank Kate for her honesty,
openness and support with this project.
References
Erskine, R.G., Moursand, J.P. and Trautmann, R.L. (1999) Beyond Empathy: A Therapy of Contact-inRelationship. New York:Routledge .
Erskine, R.G. (1995) A Gestalt Therapy Approach to Shame and Self-Righteousness: Theory and Methods. Transactional Analysis Journal. British Gestalt Journal, Vol. 4(2), 108 117.
Finlay, L. (2006) The embodied experience of multiple sclerosis: an existential-phenomenological analysis. In Finlay, L and Ballinger, C. (2006)(Eds.) Qualitative Research for Allied Health Professionals.
Sussex: Wiley-Blackwell.
Finlay, L. and Evans, K. (2009) Relational-centred Research for Psychotherapists. Chichester, West
Sussex: Wiley-Blackwell.
Gordon, Y. (2002) Birth and Beyond. Italy: Random.
Kaufman, G. (1992). Shame: The Power of Caring, 3rd Edition. New York: Schenkman Publishers.
OHara, M.W. and Swain, A.M. (1996) Rates and Risks of Postpartum Depression A Meta-analysis.
International Review of Psychiatry, 8:37-54.
Post Natal Illness Organisation UK (2010) accessed from:
http://www.pni.org.uk/symptoms, downloaded July 2010.
The Royal Colleges of Psychiatrists UK (2010) accessed from: http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatal , downloaded July 2010.
(Endnotes)
1
Levels of oestrogen, progesterone (and other hormones to do with conception and birth) drop suddenly
after the baby is born. Its not clear exactly how they affect your mood and emotions. No real difference has been
found between women who do and do not get Postnatal Depression, and research does not suggest that this is a
major reason for depression. Hormone changes may be more important in the baby blues and puerperal psychosis
(The Royal Colleges of Psychiatrists UK 2010).
Post Natal Illness (a UK based website) describes and outlines many (but not all) of the symptoms of
Post-natal Depression on their website www.pni.org.uk. They describe one of the symptoms as A feeling that if
you just disappeared out of your familys lives everything would be OK for them that youre causing your family
unhappiness just by being around. This seems to describe Kates experience of herself and this is seen in quotes
throughout the transcript.
A Phenomenological Exploration of Tattooing:

A Personal and Meaning-filled Experience
Alex Adamson, Scarborough Psychotherapy Training Institute, UK
Email: alex@the-lettings.co.uk
Abstract
This paper explores the personal and meaning-filled experience of what one womans tattoos subjectively mean to her in the context of her life. Merging a dialogical-relational Gestalt theoretical base with
a relational-hermeneutic phenomenological approach, I collected data by interviewing my participant in
a 45 minute open-ended depth interview exploring her life experience. Analysis based on iterative rereadings of the transcript drew on narrative, reflexive and creative metaphorical forms. Findings reveal
that my participants experience of her tattoos seems to link - in simple but profound ways - with grief.
Having been confronted by the ending of two of the biggest relationships with males (her father and
ex-husband), she made the somewhat unconscious choice to mark the transitioning between the roles of
daughter and ex-wife and reclaim her own sense of skin. Her tatoos of two lizards seem to symbolise
and represent her African home, sexuality, resourcefulness, survival and ultimately a reclaiming of her
own self.
Introduction
My topic of interest for this research project is tattooing, in particular the whole phenomenological experience of tattooing described by my co-researcher and myself during a recent taped interview. Being
a devotee of this, at times intensely creative and personal, form of body art - and indeed having eighteen
tattoos of my own - I have often found myself being moved and impacted, and equally at times, feeling
offended and repulsed by the images I have seen on skin.
My own choices of tattoos over the years have had a myriad of meanings to me: They speak of my
freedom of expression and my creativity, my personal history of empowerment and oppression, and my
search for identity and meaning in life. They are a coded message for my own guidance and indeed for
anybody who I trust enough, and equally who cares enough, to know my truth. In short, tattoos for me
are meaning-filled. So I was intrigued to find out the possible conscious and unconscious meanings my
research participant may have attributed to her tattoos. I sought to flesh out and amplify her experiencing, her truth.
Methodology
In choosing a methodology I had much to consider. I needed to find the methodology that best fitted
my beliefs and values, a methodology that played to my strengths and enabled me to do both myself,
and my participants sharing justice. As a trainee Gestalt psychotherapist, I have chosen to merge my
dialogical-relational Gestalt theoretical base with a relational-hermeneutic phenomenological approach
of methodology (Finlay and Evans, 2009). With such a merging, I hope to generate and enhance the
discovery of the experience and meanings of tattooing for my co-researcher.

The dialogic approach is well described by the Gestalt therapist Yontef (1993, p. 218) : the dialogic
approach requires that the therapist approach the patient with warmth, directness, openness and caring.
Phenomenology, he describes as: a search for understanding based on what is obvious or revealed by
the situation rather than the interpretation of the observer (1993, p. 182). I believe that Gestalt and the
phenomenological research approach are both congruent and compatible with each other as I find that
both approaches aim for a rich description of the individuals lived experience. The specific purpose of
phenomenological research is to formulate and develop the structure of a particular phenomenon from
the descriptions of an individual who experiences that phenomenon. This method of research utilises the
full sensitivity, knowledge, and powers of comprehension of the researcher, which again I find compatible with the practice of self and other awareness of gestalt therapy.
My choice of data collection was to conduct and record a research interview, by asking only one previously prepared singular open question: What is your experience with tattoos and possible links with
grief? I left the interview open in the interest of following the ripples and letting the data flow in an
attempt to fully explore my co-researchers life experience. I was also acutely aware that by preparing, and then asking, my singular question I had indeed configured the field and in doing so, to a large
degree I had shaped and guided the form and direction of the resulting ripples. Mackewn (1997, p.
50) describes the field as the client and counsellor jointly creating a relational field, which consists of
all of the interconnected aspects of themselves and their environment.
I conducted the interview in my office at home by prior mutual agreement, which was certainly more
comfortable for me allowing me to prepare the ground and conduct the interview in a more relaxed
manner. The interview lasted for an agreed forty-five minutes. As for recording the interview material,
I used a digital recorder which I tested and sound checked diligently before getting started. The initial
recording of the interview definitely impacted negatively on how our early relationship developed, and
I believe my participant experienced heightened anxiety as a direct result of being recorded. I experienced my own mild anxiety as a fledgling researcher coupled with my co-researchers more sizeable
anxiety by way of counter-transference, Clarkson (1995, p. 89) describes countertransference as the
therapists feelings towards the client. By tuning into this shared anxiety I paid close attention to grading both my pacing, presence and rhythm. I chose to start slowly and to ease myself into the interview
process in the interest of supporting both myself and my participant reciprocally. In terms of data protection, my participant and I had agreed to erase the research recording, which was in digital format, as
soon as my transcript was completed.
For my analysis, I have chosen to combine and blend narrative and reflexive analysis with a hint of
creative analysis (Finlay and Evans, 2009). Having decided my general path as a researcher, I set about
telling my participants story about particular life events and experiences, by following my participants
chronology. In keeping with narrative and reflexive analysis, I have identified and explored what I
believed to be the most relevant themes and scripts. And in keeping with narrative-creative analysis, I
have identified and explored the more dramatic and visual aspects of analysis through the use of metaphor. With a relational focus, I reached to find a way into my participants life story tracking through
narrative analysis, whilst endeavouring to honour my participants reflections and experiences with vitality in all of its richness. Through creative analysis I allowed myself space to connect with our shared
content, space to imagine, intuit and dance whilst keeping one foot firmly anchored in the ground of the
narrative bay.
Participant
I chose an experienced registered psychotherapist as my research participant to assist me in exploring
and explicating the subjective experience of tattooing. My participant had previously shown a keen
interest and curiosity in my tattoos. In particular she politely questioned the meaning, if any, that I associated with them. I remember challenging her at the time after satiating her query, if she would be
as generous in disclosing the meaning of her own tattoos? She replied that she would, and that she had
never associated any conscious meaning to them other than possibly grief. So I took a chance and asked
my participant if she would be interested in becoming my co-researcher on my first research project and
she happily agreed. I feel that choosing a participant with many years professional experience of being
a therapist (as well as her having benefitted from extensive personal therapy) would enable us to gain a
richness and depth of experience: meaning which I feel eradiated throughout the core of our interview,
bolstering and illuminating the research project.
Ethical considerations
After choosing the topic for my research project I set about gaining formal approval to go ahead with
the research. I did so by first consulting with my participant and gaining her informed consent before
we completed the research project proposal form given to me by my course tutor. After gaining consent
to go ahead with my research proposal I was aware that I also had a duty to continue to be as transparent
as possible in terms of data protection. We agreed by mutual consent that the data was to be stored at my
home office in a lockable filing cabinet until I had completed the written transcription, at which time the
recording would be permanently erased. Whilst the recording was not encoded, I made my participant
fully aware that no-one else had access to the one key I kept safely stored. I informed my participant
about the purpose and the process of my project prior to beginning, whilst being careful to not start the
interview early, or close the stable door after the horse had bolted, so to speak. In the tradition of gestalt
I wanted to balance and allow both transparency in my project process, whilst not endangering the here
and now organic spontaneity and integrity of the theme being researched. I informed my participant of
the possibility of unexpected revelation as we explored her, and indeed by way of reciprocal influence,
my own personal experience. Included here was a discussion about my participants rights, to grade and
appropriately select the levels of her disclosure.
I was also very careful to also check out, and then bracket off my own assumptions here around the
considerable professional respect I have for my participants hard-earned knowledge of self, and significant professional experience. What could the dangers here be I wondered? Well I could project,
aspects of myself (and thereby disown them) and ascribe them to the environment (Polster and Polster,
1973). For instance, I was aware I could project a veneer of superiority and invulnerability onto my
participant and quite possibly miss-attune to her distress and possible regression. I was also aware that
I could equally become smaller in professional comparison and become confluent. Yontef (1993, p.
36) describes confluence as being the inability to maintain a sense of self as a separate person. With
possible defensive manoeuvrings which may also be co-created, I could also risk missing the meat on
the bones. So after gaining my participants written consent and gaining permission for her identity
to be known to the research co-ordinator, I gave my participant the choice of reading the completed
research project, an option which she has taken. We had previously set aside time to de-brief, aside of
the interview room, time to wind down, consolidate and process out any residual energy if required.
We used this time and space to process and dialogue through the experiential impact of our interview,
utilising what felt like the withdrawal phase of our contact cyclic interview. I was also fully aware of
the time/subject limited boundary of our research contract as well as the fact that my participant was
gaining external support by way of regular therapy with a very experienced qualified psychotherapist.
This supported my ethical considerations of wanting to challenge us both to deeper levels of dialogue
whilst endeavouring to do no harm. I was also mindful of the duty of care that I am obligated and committed to offering at all times to both my therapeutic clients (and co-researcher in this instance).
Findings: Some core experiences and meanings

In the interview, my participant and I focused on her two tattoos of lizards: one on her breast,
the other on her leg. In repeatedly listening back over my interview taped transcript and reflect-
ing in hindsight over my notes now with an interpretive lens, I am still deeply impacted by
what I perceived to be my participants largely isolated, painful and at times intensely lonely
journey. This journey was amplified, and lifted off the page so to speak, by our gateway research topic of tattoos. Six key themes seemed to emerge about what these tattoos mean and
represent, which I have languaged as: Wearing pain on the skin; Walking on glass; Who
are you really sleeping with; Wearing hope on the skin; Reclaiming me; Growing edge,
growing a new tail.
Wearing pain on the skin

Through having such a bleak, hard and painful life, it strikes me that my participant felt the
need for her inner pain to be seen externally: A coat of arms and a rite of passage not gifted or
purchased but earned. Did it matter that the price of being tattooed is to sit through a wall of
pain, through a ritual of being punctured over and over? I doubt it. My participant learned how
to deal with pain a long time ago. She had often dealt with and overcame tough and painful
situations without full awareness as evidenced below;
Participant: So I think what I didnt realise at the time, and both times with the loss
of Ian and my father, was that I was hurt and felt really scared that I wouldnt be able
to manage, but what I didnt realise at the time was I was the one that was managing
anyway.
Her two tattoos seem to signify the ending of two significant formative relationships with male
others: her husband and her father. These relationships quite possibly taught my participant the
lesson of being able to creatively adjust. Goodman (1951) talks about how the self is formed
in contact and he called creative adjustment the me acting (creatively) on my environment
acts on, constrains, and informs me (adjustment). So these early key male-female relationships likely informed my participants creative adjustment (Goodman, 1951) to the desert-like,
harsh and barren existence of her youth. If this was the case, what was the price she paid for
this creative adjustment? I believe the primary cost for this adjustment was to sacrifice herself
for others (at the expense of her own needs), and essentially give away her dreams, hopes and
potentiality to meet the needs of firstly her father, and secondly her ex-husband. I came to my
belief in hindsight, by carefully listening back to the original recording and reading between
the lines, listening to the process as well as content. Both men shared a leech-like skill of sucking the very life blood from my participants body and soul. One of the primary reasons for
the choice of both of my participants tattoos is best described in her own words of choosing
to wear her pain and hope on her skin. This realisation was initially outside of my participants conscious awareness, the link between her pain, hope, and her tattoos was amplified and
brought to life throughout the duration of the interview.
Walking on glass
The tattoos represent walking on glass in that they chart the arduous, tough and painful journey travelled largely in isolation by my participant. Both of her tattoos are of lizards, solitary
reptiles that in their natural habitat of Africa face many forms of danger, both predatory and
secondary. I see it as important to note at this point that my participant has a strong developmental connection with the continent Africa, having being raised in Africa and having once
shared this continent with the lizard, as well as her husband and now deceased father. The
mere task of getting from A to B for a lizard is treacherous, risk of being crushed by foot or car,
preyed on by snake on land or hawk from above, walking on glass. I believe a large portion of
the pain component of wearing pain and hope on the skin is linked to my participants very
early creative adjustment (Goodman 1951) and family script of having to look after her father
at all costs: to be his confidant, therapist, and nurse maid, to be big and potent, but never as big
and potent as her father. I suggest this adjustment to walk on glass and do it the hard way
was the birth of an intensely powerful introject, premature rule or definition (Jacobs, 1992).
The introject could have led my participant to laying the blueprint for initially the taking care
of her father, then the choosing of her husband. Ultimately leading to the familiar pattern of
being let down by the same men, men with minimal parental and adult capacities who I quickly
came to believe would never, and indeed could never, offer any consistent semblance of adult
authentic support to the varied configurations of my clients there and then self as evidenced
in my participants own experience with her father here.
Participant: Like even when, when she left, and having to look after him in his two
oclock in the morning waking me up and all that crap, and kicking off and battering
us, and all of that was about his little boy who couldnt handle what had happened.
And trying to look after him was just a nightmare. And again when I went to uni even,
although he bragged to people, never to me, and tell people I was at uni, there was two
times in my life ever I phoned him and said Im really, really stuck and Im going to
have to leave if I dont get this amount of money and both times it was just Oh, Im
really sorry. My cars in the garage. I cant help you.
Who are you really sleeping with?

Who are you really sleeping with? was the proposed title of one of my participants first tutors ideas for a book. This title and theme revealed a question for my participant that highlighted the gulf between conscious and unconscious choice. She faced and battled the unwelcome
awareness of a key script choice that she had made. One that elicited repetition, whistling to
the familiar tune that had kept her embattled, chained and ultimately without support yet again.
She remembers having a big argument with her tutor after the tutor insinuated that my participant had chose a partner very similar to her violent drunk father, despite seeming to choose
one the complete opposite. Years later, in hindsight, my participant came to realise the awful
reality that beneath the softer more palatable veneer was that neither ever supported her;
Participant: The symptoms and behaviours were different, what was really true about
both of them, the bottom line for me was that when I actually needed anything for me
support-wise there was just nothing there.
A second after my participant shared this massive statement that there was just nothing there
remembrance with me, her eyes glazed over, her jaw dropped a fraction, and I felt an extremely
strong pull to respond by rescuing, yet I resisted and I offered instead:
Researcher: What happened there? As you said, there was nothing there?
And then the moment was gone, through phenomenological enquiry I saw what I perceived to
be my participants well-versed ability to regroup in a split second and come back with:
Participant: I felt sad, but Im not going to stay with that because I want to finish this
Was she deflecting? Yontef (1993) describes this as the avoidance of contact or awareness by
turning aside from her pain by staying with a known narrative. And if she was deflecting, what
has the price been to date, and what would the long term price be for deflecting such intense
sadness? I felt warned facing a very strong dont go there energy radiating through a keen pair
of eyes fixed intently on me. I wondered for a second whose eyes they were. I remember jostling with a choice, my gut implored me to challenge, but my head reminded me of the research
guideline notes of suggesting that it is better to talk with your participant than try to therapize
or interview so I made the choice to err on the side of caution and let it go.
With my newly shorn researchers hat on, I am okay with that, acknowledging that there are
deeper ethical issues at stake here, whilst the emerging gestalt therapist in me is still seething
at the missed opportunity, interesting dynamics. In hindsight I believe that there was indeed a
muted invitation, as well as a stark warning. And if I had mined further at this pivotal point
I believe that we could have possibly tapped into a rich vein of contact and awareness which
quite possibly would have furthered our relationship dramatically.
Wearing hope on the skin

Throughout the many trials and tribulations of my participants relating with both her husband
and father, she managed a stubborn and staunch refusal to give up. She displayed a remarkable resistance to being sunk and counted out. Not unlike a prize fighter under heavy fire, she
tucked up, kept her chin down and parried her way through a torrent of blows with the hope of
seeing it through to the next round.
Participant: So I think I remember saying a while ago that maybe with tattoos people
wear their pain on their skin. But I think for me there is some of that in there but its
also about wearing hope on my skin as well.
Interviewer: Wearing hope?
Participant: Yes that I actually am out from underneath those two big rocks now.
While my participant recognises her hope that the tattoos represent, I have a real sense of the
battle, the at times triathlon-like quality of my participants life to date. On several occasions
during our interview I felt bodily heavy and intensely weary. My somatic heaviness was, I believe, a relational response to my participants desensitisation. Kepner (2001 p, 98) describes
desensitisation as the process by which we numb ourselves to the sensations in our bodies, or
to external stimuli. Tuning in and tracking her phenomenology led me to wonder about her
own sense of embodiment: Was I mirroring her own sense of her heaviness and weariness? I
was picking up a strong theme of life has to be hard and my gut tells me that my participants
father plays a figural role in that credo.
In this example again the introjected, message of life has to be hard comes back to me, as well
as my felt heaviness, I wonder what it would be like to be living underneath two big rocks for
so long? I imagine I would feel exhausted, lost, claustrophobic, defeated then sad, heartbroken, angry, furious, murderous. This leads me to think about how tired and heavy I feel when
I retroflect (Perls, et al., 1951) and turn my feelings inward, squashing and pushing down my
emotions. And then I recognise how happy, elated, ecstatic, powerful and hopeful I feel when I
undo my retroflection. Was this the source of my participants hope?
Maybe, maybe not I see my participants account undoing a huge retroflected pattern by
squeezing out, reptilian style, from underneath the rocks that were metaphors for her exhusband, and then father, as being more muted than my description of my own emotions linked
to my memories of undoing retroflection. Looking back I am curious about that. The hope my
participant mentions seems tentative, almost as if is she utters hope too loud, the rocks may
roll back down and smother her as they once did so well, for so long. I feel sad imagining that
to be true and I will own that some of my own history of being squashed and smothered came
through in the latter metaphor, as well as empathy for my participants past experience.
Reclaiming me
On the road back to claiming an authentic self my participant rose from the ashes and wriggled free from the dead weight of the rock that represented her now ex-husband. As part of the
healing and regeneration process five or six months after the relationship had ended, she chose
her first tattoo. She chose a lizard which had African connotations for her, in that she spent a
large part of her formative years in Africa where lizards were common place in and around the
home.
Participant: Theres something about lizards with Africa, the African connection, and,
erm, theres something about the ability that a lizard has to lose its tail to get out of situations, and then grow another one, so the regeneration thing.
Researcher: Mm
Participant: Erm, and then I got my second one on my leg, erm, not long after, and I will
say my....erm, not long after my dad died. Erm, and again I think there was something
about Africa. And again at the time I didnt actually link the two things in my head. But
if I look back at it now, they were both about reclaiming me back at the end of relationships with the two, biggest in terms of living with, men in my life.
I remain very impacted by the reclaiming of self back at the end of my participants two significant relationships. I feel proud of her resolve and tenacity, while I also recognise both qualities in myself. I also see a lot of energy bound up between the two lizard tattoos, the husband
and father as well as the African connection between them all. It feels like Im sifting through
a spider web with my participant at times as her story weaves its way across continents. I have
a real sense of how tough and hard her journey has been at times. I can almost smell and taste
the gravel rough quality of it.
Growing edge, grow a new tail

Whilst being respectful of, and sharing the admiration my participant has for the lizard as a
species, I feel compelled to challenge and highlight some of the more fixed behaviours I witness both the lizard and my participant exhibiting: A tendency towards running away when
in proximity of close contact coupled with long periods of isolation being the most obvious
similarities to me. In therapist role, I would be keen to challenge this theme and encourage
experimentation of raising awareness to the possibility of breaking growing a new tail. During my analysis I couldnt help but also notice my participants pattern of actively handling
challenges herself, seemingly leaving others in the background. I wondered what potential
movement there may be toward allowing others to be strong enhancers of her life in both the
near and distant future.
My participant is now clearly able to recognise her transitions with her tattoos and make the
link between being able to put down the roles of wife and daughter. I also feel that she is
now able to do so whilst recognising her pain in role as wife and daughter, thus validating her
resilience that followed and leading on to what feels to me to be a tentatively emerging hope in
the now. A strong pattern that I believe once drove my participant that life is tough and full of
duty: so I must be tough and dutiful, can still today serve to empower and oppress. I believe
my participant has empowered herself both professionally and as a mother with courage and
hard work, and she has done so largely alone.
In hindsight coupled with studying our research transcript I find part of me would like to see
her have a different relational experience with perhaps a male other; possibly a male other who
actually has something clean to contribute to a relationship, somebody who could match her
undoubted will and strength with commitment, patience and compassion. Now who knows
what tattoo that fantasised relationship could result in creating?
My participant also used juicy language, for instance, dropping in almost casually:
Participant: The trick is I still just need to learn how to give myself as much as they got.
Erm, which isnt....I dont do as easily as I did do it for other people...well for them two.
In terms of growing awareness (metaphorically growing a new lizard tail) I saw my participants statement above as a great opportunity to mobilise and push for an answer to what I
believe was a natural, and very good open question from me:
Researcher: So how would you go about doing it?
Here I put responsibility back with my participant, which is more fitting with my therapeutic
style when working with clients with whom I have a good solid working alliance. My participant answered my spontaneous question, with a spontaneous answer of:
Participant: Im not too sure. I think Ive started to do it but I havent thought about it
properly.
We discussed this giving myself as much as they got conundrum at greater length as we debriefed after our taped research session, and my participant expressed the will to open it up
even further in therapy. I believe this new awareness and meaning making pays testament to
the clear relational research alliance we had forged together, underpinned by the dialogic attitude I had endeavoured to offer throughout.
Conclusion and reflection: Towards understanding

some personal meanings of having tattoos
My participants experience of her tattoos seems to link - in simple but profound ways - with grief.
Having been confronted by the ending of two of the biggest relationships with males, in terms of men
that she shared a home with (i.e. her father initially and latterly her ex-husband), she made the largely
unconscious choice to mark the transitioning between the roles of daughter and ex-wife and reclaim her
own sense of skin, and ultimately self. My participant drew a line in the sand and hoisted herself back
from the cloying clutches of these two similar males; similar in that they were both largely self-serving,
conniving, controlling persecutors. My participant draws what I believe to be a clear and pained line
saying no more in this excerpt:
Participant: I dont know whats going on. And I feel like my eyes are filling up as well.
Theres something quite strong about, will I fuck give them any homage or thats what it feels
like. You know people go up to stone deities and they kiss them and Its like will I fuck give
them anymore of me? No. And I know thats not what you meant, but thats where Ive gone
to in my head. No. No. [Pause] No, Ive had enough. Its Theyve had enough. Maybe I
need one of those green full stops tattooing on my skin next. [blows nose]
In drawing her line she chose to underline and mark the transitioning permanently by being tattooed.
She chose the form of a lizard within months of both grieving/ending processes. Initially, she chose to
have a lizard on her breast, to mark her divorce. It was placed here to signify her sexuality and chosen
due to the reptilian African connection inherent with her upbringing in Africa. My participants reptilian choice was primarily due to the lizards capacity to be resourceful, to the extent of even losing a tail
in the interest of survival allowing the lizard to evade both capture and death. For her second tattoo she
chose the now familiar form of a lizard again, this time on her leg, shortly after returning home from
Africa with her fathers ashes in late 2009. Her separate yet similar roles of being a good, selfless
and dutiful wife, and daughter were now over, her marriage was over by choice, and her role as daughter
by death and natures rule.
Being single now, and fatherless, my participant occupies herself fully by continuing to immerse herself
into the roles of excelling and duty as a good mother. She is also keeping the hard-working competitive walking on glass family theme rolling over by striving to being the best therapist, supervisor,
and manager she can be. My participants early introjects and script drivers of being the best and the
brightest in the school, are alive and well and in full awareness the majority of the time.
What my participant states she has learnt from this research experience is that one of the ways of lessening the grip of her - at times brutal - life script, is to attempt to adopt my way of utilising my various
tattoos as physical reminders. These physical reminders could act as metaphorical rubber bands, twanging us both from the past back into the now, with her tattoos reminding her that she is now without the
two poisonous tails, and that she is healing and growing fresh tails daily. My participants tattoos chart
her moving journey through confluent early relational oppression and resistance to her more recent
journeying on the road to finding her true self, in her continuing striving for enhanced authenticity, and
autonomy. It has been both my pleasure, and an honour to have hitched a ride along the way.
I believe I have made this research project my own, by immersing myself into my participants world,
whilst reflecting on my own subjective historic influences, engaging in analysis and interpretations, as
well as paying attention to, and being curious about the co-created field between us. After immersing
myself in this, my first research project, I feel inspired to conduct a heuristic piece of research on my
own experience of tattoos, and the meaning they have for me after I have completed my training.
Furthermore, having felt energised and moved by the collaboration with my co-researcher, my possible
future research avenues appear vast. Related topic options available to me offer up a variety of societal
sub-cultural tattooing trends and patterns that I have had direct contact with and have witnessed over
the years in my very colourful life to date. Ranging from Jail house prison tattoos that talk in code
to other prisoners denoting prisoner hierarchy and status, to local football hooligan tattoos denoting
allegiance to gangs and modern day tribalism. Or possibly interviewing a largely secretive local biker
gang I have ties with, where again tattooing is tribal, intensely coded and multi layered. I have recently
been reminded on good authority that with any one research study there is always more. This for me has
been a small yet intensely flavourful slice of research, I am changed by our sharing and indebted to my
co-researcher for the recipe.
References
Clarkson, P. (1995) The Therapeutic Relationship. London: Whurr Publishers.
Evans, K. and Gilbert, M. (2005) An Introduction to Integrative Psychotherapy. New York: Palgrave
Macmillan.
Finlay, L. and Evans, K. (2009) Relational centered Research for Psychotherapists. West Sussex:
Wiley Blackwell.
Jacobs, L. (1992) Insights from Psychoanalytic Self-Psychology and Intersubjective Theory for Gestalt
Therapists. XV, 2. The Gestalt Journal, 25-60.
Kepner, J, I. (2001) A Gestalt Approach to Working With The Body in Psychotherapy.
California: GestaltPress.
Mackewn, J. (1997) Developing Gestalt Counselling. London: Sage.
Perls, F. Hefferline, R. Goodman, P. (1951) Gestalt Therapy, Excitement and Growth in the Human
Personality. USA: The Julian Press, Inc.
Polster, E. and Polster, M. (1973) Gestalt Therapy Integrated, Contours Of Theory and Practice. New
York: Vintage Books.
Yontef, G. (1993) Awareness Dialogue and Process: Essays on Gestalt Therapy. The Gestalt Journal
Press.
The Value and Cost of Mandatory Personal

Therapy
Tami Avis, City University, London
Email: tamiavis@gmail.com
Money cant buy you happiness but it does bring you a more pleasant form of misery.
Spike Milligan
Abstract
Counselling psychology trainees, in the UK, are obliged to undertake a minimum of 40 hours of personal therapy as part of their DPsych course requirements. This requirement creates some stress and
remains controversial in the profession at large. This paper constitutes part of a wider doctoral study on
how this mandatory therapy is experienced from the perspectives of both trainees and counselling psychologists who have trainees as clients. Interpretative Phenomenological Analysis (IPA) was employed
to access the lived experience of four trainees and four qualified psychologists. Four overarching categories common to the two groups were identified in the broader study: impact of mandatory therapyon
therapeutic process; the therapeutic performance; the value of therapy and; boundaries. Whilst many
trainees felt that therapy should remain a compulsory course requirement, they also highlighted that it
costs them both emotionally and financially. I had not included questions regarding finance in my original interview schedules and did not anticipate that both trainees and therapists would mention finance so
often and so fervently. Consequently in this paper, I am selectively focusing on the financial and emotional side of mandatory personal therapy. This article will concentrate solely on the findings related to
the emotional and financial impact of mandatory personal therapy on trainees and their therapists.
Introduction
Previous research has discussed whether or not therapy should be a mandatory requirement and thepositive and negative consequences of the experience (Macaskill, 1999; Grimmer, 2005). Otherwise
there is a substantial amount of research which explores therapists experiences of undergoing their
own personal therapy. There is far less research on trainee counselling psychologists and their personal
therapy. Although there have been some papers on this (e.g.Kaslow and Friedman, 1984, Grimmer and
Tribe, 2001), few have addressed the mandatory aspect of trainees having to have therapy as part of
their training requirements. The only research which asks the perspectives of both trainees undergoing
therapy, and qualified therapists giving therapy in the same study, is the research conducted by Kaslow
and Freedman (1984) and that took place over 20 years ago.
As an increasing number of people apply to DPsych counselling psychology courses, the impact of
the lack of information given to students about the rationale for mandatory therapy and/or process of
possibly starting therapy for the first time, assumes a greater significance. Many studies state that the
therapeutic relationship is one of the most important factors of therapeutic success (Martin, Garske
and Davis, 2000; Bachelor and Horvath, 1999), yet there have been no studies conducted looking at the
unique relationship dynamics between counselling psychology trainees and their therapists.
The purpose of this study is to explore how DPsych trainee counselling psychologists experience their
personal therapy, and how counselling psychologists experience having trainee counselling psychologists as clients. The BPS website (2009) states that The practice of counselling psychology requires
a high level of self-awareness and competence in relating the skills and knowledge of personal and
interpersonal dynamics to the therapeutic context; consequently counselling psychologists should not
be afraid to reflect on and challenge what is part of the training to become part of this unique branch of
the profession.
Literature Review
A debated topic
The subject of personal therapy for therapists is a controversial one, with conflicting views on
whether it should be a core component of training or non-essential (Macaskill, 1999). Norcross, Strausser-Kirtland and Missar (1988, p.37) eloquently outlined the issue stating the subject is shrouded in
mystique, defensiveness and anxiety sometimes bordering on the irrational. The rationale for mandatory therapy has remained unclear. Professional difficulties are not given as a primary rationale by
counselling psychology courses. If they were, the question remains unanswered as to why therapy (like
supervision) does not remain mandatory throughout therapists careers. The notion of whether personal
therapy should be mandatory has been questioned frequently by those in the therapy profession.
Amongst the reasons given for the necessity of trainees having personal therapy are that use of the self
and interpersonal abilities are seen as key factors in the therapeutic process (Woolfe, 1996). Arguably,
if trainees are not required to have mandatory personal therapy, there are no assurances that they will
address the parts of their personality which could possibly be problematic (Thorne and Dryden, 1991).
Whilst some studies would argue that personal therapy is key in training to become a therapist, both in
addressing problematic areas of their personality and understanding therapy from the perspective of the
client (Thorne and Dryden, 1991), others have maintained that there has been no empirical evidence to
endorse these claims (Williams et al., 1999).
An ongoing debate is whether mandatory therapy is ethical and alternative personal development exercises have been suggested, including therapy as an option (Mearns, 1997; Norcross and Halgin, 2005).
It is questionable whether personal therapy is vital in therapist training and should be a key activity;
perhaps other activities in training (e.g. membership of a therapeutic group) may fulfil the tasks which
personal therapy is there to accomplish (Atkinson, 2006). Although acknowledging that there should be
substantial opportunities for personal development in the training of therapists, Atkinson (2008, p.408)
vividly described mandatory personal therapy as neither intellectually nor ethically coherent.
There is little conclusive empirical evidence as to whether mandatory therapy is beneficial for trainee
therapists, and there are opposing views about whether it should be included as a mandatory part of a
training course. There is also a lack of research concerning qualified therapists opinions on whether
therapy has been useful to their trainee-therapist clients, and indeed their experience of having therapistclients. The research that has been undertaken has mainly been by authors aligned to psychodynamic/
psychoanalytic therapy (Geller, Norcross and Orlinsky, 2005).
Therapists experience of treating fellow mental health professionals

Norcross, Geller, and Kurzawa (2000, 2001) conducted informative research on therapists experience
of treating fellow mental health professionals. They examined responses to a questionnaire from 349
psychologists of the American Psychological Association Division of Psychotherapy. Psychologists
reported that their therapy styles and therapy processes were
mainly similar for both psychotherapy patients and non-therapist patients. However, they admitted that
they felt less removed from and experienced greater comradeship toward their therapist-patients. In
spite of this, they were more also anxious about treatment effectiveness and more insecure of their
techniques when the patient was also a mental health specialist (Norcross, 2005). Heery and Bugental
(2005), who used an existential-humanistic approach to psychotherapy with psychotherapists, highlighted that special attention must be paid to the transference and counter-transference relationship with
psychotherapist - clients.
In contrast, Beck and Butler (2005, p.254) maintained that there is little difference in our cognitive
therapy treatment of therapist-patients versus other patients. They argued that issues that may be seen
as unique to trainees, such as the possibility of dual relationships, that occur with other patients as well.
A possible reason for the disparity between their views, and those of the previous studies, is the difference in theoretical orientation. Beck and Butler (2005) used CBT in their treatment of therapist-patients,
which is arguably more protocol orientated than psychodynamic therapy which is more process focused. This may explain why they noticed little distinction.
Methodology
Interpretative Phenomenological Analysis (IPA) is a version of the phenomenological method which
accepts the impossibility of gaining direct access to research participants life worlds (Willig, 2001,
p.53). Smith and Osborn (2008, p.55) described IPA as being especially useful when one is concerned
with complexity, process or novelty, such as with my own research.
Four trainee counselling psychologists and four qualified counselling psychologists were recruited.
Trainee counselling psychologists, undertaking their doctorate in counselling psychology, were recruited from the second year of their training. The second year was chosen because, similarly to my reasons
for recruiting solely counselling psychologists, I wanted as homogenous a group of participants as
possible (Smith et al, 2009). The participants were required to have had a therapeutic relationship for
at least six sessions, as this still allowed for the analysis of the therapeutic relationship in short-term
therapy. Any theoretical orientation was considered as counselling psychology incorporates different
modes of therapy. Lastly, the participants had to have finished therapy no more than three years ago
so as to make the memory of the experience of mandatory personal therapy as fresh as possible. I did
not specifically recruit trainees who had seen counselling psychologists as their therapists because at
the time, some counselling psychology courses permitted trainees to see UKCP and BACP registered
therapists.
I kept to the BPS Ethical Principles for Conducting Research with Human Participants (BPS, 2000)
and my ethics proposal form was approved by my university. Whilst planning my research I was aware
that, for the participants, talking about their therapy experiences could potentially be upsetting. It was
hoped that by making the participants fully aware of the nature of the study before they participated in
it, psychological/physiological distress would be avoided (as much as possible). When the interview
was finished I debriefed the participant both verbally and in writing.
Analysis
Consistent with the theoretical guidelines of IPA, semi-structured interviews were employed. This inductive bottom up approach permits the participant and the researcher to partake in a discussion in
which preliminary questions are changed after receiving the participants response. It also allows the
researcher to have the chance to be able to investigate significant subjects which surface and to ask the
participant for clarification (Smith and Osborn, 2008). Willig (2008) explained that, in comparison to
structured interviews, the order of the questions is less significant, and the interviewer has more flexibility in pursuing the interests of the participants. Each interview lasted for about an hour.
IPA is not a prescriptive methodology (Smith and Osborn, p.66) so I was able to adapt my approach
by using two groups of participants, looking to see if there was any connection in the themes between
the two groups. Whilst my main research interest was on the individual experiences of the trainees and
the qualified therapists, I also wanted to determine if there were any similarities, or indeed differences,
in the experiences of both groups.
There are several stages to carrying out IPA analysis for an individual case. The first step involved
reading and re-reading the transcript to get a general feel of the interview. The second stage involves
the researcher distinguishing and labelling themes (using the right hand column) that typify each segment of the text. The third stage investigates how the themes are associated with each other. This stage
requires incorporating more organisation into the analysis (Willig, 2008). The term abstraction is used
to describe the basic way of distinguishing connections between the emergent themes and finding a superordinate theme (Smith et al., 2009). This encompasses placing similar themes together and finding
a name to define the cluster.
This is an iterative type of analysis, and involved the hermeneutic principles of being aware that I was
calling upon my own interpretative resources, in order to attempt to understand what the respondent
was saying and then examining whether this was actually what the respondent had experienced (Smith
and Osborn, 2008). To ensure that this is evident, the fourth stage is to produce a list of the structured
superordinate themes, alongside quotations that demonstrate each theme. Themes were only included
if they portrayed something about the quality of the participants experience of the phenomenon under
investigation. The same process was performed for each interview.
A list of master themes is produced which depict the quality of the participants shared experience of the
phenomenon under investigation and subsequently tells the reader something about the characteristics
of the phenomenon itself. Analysing which themes were the most frequent required my taking each
theme individually and seeing how relevant it was for each of the four participants. My decision was
to focus on the pervasiveness of themes within the data, and to also highlight both the similarities and
differences between the participants in my analysis.
Comparing the groups: The master themes were found by looking at each individual interview from the
trainee counselling psychologist group and performing all of the steps above. This process was then repeated for the chartered counselling psychologists. The next step involved looking at the summary table
for each group. I noted that there were four overarching categories that clearly emerged. Whilst creating
themes/categories at ever increasing levels of abstraction I was careful not to lose the individual and
their lived experience by pondering whether this was really what the participant thought/felt.
Findings
The trainee therapists
Therapy Costs
Mandatory personal therapy comes at a price, both emotionally and financially, for thetrainees. The
financial implications of mandatory personal therapy were spoken aboutpassionately during the interviews. For trainees on courses that cost a significant amount ofmoney, the additional cost of personal
therapy causes significant financial, and therefore also emotional, stress compounding the emotional
experience of therapy. Bor, Watts, and Parker (1997) suggested that some people may be discouraged
from applying for a training course due its cost. It can be argued that the financial requirement of mandatory personal therapy adds a further obstacle. This has certainly been true at times for Robert and
frequently for Claire.
Robert: The therapy is a big part of the course fees....on one hand I could see it as being
an essential part of the course, in the other hand I could see it as being a component of
the stress ...perhaps it is counter- productive.
Roberts ambivalence raises questions about the relative costs and benefits of therapy It seems that for
Robert, he is at times uncertain of whether the experience is worth the cost. Macaskill and Macaskill
(1992) advised against being complacent regarding the advantages and disadvantages of personal therapy for trainees. This theme is illustrated in
Claires interview:
I hated having to have therapy at the beginning of the course because of finances...
Ifound myself getting quite angry having to pay for it... I was taking my anger out on
her ... I was so keen at the beginning because I wanted to get on the course that I was
prepared to take that on. But having to work and study at the same time is a real strain
on me personally and emotionally.
This quotation offers an indication of the strength of Claires emotional response to mandatory therapy.
By using the expression having to have therapy Claire implies that she has no choice in the matter,
and that an early financial commitment was something that she hated. This strong expression was
mirrored in her impassioned tone of voice. Claire feels resentful and resistant to having therapy because she disagrees, both at a financial and ideological level, with its mandatory nature. She is angry at
the counselling psychology profession and rails against its training system for her financial difficulty.
Claires words I was taking my anger out on her reveal how her anger seeps into the therapy, and
taints the experience, thereby affecting her ability to form a working therapeutic relationship. In spite
of this, Claire acknowledges that although she knew therapy was a course requirement, she had underestimated the toll it would have on her:
For Claire the strain of working and studying was taking a toll and spilling out into her therapy. Dearing et al. (2005) highlighted that psychotherapy trainees often have other stressors, aside from course
requirements, including financial worries. This is certainly true of Claire, as she says the cost of working and studying was affecting her both personally and emotionally. In separating the personal and
emotional, Claire hints at her difficulties in integrating these two areas of her life.
Wanting a return on investment

It is clear that mandatory personal therapy comes at a price for the trainees. They want value for their
financial and emotional input. This can be seen in the following extracts from Sara and Robert:
Sara: I just think to myself, right I am paying for this, I am paying more... and Im really conscious... Im committed to the therapy.
Robert: If I am not as open as I can be then Im not going to benefit from the time that
Im spending there and to be fair its not particularly cheap so I think I just kind of,
began to realize that I wanted to use the time there the best I could and to use the money
that that I was paying the best I could so I just began becoming as open as I could be.
Both Sara and Robert link their wish for value from the therapy with the amount of money that they
have invested in it. Saras investment in the therapy (I am paying more) strengthens her dedication
to it (Im committed to the therapy). Robert also highlights the fact that the onus is on him to ensure
that he is rewarded for his financial commitment. It is important to him that he obtains maximum value
from the sessions. Perhaps, despite the negative financial costs having to pay makes the trainees attach
greater importance to therapy than if it were being offered for free.
Therapy is precious
With the exception of Claire, trainees feel that despite the negative financial and emotional implications,
the return of having personal therapy outweighs the costs. This supports the findings of Williams et
al. (1999), as the majority of their participants believed that therapy should be obligatory for counselling psychology trainees, including 69 per cent of those who reported negative effects. It appears that,
despite the noted disadvantages, the trainee counselling psychologists in this study consider that they
have made a profitable investment. As Sara says: I know we have to pay for it but I think its money
worthwhile...its quite precious to me my whole therapy experience.
Her use of the word precious implies that Sara calculates that therapy is a valuable commodity. She
depicts it as a positive opportunity despite the strong emotions it evokes.
The trainees in this study clearly distinguish the positive from the negative aspects of mandatory personal therapy. Overall they express the view that the return was worth the outlay. They view it both as
an important part of their training to be a therapist, and also crucial to their development on a personal
level.
Robert: I just could go and I could bitch and I could whinge, and I could address things and the
concerns that I had, and it was just so so so helpful to do that....
Robert: I think it is a essential training tool
Claire: If we could get funding in the way that clinical psychologist trainees get funding, I wouldnt mind doing mandatory personal therapy. Id actually love it because I
think its great to have personal therapy but its just the fact that I think it seems to have
gotten in the way a little bit in terms of me being able to develop a relationship with
my therapist.
Claire feels that the return of mandatory therapy would be very positive if she were able to get funding. She goes as far as to say she would love it which was a very different take from the rest of her
narrative. Again she reiterates the interweaving of the emotional and
financial, by suggesting that if the financial burden was eased the therapeutic experience would be
something that she would actually love. Although previously in the interview Claire sounded and
appeared outraged about the inclusion of mandatory therapy, it seems that it is the self funding of the
mandatory therapy that contaminates the experience for her and impacts on the therapeutic relationship
(it seems to have gotten in the way a little bit in terms of me being able to develop a relationship with
my therapist).
The therapists
Resonating with own personal experience
The therapists have strong memories about their own training journeys, and being with the trainees triggers emotions and brings back memories of their own personal experiences.
Brian: It brought back a lot of memories about like youre at the beginning of your
programme, quite a journey to go through yet.
Brians own experience of training seems to have been a turbulent one, filled with mixed emotions. He
is well aware of the demands, both academically and personally that the course makes, and this is indicated by him saying quite a journey to go through yet. He feels and sounds empathic about the training experience for the trainees and it reawakens his own feelings regarding the training course. Wosket
(1999) stated that many authors have written on the subject of therapists latent issues being activated
when seeing therapist-clients.
Marions experience shows something of this complexity:
This is something that I have been through and had to deal with and yeah, actually that
is part of my role, sort of helping people to keep their balance.
Despite Marion wanting the trainees to use therapy and to challenge themselves, she discusses in the
interview that she is aware of the challenges the trainees are facing in the process of becoming a counselling psychologist. Seeing trainees causes her to reflect on her own experience of training. Her choice
of words something that I have been through had to deal with implies that Marion had found her
training experience taxing and that years on from qualifying as a therapist, the difficulties of the experience remain in Marions mind. Perhaps the fact that the therapists still remember the negative aspects
of their own training highlights the need to assess whether trainees are being put under an intolerable
amount of stress. It has been argued that making therapy a mandatory requirement can harm its effectiveness, and that the trainee could continue with therapy that is not suitable because it is part of the
course requirement (Grimmer and Tribe, 2001).
Alyssia: I felt that this was not what shed be doing if she didnt have to...I could really sort of
understand her perspective
Again, Alyssias mixed view about therapy as a training requirement is apparent here; her use of the
words really and sort of illustrates her ambivalence towards it. Conceivably this is how she felt in
her own personal therapy, which is suggested by Alyssia saying she can understand her perspective.
She makes the assumption based on her feelings (I felt that this was not what shed be doing)
that the trainees are only attending therapy because they have to as opposed to that being something
the trainees have articulated. Nevertheless she later discusses in her interview that she experiences the
trainees as having changing feelings regarding mandatory therapy. It can be understood from her words
that it moves from a chore to a choice for them.
Concessions: special treatment for the trainee client

The therapists care about the trainees and felt both sympathetic and empathetic towards them. This can
alter how they treat them as compared to non-therapist clients, i.e. more self disclosure, lower financial
costs and allowing them to cancel when they had work due.
Marion: With trainees I am more...confessional...I will bring in personal stuff to a greater degree... self-disclosing, yeah Because part of my role as therapist is to you know, I am sort
of the role model to a degree Im still careful, mindful of the boundaries theres a closer
identification and community of purpose really.
Marions use of the word confessional portrays an image of someone who has sinned. Her increased
self-disclosure is a decision she makes because she thinks she is a role model for the trainees. Geller
(2005) pointed out that the issue of whether to self-disclose with a therapist patient is a subjective decision and should only be done in order to achieve a therapeutic goal.
This is relevant to Marion using self-disclosure in order to aid the trainees in their developments as
therapists. Whilst she is still cautious about the therapeutic boundaries (Im still careful, mindful of the
boundaries), she will treat the trainees differently, due to her feelings of responsibility for and identification with the trainees (theres a closer identification and community of purpose really).
Alyssia: Perhaps Im a little bit too accommodating, but the three year doctorate is so demanding. I know myself, the pressures I was under.
Alyssia wants to be flexible according to trainees needs/wants which is depicted by her use of the word
accommodating. She tries to be responsive and open. Alyssia cares about the trainees and wants to
support them; she remembers what her own training was like (I know,myself the pressures I was under). At the same time she is a little bit wary of being abused by trainees and them taking advantage
of her softness. Her awareness of this is illustrated by her saying perhaps Im a little bit too accommodating. Due to previous experiences with trainees, she is cautious about taking trainees given their
particular and complex needs. For example, Alyssia mentioned that she will no longer give trainees an
evening slot which she has few of, as a result of her previous experience of losing money due to sessions being cancelled by trainees.
Discussion Relevance to practice and training

The financial implications of mandatory personal therapy were spoken about with considerable passion
during the interviews. This finding was striking given the absence of discussion about the financial impact of attending a course that is self-funded.
It is worth nothing, however, that it is not just trainee therapists who can find the financial aspect of
therapy difficult. Additionally unlike other commodities money is a different currency within the context, within the setting, of a psychoanalytic treatment...the patient is paying for something but he can
never know what the product will be (Phillips, 2006, p.284). Consequently, people have to trust that
they money they are paying will be useful for themselves, without a guarantee.
Nevertheless, for the trainees it appears that the mandatory aspect of the therapy, and the perceived lack
of choice in having to finance it, causes a strong emotional reaction. Arguably this adds an extra element
to the contentious issue of financing therapy that affects the general population. Whilst the trainees
were initially wary about the worth of mandatory personal therapy the trainees feel (with the exception
of Claire) that despite the negative financial and emotional implications, the return of having personal
therapy outweighs the costs.
For the therapists there are both positive and negative financial implications of seeing trainee-clients.
Feeling empathic towards the trainees can have a negative impact on the therapists; for example, Alyssia speaks about lost earnings when trainees missed sessions due to coursework deadlines. Conversely,
for others, having trainees as clients is an attractive prospect. As the therapy is a course requirement,
Brain acknowledges that seeing trainees normally ensures a relatively long financial commitment.
Although it could be predicted that emotional effects of mandatory therapy would mainly be felt by the
trainees, there are also significant emotional implications for the therapists. Therapist-participants reflect that memories of their own less than positive experiences of personal therapy are re-activated when
they work with the trainees. There appears to be a strong desire for therapy to be a better experience for
the trainees. The therapists occasionally feel guilty as they contemplate whether they are involved in
something unethical: seeing trainees who are required to see them. For therapists seeing trainees there is
the additional burden of being aware of the financial struggle faced by the trainees; indeed the therapists
discuss their own financial stress when training.
Herron and Rouslin Welt (1992, p.112) discussed the issue of transference and counter-transference in
the financial transaction between therapist and client. They highlighted that instead of being viewed as a
negative issue it can instead by used as a way of defining boundaries e.g. that the therapist is not there in
a social/friendship role but instead what the fee purchases is a professional relationship. They further
stated that because patients projections are the content of most psychotherapies, it is easy to see why
consumers get confused, and that increases the need for therapists to be clear and explicit about their
professional roles (1992, p.113). Perhaps in the case of the relationship between trainee psychologists
and their therapists the fees are of even greater importance in defining the therapeutic boundaries which
have been both highlighted in this research and that of other studies.
This research has emphasised that is essential to make the aims of personal therapy and the commitment that is involved explicit to trainees prior to starting the course. This could occur at the time of
interview and again at the start of the course. By outlining the financial and emotional commitment that
is involved for trainees entering therapy, courses would allow candidates to consider fully whether they
can afford it, as opposed to potentially just agreeing out of their desire to be accepted onto the course.
If potential trainees have personal reasons for not wanting to go to therapy it will also allow them to
consider if it is the right course for them.
It was interesting that Claire evaluated potential therapists on the prices that they charged trainees. It
appears that when she picks a therapist, it is not just due to the matter of whether she can afford the price
the therapist charges, but what the price suggests about the therapist as a practitioner. Therapists therefore should take into account when setting their prices the fact that they might be being judged on how
ethical they are as therapists. This may differ from the wider population as Herron and Rouslin (1992)
suggested that patients who are offered lower prices from therapists are often more suspicious about the
quality of therapy they will be receiving. They suggest that clients receiving cheaper therapy may
well devalue it unless they can be convinced that the therapists involved are sufficiently knowledgeable (p.9). This is in contrast to Claire who believes a therapist setting a lower price is in fact a more
ethical practitioner. I suggest that a stronger rationale is provided for the required 40 hours of mandatory
therapy by the BPS, given the further financial stress that therapy puts trainees under.
The trainees discuss being under a huge amount of stress during the DPsych course both emotionally
and financially. Perhaps in the first year of training trainees could have mentors i.e. trainees who are in
the year above them on the course. Trainees discussed the idea of introducing a peer discussion group.
Although many courses offer tutorials often course facilitators are present. Arguably, having trainee
groups would allow trainees more freedom in their conversation, i.e. less fear of judgement in which to
discuss their therapy or indeed any other matters. Personal development groups can provide chances for
consideration on interactions and other significant learning of counsellor abilities and processes (Payne,
2004).
Evaluation of project
One may only be aware of ones preconceptions once the interpretation is already occurring (Smith,
2007). I was surprised by some of the participants responses, especially in regards to one participant
who appeared furious about mandatory therapy. One of my own preconceived thoughts, that I had not
realised I possessed, was that by choosing to attend a counselling psychology course, one had made a
choice to have therapy. This encounter made me realise that for some people it had not seemed a choice,
but rather a condition. Researchers must wage a continuous, iterative struggle to become aware of, and
then manage, pre-understandings and habitualities that inevitably linger (Finlay, 2008a, p.29). Accordingly, whilst I was not always aware of all of my pre-conceptions I feel that when I did become aware
of them I managed to use them as a way of generating deeper insights.
Strengths and limitations of the research

This research (and the wider study it has evolved out of) has sought to shed light on the relationship
between counselling psychology trainees and their therapists. I would argue that this study has the potential to deepen understanding of the complexities involved in training and practice. Furthermore, this
research has illuminated the range and complexity of participants responses in response to the subject
of mandatory personal therapy. I suggest that a particular contribution of the research is that it suggests
an onus on course directors to address the financial and emotional implications of mandatory personal
therapy.
There are also limitations to this study. Firstly, by using two groups of participants I almost have two
research projects. Despite this, I feel that researching the experiences of both the trainees and qualified
psychologists has given my research an added dimension and relevance to counselling psychology. After all, there are two people in a therapeutic relationship and I think that trying to access the experiences
of both makes the research more interesting and informative. There has been one other study that has
attempted to do so, and that was over two decades ago (see Kaslow and Friedman, 1984).
Secondly, one key methodological limitation is the sample size, which is relatively small and also selfselecting. Perhaps the participants who volunteered to participate have particularly strong ideas about
mandatory personal therapy, whereas there may have been other people who did not feel passionately
about it, hence why they did not choose to participate. For example, Claire was particularly angry at
the BPS about funding in particular, and the disparities between the way she perceived the treatment
of counselling and clinical psychologists, which might imply a bias to the way she viewed mandatory
personal therapy.
The participants were also all from London universities. The themes and analysis produced from this
study may have been entirely different if I had interviewed trainee counselling psychologists and their
therapists from different university courses all over the country. Nonetheless, my research sample consisted of participants from a range of cultures and I hope that added to the depth of the study. It is also
important to note that IPA differs from methods such as grounded theory in that it does not aim to
produce theoretical claims from the interviews, and instead is concerned with the microanalysis of individual experience, with the texture and nuance arising from the detailed exploration and presentation
of actual slices of human life (Smith et al., 2009, p.202).
Conclusion
This research has shown that the financial and emotional implications of mandatory personal therapy
are far-reaching, both for the trainees and the therapists. Nevertheless both groups of participants
highlight that the benefits outweigh the costs. The trainees stress that the payback of mandatory therapy
outweigh the stress of combining work load, therapy and financial costs. The therapists, whilst reflecting on their experiences of mandatory therapy suggest they have a similar viewpoints. They emphathise
with the trainee-clients and accommodate to their needs, sometimes at their own cost.
This study suggests that therapists, trainees and course directors may all have to own some responsibility with regard to the inclusion of mandatory therapy:
Firstly, trainees have a responsibility for evaluating, before committing to a counselling psychology
training programme, whether they can commit financially and emotionally to a course which requires
mandatory personal therapy. Trainees also have to cope with additional pressures when it comes to the
mandatory nature of therapy given the emotional intensity demanded and the financial burden involved.
Secondly, it is significant that therapists both identify with and sympathise with the trainees, which
can results in special considerations being made. The fact that qualified therapists perceive a disparity
when working with trainee counselling psychologists, in contrast to other client groups, is significant
and should be acknowledged. The therapists lack of acknowledgment during therapy of the demands
involved from both trainee and therapist can result in not always keeping to Rogers (1961) core conditions in the counselling relationship. It is hoped that therapists reading this research will reflect on the
importance of acknowledging early on in the relationship the elephant in the room. Furthermore, as
trainees respect boundaries from the therapists, it is important for therapists to maintain their roles as
therapists as opposed to peers and/or supervisors and also for them to handle any concerns about being
judged by the trainees.
Finally, there is an onus on course directors to be more explicit, both pre-interview (in the course information) and during the interview, about the rationale and potential impact of mandatory personal
therapy.
Despite reported negative and challenging aspects of the experience, both trainees and qualified therapists feel that mandatory personal therapy should remain a key feature of the course.
References
Atkinson, P. (2006) Personal therapy in the training of therapists. European Journal of Psychotherapy
and Counselling, 8, 407-410.
Avis, T. (2010) The Elephant in the Room: a study exploring how trainee counselling psychologists
experience mandatory personal therapy and how counselling psychologists experience having trainee
counselling psychologists as clients. DPsych Counselling Psychology dissertation: City University,
London.
Bachelor, A., and Horvath, A.O. (1999) The therapeutic relationship. In M. Hubble, B.Duncan and S.
Miller (Eds.), The heart and soul of change: What works in therapy (pp.133-178). Washington: American Psychological Association.
Beck, J.S., and Butler, A.C. (2005) Treating Psychotherapists with Cognitive Therapy. In J.D., Geller,
J.C., Norcross, and D.E. Orlinsky, D.E. (Eds.), The psychotherapists own psychotherapy (pp.254-264).
Oxford: University Press.
Bor, R., Watts, M., and Parker, J. (1997) Financial and Practical Implications of Counselling Psychology Training: A Student Survey. Counselling Psychology Quarterly, 10 (1), 69-75
British Psychological Society (BPS) (2000) Ethical Principles for Conducting Research with
Human Participants. Retrieved 1 September 2007 from http://www.bps.org.uk/document-download-area/document-download$.cfm?file_uuid=F1C8E142-E935-EC00-75FD519F1FDDEA5Dandext=pdf.

British Psychological Society (BPS) (2002) Regulations and Syllabus for the Diploma in Counselling
Psychology. Leicester: British Psychological Society.
Dearing, R.L., Maddox., J.E. and Tangney, J.P. (2005) Predictors of Psychological Help Seeking in
Clinical and Counselling Psychology Graduate Students. Professional Psychology: Research and Practise, 36, 323-329.
Geller, J.D. (2005) Boundaries and Internalisation in the psychotherapy of psychotherapists. In J.D.,
Geller, J.C., Norcross, and D.E. Orlinsky, D.E. (Eds.) The psychotherapists own psychotherapy (pp.379404). New York: Oxford University Press.
Geller, J.D., Norcross, J.C. and Orlinsky, D.E. (Eds.). (2005) The psychotherapists own psychotherapy.
New York: Oxford University Press.
Grimmer, A., and Tribe, R. (2001) Counselling psychologists perceptions of the impact of mandatory
personal therapy. Counselling Psychology Quarterly, 14, 287-301.
Grimmer, A. (2005) Mandatory Personal Therapy for Therapists. In R. Tribe, and J. Morrissey, (Eds.),
Handbook of Professional and Ethical Practise for Psychologists, Counsellors and Psychotherapists
(pp.277-289). Hove: Brunner-Routledge.
Heery, M., and Bugental, J.F.T. (2005) In J.D., Geller, J.C., Norcross, and D.E. Orlinsky, (Eds.), The
psychotherapists own psychotherapy (pp.282-296). Oxford: University Press
Herron, W.G., and Rouslin Welt, S. (1992) Money matters: The Fee in Psychotherapy and Psychoanalysis. New York: Guildford Press.
Kaslow, N.J., and Friedman, D. (1984) The interface of personal treatment and clinical training for
psychotherapist trainees. In F.W. Kaslow (Ed.), Psychotherapy with Psychotherapists. (pp. 33-58). New
York: The Haworth Press.
Payne, H. (2004) Becoming a client, becoming a practitioner: student narratives of a dance movement
therapy group. British Journal of Guidance and Counselling, 32 (4), 511-532.
Phillips, A. (2006) Side Effects. London: Penguin.
Macaskill, N.D. and Macaskill, A. (1992) Psychotherapists-in-training evaluate their personal therapy:
results of a UK survey. British Journal of Psychotherapy, 9 (2), 133-138.
Macaskill, A. (1999) Personal therapy as a training requirement. In C.Feltham (Ed.), Controversies in
Psychotherapy and Counselling. (pp.142-155). London: Sage Publications
Martin, D. J., Garske, J. P., and Davis, K. M. (2000) Relation of the therapeutic alliance with outcome
and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438450.
Mearns, D. (1997. Personal Development during Training. In D. Mearns (Ed.), Person-Centred Counselling training (pp.95-108). London: Sage.
Mearns, D. (Ed.). (1997) Person-Centred Counselling training. London: Sage.
Norcross, J.C. (2005) The Psychotherapists Own Psychotherapy: Educating and Developing Psychologists. American Psychologist, 60, 840-849.
Norcross, J.C. and Halgin, R.P. (2005) Training in psychotherapy integration. In J.C. Norcross and M.R.
Goldfried (Eds.), Handbook of psychotherapy integration (2nd ed., pp.439458). New York: Oxford
University Press.
Norcross, J.C., Strausser-Kirtland, D., and Missar, C.D. (1988) The processes and outcomes of psychotherapists personal treatment experiences. Psychotherapy, 25, 36-43.
Norcross, J.C., Geller, J.D., and Kurzawa, E.K. (2000) Conducting psychotherapy with psychotherapists: I. Prevalence, patients and problems. Psychotherapy, 37, 199-205.
Norcross, J.C., Geller, J.D., and Kurzawa, E.K. (2001) Conducting psychotherapy with psychotherapists: II. Clinical practises and collegial advice. Journal of Psychotherapy Practise and Research, 10,
37-45.
Smith, J.A and Osborn, M. (2008) Interpretative Phenomenological Analysis. In J.A. Smith, (Ed.),
Qualitative Psychology: A Practical Guide to Research Methods, (2nd ed., pp.53-80). London: Sage
Publications.
Smith, J.A., Flowers, P., and Larkin, L. (2009) Interpretative Phenomenological Analysis: Theory,
Method and Research. London: Sage.
Thorne, B., and Dryden, W. (1991) Key issues in the training of counsellors. In W. Dryden and B.Thorne
(Eds.), Training and Supervision for Counselling in Action (pp.1-14) London: Sage.
Williams, F., Coyle., C., and Lyons, E. (1999) How counselling psychologists view their personal therapy. British Journal of Medical Psychology, 72, 545-555.
Willig, C. (2001) Introducing Qualitative Research in Psychology. Maidenhead: Open University Press.
Willig, C. (2008) Introducing Qualitative Research in Psychology (2nd ed.). Berkshire: Open University
Press.
Woolfe, R. (1996) The nature of counselling psychology. In R.Woolfe and W.Dryden (Eds.) Handbook of Counselling Psychology (pp.3-20). London: Sage.
Woolfe, R., and Dryden, W. (Eds.) (1996) Handbook of Counselling Psychology. London: Sage.
Wosket, V. (1999) The Therapeutic Use of Self: Counselling Practise, Research and Practise. London:
Routledge.
Its because of what we did that Im going to

university: A qualitative exploration of the
experience of growing through a schools
therapeutic programme.
Lydia Noor, Scarborough Psychotherapy Training Institute
Email: lydia@webnoor.plus.com
Abstract
This study aimed to give voice to the lived experience and perceptions of seven students (aged 15 to
17) who have used a therapeutic service in school. Group or individual interviews were employed, transcribed and then analysed using a phenomenologically-orientated relational research methodology. The
students all expressed valuing a confidential one-to-one space where they could express and explore
their worries and uncertainties. They benefitted from feeling understood and having their perspective
validated as normal. The opportunity to express feelings that distracted them from learning at school
opened up new skills of reflection, negotiation and being able to reach out for support. Through their
therapeutic experiences they learned to invest in their own success and resist potentially destructive
peer pressure. A short discussion raises wider issues around the provision of therapy in secondary
school settings.
Introduction
The aim of this research is to give a voice to the lived experience of a group of students (aged 15 to
17) who have used a therapeutic service in a variety of ways during the last five years within a Northern
Secondary School.
I began teaching in 1973 and throughout my career I have been committed to the emotional well-being
of children and young people. Since training in integrative psychotherapy, I have been centrally involved in developing and facilitating a therapeutic service within a secondary school. From my observations and experience, as well as anecdotal reports from the students, teachers, support workers and
senior leaders, the therapeutic service appears to be hugely beneficial in all sorts of ways we had not
predicted. It seemed important to collect some data in a more systematic way so I set out to investigate,
more formally, how a group of students had experienced their therapeutic input, towards subsequently
answering, the bigger question of what value there was in having this therapeutic service in a secondary
school. However, for the moment, this article seeks to focus on the experience of the students, as they
describe their engagement with group and individual therapy within their school.
The context and development of the service

Probably most secondary schools up and down the country have a mission statement which includes
aims centred on promoting resilience and positive self-regard, as well as supporting the emotional needs
and wellbeing of the child or young person. Indeed, within the school where this study was carried out,
education is viewed as a holistic endeavour, with the school as an agent that enables students to fulfil
their potential. For some students, this requires more specialised emotional support, so that challenging
life events and circumstances do not inhibit academic success. In 2004, a document published by the
Department of Health, Promoting Emotional Health and Wellbeing was distributed to all schools. It
outlines the relationship between good mental health and young peoples attainment (Department of
Health, 2004). More recently, from 2008, funding from the Department for Children, Schools and Families has been directed, via Local Authorities, towards schools for projects which promote good mental
health. These Targeted mental Health in Schools (TaMHS) projects highlight the national agenda for
the promotion of good mental health for children and young people.
In my school, there was the recognition that some students required more specific and personalised
input to meet their emotional needs, than national initiatives allowed; needs which could impact on attainment and achievement without appropriate intervention. Over a period of six years, a therapeutic
intervention team has grown in this school and now consists of three psychotherapists/psychotherapeutic counsellors in school for one day per week each, a trainee psychotherapist on placement for one day
per week and the equivalent of one full-time specialist emotional literacy teaching assistant (ELTA).
My role has been to lead the development of this team and to provide on-going regular supervision for
the team members and to other members of staff involved in delivering frontline pastoral and behaviour
intervention services.
Five years ago, as the only therapist for two days per week, the first developments of therapy within
school were within the Inclusion Faculty during a time when the culture of the school was changing.
The new direction was moving away from a predominantly punitive attitude towards a culture which,
although sanctions were clearly linked to inappropriate behaviours, the school was also developing a
range of reparative interventions. The initial aim was to enable students that were caught up in challenging behaviour patterns to access therapeutic help, to support them to make changes. However, as
the capacity within the service has grown, we have been able to respond to a wider range of emotional
needs and focus more broadly on emotional literacy. It was within this developing responsive culture
that therapy was felt to have a place ensuring students had opportunities to have non-shaming, reflective
conversations with empathic adults.
Currently, students can access therapy for one-to-one sessions through self-referral, referral by any
adult within the school or through a concern from a parent/carer. The internal referral system is via a
students Head of Year, who seeks parental permission and forwards the referral to a centralised list.
The service aims to respond flexibly and therefore some students may only need a brief input of six to
eight sessions, whereas others may require longer-term relational-developmental therapeutic support
for several months. Additionally, the service is designed to respond to students in crisis, for example,
students who are in danger of self-harm or those who have experienced a traumatic event such as a sudden loss or bereavement. On completion of therapy, students are given information about how to return
for further support if they want to.
Interestingly, there is much spoken and written about the importance of seeking the voice of the student in informing our provision for teenagers and, indeed, most schools have student councils through
which representatives of the student population can air their view regarding many aspects of school life
such as leisure facilities, extra- curriculum activities etc (Halsey, Murfield, Harland, and Lord, 2006).
In this climate of the importance of thestudent voice the views of therapy service-users seem highly
appropriate, as long as these views are used to inform access and provision. If we dont ask students
what they think and what they need, they will tell us by voting with their feet, and refuse to engage
with what we offer. The service could then become a token showcase for inspection purposes, rather
than an embedded necessity that informs and challenges the culture of the school.
This study thus seeks to capture the reflections of a small sample of students who have accessed thera-
peutic support, as they move towards the end of or are about to leave Key Stage 4.
In addition to hearing the voices of the students, this study marks a point in my personal integration
where I pause in my own quest as facilitator, teacher and therapist and listen to what those on the receiving end have to say in answer to the question of how they experienced the therapeutic service. But
I, too, am part of their story and therefore I include, latterly, something of my own story in a reflexive
discussion.
Literature review
A recent review of studies which evaluate the value of counselling in secondary schools found that the
predominant form of counselling available in schools was person-centred (Cooper, 2009). My study
seeks to look at the students view of the impact of a relational-developmental model of integrative psychotherapy which is closely aligned to the model developed by Evans and Gilbert (Evans and Gilbert,
2005).
Coopers (2009) view is that counselling in a school environment provides a non-stigmatising, accessible and effective form of early intervention (2009, p.138) and his review of both qualitative and
quantitative data lists several helpful factors such as getting things off ones chest, problem-solving,
advice and suggestions, awareness and understanding and confidentiality (2009, p.145). My particular
study is purely qualitative in nature and seeks to gather evidence from the students themselves so that
the future development of this schools therapeutic service takes into account the predominant needs of
the students within the specific culture of this school.
In 2009, the Place2Be, an extensive provider of therapeutic intervention for children and young people
since 1995, conducted a survey to measure the effectiveness of therapeutic intervention in primary
schools (Lee, Tiley, and White, 2009). Their findings were arrived at through the use of questionnaires
completed by parents and teachers to ascertain the impact of therapeutic intervention. The researchers
found that the Place2Be model of intervention had a positive influence on childrens social and emotional well-being and that significant increases in childrens positive behaviours were also identified
following intervention (Lee, Tiley, and White, 2009, p.156). Whilst these findings are supportive of
their particular model of intervention as measured by adults within the school context, I consider the
students in my sample to be capable of speaking for themselves in their own words and therefore feel
that the methodology chosen for this study is particularly suited to gathering the information that we
wish to use for informing future developments.
Within the world of therapy much value is placed on the need for adolescents to be listened to by empathic adults. Luxmore writes extensively about the range of communications from teenagers that they
express through anger. Luxmores wide-ranging understanding comes from his personal experience
of working with adolescents, which he uses to inform his work. (Luxmore, 2006). Similarly Camila
Batmanghelidjh tells the individual stories of children and young people and, through her witnessing
their lives as lived, describes her therapeutic model and intervention which is directly informed by the
children and young people with whom she has worked (Batmanghelidjh, 2007). Similarly, my intention
is to develop both a service and a model of working that is informed by the views of the young people
that use it.
Methodology
Phenomenologically-orientated relational research methodology (Finlay and Evans, 2009; Finlay,
2009) was employed to explore the perceptions seven students had of their experience of engaging in
the therapeutic intervention at their school.
In this methodology, data is seen to emerge out of the researcher-participant relationship and as being
co-created in the embodied dialogical encounter. Central to this relational approach is the understanding that the research relationship involves an interactional encounter in which both parties are actively
involved; it emerges out of a constantly evolving, negotiated, dynamic, co-created relational process, to
which both researcher and participant contribute (Evans and Gilbert, 2005). Particular attention is paid
to exploring participants way of being, including their creative adjustments (the defensive strategies
theyve developed in order to cope) and subsequent changes they were able to make through therapeutic
intervention.
Also with this approach the use of reflexivity is valued, in order to keep communication channels open
towards acknowledging emotional and relational dynamics, as well as any tensions arising from the
different social positions of researcher and participant. Here, my role as their teacher/facilitator and
differences in our power/status and age are relevant.
Participants
A convenience sample of five girls and two boys, between 15-17 years of age, was chosen (see appendix
one) because they had been offered and made use of individual therapeutic support at some point during
their five years at the school. Prior to his individual sessions one student had also attended a six-session
Learning about Anger group for boys. Two of the girls had also participated in groups which focused
on improving behaviour for learning. The students in this sample were on the point of leaving, or had
recently left, key stage 4 (Year 11). I sought to interview the young people who had completed their
therapy, rather than younger students who were still working with, or may return to work with, members
of the emotional literacy team.
Data Collection and Analysis

Data was collected in two semi-structured group interviews and one one-to-one interview, plus a reflective diary kept by myself (to record reactions, thoughts and feelings throughout the research process).
The group and individual interviews lasted approximately three quarters of an hour and took place in
a private, comfortable room away from the main school building. Care was taken that the interview
would not be interrupted, by informing other users of the building that the interviews were taking place.
Not only was the room chosen for its privacy, but as a space familiar to all the participants. I asked each
student individually whether they were willing to be interviewed and gave them several days to reach
their decisions. At the time of the interviews, each student was asked if they still wanted to participate.
The setting was informal, with refreshments. I started each interview with an introduction to the research topic and invited them to talk about the therapeutic support they had had over the years and how
they had experienced it.
As I had previously fulfilled the role of being alongside the student, interested in their views and seeing the world from their perspective, the students experienced me as someone outside of the system,
an adult who did not require compliance. Several of them had had the experience of being in a relationship with me where they could express their anger and our relationship had survived.
Throughout both the interview and analysis, I attempted to set aside previous assumptions. It was necessary for me to try to bracket my previous understandings in order to attend actively to my participants
experience. I strove to adopt an attitude of open-ended presence to their stories as they unfolded (Finlay
and Evans, 2009).
Analysis occurred in stages over several months. Firstly, the transcriptions were systematically and
repeatedly read in an attempt to become empathically immersed in the students experience. During
this process, particular statements seemed to present themselves as being indicative of the students
thoughts, feelings, needs, behaviours and changes and were duly dwelt upon; my responses to their
words recorded in a reflective diary. This was followed by a process of repeated reflection on both
scripts and diary which sought to identify emerging and recurrent themes experienced by the participants, with the aim of highlighting commonalities between them. Throughout the analysis I paid particular attention to not knowing and not assuming about the students experiences, other than from
their perspective as told on the occasion of the interviews. Having loosely identified what seemed like
key themes, I found quotations which seemed to exemplify the themes and then elaborated and explored
the themes further.
The students were invited individually by me to give me their views of the emotional literacy intervention that they had received, but then given time to discuss with each other whether or not they wanted
to take part in the research. The signed informed consent form made it explicitly clear that they could
withdraw from the research project at any time and they would have supportive access to a named contact person within the school. The participants were told that, if at all possible, their preference for the
member of the team they wanted to see would be honoured.
They students were also asked how they would like to be known in the write-up. However, although
they all chose to be known by their own names, I decided to preserve their anonymity. Each student was
offered the opportunity to come back after their interviews if any issues subsequently surfaced.
Findings
Theme one: Give me a safe space where I can show you what it is like for me
The students explained that their therapeutic time was important, as it provided a safe place where
they could explore what it was like to be them. One of the crucial things was to have a space where
they could have their story heard, and, subsequently, sense made of their inner worlds, through their
relationship to a safe, non-judgmental, empathic adult. For Jess this meant that she was neither pitied
nor judged in her therapeutic session, as she felt she might be by adults who did not know what was
happening in her life.
If you go around the staff room, then it doesnt help anybody, because they either pity you or
they judge you. (Jess)
In relation to adults who dont know and understand them at a deeply personal level, they feel mistrusting, anxious and vulnerable. The students say they pretend everything is fine, not only with adults,
but also within their peer groups. In the confidential space they feel safe and secure enough to put down
their bravado (defences) and explore their inner worlds to be known. As Kate says:
You can discuss something personal, youd normally get laughed at. Something serious that is
causing you, like, loads of upset and anger. (Kate)
Kate says that, if the space provides her with safety, she is willing to step into the relationship and
explore her inner world. However, Kate also expresses that the building of trust within a relationship
takes time.
Similarly, Rebecca acknowledges what the trust means to her.
There was this trust there. I trusted that you wouldnt say anything if I didnt want you to. If
youre going to cry and tell them everything, youve got to trust them to an extent that theyll
keep it confidential. (Rebecca)
This safe adult could be trusted not to divulge confidences and, unlike their peers, did not require
anything in return. Having this space gave the students an opportunity for their feelings to be expressed
through tears, anger, despair feelings that arise from outside school such as family stresses and within
school such as pressure from peers and adults.
The students culture tells them not to trust others and to rely only on themselves. Their stance is to
not trust anyone neither fried nor adult. For instance, Kate shares her cautious behaviour of not trusting even her best friend:
If you tell someone who is meant to be your best mate something, within a day the whole town
will know. (Kate)
Rebecca says something similar in response to my question about the importance to her of no-one else
finding out about her sessions and stresses that in order to explore her difficulties with friends, she had
to be certain that no-one from within the peer group would find out about anything that she was saying.
This also raises issues about time, place and access in relation to confidentiality.
So to engage in a personal exploration of their often unknown inner world, with the support of an adult
from within the school environment, is something of a leap of faith for them. Through the therapeutic
relationship the students learn to trust and they learn about the qualities of someone who is trustworthy
and can therefore identify safe adults/peers in other contexts.
Once you have bonded with someone, you learn how to bond with other people. Its like as soon
as I bonded with you, and when I went to go and join Cadets I knew who I could trust. And
I knew they would support me. (Kate)
In this safe space they can say things that are so forbidden in their peer groups seen as showing off,
for which they could be ridiculed. In the therapeutic relationship they can, for instance, acknowledge
and reflect upon their successes and talents. Rebecca demonstrates how she has internalised a supportive voice when she says, I did really well, didnt I? and in this moment she knows about her own
change as she reflects upon how she was able to support herself to overcome difficulties that were previously overwhelming. Perhaps, more importantly, she is now developing an internal voice that will
nurture her rather than undermine and shame her. This new voice also supports Rebecca to not go on
about not being pretty, as defined by her peers, but instead to know her own beauty.
Lauren and Annie are aware of the need to opt into the therapeutic relationship for it to work and although, throughout the interview, they clearly express the benefits of their therapy sessions, they also
make it clear that they would find it difficult to seek help again. They say:
I probably wouldnt. I wouldnt feel comfortable just going up and saying I dont know
Well if it was the same person I had, but if it was someone different I wouldnt. No. If someone
else come and got me and said have you got a problem? Id be like I dont think so some
how. (Lauren)
I dont think Id dare. I dont know I didnt come to you last time, did I? I got you coming
to me. (Annie)
The ambivalence about needing a safe relationship and not initiating the process of seeking help for
themselves is interesting and suggests to me that perhaps there is something both empowering and
shaming about needing someone to talk to. In designing a service, therefore, we need to pay particular
attention to how we create easy access that is non-shaming as well as confidential - a service that is valued by other adults within the school who might spot when a student is in difficulty and could therefore
direct them towards support.
Theme two: If you dont help me, Im going to rip somebodys head off.
Every student made reference to the importance of having a safe space with a strong adult who would
welcome, understand and explain their feelings - their anger, their tears, their excitement and their
shame. They refer to carrying feelings from incidents with their family members and peers and also
from being in the classroom, which they are frequently unable to contain. They explain how these
powerful feelings distract them from their learning, describing how their feelings build up and, although
they try to keep everything locked inside, they often feel like exploding and sometimes do. Frequently
the adult in charge fails to understand that their anger is not intended for them. Within the therapeutic
session, there is a relief at being able to cathart unmanageable feelings and maintain the relationship.
Its like you dont want to keep everything locked inside you, do you? Youve got to find someone you can talk to. Because if you keep it all locked in youre going to have a breakdown or
something. (Kate)
I had absolutely no control Id got to that point when I first come to see you and I was absolutely at rock bottom. I just cried and cried and cried (Rebecca)
The students describe a wide range of powerful feelings that need letting out. Feelings of anger are
predominant; towards themselves, their friends and particularly towards adults who appear to be unjust.
However, they also need time, space and skilful intervention to express their distress, tears, anxiety and
fears, and to feel the relief of getting it all out so that they are available to learn.
The students value having the opportunity to explore and safely express their feelings, without harm to
themselves or others. Additionally, they describe how, armed with their new awareness and knowledge
of safe ways to cathart, they create safe spaces for themselves in other environments, such as their bedrooms at home. Additionally, Ben teaches his girlfriend about anger and Annie suggests to an angry
friend that she would benefit from some therapy sessions.
It depends which way you let it out. Because if you let it out in a bad way and you go around
and smack people or smack walls And now, I put a pillow on it. So I stick my pillow on my
wall and then smack it. (Kate)
And then with [my therapist] it was physical things. Like if I was angry we would chuck beanbags at walls and stuff. It was funny but it got everything out. (Annie)
Yes. Instead of hurting yourself and that, you just let it out by swearing. (Ben)
Having a regular confidential space enables them to manage previously overwhelming feelings, and to
contain themselves until they are in a safe space and recognise that current context is inappropriate or
is not able to support them.
Its like some days, it was like, Oh God, I cant wait for this day to see you, to just talk it out.
So Id store it up and vent it when I see you. (Rebecca)
In learning, particularly about their anger, they show understanding that the apparent triggers in the
school environment are not necessarily the source of their anger and shame and thus they learn to feel
pride rather than humiliation in walking away. The recognition from his ELTA when Ben managed to
control his anger helped him to develop an internal supportive voice that he could draw upon in times
of stress, one that said, Yes I can do this.
Jess also describes her capacity to contain herself and not act out in a manner that was previously disruptive to both her learning and others in her class. She says,
Its like when youre angry you dont have to take it out on the person nearest to you. Well it
just gives you time to calm down, doesnt it really. (Jess)
The students described that not only were the sessions useful in getting rid of overwhelming feelings,
they also learn the value of talking, as Paul and Kate describe below:
It does feel a lot better when you speak. Yes, because youre the only person I can talk to about
my problems. If I go and tell my mates all the problems it goes back and youre going to have
different mates coming up to you with different stories, saying Oh, well this happened to you
(Paul)
Kate goes on to describe the difference in herself when she talks to someone rather than behaving destructively.
I always feel worse knowing afterwards that Ive just made everything more destructive. But if
you sit down and talk to someone it will work out a lot better for you. Because if youre calm
about the situation and keep a cool head on you it will be alright in the end. (Kate)
All the students who were interviewed had experienced the relief of a non-shaming space where they
could let out feelings of anger, humiliation or upset that they could no longer keep bottled up. Additionally, they could also develop contextually-appropriate strategies for managing their feelings and
even taught them to their peers. Having had the opportunity to safely get rid of their feelings within the
therapeutic space, they were available to use the therapeutic relationship to use talking to process the
challenges, difficulties and issues that lay behind their defensive behaviours. In therapy, the opportunity to get angry and maintain a relationship was beneficial in enabling them to feel proud and trusting
of themselves rather than the humiliation, remorse and poor reputations that they had felt from acting
out in more public spaces such as classrooms.
Theme three: I want to show them that theyre wrong about me

One of the themes to emerge showed that some of the students with reputations for disruptive behaviour wanted the opportunity to be known as someone who was interested in and committed to learning.
They knew that they were trapped in cycles of inappropriate behaviour which was often encouraged,
supported and enjoyed by peers. In fact, Paul describes the pleasure and belonging he felt within his
peer group when he was being disruptive, with his friends as a very willing audience. The students in
this study did not know how to change on their own and needed to step out of their learning and social
environments to access the time and space to change. They needed confidential access to someone
alongside who was invested in understanding their views and appropriately challenging them to do
something different. In using therapy as an agent of change, the time spent out of lessons was legitimised and the students therapist could, with the students permission, negotiate with teachers to release
them. In describing her awareness, Kate is very open and frank about herself:
Yes, from year seven to year nine I was awful I dont know really. I just know that I was a
very naughty girl, and then I found you, or you found me because you followed me and made
sure that I got the help that I needed and kept me on track, and then I havent been back since.
Without you and your team, like, people like us, we will still be the little shits that we were. I
know I still would be. (Kate)
Kate explains the importance of being found, to be invited into a relationship where she can explore
who she is, what is happening in her life and what she might want to do differently. She needs the ongoing commitment of someone who will allow her to falter, to make mistakes to stay invested in her
well-being and to believe in her potential.
Some of the students have a clear purpose for agreeing to come to therapy and Jess is one of these. She
knows that she has developed a poor reputation from her continual disruptive behaviour in lessons. In a
confidential space she is able to share the challenging aspects of her story that no-one knows about and,
in doing so, clear the way for exploring change. She says, I wanted to show them that they are wrong
about me. but is unable to do this alone.
The students agree that it is very difficult to change their reputation and there is hopelessness and,
potentially, a stance of despair andwhy bother? when they feel that someone elses view of them has
gone before. Lauren and Ben say this in the following ways:
If an email got round saying Oh this kid is blah blah blah horrible, then thats what they think
of you straight away. (Lauren)
I dont want him because hes a bad lad and everything. Its like everything I did was bad.
(Ben)
As well as therapy, they sometimes want the intervention of an advocate outside the therapeutic space.
They are clear that they want their permission to be sought about what can be shared and usually want to
be present if an adult is speaking on their behalf. Jess is very definite, as she wants her therapist to have
a word with teachers so that they back off a bit particularly when she needs other adults to know how
she feels. If she is going to change, she needs tolerance, understanding, time and recognition of her
efforts. Paul agrees and adds that being spoken to nicely and properly makes him just want to keep
doing it (engaging as a learner) and with consistent encouragement from teachers, he wants to do it
again so she can say Im better. Although given positive attention is an accepted strategy to improve
behaviour, these students are telling us that they need teachers to notice and amplify their appreciation
of their small steps towards change and, for this to happen, they sometimes need the advocacy of the
therapist, either directly to the teachers or via an adult in charge of their pastoral welfare.
However when we act as advocate or mediator, we need to be aware views such as Jess, who is reluctant to expect a positive reception. She says,
I dont know [about advocacy] sometimes, in some areas, it can make it good and bad. It depends what the teacher is, doesnt it?
I wonder if she is expressing her despair that the environment will not change its view of her. I am
aware of wanting to convince her that her teachers will notice and respond well but can feel my reluctance in expressing this when it may not be true.
Annie reflects on the role of advocacy to help her talk to her mother. She had learnt from therapy about
how ruptures in relationships are co-created and that the responsibility for repair belong with both participants. She describes how, with the help of her therapist, she was able to tell her mum why she was
behaving as she was and how her parents contribute to that. She goes on to reflect on the change within
herself which has enabled her to express herself to adults and how they support each other when they
are in difficult situations. Again they refer to the guiding internal voice developed through therapy.
We were taught, like, how to speak and get our point across without going off on one. (Annie)
Its like we dont get on with Miss but I can remember on various occasions saying its not
worth it [being disruptive] Its like you have it with you dont you? She [the voice of the therapist carried with her] tells you when to shut up. (Lauren)
As the students reflect on the process of change, they report that once they start they are able to access
help elsewhere. Actively seeking support, particularly through reaching out to others, becomes a more
fluent response to difficulties. However, the struggle to change is difficult, particularly when they are
being induced by peers and old scripts to stay as they are. Interestingly, recognition of change does not
necessarily come from within their families, who are reluctant to re-write their view of their teenagers.
There is, therefore, an even more pressing need for the wider school environment to acknowledge and
perhaps reward change, particularly when it may be difficult for the adults with other priorities to spot
new attitudes and behaviours. Negotiated advocacy can support a student through this process so that
the school environment can offer latitude and flexibility to encompass stumbles and mistakes on the
journey towards doing something new and different.
Theme four: Its okay to be me

The students want to change. They want to express their individuality, yet the pressure from peers to
conform to group norms is weighty. They describe this struggle and the difference between what they
feel internally and how they minimise their own needs in order to belong. They endure painful experiences from their peers to stay in the group. They feel trapped but feel too scared to express their
autonomy.
The friendship group was nasty and hurtful. Id just sit there and laugh along; you know,
laugh it off. Everyone used to say Oh you just try and please other people all timeI tried
and tried and triedI thought, like, you just think you have to belong somewhere. And maybe
its not that important [that I feel hurt] And I dont think Id have realised if it wasnt for this
[therapeutic intervention] I think Id still be there now. What do you want me to do? Jump?
How high? (Rebecca)
In feeling the competing urgencies of their own needs and the demands of the peer group, they feel confused. Through the therapeutic relationship they feel understood, validated and normal. In awareness,
they begin to make choices that are healthier for them, as they shift their focus from external demands
to internal needs.
You obviously focused on the inside of me. So I learned to listen to what I was saying to myself, instead of what other people were saying to me. It helped me to just think, no I will just do
it for myself and no one is going to get in the way of my future. (Kate)
Its like I know I have two choices. I can go along with it if I want to or I can just say No, I
dont need this person; I dont need to go along with this, there is another option. (Rebecca)
In finding this internal focus and interpersonal capacity to do something different from her peers, Rebecca describes her journey of individuation:
Because that was, like I say, Id still be stuck in the same friendship group or whatever. I
wouldnt be off to uni because Id be like Oh, this is my life here. Yes. Cant you remember
when you used to ask me? You used to be like Are you off to uni? I was like No, Im not going. Im staying here. Im scared. Yes, because I thought everything was here. I thought Why
do I have to go to uni? Everythings here. Yes and now Im going. (Rebecca)
Through this theme of its okay to be me, the students express the dilemmas that they face in choosing appropriately for themselves and having choice about whether they respond to pressures from their
peer groups. They also want to be seen as still belonging through their group behaviours and I wonder
if they are describing some sort of secrecy or privacy of having changed internally, which potentially
gives them greater choice, more autonomy and more resistance to peer pressure than they had before
their therapeutic intervention. Rebecca describes how change through therapeutic support has enabled
her to contemplate leaving the safety and familiarity of her home town and go to university she is the
first in her immediate family to do so. She feels scared in making these choices, but also able to survive
her scares, to both rely upon her capacity to meet new challenges and to seek support if and when she
needs it.
Discussion
This small-scale study of seven students experience has demonstrated something of the importance and
value that a therapeutic service can have within a secondary school setting. Four themes emerge which
encapsulate the students views about what is most valuable to them: having a regular safe confidential
space with a trained, empathic, adult; being facilitated to understand, cathart and learn to manage overwhelming feelings; sensitive mediation and advocacy; and the support, opportunity and facilitation to
change. I remain impacted by the students descriptions which powerfully describe a framework not
only for working in this context but also themes which repeatedly present themselves in experiential
groups within psychotherapy training and in my client work with adults.
However, in this study, the students also raise important dilemmas that, as service-providers, we need
to note.
Firstly, the students describe the importance of having individual attention from someone who can work
with the complexity of the issues that they bring to the therapeutic relationship. This has implications
for funding and for how the service might be embedded within the overall pastoral care on offer in a
secondary school.
Furthermore, three of the students had also experienced group intervention and expressed that, within
the group, they could discuss not very important things, but in one-to-one you can go right into personal things.(Ben). With one person that they trust they can be vulnerable, witnessed and known, they do
not need the protection and pretences of their defences defences which are often very appropriate in
less supportive contexts of peer groups, classrooms and even their families. Their clear preference for
individual rather than group work has implications for the delivery of therapeutic services, particularly
when referral lists are long and resources are limited. However, it would be useful to trial the effectiveness of group work as a follow-up to individual sessions, rather than the group experience preceding
one-to-one therapy.
Every student agreed that confidentiality was paramount for them, unless the adult negotiated with them
to speak on their behalf with teachers, heads of year and, in Annies case, her mother. My view is that
the therapist can inform the school environment and agree that therapeutic work in schools involves
deconstructing labels and discourses and challenging assumptions about what constitutes a problem
(Music, 2009, p.20). However, the students warn us that they need to keep control of what is told and to
whom. As therapists we are used to noticing small incremental changes or tolerating that there may be
a prolonged period of time where change is not evident. When we see relational change in a therapeutic
setting it can be difficult to explain when this is not apparent in the wider context of the school. Occasionally, we need to nudge our students gently, to let us be their ambassadors within limits that they
can tolerate. In talking about their internal changes, their commitment is primarily to themselves, not
a compliant adaptation towards adults. They may know that they have made positive changes but they
may not want this to be so evident that they are no longer welcome within their peer group.
Two students also said that, even though the intervention had been valuable, they would find it hard to
initiate further intervention and would like other adults within the school to notice their need. Kate said
that she needed to be found, whereas two of the participants had used the service through referring
themselves via their year managers. In designing a service where access is easy to students with all of
these views I come back to the idea of therapy being an embedded necessity, where all adults who
have contact with young people, in whatever capacity, are alert to emotional needs that might need specialist intervention. This means that, as therapists, we have the task of raising awareness of all adults
about the emotional needs of young people and to encourage those who see students in classrooms
everyday to notice when students need help and direct them accordingly.
The students described the importance of being heard when they disagreed with adults in general. Some
had used their therapeutic space to air their frustrations and vent what they would like to say when they
experienced injustices. Equally, the reflective quality of the therapeutic relationship enabled them to
rehearse different words and tones of voice, so that they could negotiate instead of shout. Four of the
students had a sense of the therapist being with them outside of the sessions. On one occasion, after
the interviews, Ben said that he felt as though he had his emotional literacy teaching assistant in his
pocket! The two boys both referred to enjoying being noticed and praised for their efforts to change
their behaviour and all of the students who had changed their behaviour - from being challenging to
being available to learn - all spoke of the difficulty in changing the view adults held of them. Each of
the girls said that they wanted to change for themselves, not necessarily for others, or for the school.
Several students described the shift from responding externally to peers to making different choices for
themselves to feeling more in tune with their internal needs and hence they became more autonomous
in their decision-making without shame, or anxiety. The findings support the practice of encouraging
young people to individuate in ways that are healthy and appropriate. That this is particularly valuable
during the developmental challenge of teens, a period of increased independence and choice has policy
implications.
Developing relationships which feel trustworthy is not necessarily a quick process, which may mean
that time-limited intervention is not appropriate to support change. Equally, others want to use the service for occasional sessions, particularly to discharge overwhelming feelings; they want to return for
longer when new difficulties emerge in their lives and sometimes they need us to respond now!
Perhaps the most impactful finding was the high value that this group of students placed on having
both privacy and safety in order to cathart their anger, frustrations and tears, as well as needing space to
express their anxieties, fear of failure and the pressures they felt from peers. They showed understanding of the relationship between their anger being triggered in the present even when the original source
was in the past. Importantly, this private space was also where they could celebrate their pride in their
personal development and achievements, something they might feel reluctant to do elsewhere.
Reflexive account
In presenting this research I want to acknowledge my commitment to providing therapy in this particular school and therefore the potential for the students, in knowing this, to be compliant in their answers.
However, except for Rebecca, the students were interviewed in groups where I believed they would be
less likely to comply with the interviewer and more likely to use the dialogue between them to reach
their own views. Additionally, the students, in engaging in therapy, described their journey as having
enabled them to focus on their own thoughts, feelings and needs rather than be confluent with others. It
was refreshing to see these students interacting with each other in a humorous, warm, playful, reflective
manner and with confident expression of their views.
At frequent moments throughout the interviews it was as if I was not part of the dialogue but rather an
observer of their relationships with each other. I was the catalyst for their discussion rather than the
guide. I was therefore able to focus on the impact of these young people and feel my pride and warmth
towards them. In adopting this stance, I was in a position of not knowing and it is only through my
engagement with the transcripts that these themes have emerged. It would be worth exploring whether
these similar themes are mirrored in, and generalize to, other student groups in other schools.
For me personally this research project marks an integration of two careers, my initial work as a teacher
and my later training in integrative psychotherapy. It also denotes integration and updating of a highly
prized family script on the value of education both as a participant and provider; a script arising out
of being the daughter of an Asian immigrant who had arrived in England as a teenager to complete his
education.
When it came to writing up my findings for this study I reached an impasse. For me, the process of
writing is an arduous one I became aware of my anxiety rising. I recognised that, unless I complete
this task, something is potentially paralleled, in that my passion for quality therapeutic provision within
the education system may not be heard. I suppose, therefore, in expressing student voices, I am equally
expressing my own.
Conclusion
This article has discussed a small research project which explored the experience of students who were
supported by a therapeutic relationship within their secondary school. Perhaps the key lesson to come
out of this research is that these students valued having a confidential one-to-one space where they
could talk about aspects of their experiences which worried and confused them. They benefit from being understood from their perspective and this makes them feel normal. The opportunity to explore
and cathart powerful feelings that distract them from learning is helpful and makes way for the development of new skills of reflection, negotiation, and reaching out for support from other sources. These
students needed support and direction to enable them to resist peer pressure and to invest in their own
success. Yet, however beneficial they find such a service, they raise important questions that we need
to consider, regarding the process of referral and confidential access to therapy in a secondary school
setting.
References
Batmanghelidjh, C. (2006) Shattered Lives. London: Jessica Kingsley Publishers.
Cooper, M. (2009) Counselling in UK secondary schools: A comprehensive review of audit and evaluation studies Counselling and Psychotherapy Research 2009, 9:137-150.
DCSF Targeted Mental Health in Schools http://www.education.gov.uk/
Department of Health (2004). Promoting Emotional Health and Wellbeing through the National Healthy
School Standard. The Health Development Agency.
Evans, K. and Gilbert, M. (2005) An Introduction to Integrative Psychotherapy. Palgrave Macmillan.

Finlay, L. and Evans, K. (Eds) ( 2009) Relational-centred Research for Psychotherapists. Wiley-Blackwell.
Halsey, K., Murfield, J., Harland, J.L. and Lord, P. (2006). The Voice of Young People: an Engine for
Improvement? Scoping the Evidence. Literature Review. Summary. Reading: CfBT Education Trust.
Lee, C, Tiley, C and White, J. (2009) The Place2Be: Measuring the effectiveness of a primary schoolbased therapeutic intervention in England and Scotland. Counselling and Psychotherapy Research
2009, 9:151-159.
Lines,D. (2006) Aggressive Youth. Therapy Today 2006 17(7), 13-16.
Luxmore, N. (2006) Working with Anger and Young People. London: Jessica Kingsley Publishers.
Music, G. (2009) Containing not blaming. Therapy Today 2009, 20(6), 20-24.
Perry, A. (Ed) (2009) Teenagers and Attachment. London: Worth Publishing.
Appendix One
Table of research participants:
Names
Rebecca
Reason for referral

Difficulties with peer group relationships.
Referred by pastoral team.
Re-referred herself when she encountered a
difficult adult relationship.
Ben
Difficulty with consistently engaging in learning/angry outbursts.

Identified by year manager.
Re-referred himself when he was having
similar difficulties in new lessons, because he
wanted to be a successful learner.
Intervention
Individual sessions of
several months on three
occasions
Six session group followed

by six individual therapy
sessions.
Two therapy sessions at a
later date for catharsis. In
class ELTA support for two
hours per week for a year.
Kate
Argumentative with adults.

Not fulfilling her academic potential.
First identified in classbased emotional literacy

sessions.
Re-referred at various intervals throughout

five years by year manager.
Annie
Jess
Paul
Lauren
Individual sessions with

two therapists on four
occasions ranging from six
sessions to several months
according to need.
Difficulties at home with Mum impacting beIndividual sessions for
haviour referred by form tutor.
several months she also
referred one of her friends
Constantly sent out of lessons challenging
Eight individual sessions
behaviour not achieving academic potential. coupled with mediation
with teachers and year
Identified through on-call system.
manager
Anger after motorbike crash
Occasional individual sessions when requested plus
Asked year manager for some help with anger. overview
Frequently sent out of specific lessons for
challenging behaviour.
Identified through on-call system.
Re-referred throughout by year manager.
Initially, block of individual

sessions for three months,
followed by intervention
when needed.
Supervision and Training of Psychotherapists

in an Indian Therapeutic Community
Usha Srinath and Vijendra Kumar S.K., Athma Shakti Vidyalaya, Bangalore, India.
E-mail: srinathusha@yahoo.com; shankrivi@yahoo.com
Abstract
The process of getting therapy supervision while working in a therapeutic community setting with
persons suffering from chronic mental illness differ from those working in other clinical settings. In
therapeutic communities, the demands on therapists are much more complex, multidimensional and
result in significant emotional stress or burn-out syndrome. For this reason, the therapists need to
undergo intensive training, supervision and personal work on a regular basis. The present article applies
a descriptive-single case study method, focusing on the process of supervision of psychotherapists in a
therapeutic community in India. We explore the process of practical training and supervision of psychotherapists and describe our approach to developing a budding therapists skills and sense of autonomy.
Introduction
The process of getting therapy supervision while working in a therapeutic community (T.C.) setting
with persons suffering from chronic mental illness differ marking from the supervision process occurring in other clinical settings. In therapeutic communities, the demands on therapists are much more
complex, multidimensional and result in significant emotional stress or burn out syndrome (Freudenberger 1975). For this reason, the therapists need to undergo intensive training, supervision and personal work on a regular basis (Meinrath and Roberts 2004). The present article, applying a descriptivesingle case study method, focuses on the process of training and supervision of psychotherapists in a
therapeutic community in India.
Literature Review
Chronic mental illness or mental disorder is a serious and debilitating condition of an individual, which
prevents the individual from making adequate adjustments to meet the demands of the society, be it
occupational, social or personal. Current interventions from the medical and pharmacological fields
are not adequate to deal with chronic cases. These conditions need to be addressed eclectically, taking
into consideration medical, psychological, occupational, socio-cultural and economic perspectives. The
treatment of persons with chronic mental illness requires not merely relieving of symptoms, but also
rehabilitating them into mainstream society as effectively as possible. Halfway homes, rehabilitation
centers and therapeutic communities aim to serve this purpose.
Definition and Principles of Therapeutic Community
A therapeutic community is a tertiary preventive measure to help reduce the impact of maladaptive
behaviour in which rehabilitation efforts are focused more from the environmental perspective (Carson and Butcher 1992).
Northfield hospital started the therapeutic community movement to treat soldiers suffering from psychoneurosis during Second World War under the leadership of Tom Main (1946). He defined therapeutic community as:
An attempt to use a hospital not as an organization run by doctors in the interests of
their own greater technical efficiency, but as a community with the immediate aim of
full participation of all its members in its daily life and the eventual aim of re-socialization of the neurotic individual for life in ordinary society (1946, p. 67).
These ideas were further developed by Maxwell Jones (1959) at the Henderson Hospital and described
a therapeutic community as:
Distinctive among other comparable treatment centers in the way the institutions total resources, both staff and patients are self-consciously pooled in functioning treatment. (Jones 1973,
p.427)
This implies, above all a change in the usual status of patients in collaboration with the staff, they now
become active participants in the therapy of themselves and other patients and in other aspects of the
over-all hospital work in contrast to their relatively more passive, recipient role in conventional treatment regimes.
In a recent article, the authors defined therapeutic community as a treatment center, where resources
of staff and patients are pooled together to enable a therapeutic process. (Srinath and Kumar, 2007).
Even though therapeutic communities are extensions of hospital and after-care centers, they differ in
their values and treatment process. Kennard observes the special potential of therapeutic community as:
In one sense TCs can be seen as all about continuous risk assessment and management, where
episodes of destructive behaviour or threats of it are regularly discussed, analyzed and commented on by staff and clients in the small and large groups. In another sense TCs can be seen
as allowing levels of risk that units with seclusion rooms, close observation policies and rapid
tranquilization avoid- at the cost of no one learning anything about changing self-defeating
ways of thinking, personal responsibility or concern for the effects on others (Kennard, 2005, i).
Principles of Therapeutic Community

Rapoport (1960), an anthropologist, who studied the Henderson hospital between 1953 and 1957 with
his team of psychologists and anthropologists, observed four themes in the hospital, which are distinctive ideologies of the community: communalism, democratization, permissiveness and reality confrontation. Kennard (1998b) defines these principles as follows:
Communalism: Stressing the importance of doing things together and respecting each other.
Democratisation: Involving patients as far as possible in their own treatment planning; encouraging all patients and staff to be involved in therapy and the running of the unit and to
express opinions.
Permissiveness: Being able to express ones distress and use staff and other patients to understand and contain it rather than to act out and transgress boundaries.
Reality confrontation: Encouraging patients and staff to recognize the reality of their situations and the necessity of boundaries and rules in communal life.
Haigh (1999) writes about principles or universal qualities of a therapeutic culture in therapeutic communities as based on object relations theory, self-psychology and group analysis. Haighs prerequisites
of a therapeutic community which are called as the quintessence of a therapeutic environment include
the following concepts:
Attachment - a culture of belonging
Containment- a culture of safety
Communication - a culture of openness
Involvement - a culture of participation and citizenship
Agency - a culture of empowerment.
Burn-Out Syndrome in Psychotherapists

Therapists working with severely disturbed individuals require a diverse kind of orientation and training compared to working in other hospital contexts. Intensive emotional involvement of the therapist
with the patients can cause a great deal of stress for the therapist. Meinrath and Roberts, 2004 write:
The demands of being a good or ideal staff member can take a tremendous toll of a therapeutic
community worker. Deprived clients often seem to ask for everything that they never had as
a child and the community seems to demand an incredible dedication from the staff member
(2004, p. 321).
Transference and counter-transference occurring between the patient and the therapist can bring about
a number of issues. At times the therapists will have to withstand the brunt of negativity, hostility and
rejection by the patients with whom they work intensively. These factors along with passive behaviours,
violence and dependency can lay the foundation for burn-out for the therapists as a tremendous amount
of emotional energy is invested while encountering each of these problems. For instance, after spending a great amount of time and energy working with a patient, the individual - as a part of their negative
coping mechanisms - reject the therapist and choose to work with someone else. This can cause hurt and
create despondency in the therapist who will need to deal with their feelings of anger, rejection, internal
conflicts and feelings of inadequacy. The following example will illustrate:
Mr. Karan, 24 joined our community in 2002 with a diagnosis of paranoid schizophrenia. As
this TC functions on the basis of attachment and bonding, this [young man] got attached to
me and vice versa was also true. With the attachment, he improved in his social behaviour, his
symptoms decreased and he was looking at career options. Meanwhile, I was out of the country
for a period of six months. I was in touch with him through emails. I could sense there was
something missing in his mails. When I got back to India, he had turned very hostile towards
me abusing and accusing me of several things. I could not connect to him like I did before and
every time we spent together would end up in arguments and fights. As time went by, he became
more and more controlling of my time with the other patients. His nastiness was affecting my
relationship with other members of the community. The statements he made were venomous
and hurt me deeply to the extent that I felt my self worth was taking a plunge and I started having paranoid ideation thinking that other people were disapproving of me.(Senior therapist,
Personal communication, January, 2004).
Another challenging issue facing therapists is the way they may be held responsible for the patients life
as well as the welfare of the members of the community. Passivity and discounting (Schiff, 1975)
by the therapist can lead to a dangerous situation which may result in patients inflicting serious harm to
themselves and others. This could have major repercussions to the morale of the whole community in
general and on the concerned therapist in particular.
Freudenberger (1975) observes that this kind of work makes the staff members feel less enthusiastic,
become increasingly rigid and readily provoked, which will lead to burn-out syndrome and can affect
staff members performance on the one hand and disrupt the therapeutic community on the other hand.
Meinrath and Roberts (2004) suggest and emphasize careful staff selection, adequate training and personal therapeutic experience as a remedial measure for burn out syndrome. For this reason, a section is
kept for staff training and supervision in Service standards for therapeutic communities (Keenan and
Paget, 2007; Healy, 2007).
Objectives of the Study

The present study explores the process of practical training and supervision of psychotherapists in a
therapeutic community setting in India.
Another objective of this study is to describe our approach to enabling and developing a budding therapists skills and sense of autonomy which can be manifested as capacity for awareness, spontaneity and
intimacy (Berne, 1966).
Methodology
Research Design
The present study utilizes a case study approach (Yin, 2003) where the purpose of the study is to describe the phenomena and process of training and supervision in a therapeutic community. It adopts a
single-case design with a single unit of (holistic) analysis. The study could also roughly be categorized
as a revelatory case because of its nature of observation and process. Within this design, self-reports of
participant-observations by therapists and trainees are used as data.
Procedure
We have described in detail the functioning of the supervision programme from the time of selection
of the staff member to the completion of his/her training as a therapist. These are presented against
the backdrop of theoretical information, case studies and personal experience of therapists/trainees (all
names have been changed to maintain the confidentiality).
Setting
Athma Shakti Vidyalaya - a residential therapeutic community - was founded in 1979 in India by Ms.
Jacqui Lee Schiff, a pioneer in cathexis school of Transactional Analysis. The community provides
treatment for persons suffering from chronic mental disorders using varied theories and practices of
counselling, psychotherapy and democratic principles. Athma Shakti Vidyalaya (ASV) is a Sanskrit derivative of the Cathexis school. Cathexis means the act of shifting of psychic energy. Athma meaning
soul, Shakti strength and Vidyalaya school: The name of our community therefore translates into a
school which trains people to empower themselves during their treatment process.
Some of the psycho-social interventions like Transactional Analysis (Berne 1961, 1966; Stewart and
Joines 1987), Neuro-linguistic programming (Bandler andGrinder 1975, 1976; Bodenhammer and Hall
1999), Schiffs Reparenting model (1969, 1970, 1975; Childs-Gowel 1979), Psycho-physical exercises
(Roberts andHouston 1978) to integrate body and mind and cognitive enhancement programmes are extensively used in the treatment process. This community has 26 patients at any given time with an age
range of 15 to 45 years. The diagnostic categories are schizophrenia, bi-polar affective disorder, obsessive compulsive disorder, severe personality disorders and behavioural disorders. Staffing is required
round the clock in order to monitor the adequate functioning of the community. As the therapeutic work
is intensive, 2:1 patient to staff ratio is maintained.
Processes of selection and training of psychotherapists

This section of the paper covers the selection process and training of the individuals who opt to become
psychotherapists. While deciding to work in a therapeutic community, careful and serious introspection
will have to be done by the candidate before accepting the responsibility of such a magnitude.
Openness to Learn a New Approach: The First Criteria in the Selection Process
While selecting staff for training to become psychotherapists, it is important to check if the person is
open to learning different treatment modalities rather than practicing arm chair psychotherapy.
Candidates are required to have a post graduate degree in psychology or psychiatric social work. They
are also expected to be reasonable persons (i.e. they should have a functional Adult where they are
aware of themselves and others).
Buddy System
As the therapeutic community functions in very different ways from other set-ups, the newcomers need
someone to guide them. This acculturation process is taken on by one of the senior therapists who are
referred to as a buddy (a mentor who can guide the trainee and offer support). The buddys role is to
explain the structure and functioning of the community to the trainee therapist. A trainee from France
expresses the experience:
I feel so at home being guided by my buddy. She was there with me through the process of
getting used to the food, culture, language and other nuances of the community. She gave me
much needed security at the anxious stage and now I am coming every year to be with the members of the community (Personal communication, April, 2006).
Getting Into Work: Initial Training and Supervision

An orientation booklet is published by the community, which is to be studied by the trainee therapist.
The senior therapists take them through the various diagnostic categories and stages in the treatment
process with each patient. They are assigned two patients for observation and are expected to keep a
record of affective, cognitive and behavioural responses of these patients. The supervisor checks these
records and gives the trainee the necessary feedback.
As the trainee becomes more familiar with the communitys culture and functioning plus the problems
of the patients, they are entrusted with higher responsibilities. They are involved in joining in therapy
groups and making relevant observations while liaising with their supervisors to clarify issues that may
arise in the groups.
They are also given reading material and books. Book review sessions take place every week where the
trainee report to the supervisor to have a discussion on what they have read.
Observation and Management

As some of the patients behaviours are dysfunctional (for instance, the personal hygiene of some of the
patients can be very poor), they need full time observation/supervision. Trainees are asked to observe
how senior therapists handle such behaviours and how, at times, patients may become hostile, aggressive and violent, when put under pressure to conform to social/community norms. Trainees are taught
to diffuse volatile situations and calm the patient down, as the following communication describes:
When I was watching my supervisor teaching Kishen, a chronic paranoid schizophrenic patient
to wash his clothes, Kishen started escalating and defying the senior staff. I was scared that he
was going to hit both of us. But my supervisor did not show his fear or anger but dealt with the
situation in a practical and mature way. The patient settled down and listened to the supervisor.
I learnt that at that time I should not use authority or come from a scared position but come from
a firm and caring position (Trainee, Personal communication, 2007).
In the following extract, a trainee describes learning to handle a difficult patient.
When I confronted Hema for her inappropriate behaviour, she started hurling abuses at me. I
felt inadequate as she had a great language ability and I felt very overwhelmed and scared as I
thought I would make a bad situation worse. Then my senior colleagues entered the room and
were just present. They did not interfere with my therapeutic interventions with Hema but I felt
much stronger handling this situation. Later I was stroked for managing the problem situation
efficiently and effectively (Trainee, Personal communication, August, 2006).
Working on Self: The First Step in Becoming a Psychotherapist

We believe, following Jacqui Schiffs approach amongst others, that the therapist should work on themselves before venturing into treating patients. To this end, psychotherapist trainees are expected to
attend a Treatment Group to be aware of their feelings, attitudes and beliefs. The process of working
on self while being a therapist may create a role conflict for the trainee. If they come from a conventional psychiatric background, they may have a belief that they have no problems and that the patients
are the ones who have problems. They may not feel comfortable accepting the fact that they need to
introspect on some of their personal issues and work on these in order to be an effective therapists. The
process can be challenging as an ex-trainee admitted:
When I was a trainee therapist, I had a lot of prejudices about patients from other religions. I
was hesitant to open up in the group as I had expectations about myself being a psychologist,
I should not have such prejudices. In one group I contracted to work on my issue and get
feedback so that I could change. When I worked on this in my treatment group, I got feedback
about my attitudes and belief system which had to be looked into and changed (Senior therapist,
Personal communication, March, 2001).
Senior therapists support the junior therapists to learn and cope with difficult patients. The following
extract concerning our experience with a person suffering from borderline personality disorder shows
how a supportive structure is essential when working in our challenging environment:

Ambuja, a 25 year old [young woman] was admitted to our community with diagnosis of
borderline personality disorder. She used to abuse and fight with staff members, putting them
down, picking their weak points and using it at the most inappropriate times. She also used to
accuse male staff members of sexual abuse etc. This was unnerving at times. She would convince people of her stories and we would be scared that people would believe her story. She
would try to divide the staff and make them into good and bad staff. In the staff treatment
groups, when the staff shared their distress, they felt that their anxieties were shared by other
members of the group also. This gave a lot of comfort as we found that we could share our feelings of inadequacies and we are not alone in feeling these feelings. There was a feeling of relief
and cohesion amongst the members when the distress was shared. This brought the stress level
down for many trainees and therapists (First author, Personal communication, June, 2005).
Learning to Take Initiative and Responsibility

It is important for trainees to take the initiative to learn and engage in both personal and professional
development. Once the trainee psychotherapists get the necessary orientation concerning the functioning of the community, they are expected to look forward to taking on more responsibilities. At each step
their supervisor would evaluate them before they move ahead to take on new tasks. This is assessed
again in their treatment group and further support is offered for their growth. Here they receive feedback and encouragement relevant to the particular area of responsibility desired by the trainee. From
here the trainee presents his/her agenda in the general staff meeting for another round of evaluation.
After getting support from the rest of the staff, the community is informed of the change in responsibility for the patients to voice their opinions and feedback. The community functions on the principles of
democracy and any member has a right to express his/her opinion freely. If the members of the community do not have confidence in the trainees ability, expectations are put on the same to improve in
certain areas where the deficiencies are noticed.
When they attain a responsible persons status, they are expected to fulfill the following responsibilities. They monitor the dysfunctional behaviours of patients and are helpful in enabling more positive
functioning in different areas. The duration to attain this level of functioning at an average is about
three months.
Once they are settled in the community, the trainees are taught basic principles of Transactional Analysis, the re-parenting model of psychotherapy, listening skills, risk management, neuro -linguistic programming, group dynamics and therapeutic interventions with different diagnostic categories. They
begin to take individual therapy sessions in the presence of their supervisor and are expected to make
notes and discuss the session with the supervisor within a theoretical framework so that theory and
practice go hand in hand while working with the patients.
Role of a Psychotherapist in Managing the Community

In a therapeutic community each therapist has to take on a diverse variety of roles and be competent in
each role. He/she will have to take on responsibilities such as being a significant parent figure to a few
patients, being a manager organizing the day to day activity of the community, documenting observations of the patients, participating in annual psychometric testing of patients, writing regular reports
of patients progress, facilitating group therapy, having individual therapy sessions, being actively involved in various in-house committees and so on. They also need to provide information and updates
to the family and organize family therapy sessions.

The therapists role is to encourage the patient to shift his or her distorted perception of self and the
world that causes him or her to have adjustment problems in life. This becomes difficult without a
relationship and trust between therapist and patient. The therapist needs to enter into a symbiotic relationship with the patient and work with him/her through the therapeutic process. The prerequisite of
becoming an effective therapist is to relate to the patient as a human being and respond to his or her
emotions and needs, rather than just as a professional providing accurate diagnosis and offering textbook solutions to their problems. A better prognosis has been identified when patients notice that their
therapists are genuine in their interest in them.
Being a psychotherapist implies entering the patients dark world and empathically reliving the experience with the patient so as to enable the therapist to understand the patients experience both cognitively
and emotionally. This will help to build a bond between the patient and the therapist helping to reinforce
changes.
Kavya, a 28 year old girl who was physically and sexually abused as a child was admitted to the
community as she could not form lasting relationships and was severely depressed and suicidal.
Through regressive work from Reparenting model, she formed an attachment to a therapist. She
progressed in therapy after regressive therapy and was able function as a responsible person
when she was discharged. She left the community 15 years ago and still has a bond with the
therapist. She keeps in touch through telephone calls, emails and greetings. She is able to hold
a job, take care of herself and her parents (First Author, personal communication, October,
2007).
For optimum functioning of the community, different committees are formed. The structure review
committee, the party committee, the housekeeping committee, medical committee, therapy overview
committee etc. The trainees are assigned to these committees depending up on their field of interest and
are rotated so as to gain broader experience.
Therapist in Action
The trainee will take about a year to come to the level of functioning where they are able to do intensive
therapeutic work with patients. They are encouraged to work at different levels with patients depending upon the relationship and quality of attachment they are able to form with the patient. Intensive
psychotherapy involves patients working on deeper issues about their past, working on their scripts and
making new decisions. They do this by forming a group of mentors to guide them through short-term
and long-term goals.
They are also expected to lead some groups like the cognitive enhancement therapy group, psychophysical exercises group and the feelings group. The therapist needs regular feedback and supervision
about his/her work. So he/she is expected to present the work he/she is doing with a patient at the staff
meeting once a week.
Open Communication and Confrontation: A New Way of Supervision

Communication and confrontation lead to better understanding of each other and foster healthy relationships in the community. This can be effective only when the following principles are practiced in
the community. They are:
Im OK and Youre OK.

All communications and confrontations are expected to be open.
Every member of the community is as important as the other.
Any staff or patient has the right to confront any other member of the community who
has violated any of the community structures.
The above principles provide a platform for maintaining high moral and ethical standards as well as
awareness of each others work professionally. The sharing of ideas with other members of the community gives an impetus in understanding the patients better. It also provides for a culture of constant
supervision and therefore security for the community.
Awareness, Reflection and Flexibility: A Process of Continuous Learning

Being part of a therapeutic community, a therapist has a tremendous potential to grow personally and
professionally. Continuous reflection on ones attitudes, beliefs, roles and involvement with respect to
their personal and professional life will bring about transformation in ones personality structure as well
as interpersonal relationships and dynamics. Psychotherapists need to be flexible with the following
belief in practice:
Im O.K. and youre O.K.
Everyone has the capacity to think (except the severely brain damaged).
People decide their own destiny, and these decisions can be changed (Berne 1966).
Evaluation and Implications

Limitation of the study
The present study, as mentioned earlier, is based on the descriptive case study approach. We accept that
our practices are culturally embedded. Other therapeutic communities in India as well as in the rest of
world may well operate in different ways. However, we believe there is value in sharing experiences of
good, successful practice. We also hope that Western readers will find this brief glimpse into our work
and attitudes in India illuminating. While findings from our participant observation experience cannot
be generalized beyond our therapeutic community, we hope that others may be able to draw upon and
apply some ideas to their own situation.
We have described some of the subjective, experiential elements of our programme, drawing on the
voices of trainees and therapists. Each trainees experience with an individual patient is so diverse; a
general pattern cannot be derived as it depends on many factors like the trainees personality, mental
makeup, cultural background, prejudices, etc.
Further qualitative research could be usefully conducted on exploring the supervisory relationship in
more depth as well as on the trainees journey. Further quantitative research could usefully compare
our practices with those in other contexts and would be valuable for evaluating the effectiveness of our
approach and therapeutic outcomes.
Implications of the study

With the increase in need for counselling and psychotherapy due to changing demands of the society,
people are seeking emotional support from professionals. While providing this emotional support, there
needs to be a regulatory system in place to ensure that professionals do not take advantage of the patients vulnerability and abuse their power and control over the patient. Intensive training and supervision methods described in the present study will improve the quality of therapists and the therapeutic
process in keeping with high moral and ethical standards.
Increased self-awareness in a therapeutic community context is essential owing to the intensity of emotional interactions and involvement of the therapist with the patient in the healing process. This intensive training and supervision process should help in sharpening the trainee psychotherapists awareness
of themselves and others. This, in turn, should have a positive trickle-down effect, encouraging patients
to be more aware of their own feelings, thoughts and behaviour towards helping them to function better
in their lives as a whole.
Conclusion
The process of training/supervision of psychotherapists is complex and multifaceted. Rather than offering a top-down classroom teaching approach, learning takes place in the community environment and
involves learning experientially to work with both attachment and involvement. Much of a trainees
development arises through relating at a practical and personal level with patients and the community.
The process can be very energizing and gratifying at times, as well as depressing and frustrating at
other times. A tremendous amount of commitment on the part of the trainee and therapist is needed
to be involved in the therapeutic process. However, handling complex demands and relationships that
come about during the therapeutic intervention will result in the overall development and growth of the
individual.
We recommend our supervision-training process to be used in other fields including health and education contexts.
References
Bandler, R. and Grinder, J. (1975) The structure of magic, Volume 1: A book about language and therapy. California: Science and Behavior Books.
Bandler, R. and Grinder, J. (1976) The structure of magic, Volume 11. California: Science and Behavior
Books.
Berne, E. (1961) Transactional analysis in psychotherapy. New York: Grove Press.
Berne, E. (1963) The structure and dynamics of organizations and groups. New York: Lippincott.
Berne, E. (1966) Principles of group treatment. New York: Oxford University Press.
Bodenhammer, B. G. and Hall, L. M. (1999) The users manual for the brain. Wales: Crown House.
Carson, C. R., and Butcher, J. N. (1992) Abnormal psychology and modern life(9th ed.). New York:
Harper Collins.
Childs-Gowell, E. (1979) Reparenting schizophrenics: The cathexis experience. Massachusetts: The
Christopher Publishing.
Freudenberger, H. J. (1975) The staff burn out syndrome in alternative institutions. Psychotherapy:
Theory, Research and Practice, 12, 73-82.
Haigh, R. (1999) The quintessence of a therapeutic environment: Five universal qualities. In P. Campling and R. Haigh (Eds), Therapeutic communities: Past, present and future. London: Jessica Kingsley.
Healy, K. (2007) Foreword. In S. Keenan and S. Paget (Eds), Service standards for therapeutic communities (5th ed.). London: Community of Communities.
Jones, M. (1959) Towards a classification of the therapeutic community concept. British Journal of
Medicine and Psychology, 32, 200-205.
Jones, M. (1973) The therapeutic community: Milieu therapy. In T. Millon (Ed.) Theories of Psychopathology and Personality. Philadelphia: W.B. Sanders Company.
Keenan, S., and S.Paget (Eds)(2007) Service standards for therapeutic communities (5th ed.). London:
Community of Communities.
Kennard, D. (1998) An introduction to therapeutic communities. London: Jessica Kingsley.
Kennard, D. (2005) Foreword. In O. Hirst and S. Paget (Eds) Service standards for therapeutic communities (4th ed). London: Community of Communities.
Lees, J., Manning, N., and B. Rawlings (1999) Therapeutic community effectiveness. A systematic
international review of therapeutic community treatment for people with personality disorders and mentally disordered offenders (CRD Report17). University of York: NHS Centre for Review and Dissertation.
Masters, R., and J. Houston (1978). Listening to the body. New York: Dell Publishing.
Main, T. E. (1946) The hospital as a therapeutic community intervention. Bulletin of the Meninger
Clinic, 10, 66-70.
Meinrath, M., and J.P. Roberts (2004) On being a good enough staff member. Therapeutic Communities, 25(4), 318-324.
Rapoport, R. N. (1960) Community as doctor. London: Tavistock.
Schiff, J. L.(1969) Reparenting schizophrenics. Transactional Analysis Bulletin, 8 (33).
Schiff, J. L (1970. All my children. New York: M. Evans and Publishing.
Schiff, J. L.(1975) Cathexis Reader: Transactional Analysis treatment of psychosis. New York: Harper
and Row.
Srinath, U. and Kumar, K. (2007) The role of attachment and containment in psychological interven-
tions in a therapeutic community setting: Three case studies. Paper presented at the International conference on psychology in mental health, NIMHANS, Bangalore city, July 26-28.
Stewart, I. and Joines,V. (1987) T.A. Today. Nottingham: Lifespace.
Yin, K. R. (2003) Case study research -design andmethods (3rd ed.). New Delhi: Sage.
Acknowledgements
We are the instruments in presenting this article which is based on the work that has been practiced for
over three decades. We are grateful to Father Hank Nunn, Director of Athma Shakti Vidyalaya for his
guidance and all other staff members for their support in this work.

Journal2011 - I5 - Gestalt Journal

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Journal2011 - I5 - Gestalt Journal

Încărcat de

Drepturi de autor:

Formate disponibile

ISSN 1756-7599

European Journal for

Published by the European Centre for Psychotherapeutic Studies

2 European Journal for Qualitative Research in Psychotherapy

Editorial: Celebrating new voices

Published by the European Centre for Psychotherapeutic Studies 3

Writers Block: a reflective literature review

4 European Journal for Qualitative Research in Psychotherapy

Some possible causes

Published by the European Centre for Psychotherapeutic Studies 5

6 European Journal for Qualitative Research in Psychotherapy

Too close for comfort

Published by the European Centre for Psychotherapeutic Studies 7

Tackling Writers Block

8 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 9

10 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 11

Shuttle, P. (2007) Making a Poem, Mslexia, JanFebMar, 28.

12 European Journal for Qualitative Research in Psychotherapy

Lived Experience of a Permanent Rupture

Published by the European Centre for Psychotherapeutic Studies 13

Data collection and analysis

14 European Journal for Qualitative Research in Psychotherapy

Shame and Pride

Published by the European Centre for Psychotherapeutic Studies 15

16 European Journal for Qualitative Research in Psychotherapy

Why? - A safer place to be

Published by the European Centre for Psychotherapeutic Studies 17

Isolation and Belonging

18 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 19

20 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 21

22 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 23

Life After Delivery: a phenomenological enquiry into one womans experience

24 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 25

Data Collection and Analysis

26 European Journal for Qualitative Research in Psychotherapy

contact with her on three separate occasions (face-to-face and by telephone).

Published by the European Centre for Psychotherapeutic Studies 27

28 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 29

30 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 31

32 European Journal for Qualitative Research in Psychotherapy

Published by the European Centre for Psychotherapeutic Studies 33

A Phenomenological Exploration of Tattooing:

34 European Journal for Qualitative Research in Psychotherapy

discovery of the experience and meanings of tattooing for my co-researcher.

Published by the European Centre for Psychotherapeutic Studies 35

Findings: Some core experiences and meanings

36 European Journal for Qualitative Research in Psychotherapy

Wearing pain on the skin

Published by the European Centre for Psychotherapeutic Studies 37

Who are you really sleeping with?

38 European Journal for Qualitative Research in Psychotherapy

Wearing hope on the skin

Published by the European Centre for Psychotherapeutic Studies 39

40 European Journal for Qualitative Research in Psychotherapy

Growing edge, grow a new tail