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P s y c h o t h e r a p is t s ’ P e r s o n a l P s y c h o t h e r a p y
and I t s P e r c e iv e d I n f l u e n c e o n C l in ic a l P r a c t ic e
A dissertation submitted in partial fulfillment o f the requirements for the

degree of Doctor of Philosophy
Karen F. Bellows-BIakely
Smith College School for Social Work

Northampton, Massachusetts
April 1999
UMI Number: 9945612
Copyright 1999 by
Bellows-Blakely, Karen F.
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Copyright by
Karen F. Bellows-BIakely
1999
ii
A cknow ledgm ents
The completed product of any dissertation is the creation of numerous
psychological “parents.” This project is no exception. The idea for it was conceived from
an awareness o f the often subtle, sometimes profoundly experienced influences of personal
therapy on my own clinical work. The project has taken on a life of its own and has
proven personally enlightening beyond my expectations.
I owe a debt o f gratitude to many who have generously shared their knowledge,
time, and talents. First and foremost, I thank the 20 clinicians who shared their personal
psychotherapy journeys with such candor. Their stories were at once unique and yet
offered a universal resonance with the poignancy of struggling toward psychological
growth. There would have been no “study” without their willingness to offer their
experiences so openly.
The dissertation committee members each provided an invaluable function.
Donald B. Colson, Ph.D., former Chief Psychologist o f The Menninger Clinic generously
offered timely input and guidance, yet intuitively allowed the investigator sufficient
psychological space to struggle productively with the essential aloneness of dissertation
work. To Roger R. Miller, D.S.W., Research Chair, Smith College School for Social
Work, I extend considerable appreciation for believing in the project since its inception
and for invariably helping me “find daylight” when my vision was routinely obscured
through the myopic lens of living in the thick of the research. James W. Drisko, D.S.W.,
Professor, Smith College School for Social Work, encouraged me to enjoy the discovery
iii
aspects of research and flexibly offered his considerable knowledge about qualitative
research design, without ever imposing his ideas.
To Barbara Berger, Ph.D., I wish to extend special thanks for our many years of
friendship, which apparently remains intact, despite the long hours of free advising
I sought. Her extensive knowledge o f research methodology, her capacity to think clearly,
and her generosity are appreciated beyond words.
I wish to thank my therapist friends who have thoughtfully encouraged my
continued focus on the work at hand, amidst the many distractions in living life-Amy
Holbrook, M.S.W., Ellen Safier, M.S.W., April Stein, Ph.D., Helen Stein, Ph.D., Barbara
Ruggles, M.S.W., Nancy Jones, M.S.W., and Peg Donley, M.S.W.
Thanks also to Smith College School for Social Work colleagues whose friendship
and commiseration has long and deeply sustained me-Judith Batchelor, Ph.D., Carol
Cohen, M.S.W., John Giugliano, M.S.W., Craig Soloman, M.S.W., Marian Harris, Ph.D.,
and AnnMarie Glodich, Ph.D.
Thanks to Menninger colleagues who have provided invaluable input and
encouragement in reading parts o f the manuscript or advising about data analysis-Mary Jo
Pebbles Kleiger, Ph.D., and Glen O. Gabbard, M.D. For her continued supportive
interest, my thanks also go to Kathryn Zerbe, M.D.
Appreciation is extended to Judy Kash and Marcy Schott of the Menninger
Professional Library for their expertise in computerized literature searching and to Barbara
Hauschild and Barbara Reed for their professionalism in the transcription o f interviews.
Grateful acknowledgment is due Norine Kerr, Ph.D., for her early editorial suggestions
iv
and to Mary Ann Clifft, M.S., for excellence in the final editing. Special thanks to
Aleta Pennington for typing near perfection.
To Gerry Schamess, M.S.S., Professor, Smith College School for Social
Work, I extend special appreciation for many years of encouragement and for his capacity
as a social work mentor in both clinical work and scholarship.
Thank you to Jennifer Kennedy, M.D., from whom I have learned much about
myself and about the nature of the two-person collaboration of psychotherapy. She-and
our work together-truly were “good enough.”
I wish to thank my mother, Jeanne Bellows, for her long years of encouragement
and for believing in me, even when I have doubted myself. She is a lifelong model of what
a woman can do when she puts her mind to it. Deep thanks to my sister, Kathy
Gunderson, whose steadfast support has sustained me to keep going. I extend appreciation
to my father, Kirk Bellows, who has modeled the courage to choose your own goals and
the diligence to achieve them. Thank you especially to David, Ben, and Sarah for
supporting me as I followed my dream, even when it meant sacrificing parts o f our
“wonder years” together. And to other family members, friends, and colleagues, thank you
for your support, ideas, and understanding during the years I have worked on this project.
You are all invited to share in this moment.
K.F.B.B.
Table of C ontents
Pape
Copyright......................................................................................................................... ii
Acknowledgments........................................................................................................... iii
Table of Contents............................................................................................................ vi
List of Tables.................................................................................................................... viii
Abstract............................................................................................................................ ix
Chapter I: Introduction................................................................................................. 1
Statement of the Study Issue.................................................................... 1
Rationale..................................................................................................... 4
Chapter II: Prior Relevant Work and Research Implications........................................ 8
Literature Review....................................................................................... 8
Theoretical Assumptions and ResearchQuestions.................................... 60
Chapter III: Research Design and Sample...................................................................... 64
Methodological Assumptions ............................................................. 64
Sample Selection........................................................................................ 65
Sample Size................................................................................................ 66
Sampling T echniques................................................................................. 66
Method for Securing D ata......................................................................... 68
Pilot Study................................................................................................. 70
Results of Pilot Study................................................................................ 70
Developing the Interview Questions........................................................ 71
Ethical Issues.............................................................................................. 72
Data Analysis Procedures.......................................................................... 74
Chapter IV: Findings........................................................................................................ 77
Data Analysis: Phase 1
Identifying and Categorizing Themes in the Narrative Data 77
Association of Perceived Influence of Personal Therapy with
Perceived Benefits, Risks, and the Interpersonal Relationship 191
Chapter V: Discussion................................................................................................... 258
Distillation of Major Findings................................................................... 258
Summary of Findings................................................................................. 259
Implications of the Findings...................................................................... 266
Limitations of the Study............................................................................ 275
Implications of Results for Clinical Practice and Future Research 282
References........................................................................................................................ 287
vi
Table of C o n t e n t s (con tinued)
Pape
Appendix A: Initial Contact Letter............................................................................... 294
Appendix B: Mail-In Response to Initial Contact L etter...............................................295
Appendix C: Informed Consent Form: Written Explanation to Participants............... 296
Appendix D: Statement o f Informed Consent by Research Participant...................... 297
Appendix E: Demographic Questions........................................................................... 298
Appendix F: Interview Questions...................................................................................299
Appendix G: Ordinal Rankings of Questions Assessing Perceived Influences of
Personal Therapy on Conducting Psychotherapy................................ 301
Appendix H: Level of Influence Scores: Perceived Positive Influence of
Personal Therapy on Conducting Therapy......................................... 303
Appendix I: Data Analysis: Phase 2
Matrix of Findings: Outline of Categories, Themes, & Subthemes.... 304
vii
L is t of Tables
Page
Table 1: Perceived Level of Influence of Personal Therapy on
Clinical Practice............................................................................................. 232
Table 2: Perceived Benefits o f Personal Therapy Compared with

Level of Influence........................................................................................... 233
Table 3: Perceived Risks of Personal Therapy Compared with

Level of Influence.......................................................................................... 235
Table 4: Perceived Overall Effectiveness of Personal Therapy

Compared with Level of Influence..................................................................237
Table 5: Perceived Interpersonal Relationship and Posttermination

Psychological Involvement Compared with
Level of Influence.......................................................................................... 238
Table 6: Gender and Professional Affiliation of Participant and

Treating Therapist and Choice or Assignment of Therapist
Presented by Level o f Perceived Influence.....................................................250
Table 7: Professional Affiliation and Level of Perceived Influence................................ 254
Table 8: Variables Related to Time Conducting Psychotherapy,

Time Receiving Psychotherapy, Years of Postgraduate
Experience and Time Posttermination, Compared with
Levels of Perceived Influence of Personal Treatment on
Clinical Work................................................................................................. 257
viii
A b st r a c t
This qualitative study explored psychotherapists’ perceptions of the influence of
their personal therapy on their clinical practice with patients. Twenty psychoanalytically
oriented therapists were interviewed in single audiotaped interviews. Participants included
experienced clinical social workers, psychologists, and psychiatrists who had terminated
from their most recent personal therapy.
The interview schedule was based on aspects of personal therapy deemed relevant
after reviewing the professional literature and conducting a pilot study. The semistructured
interview probed four areas o f personal therapy valued by therapists: benefits, risks,
influence on clinical practice, and the interpersonal relationship between former treater
and patient.
Data analysis consisted of identifying and categorizing themes in the narrative data,
then comparing them with the literature model for thematic relevance. Responses were
then ranked in high, middle, or low levels of influence and these subgroup responses were
then compared with the other areas-reported benefits, risks, and the interpersonal
relationship.
Major findings include that participants perceiving the highest level of influence
of personal therapy on their clinical practice most clearly viewed their treatment as
promoting psychological change, valued their former therapist as a professional role
model, and thought about the former treater during moments of clinical uncertainty.
Problems with the working relationship became the central focus of treatment only in the
high level-of-influence group. The working through of negative aspects o f both
ix
transference and the “real relationship” apparently contributes to a positive identification
with the former therapist as a professional role model. Those reporting the highest level of
influence most clearly wished to continue the therapeutic dialogue and had most frequently
sought contact with their former treater. Participants also reported that personal therapy
helped modify their perfectionistic traits, which influenced their clinical work. The
termination phase of personal therapy was especially important to the fate of
internalization o f the treatment relationship. To contextualize the findings, clinical practice
characteristics and personal treatment history variables of participants are presented.
Findings support that the extent to which the former treater is seen as a positive
role model is associated with the extent to which treatment relationship conflicts were
actively addressed by the treatment dyad.
Ch a p t e r !
I n t r o d u c t io n
Statement of the Study Issue
The purpose of this exploratory study was to examine psychotherapists’
perceptions of how their personal psychotherapy experience has influenced their clinical
practice as a psychotherapist. This project explored, through interviews, the personal
psychotherapy experience o f multidisciplinary psychodynamic psychotherapists. The intent
was to describe both the perceived personal benefits and the harmful effects of their
psychotherapy experience and to compare these with its perceived effect on subsequent
work with patients. The “therapist’s therapist,” as a dual role model for both personal and
professional identification and learning, has the potential to serve as an enduring and
influential internalized relationship. Hence, aspects of the perceived interpersonal
relationship and continued psychological involvement with the former therapist were also
explored and compared with the perceived influence of personal therapy on clinical work.
Recent research on this topic has centered on whether personal therapy can be
shown to have any measurable effect on the psychotherapist’s personal adjustment and
professional functioning (MacDevitt, 1987). Findings range from an absence of any clear
evidence of enhanced professional effectiveness (Greenberg & Staller, 1981), to the
position that personal therapy is correlated with greater verbal effectiveness (Strupp,
1955) with particular patients. McEwan and Duncan (1993) have suggested that personal
therapy during training may be detrimental because it interferes with the empathic
functioning o f inexperienced therapists. Rigorous efforts to operationalize these complex
concepts and to measure change in therapists’ personal functioning as a result o f personal
therapy are in their infancy. Despite the difficulty in developing a body of empirical
evidence on the benefits of therapy for this population, there is general optimism in the
literature that therapy for psychotherapists is personally beneficial, regardless o f the reason
for seeking help.
Factors that influence the personal benefits of therapy for psychotherapists include
the personality and interpersonal adjustment of the psychotherapist or trainee.
A concomitant belief is that the clinical work of impaired professionals will benefit from a
personal psychotherapy process (Deutsch, 1985; Nierenberg, 1972). Impairments viewed
as potentially amenable to personal therapy include personality or intrapsychic difficulty,
symptoms o f addiction, sexual boundaty violations, interpersonal problems, and problems
in adjustment to the developmental tasks of the life cycle (Deutsch, 1985; Pope &
Tabachnick, 1994). “Environmental” factors may also cause the psychotherapist to benefit
from seeking personal therapy; these may include the stress inherent in the work itself,
either during training or later, which can result in professional “burnout” (Farber, 1983).
Finally, the desire for personal growth and self-understanding in this articulate, self-
reflective, insight-oriented group of individuals is not only a source of motivation for
personal therapy but also indicative of the high value generally placed on it by
psychodynamic psychotherapists (Prochaska & Norcross, 1983). Notwithstanding the
difficulties in measuring such complex phenomena, if personal therapy does benefit the
adjustment o f the psychotherapist, what evidence is there that it translates to better
professional practice?
Controversy surrounds whether personal therapy affects the psychotherapist’s
professional competence. Do therapists who have sought personal psychotherapy function
differently than those who have not? Those grappling with this question must confront the
issue of how to compare basic ideological and personality differences between individuals
who do or do not seek personal therapy. Although complex variables make it virtually
impossible to capture the essential factors in question, several researchers have found
evidence of a continuum o f influence of personal therapy in the therapist’s future clinical
work (MacDevitt, 1987; Peebles, 1980). One such finding is that the greater the duration
of personal therapy and the more recently it was experienced, the more the therapist
consciously accesses it in his or her own work with patients.
These complex questions about the efficacy and influence of personal therapy for
the psychotherapist remain largely unanswered. To promote further inquiry into these
issues, this study explored specific aspects of the therapy experience to determine which
are valued and which are viewed as harmful, and whether there are conscious evocations
of the therapist’s own therapy while working with patients.
The plan for presenting the study follows: A statement of the rationale for
undertaking this study is followed by a review of prior relevant work. The prior work has
been organized into the following six sections: (1) prevalence of personal therapy for
psychotherapists; (2) rationale for recommending personal therapy; (3) subjectively
perceived benefits and harm from psychotherapy; (4) effects of personal psychotherapy on
4
professional functioning; (S) internalization of the personal therapy relationship; and
(6) the role o f self-analysis and posttermination involvement with personal therapy as a
source of help in professional functioning. Following this review of the literature, the
theoretical assumptions of the study and research questions are presented, concluding this
chapter.
Rationale
The majority of psychodynamically trained psychotherapists seek personal therapy.
Most of them report a high level of satisfaction with, and perceived benefit from, personal
therapy (Buckley, Karasu & Charles, 1981; Shapiro, 1976). Supervised conduct of
psychoanalysis, didactic learning, and personal analysis are the three cornerstones of
psychoanalytic training. The influence of the “therapist’s therapist” as a role model for
personal and professional identification and learning is widely referred to in the
psychoanalytic training literature (Mackey & Mackey, 1994). This historic valuing of
personal therapy by psychoanalysis continues to influence training expectations in the
mental health professions o f psychiatry, clinical psychology, and clinical social work
(Liaboe, Guy, Wong & Deahnert, 1989).
Although there is broad agreement among mental health professionals that their
personal therapy is valuable, both personally and professionally, there is a surprising
absence of knowledge about how the experience of personal therapy affects the conduct
of psychotherapy with patients. Specifically, what is it about their personal therapy that
therapists draw on in conducting psychotherapy themselves? That is the focus of this
study.
Geller and Farber’s work (Geller, Cooley & Hartley, 1982; Geller & Farber,
1993), on the modes and factors influencing the process of internalization in
psychotherapy, suggests that therapists who have been in therapy consciously evoke
memories o f their own therapist as a source of help while conducting therapy with others.
There is also evidence that the personal therapy experience is drawn on differentially,
depending on whether the therapist is currently engaged in personal psychotherapy or has
terminated, and depending on the therapist’s level of experience. Therapists who are still
early in their career are often engaged in concurrent training and personal psychotherapy,
so are in a position to experience the influences of their personal treatment quite vividly
and differently than the experienced therapist who is returning to psychotherapy or
analysis after a lengthy hiatus or who terminated personal therapy long ago. Evidence for a
continuum o f influence of personal therapy in one’s work with patients supports the
further exploration o f the possibility of the evolving and enduring function of personal
therapy for psychodynamic psychotherapists as a whole.
In addition, professional group affiliation and training of individual
psychotherapists may influence the personal therapy experience. The majority of studies in
this area have sampled a single professional discipline, such as psychiatrists, psychologists,
or psychoanalysts (Norcross, Strausser-Kirtland & Missar, 1988b; Pope & Tabachnick,
1994; Shapiro, 1976). Mackey’s (1994) research is the sole published study to specifically
examine clinical social work therapists’ experience of personal therapy.
Several studies have sampled an interdisciplinary cohort (Buckley et al., 1981;
Norcross, 1990), but have relied on questionnaire data. Questionnaires provide the
6
advantage of anonymity in this sensitive area and may avoid certain social response biases
inherent in personal interviews. In addition, they are generally cost-efficient and
nonintrusive. But questionnaire data cannot capture the richness and intricacy o f meanings
in individual responses obtained via in-depth interviews. The flexibility of the interview
allows for motivations, meanings, memories, and interpretations to be captured that are
possible only through face-to-face contact (Anastas, 1994). Hence, this study will not only
be interdisciplinary but will also rely on interviews.
This study was an exploratory effort at inquiry into a complex phenomenon,
focusing on the perceived benefits and risks of personal therapy and the uses that
therapists make of their personal psychotherapy in their professional practice. The results
have implications for understanding the identity development of psychotherapists, for
therapists who treat other therapists, and for psychotherapy research in general, regarding
which aspects of the psychotherapy relationship are valued, utilized, and “passed on” in
other complementary relationships.
The relevance o f this study to the profession of social work has both historical and
contemporary implications. The heart of social work always has been the relationship
between client and social worker. Charlotte Towle (1935) charged fellow social workers
to learn the impact that transference and projection had on their work with clients, noting
that “self-ignorance has defeated many highly trained, well-informed, and widely
experienced social caseworkers” (p. 43).
Clinical social work has come of age in the past 25 years as an accepted discipline
providing mental health services in direct social work practice. Clinical social workers
provide advocacy, casework, and psychotherapy services to their clients through direct
practice with individuals, families, and groups. Since the late 1970s, the number of clinical
social workers who provide psychotherapy services to the public has grown considerably
faster than that o f other disciplines (Golman,1985). This trend is expected to continue,
resulting in increasing numbers of psychotherapists whose professional identity is in social
work.
Towle’s early discussion of the benefits of personal therapy for social workers has
gained recent attention within social work circles (Mackey, 1994). Despite growing
acceptance by social workers of the value of personal therapy, and the long-held regard
for it within psychoanalytic circles, little research has been conducted in this area by social
workers. In 1918, Mary Jarrett addressed the question of professionalism in a talk to the
first class at Smith College School for Social Work:
Our new discipline, psychiatric social work, holds two possibilities: we could think
o f ourselves as assistants in psychiatry, working under the direction of
psychiatrists, or we can develop a profession in our own right, bringing to
psychotherapy the social outlook and skills which would require our thinking for
ourselves and would place us alongside psychiatrists as another, but different,
allied professional. (Reynolds, 1963, p. 62)
As autonomous professionals, clinical social workers are responsible for researching
clinical issues and exploring questions that affect the quality of service they provide.
This research was intended as a step in that direction.
C h a p t e r II
P r io r R e l e v a n t W o r k a n d R e s e a r c h I m p l ic a t io n s
Literature Review
Prevalence
The majority of contemporary American psychotherapists-between 65% and 80%
(Henry, Sims & Spray, 1973; Norcross, 1990)-have obtained personal treatment for
themselves. Although personal therapy is rarely required by training programs, aside from
psychoanalytic institute training, it is considered a desirable experience by clinical
practitioners and training programs alike (Greden & Casareigo, 1975; Norcross &
Prochaska, 1982; Shapiro 1976; Wampler & Strupp, 1976). A recent study of the personal
therapy experiences o f 800 psychologists (Pope & Tabachnick, 1994) found that the
overwhelming majority (84%) had entered therapy, although only 13% had attended a
graduate program requiring personal therapy. Slightly more than 1 in 5 o f all participants
reported that they were currently in therapy. Another survey of psychologists practicing as
psychotherapists found that only 18% had never received any form of personal
psychotherapy at any time (Guy, Stark, & Poelstra, 1988). Thus practicing
psychotherapists do, in fact, utilize the very service they provide.
Psychotherapists cite their personal psychotherapy as being second only to
practical experience as the most important contributor to their professional development
(Henry, Sims & Spray, 1971; Rachelson & Clance, 1980). Similarly, Kaslow and
Friedman’s (1984) interview study of 14 clinical psychology graduate students who were
in therapy while in training found that personal therapy tended to be more influential than
supervision in their development as clinicians. Another questionnaire survey (Prochaska &
Norcross, 1983) on the personal therapy experience sampled 400-plus members of the
American Psychological Association, Division 29 (psychotherapy). When asked to rate the
importance of personal psychotherapy as a prerequisite for their work, nearly half stated
that it was very important, while fewer than 1 in 10 thought it not important at all. Those
entering personal treatment before graduation also tended to use it after entering clinical
practice. Such studies support the view that psychotherapists highly value personal
therapy as part of their professional training.
Several studies that examined the therapy-seeking patterns of psychotherapists
after completion o f formal training found that a majority do seek it: 52% of psychoanalysts
(Goldensohn, 1977), 55% of psychotherapists (Grunebaum, 1986), and 62% of
psychologists (Guy & Liaboe, 1986). Similarly, Liaboe, Guy, Wong & Deahnert (1989)
found that a significantly higher percentage of psychotherapists enter personal therapy
after completing graduate training. Rarely is this use o f psychotherapy a component of
formal postgraduate training. In their studies of psychologists, psychiatrists, social
workers, and counselors, Norcross et al. (1988a, 1988b) asked whether recent personal
therapy was initiated for personal reasons, professional purposes, or both. The majority o f
respondents (55%) indicated that their reasons were primarily personal, a finding that
replicated the earlier work o f Henry et al. (1971, 1973). Only 10% replied that their
treatment was largely for training reasons, but 35% reported entering therapy for both
personal and professional growth. These findings indicate that the majority of practicing
10
psychotherapists seek personal therapy after formal training for personal reasons or for a
combination o f personal and professional reasons.
Studies providing data about duration of personal therapy for psychotherapists'
show that more experienced therapists (those with more than 10 years in the profession)
tend to have accrued more treatment hours than their less experienced, and likely younger,
colleagues (349 vs. 234 hours), which indicates that therapists continue to use personal
therapy during the course o f their career (Prochaska & Norcross, 1983). In a study by
Guy, Stark & Poelstra (1988), the choice o f a psychoanalytic or psychodynamic
theoretical orientation accounted for the greatest variance in the number of hours of
therapy. When Norcross (1990) studied the treatment experiences of 500-plus
psychotherapists from the professions of social work, psychiatry, and psychology, the
average number of discrete treatment episodes was 2.3. The sample was about equally
divided in reporting one personal therapy, two therapies, or three or more. Norcross also
found that having a psychoanalytic or psychodynamic orientation was significantly related
to duration of personal therapy. No differences between females and males were found on
incidence, type, or duration o f personal therapy, yet women rated personal therapy as a
significantly more important prerequisite for conducting psychotherapy (Prochaska &
Norcross, 1983). These findings support the view that psychoanalytic and psychodynamic
therapists continue to seek personal therapy during the course of their career, that most
therapists have engaged in multiple personal therapy processes, and that therapists from a
psychoanalytic or psychodynamic theoretical orientation engage in longer treatment than
do therapists of other orientations.
11
The amount of personal psychotherapy received by clinicians after entry into the
profession is influenced not only by their theoretical orientation and years of experience,
but also by the number of hours of individual psychotherapy that they themselves conduct
weekly. Those who tend to provide the greatest amount of individual therapy for clients
also receive the greatest amount of individual treatment themselves (Guy, Stark, &
Poelstra, 1988). The tendency of therapists specializing in individual psychotherapy to
obtain individual personal treatment more often suggests several possible interpretations.
Such individuals may recognize the importance of their own emotional health for the
integrity o f the treatment they provide. Those preferring to explore the individual issues
and problems o f their clients may also be more interested in better understanding their
own. On the other hand, the greater the number of hours of individual treatment provided,
the greater may be the negative impact on the personality of the therapist, who may
require more personal therapy as a result. Or perhaps the personal distress necessitating
treatment may also have compelled these therapists to escape through their work, leading
to more hours o f therapy conducted per week (Guy, Stark, & Poelstra, 1988). These
findings stress the highest utilization of personal therapy by those who are most engaged
in it as practicing professionals.
From whom do these therapists seek help? Several studies have demonstrated the
importance of demographic matching between therapist-patients and their chosen
therapists (Kaslow & Friedman, 1984; Norcross, 1990; Norcross et al., 1988a). Pertinent
factors include theoretical orientation, professional affiliation, gender, and ethnicity. The
psychotherapist’s theoretical orientation has been shown to be predictably related to his or
12
her psychotherapist’s orientation (Grunebaum, 1983). In addition, Norcross’ (1990) study
of therapist choice showed that the majority of therapists of any theoretical orientation
undertook personal treatment with psychoanalytic (41%) or psychodynamic (18%)
psychotherapists.
Regarding professional affiliation, psychotherapists seek treatment from
psychiatrists, then psychologists, social workers, counselors, and lay analysts, in that
general order. However, there are definite preferences on the basis of professional
discipline. In Norcross’ study (1990), 36% of the psychologists received treatment from
fellow psychologists, while 35% turned to psychiatrists. Psychiatrists routinely sought out
other psychiatrists-82% of the time. Social workers were the only group more likely to
enter treatment with a therapist of a discipline different from their own. There is evidence
that this pattern in social work is changing, though, given the increasing availability of
clinical social workers who are specializing in the practice of individual psychotherapy
(Norcross et al., 1988a; Sailer, 1992). Kaslow and Friedman (1984) found that clinical
psychology doctoral students, citing the importance of professional role modeling, have a
strong preference for seeking personal therapy from a competent therapist within their
own discipline.
Demographic factors such as gender and racial heritage o f the chosen
psychotherapist also exert a strong influence. Norcross et al. (1988a) noted the ubiquitous
practice of therapist-patient demographic matching on these variables and provided
evidence of an increasing tendency for mental health professionals to be treated by
members of their own gender and professional discipline. On the positive side, such
13
treatment experiences can enhance personal validation and professional socialization.
Conversely, these emerging patterns of similarity can promote professional indoctrination
and theoretical “inbreeding.” Altogether, these findings offer evidence of how important it
is to psychodynamic psychotherapists to select a personal therapist similar in theoretical
orientation, professional affiliation, gender, and ethnicity.
In addition to demographics, several other factors have emerged as important in
selecting a personal therapist. That psychotherapists select their own therapist primarily on
the basis of clinical acumen and interpersonal qualities is supported by evidence from two
pioneering studies (Grunebaum, 1983; Norcross et al., 1988a). Both identified four
essential criteria that therapist-patients keep in mind as they search for a personal
therapist. Two essential factors are perceived professional competence and interpersonal
warmth. In addition, Grunebaum’s sample noted that a treater with an active, talkative
style, outside the therapist’s professional and social network, was usually sought.
Norcross’ sample listed clinical experience and professional reputation as being important
to therapist choice. With regard to these factors, interprofessional differences evident in
the selection criteria existed between social workers, on the one hand, and psychologists
and psychiatrists on the other. Social workers accorded more weight to treatment cost,
therapist flexibility, interpersonal warmth, active style, and openness. Overall, these
findings reflect the importance o f perceived competence, interpersonal warmth, clinical
experience, and professional reputation as factors that influence a therapist’s choice of
personal therapist. Such choices also appear to be made within the demographic matching
of such characteristics as theoretical orientation, professional affiliation, and gender.
14
In summary, research on the therapy-seeking behavior of psychodynamic
psychotherapists indicates that both trainees and experienced psychotherapists use services
similar to those they themselves provide to others. As a group, they value personal therapy
as a significant contributor to their professional development, and they continue to seek it
after completing their formal training. However, the majority of experienced
psychodynamic psychotherapists seek personal therapy not so much for professional
reasons as for personal reasons, or for a combination of the two. Most have seen two or
more therapists in a significantly lengthier process than have therapists o f other theoretical
perspectives. Also, the more hours of engagement in psychotherapy practice, the more
likely it is that the therapist will utilize personal psychotherapy at some point. And, finally,
psychodynamically oriented therapists tend to seek personal therapists whose theoretical
orientation, professional affiliation, gender, and ethnicity resemble their own.
Rationale for Recommending Personal Psychotherapy
The recommendation that therapists undergo personal therapy grew out of Freud’s
discussion of countertransference, a concept first introduced in 1912 in Recommendations
to Physicians Practising Psycho-Analysis: “Everyone who wishes to carry out analyses on
other people shall first himself undergo an analysis by someone with expert knowledge”
(p. 116). Freud was concerned with the counterproductive effects of neurotic problems in
the therapist. Unresolved conflicts and characterological problems that are not dealt with
in a therapeutic manner may render a less-than-adequate therapist.
15
Freud based his injunction on technical considerations, but he came to subscribe to
the view that an analyzed therapist is a better therapist. In addition to illuminating the
therapist’s personal conflicts and bringing them under control, the training analysis
(initially called didactic analysis) was designed to give the young therapist firsthand
experience with personal psychodynamics, to increase self-awareness, to deepen
understanding o f therapeutic techniques and augment their impact, and, in general, to
strengthen the therapist’s ability to withstand the stresses of therapeutic work (Strupp,
1975).
Freud’s recognition of the importance of the psychotherapist’s personal therapy for
personal and professional functioning can also be found in his later injunction in Analysis
Terminable and Interminable: “But where and how is the poor wretch to acquire the ideal
qualifications which he will need in his profession? The answer is in an analysis of himself,
with which his preparation for his future activity begins” (Freud, 1937/1964, p. 248).
In the same paper, Freud suggested that analysts should regularly reinitiate personal
treatment because intense therapy continually exposes the therapist to the impact of
patients’ unconscious processes. “Every analyst should periodically-at intervals of five
years or so-submit himself to analysis once more, without feeling ashamed of taking this
step. This would mean, then, that not only the therapeutic analysis of patients but his own
analysis would change from a terminable into an interminable task” (Freud, 1937/1964,
p. 248).
A decade after Freud’s death, Fromm-Reichmann (1949) echoed this imperative
for those who wish to provide intensive psychotherapy:
16
And so it is, because of the inter-relatedness between the psychiatrist’s and the
patient’s interpersonal processes and because of the interpersonal character of the
psychotherapeutic process itself, that any attempt at intensive psychotherapy is
fraught with danger, hence unacceptable, where not preceded by the future
psychotherapist’s personal analysis, (p. 378)
Since Freud’s time, no training requirement for the psychoanalytic psychotherapist
has been considered more vital than personal analysis. The curricula o f psychoanalytic
training institutes have traditionally been built around this requirement. In clinical
psychology training programs, departmental attitudes toward personal therapy for students
range from benign neglect, to reticent helpfulness, to active encouragement, and-rarely-to
a requirement that trainees undergo personal therapy (Wampler & Strupp, 1976).
Graduate schools o f social work have been conspicuously silent on the issue, although the
profession as a whole recognizes that self-awareness is critical to good clinical practice
(Mackey, 1994).
Henry (1971) has pointed out that the extent to which therapists have themselves
undergone therapy is a motivating factor for entering the profession of psychotherapy.
A common property in this set of professions, and of the cultural values o f training, is the
prompting to study the self and others to determine psychological motives for behavior.
The figures on personal psychotherapy may therefore reflect the prevalence o f both the
interest in this form o f inner contemplation and the use of personal therapy as a form of
socialization that provides practice in the art of examining inner values and experiences.
Strupp (1975) noted several benefits of personal therapy. Chief among them was
that personal therapy is “a process for coming to terms with one’s personal and
professional identity” (p. 11). In so doing, the therapist-patient also learns “about
17
psychodynamics, psychoanalytic technique, insight, and therapeutic change” and confronts
“the basic problems o f human existence and the nature o f human relations in a manner
unequaled by any other learning experience” (Strupp, 1975, p. 11).
A specific rationale for personal therapy is the therapist’s need to discover and
appreciate the power of the unconscious. The issue of training analysis for analytic
candidates can be enlarged to cover other psychotherapists in training, who must choose
whether to deal with the unconscious of their patients, even in a nonanalytic situation.
On this subject, Silverstone (1970) wrote that “the primary purpose of a personal
psychoanalytic experience for student analysts is, in fact, not the eradication of personal
problems, but the personal validation by the student analyst of something which must be
experienced as foreign to him-the existence of the unconscious in himself’ (p. 284).
The unconscious is not only not conscious but also difficult for a person with intact
defense mechanisms to accept. Ekstein and Wallerstein (1958) echo this position,
suggesting “that one can only work with the unconscious of another person when he has
learned to work with his own, has relived his infantile neurosis, freed himself from its
terrors, and has resolved his basic conflicts” (p. 248). In a similar vein, Glass (1986)
noted: “It is this narcissistic wound that every [psychotherapist] who has experienced his
own unconscious remains ever mindful that more is going on than meets the eye in not
only his patient but himself as well” (p. 306). These writers have emphasized discovery of,
and respect for, the power of the unconscious as a primary benefit of personal therapy.
Understanding how one’s own defenses can interfere with the therapeutic process
is another core rationale for personal psychotherapy. Meissner (1973) stated that self-
understanding is necessary for psychotherapists to better understand others and to be able
to react in an empathic, objective manner. In his own analysis, for example, he thought of
himself as normal, but he was soon able to identify obstacles to his personal and
professional development that he would not have seen otherwise, since these obstacles
were nonetheless adaptive. Meissner’s therapy process enabled him to evolve both as a
person and as a psychotherapist. Similarly, Glass (1986) has noted that the “personal
baggage” one brings into therapy cannot but influence the dynamic process o f the
therapeutic relationship. Further supporting the view that understanding one’s defenses is
important, Rubenfine (1971) has said that analysis teaches the therapist to know “when his
own defenses interfere with the therapeutic process and, at the very least, this knowledge
should ensure the patient against becoming a target for the therapist’s own unconscious
anger and hostility” (p. 230). These writers thus view an increased awareness o f one’s
defenses as leading to a greater understanding of oneself and others that mitigates against
the therapist’s destructive aggression with patients.
A comprehensive summary o f the reasons for personal psychoanalysis or
psychotherapy has been provided by Nierenberg (1972): (1) to enhance the analyst’s
ability to conduct therapy as a more sensitive and unbiased clinical observer whose “blind
spots” and countertransference potential have been mitigated; (2) to give therapists a
personal sense of conviction about the validity of the theory and the method of treatment
they are using, by demonstrating their personal relevance; (3) to learn about technique via
a firsthand modeling experience; and (4) to make the therapist’s life less neurotic and more
19
gratifying, so that the stress of conducting therapy can be tolerated better. These gains are
often regarded as sufficiently great so as to make the experience indispensable.
The presumed benefits of personal therapy for the therapist thus include growth in
both personal and professional identity. This growth occurs through experiential learning
about the power of unconscious processes, understanding one’s own defensive patterns,
mastery of technique as a result of increased self-awareness, gaining a sense of conviction
about the validity o f the therapeutic model, exposure to a role model, and resolution of
personal problems or “emotional baggage” that could interfere with one’s therapeutic
effectiveness.
In general, the authors who support personal therapy for the therapist in training
do not insist on it as a requirement. Rather, they strongly suggest or encourage
undertaking a personal therapy process, espousing the view that no therapist can go
further in the therapy of a patient than what the therapist’s own obstacles permit.
Obviously, there are exceptions, including the fact that certain individuals may become
excellent clinicians without being analyzed (Glass, 1986).
Problems of Mandated Psychotherapy
Another group of authors is neither totally for nor against personal therapy for
therapists in training; the majority would still encourage but not require it. Arguments
against such an experience include the risk of limiting the trainees’ openness to a variety of
therapeutic models, emotional and financial stress on trainees (Clark, 1986; Macaskill,
1988), and the possibility that motivation would be diminished if the individual did not feel
the need to change. With insufficient anxiety, the trainee might lack the motivation to
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withstand the rigors of personal therapy and, hence, the student would acquire only a
superficial knowledge of psychoanalysis or psychodynamic psychotherapy. It is also
frequently argued that the competence of a therapist cannot be judged on the basis o f the
successfulness of a personal therapy. According to several studies (Garfield & Bergin,
1971; Glass, 1986; Kaslow & Friedman, 1984), psychotherapy concurrent with training
may have a detrimental effect on the functioning of therapists in training. One explanation
for this reaction is that, although these problems are often of short duration, the increased
awareness of previously repressed inner feelings that occurs during personal therapy may
interfere with the trainee’s ability to be empathic toward patients. In summary, cautions
against mandatory psychotherapy concurrently with clinical training include the risk of
indoctrination to single therapeutic models, emotional and financial stress, insufficient
motivation to change, and self-absorption with the personal treatment that may detract
from clinical empathy.
Another contraindication to personal therapy is the possibility of overidentification
with the personal therapist, which might contribute to the future psychotherapist’s rigidity.
This is a concern because it is the more flexible individuals who have, in fact, developed
new therapies and made new discoveries. In addition, those who are analyzed may be
viewed as having more insight, but they are not necessarily the best therapists. So
engaging in personal psychoanalysis or other types of personal therapy is not sufficient for
becoming a good therapist, because of the potential that doing so may reinforce
maladaptive traits o f either the therapist-patient or the personal therapist and the lack of
clear correlation between insight and therapeutic effectiveness (Glass, 1986).
Leader (1971) has noted that the motivation for personal psychoanalysis often
derives, in part, from the anxiety and insecurity of the beginning therapist, and that the
desire for a personal psychoanalysis may diminish during the course of training with
teaching and supervision. He asserts that a good training program with well-selected
candidates under competent supervision should be sufficient for understanding and dealing
with anxiety or other training-related problems. Leader emphasizes that analysis or any
other type o f therapy is indicated only for students with personal problems. He stresses
that empathy with others develops out of trainees’ real-life experiences and growing
maturity throughout the training process. Thus, in his view, empathy is not necessarily
related to personal psychotherapy. As a result, Leader suggests that those beginning
therapists who really need psychotherapy will find the means to pursue it voluntarily.
Several factors contribute to the need for personal therapy among experienced
psychotherapists, while others often prevent its use (Bermak, 1977; Greben, 1975; Guy,
Stark & Poelstra, 1988; Will, 1979). Many psychotherapists may be negatively affected by
factors inherent to the practice of psychotherapy, including physical and psychic isolation
and repeated feelings o f loss and abandonment as a result of planned and unplanned
terminations. To this list o f specific problems, Bermak (1977) adds a frustrated need for
intimacy, the need to control emotions, the frustration of omnipotent rescue wishes and
the helplessness that ensues, ambiguity in the field, and the emotional drain of constantly
being empathic. Depleted emotional reserves resulting from the professional practice of
psychotherapy can have negative consequences for the therapist’s interpersonal
functioning with family members and friends. It may also be that psychotherapeutic
22
practice actually exacerbates emotional and interpersonal problems already present in the
therapist (Henry, 1973). Because of the inherent stress in the practice o f psychotherapy,
these writers recommend that personal therapy should be positively and persuasively
encouraged by all in the field, in addition to maintaining high levels of continued training
and education with peer supervision.
It is beyond the scope of this study to review the extensive body of literature
regarding treatment that may be necessary for impaired professionals with underlying
psychopathology who are in training or practice. According to Campbell (1982), between
4% and 22% of psychiatry residents have either a minor or a major psychiatric problem.
The role of stress during the training period should be looked at more closely, because it
may lead to an increase in minor, often temporary, problems. The literature suggests
several ways of helping maladjusted trainees, as well as practicing therapists, such as
through individual psychotherapy (Gabbard, 1995; Garetz, 1976; Glass, 1986).
Reasons for Seeking Personal Therapy
Therapists give a variety of reasons for seeking personal therapy. In a number of
survey studies that have asked about the presenting problem (Guy et al., 1988; Pope &
Tabachnick, 1994), psychotherapists most frequently reported interpersonal conflicts,
depression, and anxiety. These modal complaints are consistent with other research
indicating that clinical practice exacts a toll on the practitioner, particularly in the form of
emotional underinvolvement with family members, moderate depression, and problematic
anxiety (Bermak, 1977; Cray & Cray, 1977; Deutsch, 1985; Farber, 1983; Looney,
Harding, Blotcky & Barnhart, 1980; Pope & Tabachnick, 1994).
The pervasiveness o f these struggles for practicing psychotherapists is supported
by Deutsch (1985), who investigated therapists’ personal problems and treatment in a
study of250-plus nonmedical, doctoral, and master’s level psychotherapists. It is
noteworthy that over three fourths of these subjects (82%) reported having experienced
relationship difficulties and that almost half (47%) had sought therapy at one point for
relationship problems. The figures for depression also were substantial, with 57%
reporting depression at some time in their lives. Over one fourth of the sample had been in
therapy for depression, and 11% had taken antidepressant medication. Despite these
symptoms o f distress, which may interfere with personal and professional functioning,
most psychotherapists utilized the resource of personal therapy as a result of their personal
awareness o f their own internal processes, and made an active decision to enter therapy in
response to a personal evaluation, rather than in response to external factors or specific
precipitating events (Deutsch, 1985).
Therapist Resistance
Although personal psychotherapy is accepted by most clinicians as being helpful
for the therapist in training, stigma nevertheless still seems to be attached to the role of
patient for the experienced therapist (Glass, 1986). Factors that may prevent experienced
therapists from using the services they provide include resistance to entering the patient
role because o f a sense o f professional superiority and omniscience that hinders the ability
to identify one’s own need for psychotherapy. Guy and Liaboe (1986) concluded that the
majority of experienced psychotherapists appear to resist entering personal therapy, even
during times o f distress when it could prove both useful and appropriate. Concern about
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confidentiality is an issue for some therapists, particularly those in small professional
communities. Experienced therapists may also resist therapy because o f expectations that
therapists should give rather than receive help. Even during times of distress, many
therapists do not seek psychotherapy. Rather, they minimize the severity of their struggles
and favor other sources for dealing with personal stress.
In summary, the rationale for personal therapy includes experiential learning about
the power of unconscious conflict and intrapsychic processes, mastery of technique,
exposure to a role model, and resolution of personal problems. Conversely, the argument
against required psychotherapy concurrent with clinical training includes the potential
indoctrinating effects, both from theoretical approaches and from the personal
idiosyncrasies of the therapist’s therapist, emotional and financial stress, insufficient
motivation to change, and self-absorption, which may detract from clinical empathy.
Motivation for personal therapy may diminish with time, as trainees become more secure
in their professional role. Although personal therapy encourages insight, this is not
sufficient cause. But since the stress of psychotherapeutic practice may exacerbate
emotional and interpersonal problems in the therapist, personal therapy should perhaps
also be encouraged for experienced therapists. A substantial number o f psychotherapists
suffer from interpersonal conflicts, depression, and anxiety, yet most seek personal therapy
only if they become aware of their internal processes. However, an internalized sense of
superiority and omniscience can lead experienced therapists to minimize their personal
struggles to such an extent that they will avoid entering the patient role.
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Therapists* Perceptions o f Personal Therapy
Although the literature indicates that psychotherapy generally produces positive
changes in patient adjustment, little research has focused on how a personal therapy may
affect the psychotherapist’s adjustment. At present, there is no existing empirical evidence
that personal therapy enhances therapist adjustment. However, there is considerable
indirect evidence, both through the subjectively perceived benefits and through the harmful
effects of personal therapy for psychotherapists, in several existing surveys. Prior work
related to therapists’ perceptions of the personal benefits and risks of their own
psychotherapy has focused as well on interpersonal factors related to the “fit” between the
therapist as patient and his or her therapist.
Overview
Studies surveying psychiatry and psychology trainees’ perceptions of the value of
personal therapy have found that the majority of trainees rate their personal therapy highly,
from very desirable to essential (Coryell & Wetzel, 1978; Macaskill, 1992). Shapiro’s
(1976) landmark study of graduates from one psychoanalytic training program focused
specifically on the training analysis. He found that “the vast majority [of the 121 analysts
who returned completed questionnaires] viewed their therapeutic gains favorably, despite
the complications posed in analysis concurrent with training” (p. 36).
Studying experienced social work therapists, Sailer (1992) asked respondents to
rate the overall success of their most influential personal therapy experience. Eighty-nine
percent rated their therapy as beneficial, 10% rated it as somewhat beneficial, and just one
respondent rated it as both a harmful yet beneficial treatment experience.
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Pope and Tabachnick’s (1994) large survey of practicing psychologists found that
85% o f the respondents described their personal experience with therapy as very helpful or
exceptionally helpful. Only two respondents reported that it was not at all helpful.
Seventy-eight percent found the experience not at all harmful, but 2.3% reported that it
was very harmful or exceptionally harmful. Those who believed that their therapy was at
least somewhat harmful were more likely to perceive their therapist as being unkind or as
making errors.
Findings from these studies of single professions are consistent with Buckley,
Karasu & Charles’ (1981) multidisciplinary review of psychotherapists’ perception of the
value o f their personal therapy which found the lowest outcome measure to be a 73% level
o f improvement. Overall, these studies concur that the great majority o f respondents
received considerable personal benefit from treatment, and that the few harmful therapy
experiences were associated with particular respondent perceptions about the treating
therapist.
Perceived Benefits
As a result o f personal therapy, psychotherapists report significant benefit in
multiple areas. These include perceived improvement in self-understanding or self-
awareness; self-esteem or self-confidence; interpersonal relationships; characterological
conflicts; improved therapeutic skills; and, to a lesser extent, symptom severity (Buckley
etal., 1981; Norcross, 1990; Pope & Tabachnick, 1994; Shapiro, 1976).
Some individual psychoanalysts have provided accounts of their personal therapy
(e.g., Guntrip [1975] has written of his separate analyses with Fairbaim and Winnicott,
contrasting their different personalities and therapeutic styles). But there has been no
systematic investigation o f multidisciplinary psychotherapists’ experience in therapy until
Buckley et al. (1981). The positive benefits of treatment reported by the 71 experienced
psychotherapist respondents occurred on a broad front and involved improvements in self
esteem, interpersonal relations, work functioning, and character change. Symptom
alleviation was also considered important but ranked least among these variables. The
study concluded that the majority of respondents received considerable personal benefit
from their treatment. These benefits occurred in ways that are difficult to measure, such as
improvement in self-esteem and interpersonal relations. The significance o f such change
for the individual, however, should not be underestimated. This study stressed a reliance
on the subjective report o f the person who actually experienced the therapy as an
important aspect o f what it is that intensive psychotherapy or psychoanalysis does in the
way o f effecting therapeutic change. In particular, Buckley et al. cited the “emotional
tone” of the therapeutic relationship as a key to determining perceived outcome: “The
critical importance o f the positive perception of the therapist corroborates the view that
mutative experiences can only occur in the context of a positive patient-therapist
relationship” (p. 304).
A more recent study of trainees’ perceptions of the benefits and risks o f their
personal therapy is Macaskill’s 1992 questionnaire survey. In it, 87% of the British
psychotherapy trainees who evaluated their personal therapy reported that it had a
moderate to very positive effect both on their work with patients and in their personal
lives. Positive effects included increased self-awareness (76%), increased self-esteem
28
(47%), and a reduction in symptoms (43%). The most common primary goals for personal
therapy were personal growth and the resolution of personal problems. The general
picture that emerged from Macaskill’s study is that personal therapy is an integral,
intensive, expensive, and time-consuming component o f training. It typically consists of
more than twice-weekly sessions, lasts more than three years, and produces substantial
personal and professional benefits for nearly all trainees, although sometimes at
considerable emotional and financial cost. From the trainees’ point of view, the gain is
generally well worth the pain (Macaskill, 1992).
In Sailer’s (1992) survey study o f 67 licensed clinical social work psychotherapists,
respondents reported on the accomplishments of their personal therapy. In order of
importance, they offered four main reasons for participating in therapy: (1) to gain
personal insight; (2) to learn more about the therapeutic process; (3) to improve self
esteem; and (4) to alleviate symptoms.
Although such positive perceptions of the benefits of personal therapy are
impressive, the possibility exists that therapists will overestimate the therapeutic results of
their personal treatment, especially given the therapist’s professional stake in highly
valuing his or her own investment in the product of psychotherapy. As a practitioner, the
therapist-patient has an inevitable bias toward viewing psychotherapy in a positive light.
In addition, favorable self-assessment could be based, in part, on positive transference
attachments to the therapist (Shapiro, 1976).
In summary, various studies show that a large majority of therapists who have
been in personal therapy have found it helpful in many different areas of their lives.
29
The most frequently mentioned benefits are not the accomplishment of specific behavioral
goals but, rather, such concepts as enhanced self-awareness or self-understanding and
improved self-esteem. These concepts tend to be difficult to operationalize or measure.
In addition, psychotherapy research that explores the processes by which (and the extent
to which) such benefits are accomplished is made even more difficult by the inevitable bias
in the therapist-patient’s stake in personal therapy. Even so, these subjectively perceived
benefits should not be underestimated with regard to what intensive psychotherapy does in
effecting therapeutic change. Nonspecific factors related to the emotional tone of the
interpersonal relationship between therapist-patients and their therapists appear crucial to
perceived benefits.
Perceived Harmful Effects
A minority of respondents in each of the studies reviewed did report negative
outcomes or actual harm as a result of personal treatment (Buckley et al., 1981; Pope &
Tabachnick, 1994; Sailer, 1992; Shapiro, 1976). In these studies, from 8% to 24% of the
respondents reported that their therapy or analysis had been harmful in some way.
The most common reason for a harmful treatment experience appeared to be a rigid,
distant, and uninvolved therapist who promoted a therapeutic relationship lacking in
mutual positive regard. Less common, but nevertheless detrimental, were specific
boundary violations by the treating therapist.
One fifth o f Buckley’s (1981) respondents, for example, reported that their
treatment was somehow “harmful.” Comments ranged from treatment being “deleterious
to my marriage,” to “allowing destructive acting out,” to “fostering too much withdrawal
from the outside world.” These reportedly harmful effects were not significantly correlated
with therapist factors such as a lack of warmth or empathy or not being understood by the
therapist. The most significant correlates for harmful effects included: dreaming about the
therapist; feeling that during the course of therapy, the therapist was the most important
person in one’s life; feeling that the therapist was not neutral about his or her behavior;
and feeling sad that sessions with the therapist had ended. These findings suggest that, at
least in this group of respondents, specific unresolved transferential factors are an
important component in the subjective experience of a harmful effect. It is of interest, too,
that the mean scores of items related to these “transference residues” were all significantly
lower in the no harmful effects subgroup. Those in this group appear to have been able to
successfully work through transference to a greater extent. This finding would tend to
confirm the belief of most practicing psychotherapists that management of transference
should be a central focus of treatment (Buckley et al., 1981).
In contrast, harmful results of therapy were significantly related to particular
therapist factors in Pope and Tabachnick’s (1994) study of practicing psychologists.
Therapist unkindness or errors, therapist sexual material, and patient sexual material were
all correlated with perceived harmfulness. One out of 10 participants who had been in
therapy reported that a therapist had violated confidentiality. That the patient is a member
or a soon-to-be member of the community of therapists creates numerous opportunities
for dual relationships and other blurred boundaries (which was the fifth most frequently
mentioned cause o f harm). The most serious harm, however, resulted from the therapist’s
attempted or actual sexual acts with the respondent, clinical incompetence, sadistic or
31
emotionally abusive actions, general failure to understand the patient, nonsexual dual
relationships, and boundary violations (Pope & Tabachnick, 1994).
Despite such problems, none of the trainees reported purely negative outcomes
for their therapy (Macaskill, 1992), but 38% reported some negative effects. The main
negative effects were psychological distress (29%) and marital or family stress (13%).
Half the sample commented that financial costs and time constraints in general were a
substantial stress, but they also indicated that these two factors were not necessarily
negative. Approximately one fourth reported feeling psychological distress because of
their therapy, but they viewed it as a necessary aspect of therapy and not as something
negative.
The social work subjects (Sailer, 1992) were also asked if any aspect of their
personal therapy had been harmful. Their responses are in keeping with those from other
studies (i.e., from 70% not harmful, to 24% harmful). Six percent of the social workers
were unsure whether some aspect of their personal therapy had been harmful. Recurring
themes o f harmful characteristics included problems with psychoanalytic theory being
applied too rigidly by the therapist and boundary violations of therapists.
The five most common factors that Shapiro (1976) found to be associated with
significant problems in psychoanalysis during training included: (1) characterological
problems of the candidate; (2) countertransference not related to the analyst’s role as a
training analyst; (3) evaluative or reporting aspects of the analyst’s dual role; (4) personal
attributes of the analyst; and (5) overestimation of, or excessive identification with, the
analyst.
32
In summary, a substantial minority of psychotherapists view their personal therapy
as having been somehow harmful. But, overall, trainees appear to accept that being able to
deal with psychological, interpersonal, and financial stresses associated with personal
therapy is important to becoming a professional. Nonspecific factors associated with
perceived harm relate more to the treating therapist’s rigidity, perceived emotional
underinvolvement, and lack of neutrality toward the patient. Less commonly reported
were specific therapist behaviors involving boundary violations (e.g., confidentiality,
sexual acting out). Specific, unresolved transference residues appear to be an important
and widespread component in the subjective experience of a harmful effect.
Interpersonal Factors
Significant correlations with a series of therapist variables were revealed in
Buckley et al’s. (1981) analysis o f outcome factors. Improvement in all areas positively
correlated with “mutual liking”-the feeling of liking and being liked by, the therapist.
Eschewing any mention of an affectionate bond, Greenson (1967) has defined the
“therapeutic alliance” as what occurs between the patient’s reasonable ego and the
analyst’s analyzing ego. The significant correlation of mutual “liking” with every outcome
variable in Buckley et al’s. study suggests that, at least for this group of respondents, the
therapeutic alliance may necessarily include elements of an affectionate bond. The feeling
of being understood by the therapist also correlated with all positive outcome factors
except alleviation of symptoms. Improved self-esteem significantly correlated with
perceived therapist empathy and warmth. Thus Buckley and colleagues hypothesized that
the emotional “tone” of treatment is of critical importance to a positive outcome. These
33
therapist factors would appear to be the sine qua non of an effective treatment and it is
noteworthy that they are nonspecific.
Related to emotional “tone” is the issue of the stylistic and characterological “fit”
between analyst and analysand. Seldom addressed in the literature, this factor is an
apparently crucial element in the therapeutic outcome experienced by many analysands:
A ‘good fit’ between analyst and candidate should reflect reciprocal role
expectations (the analyst believes the candidate will make a good analyst some
day, the candidate accepts the training analyst as a good role model) and
compatible professional convictions and philosophies, a fit of compatible cultural
and social values and mutual respect to the distinctive ethnic and other
sociocultural differences, and an unconscious congruence of reciprocal personality
dynamics and transference-countertransference configurations and personal
attributes. (Shapiro, 1976, p. 27)
The roles of interpretation and insight as therapeutic agents of change remain
controversial; each has been questioned as a key curative factor in psychotherapy. Data
from the reviewed studies suggest that specific technical procedures of the therapist
related to the appropriate management of transference phenomena are critical to a positive
outcome. Such factors may be central to a positive therapeutic exchange resulting from
psychoanalysis or intensive psychotherapy, provided that they are implemented within the
context o f a positive therapeutic relationship (Buckley et al., 1981).
Thus interpersonal factors, characterized by the emotional tone of the treatment,
appear vital to the perceived therapeutic outcome for therapist-patients. The factor of
“mutual liking” correlates with a broad range of perceived improvements. A “good fit”
occurs when both members of the dyad believe in the competence of the other and have
compatible professional convictions, respect for personal differences, and an “unconscious
congruence” of personality and transference-countertransference dynamics. Technical
34
factors, such as the role of interpretation, are also important to respondents within the
context of a positively experienced therapeutic relationship.
In summary, the literature indicates that most therapists perceive their personal
therapy to have been beneficial. Benefits tend to be global in nature, however, so are
difficult to measure. Nonspecific factors inherent to the interpersonal relationship appear
crucial to perceived benefits. A minority of psychotherapists report that their personal
therapy was somehow harmful. Nonspecific harmful factors were related to the
respondents’ characterological struggles and to the treating therapist’s rigidity or
emotional underinvolvement. Less common, but even more detrimental, were therapist
boundary violations involving confidentiality and sexual acting out. Unresolved
transference residues, which left the respondent feeling unfinished with the relationship,
were frequently implicated in the subjective experience of a harmful effect. In contrast, a
therapeutic relationship characterized by mutual respect for the competency and similarity
to and difference from the other, as well as by a mutual liking, appears vital to perceived
positive outcome. These interpersonal factors may be associated with more transference-
focused treatments, which enable the therapist-patient to better resolve the transference
neurosis.
Effects on Professional Practice
Despite finding in one study that supervisors observed no difference in clinical skill
between analyzed and unanalyzed psychiatry residents, Demer (1960) later recommended
35
unequivocally that personal therapy would probably be helpful to the professional
functioning o f therapists:
To judge a priori who will be a good therapist by the use o f personal therapy
experience as a major prediction criterion is questionable. The best way to judge
whether a person can be a therapist or not is to allow him to become involved in
the intimacy o f the therapeutic relationship. If his humanness can be put at the
disposal of the patient, he will probably be a successful therapist. And one way to
increase the possibility of his allowing his humanness to be at the patient’s disposal
is for a personal therapy experience to increase the therapist’s self-understanding
and skillfulness at relating. If one was of such good fortune that he was bom with
parents who helped him develop with minimal distortions in interpersonal
relationships and his life from that point on continued to be of such a nature that he
could relate well to others, personal therapy could well be dispensed with. Most of
us, however, will be better therapists as our self-understanding and ability to relate
to others is increased by our own therapeutic experience.. .. Let me state on faith
and theoretical grounds, but not verified by research, that the training of a
psychotherapist should include some therapy experience for the therapist
himself. . . . The therapist as the therapeutic tool must be able to relate on a
conjunctive level with his patient and he may need personal therapy to become
skilled at conjunctive relatedness. (Demer, 1960, p. 134)
Demer’s position highlights the conclusions of a number of other authors who
found conflicting evidence about the significance of personal therapy for professional
functioning and development. The following review of these studies is organized into five
sections: (1) an overview of the evidence; (2) findings from studies of the subjective
valuation o f personal therapy on professional functioning; (3) findings from patient-
therapy outcome studies; (4) findings from studies measuring changes in the therapist’s
functioning; and (5) conclusions.
Overview
There is considerable controversy in the literature about whether personal
psychotherapy-before, during, or after training-is a prerequisite for being a good
36
therapist. Three major views have emerged: (1) it is indispensable: (2) it is necessary for
some therapists sometimes: and (3) it has limited usefulness or is altogether unnecessary.
The first view is that personal therapy is either indispensable to, or very helpful in,
providing effective treatment (Buckley et al., 1981; Fromm-Reichmann, 1950; Peebles,
1980; Rubinfine, 1971). Those who take this position cite a variety of expectable
professional benefits: experientially derived knowledge of what it is like to be a patient,
reduced tendency to develop undetected countertransference problems, enhanced listening
ability as a result of ffeed-up defenses and increased cognitive flexibility, and more stable
and elevated self-esteem. Nevertheless, the therapist-trainee’s personal treatment can have
some temporary negative effects on any treatment he or she is simultaneously conducting.
These negative consequences arise by virtue of the anxiety that sometimes floods
therapist-trainees in treatment. But such temporary difficulties are later compensated for
by the improved functioning o f the therapist-patient as the personal treatment progresses.
The second position, that personal therapy is necessary only for some therapists at
some times (Burton, 1973; Leader, 1971), would mandate that therapists enter treatment
only when feeling stressed by their personal lives to the extent that they are unable to cope
effectively. For those individuals with satisfactory coping abilities, however, such
treatment would not be necessary.
The third view, o f personal therapy as having either limited utility or being
altogether unnecessary, emanates from several studies with conflictual findings (Holt &
Luborsky, 1958; Katz, Lorr, & Rubinstein, 1958; McNair, Lorr, & Callahan, 1963).
In their study of psychiatric residents at the Menninger Foundation, Holt and Luborsky
37
found no relationship at all between supervisors’ ratings o f residents’ clinical competency
and the existence or length o f the residents’ personal treatment history. In commenting on
this study, however, Fisher and Greenberg (1977) questioned the extent to which
supervisory ratings can be regarded as valid indices of therapeutic competency. Finally,
in other studies focusing on patient improvement rates (Katz et al., 1958) and premature
termination rates (McNair, Lorr, & Callahan, 1963), a positive correlation was found
between treatment outcome and therapist’s experience level, but not between treatment
outcome and therapist’s personal treatment history.
For purposes of the present review, empirical evidence on the effect of personal
therapy on professional practice has been organized into three areas: (1) subjective
valuations-studies of the therapist’s own evaluation of his or her personal therapy;
(2) patient therapy outcome-studies that evaluate the effects of personal analysis by
comparing analyzed versus nonanalyzed therapists via subsequent patient outcomes; and
(3) therapist functioning-studies that evaluate the effects of personal analysis by
comparing the effects of analyzed versus nonanalyzed or less analyzed therapists on
particular measures of in-session functioning.
Subjective Valuations
Perceived Benefits. Several studies have sought to understand what benefits of a
personal therapy relate to how therapists conduct clinical practice (Kaslow & Friedman,
1984; Mackey & Mackey, 1994; McEwan & Duncan, 1993; Norcross, 1990; Pope &
Tabachnick, 1994). A number of common benefits have been noted to promote change
and growth in the therapists’ professional functioning. Variations on five beneficial themes
38
appear in most o f these studies: role modeling, enhanced empathy, increased
understanding of therapeutic process, greater self-awareness, and personal and
professional development.
A particularly valued aspect of personal therapy for both trainees and therapists
early in their career is that it gives them an opportunity to learn about the process of
therapy from a seasoned professional role model (Kaslow & Friedman, 1984; McEwan &
Duncan, 1993). Studies of the therapy experiences of psychology interns and of
experienced social workers (Mackey & Mackey, 1993; Sailer, 1992) particularly
emphasize this benefit.
A second benefit related to the therapist’s professional functioning is the
enhancement o f empathy that comes from personal therapy. That is, the therapist-patient
learns the importance o f warmth, empathy, and the personal relationship. Personal therapy
also teaches empathy by increasing the therapist-patient’s appreciation of what it means to
be in the role of patient, hence increasing respect for the struggles of patients (Mackey &
Mackey, 1993).
Enhanced understanding o f the therapeutic process is a third benefit often cited. It
includes increased confidence and trust in the process and increased understanding of
which interventions and specific techniques are or are not helpful. It also promotes
improved therapeutic skills, in particular, decreasing the therapist’s need to “do for”
patients and increasing the ability to instead “be with” them (Kaslow & Friedman, 1984;
Mackey & Mackey, 1993).
39
A fourth benefit, that of enhanced self-awareness, translates into a greater ability to
use countertransference reactions more effectively with patients in sensitive areas of the
therapeutic process. Pope and Tabachnick’s (1994) subjects, in particular, reported that
their increased self-awareness and self-understanding enabled them to better handle issues
of self-disclosure, self-expression, and boundary issues.
Closely tied to this benefit is personal and professional development: the
perception that therapy is, in the long run, a growth-promoting process in and of itself.
Included here are such responses as working through one’s own issues, putting one’s
humanness in the service o f the therapeutic work, and gaining an increased capacity to
differentiate one’s affective states from those of patients (Mackey & Mackey, 1993;
Sailer, 1992).
In summary, these studies report beneficial aspects of personal therapy for the
psychotherapist that translate into enhanced self-awareness, personal and professional
development, and professional functioning in the areas of learning from the therapist as a
professional role model, gaining empathic understanding of the patient’s role and
understanding the therapeutic process. The consensus that emerges supports Ford’s
(1963) notion that the “developing psychotherapist acquires large portions of his own
personal identity and self-concept collaterally with his acquisition of professional and
therapeutic role and identity” (p. 476). In short, clinical training and psychotherapeutic
treatment simultaneously stimulate the process of continued internal development in both
students and experienced psychotherapists.
40
Perceived Risks and Negative Effects. In addition to perceived benefits, personal
therapy also poses a number of perceived risks or negative effects for professional
development. In McEwan’s (1993) study of psychology interns, therapy was seen as being
detrimental to professional development by providing poor role models or by
“indoctrinating” students into only one therapeutic model. Overgeneralization and
projection of the trainees’ own responses onto future clients were also mentioned as risks.
Similarly, several of McEwan’s respondents commented that personal therapy might instill
a false sense of confidence by conveying the impression that, as a result of being
“therapized,” the student is therefore in good psychological health and has the necessary
professional skills to work as a therapist. Risks imposed by dual relationships were also
cited in this study, as well as in others (Kaslow & Friedman, 1984; Norcross, 1990). The
data show that when therapy is included in a graduate training program, dual relationships
have been the norm, and these open-ended comments indicate awareness of such inherent
problems.
Trainees are aware o f negative effects on their clinical work as a result of being in
concurrent training and treatment. Overidentification with the patient role, for example,
can become a problem. In addition, despair about the efficacy of clinical work may surface
whenever the trainee feels at an impasse in personal therapy. More commonly, however,
students faced with increased affect, newly freed in treatment, find that it reduces the
capacity to think clearly and attend well to patients. Finally, having to invent a facade of
competency and adequacy in order to manage the work with patients can produce
overwhelming stress (Kaslow & Friedman, 1984). This problem seems to indicate that
41
having to perform a function not yet fully mastered, while attending graduate school and
undergoing the affectively stimulating experience of personal treatment, is often just too
much.
Another complication involves manifestations of trainees’ struggles with
differentiation. Kaslow and Friedman (1984) described students’ inhibitions about openly
discussing with their therapists those areas of their professional lives where they
presumably differ. These areas typically include trainees’ theoretical orientation,
therapeutic techniques, personal style, and career goals. Most studies categorize the
therapy experience as a mixed blessing for trainees because it entails both risk and benefit.
Attention should therefore be paid not only to the potential benefits of this training
experience, but also to the risks involved.
Patient Outcome Studies
No Significant Differences. A number of studies have correlated the therapist’s
use of personal therapy with measures of change in patients. Since the prime goal of
personal therapy is the production o f better therapists, from a clinical point of view, these
studies may legitimately be considered the most significant test of the effect of personal
therapy. With regard to patient improvement, studies by Katz et al. (1958), Holt and
Luborsky (1958), and Demer et al. (1963) all fail to show differences between the
analyzed and nonanalyzed groups. Numerous methodological problems exist with these
studies, however, including poor design, inadequate or vague process and outcome
measures, and small sample size, leading to provisionally acceptable conclusions.
Nevertheless, their attempt to measure change in clients, as a consequence o f treatment by
42
an analyzed therapist, found no direct evidence that personal therapy has a positive effect
on outcome. In addition, length of therapy did not correlate with outcome.
Negative Outcomes. Evidence for negative effects of the therapist’s personal
therapy on the outcome of therapy for patients can be found in two recent studies, one of
which (Wheeler, 1991) investigated therapist orientation and its relationship to the
therapeutic alliance developed with eating disordered patients. A surprising finding was
the significant negative correlation between the amount of personal therapy of the
respondents and the extent o f their therapeutic alliance with patients. Personal therapy
correlated negatively, particularly with therapist’s predictions about the therapeutic
alliance; that is, with increasing amounts of personal therapy, therapists were increasingly
negative about their alliance with patients. This pattern implies a lack o f confidence about
ability to predict a good alliance. Wheeler notes that the negative correlation of personal
. therapy and alliance could have a more positive meaning. Perhaps more personal therapy
gives the therapist more confidence to allow the development and expression of a negative
transference, which is a more reality-based relationship than one seen through rose-
colored glasses.
Another study giving evidence of a negative relationship between patient outcome
and the therapist’s personal therapy is Garfield and Bergin’s (1971) exploration of the
relationship of the amount of personal therapy to three measures of change in clients. The
18 therapist participants in this study were advanced graduate students (4 with no personal
therapy, 7 with 80-175 hours, and 7 with 200-450 hours). No information was provided as
to the type o f personal therapy or the theoretical orientations of the therapists. The results
43
indicated that patients of therapists with no personal therapy showed the greatest change.
These results were independent of differences in the therapists’ level of disturbance. But
the small sample precluded statistical tests of significance and no information was obtained
on the severity level o f initial distress for patients of the therapists by duration o f personal
analysis. The inexperience of these therapists suggests a possible differential effect for
personal analysis that occurs at different points in the therapist’s career. The lower patient
improvement in the treated group of young therapists could be explained by the fact that
they were still in the throes of the usual turbulence attendant to being analyzed and thus
were blocked in therapeutic efficacy by a current preoccupation with their own problems.
Strupp (1973) has suggested that this problem of blocked therapeutic effectiveness
is a temporary phenomenon, however, because his data also show that after many years of
experience, therapists who have been analyzed are (as a group) far more empathic than
unanalyzed therapists. Strupp’s finding would suggest the possibility that the advantage in
favor of subjects with a low amount of personal therapy revealed by Garfield’s data is a
transient one that would have been reversed if experienced therapists had been used.
These findings challenge the assumption that personal analysis and concurrent practice of
psychotherapy for the beginner can safely proceed simultaneously.
Positive Outcomes. A positive relationship was noted in the Menninger Clinic
project headed by Kemberg (1973). Therapists with many years of experience who had
completed analysis obtained greater patient improvement than relatively inexperienced
therapists still undergoing analysis. Unfortunately, this study did not factor out the
therapist’s experience as an influence on outcome. Thus, although the findings are
44
consistent with a positive personal therapy effect, they do not rule out the possibility that
experience is an important factor in outcome.
Measurable Differences in Therapist In-Session Functioning
Evidence that personal therapy influences the therapist’s in-session functioning was
found by Strupp (1955), Peebles (1980), and MacDevitt (1987). Their findings have
significance for the present investigation and are summarized below.
Strupp’s (1955) work, which used therapy analogues, focused on the therapist’s
therapeutic approach. Contrary to prediction, personal analysis seemed to lead to greater
rather than to diminished activity on the therapist’s part. Compared to unanalyzed
therapists, analyzed practitioners tended to be more active, as evidenced by a significantly
smaller number of silent responses. In dealing with transference phenomena, analyzed
therapists tended to prefer interpretations, silence, and structuring responses. The results
for the unanalyzed group were inconclusive. This evidence suggests that analyzed
therapists have learned to introduce reflective distance between their immediate emotional
reactions to a patient and their verbalizations, which enable them to be more empathic and
less punitive and disapproving. Strupp concluded that personal analysis has a demonstrable
effect on the therapist’s verbal behavior, independent of the therapist’s level o f experience.
Supporting Strupp’s findings that personal therapy changes some aspect of the
therapist’s functioning is a study by Peebles (1980) on the ability of clinical psychology
trainees to display empathy, warmth, and genuineness. She used independently rated
sample tapes o f therapy sessions to determine whether the number of hours o f personal
therapy could be positively associated with this ability. Comparisons were significant for
45
empathy and genuineness, using Truax and Carkhuff Scales for Accurate Empathy (Truax
& Carkhuff, 1967). Peebles concluded that personal therapy works on therapists by
altering their manner of perceiving themselves and the world around them, and that this, in
turn, affects their cognitive and affective capacities for displaying empathy, warmth, and
genuineness. It could thus be reasoned that the primary effects of personal therapy are on
one’s cognitive style. Given these findings, future research should perhaps examine the
effects of personal therapy by looking at variables more closely related to therapists’
functioning than at therapeutic or patient outcome measures.
Findings from MacDevitt’s study (1987) offer further evidence that personal
therapy influences the therapist’s in-session functioning by altering perceptions o f self and
other, which in turn affects cognitive and affective capacities, thus enhancing therapeutic
effectiveness. In this survey of 185 doctoral-level psychologists averaging 16 years’
experience, respondents answered questions about their personal therapy history, then
gave their professional reactions to 24 hypothetical psychotherapy situations. The results
suggest that awareness o f countertransference issues is highly significantly and positively
related to the amount-and rated professional value of-personal therapy received. This
connection might be explained as due to self-reflective therapists not only scoring high on
countertransference awareness but also finding personal therapy valuable professionally.
MacDevitt also concluded that personal therapy may be more valued by those whose
exclusive function is providing therapy and who therefore conduct more therapy weekly.
MacDevitt concluded that the number of hours of personal therapy makes its own
sizable and independent contribution to countertransference awareness and to the
46
perceived professional value of therapy. These findings lend support to the notion that
personal therapy is an experience that leads to greater professionally relevant self-
awareness and better professional functioning. There is some support in the data for
hypothesizing a tendency or ability to be introspective or some similar variable as a
significant determinant of the professional value of personal therapy. Other pertinent
questions suggested by MacDevitt’s study are: Besides increasing professional self-
awareness, how does personal therapy contribute to the therapist’s practice? Is the
modeling effect important? Does the experience create better empathy or more social
savvy regarding the patient role?
In summary, these studies have attempted to measure various aspects of therapist
in-session functioning due to varying amounts of personal therapy experience. The results
o f these three investigations must be viewed with some caution, however, because two of
them are based on experimental analogues rather than on actual therapy interactions.
Nonetheless, they do suggest that therapists who have had personal therapy may be more
responsive in some ways to the therapeutic needs of patients. The responses of analyzed
therapists, for example, were seen as being more consistent with recommendations in the
literature as to the optimal way to handle various therapeutic situations. In addition, the
behavior of therapists with personal therapy was more in keeping with recent findings
about the importance of transference interpretations and the need for increased therapist
activity in dealing with seriously disturbed patients. These findings suggest that internal
change in the therapist is translated into enhanced empathy with patients, increased self-
awareness, and increased sensitivity to countertransference. Overall, the findings from
Al
these three studies of altered therapist functioning support evidence from the literature on
therapists’ subjective valuations of the beneficial aspects o f their personal therapy.
Conclusions
These studies suggest a number of possibilities that are tempered by design
difficulties. It is extremely difficult to design a study in which the variable of personal
therapy is not influenced by some other variable, such as the therapist’s experience or
personality. And particularly in outcome studies, patients treated by all the therapists
would need to be sufficiently similar to be compared. Since isolating the personality of the
therapist as a variable is such an unsolved problem, the therapy versus no therapy group
design is probably not the way to test this question. The evidence already gathered
indicates that some therapists can be effective without having had personal psychotherapy.
It also indicates that personal therapy can affect the practice of psychotherapy, although
not always as expected. The effects that occur appear complex and reflect not only when
the personal therapy took place within the therapist’s practice career but also specific
therapeutic skills, such as empathy. It may be that it is only during therapy with a
particularly disturbed patient or a borderline patient who elicits substantial
countertransference reactions that the effects of a personal analysis are likely to be most
evident, or equally in the psychotherapeutic training o f the substantially disturbed trainee
who has a tendency toward counterproductive countertransference responses. Although it
may be possible to design a study that attempts to account for the individual contribution
of personal therapy, the clinical relevance of the results would certainly be questionable,
given the highly intercorrelated nature of the variables.
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Despite clear limitations in the available data, these studies imply certain effects of
personal therapy:
1. Personal therapy seems to affect a therapist’s verbal behavior. Clinicians may
become more appropriately responsive to patient needs as a result of having been in
therapy themselves.
2. Personal therapy, when combined with clinical experience, has been found to
have some positive effects on the therapist’s subsequent professional relationships.
Empathic ability, for example, may be facilitated in therapists who have undergone therapy
themselves. Some evidence also suggests that a personal therapy experience makes it less
likely that a clinician’s dislike of a patient will produce a negative treatment.
3. Personal therapy seems to lead to increased self-awareness and, hence, to
enhanced awareness of countertransference.
4. Undergoing therapy and doing psychotherapy at the same time may be
antitherapeutic for inexperienced trainees, but this situation appears to be a temporary
problem that reverses with clinical experience.
5. There is no evidence to indicate that psychotherapists who have undergone
psychotherapy themselves will be seen as superior trainees or will have more successful
careers than their untreated colleagues.
6. In general, the data linking personal therapy with outcome are inconclusive.
Among the respondents in the subjective valuation and therapist in-session
functioning studies, therapy appeared to nurture the development of personal qualities
essential to effective clinical practice to produce a caring, respectful, and accepting use of
self with clients. Therapy also enhanced the development o f empathy as a professional
skill, including integration of cognitive and affective dimensions in relationships
characterized by balancing connectedness with separateness. Therapists attributed these
gains, along with a deeper understanding of the therapeutic process, to identification with
their therapist, which appeared to become increasingly selective over the course of
treatment. Many o f the perceived risks of personal therapy are associated with the
trainee’s role as learner. The potential for personal and professional growth through
identification with a competent therapist who is a “good enough” role model appears more
prevalent than the harm that comes from an incompetent therapist’s therapist, who would
make a poor role model. However, most trainees acknowledge the inherent risks of
personal therapy concurrent with clinical training.
Most of these studies do not focus on the meaning o f personal therapy for one’s
professional practice. The outcome studies touch only indirectly on the relationship
between personal therapy and the development of professional identity. On the basis of
research to date, relatively little is known about the relationship between personal therapy
and the psychotherapist’s sense of a professional self. We do know, however, that those
who have undergone personal therapy view it as helping them to be more effective in their
professional work.
Internalization of Personal Therapy
Several studies previously reviewed have emphasized the importance of
identification with the therapist’s own therapist in the development of personal and
50
professional identity formation (Kaslow & Friedman, 1984; Mackey, 1994; Shapiro,
1976). Articulated directly by almost everyone in Kaslow and Friedman’s (1984) study of
psychology graduate students was the wish to have a professional role model with whom
to identify. Mackey (1994) also noted the theme of therapist as model, stating that
respondents talked of wanting to emulate their therapists in their professional lives. These
identifications were based on relational or “nonspecific” factors observed in therapists who
offered trusting, secure, and safe environments wherein professionals could explore their
inner world. This identification was more pronounced among therapists early in their
careers who were struggling to find themselves and felt “incomplete” or “unfinished.”
They often viewed their therapist as someone to emulate and with whom they could
identify. Mackey (1994) found that, as professionals progressed in therapy, the mode of
identifying with therapists took on a character different from earlier, more holistic
identifications. This new dimension of modeling involved more selective identifications
and often included both positive and negative qualities. Along the same lines, Shapiro
(1976) noted that “the [therapist’s] necessity for identifying with the analyst in his work as
part of the development o f a new role is universally acknowledged” (p. 28). He also cited
the tendency in a number of his respondents to overidentify with the training analyst,
which can pose real problems o f dependency versus autonomy for the graduate’s
postanalytic working-through period. These researchers all noted the importance of the
therapist’s therapist as a positive professional role model.
Although frequently used in the literature, terms such as professional role model
and ego ideal are rarely defined. Part of the difficulty with defining the professional role is
51
the variety of human developmental stages used as analogies to this professional
development process. Reference to a specific developmental stage is not necessary if we
suppose that the common thread to these analogies is that they contain progressively
higher levels of introjection, identification, and ego integration (Roy, 1992).
Pfeffer (1963) emphasized the conflictual but progressive nature of aspects of
identification:
In the course of the analysis, the person of the analyst becomes, and after the
analysis remains, a permanent intrapsychic image intimately connected with both
the regressively experienced conflicts and the resolution o f these conflicts in the
progression achieved. . . . In analysis, conflicts are organized around the person of
the treating analyst and, with interpretation, these are resolved. However, the
treating analyst remains, perhaps forever after, an important intrapsychic
representation for the patient and a point of anchorage for the resolution of
infantile conflicts, (p. 230)
According to Geller and Farber (1993), the concept of internalization encompasses
introjection and identification, whereby individuals transform personally experienced
events into networks of emotionally charged representations of self and others.
Introjection is primarily responsible for the construction of emotionally charged
representations o f the self in relation to others, whereas identification entails the
modification of self-representations. Individuals model themselves after, or identify with,
the representations of others that are brought into existence by the process of introjection.
Identification refers to the processes whereby individuals increase their felt resemblance to
other persons. Like imitation, identification aims toward sameness or likeness. Geller and
Farber (1993) assume that identifying with another person requires the modification of
one’s self-representations so that they more closely resemble mental representations of the
other person’s characteristics, roles, and functions.
The work of Geller, Cooley and Hartley (1982) and of Geller and Farber (1993)
holds considerable significance for the current investigation. That research involved an in-
depth examination of the internalization process in psychotherapy with subjects who were
all psychotherapists themselves. Factors affecting the recall, forms, themes, and
phenomenological properties o f internalized representations of the psychotherapist and the
psychotherapeutic relationship were investigated in a sample o f 206 current or former
therapist-patients (Geller & Farber, 1993). Responses on the Therapist Representation
Inventory (TRI) indicated that representations are most likely to be evoked when painful
affect is experienced; that regardless o f when therapy was terminated, the greater the
number of therapeutic sessions, the greater the likelihood that patients will use
representations of the therapist to continue the work of therapy after termination; and that
among both current and former patients, positive therapeutic outcome is significantly
associated with the tendency o f representations to reflect a wish to continue the
therapeutic dialogue. These findings indicate that the history and continuing influence of a
psychotherapy relationship can be discerned in the functions and qualities patients ascribe
to representations of themselves in relation to their therapist. Finally, almost 1 in 5
therapist-participants in Geller and Farber’s study was aware of bringing to consciousness
the representations of their own therapist when conducting therapy with others.
Consistent with the view that the process of internalization makes a vital
contribution to the therapeutic action o f psychotherapy, Geller and Farber’s (1993)
findings indicate that these representations potentially serve a wide range of adaptive and
reparative functions. In contrast to merely “remembering” information about their
53
therapist, patients also bring forth representations of themselves in relation to their
therapist to regulate painful affects, assuage feelings of loneliness, and facilitate problem
solving and conflict resolution. For example, by reuniting the patient with calming and
soothing images of the therapist and the therapeutic relationship, these representations can
attenuate the negative consequences of a self-deprecating self-image.
One goal of psychoanalytic psychotherapy is to promote the development and
stability o f the capacity for self-analysis. This attribute is frequently cited as a criterion of
termination readiness, and its development is usually seen as being mediated by the
patient’s identification with the analyst’s “analyzing functions.” Among other things, these
functions refer to the therapist’s knowledge, creativity, and problem-solving and decision
making abilities. Geller and Farber’s (1993) data indicate that the ability to engage in
internal dialogues with one’s therapist-both during therapy and after termination-is
significantly correlated with self-perceived outcome. This finding confirms Loewald’s
(1960) belief that the very essence of psychotherapy is the patient’s internalization of the
therapeutic dialogue.
Some theorists argue that, with increased maturity, the patient gives up
“dependence” on the felt presence of the therapist; others contend that continued access to
that felt presence may serve highly adaptive functions. In the absence o f normative data, it
is impossible to determine whether the use of introjects is a transitional mode en route to
autonomous self-regulation or whether their continued use is necessary to autonomous
self-regulation. The current study inquired about the use of such evocations of the
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therapist’s therapist during clinical work, in an attempt to contribute to an understanding
of the role that introjects play in professional functioning.
In summary, a number of psychoanalytic theorists and researchers concur on the
importance of the therapist’s therapist as a potent role model professionally. Implied in
some o f the literature is a developmental progression through distinct stages. A more
useful concept may be the recognition of aspects of intemalization-introjection,
identification, and ego identity-at progressively higher levels. There is evidence that, even
after termination, the analyst remains an important intrapsychic representation and an
anchor for the resolution of internal conflict. To identify with another person requires
modifying one’s self-representations so that they more closely resemble mental
representations of the other person’s characteristics, role, and functions. Geller and Farber
(1993) stated that the history and continuing influence of a psychotherapy relationship can
be discerned in the functions and qualities that patients ascribe to representations of
themselves in relation to their therapist. These representations potentially serve a wide
range o f adaptive and reparative functions. The development and stability of the capacity
for self-analysis is related to the patient’s internalization of the therapeutic dialogue. It is
not clear whether the use of introjects is a transitional mode en route to more autonomous
self-regulation or whether their continued use is vital to autonomous self-regulation. In an
effort to promote this inquiry, the current study addressed questions about evocations of
the therapist’s personal therapy while conducting psychotherapy.
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Self-Analysis and Posttermination Intrapsychic Involvement
The findings o f Geller et al. (1982, 1993) identify the internalization process of the
personal therapy relationship as an important source of influence on the therapist-patient’s
professional practice o f psychotherapy, which will be pursued in the current study. This
internalization process continues after termination of psychoanalysis or psychotherapy and
may be related to the capacity for self-analysis.
The recognition that the patient has acquired a capacity for self-analysis is a
generally acknowledged reason for considering termination. This self-analytic function is
regarded as a capacity that develops during the course of analysis, in that the patient’s ego
identifies with the analyzing functions of the analyst (Norman, Blacker, Oremland &
Barrett, 1976). Describing the challenges to preserving the intrapsychic changes,
posttermination, that psychotherapy promotes, Geller et al. (1982) quoted Edelson:
The problem o f termination is not how to get therapy stopped, or when to stop it,
but how to terminate so that what has been happening keeps on ‘going’ inside the
patient. The problem of termination is not simply one of helping the patient to
achieve independence in the sense of willingness to function in the physical absence
of the therapist. More basically it is a problem of facilitating achievement by the
patient of the ability to ‘hang on’ to the therapist (or the experience o f the
relationship with the therapist) in his physical absence in the form of a realistic
intrapsychic representation (memories, identification associated with altered
functioning) which is conserved rather than destructively or vengefully abandoned
following separation, thus making mastery of this experience possible, (p. 127)
Although psychoanalytic theory has historically emphasized the interpretive resolution of
the transference neurosis as fundamental to the analytic process, more recent findings
consistently demonstrate that transference persists beyond termination (Gabbard & Lester,
1995).
In his pioneering study of postanalytic follow-up, PfefFer (1963) reported on
individual case studies o f patients who were interviewed within 5 years of termination.
Satisfactorily analyzed patients reacted to the follow-up interviews as though in analysis,
with transient regressive revival of the transference neurosis and reexperiencing of the
symptomatology and character difficulties for which they had first sought analysis. PfefFer
posited that the investigator became a new transference figure who mobilized both
transference residues and partly resolved infantile conflicts. In subsequent work, published
30 years later, PfefFer (1993) notes that the former analyst is represented as both an old
object (a residual displacement from past figures) and a new object (on the basis of new
integration of conflicts integral to the transference neurosis). He stressed that both mental
representations remain indefinitely.
That many former patients make consistent use in fantasy o f the “benign presence”
of the former analyst to facilitate conflict resolution after analysis is reported in the
literature (Buckley et al., 1981; Norman et al., 1976; Schlessinger & Robbins, 1974).
These authors share the view that analysis does not obliterate the transference neurosis.
They also note that each patient experiences varying degrees of control over the
transference neurosis, or that it could be viewed as a new psychic structure under the
purview o f the unconscious ego (Gabbard & Lester, 1995).
In reviewing these contemporary views o f the fate of the transference neurosis
after termination, Gabbard and Lester (1995) found that, although the transference
dispositions persist, as a result of analysis they are much more thoroughly understood and
mastered. Although transferences are not necessarily resolved, they are modulated to the
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point that patients can deal with them more effectively. Transference wishes remain, but
the expectation of how others will react to those wishes is significantly altered.
A contemporary and relevant study on posttermination follow-up is the work of
Kantrowitz, Katz & Paolitto (1990). This study examined the relationship between the
extent of resolution of the transference at termination and the characteristics of the
analyst-patient match. The interdigitation o f the personal characteristics of the analyst with
the particular difficulties and characteristics of the patient was a crucial factor in
determining a facilitating or an impeding match. For the majority of patients interviewed
5 to 10 years after termination, the researchers found that the analyst-patient match played
a role in the outcome of analysis. Whether factors related to the perceived match would be
discernible in the current study and whether these are associated with perceived influences
of personal therapy on the professional conduct of psychotherapy, was a focus of this
study.
Evidence o f continued psychological involvement in therapy posttermination
comes from Pope and Tabachnick’s (1994) study of psychotherapists. O f 297 respondents
who had been in personal therapy, almost 40% reported at least some continuing
psychological involvement. That is, they answered positively one or more of the following
questions: Have you recently daydreamed about a former therapist? Dreamed, while
asleep, about a former therapist? Felt intense anger at a former therapist? Or experienced
sexual feelings or fantasies about a former therapist? Continuing psychological
involvement was related to therapist unkindness or errors. Pope and Tabachnick’s findings
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support the idea that unanalyzed aspects of both erotic and aggressive transference may be
involved in continued posttermination psychological involvement.
In exploring the effects of passage of time on posttermination intrapsychic
involvement, Buckley et al.’s. (1981) study is an important reference. Their data indicate a
changing response over time in “transference residues” in the posttreatment period. The
ratings o f both the outcome factors and nonspecific items (e.g., “warmth” and “mutual
liking”) did not differ significantly, however, with time since termination. Forty percent of
the group who had terminated treatment within 4 years responded that their treatment had
been harmful somehow, as opposed to only 12% of the posttreatment group that had
terminated 11 to 20 years earlier. This difference may reflect a gradual working through of
unresolved transference issues with the passage of time. Analysis of the data also revealed
that thoughts about the therapist reach a peak, then wane, 5 to 10 years after treatment.
All respondents in this period reported experiencing thoughts of returning to analysis or
therapy. They voiced concerns, such as the “wish to see the therapist again,” and they
viewed the therapist as a “friendly spirit” (all rated significantly higher in this group), so
this period would seem to be a critical time in posttherapeutic development. Thoughts of
returning to treatment may eventually lose their urgency, especially as life conflicts are
successfully traversed. How the passage of time influences posttermination psychological
involvement with the therapist may also bear on the perceived influence of personal
therapy on the therapist’s professional conduct of psychotherapy.
Findings from these studies suggest that termination does not mark the end of
cognitive and emotional involvement with the therapist or of consideration of additional
therapy. These posttermination follow-up studies also support the importance of
considering whether images or introjects of the therapist’s therapist function as a
transitional mode en route to more autonomous self-regulating, or whether their continued
use is vital to self-regulation. The findings regarding self-analysis and posttermination
psychological involvement with therapy have direct bearing on the current study, given the
significance of the therapist’s therapist as a “permanent intrapsychic representation,” and,
therefore, one with potentially great impact on the therapist-patient’s continued
professional practice of psychotherapy.
In conclusion, there is considerable evidence that the internalization of the
therapist’s therapist is an ongoing developmental process that changes over many years
after termination. This process involves the self-analytic function, or the capacity to keep
the therapeutic process alive inside the former patient. The current investigation explored
the relationship between the subjects’ perceptions of an internal therapeutic dialogue and
its potential usefulness for conducting clinical work. Aspects of the perceived therapist-
patient match or “goodness of fit” were also explored through interview questions. Based
on findings in prior work, ongoing internalization of the personal therapy relationship is
seen as an important developmental process with lasting implications for the therapist-
patient’s professional conduct o f psychotherapy.
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Theoretical Assumptions and Research Questions
Statement of Learning Goals
The investigator’s interest was to learn more about how reported benefits and risks
o f psychotherapists’ personal therapy are related to its perceived influence on conducting
their professional work. Also, how does the reported level of overall effectiveness of
personal therapy affect its reported influence in the conduct of psychotherapy? This
investigator found a body of literature suggesting that specific aspects of personal therapy
are valued by psychotherapist-patients, while other aspects are viewed as potentially
negative or riskier. This study was designed to confirm or disconfirm previously reported
findings about benefits and risks of psychotherapists’ personal therapy, especially given
that these have not been systematically compared with the perceived influences of
psychotherapists’ personal therapy on their professional conduct of psychotherapy.
The literature also suggests that complex but nonspecific “process” variables may
influence how psychotherapists perceive their personal therapy. These processes include
various aspects of the interpersonal relationship between therapist-patients and their
psychotherapists and continued posttermination psychological involvement with the
former therapist. This study compared the level of reported influence of the participants’
personal therapy on conducting psychotherapy with perceived benefits and risks of
personal therapy, with perceived overall effectiveness of personal therapy, and with
perceptions of the interpersonal relationship with their therapist.
The Philosophy of Science Employed in the Study
In articulating the philosophy of science from which this study emanates, the
author finds several tenets o f “fallibilistic realism” relevant. This philosophy incorporates
the critiques of logical positivism without abandoning entirely the concept of “knowable
reality” (Anastas, 1994). Fallibilistic realism is a model of science that emphasizes the
complexity of the actual research situation and views the relationships between data and
concepts as reciprocal. The personal and theoretical lenses through which the researcher
views reality and theory, and the impingements of the social context onto the research
enterprise, are considered important in this model of science. Both description and
explanation are the purposes of this approach. The central goal is to describe how
phenomena react or change in the presence or absence of other specific elements in an
open system.
Development of Research Questions
This researcher conducted in-depth interviews with psychotherapists to assess
three related issues: (1) how therapists perceive the benefits and risks of their personal
therapy experience; (2) how therapists perceive their interpersonal relationship and their
posttermination psychological involvement with the former treater; and (3) how these
perceptions compare with their perceptions about the influence of their personal therapy
on conducting psychotherapy. Although there are obvious limitations in using therapist-
patients’ subjective accounts alone as a measure of outcome, these data are central to any
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meaningful understanding of exactly what it is that intensive psychotherapy does in the
way of effecting personal and professional change.
Within the reviewed literature, certain central themes emerged. In general,
psychotherapists have reported that their personal therapy has helped them in the
following ways:
1. Enhanced self-understanding and self-awareness.

2. Enhanced self-esteem and self-confidence.
3. Improved interpersonal relationships.
4. Enhanced therapeutic skills (empathy, in using countertransference, in
structuring their treatment, in understanding the process of psychotherapy).
5. Reduced characterological conflicts and enhanced symptom alleviation.
Likewise, certain risks o f personal therapy have been identified as:
1. Stress and psychological distress.

2. Related to alliance problems.
3. Related to treatment errors.
4. Related to over or underidentification with therapist.
5. Blocked therapeutic effectiveness due to role confusion (being both patient and
therapist, concurrently, in training).
The themes o f reported influences of personal psychotherapy on the conduct of
psychotherapy that were reported in the literature include:
1. Different activity, verbal level.

2. Different way of dealing with countertransference.
3. Therapist as role model.
4. Functions o f therapist as mentor-introject.
The present study compared the perceptions of practicing psychotherapists with
the literature model in order to determine the relative congruence or incongruence with
the model, to determine relationships within the various areas of the model, and to account
for possible variations in participants’ experience within the model elements by comparing
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them with the perceived influences on conducting psychotherapy. This was done by
seeking to advance an understanding of the following questions:
1. Will particular themes of benefits, risks, and relationship variables be associated
with particular reported influences of personal therapy on their clinical work?
2. Will therapists who report more particular benefits and fewer specific risks in
their personal therapy also report greater influence of their personal therapy on their
conduct o f psychotherapy than will therapists who report fewer specific benefits and more
specific risks in their personal therapy?
3. Will therapists who report higher overall effectiveness of their personal therapy
report greater influence of their personal therapy on their conduct o f psychotherapy than
will therapists reporting less overall effectiveness of their personal therapy?
4. Will therapists who report having experienced an interpersonally highly
significant relationship with their own therapist also report more particular benefits, fewer
risks, and a higher level of perceived influence of personal therapy on their conduct of
therapy, compared with those who report an interpersonally less significant relationship?
5. Will therapists who report more evidence of continued posttermination
psychological involvement with their therapist report more particular benefits, more risks,
and higher levels of perceived influence of personal therapy on the conduct of therapy than
will those who report less evidence of continued posttermination psychological
involvement?
C h a pter m
R e s e a r c h D esig n a n d S a m p l e
Methodological Assumptions
This study combined aspects of a concept-driven, deductive method of data
collection with a flexible method o f data analysis, in order to study emerging data not
encompassed in the conceptual model derived from the literature. Flexible method
research is used both for verification of theory and for attempting to generate new
“theory” about a topic.
Qualitative approaches are advantageous for studying subjectively experienced
phenomena, such as a person’s experience of his or her psychotherapy process.
A prevailing ideology in psychotherapy research has prejudiced the acceptance of studies
o f this type, under the guise of “external validity.” Several studies (e.g., Beutler &
Mitchell, 1981) have discerned that therapists’ self-reports of behavior do not correlate
well with outside observers’ ratings of activity. The preponderance of research has gone to
external observation, rating, and coding of therapist behavior. Although this approach has
considerable merit, psychotherapists’ phenomenology should not be so easily dismissed.
Imposed, externally defined dimensions of therapist behavior may say more about the
researcher’s phenomenology than about the clinician’s experience. Moreover, externally
generated behavior may be considered irrelevant by participants (Bern & Allen, 1974).
The question of “valid” therapist behavior is not simply an empirical one; rather, it is a
deeply personal and philosophical issue concerning “reality” and perceived meaning
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(Wogan & Norcross, 1985). Although qualitative modes are no better at dealing with
complex questions o f validity and reliability than are other modes, they do provide space
within a fairly defined structure for in-depth exploration of the significance of personal
psychotherapy for professional practice. When analyzed collectively through the
identification o f themes, such explorations may deepen our understanding of the potential
connections between these variables.
In summary, the goals of the research called for a deductive study, using a fixed set
of questions that still left room for the discovery of new findings. This study drew on the
literature for a model against which to compare study findings. Such a theoretical model
provided a schema against which data were analyzed and interpreted. In addition, the
study used a flexible approach to summarize and code findings within each area of the
study and then compared them with levels of perceived influence o f personal therapy on
the conduct o f psychotherapy.
Sample Selection
The study was limited to therapists who have engaged in, and currently conduct,
psychodynamically oriented individual psychotherapy, given the theoretical importance
paid to the therapist-patient relationship as a vehicle for change in this kind of therapy.
Sustained focus on the treatment relationship is not emphasized in other theories of
psychotherapy, such as systems or behavioral treatments, and hence was beyond the scope
of this study.
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The sample for the study included professional staff at The Menninger Clinic in
Topeka, Kansas, and other licensed psychotherapists in the local community who met
selection criteria and were willing to participate. By professional affiliation, participants
included psychoanalysts affiliated with the Topeka Institute for Psychoanalysis and
psychodynamically oriented psychiatrists, psychologists, and clinical social workers.
All participants were licensed therapists who met the following inclusion criteria:
(1) have practiced individual psychotherapy for at least 5 years, in order to report a well-
grounded experience of themselves as psychotherapists; (2) have concluded a personal
psychodynamic psychotherapy or psychoanalysis process at some point in their lives; and
(3) have identified a significant part of their professional work as providing individual
psychotherapy or psychoanalysis to adults.
Sample Size
The researcher planned to conduct a single in-depth interview with 20 to 24
therapists, depending on the variability of their individual responses. Relying on a principle
of flexible method research, the researcher determined that, after interviewing
20 participants, the variation in their responses was sufficiently broad as to likely yield
little new information by continuing to interview more participants.
Sampling Techniques
Given the variability in training among the three mental health professions sampled,
it seemed vital to include a roughly equal number of members from each discipline in this
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nonrandom sample, as a dimension of sampling on the basis of concepts that have proven
theoretical relevance.
With only 20 participants, purposely stratifying the sample by length of time in
personal therapy and clinical practice was not feasible. The literature indicated that time
since termination is a variable that affects a therapist’s perceptions of its influence
(Kantrowitz, 1990). These differences were limited by interviewing only therapists who
had terminated their personal therapy, and only therapists with a minimum of 5 years
postgraduation experience. This approach focused on better understanding the long-term
influences that personal psychotherapy casts on professional functioning. The investigator
hoped to interview a significant number of therapists 5 to 10 years posttermination from
personal therapy, since the literature indicates that this is a crucial time for internalizing
the therapy (Kantrowitz, 1990). By happenstance, half the study sample fell into this
posttermination time range. In the final stage of the data analysis, their responses were
compared with those of the other respondents.
Since many participants had sought multiple psychotherapies, their most recent
psychotherapy or psychoanalysis received the primary focus. This decision was based on
findings from a pilot study conducted by this researcher in which the cumulative “effects”
of the participants’ multiple therapy processes were available for recall by focusing on the
current or most recent therapy.
To strengthen the trustworthiness of the study, the investigator looked for
disconfirming evidence for the model by asking in the interviews whether the questions
captured what was essential in the participants’ personal therapy and what other
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significant aspects o f their personal treatment were not addressed in the interview.
Considering that the literature findings reveal that 20% o f therapists report some degree of
harm from their personal treatment (Buckley, 1981), it was deemed important to interview
some psychotherapists who reported specific risks and negative effects of their treatment,
as well as to interview therapists who believe that their personal therapy has had little
influence on their practice of psychotherapy.
Method for Securing Data
Prospective participants were therapists listed as providing individual outpatient
psychotherapy or psychoanalysis at The Menninger Clinic, or those in the Topeka
community who were so identified through their local telephone directory listing.
On completion of the Institutional Review Board approval process at Menninger, the
researcher sent 18 o f the randomly chosen prospective participants (6 from each of the
3 professions being studied) a letter of introduction (Appendix A). Included was a
response form to the initial contact letter (Appendix B) and a self-addressed, stamped
envelope. If an affirmative response was returned, the prospective participant was
contacted by telephone, at which time the researcher further described the study,
confirmed its purpose and nature, and answered any questions. If the prospective
participant met the study criteria and remained willing to participate, a specific
appointment for an interview was scheduled. A written explanation of the study was given
at the actual interview (Appendix C), as well as a copy of the informed consent form
(Appendix D), which both the participant and researcher signed. This process allowed
69
time for any uncertainties to be resolved so that consent was truly informed. In all,
54 prospective therapists were contacted about participating in the study in order to obtain
the 20 participants who were interviewed. Five therapists expressed an interest in
participating, but did not meet the study criteria, and another agreed to participate, but
then was repeatedly unavailable. Two therapists wrote to express regret in declining
participation, citing their dual relationship with the dissertation adviser, which created
confidentiality concerns for them. Hence, 27 therapists did not respond to the initial
contact letter.
The researcher conducted one semistructured, audiotaped interview with each
participant at a site convenient to both, usually the office of the participant or researcher.
Several participants preferred to be interviewed in their home, given their need to do so
after working hours. After the confidentiality and informed consent issues were discussed,
the investigator asked each participant information about their years of postgraduate
clinical practice experience, their current weekly hours conducting individual
psychotherapy, and their own treatment histoiy (i.e., number of discrete treatments,
approximate hours in personal therapy, and amount o f time posttermination from their
most recent treatment) (Appendix E). The interview questions (Appendix F), developed
over the course of the pilot study and review of the literature, were then employed. The
length of the interviews averaged about 90 minutes, and ranged from 1 hour to 2.5 hours.
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Pilot Study
To determine the feasibility of this study, a pilot study was conducted earlier
by this researcher, who interviewed 11 psychodynamically oriented psychotherapists.
Specifically, its purpose was to determine whether psychotherapists would be willing
to candidly share, through an in-depth interview, their experiences of personal therapy?
Given the highly personal nature of the study questions, would the narrative accounts
enable the researcher to examine influential aspects of their personal treatment
experiences? Would the content of the interviews point to identifiable themes? Conducting
the pilot study helped to determine what kind o f coding methodology might be appropriate
as well. Early interview questions for the pilot study were less structured, to assist subjects
in describing their “lived experience” of psychotherapy. Participants in the pilot study both
appeared and reported feeling at ease, and were candid in sharing their personal
experiences.
Results of Pilot Study
Themes that emerged as important to pilot study respondents in their personal
therapy included the structural aspects of the treatment, such as time management, and the
availability, reliability, and predictability of the analytic environment. Technique-related
aspects, such as the timing of interventions and the perceived responsiveness and
involvement o f the therapist, were valued, as was the communication o f accurate empathy
in supporting self-esteem. Enhancement of personal self-confidence and competency was
also valued as a benefit of personal therapy by the pilot study respondents.
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How the therapist’s mistakes were dealt with and how the inevitable
misunderstandings in the dyadic relationship were worked through was significant.
The respondents valued seeing their therapist as “someone who owned her mistakes,” or
as being “a real person who let his vulnerability show.” The pilot study raised questions
about the conditions under which therapists’ mistakes have proven harmful to the
participant and his or her clinical work, or are used to promote psychological growth.
The importance of the interpersonal relationship with the treater was noted.
It often contributed to a deepened understanding of transference and countertransference
phenomena. Also prevalent as an important aspect of the interpersonal relationship was
the valuing of spontaneity, flexibility, and even departure from strict analytic technique
by the respondent’s therapist.
Aspects of identifying with the therapist as a mentor to be at times imitated, to be
differentiated from, and with whom to compare oneself as a therapist also emerged in the
pilot data. Prior therapy deemed unsatisfactory by participants provided a negative model
with which participants apparently dis-identified in their professional conduct. These
themes were further probed in the subsequent study.
Developing the Interview Questions
The pilot study and the model elements described in prior cited work were used to
develop the following interview format. The researcher asked the first question and
allowed the participant to respond fully before inquiring about the specific elements of that
part o f the model. This format was used for the second and third areas of the model as
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well. The specific questions asked are presented in Appendix F. The questions used to
explore the areas of benefits and risks are straightforward, and therefore do not require
explanation here. Two questions about the perceived overall effectiveness of personal
therapy were included as global appraisals of the value o f personal therapy. These
questions also replicated those asked in studies reported in the literature (Kantrowitz,
1990; Mackey, 1994; Shapiro, 1976). Questions in the third area, about influences of
personal therapy on conducting therapy, reflect some elements of the findings of prior
studies, and in addition asked about aspects of role modeling and introjection or imitation,
which have not been well studied. What kinds of responses would be generated by these
questions, or how they actually would reflect the model elements that they sought to
probe, was unclear at the outset. The final set of five questions inquired about continued
psychological involvement and the perceived interpersonal relationship with the personal
therapist. The review of prior work and the author’s own pilot study findings suggested
these two processes as being explanatory for some of the variations in the participants’
perceptions of the benefits, risks, and reported influences or uses of personal therapy in
conducting psychotherapy.
Ethical Issues
Several ethical issues were deemed important to consider from the initial stage of
this project. According to principles outlined in the Code o f Ethics o f the National
Association o f Social Workers Pertaining to Research and Knowledge Development
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(1990), relevant issues include potential harm to subjects, limits of confidentiality, and the
recording or maintenance o f data.
Participants in this study typically would not be considered a vulnerable
population, given their level of professional education or training, socioeconomic status,
and overall psychological strengths requisite of those providing psychotherapy services to
others. However, they were asked to reflect on personal therapy experiences that
potentially could provoke painful psychological material. The researcher’s sensitivity to
this potential distress and respect for the autonomy o f the individuals being interviewed
was one safeguard against any untoward psychological distress. As described in the
consent form (Appendix D), subjects had the right to refuse to answer specific questions,
the right to end the interview at any point, and/or the right to retract consent to participate
in the study.-These issues were discussed during the initial telephone contact and again at
the beginning o f the interview.
Protection of the privacy of subjects was safeguarded by not interviewing subjects
who were involved in close relationships with this researcher or her dissertation adviser.
In addition, the identity o f subjects has been, and will continue to be, disguised in all
written and oral presentations of findings.
The researcher also informed potential participants prior to scheduling an interview
that the on-site dissertation adviser, with whom carefully disguised interview data would
be discussed, was Donald B. Colson, Ph.D. This was deemed especially important as
Dr. Colson served as Chief of Psychology at Menninger at that time. This approach
addressed the potentially varying interests of the participants and the researcher, given the
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need to discuss the unfolding data with the advisor, as well as to inform participants of this
limitation on confidentiality.
Participants also were asked for permission to audiotape the interview. Transcripts
of interview data were typed by one of two clinical research transcriptionists, hired by the
researcher, who were experienced with confidentiality standards in clinical research. Their
identities were told to the participants prior to the interview, in order to ensure that the
participant did not know the transcriptionist, so that voice recognition on the tape would
not compromise their confidentiality. Once the recording of an interview began, the
researcher did not address the participant by name. Materials were securely stored in the
researcher’s home office in locked files. On all transcripts, participants were identified by
an assigned number rather than by name or initials, in order to further protect anonymity.
Data Analysis Procedures
As in most flexible method studies, the proposed data analysis procedures and
those actually executed were in some variance. In an attempt to best describe and compare
the nature o f the findings as they unfolded, the researcher made some modifications in the
plan. The proposed plan called for three aspects of data analysis, which included:
(1) comparing the study sample with the model from the literature for thematic relevance;
(2) describing which themes of reported benefits and risks relate to reported influences on
personal therapy in conducting psychotherapy; and (3) explaining how reported benefits,
risks, and influences o f personal therapy on professional functioning relate to various
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aspects of the interpersonal relationship and to continued posttermination involvement
with one’s therapist.
The implementation o f the actual data analysis involved first identifying and
categorizing themes in the narrative data of each participant’s responses. These categories
o f themes and subthemes were organized by aggregating the responses of every
participant for each of the 27 questions on the interview schedule. Included in this
summary are quotations from the participants that illustrate those themes. This process
was followed by the second phase of the data analysis, which entailed mapping and
counting the number of subjects who responded that a particular theme was relevant.
These data were displayed in the form of a data matrix outline (see Appendix I). Each
participant’s responses in the major categories of each interview question were recorded
and displayed for each of the four domains (perceived benefits, risks, influence on
professional conduct, and interpersonal relationship).
Considering that the primary goal of the research was to better understand the
influences o f personal therapy on therapists’ clinical practice, the final stage o f the data
analysis involved comparing the individual results in this area of inquiry with the other
three areas o f the study: benefits, risks, and interpersonal relationship. In looking at the
individual questions in this third area of the model and at the aggregate responses of
participants, the investigator decided to rank the participants’ reported influence of
personal treatment on clinical work into high-level, middle-level, and low-level groups
(see Appendix G). A comparison was then made by looking for patterns of association
between the three groups’ responses in each of the other areas (perceived benefits, risks,
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and interpersonal relationship). This comparison created a composite picture o f the
variations between the perceived benefits, risks, and interpersonal relationship for group
members at the three levels of perceived influence, which made up the third and final
phase of the data analysis. The goal here was to identify and summarize differences in the
various levels of influence that emerged in the responses of members. A summary of these
findings is then reported as integrated responses in each of the four domains. This
summary is followed by a visual display in chart form of the variations between the levels-
of-influence group in each domain. Conclusions of this phase o f the data analysis are then
presented.
The presentation of findings ends with a description of two unanticipated themes
that emerged from the data, followed by an effort to contextualize the findings by
presenting variations in the study participants’ years of clinical experience, professional
affiliation, and personal treatment history, compared with the level o f perceived influence
of personal therapy on their conduct of psychotherapy.
C h a p t e r IV
F in d in g s

Identifying and Categorizing Themes in the Narrative Data
The first phase o f the data analysis involved identifying and categorizing the
aggregate responses for each of 27 questions on the interview schedule. Eveiy response
from each participant was reviewed and themes were identified and organized according
to patterns o f response. The patterns of response for each question are presented with
selected verbatim narrative data that support the development of the categories and
themes. During this process, the researcher recorded the participants’ code number, in
order to map each participant’s specific response categories. These code numbers have
been removed from the first phase of the data presentation, to facilitate reading the
document.
The interview began with an open-ended exploratory question about the benefits
of personal therapy. The responses were deemed to merit particular weight, since they
were provided before the interviewer probed the specific categorical questions. Thus, it is
believed that these responses were less likely to be influenced by what the participant
perceived as a desirable response. For this reason, more space is given to responses on the
first question, as well as to the one other similarly structured question that introduced the
perceived risks section of the interview. The percentages of respondents who mentioned
particular themes of benefits in the first question were calculated and are displayed.
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Participants’ responses to open-ended question 1. (Please describe w hat has
been beneficial to you in your personal therapy or analysis?) were categorized into
the following themes, followed by the percentages o f respondents who spontaneously
addressed each category:
1. Enhanced self-understanding and self-awareness (55%)
2. Enhanced separation-individuation related to family of origin (40%)
3. Improved interpersonal relationships with contemporaries, including intimate
relationships (40%)
4. Symptom alleviation (40%)
5. Enhancement o f professional work with patients (35%)
6. Improved self-esteem and self-acceptance (30%)
7. The importance of the interpersonal relationship with one’s analyst (20%)
8. Initial treatment unhelpful, subsequent treatment sought (10%)
Responses to this initial open-ended question were organized into the above themes and
are further described below:
Enhanced Self-Understanding and Self-Awareness
Responses related to enhanced self-understanding included comments describing a
gradual growth in introspection and self-awareness, such as: “I valued the opportunity to
examine my inner world and workings for a period of time in a very regular way,” and
“It helped me trust my ability to be introspective and I became much more comfortable
with my inner feelings.”
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Perceived growth in self-understanding revealed implications for understanding
others differently in one participant’s statement: “I gained a deeper awareness of how
powerfully issues affect people’s lives, through my own experience. And I know that
everybody else is also under the sway of the kinds of matters that I discovered within
myself.”
The view that self-understanding is relatively situated, in an existential sense, is
reflected in one participant’s response that he was left “with the sense being reinforced
that most o f the time, we live in the questions and not the answers.” He implied, however,
that his analysis has left him feeling more comfortable in living with these uncertainties.
Enhanced Separation-Individuation Related to Family o f Origin
Spontaneous responses related to parent-child separation-individuation themes
were organized into two subgroups. Three participants spoke of their adaptation to
traumatic separation and loss of one or both parents in childhood, due to illness or death.
Each o f these participants described themselves as being resilient in their capacity to elicit
care from substitute caretakers. This group seemed to value their analytic experience as a
place to rework the meanings and impact of such profound childhood loss. The second
group, reared in intact families, spoke of “coming to terms with who my parents are and
who I am because of the family I came from.” Several of these participants described
having unresolved emotional issues that trace back to their family of origin and are an
indelible part of who they are and how they relate. Two respondents referred to “oedipal
conflicts” in competitive struggles with their same-sex parent during separation in late
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adolescence and early adulthood. Both spontaneously offered that their analysis helped
them find new solutions through which to experience their competency as adults, both
similar to, and yet different from, their parent.
Improved Interpersonal Relationships
The capacity for relating differently to others, which has generally enhanced their
interpersonal relationships, was spontaneously noted by seven participants in the open-
ended question about the global benefits of psychotherapy. One participant noted that,
“As a result of the process, I experience myself differently and I relate differently, not just
as a professional, but as a human being. The most important aspect was I learned how to
be in a relationship in a different way that has profoundly affected the way I relate to
people now.”
The perception that their personal therapy enhanced their interpersonal
relationships was described by participants in terms of deepening both their capacity for
commitment and their tolerance for the humanness of others. Several participants noted
their prior struggles to make commitments in intimate relationships, while one quipped
that his spouse tells him he is a better partner since his analysis. This same participant
observed that analysis has helped him become “more tolerant of people and not just o f
patients.” Finally, another participant noted that having worked on dynamic issues related
to her relationship with her parents has had a lasting impact on her interpersonal
relationships, with both men and women. She then noted that she “tends to expect or
allow imperfection or humanity much more in relationships” than she used to.
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Symptom Alleviation
Approximately half the participants mentioned a reduction in symptomatology as
a benefit of their personal therapy. Their symptoms included fairly severe depression,
generalized anxiety and guilt, obsessiveness, self-consciousness and anger. In the group
of 8 who mentioned benefits o f symptom reduction, 4 participants noted that they entered
personal analysis in large part because of depression, anxiety, or guilt, and the remaining
4 expressed pleasant surprise in noticing well into, or after their, analysis that their
presenting symptoms had abated. One participant explained, “I realized after termination
that a lot o f nervous habits I’d had had disappeared.”
Enhancement of Clinical Work with Patients
Seven participants spontaneously spoke o f the beneficial influences of their
personal therapy on their clinical work with patients. One participant noted that therapy
was close to the best thing she has done for herself and one of the best things she has done
for her patients. Another participant who noted the ongoing influence of his treatment on
his clinical work commented that he continues to use the analysis, that is, he can think
about himself with certain skills and techniques that he learned there and continues to use
now.
Several participants also mentioned enhanced awareness and attunement to
multiple levels of the treatment process with their patients as a benefit of personal therapy.
One participant noted:
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It’s made me much sharper as a treater, because I do have a grasp of the process,
of how things that you cannot be aware of are still very much a part of your life
and propelling you and get played out in relationships and in transference. I know
from firsthand experience and can extrapolate from that and pick up on things
much more astutely and quickly in relating with people, as well as working with
patients. I’m much more aware o f the implications of seemingly insignificant
behaviors in general. I hear metaphor and can conceptualize it more immediately to
implications for levels of functioning and personality organizations, for better or
worse, with friends, family, and with patients.
The value of engaging in personal therapy concurrently with their clinical training
was mentioned by two participants in response to the initial question about general
benefits. One participant noted the value of “engaging in a lot of work with patients
concurrently, having a chance to see how that was resonating. It helped me examine, in
vivo, what was happening to me in response to patients.” Another participant observed
that the dual roles of her analyst, who also taught in her clinical training program,
encouraged her to bring her clinical cases into their analytic work. She noted that she
“learned a lot o f theory and didactic stuff as well, within the context of the analytic
relationship.”
Improved Self-Esteem and Self-Acceptance
Improvements in self-esteem were described by three participants in such
comments as: “Generally, I felt better about myself. My perception of who I am and what
I am capable of is probably what’s changed the m ost. . . my own self-view, self-concept,
changed in that I learned to like myself, and that wasn’t any small achievement.” The
notions o f feeling both better about oneself and more confident about one’s capabilities
can also be seen in a participant’s comments that her analysis helped her “learn not to be
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so scared and get much more sense of my own competence. Toward the end o f my
analysis, I had a much stronger sense of really trusting myself, listening to what I felt and
believing it and going with it.” She noted that this self-confidence was particularly true of
her clinical work.
Enhanced self-acceptance as a perceived benefit is reflected in several participants’
expressions o f progressively viewing themselves as “good enough” and feeling entitled to
be how they are. One participant noted being “more comfortable with who I am, not
feeling like I should try to be different or that I shouldn’t have particular feelings, feeling
more self-acceptance, and feeling more entitled to whatever I feel.” With enhanced self
acceptance came an increased capacity for self-comforting, as one participant explained:
Because o f a lot o f premature losses early in life, from the analysis, I came to feel
not so alone because I became my own friend in a way I hadn’t been before . ..
I came to accept and view myself in a way I hadn’t before, through his acceptance.
So I’ve had an inner peace since my analysis that I never had before, which is
invaluable, and this feeling has grown since we terminated.
Enhanced self-acceptance can also be heard in the comment made by one participant who,
with therapy, became increasingly aware of the harshness of his “superego”: “It
tremendously reduced my self-criticism, which I was not aware was even there. I had no
idea that I was talking that way to myself, treating myself so critically.”
Benefits of the Relationship with One’s Analyst or Therapist
Four participants mentioned the relationship with their analyst or therapist as a
valuable benefit o f their treatment. Two of them, both men, described the importance of
developing a close relationship with a man, in light of their early father loss or a strained
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and distant relationship with their father. Both noted this as an “educational” benefit of
their treatment. Their references to being taught related primarily to the help they received
from their analyst in learning, first, about being a competent man, and second, about
becoming a competent psychotherapist. Hence, the analyst as a model for gender-role
identification was relevant to these participants, both of whom had experienced early
parental object loss. The importance of such closeness and containment is revealed in this
participant’s initial description o f his relationship with his analyst:
My analyst and I had a funny relationship. He was helpful to me, a sort of father
figure. We had quite a bit o f postanalytic contact. He liked me and was surprised
by the fact that I had the capacity to regress deeply and then pull myself together
quickly. I was able to make good use of the process because I felt contained by
him. In fact, it was his work with me that made me feel confident in myself. The
containing or holding environment is very important.
Another participant noted the importance of being treated like a colleague in his
second analysis, which was very reinforcing to his self-esteem and professional
competence. Unfortunately, he had had a different experience in his first analytic
encounter.
Finally, another participant who offered comments specifically related to her
relationship with her analyst emphasized the value of the unique intimacy of the analytic
relationship, noting:
Though it cleared up a lot of conflicts, what I most value about my experience was
and is the relationship. I don’t think I’ve ever experienced the level of intimacy
with another human being that I did with my analyst. That can be a double-edged
sword, because I longed for that in other relationships and it’s possible to have, but
this was a very unique kind.
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Initial Treatm ent Not Helpful, Subsequent Treatm ent Sought
Two participants noted that their first psychoanalysis was not helpful. One sought
a subsequent analysis, which proved highly satisfactory and contributed favorably to his
own career path as an analyst. He said that he felt his first analyst didn’t like him and that
he felt quite differently with the second one. The other participant who spontaneously
reported that his psychoanalysis was not helpful noted that his analyst not only
underdiagnosed him, but also was “struggling, too; I felt I had to take care of him. He had
political problems in the institution and this felt to me like a traumatic reenactment of my
own parents’ intense marital conflicts.”
In summary, the participants in this study responded to the initial open-ended
question about the general benefits of their personal therapy with accounts that were
highly congruent with the model developed from reviewing the literature. The various
categories are valued very similarly, with the exception that symptom alleviation was
perceived as a more frequently mentioned benefit by this study sample than reported in the
literature. The significant addition to the model would be the study participants’
perception o f the relationship with their analyst or therapist as a beneficial aspect of
treatment unto itself, rather than viewing the treatment relationship merely as a means to
an end. These study results suggest the importance of the therapist’s therapist as a
continued “real object” for the participants, long after termination of the treatment
relationship.
Responses to question 1. a. (How useful was your therapy in enhancing your
awareness and understanding of yourself?) have been organized into the following five
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predominant subthemes related to enhanced self-awareness: (1) improved understanding
o f one’s psychodynamics: (a) based on understanding oneself in the context o f relatedness
with one’s original, infantile objects, and (b) based on perceived contemporary ego
functioning; (2) related to the relationship with the analyst; (3) regarding needs for both
connectedness and separateness of self and others; (4) regarding effects on one’s
professional development; and (5) concerning disappointments or limitations in the
enhancement of self-awareness.
The theme of reported improvements in self-understanding and self-awareness
related to understanding oneself in the context of early object, or familial, relationships
included responses by several participants. Exemplifying these were comments such as,
“My analysis reinforced my strong self-awareness and intuition, which had been stifled in
my growing up-I reclaimed part of me.”
Reported enhancement in self-understanding also was related to the participants’
self-reported contemporary ego functioning and appreciation of their dynamic intrapsychic
conflicts, defensive functioning, coping style, and adaptation to the demands o f reality.
One participant noted that it stimulated his curiosity about his dreams and he wondered
who he would have been without his analysis. He believed that he would be more action-
oriented and more prone to live “on the surface.” Another participant observed that, with
his increased self-awareness, he could see that he had coped with loss through looking for
stimulation or getting a little hypomanic.
Dynamic issues related to growing self-awareness about narcissistic vulnerabilities
was reflected in the comments of several participants, such as: “My analysis was too short.
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I wasn’t aware o f the extent o f my narcissistic problems, which left me with anger and
isolation as symptoms. I wish I’d have continued in the analysis, to work more o f that
out,” and “I became more aware of how reactive I can be to breaks in attunement to me,
to anticipation o f loss. That increased my observing ego and led to less reactivity to my
own dynamics.”
Closely related to the perceived changes in narcissistic vulnerabilities is the theme
o f increased competence, self-confidence, or self-esteem in response to the question about
increased self-awareness. Participants noted that analysis helped them feel more competent
and better able to think about their self-concept and problems with self-esteem.
A second subtheme o f response to the question about the usefulness of therapy in
enhancing self-awareness and self-understanding relates to the relationship with the
therapist and includes transference and identifications with the analyst. One of the two
participants who described at least one negative psychotherapy experience noted that he
and his last psychiatrist were a very good match and that it was a helpful treatment.
Another participant noted that he didn’t choose his analyst, however, he felt that he had
“lucked out” in getting the one he got.
Several respondents noted the importance of being able to develop a negative
transference to their analyst, as a painful but necessary part o f the work, evidenced by
such comments as: “I was surprised at my level of rage. My analyst wouldn't let me avoid
it in the transference work.” Another participant related: “I needed to and was able to
experience a negative transference in the analysis, which was unpleasant but necessary and
helpful.”
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Developing identifications with the analyst as a new object was observed in
comments by several participants. One noted that she developed some healthier
identifications with her mother and some new feminine identifications that her mother
doesn’t have. This participant recalled wanting her analyst to “put his foot down” on her
behalf with her mother by helping her learn to set limits with her mother, which he
wouldn’t do. But, she noted, he did “put his foot down in a different way with me
(in setting limits around self-disclosure of his personal life), and it hurt my feelings, but
now I see maybe it was helpful in helping me learn to set limits with my [intrusive]
mother.” Another participant noted that his analysis changed his “sense of self and perhaps
it has to do with identification with her [his analyst]. Perhaps, because o f my identification
with her, I could conceive of myself as a practicing mental health professional. So in that
sense, my psychotherapy changed my representations of myself in a major way.”
A third subtheme o f responses to the question about the usefulness of personal
therapy in enhancing self-awareness and self-understanding relates to autonomy and
relatedness in object relationships. On the side of promoting separation-individuation, one
participant noted that his analysis increased his autonomy and his ability to self-soothe
through self-analysis and through reading psychoanalytic theory: “I have continued to read
psychoanalytic theory and it has come much more alive for me. Bibliotherapy is part of my
ongoing self-analysis.” Another participant noted her sense of enhanced self-reliance
through learning how to carry out a procedure on herself. She observed:
I think I refined a model or a procedure for how you go about gaining insight.
It has to do with allowing myself to focus on a particular thought or affect, rather
than run away from it, to not be afraid of it. And to simply trace that affect or
thought back to the point where it started and then see what was happening in my
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life that would help me gain insight into it. And also to just let my mind free-
associate to the event that had triggered it to see where, in the past, I might be able
to get insight from other situations. And then to try and sort out how much of the
current affect was a realistic response to my current-day reality and how much of it
came from past things. And if it came from current day, what did I need to do to
rectify the situation? So I came to appreciate that emotions are really kind of
crucial messages I ’m sending myself and to think about them. This was
phenomenally powerful!
An example of relatedness can be found in the report of one participant who noted:
“I was already intuitive and this helped me put words to my experience and gave it some
validity. It was very powerful for me to be able to put words to my experience and then
not to feel isolated in my own narrow understanding of things.” Another participant
explained: “It gave me an introduction to the world of feelings and relationships and a
greater appreciation for subtleties.”
A fourth subtheme o f responses to inquiry about self-awareness and self-
understanding relates to the ongoing development of professional identity. Several
participants addressed this in their comments. One respondent noted that her enhanced
self-awareness has affected her clinical practice, “by helping me believe that everything
people do is understandable-there are reasons for what they feel and why they do what
they do.” Another participant noted feeling more self-aware and more differentiated with
her patients in her observation:
I became aware of my issues and hopefully more sensitive about not putting my
issues into my patients, being able to separate them-using my own experience to
understand them, but not putting my issues on them.
A third participant noted the usefulness of the self-understanding he gained from his
second analysis, particularly in his work with analytic patients:
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I think if I had tried to do analysis based on my first analytic experience, I would

have felt very little freedom. I experienced my second analyst as being comfortable
with being gentle and approving. He was a model of what I needed and what
I wanted and I think that that probably affected the way I work because I had very
little confidence in the way I worked. I thought I was too much of a pushover and
too softhearted. So it changed my whole view of myself as a therapist. I had been
doing better therapy than I realized. So it had a powerful affect on me. I feel best
about myself as a therapist in the last few years than I’ve ever felt before.
Finally, a fifth subtheme of responses to inquiry about the perceived significance of
enhanced self-understanding and self-awareness as a benefit of personal therapy relates to
limitations regarding this dimension, as noted by several participants. One participant said:
“it’s not perfect, there were some disappointments and a sense o f ‘unfinishedness,’ yet
both came at good stages of my life.” Another respondent reflected: “It didn’t change my
life profoundly, but it stirred things and helped me live deeper, and at a less superficial
level.”
In summary, the range o f responses to inquiry about perceived enhancement of
self-awareness and self-understanding stemming from personal therapy reflects several o f
the benefits reported in the model from the literature, particularly improved self-esteem,
improved interpersonal relationships, and enhanced therapeutic skills. The participants’
responses further emphasize the importance of the relationship with their analyst or
therapist as an identification figure and the analytic process as one promoting the
development o f enhanced separation-individuation, including through experiencing
negative transference reactions.
Responses to question 1. b. (How useful was your therapy in enhancing your
self-esteem and self-confidence?) fall into two categories-those who experienced their
self-esteem as being clearly enhanced by their therapy and those with mixed or equivocal
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responses. In both categories, responses reflect changes in both personal and professional
self-esteem and self-confidence. Numerous participants mentioned the therapeutic activity
of their treater, which promoted or hampered the development of their self-esteem and
self-confidence. The aggregate results of this question will be presented by category, with
reported personal and professional changes in self-esteem followed by perceived
therapeutic actions by the treater associated with these changes.
Over half the participants reported that their analysis or therapy had clearly
enhanced their self-esteem and self-confidence. Their responses reflect both enhanced
personal and professional self-esteem. Perceptions of improved self-confidence and self
esteem in their personal life include such comments as, “My analyst’s confidence that
I could have a healthy relationship with a man was really important to me.”
Although several participants noted that their struggles with self-esteem remain
incompletely resolved, they nevertheless found their personal therapy to be quite helpful.
One participant noted:
I ’m still not what you’d call ‘Mr. Assertive,’ by any means. I ’m still very much
a quiet person and shy at times, but I am much more comfortable with myself.
So it really sparked my self-esteem in terms of catching myself being negative or
defeatist and saying, ‘Wait a second, I can do this,’ and do it. It made a big
difference.
Within the category o f those participants who felt positive about the benefits to
their self-esteem and self-confidence, seven identified perceived benefits to their
professional identity or clinical practice. Included in their responses were such comments
as, “I would have perceptions validated as making sense and my clinical work as being
solid, so that nudged me along in self-esteem.” Another participant observed that the
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benefits to his self-esteem were relative, considering where he had started, yet very
helpful: “From my personal history, issues of self-esteem and self-confidence are still
incompletely resolved. But the analysis was enormously useful in clarifying what the issues
were and helping me arrive at a better sense o f who am and of my right to be doing this
work and to be able to see it as valuable to other people.” One participant noted that she
went through several job promotions during her analysis and would play out whether it
was okay for mother, father, and analyst if she took each new step. She observed that her
analyst helped her contain her anxiety about her success and competition and helped her
deal with her fear of shame if she failed to win in the competition. Finally, one participant
very eloquently described her dilemmas with professional competence and what she
learned about herself in her analysis:
I can remember the minute I said in analysis, after I had just done a videotape with
a family and had to watch myself with my supervisor, then going into my analytic
hour, and feeling, ‘You know, she’s not perfect, but she’s okay.’ And it was a very
powerful thing to think, ‘I don’t have to be perfect to have something to
contribute; I don’t have to know everything to be helpfiil-that I know something
and that can be found by my patients in a way that is helpful.’ So my analysis
validated my self-confidence. One o f the things that I learned in my analysis that is
very powerful in my clinical work and I use a lot is that, if the standard that you’re
striving for is perfection, all that does is isolate you. And that, really, it’s by our
imperfections that we’re really allowed to connect. So when ‘good enough’ is
better than perfect, is the theme that I walked away with. It’s given me permission
to just be who I am and then I feel like I can turn around and try and help patients
do the same thing. You don’t have to be perfect to be lovable or accepted.
The therapist’s role in promoting personal self-esteem and self-confidence is a
theme that is reflected in numerous participants’ comments. One person noted that
“a couple of things in the therapy helped with my self-esteem. One was how he made me
feel, or the feeling I got. I just felt totally respected. I’d never experienced this feeling of
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incredible respect, with this person listening to you, concentrating on you. It was
amazing!”
Almost half the participants reported mixed or equivocal changes in their self
esteem, which they associated with their personal therapy. One participant noted,
“My analysis was not very helpful to my self-esteem and self-confidence, although
I always kept a good sense of myself as a therapist somehow.” However, this participant
added that a later psychotherapy process had been quite helpful with his self-confidence.
Two participants, in particular, noted the benefits to their professional functioning with
their second treatment experience. One participant’s mixed responses reflected his
experience of a therapeutic mismatch with his first analyst, which left him feeling less self-
confident after his initial therapeutic analysis, but then he availed himself of a training
analysis, with much more positive results for his self-esteem. Another person whose
description falls into the mixed results category described his first analysis as helping him
reduce symptomatology and function better in some ways, but he noted that it was a very
frustrating process, followed by one that he felt supported his self-esteem:
There were things left undone [in the first analysis] and it didn’t have a traditional
termination phase, where I left feeling I had significantly resolved a lot of issues.
I thought it just petered out a bit toward the end, and I terminated because
I thought I couldn’t do more. Whereas my second analysis was very helpful,
because it focused so directly on issues of self-esteem and earlier narcissistic
injuries in childhood, and it gave me the courage to make a career change and to
go into clinical work, which I’ve enjoyed a great deal, and since it worked
specifically on that issue, it was very helpful.
Two other people in this mixed results group regarding self-esteem spoke of not having
much of a problem with self-esteem or self-confidence before their analysis yet, over time,
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seeing that it helped some of their self-perceptions about their confidence level to become
more realistic.
Finally, three participants noted mixed results for their self-esteem due to
limitations in the analytic process itself. One noted that her self-esteem eventually did
benefit but could have been helped much more quickly if her analyst had confronted,
rather than only explored her unrealistic and very burdening sense of responsibility for
others. She added that she plans to tell him this someday. Another participant noted his
own increased and unabating anxiety, confusion, and bewilderment throughout analysis,
by virtue o f doing something as difficult as “being forced to face your deepest fears.” He
added that he now thinks it was probably good for him, although it certainly shook his
self-confidence during the entire analysis. A third participant noted that while the analytic
process made him “more reflective, less action-oriented, and more receptive to looking at
things” in himself, he observed certain doctrinaire aspects of analysis. He reported,
“disdaining the analytic rigidity that mimics religion, the closed attitudes in buying only
into drive theory, for example. On the one hand, analysis can open you up, can enhance
your sense o f discovery of the patient. This participant appeared to develop self-
confidence in his professional convictions through differentiating his theoretical beliefs
from classical psychoanalytic drive theory, to which he felt his own analyst subscribed.
In summary, the range of responses to inquiry about perceived enhancement of
self-esteem and self-confidence associated with personal therapy reflects the participants’
varying capacities to acknowledge and work on their narcissistic vulnerabilities within the
context of their particular treatment relationship. Therapeutic action that was described as
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beneficial to self-esteem included the analyst’s ability to help contain anxiety about both
success and failure in issues related to competition, the patient’s experience o f being
respected by the analyst, helping the patient resolve unrealistic and defensive
perfectionistic strivings, technical aspects of analysis of resistance (such as the timing of
silence and interpretation), and the therapist’s perceived comfort and expertise in helping
the analysand work on painful issues related to early narcissistic injury. Limitations in the
therapeutic action that were associated with mixed results or unimprovement in reported
self-esteem and self-confidence include a perceived therapeutic mismatch, perceived
constraints in the analyst’s method or technique, including not structuring the termination
phase of treatment, and inherent limitations in the psychoanalytic process itself.
Responses to question 1. c. (How useful was your analysis or therapy in
improving your interpersonal relationships?) cluster into two broad groups: those for
whom personal therapy was perceived as clearly helpful to their interpersonal
relationships, and those for whom the implications for their relationships were more
complicated, with enhancement in some relationships but no clear improvement in others.
The “clearly improved” interpersonal relations group of responses is presented first,
followed by the “mixed results” group. Within both groups, specific themes are presented.
Over half the participants reported that their interpersonal relationships improved
with treatment. Their responses cluster in three thematic areas: (1) their own enhanced
capacity to form “healthy” relationships; (2) enhanced relations with significant others,
including family of origin, romantic or marital partnerships, and friendships; and
(3) enhanced professional relationships. Several respondents who perceived that their
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capacity to develop positive interpersonal relationships was enhanced by treatment
described themselves as less self-preoccupied, less self-referential, and better at listening.
Two believed their analyses made them “less superficial,” more introspective, and
reflective, which they viewed positively. Yet another participant noted that her analysis
helped her become less defensive about what was her responsibility and what was other
people’s responsibility in her interpersonal relationships.
Eight participants reported enhanced relationships with significant others, including
family-of-origin, romantic or marital relationships, and friendships. Their comments
included the following: “The quality of my friendships have changed as a result of my
analysis. It’s made a significant difference in my ability to approach my family members,
individually and collectively. I don’t think I ’d be as content with my family relationships as
I am, not having experienced the analysis.” Another commented, “I’m sure it’s made some
relationships richer, particularly relationships with other men.” A female participant noted,
“It was useful in helping me to clarify a lot of anger I’ve had in relationship to men and
with my father. . . and it helped me feel like I could have a relationship with a man and
stay clear about who I was.” Two male participants noted that during their analyses, they
finally extricated themselves from an “unhealthy” relationship and met the woman they
would later marry. Both these individuals described their marital relationship as rich and
fulfilling and credited their analytic work with helping them move into a committed
intimate relationship with a mature partner.
Two participants in the “clearly beneficial to interpersonal relationships” group
described examples of enhanced professional relationships. One observed that he became
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clearer about the senior analysts whom he admired and wanted to emulate and that he
cultivated mentoring relationships with them. He also became aware of who he did not
respect, “teachers that were too doctrinaire, too much like priests at the temple.” He
found his capacity to thus differentiate himself to be quite helpful overall to his
professional identity.
O f the eight participants reporting “mixed results” for their interpersonal
relationships, the responses o f the five female participants shared a common theme-that
their treatment helped them clarify the boundaries of their personal responsibility in
relationships. Two o f these women noted changes in their relationships generally, which
they eventually connected with changes in their relationship with their mother. One
participant noted:
What’s useful is that I don’t feel so much like I’m totally responsible for how a
relationship goes. So some of my relationships are improved and some o f them
aren’t, but I don’t see it as my total job to improve them. I think my relationship
with my mother is improved a lot. Partly because I’ve just accepted the fact that
she really is a difficult person and it’s not just me or our interaction, and I think in
large part I ’ve quit trying to make her into the kind of mother I might want, and
I think we’re just easier with each other this way.
Another participant noted that her therapy helped her a lot:
Yet there are some ways that it actually disenhanced my relationships . . . I think
I was a much nicer person before my analysis. I think that I am much more up
front with my aggression now. I tend not to welcome everybody into my life.
I guess I would say that I don’t try and please people as much, so I have deeper
friendships, but I don’t have as many people. I think I became a more assertive
daughter in a lot of w ays... . And I learned in my analysis that my mother has
more to lose by holding on too tight. I can leave and it’s made it a lot easier.
And, finally, another female participant noted her struggles with significant others during
her analysis:
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During the process of analysis, it probably was not terribly helpful. I went through
it being married, being a mother, dealing with parents going through elderly crises
and I think I was self-centered and irritable with the distractions of other people’s
issues. It was probably hard for them to understand my self-centeredness. In the
heat o f the analysis, for an extended period of time, I was less pleasant to spend
time with, to put it mildly. But, ultimately, I think my interpersonal relationships
were greatly enhanced. Having gone into the analysis realizing I was kind of angry
and guilt-ridden and kind of neurotic in a number of ways and resolving some of
that, I was less irritable and impatient and irrational in my relationships with other
people.
Two o f the three men in this group of “mixed responses” regarding interpersonal
relationships noted that their spouses encouraged them to seek analysis and supported the
results for their marital relationship. One noted, “At the time, I didn’t see that it had much
effect, but my wife would say it improved me a lot.” Another male participant noted:
“I think that is an area that is clearly improved. In some ways, interpersonal relationships
would be the clearest benefit, clearer than internal changes, like self-esteem. The
interpersonal relationship with my wife is clearly improved.” However, this same
participant went on to state:
A cost of going through an intensive psychotherapy process is that you don’t

suffer a lack o f insight in others, including your friends as well. If you feel your
friends are stuck, it’s very difficult to have the relationship continue for years and
years and if they don’t get into therapy for various reasons, your threshold for
friendships changes and is more exclusive, to a higher threshold, which makes it
a little harder to form close friendships.
Finally, the “mixed responses” of these participants include a theme of change in
professional relationships. A female participant noted: “I’m more direct in work situations.
I’m less fearful about telling people when I disagree. I don’t think I always do it with as
much equanimity as I would like. .. . I’m passionate, but I’m much more able to be direct
and care less about the outcome o f it.” A male participant noted that during his analysis,
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he had more conflicts with patients than before and that a number of patients didn’t want
to be treated by him, but that has changed in recent decades. He observed: “I think my
analysis helped me, that it had some significant effect on my capacity to establish a
therapeutic relationship with patients. And that’s one thing I emphasize now with
trainees-is the importance o f building a relationship with their patients. It’s more
important than getting rid of symptoms or other problems.”
The “mixed response” for interpersonal relationships group themes are thus
separable by gender, with women describing themselves as developing clearer boundaries
between self and other, and becoming less “people-pleasing.” Male respondents seemed to
be saying that they have become easier to get along with, especially in marriage, although
more discriminating in relationships generally. Reported changes in professional
relationships involved a sense of greater personal assertiveness, less anxiety about
disagreeing with others, and the view that establishing a therapeutic relationship is a
process that requires careful attention by the therapist.
In conclusion, the “clearly improved” relationships group described beneficial
changes in their capacity to form positive interpersonal relationships with implications for
relating to their significant others and in professional situations. Their responses focused
on feeling they had improved in their capacity to relate to others, which did not seem to
create interpersonal conflict for them. The “mixed response” group, however, noted that
their desired personal changes often met with opposition or created interpersonal conflict
for them, at least for a period o f time.
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Responses to question 1. d. (How useful was your therapy in enhancing your
therapeutic skills?) have been organized into three broad groups for presentation. The
groups include responses related to: (1) perceived changes in oneself that have
implications for one’s professional practice of psychotherapy, including greater conviction
and self-confidence as a therapist, greater self-acceptance, and a better capacity to help
patients work with issues similar to one’s own; (2) the importance of the interpersonal
relationship between therapist and patient, including “the real relationship,” transference,
and identification with the analyst or therapist; and (3) learning about the therapeutic
process, including structure, technique, and concurrent treatment and training.
Thirteen respondents noted changes in themselves as a consequence of their
personal therapy, which they perceived as having implications for their clinical practice.
Responses related to changes in oneself also addressed their perceived growth in
conviction and self-confidence as a therapist. These included one participant’s comment
that “My treatment increased my self-confidence to take a clear position o f hope with my
patients when I believe it, like my analyst did with me.” Another participant noted that her
analysis has helped her to trust her intuition and what she was learning, to think that she
“might have something to say or offer . .. feeling that there was something inside to be
able to give and it didn’t have to be perfectly tailor-made at the start. . . that there was a
way to connect with the patient and grapple with issues that was safe for both of you.”
Yet another participant noted that, through her analysis, she “learned, not just at an
empathy level, but also at an intellectual level, which led to a greater sense of conviction
that these phenomena-of resistance and transference-do exist. That they’re complex,
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powerful vehicles for change and also carry some danger for both parties involved.”
Another participant, who noted his analysis has changed how he thinks of himself,
observed that he is very good, in fact, a “crackeijack” with patients with poor self-esteem.
Perceived changes in oneself related to greater self-acceptance included comments
by nine participants. One participant noted: “My perfectionistic tendencies were enhanced
by my training institution . . . but, my analyst gave me permission to be myself.” Another
participant noted some personal things about her analyst that “made me realize that you
could be vulnerable and be a human being and also do very good clinical work, so I’ve
taken a self-acceptance o f my humanness from my analysis.”
Several participants observed that following their personal treatment, they felt
better able to help their patients with similarly conflictual issues. One participant noted:
The more I was able to explore about myself, the less fearful I’ve been about
exploring that [type of issue] with my patients. The more I ’m able to hear what
they’re saying about some things, [I can] get more deeply into it instead of staying
away from it.
Other participants noted the professional benefits of their personal therapeutic work on
specific issues related to shame, trauma, and issues related to loss and mourning and
instilling hope.
Numerous responses to the question, “How useful was your therapy in enhancing
your therapeutic skills?” spoke to the importance of the interpersonal relationship with the
treater. These included aspects of the “real relationship,” transference, and identification
with the analyst or therapist. By the “real relationship,” these respondents were referring
to “objective” qualities o f their treatment relationship, which they distinguished from
transference manifestations. At the core o f this distinction seemed to be the experience of
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being treated with genuine respect, based on common humanness. One participant noted:
“The experience o f the relationship has meant and made all the difference in the way
I practice-I’ve internalized my analyst and the relationship, but it’s automatic.” Another
participant observed, “What’s valuable comes from my analyst being real and it comes
from the heart.”
Almost half the participants noted their enhanced ability to work with transference
as a treater, which they attribute to their personal therapy. One participant observed,
“After you’ve been in analysis, you understand the power of regressive experience and
have an understanding of transference in a way you never could possibly understand if you
haven’t had that experience. And I think then you have an understanding of your patients
that nobody can teach you out of a book.” This belief was expressed by several others as
well. The capacity to better tolerate negative transference manifestations was expressed by
three participants. One participant observed:
It helped me tolerate anger and being hated. It’s made it possible for me to be
much more available to patients, that I don’t have to be warding off the negative
stuff in particular, which I think was hard for me to deal with.. . . I think that was
one difficult area for me, to really be able to tolerate and focus on and go after the
negative transference.
Another theme o f response related to the interpersonal relationship between
patient and therapist concerns identification with the analyst or therapist, which was
reported by seven participants. One noted, “I have identified with my therapist as a
thoughtful, rational person who is also comfortable with affect.” Another participant
observed, “For the first decade or so after my analysis, I could see that much of what I did
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was, in a way, a copy of what my analyst had done, more in terms o f attitude than
technique. I think that had a major impact in my relationship with patients.”
The third theme of responses to the question, “How useful was your therapy in
enhancing your therapeutic skills?” related to learning about the therapeutic process,
including structure, technique, and influences of concurrent treatment and clinical training.
Three fourths of the participants offered comments related to valuing learning about the
therapy process through their personal treatment. Many of them reflected on their growing
patience with, and trust in, the treatment process, a respect for the complexities of change,
and empathy for human struggles. One participant observed:
My analysis has certainly made me more empathic. It has helped me understand

people’s struggles when they didn’t seem reasonable. I knew there was a reason
for it, even though it didn’t look reasonable on the surface. And so I have a respect
for people’s struggles that I don’t think I had before.
Other comments that reflect learning about the treatment process from one’s personal
treatment include a participant’s observation of having gained an “increased appreciation
for the power of knowing somebody over time and of giving people room to react.”
Another aspect of learning about the psychotherapy process from one’s own
treatment relates to the structural aspects of the enterprise, such as the framework of the
setting, time management, and fee arrangements, all of which create the therapeutic
environment. Several participants commented on learning about the treatment structure
through their personal therapy. One participant observed that he has “internalized the fact
that this has to be a safe environment,” while noting his struggles to achieve such an
atmosphere with his patients despite the time pressures of managed health care dictating
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so much about treatment structure. Yet another participant critiqued the 50-minute time
frame of psychoanalytic treatment, stating:
What stands out most is in terms of structure. Analysts, including mine, believe
that everything happens in 50 minutes and that the work is never done. I also think
that not all work happens then and to finish a piece of work is important. So that’s
something very different than what I got in analysis, but I believe in that and it’s
affected how I work.
In contrast, another participant noted specific ways she practices that resemble her
analyst’s techniques with regard to structural aspects o f the treatment:
It continues to astound me how I have consciously identified, by little things I do-

the way I end the hour. I always say things like, ‘well, we need to leave it there.’
I call vacations ‘interruptions.’ I also go downstairs and greet my people, like he
did-I think it’s primarily an identification with him.
Half the participants addressed some aspect of treatment technique in their
response to the question about the usefulness of personal therapy in enhancing their
therapeutic skills. Their responses showed how they value the therapeutic activities of
listening and understanding, interpreting conflict and confronting defenses empathically,
and modeling thoughtful self-disclosure. One participant addressed several o f these points
in her response:
I found myself at times, in almost a humorous fashion, remembering when I was a

little girl and used to put my dad’s shoes on and put his tie around my neck and
walk around the house pretending like I was a business man. And I would have
that experience afier analytic sessions of leaving my own session, going to another
one and hearing the same words come out of my mouth that my analyst had said to
me and having that image in my mind of me in my daddy’s shoes, you know? So it
was kind o f a practicing, a modeling, in identification with him and what he was
doing, so I had the benefit of both my own immediate experience and my reflection
on my immediate experience and identifying with him, so both of them. So it
helped improve technique as well. And it helped me know I could be there without
being overwhelmed by it. ‘Oh, my God! I don’t know what to do. I don’t know
what this means!’ More caught up in my own experience o f not knowing how to
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make sense of my patient than to be able to say “I ’m understanding this and I will
understand it better, if I can listen and remain present.
Another participant observed the importance of feeling understood and communicating it
in her comments:
Where I learned the most is that I felt understood through his interpretations.
It used to make me cry sometimes when I felt understood. It was such a relief.
And it convinced me that understanding is where it’s at. Listening is 75% o f the
road and then 25% is communicating your understanding. So I really work hard to
understand what people are telling me, because it’s a gift that I want to be able to
give them back.
In learning about the technical aspects of interpretation from his analyst, one participant
noted:
My analyst would interpret things as both a resistance and an attempt to develop a

healthy ego, which helped me a great deal and that’s been very influential in my
work-I use that approach when I’m doing interpretive work, if I’m confronting.
With regard to learning about technical aspects of treatment from personal
therapy, participants described themselves as becoming more interested in understanding
intrapsychic conflict than in trying to control symptoms, more comfortable with their
patients’ disturbing feelings and behaviors, and more thoughtful about issues related to
self-disclosure with their patients based on the model of their own treater.
Four participants commented on the influences of concurrent professional training
and personal treatment, noting that while there are risks involved, their increased insight
about themselves and others, and their growing comfort with, and conviction about, the
value of the therapeutic process helped promote their ability as psychotherapists.
In summary, most of the study participants believed that their personal therapy
promoted their belief in the value of the therapeutic enterprise. They described it as giving
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them a firsthand experience with the power of the “humanness” o f the therapeutic
relationship, as the foundation of the change process. Although learning about
transference and treatment technique from one’s therapy process was valued as an
important aspect, it was subsumed in the larger context of the treatment relationship.
Responses to question 1. e. (How useful was your therapy in resolving
characterological issues and alleviating symptoms?) can be categorized into four
groups: (1) Those who found their treatment to be very helpful in alleviating both
symptoms and promoting significant character change; (2) Those who obtained symptom
alleviation, but only attenuation o f characterological issues; (3) Those who did not believe
they had symptoms per se, but noted positive changes in some character traits; and
(4) Those who did not observe any alleviation of symptoms or characterological change.
The group of seven participants who noted positive changes in both their
symptoms and character reported significant improvement in symptoms related to anxiety
and depression and in conflictual issues that included struggles with dependency and
perfectionism. One participant noted:
Before my analysis, I really had the deep-seated belief system that if I did
everything perfectly, if I was a “good-enough girl,” nothing bad would ever
happen, which left me with some anxiety kinds of symptoms. And when I finally
realized, on a gut level, this isn’t in my control and I will just do the best I can to
cope with whatever comes along and if something bad happens, it doesn’t mean
I did something wrong, this was very helpful in getting rid of some of my
underlying, free-floating anxiety.
Nine o f the participants described their personal treatment as helpful in alleviating
symptoms related to anxiety and depression, but resolution of characterological conflicts
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was described as “modified” or “neutralized and made more manageable,” rather than
resolved. One participant observed:
It was very useful, and consistent with a lot of what the research suggests. It’s not
that I am free now o f anxiety and guilt, but they are both somewhat less, because
I do believe, to some extent, conflicts that I had that created those feelings have
been muted. I don’t think they’re ever erased, but I think they’ve been muted.
Other participants in this group observed that traits such as being overresponsible for
others, overcontrolling, and perfectionistic were not resolved, but were instead modified
enough to help them realize when they enact these struggles now and so they can better
modulate them. They each offered some observation that analysis doesn’t turn anyone into
a different person, but instead it lessens vulnerability to one’s own defensive
symptomatology, which is helpful to clinical work. The third category of response found
in the data consists of the responses of two participants who believed that they didn’t have
symptoms as such but that, characterologically, their personal therapy helped them make
more creative and effective use of their aggression by rechanneling it and softening the
intolerant attributes of their character structure.
Finally, the fourth category consists of responses from two participants that reflect
a belief that neither symptoms nor character change occurred as a result o f their personal
treatment. One o f them regretted not being able to go deeply enough into the work so that
more character change was possible, and the other described his analysis as “the wrong
kind of psychosurgery for what ailed [him].”
In summary, over half the participants believed that their treatment helped alleviate
their symptoms, and all but two perceived their characterological conflicts as being
modified or attenuated, although not resolved, following personal therapy. Despite the
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overwhelmingly positive responses of these participants, symptom alleviation was
spontaneously mentioned fewer times than all but one other benefit noted in the initial
open-ended question about benefits of personal treatment, which is congruent with the
model from the literature.
Aggregate results of question 1. f. (Do any other benefits come to mind now
th a t haven’t been addressed?)
About half the participants offered additional thoughts. Their responses reflect
three themes: (1) valuing the treatment relationship and how it promotes change;
(2) gaining a more realistic perception of themselves and their significant relationships; and
(3) perceptions about termination and how “complete” they regard their personal analytic
work.
Five participants addressed the treatment relationship and its contribution to
psychological change. One stated, “I think the relationship with my analyst is probably the
most important in my life.” Another noted, “There is always that other voice in your life to
moderate or titrate situations . .. the message of the analysis and the things that were
helpful stay with you and you kind of step outside and consult with that.” Yet another
participant observed:
It’s quite clear that I’ve internalized her, that there’s a permanent internalization.
I don’t think there’s any question that there’s a soothing internalization and one
which is nice to go through life with, especially professional life, because it’s the
same work, where there’s a legitimizing of doing it.
Other participants observed that psychotherapy is about understanding and valuing the
subjective experience of the person “by wanting to hear their story” and that this is what
can help people change.
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A second theme, that of gaining a more realistic self-perception and a clearer
perception o f significant others, was described by two participants. One found that he had
developed “a real appreciation of the weaknesses and strengths” o f his parents and his
wife that led him to see his relationships in a clearer, more realistic way. Another observed
increased differentiation of herself from her mother’s life, noting her sense of “being
doomed to re-live [her] mother’s life.” She explained that her mother “was a very hard
working woman who accomplished amazing things, yet could never allow herself an
appreciation of what she could do, instead viewing herself as a second-class citizen.” This
participant recalled her analyst’s helpful response that, unlike the participant, her mother
didn’t have a chance to think things through, to look at things, with help. This comment
gave the participant much hope that she could create something different for herself.
A third theme found in response to the question of additional benefits regarded
termination and the relative completeness of the treatment relationship. Four participants
addressed this concept, through such observations as, “He was much more planful of the
termination than other past treaters I ’ve had. He was attentive to dealing with the issues
that reemerged at termination.” Yet another respondent noted feeling “cleanly
terminated,” despite her analyst leaving the profession after their termination. The two
other respondents who commented about termination were uncertain about the
completeness o f their work, believing they terminated arbitrarily, which left them with the
unanswered question, “Am I done yet?” Both reported that they did not get clear feedback
from their treater about their readiness to end.
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In conclusion, almost half the respondents offered additional comments in
concluding the benefits section of the interview. They seemed to be left with thoughts
about their treatment relationship as an ongoing source of strength, with clearer
perceptions of themselves and their significant relationships, and with definite perceptions
about the relative completeness of their personal therapy.
Perceived Disappointments, Risks, or Negative Effects
As with the benefits questions, the respondents were first asked to describe any
general disappointments, risks, or negative effects of their personal therapy or analysis.
Their responses have been organized separately by “negative effects,” “risks,” and
“disappointments,” since virtually all participants specified which of these categories
characterized their experience. Only one of the 20 respondents described actual negative
effects of his analysis. Seven respondents described at least one perceived risk o f their
personal treatment and 14 described at least one disappointment in theirs. Responses will
be reported by themes and categorized subthemes of negative effects, perceived risks, and
perceived disappointments of personal therapy, in that order.
Perceived Negative Effects
The one respondent who perceived actual negative effects from his analysis related
that his analysis never came close to touching on his issues with alcohol abuse and his
resistance to honestly exposing his vulnerabilities. He believed that he had successfully
kept his addiction hidden from his analyst.
Ill
Perceived Risks
Seven respondents described perceived risks of personal treatment. Subthemes
emerging in their responses included: anxiety related to completing the analysis; issues
about the relationship with the analyst; psychological distress as a consequence of
treatment; and financial costs.
Four respondents reported anxiety related to uncertainty about completing
treatment. Two noted that their analyst’s unavailability due to illness during the course of
treatment, “stirred up premature feelings of loss, uncertainty, and ambivalence,” which
mirrored their anxiety about earlier object losses in their lives. However, both participants
noted eventual growth from dealing with this anxiety, leading them to feel more capable of
living with uncertainty and more accepting of their own and their analyst’s vulnerabilities.
Another participant noted the risk involved in even beginning her analysis,
knowing she was guaranteed only two years of self-sustaining work at the institution
where she was concurrently in training. Had employment opportunities necessitated her
moving immediately after her training was completed, it would have precluded her ending
her analysis “naturally.” A fourth respondent, who did conclude her analysis “naturally,”
observed that having recently ended it, she is aware of experiencing a mourning process,
as if she has become an orphan. She described feeling sad because she can no longer tell
her analyst what has been going on, come Monday morning.
A second subtheme of risk involved the relationship with the analyst. Three
participants spontaneously addressed this theme. One respondent observed that he had
overidentified with his analyst’s working style as a therapist but had gradually freed
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himself: “I decided I was not going to have any superego sitting on my shoulder, telling
me, ‘Dow't do this, do this; don’t say this, do say this.’ So, I ’m at that phase of my work
when I ’m applying different models.” Another respondent noted her ambivalence about
the dual relationship she experienced with her treater, who worked at the same institution.
She observed that although she sometimes felt uncomfortable, she had chosen to see
someone who worked in the same setting, “wishing to integrate my vulnerability and my
strength.” Yet another participant noted as a risk o f treatment the intensity of the negative
transference, leading to the experience of feeling somewhat persecuted by her analyst,
“When I felt miserable about life, myself, and my family, I would feel angry that she was
seemingly trying to make me feel worse, instead of better.”
A third subtheme, that of psychological distress, was described by two
participants. One noted, “the loosening of old defenses, which led to greater pain for
awhile. It opens you up and creates more distress, temporarily.” Another respondent
described her great self-absorption during the analysis, which at times made her feel less
connected to her significant others.
The fourth subtheme of risk concerns the financial cost of treatment. Two
participants described the expense as a real factor in weighing the costs and benefits of
personal therapy.
Perceived Disappointments
About three fourths of the participants reported at least one disappointment in
their therapy, with several of them naming two or three subthemes. The subthemes o f
reported disappointment have been categorized into four groups listed by frequency:
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(1) unresolved psychological issues not experienced as related to limitations of the analyst;
(2) unresolved psychological issues experienced as related to perceived personal
limitations o f the analyst; (3) unresolved psychological issues experienced as related to
limitations in the analyst’s therapeutic technique; and (4) disappointments related to the
wish to be perfected.
About half the participants in the study reported perceived disappointments in their
personal treatment related to unresolved psychological issues that were not described as
related to limitations of the treater. These have been categorized according to several
subthemes: feeling unfinished because of not being able to go further or more in depth
with a number of psychological issues; frustrations in working through issues of early or
preoedipal development related to fears of dependency on the analyst; unresolved issues in
relation to separating from an aging parent; and disappointment that therapy was not more
helpful in resolving sexual issues.
Participants related perceived disappointments in their personal treatment to
personal limitations o f their analyst. One participant described his analyst as being, “too
doctrinaire, too interested in his own narrow perspective.” Yet another participant
observed his analyst was at times too free-wheeling, which made her “a real object and
sometimes too real, for better and for worse.” Two other participants wished their analyst
could have been more helpful in a particular prolonged life situation, such as in dealing
with the illness of a significant other. Finally, one participant observed that she wished her
sexuality had been dealt with differently by her analyst. She felt that it was a limitation in
her analyst that he wasn’t better able to explore it.
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A third category o f response to questions about perceived disappointment in
personal therapy related to unresolved psychological issues concerning limitations in their
treater’s psychotherapeutic technique. Three respondents addressed this area in comments
about their analyst preserving technical neutrality, which they felt slowed their change
process or left them feeling disrespected or misunderstood.
Finally, a fourth category o f response to questioning about perceived
disappointments in personal therapy related to the wish to be perfected. These inevitably
frustrated wishes were expressed by two respondents, both of whom also cited the
benefits of accepting imperfection as part of termination. Their responses reflect that
coming to terms with disappointment in the wish to be perfected has profound
consequences, both personally and professionally. This theme is further discussed in the
final stage o f the data analysis.
In summary, the participants responded to the initial open-ended question about
the general disappointments, risks, or negative effects of their personal therapy with
responses that only partially concurred with the model developed from reviewing the
literature. If the concept “psychological distress” includes the risks o f anxiety about
completing analysis, as well as responses directly addressing temporary self-absorption
and loosening of defenses, the literature model concept of psychological distress as a risk
o f personal therapy is fairly congruent with the study responses.
The concept of “the working relationship,” as found in the literature model, refers
to the rational parts of the patient’s ego that collaborate with the treater to accomplish the
goals o f treatment. If both “objective reality” and transference are seen as affecting this
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collaboration, then the “risk” of a perceived dual relationship increases the potential for
complications in the working relationship. The literature model concept o f “treatment
errors” was somewhat congruent with the study findings in this open-ended question,
given that three participants spontaneously noted the untoward effects of preserving
technical neutrality “at the expense of the patient.”
Only one respondent spontaneously described untoward effects on his work of
overidentifying with his analyst while in training. Hence, the spontaneous responses of
these participants lacked congruence with the model concept of “adverse identification
with one’s treater.” None o f the participants spontaneously mentioned that they perceived
their effectiveness as a therapist was blocked because of confusion in being both a patient
and a therapist at the same time.
The study results of this open-ended question differ from the model elements most
substantively in the emphasis that almost half the respondents placed on their
disappointment in experiencing unresolved psychological issues after termination, which
they perceived as not related to personal limitations in the analyst or the therapeutic
technique.
Participants responses to question 2. a. (To what extent did you experience
excessive stress o r psychological distress as a consequence of your personal
therapy?) fall into four categories: (1) those who reported there was nothing excessively
stressful about their therapy and offered no further elaboration; (2) those who reported
nothing excessively stressful, yet offered anecdotes about “nonexcessive” stress related to
their personal therapy; (3) those who acknowledged some “excessive stress” or
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“psychological distress” as a consequence of personal therapy, yet viewed it as an
inherent, necessary, or inevitable part of their experience, which in the end was a
meaningful part of the therapy process; and (4) those who acknowledged that their
treatment was “excessively stressful” but did not view that stress as an essential,
meaningful, or purposeful part of their treatment process.
Four participants reported nothing stressful about their personal therapy. One
participant in this group elaborated, noting, “I found it to be extremely luxurious and
stress reducing. That tells you how anxious I was, when I came in!”
About half the participants reported nothing excessively stressful in their therapy,
but offered anecdotes about nonexcessive stresses associated with their treatment. Their
comments included the wish to have been referred for antidepressant medication and their
preoccupation with the analysis as initially unbalancing. Several noted that they acted out
some things that were related to the transference, but this did not cause any kinds of
trouble in their external functioning. The comments of one participant capture a number of
these subthemes:
It was mostly a relief. I would certainly get stirred up by it I never had to leave
work. I would get embarrassed because I cried a lot. I was embarrassed because
I’d rage in the analytic hours, and I ’m sure every training analyst and my
colleagues heard me. I had a lot of affect, but I could always pick myself up and go
on with my day and be fully engaged in my work. But it is a very self-solipsistic
world. I’d go home and then I’d tell him about all the sessions we’d have in my
mind and all the things I’d say. But I functioned great! I functioned better and
better. I didn’t have to take meds, I didn’t have to be hospitalized, I didn’t lose
sleep. Work went well. Initially, I did go into a flight into health-I felt so relieved
by being in treatment. And I liked it.
The third group is comprised of the responses of six participants who
acknowledged some “excessive stress or psychological distress” as a consequence of
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personal therapy, yet viewed this stress as an inherent and essential part of a meaningful
treatment process. The comments of two participants addressed their perceived self
absorption with the analytic process, which had repercussions for other relationships.
One participant related:
A couple of times, I was upset to the point of having difficulty concentrating on

work. O r even more, when I would go home and you have a family and kids there,
they really don’t let you concentrate on your problems, so maybe that’s useful.
It didn’t affect my ability to meet my kids’ immediate needs, though there may
have been times where I was a little bit out of tune with them, because I was
preoccupied with something that I was upset about in the analysis.
Other participants noted that their excessive stress was related to distressing life events
during the analysis, such as the illness or death of a family member, during which time the
analyst’s active support was especially needed; to core psychological issues around
separation and loss; and, in one case, to the participant’s experience of his analyst as
acting out countertransference issues at the time of termination:
The only time [I felt excessive stress] was when I was terminating. Despite my
overall very positive feelings about him, I was distressed about the fact that he
strongly urged me not to break off the treatment. I perceived a significant amount
of anger and countertransference on his part when I wanted to leave. [But over
time, this issue was worked through, in part, by the analyst taking responsibility for
his part in creating the impasse, while keeping clear professional boundaries.]
And that’s one thing that’s influenced my own work: How to make use of your
personal reactions in psychotherapy, but be very careful of the boundaries while
you do it. Revealing certain aspects of yourself in a careful, measured way for the
purposes of using it for the benefit of your client in psychotherapy. It had a strong
reparative effect on our work. One of the issues I was dealing with related to needs
for perfection. And he was pointing out to me how it’s important to be able to
recognize mistakes one makes and not need to be perfect, and that you can benefit
sometimes more by recognizing your limitations.
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The comments of this group thus reveal that ultimately the excessive stress or
psychological distress they experienced has meaningfully promoted their psychological
maturity.
Finally, the fourth group of two participants experienced their analysis as
excessively stressful, and not directly promoting their psychological growth. One
described extreme psychological distress, noting, “I did not decompensate psychotically,
but I was a mess.” The other participant felt that he began to explain everything within the
context of the analysis and he wished to be free of it because it was sometimes repetitious.
He reported an internal struggle with his readiness to terminate, wanting the analyst’s
approval and eventually coming to terms with his decision, yet without a sense of
collaboration with his analyst.
In summary, the range o f responses to inquiry about perceived excessive stress or
psychological distress as a consequence o f personal therapy reveals that the vast majority
o f respondents viewed the stress they experienced as either not excessive or, if excessive,
as necessary to the process of achieving their therapeutic goals. The nonexcessive stress
group described less intense transference reactions and noted their continued ability to
function well at work. The “excess stress” themes included being self-absorbed by the
analytic process, being preoccupied with the transference relationship, and dealing with
core issues especially related to separation and loss at termination. The two participants
whose excessive stress from treatment did not appear to have ultimately promoted their
psychological growth both described a sense o f extreme isolation in their analytic
relationship.
The responses to question 2. b. (Did you experience any problems with the
working relationship with your analyst?) fall into two major categories that have been
further subdivided for clarity of presentation. Nine respondents indicated that they
experienced no problems with the working relationship with their treater. O f this group,
four gave no evidence of any complications to the working relationship. One described
“a mutual liking and a good fit,” and another offered her definition of a good working
relationship, which included having a treatment goal, a method to arrive at it, faith in the
process, and a respectfulness in the relationship as a vehicle for the treatment, all of
which she perceived her treatment was to contain. The five other respondents in the
“no problems” group each added a qualifier to their response which implicated the
therapist or themselves as a source of some complication to their treatment alliance.
Several individuals found some flaw in their treater, despite their denial o f a problem with
the working relationship. These included a belief that their analyst was “too nice,” which
prevented one participant from exploring his anger and identification with his father’s
meanness without feeling overwhelming shame. Another believed his therapist was not
forthcoming enough with her understanding about the patient. He wanted more feedback
from his treater, which eventually, she did provide. The third participant noted that her
analyst’s chronic five-minute lateness helped her “learn to take imperfect men to task.”
The fourth participant viewed himself as the source of complications in his working
relationship with his analyst. He noted a problem with experiencing her as being
emotionally important in his life because of his early object loss. Finally, the fifth
participant noted that the dual relationship inherent in being treated by a person with
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whom he had professional contact contributed to his regretfully not being able to go
deeper into the work, although his analyst invited him to. These respondents seemed to
experience the complications they mentioned as not overriding their sense o f a good
therapeutic alliance with their treater, and it is noteworthy that all of them believed they
had worked in some depth on analyzing these issues.
The second major category of response to this question consisted of respondents
who replied that they did experience some problem with the working relationship with
their therapist. Over half of the participants perceived some problem in this category.
Their responses are related to four subthemes, which included: (1) the perception of the
analyst as vulnerable and in need of the patient’s care, due to the life circumstances of the
analyst; (2) perceptions of the analyst’s personality traits, such as being oversensitive to
criticism or being very serious or formal; (3) the therapeutic action or technique, due to
the analyst’s nonadherence to the treatment frame by starting the sessions chronically late,
to perceived “lack o f neutrality,” and to a lack of understanding of a psychodynamic issue
by the therapist; and (4) the participant’s perceived resistance to treatment.
The perceived effects of these problems with the working relationship on the
participants can be categorized as either contributing to a positive identification with, or
a dis-identification with, the analyst’s working style. It is noteworthy that the respondents
who accepted and identified with their analyst’s way of handling a conflictual situation in
their treatment-such as charging fees for missed appointments, even due to life-
threatening illness-reported that the conflict was discussed at length in their treatment,
with the analyst eventually making a statement about his or her position on the issue or
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assuming responsibility for his or her part in contributing to the problem. In comparison,
the respondent who reported that she dis-identifies with how her analyst handled a
particular situation stated that he never explained why he operated in a particular way.
It thus seems that the participant’s perception of the analyst’s willingness to discuss why
the analyst acted in a particular way determines the identification influence o f resolving
conflict in the working relationship for this group.
In contrast is the experience of the participant who reported a highly beneficial
analysis, yet noted an unresolved problem in her working relationship with her analyst on
the issue o f names, which she saw as a metaphor for maintaining an unhelpful formality in
their relationship:
Before we knew each other in this role, I knew him as a supervisor. He called me
by my first name and I called him by his first name. Then we started analysis and he
called me Dr. and I still called him by his first name-and did, throughout the
treatment. And I said, ‘This is phony! Stop it!’ and he’d grunt and say, ‘Dr. [her
last name]’ and he would analyze it with me, but he never said why he believed it
should remain on a last-name basis.
In summary, responses to this question fell into two approximately equal groups,
with about half the respondents claiming no problems with their working relationship and
half acknowledging some relationship problem with their former treater. Of the group who
reported no problems, half qualified that there were, however, some complications to the
working relationship created by the therapist’s foibles, the respondent’s foibles, or the
existence of a dual relationship. The 11 respondents who acknowledged that they did, in
fact, experience a problem with the working relationship implicated such issues as role
reversal with their treater, perceived flaws in the therapist’s practice techniques, or their
own resistance to treatment. A conscious identification or dis-identification with the
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former treater’s working style was associated with whether the perceived problems were
openly discussed in treatment, with the therapist acknowledging his or her contribution to
the relationship problem or explaining his or her therapeutic actions.
Responses to question 2. c. (To your way of thinking, did your analyst or
therapist make treatment errors in your work together?) have been organized into
four main categories: (1) those decisively reporting no treatment errors; (2) those claiming
no treatment errors, but who were left with questions about their analyst’s understanding
o f them or acting out of personal needs that did not advance the treatment enterprise;
(3) those acknowledging treatment errors that were not experienced as impeding the
treatment process; and (4) those experiencing treatment errors that were perceived as
impeding the treatment process.
Five participants reported experiencing no treatment errors. One noted the
difference between the analyst having human foibles and making treatment errors. Another
added that she and her analyst were a good match, linking the concept of interpersonal
match with the participant’s perception of treatment errors.
Another group of seven participants reported no treatment errors, yet offered
evidence o f grappling to resolve such internal questions during and after their analysis.
These questions included one participant’s wondering whether his analyst fully understood
the impact o f chronic family stress on the participant’s life throughout the analysis.
Another participant believed that his analyst had been remarkably dedicated to the
treatment and he was amazed by her memory and capacity for well-timed interpretations.
Rather than not feeling well-enough understood, he related that his “narcissistic needs
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were not being fulfilled in a traditional analysis.” Yet another participant observed an
unfinished issue in wondering whether his analyst believed he was competent to have
pursued taking on more professional training after being denied admission into one
program. The issue o f the analyst’s perception of the analysand’s competence was also
observed in the comments o f another participant. He felt humiliated when his analyst
spontaneously chuckled at his admission of erotic feelings toward her. He acknowledged
his wish to “pull her out of her analytic neutrality,” but considered his momentary success
in this to have proven quite hurtful and stated that he could not explore the erotic
transference thereafter. Another participant noted that while she didn’t view it as a error,
her analyst “didn’t use the best approach in helping [her] work on issues of
overfunctioning in interpersonal relationships.” Two other participants in this group had
grappled with issues concerning the analyst’s management o f the therapeutic frame.
One noted his professional identification with his analyst’s “frequent lateness, yet making
the time up eventually and balancing eveiything out, in the end—playing it loose, which for
better or worse consolidated that style for me.” The other participant in this group
observed that, during the termination stage of their work, her analyst expressed his own
countertransference needs related to liking her, which she felt diminished the power of the
analytic work.
A third group o f three participants responded that their analyst did make treatment
errors, but they described these as not substantively impeding their treatment process.
Included were perceived mistakes related to a limited exploration of variations in the
analyst’s schedule, and one participant’s perception that his analyst liked him “too much,”
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so that it would have been easy to seduce or fool the analyst. The other participant in this
subgroup sensed that her analyst “owned way too much in the intersubjective field,” but
while he made technical errors, she felt they ultimately promoted her growth:
He would [make mistakes] all the time and I would call him on it. Like, ‘Wait a
minute, that’s your free-association, it’s not mine!’ He’s a very lively, passionate
guy and he kind o f got ahead of himself. And that was the other pattem-he would
be so excited about how we were finally dealing with, you know, penis envy, in
Freudian terms, or aggression and, I mean, given my fear of it, he would go too
quickly and then I would get scared and backpedal and then that would take some
repairing the rupture. So it was very well understood by both of us that when he
did something, I had the strength to call him on it. And it didn’t feel as though
I was being a noncompliant analysand. He owned way too much. I just felt like,
‘Just shut up and let me get a word in edgewise,’ towards the end.
Finally, a fourth pattern o f response was the acknowledgment of treatment errors
that were experienced as hurtful or as impediments in the participant’s treatment process.
Seven respondents described such mistakes, which included one participant’s perception
that his analyst failed to understand him diagnostically. Another participant experienced
her analyst as maintaining neutrality at the expense of reacting supportively during a brief
health crisis she experienced, which left her angry and clearly dis-identifying with him
professionally:
He was very neutral about [my thinking I might well have a life-threatening illness]
and I raised holy hell! I said, ‘Don’t you want to know?’ There were a few times
I really called him on t hat . . . I said, ‘I can’t believe this. If this is what
psychoanalysis is, I not only don’t want to be in treatment, I don’t want to practice
it. Period!’
Three participants reported mistakes related to limited exploration of their
psychodynamic issues, including insistence on analyzing preoedipal material to the
exclusion of oedipal problems; inadequate exploration of one participant’s sexual identity;
and inadequate analysis of a participant’s marital relationship to a person suffering from
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substance abuse. Each o f these participants felt that such oversights compromised their
treatment.
Harmful countertransference enactments were described by two participants, one
of whom related having her verbal hostility toward the analyst returned in kind, which hurt
her feelings and made her ever careful of not expressing anger at her analyst except in a
very restrained manner. She felt it further inhibited her development in coming to terms
with asserting and exploring her aggression, which was already a conflictual issue for her.
The second participant, in describing harmful countertransference enactments, noted that
his analyst was overly sensitive to criticism, reacting too quickly and with premature
interpretations because of his own narcissistic limitations.
The technical aspect o f timing interpretations was a final issue mentioned by
participants in this subgroup o f treatment errors experienced as harmful or detrimental to
the treatment process. One participant noted this theme in her comment that her analyst
“could be a little bit wild in her interpretations, maybe not doing enough groundwork.”
She noted a particularly infuriating interpretation her analyst made that reinforced her
problem of feeling overly responsible for everything that happens to everyone around her,
resulting in an experience o f not being understood.
In summary, more than half the respondents reported no perceived treatment
errors or expressed doubt about whether true errors had been made. Those who were
unequivocal in their response noted their analyst’s humanity and the goodness of the
character match. Those participants who reported no errors but who still questioned some
aspect o f their treatment that remained unfinished seemed unsure about how their analyst
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understood them and their needs: their level of stress, their suitability for analysis, their
professional competence, their personal attractiveness, and their need for analytic
neutrality. Those who acknowledged errors but felt them not to be detrimental to the
treatment process described the analyst as never explaining his idiosyncratic practice of
scheduling the 50-minute sessions at 10 minutes past the hour, and countertransference
positions of being either too active in the session or too fond of a participant, which made
the participant believe he could have “fooled” or seduced his analyst. Those who
acknowledged that treatment errors may have been detrimental to their therapy process
described the analyst’s failure to understand their dynamic conflicts or diagnostic picture
and technical errors in treatment, such as poorly timed interpretations or rigid adherence
to neutrality during a life crisis, as well as engaging in harmful countertransference
enactments.
The results of question 2. d. (Do you think you have identified with your
therapist in some way that has affected you adversely?) have been organized into four
categories of response: (1) those who replied that they have not consciously identified
with their analyst in any way that affects them negatively; (2) those who reported that they
have not identified in any way that affects them negatively but elaborated on ways they
consciously identify with positive aspects of their therapist; (3) those who reported that
they dis-identify with negative aspects of their therapist; and (4) those who believe that
they have identified with their therapist in some way that has affected them adversely.
Seven participants reported succinctly that they do not think they have identified
with their treater in any way that has affected them negatively.
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A second group o f five participants reported no adverse identifications but
spontaneously added their perceived positive identifications. O f this group, two
respondents briefly noted long-term positive identifications with their analyst’s excellent
therapeutic style and professional attitude. Another participant related that his
identification with his analyst as an immigrant has been helpful to his self-esteem and
professional self-confidence. Another participant, in analysis concurrently with training,
noted that her identification with her analyst as a new kind o f father figure-one who was
kind and generous-led her to think of this as the therapeutic ideal with all her patients,
which then led her to need to learn about also setting appropriate limits and boundaries
with different types of patients. Finally, another participant believed she walked away from
her analysis with a sense of empowerment about her own thoughts, feelings, and beliefs.
She noted no pull to be like her analyst, but viewed the two of them as “kindred spirits,”
as people who shared similar spiritual convictions. She chose her analyst believing that
they would be a good match and noted that, in her professional experience, it has been
hard to make a truly deep connection in the treatment relationship with people who have a
contrasting world view.
The third group o f participants responded that they have dis-identified with
negative aspects of their therapist. One participant from a different culture noted his
analyst’s lack of sensitivity to cultural contexts. He believed that he learned a lot about
examining where his orientation to a patient comes from through experiencing his own
analyst’s lack of sensitivity. The second participant observed that his analyst didn’t take
good care of her physical health, although she gave a lot to others. After noting his
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similarity to her in ambition and commitment to working long hours with patients, he
noted his own intention to begin getting regular physical exercise, unlike his analyst.
The fourth group of six participants believed that they had identified with their
therapist in some way that had affected them adversely. Four participants described an
identification with their analyst’s neutrality that affected their personal and professional
sense o f self. Their comments included one participant’s noting that she has become less
playful since her analysis and considers undertaking a future analysis, “just to free [her] up
a bit more.” Another participant observed his wish to loosen up more with his child cases,
in particular, while still another noted identifying with her analyst’s reserved personality
style and her sense of their shared difficulties in forming intimate relationships, which she
sees as more pronounced as a result of identifying with him. Yet another participant noted
the adverse effect o f her analyst’s neutrality on a particular issue in her treatment, which
she believes has limited her clinical effectiveness with her patients who present with the
same issue. A fifth participant observed his similar personality traits of arrogance and
pontificating, as well as an old habit of smoking cigars, like his analyst. He related with
mortification his repudiation of “stinking up others’ airspace.”
Finally, the sixth participant noted his identification with his analyst’s annoying
verbal mannerism. This participant also noted the power of multigenerational analytic
voices as identificatory “ghosts” that can sometimes haunt the dyadic relationship:
He had a little verbal mannerism that I found mystifying and totally annoying. The
mannerism was that he would make a therapeutic point to me and say, for instance,
‘I think we can see how that affects your relationship with so-and-so, hmm?’ That
little ‘hmm’ felt odd, maybe a little too presumptive. Like, ‘Well, we both know
that, right?’ It had a quality of being an alien voice and now that I think about it,
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I wonder if it was his analyst’s, because now, I do it and I hate it! But I can’t stop
it. It’s like just there, the shadow on my ego.
Many in the group o f participants who believed they had adversely identified with their
analyst spoke o f the influence o f analytic neutrality on inhibiting some o f their spontaneity
and playfulness or their effective expression of aggression. The adverse identifications
involved experiencing these libidinal derivatives as undesirable. Two participants noted
that likely there are numerous unconscious identifications with one’s analyst, which can
only be known at the surface level.
In summary, 12 of the 20 participants did not believe they had consciously
identified with their analyst in any way that affected them negatively and almost half of
them spontaneously mentioned their perceived positive identifications. Only two
participants noted a specific conscious dis-identification. Almost one third of the
participants noted some adverse conscious identification with their analyst that was
predominantly related to the perceived inhibiting influences of analytic neutrality.
Responses to question 2. e. (In your view, was your effectiveness as a therapist
ever blocked due to confusion in being both a patient and a therapist at the same
time?) have been categorized into four groups, consisting of (1) respondents who
succinctly reported no perceived adverse effects on their clinical work due to concurrent
clinical work and treatment, and offered no other details; (2) those who reported no
adverse effects but added that, in fact, their clinical work had been enhanced by being in
personal treatment concurrently; (3) those who perceived no blockage in their therapeutic
effectiveness, but experienced some complications with concurrent clinical work and
treatment; and (4) those who experienced some blockage in their therapeutic effectiveness
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due to confusion about being concurrently engaged in clinical practice and personal
treatment.
Two respondents briefly commented on not being aware of having felt any
confusion in concurrent clinical work and treatment, which might have blocked their
effectiveness with their patients. Both of these participants were engaged in postgraduate
clinical training during their treatment.
The second group of 10 participants noted that they did not think their
effectiveness as a therapist was blocked due to their concurrent treatment and clinical
work, adding that it was only helpful to the latter. Three subthemes were identified, which
included comments that their treatment served the function of containment-that is, giving
the participant a place to discuss and explore their experiences as a therapist and a
patient-in the context o f a therapeutic relationship. Most o f these respondents were
engaged in postgraduate clinical training concurrently with their personal treatment.
A second subtheme involved the participants’ enhanced sensitivity, empathy, and
identification with their patients, based on knowing what it feels like to be a patient.
Illustrating this were comments about an increased awareness of similarity with their
patients, and the common experience of their humanness. The third subtheme was related
to enhanced technical skills as a therapist, consequent to concurrent treatment and clinical
work. One participant observed: “The transition from patient to therapist was never a
problem. It sharpened my attunement to the depths of process and metaphor.”
A third group of five participants perceived no blockage in their therapeutic
effectiveness with patients, but reported some complications with concurrent clinical work
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and personal treatment. Three of these participants engaged in personal treatment
concurrently with postgraduate training. Most added that despite the complications
involved, they perceived that their therapeutic skills were, in fact, enhanced by their
concurrent clinical work and treatment. One participant commented that, “If anything,
[concurrence was] helpful because it made it easier to identify with the patient, which
sharpened my interventions. I would ask myself, how would it feel if my therapist said
this?” Three subthemes of complications were identified. The first subtheme consisted of
participants who noted being preoccupied with their own psychological issues to the point
that it was difficult to be truly present for their patients. One participant reflected on her
own unresolved narcissistic vulnerabilities, given her embarrassment and shame that some
o f her analytic patients would see her leaving her training analyst’s office and realize that
she also was a patient. A second subtheme involved the complications of making the
transition from being the patient to being the therapist. One participant noted: “It was
hard, because I used to do them, time-wise, very close. Yet I oftentimes pulled on what
felt to me was his wisdom, in knowing how to respond to patients, so I don’t think my
experience was of being blocked.” A third subtheme noted in this group addressed the
issue of anxiety related to competition with one’s own analyst, in “being in his chair and in
his place.” This participant added that her analyst not only survived her success in
becoming an analyst, but has seemed to revel in it. She went on to describe him as
“a different kind of mother” to her, in this sense.
The fourth group of participants perceived that they did, in fact, experience some
blockage in their therapeutic effectiveness due to confusion in being engaged in concurrent
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clinical work and personal treatment. Only one of them was engaged in postgraduate
clinical training and personal treatment concurrently. Two participants in this fourth group
observed that, at the time, they were unaware of these adverse effects, and that it was only
later that they could perceive the adverse effects on their work. One of them noted her
occasional difficulty in making the transition from being the patient to being the therapist,
“because it was hard to leave behind stirred-up feelings about my analysis. This led to my
not being fully present with my patients a few times.” The other participant in this group
noted that, very early in her training and her treatment, she had had a countertransference
enactment of abruptly terminating with a patient who had issues similar to her own.
She reported that this event led her to intensify her training efforts, so as not to make
treatment decisions that hurt people out of her own countertransference reactions.
In summary, 17 of 20 participants believed that engaging in personal treatment
concurrently with clinical work did not block their therapeutic effectiveness with their
patients. Half the participants in the study believed that their personal treatment was
actually helpful to their clinical work, a finding that is supported in the professional
literature (Mackey & Mackey, 1994). These participants specified as helpful the
containment function o f their treatment, the promotion of empathic identifications with the
role of patient, and their learning of technical skills from their therapist. Thirteen of the 20
engaged in their target analysis concurrently with postgraduate clinical training. Those few
participants who perceived their therapeutic effectiveness to be blocked due to confusion
in being both a patient and a therapist at the same time noted such issues as anxiety over
competitive wishes and fears about replacing their analyst, or being so self-preoccupied
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with intense affects related to personal therapy that it detracted from optimal attunement
to patients, or being affectively stirred up by personal treatment that colored their
perceptions o f their patients’ material. Whether or not they perceived their therapeutic
effectiveness as being influenced adversely by concurrent personal treatment and clinical
work, many of the participants observed that their self-awareness about this issue may
have been quite limited at the time of their treatment.
Responses to the first question about perceived overall effectiveness of personal
therapy 1. (Overall, how well do you believe your therapist understood you and
communicated his o r her understanding to you?) have been categorized into four
groups, ranging from (1) those who felt very well understood and offered no further
elaboration; to (2) those who felt very well understood and added specific supporting
details; to (3) those who felt generally well understood, but added a qualifier or exception
to feeling understood; and, finally, to (4) those who reported they did not feel well
understood by their therapist.
Three respondents replied that they felt very well understood but did not elaborate
further.
Nine respondents reported that they felt very well understood and elaborated with
supporting details. The quality o f experiencing a common humanness and intersubjectivity
with their treater permeated their responses, which have been categorized into three
subthemes: (1) the therapist treated the participant as though he was important; the
therapist was not seen as being elitist-he didn’t hold himself above the participant; (2) the
therapist had his human flaws and didn’t always understand the participant, but he was
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reliably striving for understanding, which was highly valued; and (3) the participant gave
himself or herself some personal credit for developing the kind o f treatment relationship in
which he or she felt well understood.
Seven respondents reported feeling generally well understood but added a qualifier
or exception to this statement. Their responses have been organized into the following
four subthemes: First, there was the need for more direct communication from the treater
o f his understanding of the patient’s material. The absence of this additional explication
left three participants feeling anxious, uneasy, or “cheated” in not knowing their treater’s
impressions. Second, two respondents noted that certain aspects of the treatment
relationship were not explored as thoroughly as the participant would have wished. One
described his analyst as being “too nice” and not helping him more thoroughly explore his
preoedipal rage. Third, another participant observed that his analyst overvalued theoretical
neutrality, which left him too aloof and detached, and too concerned with maintaining
“a priestly appearance,” which mitigated against the support and encouragement the
participant felt would have better promoted his growth at the time. Finally, one participant
noted that, despite her overall feeling of being quite well understood, her treater had been
befuddled by her unremitting depression and failed to refer her for antidepressant
medication.
Only one respondent believed that, overall, his analyst did not understand him
very well. This participant reported that his analyst did not understand the role played
by traumatic separation and loss during his adolescence or the role of ongoing substance
abuse in his life. He said that his analyst seemed to know that the participant was
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deteriorating, but not that psychoanalysis was an inappropriate treatment for him at
that time.
In summary, over half the participants said they felt overwhelmingly positive about
being understood by their analyst and having that adequately communicated. Another third
o f the participants, while feeling generally well understood, noted a lack of feeling
understood with such issues as wanting more feedback from their treater that would tell
them what the therapist thought about their material or that would explore a transference
relationship issue in more depth. Maintenance of analytic neutrality at the expense of
supportive engagement with the participant was also mentioned here. Only one respondent
believed that his analyst failed to understand him, a feeling that the participant based on his
perception of being in the wrong form of treatment at the time. Hence, the vast majority of
participants in this study perceived that they were very well understood by their treater
and that the therapist’s understanding was, for the most part, communicated adequately.
Responses to the second question about the perceived overall effectiveness of
personal therapy 2. (Overall, how successful or satisfactory do you believe your
psychotherapy or analysis was?) have been organized in the following four categories:
(1) respondents who stated only that it was quite successful, or gave supporting evidence
related to benefits to their professional work, or added that it was their own clarity of
goals initially that contributed to their satisfaction; (2) respondents who stated that their
personal therapy was quite successful, especially by helping them come to terms with their
perfectionism; (3) respondents who described their therapy as quite successful or
satisfactory, with one disappointing exception, related either to their own personality
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limitations or to limitations of the analytic process; and (4) respondents who stated that
their personal therapy was unsatisfactory.
Seven respondents replied that their psychotherapy or psychoanalysis was highly
successful or satisfactory and gave further elaboration that involved either crediting their
clarity o f therapeutic goals or the benefits of therapy to their professional work.
Six respondents described their psychotherapy or psychoanalysis as very
successful, an opinion they supported with descriptions of coming to better terms with
their struggles with perfectionism. Subthemes related to this perfectionism involved being
less self-critical as well as more accepting of the foibles of others; becoming convinced
that being “good enough” is an improvement over one’s perfectionistic strivings; and
relating personal progress with this issue directly to repercussions for their own clinical
work. The response of one participant addressed several of these subthemes, particularly
in using the relationship with her analyst to come to terms with her own and her analyst’s
imperfectibility:
I think it really was very helpful, despite the problems and the misunderstandings
and the hurt feelings and the anger. In some ways, that was real valuable, to go
through that with somebody and to have somebody acknowledge that part o f the
problem was their problem, to see that I didn’t destroy that person and didn’t
destroy the relationship and didn’t get destroyed myself. That we all came out of it
better, I think. And that issue o f just being able to accept all three of those areas as
being imperfect, but still worthwhile. She didn’t have to be perfect. She made her
goofs, but she was still able to be helpful, in the long run. And my life isn’t perfect,
but it’s a work in progress.
The third category of response to this question consists o f six respondents who
described their therapy as overall quite successful or satisfactory, with one disappointing
exception, related either to their own personal limitations or to limitations of the analytic
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process. The four participants who expressed disappointment in themselves offered
descriptions of needing, but not pursuing, continued treatment for relationship issues; of
an internal struggle with allowing sufficient dependency on the analyst to deepen the
work; and o f some sadness in deciding that, given the perceived pervasiveness and depth
o f their problematic personality traits, the treatment was quite satisfactory.
Despite reporting an overall successful or satisfactory treatment experience, two
participants expressed disappointment in the analytic treatment process itself. One
described psychoanalytic theory as an inadequate explanation for understanding all mental
processes and human behavior. Yet this same participant observed that the positive
outcome of treatment for him was to expand his world view, thereby differentiating
himself from the perception he had of his analyst’s self-limiting theoretical world view.
The other participant in this group noted his disappointment in having to prematurely
terminate from his analytic work, due to his analyst’s career move. Being near enough to
his own sense o f readiness to end, he chose not to engage with another analyst, yet felt he
could have benefited from further work with his analyst and a termination that was attuned
to his readiness rather than to the external realities of his analyst’s life.
Finally, only one participant responded that his personal analysis was
unsatisfactory. He stated that his analyst and the psychoanalytic institute where he trained
mistook his excellent education for brilliance and for psychological stability. He added that
psychoanalysis was not the appropriate treatment for him but that subsequent
psychotherapy o f a more supportive nature had been quite helpful.
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In summary, all but one of the participants in the study perceived their personal
treatment to have been quite successful. Two thirds of the respondents believed that their
personal therapy helped them clarify their personal goals and helped them modify their
perfectionistic strivings, with good consequences for their professional psychotherapy
work. Another one third reported a successful personal therapy experience, yet one with
disappointing exceptions, which were attributed to their own limitations, such as conflicts
about dependency on the analyst or other resistances to treatment. Limitations related to
the treatment process included the perceived limitations of psychoanalytic theory as an
adequate framework for understanding human motivation and behavior. Premature
termination was cited as another limiting factor by one participant. The sole participant in
the study who found his personal treatment to be unsatisfactory believed that he had been
misdiagnosed and that an exploratory, psychoanalytic treatment process was not
appropriate for him at that time.
Perceived Effects of Personal Therapy on Conducting Therapy
Responses to question 3. a. & b. (Do you believe you work differently with
your patients or clients as a consequence of having received your own therapy? If so,
in w hat ways: which aspects of your therapy do you think you draw upon?) have
been separated by those who expressed uncertainty about their personal treatment
influencing their clinical work from those who perceived that they work differently with
patients subsequent to their personal therapy. Only three participants reported that they
were not sure whether their personal therapy informs their clinical practice of
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psychotherapy. They each noted that their clinical practice has been more influenced by
experience doing the work itself, by their formal education and by life experiences in
general. However, one participant in this group acknowledged some effect:
It’s hard to know [how much influence my personal therapy has had on my clinical
work], because I never did this work before my analysis. I don’t know if it’s from
treatment or experience doing the work, but I believe that ultimately it’s the
patient who does the w ork.. . . [My personal treatment has] given me more
freedom to know that psychotherapy is very hard and there’s a certain emotional
security you take away from your own therapy, knowing it’s hard and slow and it
gives you an anchoring in your clinical work.
Seventeen respondents said they believed that their personal psychotherapy or
analysis influenced their work with patients. Reported aspects of personal treatment that
they draw on have been organized into the following five categories: (1) enhanced
awareness of the importance of the treatment structure; (2) ability to draw on a broader
range of interventions; (3) enhanced confidence in the therapeutic process; (4) deepened
conviction about the value of the treatment relationship as an important vehicle for psychic
change and growth; and (5) greater acceptance of the realistic limitations of the
therapeutic enterprise. Each of these categories has been further organized by subthemes,
which are presented with occasional substantiating quotations. Learning about the
importance of the treatment structure was addressed by one participant, who noted her
therapist’s careful attention to ruptures in the session schedule, which she has drawn upon,
especially in treating patients with a history of inconsistent early caretaking.
Drawing on a broader range of clinical interventions consequent to personal
treatment was reported by two participants. One observed that she “validates the patient’s
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reality more and is less neutral” with her patients who have a trauma history than she
believes she would have been without personal treatment.
Enhanced confidence in the therapeutic process was reported by eight participants.
Their responses have been organized into three subthemes. The first subtheme is that
feeling confidence in one’s personal therapy process leads to instilling confidence in one’s
patients. The second involves an underscoring of the importance of listening and
understanding. This subtheme includes the patient’s experience of the therapist as actively
listening and as making a sustained effort to understand. The therapist also listens for
latent as well as manifest content and views the sustained effort at understanding the client
as the central therapeutic action, instead of experiencing significant internal pressure to
react immediately to the patient’s material. The third subtheme in this category is greater
patience with the slow evolution of psychic change reported by one participant as a
consequence of personal therapy.
The fourth category of response to this question relates to a deepened conviction
about the treatment relationship as the vehicle for psychic change and growth, reported by
about three fourths of the participants. Three noted feeling greater empathy for their
patients’ struggles to change, based on their identification with the role of the patient.
Their responses included comments about being more open than their analyst in expressing
empathic understanding to patients and having the analyst model “a loving acceptance,”
which helped with issues related to shame.
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Using the treatment relationship to promote the patient’s self-esteem is yet another
subtheme in the category o f the treatment relationship as a vehicle for psychic change. One
participant noted:
My treatment impressed upon me the benefits o f the psychotherapeutic approach

that can effectuate changes in self-esteem and functioning, even when underlying
conflicts remain ‘on the books.’. . . Self-esteem is an overarching concept that may
be more important than any particular manifestations o f psychopathology.
Understanding and using transference and countertransference from a personal
treatment experience to promote treatment with patients is another subtheme identified by
eight respondents in this category. Respondents noted feeling more aware of, and more
respectful of, the power of transference. One participant noted gaining an appreciation
from her analyst “that the most effective interpretations are not always transference
interpretations. He was very good with that-knowing when to do which and his
transference interpretations were very, very powerful and focused.” Another participant
noted that by virtue o f the work she has done in her personal analysis, struggling with
issues of her analyst’s reactions to her growth, she is sensitive to patients’ issues around
growth:
And attuning myself to nuances of the transferences that are indications of their
struggle with me about can they grow? Can they have a different life? I think
I hear that and by focusing in on those conflicts and struggles, there is a permission
to grow.
Six participants noted an enhanced understanding of, and use of, their
countertransference responses to promote their psychotherapy •with patients. Several
related that they draw on how a sensitive issue was understood in their personal analysis
and use that to explore the patient’s experience. Two participants observed that their
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analyst modeled sharing his countertransference reactions and that they similarly share
their reactions to patients when they believe it will promote a patient’s self-understanding.
Five participants observed that their personal treatment enhanced their
understanding of psychotherapy as a two-person psychological process or as an
intersubjective experience. Four observed that their own contributions as a treater in the
therapeutic enterprise are bathed in a brighter light following their own treatment
experience. One said that, as a psychotherapist, “nothing is neutral about a human being,”
and that it’s the studied use of one’s subjectivity that is used for the patient’s benefit.
Another participant noted the profound subtlety of discovering through her analysis that
she could be both herself and a good therapist.
A fourth subtheme in this categoiy, noted by two participants, addressed the type
o f therapeutic relationship viewed as curative. The two models described by participants
regard the therapist as a developmental partner for preoedipal reparenting and as a
collaborator in alliance with the “reasonable” part of the patient’s ego.
A fifth subtheme, related to gaining a deepened conviction about the treatment
relationship as the vehicle for psychic growth, involved the responses of five participants
who noted that they draw on the analyst’s personal qualities as a model for clinical
effectiveness. These respondents revealed conscious attempts to draw on and emulate
helpful personal qualities of the analyst, such as his sense of humor; her capacities to admit
her misunderstanding and be corrected by the patient; his reveling in (vs. being damaged
by) the participant’s successes, thereby giving her permission to grow and surpass him;
and her sustained, thoughtful focus on the patient. Two participants described an
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identification with their analyst as an ego ideal in comments such as, “My analyst was the
first sane adult in my life,” and “my treaters have all been part o f ‘the committee’ of
helpers upon which I draw in my life and in my work.”
Finally, the fifth major category of response to this question addressed the
participants’ acceptance of the realistic limitations of the psychotherapy enterprise. Five
participants commented that accepting limitations in their personal treatment has positively
influenced their clinical work. This sense of greater realism included feeling more
compassionate with, and respectful of, patients in their struggles, given the difficulties
inherent in the process of psychic change, and a greater comfort in admitting one’s own
personal limitations in being of help to others. These participants appear to have come to a
greater acceptance of the inevitable limitations of this unique human psychotherapy
relationship, based on gaining greater patience, compassion and acceptance of the foibles
o f both themselves and their patients.
In summary, only three respondents were doubtful about the influence of their
personal therapy on their clinical work, citing other more clearly influential sources. Of the
17 respondents who perceived influences of their personal therapy on their psychotherapy
practice, 14 noted the deepening of their conviction that the treatment relationship is an
important vehicle for psychic change and growth. Frequently mentioned subthemes of this
category included gaining a better understanding of, and using concepts of, transference
and countertransference to promote clinical treatment, valuing personal treatment as
promoting an understanding of psychotherapy as a two-person, intersubjective process,
and drawing on the analyst’s personal qualities as a model for clinical effectiveness.
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Another major category identified by almost half the participants in this group is an
enhanced confidence in the usefulness o f the therapeutic process, which included concepts
such as having patience with the slow pace of change, listening actively, and
communicating one’s understanding to patients.
The other prevalent category that was mentioned by about one third o f the
participants involved the increased acceptance of realistic limitations of the psychotherapy
enterprise. This reaction was based on their acceptance of the human foibles o f both
treater and patients, which diminished the participants’ perfectionistic strivings.
The responses to question 3. c. (i) (To what extent has your analyst or
therapist served as a role model for you in conducting psychotherapy) have been
organized into three categories: (1) those participants who reported that their analyst had
served as a role model for their work and who cited only examples of positive
identification with the analyst; (2) those participants who reported that the analyst had
served as a role model yet cited examples o f both positive identifications and ways they
viewed themselves as practicing differently from their former treater; and (3) participants
who reported that their analyst was not a significant role model for their work.
The 12 participants who experienced their treater as a significant role model for
conducting psychotherapy and who cited only examples of positive identifications
addressed both technical aspects of conducting therapy and how their treater related to
them as a human being. The therapeutic techniques noted by five participants included
using questions or comments similar to those o f the analyst to help their patients explore
dilemmas similar to ones the participants had dealt with in personal analysis. These
participants noted feeling more confident about helping their patients explore these issues,
due to a belief that the exploration can be of help. Another participant observed that his
first analyst “loosened [him] up by modeling playfulness as a therapist, without losing sight
o f the basic goal o f the work,” whereas his second analyst helped him become more
comfortable with being reserved and in giving patients room to experience discomfort
without rushing in to provide comfort that might stymie the treatment goals. Another
participant identified with his analyst’s capacity to use his free-associations to promote the
treatment. Noticing his own comfort level in using free-associations to interpret a
psychotic patient’s material, the participant linked this capacity to his analyst’s “never
sharing his personal associations, but obviously being usefully attuned to them.” Two
other participants cited their respect for how their analyst “went about his work.”
Seven participants gave examples of identifying with their treater’s qualities of
human relatedness, after which they consciously model themselves. This sense is captured
in one participant’s comment that, “I’ve internalized him as a person, as well as an
analyst.” Qualities o f their treater that they admired, found personally helpful, and strived
to emulate included the analyst’s integrity and flexibility with his neutrality and his
support, such as by laughing at one participant’s jokes. This mirroring is echoed in another
participant’s words, “I probably act, smile, and laugh like him. It’s a pleasure to see his
photo [on a wall, at work], I feel like he’s smiling at me-I have a sense of affirmation.”
Two participants cited their analyst as a role model for treating people humanely, with
respect and dignity, by giving them time and staying with them in treatment. One
participant admired his analyst’s willingness to engage with him on a level “that
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acknowledged and allowed [him] to explore [his] experience of the analyst’s humanness.”
He believed that his analyst had “the courage to be honest and the courage to be human,
including acknowledging her personal flaws.”
The second category o f responses to this question includes those of six participants
who viewed their personal treater as a significant role model, yet cited examples not only
of identifications with the treater, but also of differences in how they practice
psychotherapy. The valued aspects of the treater, which the participants desire in
themselves as therapists, included the analyst’s sensitivity to the meaning of ruptures in the
treatment, presentation as “a well-trained, good human being,” acceptance o f people and
compassion and empathy for whatever the patient is experiencing, and concepts and ways
o f thinking about patients.
The areas of differentiation from the treater include the experience of the treater as
not revealing as much o f her conceptual thinking to the patient as would have been
helpful, which the participant noted he does differently with his own patients. Closely
related to this difference was another participant’s awareness of her therapist as being too
inhibited about sharing her own experience. This participant noted that she does not want
to practice that way, but realizes it is helpful in containing some patients. Two female
participants who cited their stylistic differences with their male analyst as being at least
partially gender based described themselves as being more animated and their analyst as
more reserved. One believed that her analyst’s classical training was the main source of
this difference, however. This same participant noted:
I think he gave me permission to be different. I don’t think he would disapprove of

how I do it. But I learned from him that you have to do what feels right to you, in
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order to make a real connection with patients. Otherwise, you’re kind of playing
a role.
That these perceived differences can promote differentiation in the participants, which can
positively influence their clinical work, is exemplified by one participant’s observation.
Despite having a different frame of reference and not working the same as her analyst, she
found that:
If your heart’s in the right place, and you’re basically kind and accepting o f people,
and not critical, and if you take them seriously, they can accept a lot. Because then
they can accept you for who you are, and I think that’s a corrective experience in
their other relationships, as well as in their most basic relationship with their own
self. And coming to accept yourself for who you are and how you are.
The third category of response to this question is the response of two participants
that their treater was not a significant role model for them in conducting psychotherapy.
One participant noted that he might find “helpful bits and pieces” of his analyst, but he
reported “a collective contribution of so many other people” that he has encountered. The
other participant responded that his analyst was somewhat o f a model, then he added that
he subsequently has learned about other models of treatment that include self-disclosure
on the therapist’s part, which have been more important to him professionally.
In summary, responses to this question about the personal treater as a professional
role model revealed that 18 o f the 20 participants experienced their treater as a significant
role model for conducting psychotherapy. Of the one third o f this group who also cited
differences between how they and their treater practice, a few noted feeling that these
differences were supported by their treater, while the others also eventually used their
differences to promote their own individuation in “becoming their own person” as a
psychotherapist. The two participants in the group who reported not experiencing their
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analyst as a significant role model in conducting psychotherapy revealed that while some
aspects of their treater might be helpful, other people have better exemplified models that
more clearly match their ideals for professional conduct.
Responses to question 3. c. (ii) (W hat do you perceive as being your analyst’s
o r therapist’s limitations or mistakes which have influenced your work with your
own patients?) have been categorized into those who report no limitations or mistakes,
instead offering only what was helpful, and those who did report some type o f limitation
o f their treater that they believed influenced their own clinical work. Nineteen responses
are reported, as the interviewer omitted asking this question of one participant, due to an
oversight. Of the four respondents who reported no limitations and instead focused on
what was helpful, responses included the analyst’s genuineness and authenticity, and the
analyst’s modeling that a “good enough” therapist does not have to be perfect or without
personal limitations or misfortunes to do good work.
Of the 15 participants who acknowledged some limitation or mistake on the part of
their analyst, three themes emerged, including: (1) limitations due to theoretical biases,
which at times led to developmental or situational issues not being understood as well as
the participant had hoped; (2) limitations perceived as being related to the analyst’s
technique; and (3) limitations perceived as being related to the analyst’s human foibles.
The perceived limitations or mistakes due to the analyst’s theoretical biases
included one participant’s perception that her analyst had “a classical Freudian view of the
oedipal struggle as explaining everything,” which led him to miss helping her explore the
wonders of her pregnancy during her analysis from other than a phallocentric view of
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development. She reported feeling hurt that he didn’t sufficiently value this experience,
which was unique to her as a woman. Another participant noted o f his analyst that
classical psychoanalytic theory 20 years ago, during his analysis, appeared blind to the
influences on them o f their different cultures, social classes and native languages. This
participant assigned responsibility for this “culture blindness” to the then-prevailing
psychoanalytic views and the particular psychoanalytic institute more than to his analyst.
He added that, whenever possible, every effort should be made to match the analysand
with a treater from his or her own culture.
Another six participants noted that theoretical biases led to their analyst not
understanding a particular developmental or situational issue with which they struggled.
These issues included the analyst not referring the participant for antidepressant
medication; not understanding the challenges the participant faced in coping with a
spouse’s chronic illness; lacking sensitivity to the complexities of parental anxiety
regarding a child’s chronic illness; and bypassing a thorough analysis o f preoedipal issues
in the analysand in favor of focusing on oedipal interpretations. Several participants
believed that their analyst’s limited understanding was also a consequence o f personal
inexperience with the issues, such as by not being a parent or never having faced chronic
illness in a spouse. In the face of such unfamiliarity, the analyst reverted to a classical
theoretical understanding, which prevented helping the participants find more satisfying
solutions to their dilemmas.
The second theme that emerged in this group of participants who acknowledged
some limitation or mistake by their treater relates to the analyst’s technique. Six
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participants observed a technique-related limitation. Two participants viewed their analyst
as valuing adherence to classical technique over the human relationship. Both saw
themselves as being more flexible with technique, in favor of putting the human
relationship first. However, both viewed their analysts and themselves as products of the
times in which they were trained. Another participant believed that her analyst “too
directly confronted [her] defenses,” which reinforced them, and that the analysis of her
core issue with dependency was thereby encumbered. She has since learned that initially
joining the patient’s defenses “promotes movement to the other side of the conflict,” that
is, it enables the patient to explore issues more safely without having to resist premature
confrontation from the analyst. Other participants cited such limitations as their treater not
giving them enough direct feedback. Another participant noted that his treater did not take
control of directing the sessions, which left him without a model for doing so in his own
work. Two of these participants added, however, that their analysts were following
acceptable psychoanalytic technique and that they admired their analyst’s principled
adherence, despite the perceived limitations. One participant noted, “One person can’t do
everything.” Finally, one participant in this group perceived that a limitation from her
analysis is that she strongly identified and agreed with her analyst’s view of the importance
o f neutrality, which precludes her working well with patients with a severe trauma history
who may need their therapist to affirm their perceptions of reality in ways that this
participant would not feel comfortable doing.
The third and final theme observed in the group of participants who perceived a
limitation or mistake by their treater that influences their own practice involves limitations
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related to the analyst’s human foibles. These included the perceptions that the analyst was
overly sensitive to personal criticism; allowed his personal issues with separation and loss
to color the termination process; was habitually late for sessions; and was self-disclosing in
ways that sometimes distracted from the participant’s analytic work. These participants
noted that when they discussed these relationship issues in their treatment, with the
therapist acknowledging his or her personal flaw or error, the treatment process was
promoted, and they subsequently gained more confidence in working through difficult
interactions with their own patients.
In summary, three fourths of the respondents noted some limitation or mistake by
their treater. Of the five participants who reported no limitations or mistakes, three alluded
to their treater’s humanness, genuineness, and authenticity as being central to their not
perceiving the analyst’s flaws as harmful, but as an inevitable and even useful part of the
process with which they identify professionally. Of the 14 respondents who noted some
limitations or mistakes, participants either dis-identify with their treater’s perceived
limitations, as harmful pitfalls to be recognized and avoided, or they tend to view their
analyst’s mistakes as inevitable and as both personally and professionally helpful to their
own clinical work. Those in the latter group revealed that their treater modeled that his
inherently flawed humanness could be acknowledged forthrightly and the participant’s
reactions to it could be carefully discussed as to its meaning to the participant and for the
treatment relationship. This, paradoxically, left the participants with greater confidence in
being similarly able to accept their own humanness and yet view themselves as being able
to help others in the therapeutic enterprise.
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Responses to question 3. d. (i) (Do images or thoughts of your therapist ever
come to mind while you’re conducting psychotherapy or psychoanalysis?) have been
organized into three main categories: (1) those who reported that they do not currently
have thoughts or images of their treater(s) during sessions and who did not think that they
had, in the past, during the course of their treatment; (2) those who could not recall having
thoughts o f their past treater(s) while conducting psychotherapy at present, but reported
that they have had them during sessions in the past; and (3) those who reported currently
having thoughts or images of their treater(s) while conducting psychotherapy. Responses
of 19 o f the 20 participants are reported here, as the interviewer mistakenly omitted asking
this question to one participant.
Six participants responded that neither currently nor in the past have they ever had
thoughts o f their former therapist(s) while conducting psychotherapy sessions. Three of
them noted that thinking of one’s therapist may be an unconscious process, so they would
not be aware of it. Two participants noted that at times outside of sessions they have
thought about their therapist. One recalled wondering, when he was reflecting on his work
outside a session, what his therapist would have said to a particular patient. The second
one noted that he has evoked vicarious experiences of relating to his now-deceased analyst
by imagining the two o f them having a drink together, which he felt represented his greater
sense of safety in closeness with men since his analysis. He added that this ability to
visualize such an interaction has had both personal and professional benefits.
Four participants responded that they do not currently have thoughts or images o f
their treater(s) while conducting psychotherapy, but that they have had them in the past.
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One participant noted two types of occurrences of these images. One entailed her actively
questioning, “What would he be making of what this patient is saying?” And the second
type was after the fact, “When I found myself saying something to a patient without any
conscious thought of what he would say, but it sounded just like him. I’d have an image
of him in my mind.” Echoing the concept of actively evoking helpful images of one’s
therapist during clinical sessions is another participant’s comment that he would hear his
analyst’s voice inquiring in a particular direction:
These images make me feel like I’m directly modeling or connected to her or
calling upon that memory at a particular moment. Doing that thing and it feels like
this is a good thing when it happens. It feels pleasant and like it’s something that’s
going to be helpful to the patient. It’s not intrusive thoughts.
Another participant in this group noted that while engaging in long-term treatment with a
very difficult character-disordered patient soon after terminating his analysis, he thought of
his analyst especially to help him safeguard from boundary violations, as the patient spoke
of her sexual arousal during sessions. He observed that his analyst was an “ethical
representative” for him.
Nine participants responded that they continued to have thoughts or images of
their treater(s) while conducting psychotherapy. One of these participants also noted
actively wondering what her analyst would say or ask or do at a particular moment with
a particular dilemma. Another respondent revealed experiencing the after-the-fact
identification previously described: “Every now and then, I find myself putting something
exactly the way he would have, which feels good. Images, little anecdotes. He just stays
with me. Little flashes of things.” At termination she gave her analyst a small painting that
had some significance for them both, and then she got herself a small sketch of the same
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thing, so she could see it also. She noted that “It’s a nice connection that is reminiscent.
I deliberately want his work to keep informing mine, so I’ve kept that [sketch] in view.”
Two participants reported having thoughts about their former analyst related to
therapeutic technique. One noted that when “subterranean issues” are going on with her
patients, that is when she draws on her own free-associations and will then think of
something helpful her analyst said to her. She observed that she identifies with what her
analyst was doing with her-drawing on his free-associations to promote understanding of
his patient. The other technique-related comment came from a participant who noted that
he thinks about his most recent therapist whenever he is talking too much in a session and
he feels that he needs to be quiet and listen more.
Four participants in this group who reported having thoughts or images of their
therapist while conducting psychotherapy addressed a relational aspect of their experience
with the former therapist. Included here are observations of one participant who noticed
that she made the same noises her analyst did and that she had become more relaxed and
casual in her style, like her analyst. This participant felt that this emulation was beneficial,
given her “internalized, rigidly high standards” from earlier in life. Another participant
recalled his analyst’s style of external detachment, but internal connectedness. He noted
his difference in that he strives to connect, to have a “personal encounter” with his
patients, unlike what he experienced with his former analyst. Another participant noted
that when she is perplexed in a session, she finds herself thinking of her former analyst, or
when she finds herself sitting in a particular way, she wonders if her analyst also sat that
way, behind the couch, in their sessions. Finally, one participant recalled her analyst’s very
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reserved style, which she emulated in their sessions, thinking that that was the proper
analytic style. Then, far into her analysis, while in a playful mood, she joked with her
analyst and he spontaneously laughed. She related:
Making him laugh was very powerful to me. It showed me he really was
emotionally with me. That he could let himself spontaneously be delighted showed
me something vital about his resonating with me. And when I ’m with my patients,
there’s a line in my mind that I dance close to and away from. Often, it’s around
how separate am I from them and how much do I actually just join them in the
experience of being human? And having been in treatment, I ’m more comfortable
with feeling very close.
In summary, about one third of the participants in the study did not recall ever
thinking about their former therapist while conducting psychotherapy. However, half of
this group noted that drawing on experiences from one’s personal treatment may remain
an unconscious process and hence out of awareness. Two others added that they think
about their former analyst at other times, even to draw on the analyst as a source of
clinical help, yet not while conducting psychotherapy sessions. One fifth of the participants
report that they used to consciously think about their analyst while conducting treatment,
but do not do so currently. In the past, they thought of the analyst by actively evoking or
drawing on thoughts or images of him or her, as well as after the fact, discovering
similarities to the analyst in some way through their own patients. This phenomena might
have occurred during clinical dilemmas of uncertainty or risk for the participant as
therapist. About half the participants reported that thoughts or images of their former
treater do currently come to mind while they’re conducting psychotherapy. They also
observed aspects of both actively drawing on helpful images of the former treater, as well
as after-the-fact discovery of identification with the former therapist. Participants in this
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group noted that both technique-related and personal qualities of their former treater come
to mind, as if they were attuned to an often-preverbal level of object relatedness. They
mentioned pleasurable feeling states of being with, or in the presence of, the therapist as a
powerful maternal presence on whose strength the participant can draw for steadiness in
providing therapeutic relatedness to their own patients.
Responses to question 3. d. (ii) (Do you remind yourself of your analyst while
you’re working? If so, can you describe any such moments, or any particular clinical
circumstances?) have been organized into two main categories: (1) those participants
who report not reminding themselves of their analyst; and (2) those who do find
themselves in some way to be like their analyst while working. Only two participants
reported that they neither think they are like their analyst while working nor remind
themselves o f their former treater. One noted that this differentness is partly because he
has not treated neurotic, high-functioning professional people in a number of years
(e.g., people who are like him as a patient and who would evoke countertransference
reactions similar to those his analyst likely experienced with him).
O f the 18 participants who reported that they do remind themselves of their former
treater in some ways while conducting psychotherapy, three themes o f perceived similarity
to the former treater emerge in the areas of: (1) therapeutic technique; (2) style of
interpersonal relatedness; and (3) theory of what is curative in psychotherapy.
Half the participants in this group offered that they perceived similarities between
their own and their treater’s therapeutic techniques. Two participants said that they
reminded themselves of their former analyst when it came to the structure of beginning or
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ending the sessions and the handling of interruptions. Another noted that he emulated the
body language o f his former female analyst in cross-gender clinical situations when he
wanted to convey safety with sexual tension. He observed his body posture “as not always
being exactly [his] own” and as signaling his attentiveness in a nonaggressive way.
Another participant eloquently asserted:
I think we want to be most like our treaters when we are the most perplexed or
we’re starting out with a new case; when we want to feel and we need to put on
the suit o f armor, to take in the strength. It’s like the warriors who used to drink
the blood o f the animal before going into battle.
One participant pointed out that, for her, it is a conscious process of drawing on the
memory o f something her treater said that she now uses with her own patients. She also
knows that the developmental level of the patient contributes to her drawing on her
memory of her first therapist. When she is treating an adolescent, she is inclined to be
most like the treater she had as an adolescent-to become as “unflappable” with her
patients as he was with her. Another participant cited that, at times, he usefully reminds
himself to talk less and to listen more to his patients, just as his therapist did with him.
Four participants noted the importance of techniques that respect the patient’s pace of
doing the work. This technique-related knowledge respects the need for balance in
providing connection with, and separateness from, the patient, respect for both the
patient’s resistance and adaptive strengths, and appreciation for the very slow pace of
psychic change that requires both supportive and expressive work, encompassing respect
for the need for flexibility yet holding clear limits and knowing when each is needed to
promote psychic growth in the patient. Participants cited these technique-related aspects
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o f balance and pacing as similarities between themselves and their former treaters in that
the participants draw on their memory of this type of experience with their own treater.
Six participants noted some similarity with their former treater’s style of
interpersonal relatedness. These similarities include the capacity to relate authentically
with patients. Another participant noted herself becoming more self-accepting because of
the work in her personal analysis and in now accepting her patients for who they are. She
added, “There was some basic core of how he felt about me that I’ve intemalized-it’s now
me. And how I feel about myself and people is different!” Echoing this is another
participant’s observation that his analyst helped him to stop being so hard on himself by
giving him a very natural human response. He noted that sometimes he observes himself
using her same phrasing when his patients are struggling with similar dilemmas. He views
this emulating as a human response that she modeled with him. Another participant noted
that he catches himself repeating his former analyst’s phrase to patients about “entering
the complexity of the world of relationships and how one can not like somebody’s
behavior and yet feel very close to them.” Another aspect of similar relatedness with
patients is noted in a participant’s observation of the special type o f love she felt for her
analyst, which she felt was reciprocated and well boundaried. She expressed that she has
felt similar bonds with a few of her long-term patients and believes that her former analyst
“is an anchor in [her] work with [her] patients.” Finally, one participant in this group
reflected on the progression of internalizing his former analyst’s style of relatedness:
I thought I always wanted to be like him in the way I made people feel, but I didn’t
want to adopt his mannerisms per se. I wanted to be myself, to tty to work myself
into doing that sort of thing. I think probably early on, I might have tried to adopt
some of his mannerisms and I would say now, looking back on it and thinking
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about it, I just want to integrate or adopt his attitudes into the way I am. But,
certainly, early on, I wanted to almost mimic, like a little kid mimicking their
parent. I wanted to mimic his thoughtful, understanding style.
Three participants reported a similarity between their own and their former
therapist’s theories of what is curative to patients. One participant cited their common
understanding o f a need to regress “in the service of the ego,” under the stress o f psychic
growth. Another noted the importance of challenging patients to shift from “an
experiencing to an observing ego” at times, in order to see opportunities for making
conscious choices that can promote psychic growth and reveal resistances to it. A third
participant cited her similarity to her former analyst in her capacity to nurture the patient’s
attempts at mastery over resignation in even the most bleak situations, such as dealing
with life-threatening illness or the effects of chronic childhood sexual abuse.
In summary, nine tenths of the participants in the study believe they are in some
way similar to their former therapist while conducting psychotherapy. Half of this group
perceived a similarity with their former therapist’s technique in such ways as handling
structural aspects of beginning and ending the hours or in handling interruptions in the
work. Similarities with body language or nonverbal behavior were noted, as well as
consciously drawing on the former therapist’s words or exact phrases. The developmental
level of the participant’s patient may influence the content and form of these memories.
Identification also occurs with the former therapist’s ability to use restraint by listening
and limiting verbalizations in order to give the patient ample space to do the work.
A balanced approach of technique, which both respects the difficulty of psychic change,
and yet flexibly provides both supportive and expressive interventions, was valued by
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these participants and reportedly modeled by their former treaters. Identifications with the
therapist’s style o f relating included seeing oneself as similar in authenticity, acceptance of
self and others, appreciation for the complexity of intimate interpersonal relationships, and
experiencing a unique kind of love in the therapist-patient relationship. This process of
internalization appears to move through stages of mimicking words and behaviors to
identifying with the analyst’s attitude and style of relatedness. Several study participants
also identified with what they perceived as their treater’s theoiy of what is curative for
psychotherapy patients, consciously taking it into their own clinical work.
Responses to question 3. d. (iii) (Which, if any, personal attributes of your
therapist or analyst do you find yourself most identifying with in your work?) have
been organized into three main categories: (1) respondents who reportedly identify with
how their former therapist conducted his or her life outside the treatment relationship;
(2) respondents who reportedly identify with admirable personal character traits of their
former therapist; and (3) respondents who reportedly identify with the therapist’s
capacities or abilities in conducting treatment. The responses of 19 of the 20 participants
are included in this analysis, as the investigator mistakenly omitted asking the question of
one participant.
Four respondents described admiring and identifying with how their former
therapist lived his or her personal life outside the therapeutic relationship. Two
participants noted their former therapist’s ability to assert differences from others yet stay
connected simultaneously, thus modeling the capacity to make desired changes in a
powerful, proactive way. These changes involved one analyst’s changing his work
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environment and another analyst’s publicly advocating for health care reform. Another
participant observed his former analyst’s integrity in how he conducted his life, even in the
way he lived as he was dying, some time after the participant had terminated. The fourth
participant noted her identification with her former analyst’s “style in the world”:
It’s nonverbal. I just like his style in the world. He was kind of laid back. It’s just
kind o f an atmosphere of him that I’m comfortable with. It wasn’t like coming
along copying, it was just that I found myself to be the same kind o f way and that’s
comforting, or pleasant.
A second group of four participants described admirable personal character traits
of their former therapist, that had a powerful impact on them as a patient and with which
they identify as a therapist. These characteristics included the analyst’s calmness and soft-
spokenness, which one participant believed he shares as a therapist with his patients, and
qualities o f personal warmth, kindness, and “a caring from the heart,” which were
expressed by two participants. Another participant in this group described his analyst as
“remaining [his] ego ideal for the traits of honesty, patience, and hard work, dependability,
and deep caring.” He added that his admiration of her as “a first-class individual,” who
was also very beautiful, made for an idealized, erotic transference which, to some degree,
limited his analytic work, but which has also sensitized him to the power of covert
transferences in treating his own patients. The emphasis in these responses was on the
personal qualities of the former treater.
The third category o f 11 respondents emphasized identification with the former
therapist’s capacities to do the treatment. Their responses focused less on the influence of
how the therapist is as a person, and more on what the therapist did or how the therapist
behaved, (i.e., how the therapist’s capacities and abilities influenced the conduct of
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therapy with the participant.) The responses have been divided into four subthemes, which
include the capacity to: (1) respect the patient; (2) appreciate what is humorous and laugh
with the patient; (3) take the work itself very seriously; and (4) be engaged with the
patient yet maintain clear personal boundaries. Five respondents noted that their former
therapist showed respect for them as a patient through such capacities as maintaining
impeccable ethics, acknowledging mistakes, and interpreting painful material without
being sadistic. Three participants identified with their analyst’s capacity to appreciate what
is humorous and to share laughter with the patient. One of these participants noted:
“I learned from him that life is too damned sweet to take too seriously, which only gets in
the way o f really being able to savor it.” Four participants noted that their analyst took the
work seriously and was quite absorbed in it. An additional three participants observed that
their therapist was immersed in the work, yet kept good personal boundaries by always
keeping the work focused on the patient.
In summary, it is noteworthy that all the participants in the study responded that
they experienced some conscious identification with personal attributes of their former
therapist. They identified with how their former therapist apparently lived life, and with his
or her character traits or relational capacities in conducting treatment. Noted as admirable
in how the therapist lived in the world were abilities to cope with separation and loss, that
is, to take a stand that differentiates oneself when needed and to live with integrity, even
while facing death. Personal traits such as calmness, warmth, kindness, and genuine caring
contributed to positive identifications, which several participants observed as evidence of
their “idealized transference.” Relating respectfully to the patient was valued as a positive
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capacity for conducting psychotherapy by more than half the participants. This respect was
communicated by the therapist’s ability to maintain impeccable ethics, acknowledge
mistakes, and interpret without sadism. In addition, a willingness to appreciate what is
humorous, yet to take the work seriously, while maintaining clear personal boundaries was
admired and consciously identified with.
Perceived Interpersonal Relationship and the Process of Continued Psychological

Involvement with the Therapist
Responses to question 4. (1.) (How would you describe the interpersonal
match or fit between you and your most recent therapist?) have been divided into
three categories: (1) respondents who initially experienced a good interpersonal match that
later deteriorated; (2) respondents whose initially poor interpersonal match with their
therapist later became good; and (3) respondents who initially experienced a good
interpersonal match that remained good.
Only one participant reported that the interpersonal match initially felt good, but he
later viewed it more negatively. This attitudinal change occurred when he discovered that
he was in the wrong form of treatment with an aging, declining analyst, of whom he felt
compelled to take care.
Several participants reported that initially the interpersonal fit between them and
their therapist felt poor but that, over time, they came to develop a good match. The
reasons offered for these “mismatches” include one participant’s experiencing a sharp
contrast with his previous therapist’s warm style, as well as with his own personal style of
relating. Another participant found her analyst to be “too different from [her] oedipal
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father,” and also noted struggles to work on feminine identity issues with a male treater,
while the third participant observed that, initially, she found her analyst to be “a cold,
computer-like person who merely spit out correct interpretations.” She added that
weathering a very lengthy negative transference toward her analyst was probably one of
the most helpful parts of her analysis. This participant observed that she was able to get
into some issues that she had been blocked on in previous therapy processes. Each of
these participants observed a change in their initial sense of mismatch, based on working
directly with these feelings in the analysis. They believed that this working through process
contributed something important to their own therapeutic acumen, as evidenced by one
participant’s comments:
We found each other, despite those initial external impediments. And in that sense,
I think it was very important not only personally, but in working as a therapist, in
being less quick to think of a therapeutic mismatch as a fatal problem.
Finally, the participant who initially struggled with working with “a different kind of father
figure,” also noted that she never would be able to do the kind of intensive transference-
based clinical work she does without having first had that relationship with her analyst.
Interestingly, each o f these participants was assigned to their analyst by the institution
where they were treated.
Sixteen of the participants reported experiencing an initially good interpersonal
match that remained good between themselves and their treaters. This group is further
divided into those respondents who emphasized the similarities between themselves and
their treater and those who emphasized the differences between them. Ten participants
believed that the match with their former therapist initially was good and remained good
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emphasized similarities they experienced. Their responses contained three subthemes:
comfort with having a similar personality style with their treater, admiration o f the
therapist’s personality traits and aspiration to be more like the treater, and the perception
o f sharing certain values and life experiences with the treater. Emphasizing the complexity
of aspects o f what makes for a perceived good fit is one participant’s observation:
The fit between me and my second therapist was a very good fit, I felt intuitively,
from the beginning. The things I wanted to achieve and be like, I saw in him and
yet some of the traits I perceived that were negative within myself, I also perceived
in him. In fact, these tended to play out somewhat that way. Some of the things
I became angry with him about, at the end-a certain type of manipulativeness-are
things I struggle with within myself. So in some ways, I felt it was a
disconcertingly good fit and stirred up a lot.
It is noteworthy that only three of the 10 participants in this group chose their
therapist. The institution matched the other seven, who nevertheless emphasized their
perceived similarity with their treater. Results indicate that o f the three participants who
chose their treater, they all viewed their own style as similar to the treater’s personality
style, two reportedly aspired to be like their treater, and one of them reported sharing
values and experiences in common with the treater. These results suggest that therapists
who chose their treater and experienced a high degree of similarity with their therapist’s
relational style reported that the interpersonal match remained good throughout the course
o f their treatment.
O f the seven participants in this group who did not choose their treater four
described similarity with their treater’s personality style, two described admiring the
therapist and aspiring to be like him or her, and four reported sharing values and
experiences in common with their former treater. It would thus appear that for those
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participants who did not choose their treater, feeling a similarity with the therapist’s
personality style and having a perception of sharing common values and experiences is
important for experiencing a good interpersonal match throughout treatment.
Six participants emphasized the differences between themselves and their former
therapist in describing the initially good interpersonal match that remained good. Two
described their differences as complementary and as promoting their treatment. One
participant observed:
It was an excellent match, but we’re as different as night and day. He’s quiet,
thoughtful, reserved, intellectual. I’m brash, excitable, full of affect, petulance,
reactivity. It overtly sounds like oil and water, unless you believe opposites attract,
which apparently they did in our case.
It is noteworthy that both o f the participants who described their perceived differences
with their former treater as complementary chose their own therapist, knowing something
beforehand about his or her clinical working style and reputation.
Four participants who described the match as being good and remaining good
emphasized the differences between themselves and their therapist as related to the
inherent vulnerability of being in the patient role. One noted his own resistance to doing
the work, another observed his need to idealize his therapist in order to preserve a fantasy
image of the analyst as “a really good person,” and a third, a physically petite woman
observed her initial anxiety about her analyst’s great physical stature, which apparently
represented a threat of being overpowered. A fourth participant noted instability in his
analyst’s mood and behavior that sometimes created an unsafe therapeutic environment.
Despite these differences, which led to feeling vulnerable, the participants viewed the
interpersonal match between themselves and their treater as a good one that remained so.
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It is noteworthy that none o f these four participants selected their analyst; rather, the
match was assigned by the institution where they were treated.
In summary, 19 o f 20 participants in the study reported experiencing a good
therapeutic match as their treatment unfolded. Only three participants initially experienced
a poor fit between themselves and their therapist. Each of these three experienced negative
transference to the personal style of their analyst, which was in sharp contrast to what they
initially believed they needed. Four fifths of the participants initially viewed the
interpersonal match as a good one that remained good throughout the treatment. Those in
this latter group described the ongoing goodness of fit either in terms of their perceived
similarities to, or their perceived differences from, their former therapist. Similarities
included sharing a similar interpersonal style, aspiring to be like the treater, and having
values and life experiences in common. Perceived differences between the participants and
their former therapist included different, but complementary, personality traits and
differences in the level and kind of vulnerability experienced in the patient role versus the
therapist role.
Responses to question 4. (2.) (To what extent did you like your most recent
therapist, or feel fondness and affection for him or her and experience th at he or she
liked you? Did you sometimes dislike him or her, or feel disliked?) have been
organized into four categories: (1) respondents who reported liking and being liked
throughout their treatment and who reported no experience of disliking; (2) respondents
who reported liking and being liked by their treater, yet sometimes disliked their treater
but did not think their treater disliked them; (3) respondents who reported that by the end
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o f the treatment, they liked their treater, but earlier on, they had experienced a mutual
disliking; and (4) respondents who reported not liking their treater, but experienced being
adequately well liked by the treater.
Over half the participants reported an overall experience of liking their treater and
being liked throughout their treatment with no experience of being disliked or feeling
disliked. All these respondents noted feeling a real fondness or affection for their treater,
and two o f them mentioned experiencing loving feelings toward or from their treater. Nine
o f the 11 participants in this group reported experiencing some negative reaction toward
their treater. These included feeling angry sometimes with their treater, fearing that the
treater was bored with the participant, and experiencing distance and aloofness from the
treater. Three participants in this group reported their awareness of experiencing idealized
or eroticized transference reactions and three reported the fear of becoming disliked. It is
noteworthy that, despite experiencing anxieties about intense negative affects, these
participants perceived an overall mutual liking and an overall absence of disliking.
Six participants reported an overall outcome of liking and being liked by their
treater, yet at times during the process, they disliked the treater, but did not think the
treater reciprocated their dislike. All participants in this group reported a mutual fondness
and affection, with one o f them adding that she experienced a mutual loving, and half of
them valued being able to safely “fight” with their treater. Only two of these six offered
specific examples of what they disliked about their treater. One described his treater’s
narcissistic need for admiration, and the other disliked her analyst’s neutrality and distance
at a point in her life when she was experiencing a health crisis. The other four participants
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merely affirmed their temporary anger, hostility, or negative transference enactments.
While denying feeling actually disliked, four of the participants perceived that their treater
did experience some negative affect toward them, as evidenced by the treater’s
acknowledgment o f irritation, mere tolerance for the participant’s negativity, or expressed
anger at the furious participant. What stands out in all these accounts is that the upsetting
issues were worked on within the relationship and resulted in an eventual outcome of the
participant feeling liked and being liked, yet consciously remembering and reporting the
experience of disliking, while in the treatment process.
Two respondents reported that, by the end of treatment, they had experienced a
mutual liking, but at some time earlier, they had felt a mutual disliking. Specific reasons
they offered for disliking their treater included finding the treater to be cold and computer
like or not helpful and not giving the participant her money’s worth. These participants felt
disliked because o f the treater’s lack of personal relatedness and because they felt withheld
from and not helped enough during “long, rocky moments.” Both noted that it was only
through long and difficult work with their treater on these intense relationship issues that
they eventually came to experience a mutual liking.
Finally, one participant reported being left at the end of treatment with the sense of
not liking his most recent treater, although he himself felt well enough liked. This
experience stood in contrast to his earlier analysis. Nevertheless, he noted that he had been
helped by both treatment processes, and he addressed subtle differences between being
helped by and liking his treater.
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In summary, over half the participants in the study reported experiencing a mutual
liking and no disliking of or from their treater, despite having consciously experienced
negative emotions toward the treater. The one third who reported an outcome of mutual
liking, but who sometimes disliked their treater during the process, reportedly worked
through upsetting relationship issues. A working through o f difficult treatment relationship
issues was also described by those respondents who eventually experienced a mutual
liking, but who had felt a mutual disliking during the process. Only one participant overall
was left with a sense of not liking his most recent therapist, despite having benefited from
the treatment. This reaction had to do with his doubts about the therapist’s integrity and
trustworthiness, despite his skill as a therapist. It thus appears that the participant’s
experience of a fundamental honesty in the treater, as well as the working through of
relationship impasses, is intrinsic to being left with a sense o f mutual liking.
Responses to question 4. (3. a.) (Regarding the match between you and your
most recent therapist: Did you think of your therapist as professionally competent?
Do you think your therapist thought of you as professionally competent?) have been
organized into three main categories: (1) respondents who replied affirmatively to both
parts of the question; (2) respondents who perceived their therapist as professionally
competent, but who expressed uncertainty about their therapist’s view of the participant’s
competence; and (3) respondents who expressed uncertainty about their therapist’s
professional competence but believed that the treater viewed them as professionally
competent.
Over three-fourths of the participants (16) responded affirmatively to both parts of
this question. Some participants related that they definitely felt their therapist was
competent, and they elaborated on their sense that their therapist also regarded the
participant as competent. One participant observed that his analyst did not oppose the
numerous personal “life changes” he made during his analysis, which he took as tacit
support o f his personal and professional competence, while another noted that his
therapist affirmed the participant’s professional competence at a time when he felt
extremely vulnerable and was temporarily unable to work due to depression. Two
participants in this group observed that their analysts implicitly validated their clinical
work when it came up in analysis by conveying an attitude of respect for their
interventions. One of these two was in a training analysis and one was in a therapeutic
analysis. Finally, three participants commented that their analyst seemed to credit them
with more professional competence than they credited themselves with at the time.
A second group of two respondents perceived their treater as professionally
competent, but expressed some uncertainty about their therapist’s view of the participant’s
competence. Both participants were graduate students at the time of their treatment, in the
same professional discipline as their treater, and both noted how exquisitely sensitive they
were to wanting their treater’s approval. Both added that, although they got no direct
feedback, their treater probably did respect their professional competence, yet their own
anxiety about their budding professional skills colored their perceptions.
A third group of two participants related that they sometimes questioned their
treater’s professional competence during the course of the treatment but believed that the
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treater viewed them as professionally competent. The first described these doubts as
stemming from the perceived rigidity of the treater, while the other participant viewed
them as coming from doubt about his own competence, which he thought he had
projected onto the analyst. This participant addressed his view of his analyst’s competence
as being intimately intertwined with his own dynamic issues:
I had questions about whether she was professionally competent. She was a
candidate and a woman. I’m saying that tongue in cheek, because those two issues
take me pretty quickly to the whole issue of safety and competence and
consistency in relation to the losses I shared with you and the inconsistencies in my
background. So, essentially, I’m saying a lot of the treatment was about my
resistance to experiencing her as real, and questions about her being competent
constituted a fair amount of the treatment.
Both of these participants added that, by the end of their treatment, they had come to view
both themselves and their analyst as professionally competent, and their views on this
point changed only by working on these painful issues related to their early struggles with
trusting in the goodness of caretakers.
In summary, it is noteworthy that four fifths of the participants in the study were
definite in their affirmation of professional competence, both in their view of their treater
and in their treater’s view of them. It appears that the realistic external circumstances of
the participants as vulnerable, often youthful trainees in the early stages of learning to
conduct psychotherapy, as well as persons less experienced in making life decisions,
contributed to the significance of both wanting and believing in the therapist’s affirmation
professionally. Those few participants who questioned whether their treater viewed them
as competent also described their vulnerability as students and consciously recalled their
self-doubts, which they believed were at times readily projected onto their idealized,
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experienced therapist. An interesting question is posed as to whether these participants
were unable to internalize any existing affirmation that was intended by the treater and to
what extent analytic neutrality precluded the treater’s imparting even implied support of
the participant’s professional competence. The very small minority o f participants who
doubted their treater’s competence also noted treatment relationship issues that they
viewed as involving highly transference-laden images of primary caretakers as rigid and
unbending or unavailable and inconsistent. These participants noted that much of their
work in therapy entailed working in the transference on their dynamic conflicts related to
trusting in the capacity of significant others to be consistent, caring, and authentically
affirming. Over time, they came to believe both in their own and in their therapist’s
professional competence.
Responses to question 4. (3. b.) (How compatible were your professional
convictions?) show that all the participants replied that they perceived their professional
convictions and their former therapist’s professional convictions to be compatible.
Nineteen o f the 20 participants’ responses are included in this analysis, as the interviewer
unintentionally omitted asking the question of one respondent. Responses to this question
have been organized into three categories: (1) respondents who emphasized the mentoring
role o f their treater; (2) respondents who described only similarities between their own and
their treater’s professional convictions; and (3) respondents who described differences as
well as similarities between their own and their analyst’s professional convictions.
In describing their professional convictions, three respondents emphasized the
mentoring role o f their treater. Two of these respondents were new trainees as they began
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their personal treatment, and they observed that their treatment was a place to process
how de-skilled they felt and to have modeled for them what a good psychotherapist was.
The other participant in this group was an experienced, analytically trained therapist when
he sought his most recent treatment. He noted that his therapist, who held more o f an
existential view, broadened his horizons and taught him some of the validities o f another
perspective.
Just over half of all the respondents (11) described only similarities between their
own and their therapist’s professional convictions. Three themes of responses were found
in their answers: (1) respondents who perceived their clinical approach to patients as being
similar to their therapist’s; (2) respondents who noted personal similarities with their
former treater in holding high ethical standards, while living a very full and enjoyable
personal life; and (3) respondents who replied affirmatively about their professional
compatibility but did not elaborate on their perceived similarities.
Participants in this group commented on the similarity between their clinical
approach to treatment and that of their therapist. Their comments were further
categorized into perceptions that they hold similar views about what is curative to
patients, they hold similar theoretical beliefs, and they share similar clinical interests,
which may include a preference for working with the same patient populations.
Two respondents observed personal similarities with their former treater with
regard to holding high ethical standards, while living a full personal life.
Two respondents replied that they felt a similarity with their treater’s professional
convictions but did not specify more details about those similarities.
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Finally, five participants described differences as well as similarities between their
own and their therapist’s professional convictions. Three themes emerged in the area of
perceived similarities with professional convictions in this group. First, three participants
noted their shared respect for, and belief in, the therapeutic process and an approach that
values understanding the patient and puts a premium on a respectful therapeutic
relationship as curative. Second, two respondents perceived that they and their treater
shared a quest for seeking answers to existential questions that in one led to an emphasis
on growth in spirituality. Third, one respondent noted his and his treater’s shared
convictions about the usefulness of traditional ego psychology as a model for
understanding psychic phenomena.
Three themes also emerged in the perceived differences between professional
convictions in this group. First, three participants commented that they have less
conviction about the exclusive usefulness of a classic psychoanalytic theoretical approach
than did their former therapist. One of them noted that he has added a self-psychology
approach, and another stated that his convictions about the usefulness o f psychoanalytic
theory, unlike those of his former analyst, are not steady but are instead in a process of
evolution and change. Second, one participant observed that, unlike her former analyst,
she cannot put the practice o f psychoanalysis as preeminent, instead believing that
psychotherapy is as important and valuable a mode o f clinical practice. Third, one
participant noted that her former treater emphasized a spiritual base in their work more so
than she does with her patients.
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In summary, all the participants in the study described compatibility between their
own and their treater’s professional convictions. Over half of the respondents cited only
similarities of convictions. The most frequently cited conviction was a similar clinical
approach to treatment, particularly shared beliefs about the interpersonal nature of cure in
psychotherapy. The most frequently reported perceived difference between professional
convictions was the lower priority given by participants to the exclusive usefulness of a
classic psychoanalytic approach to treatment. Several respondents also described their
former therapist as a mentor. These results offer strong evidence that perceived
professional compatibility between the participants and their former therapist is based on
the relational aspects of the treatment enterprise.
Responses to question 4. (3. c.) (Did you feel respected by your therapist and
do you think your therapist felt respected by you?) have been organized into three
categories: (1) respondents who succinctly replied yes to both parts of the question but did
not elaborate; (2) respondents who replied yes to both parts and elaborated; and
(3) respondents who replied yes to both parts, but qualified how their treater felt respected
by them. Nineteen of the 20 participants’ responses are included here, as the interviewer
mistakenly did not ask this question of one participant.
Eleven participants responded succinctly in the affirmative with such responses as
“yes, to both.” Five respondents replied in the affirmative with elaboration. Two of these
participants described an idealizing transference to their treater early in the process. One
of them commented that the termination phase of her work was a very rich time in the
treatment. She added that it had been important to her to terminate “with dignity and not
Ml
to be encouraged by her treater to feel only the loss of the relationship.” Yet another
participant observed that he felt respected by his analyst, except for some moments in
reaction to her repeated lateness. He added that this was just his analyst’s “humanness and
it wasn’t a big deal. I could be forgiving, especially when a person admits a mistake.”
Three participants observed that while they felt respected by their treater
throughout the treatment, there was a period when their analyst most likely did not feel
respected by them. Two of them acknowledged that because of their being distressed by
their analyst’s withholding style, the analyst may not have felt respected by the participant
early in the process. Both of these participants felt certain, however, that their treater did
feel respected by the end of treatment. Another participant noted that, despite elements of
disliking and being angry with his therapist, he respected the therapist: he acknowledged,
however, that during their rocky termination, the therapist may have felt disliked or
disrespected beyond what the participant actually experienced.
In summary, it is noteworthy that all the participants reported feeling respected by
their treater and only one participant noted feeling disrespected by his analyst’s “human
foible” o f lateness, o f which he was forgiving. Three participants, who were disappointed
by some aspect o f their interpersonal relationship with their treater, believed that their
therapist might not have felt respected at some point in the treatment. Themes connected
with mutual respect point to how idealizing transference was worked with in the
treatment, whether the analyst’s neutrality was perceived as unhelpfully withholding, and
how the termination phase was handled, especially in reference to respecting the
participant’s need for autonomy.
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Responses to question 4. (3. d.) (How compatible were your personality
styles?) have been divided into three major categories: (1) respondents who perceived that
they were compatible because of similarities with their treater’s personality style;
(2) respondents who perceived that they were compatible because of differences between
their own and their therapist’s personality style; and (3) Respondents who perceived that
they were compatible, despite the differences between their own and their therapist’s
personality style. Responses from 19 of the 20 participants are included in this analysis, as
the interviewer mistakenly omitted asking the question of one participant.
Respondents described their sense of similarity with their former therapist in
assessing compatibility with their treater’s personality style. These similarities involved
three themes, including character traits, such as affective intensity or social
gregariousness. Similarity o f professional practice was another theme. It included similar
clarity about ethics, boundaries, and the nature of the therapeutic contract, as well as a
shared love for the profession of psychotherapy and shared “profoundly positive
institutional transferences to Menninger.” The third theme of perceived similarity involved
shared cultural interests in the performing or visual arts.
Some respondents perceived that they were compatible because of differences
between their own and their therapist’s personality style. Two themes emerged in their
responses, including a perceived complementarity of personality traits, which helped the
participant feel more emotionally contained and better able to modify intense affect that
inhibited rational thinking. Conversely, a second subgroup of respondents in this group
perceived a complementarity of personality that lowered the participant’s inhibitions and
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usefully encouraged the experiencing and exploring of internal affects. The
complementarity involved having a therapist whose quietness was helpful to the
participants in finding their own voice, or whose perceived forcefulness of character
usefully modeled a self-assuredness with which the participant identified.
Finally, half the participants perceived compatibility between their own and their
therapist’s personality style, despite some differences. Two themes that emerged in their
responses included a perception that the differences in personality style were benign to the
therapeutic process, that is, that the differences were neither enhancing nor interfering
with the participant’s treatment. These respondents mentioned such traits as the analyst’s
perceived extroversion, compared with the participant’s introversion, and the opposite
(i.e., a more animated, self-revealing participant with a reserved, stoic analyst). Also in this
group were comments by one participant about his analyst being from a different part of
the country than himself, and by another of her experience o f her analyst as being from a
wealthier, more culturally sophisticated background. The participants in this subgroup all
experienced these differences as benign to their therapeutic process and as not particularly
detracting from, or enhancing o f their sense of compatibility with their therapist’s
personality style.
The second emerging theme involved a perception that the differences in
personality style increased the participant’s resistance to treatment. These respondents
described such traits as the therapist’s rigidity, because o f his or her inexperience as an
analyst. Therapeutic techniques that were either perceived as too withholding or too
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supportive were also mentioned as personality style differences that interfered with the
therapeutic process by increasing the participant’s resistance.
In summary, it is noteworthy that all participants experienced a basic compatibility
with their therapist’s personality style. This compatibility was reported not only by the
minority o f participants who noted just the similarities between their personality style and
that o f their treater, but also by the vast majority of 15 participants who cited differences
in the two personality styles. These stylistic differences were viewed as complementary
and contributing to the perceived compatibility of the personality match between the
participant and therapist by one third of those who emphasized the differences in their own
and their therapist’s personality style. One half of the participants in the study viewed the
personality differences as either benign to, or as somewhat inhibiting of, their treatment
process, the latter by increasing their resistance. Despite these variations, the participants
described perceived compatibility of personality as the norm, whether in regard to
similarities, complementary differences, benign differences, or more inhibiting differences
in personality style.
Responses to question 4. (4.) (Do you sometimes find yourself thinking about
your therapist or wishing to talk with your therapist? If so, under what
circumstances?) have been organized into three categories: (1) respondents who reported
ambivalence in thinking about, or wishing to talk with, their therapist; (2) respondents
who reported thinking about and wanting to talk with their former therapist primarily
about matters of professional practice; and (3) respondents who reported thinking about
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and wanting to talk with their former therapist primarily about matters in their personal
life.
Four respondents reported significant ambivalence in thinking about, or wishing to
talk with, their former therapist. In two cases, there was a premature termination due
either to the participant’s or the therapist’s career move. The other two participants
reported that, after termination, their former therapist left the institution involuntarily,
“under a cloud,” which did not negate their prior analytic work but which saddened them.
These participants were acutely attuned to the fact that their former analyst had been
forced out, which made for their considerable ambivalence about continuing contact with
the former treater. The participant in this group who left his treatment early to pursue
advanced clinical training noted his anger with his therapist during their termination phase.
He linked his anger to struggles with leaving while the erotic transference remained so
strong.
Six participants reported thinking about and wanting to talk with their former
therapist, primarily about matters of professional practice. However, wishes to speak with
the former therapist about clinical matters invariably were intertwined with the
participant’s personal life, as exemplified by the following response:
Both of my former treaters are now deceased. However, I think of them both often
and often wish that I could talk with them about treatment issues that come up, or
issues o f professional life. Because they know me so well and because I ’ve
respected them both so much, I wish I had them as colleagues, as friends, to share
some perspectives o f the world, managed care, transference-countertransference
paradigms, just name it. They are the people most centrally involved in my
personal and professional development. I had concluded by the age of 14 that
I wanted to be an analyst.
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These respondents indicated that they wished to consult with their former treater
at times o f uncertainty about clinical dilemmas with patients. Four of them wondered what
their analyst would say about their dilemma and reported drawing on a helpful internal
conversation-a “mini-session”-with their former therapist. In this group, only one
participant had, in fact, spoken to her former therapist about clinical dilemmas after
terminating. Two reported significant postanalytic contact with their treater and one
returned for a one-time consultation during a relationship crisis with a partner.
Finally, half the participants (10) reported thinking about and wanting to talk with
their former therapist, primarily about matters in their personal life. Their responses have
been organized into two subcategories, which included both what the respondents wished
to talk about with their treater after termination and what they had, in fact, spoken about
with their former treater.
Seven of the 10 participants articulated a wish to speak with their former treater
about both exclusively or primarily personal and secondarily, professional matters. The
personal issues included three subthemes: (a) marital relationship issues; (b) developmental
stage issues, such as struggling with child-rearing concerns, or the death of an elderly
parent; and (c) situational crises, including “emotional struggles” and health-related crises.
The professional issues related to a wish on the part of the participant who had only
recently terminated to report how a particular legal situation came out, and wishes to
discuss impending career changes with the former therapist, including career development
and retirement plans.
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Describing posttermination psychological change as a continuing process set in
motion by his treatment, one participant in this group commented:
As time progressed, after ending the treatment, I could look back and see things
that were continuing to change in my life, as a consequence of the process with
him that had set things in motion. I could tell you about my relationship with my
therapist, maybe right after I got out of therapy. But in terms of the relationship
with my father, there were things that happened between my father and I, four or
five years later, and it was like the process had been started with my therapist.
And I would think, ‘God, I wish I could tell him about this!’
Five of the 10 respondents in this category had, in fact, spoken with their former
treater about exclusively personal or primarily personal and, secondarily, professional
matters. The personal issues involved: (a) marital relationship issues; (b) developmental
“growth” issues, such as becoming a grandparent or purchasing a new home; and
(c) situational crises, including difficulty with pregnancy. The professional issues involved
having collaborated on the clinical treatment of patients and calling the former treater for
an informal consultation on systemic, organizational issues at work, or being in an analytic
study group together.
Addressing the posttermination relationship with her therapist as an evolving
process, one participant in this group noted:
It’s really something to sit back and realize that there have been a number of
phases in the postanalytic relationship between us. I’ve gone back for consultations
and I used to see him every six months just to keep him posted. Now he comes
over to the house. We have a study group together and I got brave this week and
even talked about my analysis, in the sense that I ’m talking to you about people
having to own their stuff and make their own decisions, with him right in the
room! I thought that it was very brave. And I think he took it very well. He gave
me a hug afterwards.
In summary, fourth fifths of the participants in the study (16) reported thinking
about and wanting to talk with their former therapist about personal or professional issues.
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The few respondents who reported ambivalence about posttermination contact reported
issues of premature termination or conflictual feelings about the former treater’s apparent
loss o f credibility within the psychoanalytic community. The respondents who emphasized
their wish to consult with the former therapist primarily about clinical practice sought
guidance at times of uncertainty. Half the study participants reported wanting to speak
with their former therapist about issues related to their personal life, including their marital
relationship, developmental stage issues, or situational crises. Half this group of 10 who
wished to speak with their former therapist during stressful times about personal or
professional issues had never initiated any contact posttermination. Only about one third
o f the study participants have maintained some sustaining postanalytic contact with their
former therapist. Posttermination psychological change and relatedness to one’s former
therapist were described as an evolving process by several participants. It thus appears
that, for the majority of respondents, continued psychological involvement with their
former therapist takes place as an internal object relationship that sustains them in both
their clinical practice and personal life.
Responses to question 4. (5) (In your conduct of psychotherapy, do you ever
engage in an internal dialogue with your therapist? If so, under w hat
circumstances?) have been organized into three categories: (1) respondents who replied
that they have engaged in an internal dialogue with their former therapist while conducting
therapy; (2) respondents who replied that, while not having consciously engaged in an
internal dialogue with their former treater while conducting therapy, they have
experienced other types o f psychological relatedness with their treater during clinical
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sessions; and (3) respondents who replied that they do not presently engage in an internal
dialogue with their former treater while conducting psychotherapy, but believe they may
have done so in the past.
Four respondents replied that they have engaged in an internal dialogue with their
former therapist while conducting psychotherapy. Three indicated that this internal
dialogue has occurred when they feel uncertain of how to understand the patient’s material
or the process between their patients and themselves, and they have actively wondered
what their former treater would say. Two noted that when patience with letting the
process unfold is called for, they have thought o f their former treater. This is elucidated in
one participant’s comments:
The most powerful example of this is that a lot of times, what I hear in my mind
from him is that often it’s okay to say nothing. And to just sit with the patient.
So that’s probably the most powerful dialogue that I get from him, because I tend
to err on the side of talking too much. And so he helps me practice some restraint,
to be quiet. So he’s very much there.
The other circumstance identified as a reason to dialogue internally with the former
treater was when the patient’s material touches very closely on one’s own dynamic issues,
which was noted by two participants. One said that when she evokes her former analyst’s
help to sort out the patient’s material and “to say the right thing,” she has felt helped by
“almost a spiritual sense that [her] analyst’s unconscious, [her] own unconscious, and
[her] patient’s unconscious-all three-are connected in some primary process way that is
therapeutic.” The other participant observed that in reflecting on this question, he learned
something new about what his former analyst was trying to tell him and what he thinks he
has perhaps unconsciously drawn on.
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One participant in this group of four noted that he thinks about his former analyst
more when he considers who has influenced him and the ideals for which he strives, than
when he is with patients. He described his first analyst as an influential person who helped
form his ego ideal in a more fundamentally personal way than as merely an influence on his
clinical work. This same participant described the notion of internal dialogue as an
evolving but only partially conscious process that changes over time, posttermination:
With my second therapist, not so much in recent years, but for the first few years
after, I often had kind of an internal dialogue with him. He made a veiy vivid
impression on me and we’re a lot alike. So in more recent years, I don’t so often
do that. Though nothing specific comes to mind, over the years, there have been a
half dozen or so instances when I’ll find myself saying something and
remembering, ‘That’s almost precisely what he said to me.’
Half the study participants (10) replied that they have never engaged in an internal
dialogue with their former treater while conducting therapy, yet most report experiencing
other types o f internal relatedness. Although two participants offered only that this internal
relatedness does not occur in their experience, several subthemes emerged in the group
overall. One participant who had terminated only recently observed her wish to continue
the actual therapeutic dialogue with her treater only when she is feeling personally
stressed. Two participants offered that they believe they have internalized their former
treater’s careful listening and therefore are not focused on a separate dialogue while with
patients. One participant mentioned the self-analytic function that he carries from his
analysis, describing it as part o f himself that takes place during clinical sessions when he
experiences particular countertransference reactions:
Rather than having an internal dialogue with him, I do a lot of self-analysis. For
example, if I’m feeling inadequate in understanding the patient, it used to be that
I believed that generally. Now I’m apt to say, ‘This is countertransference. What
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am I contributing and what is the patient contributing?’ I think that’s a skill I’ve
developed, and it’s so much a part of me that I don’t think about it, but it’s there.
Because I know that if I went to see my analyst and talked about that, I’d probably
engage in some self-reflection as to what set off those feelings, and I’m pretty sure
that I know what does, regarding a loss or competition.
Four participants reported that they do not have an internal dialogue with their
former treater during clinical sessions, but they do experience “verbal memories” of their
analyst during sessions. They may remember what the analyst might have said or may find
that they are “using his words.” The contents of these verbal memories were related to
appreciating the power of the analyst’s simple statements as a good clinical model and the
importance of interpretations being made from a position of feeling supportive rather than
critical of the patient. Finally, one participant addressed the internalization process of her
analytic work as contributing to her identity as a therapist, noting that she did not engage
in an internal dialogue with her former therapist during sessions but did rely on the essence
o f his presence:
It’s more capturing the feeling tone of words than concrete incidents. It’s not
like thinking about him and thinking what he might have said. It’s much more
interwoven into the fact o f how I work and how I think.
Finally, six respondents replied that while they do not presently engage in an
internal dialogue with their former treater while conducting psychotherapy, in the past
they may have done so. It is noteworthy that these participants who were quite clear that
they do not presently engage in an internal dialogue, noted that it “makes theoretical
sense” that this may have happened in the past, but they have no specific, subjective recall
o f it, only a dim awareness. Two in this group of six conjectured that such dialoguing
might have happened in the past during times of clinical uncertainty. The lack o f specificity
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in their responses may reflect a fading awareness of a process of internalizing the object
relationship and being left with little conscious recall of doing so, as reflected in this
participant’s comments:
I think, early on, I might have dialogued with my analyst when I would be
uncertain, like ‘Jeez, what do I do now?’ When I was into something that just was
really overwhelming. I think I’ve kind of moved away from that at this point.
In summary, only one-fifth of the participants in the study (4) reported having
engaged in an internal dialogue with their former treater while conducting psychotherapy.
Situations of clinical uncertainty tend to actively evoke an image of the former therapist
and how she or he would intervene. These evocations might serve to give the participant
some needed patience and respect for the slow process of psychological change.
In addition, when the patient’s material is uncomfortably similar to the participant’s own
dynamic struggles, an image of dialoguing with the former therapist may provide direction
in the analytic enterprise. The very limited internal dialogue during clinical sessions
described by these participants appears to have served the function of providing clinical
guidance during uncertainty but only relatively early after termination from personal
treatment.
Evoking memories of their former therapist through an internal dialogue was
considerably less prevalent than were other types of reported internal relatedness. More
prevalent was identifying with the analyst’s careful style of listening or recalling “verbal
memories” of what the former treater said in particular situations and, thus, how she or he
modeled good clinical intervention. Interestingly, only one participant described his
continued self-analysis of countertransference paradigms as a form of connectedness with
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his former analyst. There was considerable evidence that memories o f discreet interactions
with the former treater fade over time, leaving the emotional tone of the treatment as the
substrate through which evocative memories are filtered. The study participants described
an evolving and only partially conscious process of identification that leaves them feeling
as if their personal treatment experience is indeed woven into how they work and think
and who they have become as a psychotherapist.
At the conclusion of the interview, each participant was asked to offer any
additional thoughts about the research topic. Six participants added comments. One
observed that, rather than traditional psychotherapy, the Twelve Steps of Alcoholics
Anonymous is the best blueprint for personal reconstruction. Another respondent
addressed the differences between analytic treatment relationships in a small, close mental
health community, such as where this study was conducted, and in large cities, where
patients might never know the background of their therapist. She wondered how the
current study results would be influenced by the small, “hothouse, fraternity” feeling in this
close analytic community. Four participants elaborated on the importance of personal
therapy in coloring their life, both personally and professionally. One noted being further
convinced of the importance of having been a patient before trying to work therapeutically
with patients. Another participant, who had responded generally doubtfully throughout the
interview as to whether his clinical work had been influenced by his personal treatment,
added:
Once we got going, it was clear to me that it’s had some influence. More than
I’ve thought, once I got talking about it and followed the leads of your questions.
And it’s kind of too bad, in some ways, although I wouldn’t want to belong to a
discussion group to obsess about that necessarily. It’s kind o f too bad that at least
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I probably don’t take time to think about that veiy much. I think it would be
important to do that. So I think the process here, for me, but also your research,
is veiy useful in that sense. Maybe other people do a lot more of that and I just
don’t, particularly in terms of influence on my work. As we talked about it, I can
see other influences on me as a person and, consequently, on my work.
In summary, approximately one fourth of the respondents offered their additional
thoughts at the conclusion of the interview. Their comments included one participant’s
view that a 12 step program was more helpful than traditional psychotherapy for personal
change. Another respondent noted that the sociocultural context of this study in a small
psychoanalytic community might bear heavily on the results. Five of these six respondents
elaborated on the positive influences of their personal therapy, both personally and for
their professional work.
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Association of Perceived Influence of Personal Therapy with Perceived Benefits,
Risks, and the Interpersonal Relationship
The data analysis involved first identifying and categorizing themes in the narrative
responses of each participant to the interview questions developed from the literature
model. In the second phase of data analysis, the aggregate responses were then outlined
(see Appendix I). The third and final phase of the data analysis sought to identify
relationships within the various areas of the model by determining whether particular
themes o f benefits, risks, and aspects of the interpersonal relationship would be associated
with varying levels of reported influence of an individual’s personal therapy in informing
the clinical work. The level of data from the outlined results which was analyzed in this
final phase of comparing themes, includes only the major categories of response for each
question in the model. It was determined to be a reportable level of analysis, given
limitations on the volume o f data that can be effectively compared without computer
assistance.
The first step was to display the individual responses of each participant’s
categorized results in each o f the study’s four areas: benefits, risks, influence on practice,
and interpersonal relationship. This arrangement enabled the researcher to begin
identifying patterns of response in each of the four model areas.
The goal of this phase o f data analysis was to compare participants’ perceptions of
the influence of their personal therapy on clinical practice with their responses in the other
areas o f the model. This process called for organizing the various themes in the third area
of the model-the reported influences of personal therapy on the professional conduct of
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psychotherapy. After reviewing the outlined responses to the six questions on the
interview schedule that evaluated perceived influences of personal therapy on conducting
psychotherapy, the investigator determined that the descriptive responses could be
effectively ranked into levels of relative influence. For example, responses to question
3. d. (i) (“Do images or thoughts of your therapist ever come to mind while you’re
conducting psychotherapy?”) resulted in three basic response variations with implied
ordinal levels of ongoing influence: (1) no current or past thoughts of treater; (2) no
current but past thoughts of treater; and (3) ongoing, continued thoughts o f treater, now
and in past.
The five remaining questions in this section produced thick descriptive data.
Nevertheless, the responses can be usefully quantified, with the addition of qualitative
themes within categories to capture their intended meaning. For example, responses to
question 3. a. and b. (“Do you believe you work differently with your patients as a
consequence of having received your own therapy? I f so, in what ways; which
aspects of your therapy do you think you draw on?”) were categorized as:
(1) uncertain that personal therapy informs clinical work; and (2) yes, personal therapy has
influenced my work with patients. There were five identifiable themes of influence in the
affirmative responses in the latter category. These consisted of: (a) enhanced awareness of
the importance of the treatment structure; (b) drawing on a broader range o f interventions;
(c) enhanced confidence in the therapeutic process; (d) deepened conviction about the
treatment relationship as an important vehicle for psychic change and growth; and
(e) increased acceptance of the realistic limitations of the psychotherapy enterprise.
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Of the six questions in the perceived influences section, only the final one was
entirely qualitative in nature. Question 3. d. (iii) (“Which, if any, personal attributes of
your therapist do you find yourself most identifying with in your work?”) garnered
three themes o f response, with participants identifying with: (a) how the therapist
conducted his or her life outside the treatment relationship; (b) admirable personal
character traits of the former therapist; or (c) the therapist’s capacity to conduct
treatment.
The researcher then assigned a rank to the categories of response to all except the
final question in the section on perceived influence. Individual responses were ranked
according to the strength o f the participants’ perception that personal therapy had had a
significant and positive influence on their clinical work. For example, responses to
question 3. c. (i) (“To w hat extent has your therapist served as a role model for you
in conducting psychotherapy?”) fell into three rankable categories. These consisted of:
(1) the analyst had been a significant role model and only positive identifications were
described; (2) the analyst had been a significant role model and the participant offered
both positive identifications with, and differences from, how the analyst practiced; and
(3) the analyst was not perceived as a significant role model in conducting psychotherapy.
That the second category, in which participants offered areas of differentiation, actually
describes less positive identifications can be discerned by examining the differentiation
subthemes in the treater’s practice conduct. These points of differentiation include a
perception o f the former treater as withholding useful conceptual thinking or emotional
relatedness. Therefore, the first category contains the most positive responses and is
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ranked “2,” the second category is ranked “ 1,” and the third category is ranked “0”
(see Appendix G).
Using the outline o f responses coded for each participant in the prior phase of the
data analysis, the researcher calculated each participant’s categorized responses to each of
the six questions in the section. The scores fell between -1 and 7. This range was divided
into equal thirds, with the levels of influence termed “low level,” “medium level,” and
“high level.” The “low level” of influence consists of two participants whose combined
rankings on the six questions fell between -1 and +1. The “medium level” of influence
consists of nine participants whose rankings fell between 2 and 4. The “high level” of
influence consists of nine participants whose rankings fell between 5 and 7.
The responses of one participant exemplify this process. This participant’s
responses are ranked after each abbreviated question:
3. a. & b. Work differently because of personal therapy? If so, how? (2) Yes = 1
d) deepened conviction about importance of therapy relationship;
e) increased acceptance of realistic limitations of psychotherapy
3. c. (i) To what extent was treater a professional role model?

(1) Significant and only positive identifications noted = 2
3. c. (ii) What do you perceive as being your therapist’s limitations or mistakes that have
influenced your work with your own patients?
(2) Limitations that influence my work = -1
due to: a) theoretical biases of analyst
3. d. (i) Do images or thoughts of your analyst ever come to mind while conducting
psychotherapy?
(2) Yes, currently and in past = 2
3. d. (ii) Do you remind yourself of your analyst while you’re working? If so, describe.
(2) Yes, I do = 1
a) similar with analytic technique
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3. d. (iii) Which, if any, personal attributes of your analyst do you find yourself most
identifying with in your work?
(2) admirable personality traits of analyst
Adding the rankings in the first five questions gives a response of 5: (1 + 2 +
[-1] + 2 + 1 = 5) as the assigned level of positive influence of personal therapy on
conducting psychotherapy described by this participant. This process was undertaken for
each participant (for results see Appendix H). Both the high and middle levels-of-positive-
influence groups consist o f nine members each, with only two members making up the low
influence group.
After determining the relative reported level o f positive influence for each
participant, the researcher examined the participants’ responses within each o f these three
levels-high, middle, and low-to discover whether clusters or patterns existed in intragroup
responses. An analysis of these intragroup responses is followed by an analysis comparing
the patterns of response in the high, middle, and low level-of-influence groups within each
of the other areas of the model (i.e., benefits, risks, and the interpersonal relationship with
the treater). The results of this data analysis are presented in the following section.
Patterns of Response in Perceived Influences of Personal Therapy on Conducting

Psychotherapy
3. a. & b. Do you believe you work differently with your patients as a consequence o f
having engaged in your own therapy? I f so, in what ways; which aspects o f your
therapy do you think you draw on?
In both the high and middle level-of-influence groups, there was practically
unanimous reporting o f working differently as a consequence of personal treatment, with
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all but one individual in both groups emphasizing increased conviction about the
importance of the treatment relationship. Over half the middle-level group noted that
treatment increased confidence in the treatment process. Conversely, both members in the
low influence group expressed uncertainty that their personal therapy informs their clinical
work, noting that their practice has instead been more influenced by experience doing the
work itself, by formal education, and by life experience.
3. c. (i) To what extent has your therapist served as a role m odelfor you in conducting
psychotherapy?
All but one of the high level-of-influence group members reported that their former
treater was a significant role model and that they had only positive identifications with
their former therapist. The sole participant who reported that her analyst was a significant
role model, but then offered evidence of both positive identifications and areas of
difference, noted that the differences concerned benignly experienced, unavoidable,
gender-based, stylistic variations in one’s degree of reserve with patients.
In contrast, the middle level-of-influence group’s results were evenly divided, with
about half the participants experiencing the therapist as a significant role model-with only
positive identifications-and about half experiencing the therapist as a significant role
model but one with both positive identifications and areas of difference. Those who cited
areas o f positive identification as well as areas o f difference described their therapist as
well-trained, compassionate, and empathic, yet with an occasionally withholding style.
One participant in the low-level group described his former therapist as a
significant role model, citing evidence of his identification with her capacity to listen
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carefully, yet differing from her in that he was more forthcoming with his own patients.
He experienced his analyst as withholding her conceptual thinking from him, which he
believed prolonged his treatment unnecessarily. The other participant did not experience
his former analyst as a significant professional role model.
3. c. (ii) What do you perceive as being your therapist's limitations or mistakes that
have influenced your work with your own patients?
Responses to this question were about evenly divided between “no perceived
limitations and only positive comments offered” and those who described limitations that
they thought had, in fact, influenced their clinical work. The praises o f the former group
included perceived genuineness and authenticity in the treater and a belief that the “good-
enough therapist” does not have to be perfect or without personal limitations or
misfortunes to do good work. The most common limitation involved perceived theoretical
biases o f classical psychoanalytic theory. None in this group reported limitations due to
their analyst’s countertransference errors or human foibles.
Unlike participants in the high level-of-influence group who were evenly divided
on this question, respondents in the middle level-of-influence group all experienced
limitations in, or mistakes by their analyst that they believe influenced their own clinical
practice. In turn, these limitations were about evenly divided among those caused by the
treater’s perceived theoretical biases or limitations due to technique, and limitations due to
the analyst’s personal vulnerabilities.
Both participants in the low level-of-influence group reported limitations that
affect their clinical work. These involved the analyst’s theoretical biases and inability to
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structure the direction of the hour as much as the participant believed would have been
helpful. One participant noted the analyst’s perceived vulnerability (i.e., being overly
sensitive to personal criticism). Both participants remarked on their ongoing attempts to
navigate these issues differently with their own patients.
3. d (i) Do images or thoughts o f your therapist ever come to mind while you ’re
conducting psychotherapy?
Three fourths of the participants in the high level-of-influence group of nine
reported that thoughts of their analyst have come to mind, both now and in the past, while
they are conducting psychotherapy. These thoughts tend to occur whenever a patient
presents puzzling material. In contrast, three participants said that they had not currently,
nor in the past ever had conscious thoughts of their former treater while conducting
therapy. But two of these three observed that they identified with their former analyst in
that he or she was a very thoughtful listener who focused exclusively on their material
during sessions and that they strived to provide the same kind o f active, focused attention
to their patients. Consequently, they believed that conscious thoughts of other
relationships-even with their former therapist-would not tend to enter their awareness in
the consulting room.
Unlike those in the high level-of-influence group, respondents in the middle level
were about evenly divided among three groups: (1) those not currently, nor in the past,
having thoughts or images of their former therapist while conducting psychotherapy;
(2) those reporting that not currently, but in the past, they had had thoughts or images of
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their treater while conducting therapy; (3) and those continuing to have thoughts or
images o f their former treater while conducting psychotherapy.
Both participants in the low level-of-influence group responded that they do not
currently have thoughts or images of their treater while conducting sessions and that they
do not think they ever have had in the past, even during the course of their own treatment.
One of them added that perhaps this process is unconscious and hence, does not reach his
awareness.
3. d (ii) Do you remind yourself o f your psychotherapist while yo u ’re working? I f so,
can you describe any such moments, any particular clinical circumstances?
All nine respondents in the high level-of-influence group reported that they do
remind themselves of, or think they are similar to, their former analyst in how they
conduct psychotherapy. Over half linked the similarity to technique-related aspects of
conducting therapy.
Eight of the nine participants in the middle level-of-influence group reported that
they do remind themselves of, or think they are similar to, their former analyst. Their
responses were about evenly divided among perceived similarities in therapeutic
technique, interpersonal style, and theories about what is curative.
Responses were mixed in the low level-of-influence group, with one of the two
respondents there reminding himself that he sometimes used an aspect of his former
therapist’s technique while conducting treatment. This mirroring involved emulating her
nonintrusive, nonseductive body language, in cross-gender treatment relationships.
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3. d (iii) Which, if any, personal attributes o f your therapist do you fin d you rself most
In both the high and middle level-of-influence groups, responses to this question
were about evenly divided between those who reported identifying either with the personal
traits o f the analyst and how he or she apparently conducted his or her life outside the
consulting room or with the analyst’s capacities in conducting treatment. No readily
apparent pattern was observed with this variation.
Both respondents in the low level-of-influence group replied that they identify with
their former therapist’s capacity in conducting treatment by taking the work very seriously
and being very absorbed in it. It is noteworthy that neither participant included as
identifications the treater’s personal qualities or perceptions about the therapist living life
outside the analytic hour.
In summary, the patterns that emerge in the high level-of-influence group include
increased valuing of the treatment relationship between the therapist and patient. They
noted only positive identifications with their former therapist as a professional role model.
When asked about their former treater’s limitations or mistakes, they instead described the
treater’s genuineness and authenticity and their belief that their treater modeled being
good enough (i.e., not without personal limitations) to do good clinical work. The
majority believed that their former analyst might feel puzzled at times by their patients’
material. All reported reminding themselves of, or thinking they are similar to, their former
therapist while conducting psychotherapy, mostly with regard to therapeutic technique.
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Patterns that emerged in the middle level-of-influence group similarly include the
greater valuing of the treatment relationship between the therapist and patient, as well as
increased confidence in the treatment process. About half this group noted positive
identifications, as well as areas of differences, such as an occasionally withholding
relational style that was viewed as unhelpful. Unlike the high level-of-influence group, this
group experienced limitations in, or mistakes by, their analyst that they believe have
influenced their clinical practice. No clear patterns emerged regarding thoughts about their
former treater while conducting psychotherapy, but virtually all o f them believed that they
are similar to their former treater.
Finally, patterns emerging in the low level-of-influence group (of two) include
expressed doubts about working differently with patients after a personal therapy. One
respondent did not experience his former therapist as a significant professional role model,
while the other revealed that his analyst is a professional role model, but he dis-identifies
with her tendency to withhold her conceptual thinking and strives to avoid doing this with
his own patients. Both cited personal limitations in their analyst or his or her practice
conduct from which they strive to differentiate themselves professionally. Neither is aware
o f currently or previously having thoughts of their former therapist during clinical hours,
although one did acknowledge identifying with an aspect of his former therapist’s
technique related to body language. In contrast to the two higher level-of-influence
groups, both respondents identified with their former analyst’s absorption in the clinical
work, but not with the therapist’s activity as a person in the world.
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An integrated comparison of the responses of these three groups indicates that the
low level-of-influence group differs from the two higher ones in that the participants do
not view personal therapy influencing their clinical work. There is, in fact, a progressive
decrease in reported positive identifications with the therapist as a professional role model
from high to middle to low level. In addition, their perceptions of mistakes and limitations
in the treater differed greatly among the three groups, as did thoughts about the former
treater during moments of clinical uncertainty. Interestingly, all three groups reported
thinking that they work similarly to their former treater, in at least some circumscribed
way.
Comparing Levels of Influence o f Personal Therapy on Clinical Practice with

Associated Benefits of Personal Therapy
After identifying the intragroup patterns of response within the various levels of
perceived influence of personal therapy on conducting psychotherapy, the researcher
analyzed the data in the first section o f the interview, the perceived benefits, by seeking
associated patterns of response for each of these three levels of influence. As in the prior
section, the findings are presented for each of the six questions that make up the benefits
section of the study. Summarized results of associated benefits for each level of influence
conclude this section.
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1. Please describe what has been beneficial to you in your personal therapy or
analysis?
About half the members of both the high and middle level-of-influence groups
identified increased self-understanding and alleviation of symptoms as benefits. The high
level group also noted benefits of enhanced clinical work and improved self-esteem and
self-acceptance, while the middle level group reported improved interpersonal
relationships. The two participants in the low level-of-influence group both spontaneously
reported that their self-understanding was promoted by their personal therapy.
1. a. How useful was your therapy in enhancing your awareness and understanding o f
yourself?
About two thirds of the respondents in both the high and middle level-of-influence
groups reported an improved understanding of their psychodynamics after personal
therapy. About half o f those in the high influence group also noted the importance of their
relationship with their former treater in promoting self-awareness. Both members of the
low level-of-influence group reported improved understanding of their psychodynamics as
a subtheme o f enhanced self-awareness and self-understanding.
1. b. How useful was your therapy in enhancing your self-esteem and self-confidence?
Eight of the nine respondents in the high level-of-influence group believed their
personal therapy clearly enhanced their self-esteem and self-confidence. Over half of them
identified enhancement of their professional identity as a component of their improved
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self-esteem. Almost half also emphasized the therapist’s role in promoting their self
esteem.
No clear pattern of response emerged in the middle group, with about half the
respondents there reporting that their therapy clearly enhanced their self-esteem and self-
confidence and the other half reporting mixed or equivocal results.
Both participants in the low level-of-influence group described mixed or equivocal
results regarding enhancement o f self-esteem and self-confidence as a benefit of their
personal therapy.
1. c. How useful was your therapy in improving your interpersonal relationships?
The majority of respondents in both the high and middle level-of-influence groups
responded that their treatment was clearly helpful in improving their interpersonal
relationships with significant others. However, just under half the members in the high
level-of-influence group(all women) believed it was equivocally helpful to their
relationships (e.g., by enabling them to clarify relationship boundaries, which created some
interpersonal conflict but resulted in greater mutuality).
One participant in the low level-of-influence group described his personal therapy
as clearly enhancing his interpersonal relationships, while the other noted mixed results for
his interpersonal relationships.
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1. d. How useful was your personal therapy in enhancing your therapeutic skills, fo r
example, with empathy, in using countertransference, in structuring treatment, in
understanding the process ofpsychotherapy?
Over three fourths of the members in both the high and the middle level-of-
influence groups reported that their personal treatment led to psychological changes
promoting changes in their clinical practice. Members in both groups also noted that their
personal treatment aided them in learning about the therapy process. Over half commented
on the importance o f the treatment relationship with their former therapist in promoting
their therapeutic skills. Within the subtheme o f learning about the therapeutic process,
both participants in the low level-of-influence group described enhancement of their
therapeutic skills.
1. a How useful was your therapy in resolving characterological issues and alleviating
symptoms?
Three fourths o f the participants in the high level-of-influence group reported
that their treatment helped alleviate psychological symptoms, but only modified their
characterological issues. The rest believed their treatment both alleviated symptoms
and resolved their characterological issues.
Although symptom alleviation was experienced by virtually everyone
in the middle level o f influence group, a minority o f them indicated significant shifts
in both symptoms and character.
Interestingly, both participants in the low level-of-influence group reported their
treatment to be beneficial both with symptom alleviation and with resolving or modifying
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characterological issues. It is noteworthy that even in this small group of respondents who
report the least influence o f their personal treatment on their clinical work, symptom
alleviation was nevertheless experienced as a clear benefit. Symptom alleviation was
valued across the spectrum of participants.
In summary, several patterns emerge in analyzing the benefits of personal therapy
that were reported by members of the high level-of-influence group: (1) improved
understanding of their own psychodynamics; (2) enhancement of self-esteem and self-
confidence, as well as promotion of their professional identity; (3) psychological changes
that affected clinical practice; and (4) symptom alleviation. The somewhat mixed results of
benefits to interpersonal relationships stem from the female participants’ noting
temporarily increased interpersonal conflict as they clarified their personal boundaries.
Reported psychological changes that resulted in changes in clinical practice were also very
prevalent in this group, as were an emphasis on the value of learning about the treatment
process and the treatment relationship within the context of enhancing therapeutic skills.
This entire group reported symptom alleviation, with either modification of, or resolution
of, characterological issues.
A summary of emergent patterns of benefits associated with the middle level-of-
influence group includes a similar valuing o f self-understanding and a crediting of the
treatment relationship with promoting self-awareness. No clear pattern emerged, however,
regarding self-esteem and self-confidence. Nevertheless, these participants emphasized
that their relationships with significant others were improved with personal treatment
more so than did those in the high level-of-influence group. This group also valued the
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usefulness of their personal therapy in enhancing their therapeutic skills and in alleviating
symptoms, but no clear pattern regarding characterological change could be identified.
Finally, a summary of the patterns of benefits reported by the low level-of-
influence group includes a similar valuing of self-understanding and a crediting of the
treatment relationship with contributing to self-understanding. Both participants described
mixed or equivocal results about enhanced self-esteem and self-confidence. Reported
benefits to interpersonal relationships offer no emergent pattern in this group. As a sub
theme o f enhanced therapeutic skills, both participants valued learning about the
therapeutic process. Both reported symptom alleviation and resolution or modification of
characterological issues.
An integrated comparison of these results reveals that the high level-of-influence
group reported benefits in all categories of inquiry. Both the middle and low level-of-
influence groups reported benefits similar to those of the high level-of-influence group
with regard to valuing self-understanding, learning about conducting psychotherapy, and
alleviating symptoms. The apparent differences lie in the category o f enhanced self-esteem,
where the middle and low level-of-influence groups report a relative absence of enhanced
professional identity. The other area of difference lies in the perceived enhancement of
their interpersonal relationships, where the low level-of-influence group reports no clear
pattern o f benefit.
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Comparing Levels of Influence of Personal Therapy on Clinical Practice with

Associated Risks and Disappointments o f Personal Therapy
2. Please describe any disappointments, risks, or negative effects o f your personal
therapy or analysis.
Responses to this question show a similar pattern for both the high and middle
level-of-influence groups, with the vast majority o f participants noting some
disappointment in their therapy and only a few acknowledging risks of treatment.
Surprisingly, the single participant in the study who reported a negative effect of personal
treatment was a member of the middle level-of-influence group, whereas the members of
the low level-of-influence group reported only a risk of, or disappointment in treatment.
2. a. To what extent did you experience excessive stress or psychological distress as a
consequence o f your personal therapy?
Three fourths of the members of the high level-of-influence group reported no
excessive stress as a consequence of their personal treatment. Most, however, noted some
“nonexcessive” stresses. The few who noted excessive stress viewed it as an inherent,
meaningful part o f treatment. The patterns of response in the middle level-of-influence
group were similar except that one participant believed the stress he experienced was not a
necessary and inherently purposeful part of his psychological growth. One member of the
low level-of-influence group reported no excessive stress or distress consequent to
treatment. The other participant at that level related the excessive stress he experienced as
due to a lack of mutuality in discussing his readiness to terminate, which left him feeling
that his treatment was unfinished.
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2. b. D id you experience any problems with the working relationship?
Surprisingly, two thirds of the high level-of-influence group reported problems
with the working relationship with their former treater. These participants described
complications related to their perceptions of the therapist as vulnerable and in need of
protection (due to a sudden relationship loss), as overly sensitive or too focused and
serious, or as having flaws in technique, (e.g., nonadherence to the time frame, with
chronic lateness), or lacking in neutrality. Only one participant noted her own resistance
as contributing to the perceived problem in the working relationship.
The majority o f those in the high level-of-influence group who experienced
problems with the working relationship added that working actively on these problems
eventually led them to a positive identification with their analyst as a professional role
model. Discussing the issue as part of their therapeutic work led to an acceptance of the
analyst’s way o f working, which had initially created conflict. For example, discussing at
length one analyst’s persistence in charging for missed sessions during the participant’s
illness, or another analyst’s personal problem with lateness was cited as contributing to
positive identifications and helping to resolve the perceived difficulty in the working
relationship. The one participant in this group who described a dis-identification with
her analyst’s working style revealed that her analyst never did explain why he persisted
in calling her by her surname, although she had long requested that he address her less
formally.
In fact, the responses o f the middle level-of-influence group rank more positively
than do those o f the high level group. In this group, over half the respondents noted no
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problems in their working relationship. Of the four participants who did report
experiencing problems, unlike in the high level group, only one respondent reported
focusing actively on the conflict, with the analyst’s help, in treatment. It thus appears that
participants who believed that their problems with the working relationship became a
central focus of the therapeutic dialogue ultimately became more positively identified with
their former therapist as a professional role model than did those participants who do not
report that problems in the working relationship were thoroughly discussed in treatment.
One of the two members of the low level-of-influence group reported no problems
in the working relationship, but still viewed his therapist as not being forthcoming enough
about her thoughts, which extended his treatment unnecessarily. The other participant at
this level perceived his analyst as vulnerable and in need of protection, due to life
circumstances and to a personality trait of oversensitivity.
2. c. To your way o f thinking, did your therapist make treatment errors in your work
together? I f so, please specify.
The responses of the high level-of-influence group were roughly evenly divided
between four categories of responses to this question. Two participants perceived no
treatment errors. Another three reported no actual errors, yet wondered whether their
former analyst fully understood them (e.g., the amount of their family relationship stress),
or questioned the analyst’s loose management of the therapeutic time frame, or differed
with the analyst’s move away from analytic neutrality at termination.
The high level-of-influence participant who noted a minor treatment error not
substantively detrimental to his treatment process (time management) nevertheless
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wondered why it was uncharacteristically not open for exploration with his analyst.
Three other participants in this group experienced treatment errors they viewed as
detrimental. These mistakes involved incompletely exploring the participant’s dynamic
issues, using flawed analytic techniques (e.g., mistiming interpretations, which was
experienced as hurtful ,or rigidly maintaining neutrality), and enacting harmful
countertransference reactions.
The middle level-of-influence group’s responses to this question are again more
apparently positive. Only one participant noted experiencing treatment errors detrimental
to his process, based on the analyst failing to accurately diagnose the extent of the
participant’s psychological problems.
One member o f the low level-of-influence group described no treatment errors, but
questioned whether he could safely explore issues related to his sexual competence, given
his erotic transference to his female analyst. The other member of this group described
treatment errors related to harmful countertransference enactments by his analyst, which
he experienced as detrimental to his treatment process.
2. d. Do you think you have identified with your therapist in some way that has
affected you adversely?
The responses o f the high level-of-influence group were also fairly evenly divided
among the four levels o f overall responses. Two participants reported that they did not
experience adverse identifications, but instead noted some positive ones. Three in this
group simply replied that they experienced no adverse identifications, while one described
a dis-identification with a negative aspect of his analyst, whose failure to take good
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physical care of herself influenced his resolve to begin exercising regularly. Three
participants believed they identify with their former analyst in some way that affects them
adversely: (1) identifying with the analyst’s neutrality to such an extent that it stifles the
participant’s clinical spontaneity and playfulness; (2) feeling “defensively stuck in
neutrality”, like an analyst whose neutrality limited his clinical effectiveness with a
particular dynamic issue in treatment; and (3) suffering an adverse identification, or a
“multigenerational influence of the negative” by adopting the former analyst’s annoying
verbal mannerism. All of these adverse identifications relate to the analyst’s conduct of
professional practice, rather than to his or her personal life.
Again, the middle level-of-influence group described more apparently positive
results on this question than did the high level-of-influence group. Seven of the nine
experienced either positive identifications or at least no adverse identifications. O f the two
respondents in this group who did experience an adverse identification with their treater,
one noted that he shares similar distasteful personality traits with his analyst, and the other
observed that her identification with her analyst’s reserved, cautious personality style has
contributed to her difficulty in forming friendships. Unlike those in the high level-of-
influence group, these two participants report the adverse identifications to be on a
personal rather than a professional level.
Both members of the small cohort of low level-of-influence described negative
aspects of their treatment relationship. One cited a dis-identification with his former
analyst’s cultural insensitivity, believing that it enhanced his own. The other participant
noted an adverse identification with his former analyst, in which his experience of his
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analyst’s neutrality has resulted in making him feel less spontaneous and playful as a
treater.
2. e. In your view, was your effectiveness as a therapist blocked due to confusion in
being both a patient and a therapist at the same time?
About half the participants in the high level-of-influence group responded that their
clinical work was enhanced by being in personal therapy concurrently. One participant
simply stated that there were no adverse effects. Three others denied any perceived
blockage in their therapeutic effectiveness with patients yet acknowledged complications
(e.g., preoccupation with one’s own psychological issues that made it occasionally difficult
to attune to patients; the struggles to transition from being the patient to being the
therapist; and competitive anxieties about being in the analyst’s chair). The one participant
in this group who did perceive blockage in her therapeutic effectiveness was just beginning
her clinical training and thought she had engaged in a countertransference enactment that
led to premature termination with a patient struggling with issues similar to hers.
The middle level-of-influence group’s responses to this question cluster much like
those of the high level-of-influence group. The exception is that one more participant in
this group reported experiencing blocked effectiveness. One participant cited such adverse
effects as feeling overwhelmed by engaging in personal therapy concurrently with rigorous
postgraduate training, which made it difficult to transition from being the patient to being
the therapist, because of feeling too stirred up to attune well to patients at times.
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Interestingly, both members o f the low level-of-influence group believed that then-
personal treatment promoted their clinical work by serving a containing function, which
enhanced their sensitivity, empathy, and identification with their patients.
In summary, several patterns emerge in analyzing the disappointments and risks of
personal treatment which were reported by members of the high level-of-influence group.
The majority noted some disappointments, rather than actual risks, but none in the group
noted true “negative effects.” The few who acknowledged excessive stress viewed it as an
inherent, meaningful part of in-depth psychological treatment. Surprisingly, well over half
the high level-of-influence participants reported problems with the working relationship
with their former treater. These complications were due to perceptions of the analyst as
personally vulnerable and in need of protection, or to perceived flaws in analytic
technique, especially with regard to a lack of analytic neutrality. Noteworthy is that a large
majority of participants in this group who experienced working relationship problems
spontaneously added that they had actively worked on them as a central part of the
treatment process. This apparent “working through” contributed to an eventual positive
identification with the analyst as a professional role model. A range of experiences
regarding perceived treatment errors was found in this group. Those few participants who
reported the most detrimental errors experienced incomplete analytic exploration of their
dynamic conflicts, or flawed analytic technique in mistimed interpretations, rigid
maintenance of neutrality, or countertransference enactments. Their responses were also
evenly divided regarding adverse identifications with the former analyst. The majority did
not experience adverse identifications, but those who did feel they have identified with the
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analyst’s neutrality in a way that has stifled clinical spontaneity and playfulness or limited
clinical effectiveness. Rather than blockage of their clinical work, the majority experienced
enhancement o f it. However, several in the high level-of-influence group noted temporary
complications due to a preoccupation with their own psychological issues, especially those
inexperienced therapists engaged in concurrent training and treatment.
A summary o f the middle level-of-influence group’s perceived disappointments and
risks in personal treatment includes some surprising similarities and differences from those
of the high level group. The sole participant in the study who reported a negative effect of
personal treatment belonged to this group. This middle group similarly reported
experiencing some nonexcessive stresses consequent to personal treatment. One
participant in this group experienced excessive stress not conducive to his psychological
growth. Regarding perceived problems with the working relationship, over half the
respondents noted none, which appears to be a more positive response than that of the
high level-of-influence group. However, unlike the former group, of those who did
experience problems, only one reported actively engaging in working on it in the treatment
relationship, as a central part of the therapeutic dialogue. Regarding treatment errors, the
middle level-of-influence group’s responses again appear to be more positive at first
glance. Only one participant noted treatment errors that were detrimental to his process.
This group also responded apparently more positively than did the high level-of-influence
group to the question regarding adverse identifications. However, unlike the high level-of-
influence group, the few respondents here who did report adverse identifications cited the
source as untoward personality traits of the analyst, rather than his or her professional
216
practice. This group reported similarly positive responses as the high level group
concerning the effects of engaging in concurrent personal treatment.
A summary of the low level-of-influence group’s perceived disappointments and
risks o f personal treatment includes that no actual “negative effects” were initially reported
in the open-ended question by either of the group members. Their responses were divided
on most of the remaining questions assessing risk and disappointment, however. One
participant reported excessive stress, which he felt was not an inevitable part of treatment,
that was related to an “unfinished” termination. The same participant reported no
problems in the working relationship but viewed his therapist as withholding important
feedback. The other member reported problems in the working relationship associated
with his view o f the analyst as vulnerable and in need o f protection. The respondents in
this small cohort were also divided on their experience o f treatment errors, with one
claiming no actual errors, yet longing to have more completely explored questions related
to his sexual competence that were impeded by his “unprocessed” erotic transference. The
other group member acknowledged treatment errors by his analyst’s harmful
countertransference enactments. Both participants also noted adverse identifications with
their former analyst. Noteworthy, however, is that even in this low level-of-influence
group, the participants concurred that their clinical work was promoted by the containing
function served by their personal treatment.
An integrated comparison of these results reveals that the level of perceived
influence o f one’s personal treatment on clinical practice is positively associated with the
extent to which psychological stress was seen as a purposeful, sometimes necessary, part
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o f the treatment process. However, a comparison o f the intergroup results on questions
about problems in the treatment relationship and perceived treatment errors offers some
counter-intuitive findings, in that the high level-of-influence group reported the most
problems in the working relationship. Yet in the high level group more than in the others,
these treatment relationship problems became the central focus of the analytic dialogue.
The middle and low level -of-influence groups described a need to side step these conflicts
in order to protect the analyst from their negative experience. This finding suggests that
the level o f influence of personal treatment on one’s clinical work is positively associated
with risking negative feelings about the treatment relationship and, in bringing these
problems into the analytic dialogue, in having a therapist who is receptive to working with
the participant’s negative experience. These participants also experienced their analyst as
thoughtfully considering their own contributions to the problems, while continuing to
analyze the relative contributions of the participant’s transference and resistances. The
high level-of-influence group described treatment errors related to the treater’s analytic
technique, whereas the other groups cited relatively more errors related to their
perceptions o f their analyst’s personal character shortcomings. Finally, the low level-of-
influence group members described having the least well-explored reactions to their
former treater, who was seen as vulnerable to criticism, as vulnerable to the erotic
transference, and as prone to enacting negative countertransference.
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Comparing Levels of Influence of Personal Therapy on Clinical Practice with

Associated Effectiveness of Personal Therapy
1. Overall, how well do you believe your therapist understood you and communicated
his or her understanding to you?
Eight o f the nine participants in the high level-of-influence group felt veiy well
understood by their former analyst. The single participant who felt generally well
understood, with some exceptions, noted that certain aspects of the treatment relationship
with his analyst were not explored in enough depth. Although the middle level-of-
influence group’s responses ranged among all categories, from very well understood to
not well understood, about half of them described feeling well understood. The experience
o f “egalitarianism” and o f recognizing that the therapist, although flawed, reliably strived
to understand the participant contributed to this perceived high level of understanding.
Almost half the middle level-of-influence participants reported feeling generally well
understood, with some exceptions. The most prevalent exception involved the need for
more direct communication from the treater. The single respondent in this group who felt
not well understood believed that his analyst did not appreciate the role played by
traumatic separation and loss during the respondent’s adolescent development. Both
members o f the low level-of-influence cohort responded that they felt generally well
understood, with some exceptions. One participant cited his need for more direct
communication from his treater about the analyst’s understanding of the participant’s
material, and the other observed that his treater overvalued analytic neutrality, which left
him too aloof and detached, and which denied the participant the warmth and support
needed to promote his psychological growth.
219
In summary, there is a positive association between findings comparing the level o f
influence o f one’s personal treatment and the participant’s perceptions of being
understood by the treater. Respondents in the high level-of-influence group offered
evidence o f feeling the most thoroughly understood by their former treater. Although all
three groups reported quite high levels of feeling understood, the middle and low level-of-
influence groups offered progressively more evidence of the treater not communicating his
or her understanding to the participant, reportedly either because the analyst misperceived
the participant’s material or more prevalently, because the analyst was seen as overvaluing
analytic neutrality and hence withholding feedback.
2. Overall, how successful or satisfactory do you believe your personal treatment was?
Eight of the nine participants’ responses in the high level-of-influence group
clustered in the “quite successful” category and the “quite successful, especially in helping
with perfectionism” category. The one participant who described his analysis as being
“quite successful, with one disappointing exception” related it to his perceived personal
limitation in needing, but not pursuing, continued treatment after the analysis for ongoing
family relationship issues. Responses of the middle level-of-influence group ranged among
all subcategories with almost one half reporting quite successful treatment and almost all
the rest reporting quite successful treatment, with one disappointing exception. The
majority of these disappointments were related to the respondents’ perceived personal
limitations, which they believed kept them from experiencing greater success with their
treatment. The single respondent in the middle level-of-influence group who reported an
unsatisfactory treatment related it to his underdiagnosis by the therapist and to his belief
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that psychoanalysis should not have been the treatment o f choice for him. One member of
the low level-of-influence group reported a quite successful analytic experience but
offered no supporting comments. The other participant in this group believed that his
analysis had been quite successful, despite the limitations in psychoanalytic theory as a
sufficient explanation for understanding human motivation and behavior.
In summary, findings comparing the level of influence of one’s personal treatment
with the participant’s perceptions of treatment success show a positive association.
Respondents in the high level-of-influence group offered evidence of experiencing their
treatment as most successful. Respondents in both the high and middle level-of-influence
groups who revealed a disappointment in their treatment usually attributed it to internal
limitations or resistances that kept them from experiencing greater success. One
respondent in the middle level-of-influence group reported an unsatisfactory treatment
related to the external factor of being incorrectly diagnosed. This respondent also believed
that psychoanalysis had been an inappropriate treatment for him. Responses o f the low
level-of-influence group were divided, with one participant reporting a very successful
treatment and the other being disappointed in the limitations o f psychoanalytic theory. The
perceived success of treatment was thus positively associated with the level of perceived
influence. Perceived disappointments in personal, treatment were negatively associated
with the level of perceived influence. Disappointments were perceived as more internally
located by those respondents who reported higher levels of influence o f personal therapy.
R eproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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Comparing Levels of Influence o f Personal Therapy on Clinical Practice with

the Perceived Interpersonal Relationship and Posttermination Psychological
Involvement with the Therapist
4. (1.) How would you describe the interpersonal match or f it between you and your
most recent therapist or analyst?
Results o f both the high level-of-influence and middle level-of-influence groups
indicate that seven of the nine respondents in both groups experienced the interpersonal
match with their treater as good and remaining good throughout the treatment. Two
participants in the high level-of-influence group initially felt the interpersonal match was
not good due to the analyst’s reserve and due to their own manifestations of negative
transference. These participants did not choose their treater. One participant in the middle
level-of-influence group described an initial feeling that the match was good yet, over
time, it changed to not being good. Surprisingly, both members in the low level-of-
influence group described experiencing a good match with their analyst that remained so
over time.
4. (2.) To what extent did you like your therapist, or feelfondness and affection fo r
him or her and experience that your therapist liked you? D id you sometimes dislike
your therapist or fe e l disliked?
Results of both the high and middle level-of-influence groups are similarly
clustered in the high range of mutual liking. Mutual liking and no disliking meant that
participants felt genuine fondness and affection for their treater, which they believed to be
mutual. These participants did, however, report experiencing negative emotions toward
their treater, experiencing idealized and eroticized transference reactions, and fearing that
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they would be disliked by the treater. Surprisingly, the sole participant who reported not
liking his therapist by the end o f treatment was a member of the middle level-of-influence
group. This participant reported not liking his former treater’s glibness, which reduced the
level of trust in him. The two respondents who reported a period of mutual disliking that
later changed to mutual liking were also in the high level-of-influence group. They
described a period o f mutual lack of relatedness and withdrawal from one another in the
treatment, that was eventually worked through. Also noteworthy is that the two low level-
of-influence group members described high levels o f mutual liking.
4. (3. c l) Regarding the match: Did you think o f your therapist as professionally
competent? Do you think your therapist thought o f you as professionally competent?
Surprisingly, the high level-of-influence group’s responses ranged lower than did
those of either of the other two groups. Two participants in this group described feeling
uncertain about their therapist’s competence. Their uncertainty involved highly
transference-laden images of significant others as rigid and unbending, or as unavailable
and inconsistent. Much of their therapeutic focus involved working in the transference on
dynamic conflicts regarding the capacity to trust in the steadfastness of authorities, which
led them to eventually view the self and the therapist as professionally competent.
All members of the middle level-of-influence group reported thinking that their therapist
was competent, as well as believing that their therapist considered them likewise.
Interestingly, both members of the low level-of-influence group considered their treater to
be professionally competent.
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4. (3. b.) How compatible were your professional convictions?
The high and middle level-of-influence groups gave very similar responses to this
question. In both groups, a majority of respondents emphasized the similarities between
their own and their therapist’s professional convictions, rather than noting both similarities
and differences. These similarities involved mutual clinical interests, theoretical beliefs, and
ethical standards. Those who reported differences mentioned theoretical approaches to
treatment, convictions about the preeminence of classical psychoanalytic theoretical
approaches, and the spiritual basis of treatment. Interestingly, very few participants in
either group described their former therapist as primarily serving a mentoring function;
those who did were new trainees who could talk in treatment about feeling temporarily de
skilled. The low level-of-influence respondents were divided evenly between those noting
only similarities and those noting both similarities and differences in professional
convictions.
4. (3. c.) Did you fe e l respected by your therapist? Do you think your therapistfelt
respected by you ?
It is noteworthy that in all three levels-of-influence groups, the vast majority of the
respondents felt well respected by their former treater. Only three participants overall, two
of whom were members of the high level-of-influence group, perceived that their former
treater might not have felt respected by them. The third participant was from the middle
level-of-influence group. Both members of the high influence group noted that their upset
with their former treater became a major focus of the analytic work until the relationship
issues were resolved. These issues involved the participant’s distress with the analyst’s
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withholding style. Interestingly, respondents who elaborated about the respect felt in both
directions added that early idealization was a factor in the respect issue and that the
therapist’s eventual acknowledgment of the participant’s acceptance o f the therapist’s
human foibles was an important part of that mutual respect. Another participant
expressing mutual respect noted that her dignity and autonomy were respected at
termination.
4. (3. d.) How compatible were your personality styles?
It is noteworthy that every respondent in the study felt that his or her own and
their analyst’s personality styles were compatible. Interestingly, the results o f the high
level-of-influence group are strikingly different than those of the other groups, in that all
but one member of the high level-of-influence group believed the compatibility existed
despite their differences in personality styles. Results were more evenly distributed in the
middle level-of-influence group. This finding suggests that participants reporting a high
level of influence of their personal treatment in their clinical work perceive differences in
personality style not as complementary or as contributing to the perceived compatibility,
but as a potential challenge to compatibility that was overcome.
4. (4.) Do you sometimes fin d yourself thinking about your analyst or therapist or
wishing to talk with him or her? I f so, under what circumstances?
A significant majority of respondents in the high level-of-influence group reported
that they do find themselves thinking about and wanting to talk with their former therapist,
primarily about matters of personal life. Over half the members in this group have, in fact,
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sought out their former therapist for posttermination contact. In the middle level-of-
influence group, about half the members reported wanting to talk with their former
therapist, primarily about matters related to professional practice. Three in this group
initiated posttermination contact with their former therapist. It appears that a high level-
of-influence is associated with participants who readily wish to continue the therapeutic
dialogue with their former treater, primarily on matters of their personal well-being, but
also regarding their professional life. These participants are more likely, in fact, to initiate
posttermination contact than are participants who report a lower level o f influence. The
low level-of-influence group noted ambivalence in thinking about or wishing to contact
their former treater, adding that there was a premature or incomplete termination.
4. (S.) In your conduct o f therapy, do you ever engage in an internal dialogue with
yourform er therapist/analyst? I f so, under what circumstances?
Surprisingly, those in the high level-of-influence group responded overwhelmingly
that they do not consciously experience an internal dialogue with their former treater while
conducting psychotherapy, but they added that they have conscious experiences of “verbal
memories” o f what the therapist said. One observed that his self-analytic function in
understanding transference-countertransference paradigms is a direct connection to the
former analyst, as is a conscious identification with the former analyst’s careful listening.
The middle level-of-influence group offered a wider range of responses, with three
members describing an internal dialogue with their former treater when in need of clinical
patience and guidance or when the patient’s material resonates with the participant’s
earlier dynamic conflicts. Almost half those in the middle level-of-influence group reported
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that they may have engaged in an internal dialogue with their former therapist during times
o f clinical uncertainty but do not do so presently. Neither member of the low level-of-
influence group noted internally dialoguing with their former treater, yet one of them
consciously identified with his former therapist’s careful and active listening.
In summary, the vast majority of the high level-of-influence group reported a good
interpersonal match with their treater. They also reported high levels of mutual liking,
despite feeling a range of negative emotions and complicated transference reactions. The
small minority in this group who described a period of mutual disliking noted that these
relationship issues were worked through in the treatment process with the former treater’s
help. Regarding perceived professional competence, the high level-of-influence group’s
responses ranged lower than did those in the other two groups. Their responses also were
related to negative transference-laden views of authority figures. Again, these difficult
issues were described as becoming the central focus of therapy for the high level-of-
influence group members and promoted an eventually more positive view of self and
others regarding professional competence. Regarding compatibility of professional
convictions, a majority of respondents emphasized the similarities of their professional
conviction and de-emphasized their differences. Very few participants in this high level-of-
influence group described their former therapist as serving primarily a mentoring function
unless they were trainees at the time. Although a large majority of respondents felt well
respected by their former treater, for the few who did not, this issue became the central
focus of treatment until it was worked through. Although all respondents in the study
perceived that they had compatible personality styles with their treater, only those in the
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high level-of-influence group believed that such compatibility existed despite differences
between their own and their treater’s personality style; thus these differences were not
perceived as complementary, but rather as challenges to be overcome. A significant
majority of respondents in thus group reported that they do think about and often wish to
talk with their former treater, primarily about matters regarding their personal life and
secondarily about their professional life. The majority in this group had, in fact, sought
contact with their former treater following termination. Participants reported that they do
not consciously experience an internal dialogue with their treater while conducting
treatment, but instead have “verbal memories” of what the therapist said during sessions.
This self-analytic function served as a connection with the former treater for a few
respondents.
In summary, as with the high level-of-influence group, most of the members of the
middle level-of-influence group described a good interpersonal match with their treater
throughout psychotherapy. They reported a high level o f mutual liking, except for one
participant, who did not like or completely trust his therapist at termination. All members
of this group described their therapist as competent and believed that their therapist
considered them likewise. This group’s responses to perceived compatibility of
convictions also closely mirrored those in the high level group, with a majority
emphasizing the similarities between their own and their treater’s convictions, yet few
believing that their former treater served primarily a mentoring function. With regard to
mutual respect, all but one member of this group responded affirmatively. Although all
respondents in the study perceived compatibility between their own and their treater’s
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personality styles, the source of that compatibility ranged from similarities to perceived
differences or despite perceived differences. In this group, about half the members
reported wanting to talk with their former therapist primarily about matters related to
professional life. However, only one third had initiated posttermination contact. Regarding
an internal dialogue with the former treater, this group again offered a wide range of
responses, such as doing so when clinical patience or guidance was needed. About half of
them report not currently engaging in an internal dialogue with their former treater, but
think that they may have in the past during times of clinical uncertainty.
A summary of the results from the low level group includes that both members
described a good interpersonal match with their analyst and a high level of mutual liking.
These participants also considered their former treater to be professionally competent.
Although they both perceived compatibility, one emphasized differences from, as well as
similarities to, his treater’s convictions. Like the participants in the higher levels of
influence groups, both low level group members felt mutual respect toward their former
therapist and experienced compatibility of personality styles. They noted feeling
ambivalent about thinking about or wishing to contact the former treater, due to a
problematic termination. Neither one noted internally dialoguing with the former treater,
yet one identified with his former treater’s style of actively listening.
An integrated comparison of these results reveals that in all levels of influence, the
majority of participants reported a good match with their former treater, and most
experienced this throughout their treatment. With regard to mutual liking, the high level-
of-influence group is associated with working through any feelings of mutual disliking.
With regard to the perceived character match, the working through of negative
transference also appeared more centrally in the responses of the high influence group and
is notably absent in the apparently more “positive,” less conflict-ridden responses of the
middle and low influence groups. Compatibility of perceived professional convictions was
similarly high in all groups. Responses to the mutual respect question again showed the
pattern o f positive experience in all groups, yet only in the high level group did any
respondents describe a working through of problems related to mutual respect in the
treatment relationship. Although all respondents in the study reported compatibility with
their treater’s personality style, only the high level influence group showed a clear pattern
of experiencing compatibility despite the perceived differences in personality styles. This
finding again suggests more awareness of, and working through of, negative emotional
reactions in the high level-of-influence group. Another clear pattern is the strong positive
association between level of influence and posttermination psychological involvement with
the treater. Only in the high level-of-influence group was there a universal wish to
continue the therapeutic dialogue with the former treater, whereas ambivalence in thinking
about or actually contacting the former treater grew in the lower level-of-influence
groups. The intergroup patterns of response about engaging in an internal dialogue with
the former treater during clinical sessions showed that few respondents at any level of
influence report doing so. However, other forms of psychological relatedness, such as
recalling “verbal memories” of the former therapist’s words, is positively associated with
level o f influence. These combined results support an overall impression o f a positive
association between level o f influence of personal therapy for one’s clinical work and
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working through negative interpersonal experiences in the treatment relationship. The
therapeutic work done on resolving these issues is a common theme in the responses of
the high level-of-influence group. This group also reported the strongest and least
ambivalent posttermination psychological involvement with the former treater. There thus
appears to be a positive association between working through negative emotional
experiences with the treater and the level of posttermination psychological involvement.
These combined results support evidence of a positive association between level of
influence of personal therapy on one’s clinical work and level of posttermination
psychological involvement with one’s former therapist.
Integrated Responses of the Four Domains o f Study
The findings reported in the preceding section were then integrated by comparing
the summarized variations in the response patterns between the three levels in each of the
domains of the study. To illustrate the variations between the responses of high, middle,
and low levels o f influence groups, these results are visually displayed in table form
(see Tables 1-5).
Levels o f Perceived Influences of Personal Therapy on Conducting Psychotherapy
These levels were created by ranking the varied responses o f the participants’
perceptions about how much influence personal therapy has had on their clinical work.
At variance was the belief that the participant works differently as a result of personal
therapy. The degree to which the former therapist is seen as a professional role model also
varied among participants, as did perceptions about mistakes and limitations in the treater,
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and thoughts about the former treater during moments of clinical uncertainty.
Yet, all participants believe they work similarly to their former treater, in at least
some circumscribed way. These results are displayed in Table 1.
Levels of Perceived Benefits of Personal Therapy
Those participants reporting the highest level of influence of their personal
treatment on their clinical work also reported the most areas of benefit. Hence, there is an
association between the level o f reported influence and the number o f reported benefits.
The two areas o f benefit that show clear differences in responses between the levels of
influence are self-esteem/self-confidence and interpersonal relationships. Those reporting
the highest influence of their personal treatment on their professional practice also report
the clearest enhancement o f their professional identity as part of increased self-esteem and
self-confidence. Having improved interpersonal relationships as a benefit of personal
therapy was also associated with higher levels of perceived influence of personal treatment
for clinical work. These findings are displayed in Table 2.
Levels of Perceived Risks o f Personal Therapy
The level of perceived influence of one’s personal treatment on clinical practice is
associated with the extent to which psychological stress is viewed as an inherent and
meaningful part o f the treatment process. Surprisingly, the highest level-of-influence group
reported the most problems in the working relationship. However, in this group more so
than the others, the treatment relationship problems became the central focus o f the
analytic work, in the lower level-of-influence groups, these conflicts were more likely to
have been defensively avoided by both members of the therapeutic dyad. Hence, the level
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Table 1
Perceived Level of Influence of Personal Therapy on Clinical Practice
Questions Determining Level-of-Influence Ranking
Perceived Level of Influence High Middle Low
3. a. & b. Work differently Yes, valued Similar and more I don’t think I do
consequent to personal relationship confident in work differently
therapy? If so, how? more highly. treatment process. now.
c. (i) To what extent has All: yes; very Half: therapist was One: analyst not a
your therapist served as a much a a positive professional model.
role model for you in positive professional role One: yes, but I dis-
conducting psychotherapy? professional model. Half: both identify with her
role model. similarities and withholding.
differences from
analyst, who was
withholding, at
times.
c. (ii) What do you perceive No mistakes; Limitations and Limitations were

as being therapist’s my therapist mistakes have been due to therapist’s
limitations or mistakes that was“good influential due to personal foibles-
have influenced your work enough,” therapist’s I strive to be
with patients? which is better theoretical biases, different.
than perfect. flawed techniques,
and personal
foibles.
d. (i) Do images or thoughts Yes, I think (No clear pattems- No, not while
of your therapist ever come about him or results divided.) working.
to mind while conducting her when I’m
psychotherapy? uncertain or
puzzled.
d. (ii) Do you remind Yes, with Yes, I do. (Similar Yes, in a limited
yourself of your therapist regard to to high level way.
while working? If so, how? treatment group’s responses.)
technique.
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Table 2
Perceived Benefits of Personal Theraov ComDared with Level of Influence
Level-of-influence Ranking
Perceived Benefits High Middle Low
1. a. Enhanced self- Yes, especially with Similar. Similar.

understanding and psychodynamic
self-awareness? conflicts.
b. Enhanced self Yes, professional No clear Mixed,

esteem and self- identity especially pattern. equivocal
confidence? enhanced. results.
c. Improved Mixed, because of More clearly Not clear.

interpersonal female participants’ than in high
relationships? responses. level group:
enhanced
interpersonal
relationships.
d. Enhanced Yes, very much; Similar. Similar.

therapeutic skills? changes in myself led
to changes in my
clinical work;
treatment process
and relationship
taught me a lot about
what is curative.
e. Alleviated Symptom alleviation Similar, but less Similar to

symptoms and occurred. Mixed character high level
changed character? results with modification. group.
character
modification or
resolution.
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o f influence o f personal treatment on one’s clinical work is positively associated with
risking negative emotions in the treatment relationship and with experiencing the therapist
as seriously engaging in understanding these problems as the central task o f the analytic
work at that juncture. These participants describe their former treaters as having engaged
in analyzing the impasses as manifestations of negative transference, while also seriously
considering their own relative contributions to the problems in the working relationship.
The level of influence was also associated with differing types of perceived treatment
errors, with those in the lower levels reporting relatively more errors linked to the
therapist’s personality flaws and harmful countertransference enactments. Adverse
identification with the therapist also varied with the level of perceived influence, with
those in the higher groups reporting fewer adverse identifications. These results are
displayed in Table 3.
Levels of Perceived Overall Effectiveness o f Personal Therapy
There was a positive association between level of influence and feeling understood
by the former treater. All three groups reported quite high levels of feeling understood,
but the highest level-of-influence group offered the most evidence that the treater had
communicated his or her understanding to the participant.
Findings that compared the level of influence and the participants’ perceptions of
treatment success also showed a positive association with the highest level group
experiencing their treatment as most successful. Perceived disappointments in personal
therapy were negatively associated with the level of influence and were seen as more
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Table 3
Perceived Risks of Personal Theraov Comoared with Level of Influence
Level-of-Influence Ranking
Perceived Risks High Middle Low
2. Any disappointments, Disappointments only. Disappointments, Disappointment and

risks, or negative effects? risks, and one risk; no negative effects.
reported negative
effect.
a. Excessive stress or Little excessive stress; Similar with regard Mixed; one “no,” one
psychological distress? purposeful, necessary to nonexcessive “yes.” Both: “unfinished
stress. stress; one reported termination.”
stress as excessive
and not necessary to
the process.
b. Problems with the Yes; majority had Majority: no Mixed with problems:
working relationship? problems, but worked problems; minority: one, no problems; one,
through them to a yes, problems that yes, but analyst seen as
positive identification were not worked vulnerable, so problems
with analyst as through with treater. not talked about.
professional role
model.
c. Therapist’s treatment Range of responses: More positive: only One: no, but unresolved
errors? most detrimental were said treatment errors transference love. One:
professional practice were detrimental to yes, hurtful
“errors” by three process. countertransference
respondents’ enactments.
therapists.
d. Adverse identifications Majority, no; Majority, no; Yes, to adverse

with therapist or analyst? minority, yes, with minority, yes identifications.
less spontaneity, (regarding
hiding behind neutral personality traits of
ity seen as clinical treater).
practice issues.
e. Blocked therapeutic Majority: no, it Similar. Similar.

effectiveness due to helped; minority:
concurrence? temporary
complications due
to inexperience.
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internally located by respondents in the group reporting the highest level of influence.
These findings are displayed in Table 4.
Perceived Interpersonal Relationship and Process o f Continued Psychological Involvement

with Therapist
The working through of negative emotions related to disliking the therapist, to
believing the therapist was professionally competent, and to feeling respected by the
former therapist prevailed only in the high level-of-influence groups. Participants in this
group also emphasized differences between themselves and their former treater as
obstacles to compatibility of personality styles, which were apparently overcome. Such
patterns suggest a greater awareness of, and therapeutic work focusing on, the negative
reactions in the interpersonal relationship with the treater. Interestingly, only in this high
level-of-influence group was there a universal wish to continue the therapeutic dialogue.
In contrast, the middle and low level groups lacked a sustained focus on negative
emotional experiences but had considerably more ambivalence about contacting the former
treater. Although there was little evidence that respondents engaged in an internal
dialogue while conducting psychotherapy, other forms of psychological relatedness were
reported. Having verbal memories o f the former therapist’s words was most prevalently
reported in the high level-of-influence group.
These combined results support the existence o f a positive association between the
level o f perceived influence of personal therapy for one’s clinical work and the working
through of negative interpersonal experiences in the treatment relationship, and also of a
positive association between level of influence and posttermination psychological
involvement with the former treater, as displayed in Table 5.
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T ab le 4
Perceived Overall Effectiveness of Personal Therapy Compared with Level of Influence
Level-of-influence Ranking
Perceived Overall Effectiveness_____________________________ High Middle Low
1. How well did therapist understand you and communicate

that understanding to you?
Very well. 8 4 0
Generally well, but with exceptions. 1 4 2
Not well. 0 1 0
2. How successful or satisfactory was your personal treatment?

Quite successful 8 4 1
Quite successful, with one disappointing exception. 1 4 1
Unsatisfactory. 0 1 0
Note: Numbers represent number o f respondents.
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Table 5
Perceived Internersonal RelationshiD and Posttermination Psvcholocical Involvement Comnared with Level of
Influence
Perceived Interpersonal
Relationship and
Posttermination Psychological Level-of-Influence Ranking
Involvement High Middle Low
4. (1.) Description of Majority: good match Similar. Similar.

interpersonal match or fit. throughout.
4. (2.) Mutual liking or Majority: high levels, High levels, except for one High levels.
disliking? despite negative reactions. who didn’t like therapist
If mutual disliking, this and had bad termination.
was worked through.
4. (3. a.) Therapist Lower than other groups; Yes, more so than in high Yes; yes.
professionally competent? negative transference led to level group; yes.
Therapist thought you working on it in the
professionally competent? treatment and it changed.
4. (3. b.) Compatibility of Emphasized similarities, Similar to high level, Compatible; one:
professional convictions? de-emphasized differences. emphasized similarities, but only similarities;
few said treater was mostly one: both similar
a mentor. and different.
4. (3. c.) Felt respected by Most: yes; few: this Most (8 of 9): yes. Yes.
treater? became the focus of
treatment and it changed.
4. (3. d.) Compatibility of Most (8 of 9): yes, Yes, compatible because of Yes, compatible
personality styles? compatible despite similarities; because of because of
differences. differences; despite differences.
differences.
4. (4.) Think about, wish to All: yes; significant Two: ambivalent; about Both: ambivalent;
talk with former treater? If so, majority: yes, to think half: yes, on matters of termination was
when? about personal matters and professional life; one third problematic.
to talk about professional initiated posttermination
life (most sought contact). contact.
4. (S.) Engages in internal One, yes; others: no One third: for guidance; one No internal
dialogue with treater while internal dialogue but third: no, but other dialoguing, but
conducting treatment? If so, “verbal memories” or self- connections; one third: no, identified with
when? analysis (connection to the but may have in past. treater’s active
former analyst). listening style.
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Conclusions
To conclude this report o f findings, the integrated responses o f the high level-of-
influence group are described here, as their responses most clearly illustrate the patterns of
association found between the domains. Following this overview is a description o f the
unexpected findings in the high and low level-of-influence groups.
The high level-of-influence participants were ranked as such because their replies
most definitively indicated that their personal treatment influenced their clinical work.
The members of this group believed that they work differently as a result of their personal
therapy, primarily because it deepened their convictions about the treatment relationship as
an important vehicle for psychic change and growth. They viewed their former therapist as
a very positive professional role model who made few mistakes in treatment. They also
reported having thoughts about their former treater during moments of clinical
uncertainty, unlike participants in the low or middle level-of-influence groups.
The high level-of-influence group reported benefits in all areas. These participants
differed from the others in clearly reporting enhanced self-esteem and self-confidence,
especially concerning their professional identity development. Improved interpersonal
relationships also varied in this group, with greater mutuality experienced eventually,
sometimes after a period of increased interpersonal conflict.
The high level group varied from the others on five of the six questions related to
harm from personal treatment. This group described only disappointments and no risks or
negative effects, unlike the other groups. They reported experiencing little excessive stress
from personal treatment, but unlike the other groups, when they did experience excessive
stress, they believed it was a purposeful, inherent part of the therapy process. Also
different from the other groups is that the majority of the members of the high level-of-
influence group reported problems in the working relationship with the analyst, which
were resolved well enough to allow a positive identification with the analyst as a
professional role model. They reported a range of treatment errors, which, unlike in other
groups, were not perceived as detrimental to the therapeutic process. The majority of high
level-of-influence respondents did not identify with their former treater in ways that
affected them adversely. However, the few who did report adverse identifications noted
issues related to the analyst’s practice techniques (e.g., one participant viewed himself as
being less spontaneous and as hiding behind neutrality, which his analyst had done on
occasion). In comparison, those in the other groups noted negative personality traits of
their analyst. The three groups offered essentially similar responses about minimally
blocked therapeutic effectiveness due to the concurrence of treatment and clinical work.
The high level-of-influence group reported feeling very well understood because
the therapist communicated his or her understanding well, which was a more positive
response overall than that of the other groups. Only one participant reported an exception
to feeling generally well understood, which involved wanting certain aspects of the
treatment relationship to be explored in more depth. These responses were considerably
more positive than those o f the other groups. As for perceived success and satisfaction
with personal treatment, the high level group reported a quite successful experience,
except for a participant who felt his treatment had been successful despite a disappointing
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exception, which involved his personal limitation in needing but not pursuing continued
treatment for relationship issues.
The high level-of-influence group alone reported that the focus of their therapeutic
work became the working through of negative emotions related to the therapeutic
relationship. These areas included mutual liking, working through negative transference
related to the therapist’s professional competence, and mutual respect. This group, more
so than the others, cited compatibility of personality styles despite differences. Yet, only in
the high level-of-influence group was there a universal desire to continue the therapeutic
dialogue, primarily about matters of personal life and, secondarily about professional
dilemmas. Unlike the other groups, most of the members in the high level-of-influence
group have indeed sought contact with their former treater. Although there was little
evidence supporting the presence of an internal dialogue with the former treater while
conducting psychotherapy, memories of what the former therapist said were described as
being sustaining to the participants’ clinical work. Some evidence was offered that
members of this group engaged in self-analysis, which sustained an ongoing psychological
connection to the former therapist.
Unanticipated Findings
Two unanticipated themes emerged from the data to further distinguish the high
and low level-of-influence groups’ perceptions of their personal psychotherapy
experiences. The first of these relates to the wish to be perfected by the treatment and to
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the eventual fate o f identification with the analyst in light o f the inevitable disillusionment
of this wish.
The theme of struggling to come to terms with wishes to be perfected, and with
learning tolerance of their own and others’ imperfections, was reflected in many responses
throughout the interviews. Acceptance of their own inevitable human imperfections was
viewed by numerous participants as essential to enhancing their clinical work by increasing
their compassion for their own patients’ struggles and limited ability to change. The theme
of struggling with perfectionistic strivings is particularly reflected in responses to the areas
of inquiry about benefits to self-esteem and perceived disappointments in therapy.
Several participants noted the importance of discovering in their personal
treatment that they could be themselves and yet still be a good therapist. This resolution is
evident in the experience o f the participant who observed:
‘I don’t have to be perfect to have something to contribute; I don’t have to know

everything to be helpful-that I know something and that can be found by my
patients in a way that is helpful.’. . . And that, really, it’s by our imperfections that
we’re really allowed to connect. So when ‘good enough’ is better than perfect, is
the theme that I walked away with. It’s given me permission to just be who I am
and then I feel like I can turn around and try and help patients do the same thing.
That treatment helps modify perfectionistic traits, which participants believe has
benefited their clinical work, appears to have been promoted by identification with the
former therapist’s apparent acceptance of his own fallibility. Noting her former therapist’s
human flaws, one participant observed:
Some personal things about my analyst made me realize you could be vulnerable
and be a human being and also do very good clinical work. My therapist modeled
that ‘good enough’ includes having human imperfections and misfortunes. So I ’ve
taken a self-acceptance of my humanness from my analysis.
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This acceptance o f the therapist’s fallibility by the participant may thus be promoted by the
therapist’s capacity to admit mistakes and his willingness to be corrected. This participant
claims a conscious identification with the former therapist’s admirable trait of
acknowledging fallibility. Being perceived as respecting patients by acknowledging
personal mistakes promotes a view o f the former therapist as a professional role model for
clinical effectiveness.
Closely linked with accepting human imperfection in oneself, in one’s patients, and
in one’s therapist is evidence suggesting that a modification of perfectionistic traits
extends to discovering and accepting limitations in what the process of psychotherapy or
psychoanalysis can realistically accomplish. The experiences of two participants in the high
level-of-influence group, at the time of their termination from psychoanalysis, reflect
multiple ways of grappling with accepting disappointments and limitations concerning
imperfection:
The one major disappointment in my treatment was also a benefit: I discovered

that the outcome of the analysis wasn’t going to be that I became perfect.
As termination was on the horizon, I was enormously disappointed as I realized
that my wish to be perfected by the other person was going to be disappointed and
that it really was going to be for me to continue the work, knowing that I, too,
could not perfect myself, but that I could take what was coming up, just as I had
during the analysis, and continue this lifelong process of working at finding more
satisfying solutions to my own stuff. So, on the one hand, this was a great
disappointment, but on the other hand, it was a profoundly important benefit,
because to be under the illusion that I was perfectible would, I think, carry over
into the work in the sense of expecting that I could be a perfecting agent for other
people, or that it would be up to me to make them perfect, or that their having
more limited results than their wishful goals was not something I had to berate
myself for.
The benefits of accepting imperfection as part of termination is also reflected in the
comments of another participant:
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One of the things we worked on in termination was the idea that I had to stay in
therapy until my life was perfect and then I would know I was really ready to
terminate. I think part of that was just accepting that chances are pretty good my
life is never gonna be perfect, that there were going to continue to be times, even a
lot of the time, major problems, major worries-that analysis can’t fix everything in
your life. There was a bit of disappointment with that, although I think it was also
therapeutic to realize that. It kind of lifts a burden from you to realize that you
don’t have to be perfect and your life doesn’t have to be perfect.
These results suggest that participants whose struggles with perfectionistic wishes
became a meaningful part of their therapeutic work did experience some useful changes in
their perceptions of self and others related to a greater acceptance o f limitations. There is
evidence in their remarks that, with treatment, acknowledging the limitations of self and
others has become less equated with narcissistic injury. This process seemed to unfold
with the inevitable disappointment in being perfected by the analysis leading the participant
to identify with the therapist’s apparent self-acceptance of his own humanness. By
implication, being able to embrace as “good enough” the imperfectibility o f oneself and
others, and the limitations imposed by an imperfect world, was essential to a readiness to
terminate from the treatment process for these individuals, the majority of whom were
ranked as members of the high level-of-influence group.
This acceptance of imperfection leads to the second unanticipated theme in the
study findings, which appears also to vary with the level of perceived influence of personal
therapy on one’s clinical work. The termination process, per se, was not specifically
inquired about in the interviews. However, the importance of the termination phase of
personal treatment was spontaneously mentioned by numerous participants. Surprisingly,
to the open-ended question about perceived risks o f personal therapy, four participants
offered that they had been cognizant from the beginning of the inherent risk of not being
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able to complete treatment, due to the possibility of a premature ending, related to either
their own or their therapist’s career move.
Participants noted the benefits of a good termination and the complications left by
an inadequate termination. Four respondents raised issues related to termination when
asked about any other benefits o f their personal treatment that had not been addressed. In
their responses, the perceived completeness of termination was associated with a clear
termination phase, versus an arbitrary, incomplete ending, where the patient was left
wondering, “Am I done, yet?” A lack of clear feedback from the therapist on the
participant’s readiness to end was apparent in the responses of two participants. However,
disappointments in oneself also contributed to perceived problems with termination. Three
participants (one from each level of influence) felt unfinished, because o f not being able to
go into more depth in their therapeutic work. Each reported that resistance or inability to
deepen the work frustrated and disappointed them.
That an adequate termination phase of treatment can promote autonomy and
mutual respect was attested to by one participant, in describing her termination:
I remember the termination stage to be a very rich time in the treatment. And my
saying how important it was that I terminate with some dignity, that I not throw
myself around his ankles and clutch and say, ‘I’m not going! I ’m not!’ And he kind
of chuckled and he did nothing to provoke any sob scenes. He gave me every
opportunity I wanted to say positive and negative things, but had no need to
reduce me to tears about what a horrible loss it was going to be and allowed me to
leave with a lot o f dignity and it felt very good. And I think he probably also had
some sad feelings around the termination.
There is evidence that how the termination was experienced contributes to
identifying with the former treater as a professional role model. One participant noted his
disappointment in the lack of a structured termination phase, which left him feeling that
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the treatment was incomplete. This same participant described his analyst as evidencing
personal struggles with separation and loss, in not wanting the participant to end the
treatment, which complicated the termination process. He reported that he and his
therapist “fought this through” to the point that the analyst eventually apologized for his
countertransference enactment, thus restoring the analytic focus on understanding the
participant’s decision to terminate. The analyst’s acknowledgment contributed to the
participant’s ultimately respecting his analyst, despite moments of disliking him and being
very angry during the termination process. This participant noted his identification with
the analyst’s eventual acknowledgment of his countertransference-induced error, which
makes him consciously strive to model the same courage with his own patients.
Another participant, a member of the high level-of-influence group, described how
the termination process in her personal therapy informs her clinical work. She observed
that while she didn’t consider it a real treatment error, her analyst’s moving away from
neutrality at termination did not enhance the power of the analytic work. She believed that
her former analyst’s fondness for her prompted his slight departure from neutrality when
he gave her a few professional articles to read. Her advice to analysts is, “Adhere to
neutrality to the end, because the analysis is enough.”
Finally, several respondents spontaneously referred to their termination process in
describing posttermination psychological involvement with their former therapist. Of the
only four participants in the study who reported ambivalence in thinking about or wishing
to talk with their therapist (both low level participants and two from the middle level), all
of them connected that ambivalence to problems with termination. Two of these four
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participants described a premature termination, one due to his career move, which he felt
precluded his adequately resolving an erotic transference to his female analyst. The other
participant reported a premature termination due to his analyst’s making a career move.
The other two participants who reported ambivalence in thinking about or wishing
to talk with their former therapist, described the analyst as being forced out o f the
psychoanalytic institute, due to either a severe health impairment or an alleged sexual
boundary violation. These unfortunate departures occurred after the two participants had
terminated, yet their disappointment and anger was evident during the interview and was
directed at both the former analyst and at the psychoanalytic institute. Both described
feeling conflicted loyalty toward their former treater, as well as a sense of betrayal by the
analyst’s vulnerability. Neither had initiated postanalytic contact with their former analyst
and both appeared to struggle to maintain a positive image of the former analyst, who had
been censured by the local psychoanalytic community. However, both participants
hastened to add that these unfortunate events did not undo their therapeutic work with
the analyst.
In summary, these findings support the significance of the termination process as
influencing participants’ overall perceptions of their personal therapy experience.
A number of participants were aware, at the outset of treatment, o f the importance of
having a “completed” treatment. The study findings suggest that a “complete” termination
process was associated with a distinct phase of the treatment, in which issues related to
loss and change were central to the therapeutic dialogue. There is some evidence from
these findings that getting sufficient feedback from the therapist about the participant’s
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progress and readiness to end is associated with a “complete” ending. There is evidence
that termination poses particular risks for both the participant and the therapist to enact
their personal struggles with separation and loss. One participant each in the middle and
high level-of-influence groups described the analyst’s extraordinary behavior at
termination as being related to countertransference vulnerability to loss. Confronting and
working through these struggles led one participant to respect and identify with his former
analyst’s assumption of responsibility for countertransference errors. Premature
termination from treatment was associated with posttermination ambivalence in thinking
about or wanting to contact the former therapist to continue the therapeutic dialogue.
There is evidence that, even after termination, negative events in the former analyst’s life
have significant meaning for participants’ perceptions of their earlier analytic work with
the former treater.
Variables Related to Personal Treatment History
Concluding this presentation of findings are data about certain variables of the
study sample, which prior published studies have identified as having an impact on
therapists’ use o f personal therapy. These variables include: (1) choice or assignment of
therapist; (2) the match between gender and professional affiliation o f participants and
their former therapist; (3) the participants’ average weekly hours currently engaged in
providing individual psychotherapy to others; (4) their years of postgraduate clinical
experience; (5) the extent o f personal treatment; and (6) time since termination from
personal therapy. These variables are presented according to the perceived level-of-
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influence group into which each participant was ranked (see Tables 6-8). They were
compared with the perceived level-of-influence of personal therapy on the participants’
clinical work, in keeping with the overall data analysis plan of looking for patterns of
association between perceived level-of-influence of personal therapy on clinical work and
other variables.
Choice of Therapist: Gender and Professional Affiliation
As noted in this study’s review of relevant prior literature, several studies have
demonstrated the importance of demographic matching between therapist-patients and
their chosen therapists (Kaslow & Friedman, 1984; Norcross et al., 1988a). Pertinent
factors include theoretical orientation, professional affiliation, and gender and ethnicity.
The theoretical orientation of this study sample and that of their psychotherapist is highly
matched in that all the participants identified themselves as either psychoanalysts or
psychoanalytically oriented psychotherapists and sought a therapist with the same
orientation. This finding mirrors those of Grunebaum (1983), in which the
psychotherapist’s orientation was predictably related to his or her psychotherapist’s
orientation, and of Norcross (1990), whose study of therapist choice showed that the
majority of therapists of any theoretical orientation undertook personal treatment with
psychoanalytic or psychodynamic psychotherapists.
Regarding professional affiliation, prior studies show that psychotherapists seek
treatment from psychiatrists, then psychologists, social workers, counselors, and lay
analysts, in that 'order. There are definite preferences on the basis of professional
discipline, however. Norcross (1990) found that psychologists sought treatment equally
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from other psychologists or from psychiatrists, while psychiatrists routinely sought out
other psychiatrists. Social workers were the only discipline more likely to enter treatment
with a therapist of a different discipline. The present study’s findings reflect this pattern, in
that seven o f the eight psychiatrists were treated by other psychiatrists, whereas the
psychologists were treated by either another psychologist or a psychiatrist, as were the
social workers (see Table 6).
Table 6
Gender and Professional Affiliation of Participant and Treating Therapist and Choice
or Assienment o f Therapist Presented bv Level of Perceived Influence
Participant // Therapist: Choice or Assigned High Middle Low
male MD // male MD : assigned 2 3 1

female MD // male MD : chosen 1
female MD // male PhD : chosen 1
male PhD // male PhD : assigned 1
male PhD // female PhD : assigned 1
male PhD // female MD : assigned 1
female PhD // female MD : assigned 1
female PhD // male MD : chosen 1
female PhD // male MD : assigned 1
male MSW // male MD : chosen 1
male MSW // male MD : assigned 1
female MSW // male PhD : chosen 2
female MSW // male MD : chosen 1
female MSW // male MD : assigned 1
Total 9 9 2
Demographic factors, such as gender and racial heritage of the chosen
psychotherapist, also exert a strong influence on therapist selection. Norcross (1988)
noted the ubiquitous practice of therapist-patient demographic matching on these variables
and provided evidence of an increasing tendency for mental health professionals to be
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treated by members of their own gender and professional discipline. Taken altogether,
these findings offer evidence that psychodynamic psychotherapists prefer a personal
therapist who is similar in regard to theoretical orientation, professional affiliation, gender,
and ethnicity.
However, a factor affecting therapist choice that may well override these apparent
patterns is that this study sample was obtained in a small psychoanalytic community,
where 17 of the 20 participants have engaged in at least one psychoanalysis, a pattern that
is changing only recently. When these participants sought treatment, the predominant
providers o f psychoanalysis were white, male psychiatrists. Thirteen o f the 20 participants
in the study sample did not choose their therapist, but rather were assigned one, which is
standard for therapists seeking psychoanalysis or psychoanalytic psychotherapy through a
psychoanalytic training institute or clinic. The other seven of the 20 chose their most
recent therapist. Given these special parameters on therapist choice, the participant-
therapist matches regarding professional affiliation cannot be compared fairly with prior
studies.
In light o f this “matchmaking” function of the psychoanalytic institute, which
assigned the therapist for the majority of the study sample, how did the participants’
“arranged marriages” compare, regarding similarity or difference of gender and
professional affiliation with their level of perceived influence of personal therapy on
clinical work? Did those participants who chose their treater choose therapists o f the same
gender and professional affiliation and did they perceive a higher level of influence of
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personal therapy on their clinical work than did those participants who were assigned a
therapist?
Taking this second question first, four of the seven participants who chose their
most recent treater were social workers, one was a psychologist, and two were
psychiatrists. Only one o f the seven chose a treater o f the same professional affiliation.
Six o f the seven were female participants who chose a male treater and the seventh was
a male participant who chose a male treater. Five of the seven had engaged in a
psychoanalysis. Three of the seven, all of whom had engaged in psychoanalysis, ranked in
the high level of influence of personal therapy on clinical work. The other four
participants, two o f whom had engaged in psychotherapy and two in psychoanalysis,
ranked in the middle level of influence. These results support the prior findings that social
workers, more than those in other mental health professions, seek treatment outside their
own professional affiliation. However, the findings do not support the idea that
psychotherapists seek treaters of a similar gender or professional affiliation. Nor is there
evidence from this finding that choosing one’s treater is associated with a higher level of
perceived influence of personal therapy on one’s clinical work.
Similarity or difference of gender and professional affiliation with one’s therapist
was then compared with the levels of perceived influence o f personal therapy on one’s
clinical work for the 13 study participants who were assigned their therapist. Three
participants in both the high and middle level-of-influence groups were assigned therapists
of both the same gender and professional affiliation, as was one of the two participants in
the low level-of-influence group. At the other extreme, two participants in the high level-
of-influence group, one participant in the middle level-of-influence and none in the low
level were assigned therapists of both a different gender and professional affiliation. Given
this variability, the patterns do not support an association between the level of perceived
influence of personal therapy on clinical work and similarity o f gender and professional
affiliation with one’s therapist. It would thus appear that factors other than gender and
professional similarity or difference between participants and their treater are at work in
determining the level o f perceived influence of personal therapy on one’s clinical work,
regardless of whether the participant chose his or her treater.
Professional Affiliation and Level of Perceived Influence of Personal Therapy
Prior studies indicate that psychotherapists trained in the three professional
disciplines of psychiatry, psychology, and social work similarly value personal
psychotherapy. When clinical hours engaged in conducting individual psychotherapy are
comparable, there is no evidence that therapists vary by discipline in their valuing of
personal therapy (Deutsch, 1985). Findings in the current study support this view, given
the roughly similar patterns of the perceived influence of personal therapy on clinical work
by the participating social workers, psychologists, and psychiatrists (see Table 7). About
half the respondents from each discipline were ranked in the high and half in the middle
level-of-influence groups. One psychologist and one psychiatrist were ranked at the low
level of influence.
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Table 7
Professional Affiliation and Level of Perceived Influence
Professional Level-of-influence Ranking
Affiliation High Middle Low Total
MSW 2 4 0 6
PhD 3 2 1 6
MD 4 3 1 8
Total 9 9 2 20
Number o f Hours Conducting Psychotherapy and Level of Perceived Influence o f Personal

Therapy
Prior studies show that the amount of personal therapy received by clinicians after
entering the profession is influenced by the number of hours of individual psychotherapy
that they themselves conduct weekly. Those who tend to provide the greatest amount of
individual therapy for their clients also receive the greatest amount of individual treatment
for themselves (Guy, Stark & Poelstra, 1988). The results of the current study confirm this
relationship (see Table 8 for details on the participants who currently conduct more
individual psychotherapy and have also received more personal treatment).
In addition, it is noteworthy that both the average number of hours spent treating
individuals and the average hours of personal therapy received are highest in the high
level-of-perceived influence group (22 hours per week, and 1,537 hours, respectively).
The average number of hours currently providing individual treatment and the average
number of hours of personal treatment received is substantially lower in the low level-of-
influence group (12.5 hours per week and 800 hours, respectively). These results suggest
an association between the number of hours spent conducting individual psychotherapy,
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the amount of personal treatment received, and the perceived level of influence of personal
therapy on clinical work (see Table 8).
Amount of Personal Treatment Received and Level of Perceived Influence
Participants in this study averaged 2.1 discrete treatment episodes. This finding
closely mirrors Norcross’ (1990) national sample of 500-plus psychotherapists from the
professions of social work, psychiatry, and psychology, whose average number of discrete
treatment episodes was 2.3. In the current study, the average number of discrete treatment
episodes in the high level-of-influence group, at 2.4, is more than twice that of the low
level-of-influence group average of 1 discrete treatment episode. These results suggest an
association between the number of discrete treatment episodes and the level of perceived
influence of personal treatment in conducting psychotherapy (see Table 8).
Amount of Personal Therapy Received. Average Years Postgraduate Clinical Experience,

and Level of Perceived Influence
Prior findings note a positive correlation between discrete treatment episodes and
time in professional practice, indicating that psychotherapists tend to seek personal
therapy throughout the course of their clinical work (Norcross, 1990; Prochaska &
Norcross, 1983). The current study results support this finding as well. Prior findings also
indicate that the number o f hours of personal therapy is positively correlated with the
therapist’s number o f years of postgraduate clinical experience, which indicates that
therapists continue to use personal therapy during the course of their career (Norcross,
Strausser-Kirtland & Missar, 1988; Prochaska & Norcross, 1983). Findings in the current
study reveal a similar general trend, with participants who reported more hours of
personal treatment also having more years o f clinical practice experience. However, this
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trend is not absolutely associated, because participants in the high level-of-influence group
averaged 547 more hours of personal treatment than their middle level-of-influence
counterparts, yet 2.6 years’ less practice experience.
In the current study, both the average number of discrete treatments and the
average number o f years in postgraduate psychotherapy practice were substantially higher
in the high level (2.4 episodes and 20.8 years), compared with the low level-of-influence
group (1 episode and 13 years), as displayed in Table 8.
Time Posttermination from Personal Therapy and Level of Perceived Influence
The average number of years posttermination was lower in the high level-of-
influence group (9.4 years) than in either the middle or low level-of-influence groups
(11.7 and 11.5 years, respectively), as shown in Table 8. Over half the participants in the
high level group had terminated from their most recent treatment five to 10 years prior to
the interview, a time which is crucial to the internalization of the therapeutic work,
according to studies by Kantrowitz et al. (1990). The potential implications of this finding
are further discussed in the discussion section of this study.
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Table 8
Variables Related to Time Conducting PsvchotheraDv. Time Receiving PsvchotheraDv. Years o f
Postgraduate ExDerience and Time Posttermination. Compared with Levels o f Perceived Influence o f
Personal Treatment on Clinical Work
Psychotherapy Variables High Middle Low
n=9 n=9 n=2 (Mean) (S.D.)
Average Hours Conducting 22 hrs. 19.1 hrs. 12.5 hrs. 20 hrs. (4.39)
Psychotherapy / week.
Time in Personal Treatment

Average Hours o f Psychotherapy 1,537 hrs. * 990 hrs. 800 hrs. 1,145 hrs. (325)
Average Number Discrete Treatment 2.4 2.1 1 21 (0.66)
Episodes
Average Years Postgraduate Experience 20.8 yrs. 23.4 yrs. 13 yrs. 20.7 yrs. (4.90)
Average Years Posttermination from 9.4 yrs. 11.7 yrs. 11.5 yrs. 10.6 yrs. (1.07)
Personal Treatment
* Includes average hours o f treatment f o r 8 o f 9 participants in high level-of-influence group. Only one
p a rticipan t in the entire study had engaged in less than 400 treatment hours. This individual reported
100 treatment hours and w as ranked in the high level-of-influence group. This outlier was not included
in calculating the group mean or the overall mean.
Ch a pter V
D is c u ss io n
Distillation o f Major Findings
1. Participants perceiving the highest level o f influence of personal therapy on
their conduct o f psychotherapy most clearly reported that their treatment relationship
promoted psychological change. They also most clearly valued their former therapist as a
professional role model and thought about the former treater during moments o f clinical
uncertainty with their own patients.
2. Participants reporting the highest level o f influence o f personal therapy on their
clinical work most clearly described enhancement o f their professional identity and
improved interpersonal relationships consequent to personal treatment.
3. Participants reporting the highest level o f influence o f personal therapy on their
clinical work reported the lowest level of harmful effects from their treatment. However,
psychological stress was seen as a purposeful, inherent part of the treatment process in this
group only.
4. Problems with the working relationship became the central focus of the
treatment in the high level-of-influence group only. The working through of negative
aspects o f both the transference and the real relationship apparently contributes to a
positive identification with the former therapist as a professional role model. Those
reporting the highest level o f influence most clearly wished to continue the therapeutic
dialogue with the treater and most frequently sought contact with their former treater.
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259
5. Acceptance of personal imperfectibility is seen by participants as a benefit of
personal therapy that enhances their clinical work by increasing empathy for the difficulty
o f change, both for themselves and for their patients. The modification of perfectionistic
traits is apparently promoted by identifying with the former therapist’s acceptance of
personal fallibility. The former therapist’s capacity to admit mistakes and to be corrected is
associated with the participant identifying with the therapist’s respectful treatment of
patients and to self-acceptance as a model of clinical effectiveness.
6. Getting sufficient feedback from the therapist about the participant’s progress
and readiness to end treatment contributes to a satisfactory termination. Experiencing a
satisfactory termination is associated with the participant’s identifying with the former
treater as a professional role model. “Good enough” terminations promote the
internalization o f the therapeutic relationship through attempts to keep the therapeutic
dialogue going internally, whereas unresolved treatment relationship problems during
termination contribute to ambivalence about continuing the therapeutic dialogue.
Summary of Findings
The high level-of-influence group developed a positive identification with the
analyst as a professional role model. Those reporting the most influence also believe their
personal therapy most benefited their self-confidence and self-esteem.
Perhaps most striking in the findings was the prevalence of problems in the
working relationship with the analyst reported by members of the high level-of-influence
group. However, only in the high level-of-influence group did treatment relationship
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problems become the primary focus of the treatment and were reportedly worked through.
This apparently resulted in a positive identification with the former treater as someone
who was authentic and able to sustain a treatment relationship through tumultuous times
related to the patient’s need to express and work through negative transference
manifestations. This process appeared to result in participants identifying with their former
therapist’s integrity in acknowledging personal human foibles or subjectivity, while
continuing the analytic work of helping the patient to better understand herself or himself
in the context o f the co-created treatment relationship.
Treatment errors were seen as not detrimental to the therapeutic process only in
the high level-of-influence group. Fewer adverse identifications with the former analyst
were noted by those reporting the highest level of influence. The adverse identifications
with the former treater which were reported by the high level-of-influence group involved
unhelpful practice techniques, while those participants in the lower levels o f influence
described more negative personality traits of their former treater.
The level o f influence of personal therapy on conducting psychotherapy was
positively associated with feeling well understood by the former therapist and with
perceived success of, and satisfaction with, personal treatment.
Treatment relationship variables included mutual liking and respect and working
through the negative transference. Level o f influence was positively associated with a
compatibility of personality styles, despite differences with the treater. This suggests that
treatment promoted greater differentiation of self and object as a prelude to more mature
internal object representations.
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Level o f influence was strongly associated with a desire to continue the therapeutic
dialogue and with having sought posttermination contact with the former therapist. Little
evidence supported the presence of participants engaging in an internal dialogue with their
former treater while conducting psychotherapy. However, remembering their therapist’s
words at other times was experienced as sustaining to clinical work. Exploring the extent
of engagement in self-analysis was not a major focus of the study. However, there is some
evidence that self-analysis sustains an ongoing psychological connection to the former
therapist and thus may be associated positively with the level of perceived influence of
personal treatment in conducting psychotherapy. These findings indicate that the
participants believe in the growth-promoting value of ongoing continued psychological
work as represented by their personal treatment relationship.
Unanticipated Findings
A summary o f the two unanticipated findings notes that acceptance of one’s
personal imperfectibility was viewed as enhancing clinical work by increasing the
participants’ compassion for the struggles and limitations of change for both themselves
and their patients. That treatment helps modify perfectionistic traits, which participants
believe has benefited their clinical work, appears to have been promoted by identification
with the former therapist’s acceptance of fallibility. This more realistic and tolerant
experience o f the self appears to be promoted in the treatment by the therapist’s capacity
to admit mistakes and his or her willingness to be corrected by the patient. This, then,
leads the participant to identify with his former treater’s respectful treatment o f patients
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and promotes an identification with self-acceptance as a model o f clinical effectiveness.
Discovering and accepting limitations in what the process of psychotherapy or
psychoanalysis can realistically accomplish is closely linked with the acceptance of
personal imperfectibility. The findings also suggest that tolerance of the imperfection in
self and others and an acceptance of limitations in the psychotherapy process itself may be
associated with termination-readiness.
The second unanticipated discovery was that the termination process was
spontaneously mentioned as influencing the participants’ ongoing perceptions about their
personal therapy. Experiencing a “complete” termination was associated with having a
distinct termination phase o f the treatment that focused on separation, loss, and change.
Results suggest that how termination was experienced contributes to identification with
the treater as a professional role model. The findings suggest that unresolved problems
during termination are associated with conflictual internalizations of the treatment
relationship, as evidenced by ambivalence about continuing the therapeutic dialogue.
Getting sufficient feedback from the therapist about the participant’s progress and
readiness to end appears to be associated with a “good enough” ending. Termination is
viewed as a high-risk time for both members of the dyad to enact their personal struggles
with separation and loss. “Good enough” terminations tended to involve an authentic
engagement by both participants around the analytic material that arose. Unsatisfactory
terminations were associated with posttermination ambivalence about the interpersonal
relationship with the former therapist. Satisfactory terminations may promote the
internalization o f the therapy relationship through attempts to keep the therapeutic
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dialogue going inside oneself. Posttermination negative events in the former analyst’s life
appeared to contribute to participants’ ambivalent or conflictual identifications.
In an effort to contextualize the findings, certain variables were compared that
relate to the personal treatment history of the participants. A summary o f these findings
follows.
Personal Treatment History Variables
Choice o f Therapist: Gender and Professional Affiliation
The theoretical orientation of the study sample and that of their psychotherapist
was highly matched, with all participants identifying themselves as psychoanalytically
oriented and as having sought a therapist with this same orientation. However, there was
no overall evidence supporting the idea that psychotherapists seek treaters o f a similar
gender or professional affiliation. Nor was evidence found that choosing rather than being
assigned one’s treater was associated with a higher level of perceived influence of personal
therapy on one’s clinical work.
Professional Affiliation of Participants and Level of Perceived Influence of Personal

Therapy
Findings in the current study support those from the literature (Norcross et al.,
1988) indicating that psychotherapists trained in the three professional disciplines of
psychiatry, psychology, and social work find personal psychotherapy to be useful to their
clinical work.
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Number of Hours Conducting Psychotherapy and Level of Perceived Influence of Personal

Therapy
Results of this study suggest an association between the number of hours spent
conducting individual psychotherapy, the amount o f personal treatment received, and the
perceived level of influence o f personal therapy on clinical work. Those who conduct the
most individual psychotherapy have received the most treatment and are also rated in the
highest level group o f perceived influence.
Amount of Personal Treatment Received and Level of Perceived Influence
Participants in the current study averaged 2.1 discrete treatment episodes,
commensurate with averages reported in the literature (Norcross, 1990). Participants who
rated in the highest level o f influence had sought an average of 2.4 discrete treatments,
compared with an average of only one treatment episode in the low level-of-influence
group These findings raise several possible questions: Are some individuals more prone to
need and therefore to repeatedly seeking an “influential” relationship with a
psychotherapist? If disappointed in an initial treatment process, are some therapist-patients
more likely than others to turn away from seeking subsequent treatment and instead to
seek other sources of growth in professional role identification? Findings in this study
offer inconclusive evidence, one way or the other. Overall, the results suggest an
association between the number of discrete treatment episodes and the level o f perceived
influence of personal treatment in conducting psychotherapy.
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Amount of Personal Therapy Received. Average Years Postgraduate Clinical Experience,

and Level of Perceived Influence
In this study, both the average number of discrete treatments and the average
number of years of postgraduate psychotherapy practice were substantially higher in the
high level (2.4 episodes and 20.8 years), compared with those in the low level (1 episode
and 13 years). Given the very small number of participants in the low level-of-influence
group, these findings are difficult to interpret. Future studies might focus on the
experiences o f this group, sampling a larger number of participants who report a perceived
low level of influence of their personal therapy on their clinical work.
Time Posttermination from Personal Therapy and Level of Perceived Influence
Over half the participants in the high level group had terminated from their most
recent treatment between 5 and 10 years prior to the interview, a time that has been found
to be crucial to the internalization of the therapeutic work (Kantrowitz, 1990). There is no
evidence from this study that the level of perceived influence progressively decreases with
continued time, posttermination. It is noteworthy that half the participants in the study had
terminated within this 5-to 10-year period, which Buckley et al. (1981) identified as an
important time because thoughts about the former therapist reach a peak. Of these 10
participants, six were members of the high level-of-influence group and one was a member
o f the low level group. With a sample of 20 participants, it is not possible to know if this
variation occurs merely by chance, or whether during the 5-to 10-year posttermination
phase, there is some particular psychological work of internalizing the former therapy
relationship that contributes to perceptions of higher levels of perceived influence o f
personal therapy on clinical work.
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Implications o f the Findings
From conducting an in-depth review of the literature and undertaking a pilot study,
the investigator discerned a configuration of model elements that have been influential in
the personal psychotherapy of psychotherapists. These elements included themes related
to benefits, risks, influence on professional conduct, and aspects of the posttermination
relationship with the former therapist. As a result, the research project initially sought to
advance an understanding of the following questions:
1. Will particular themes of benefits and risks be associated with particular
reported uses of an individual’s personal therapy to inform clinical work?
2. Will therapists who report more particular benefits then specific risks in their
personal therapy also report more specific influences of their personal therapy on their
conduct o f psychotherapy than therapists who report fewer specific benefits than specific
risks in their personal therapy?
3. Will therapists who report higher perceived overall effectiveness of their
personal therapy report different influences of their personal therapy on their conduct of
psychotherapy than therapists reporting less perceived overall effectiveness of their
personal therapy?
4. Will therapists who report having experienced an interpersonally highly
significant relationship with their own therapist report more particular benefits, fewer
risks, and more specific examples of consciously drawing on their personal therapy
267
experience in the conduct o f their own work, compared with those who report an
interpersonally less significant relationship?
5. Will therapists who report continued posttermination psychological
involvement with their therapist report more particular benefits, yet also more risks, and
more specific evidence of consciously drawing on their personal therapy experience in the
conduct of their work than those who do not report continued posttermination
psychological involvement?
Having completed the study, it became clear that several of these questions would
be more relevant if altered. These changes are reflected at the conclusion o f Chapter II.
Following is a discussion of how the findings suggest a reconfiguration of the model
elements that are influential in the personal therapy of psychotherapists.
The first question was changed from looking only for benefits and risks o f personal
therapy to adding the relationship variables as another domain for comparing associated
themes. This change was made to clarify the relevance of influence on clinical work to the
research goals. Since the unfolding data revealed a rankable set of responses in the
influence on clinical work, it became possible to compare the associated variability of
themes within each of the other domains in the model. The complex answers to this first
question are presented in the third phase of the data analysis and have been discussed
earlier in this chapter.
The second proposal question was reworded slightly in the final study, but
remained essentially intact as a query into the relative quantity of the benefits and risks
compared with influence on clinical work. After conducting the literature review and pilot
268
study, the investigator surmised that therapists reporting relatively more benefits and
fewer risks would view their personal therapy as exerting more influence on their clinical
work.
Results of the completed study suggest that, rather than quantity or amount of
benefits and risks associated with level of influence, instead particular themes of benefits
and risks support an association with the perceived level of influence of personal therapy
on clinical work. As indicated in the findings, all participants experienced similar
improvements in self-understanding, enhanced therapeutic skills, and symptom alleviation.
What varies by level o f influence is the extent to which the participants’ professional
identity was enhanced by the treatment relationship. This factor related to self-esteem and
self-confidence. There was also variability in improved interpersonal relationships between
the high, middle, and low level-of-influence groups, although clear patterns are less easy
to identify.
Rather than sheer number of benefits, specific benefits related to self-esteem and
interpersonal relatedness appear to be associated with influence o f personal therapy on
clinical work. This finding was also discovered with regard to risks o f personal therapy
and their association with level of influence of personal therapy on clinical work.
In summary, only disappointments, rather than risks or negative effects, were
associated with higher levels o f influence, and psychological stress was viewed as
“meaningful or purposeful,” consequent to being in treatment. Problems in the working
relationship were the most prevalently identified and reported as “worked through” by the
high level-of-influence group. Differences in perceptions about treatment errors exist but
269
do not suggest clear patterns of variation. Adverse identifications with the former treater
prevailed more in the lower level-of-influence groups, which suggests that psychological
growth was experienced by confronting and working through negative emotion associated
with the treatment relationship, rather than through an absence of risks. This working
through o f negative emotion about the treatment relationship was described most
prevalently by the high level-of-influence group.
The third research question involved comparing the perceived overall effectiveness
o f personal therapy with the level of its influence on clinical work. The wording was
changed from seeking to identify specific influences to identifying levels of influence,
which better reflected the unfolding data. The results show that the high level-of-influence
group members felt best understood by their former treater and, as a group, were most
satisfied with their personal treatment. However, to contextualize these findings, it is
important to note the generally positive responses of 19 of the 20 participants in the study.
For example, the various categories discovered in the therapist understanding question
included: “very well,” “generally well, but with exceptions,” and “not well.” Only one
person, ranked in the middle level-of-influence group, believed that his analyst did not
understand him well. The responses to the success or satisfaction question reflect this
same pattern, with the choices being: “quite successful,” “quite successful, with one
disappointing exception,” or “unsatisfactory.” Only one participant, again in the middle
level-of-influence group, was left with a perception that his analysis was unsatisfactory.
Although twice as many of the high level-of-influence group respondents replied in the
most positive categories as did the middle level group, the overall findings for the entire
cohort are quite positive regarding overall effectiveness of personal therapy. It may well
be that those who practice psychoanalytically oriented psychotherapy are a self-selected
group who not only value self-awareness and self-reflection, but also are insight-oriented,
thus predisposing them favorably toward utilizing the very services that they themselves
offer.
Possible speculations for this degree of overall positiveness regarding the
effectiveness of personal therapy include a professional “blind spot” in an inherent bias of
psychotherapists toward overvaluing psychotherapy as personally enriching, given the
many years o f professional training and practice of this very activity to which they have
dedicated themselves.
Another possibility for this high degree of belief in their personal psychotherapy’s
effectiveness relates to the self-selection of the participants. There is no way to know
whether the 29 therapists who declined to participate in the study were significantly
different in their view of whether a personal psychotherapy was effective, compared to
those who agreed to participant. Two of them wrote back, declining participation because
o f their collegial relationship with the researcher’s dissertation advisor. However, it is
possible that some who declined to participate did not place the same value in their
personal treatment and hence lacked sufficient incentive to be interviewed. It is also
possible that those not wishing to participate found the nature of the questions to be too
personal. Given the small mental health community from which the pool o f participants
was drawn, resulting in a relative lack o f anonymity with the interviewer, it is quite
possible that those agreeing to participate might have felt less self-conscious about
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discussing their personal treatment because they had experienced largely positive
experiences in personal psychotherapy. Thus accessing the “negative case” was perhaps
less likely under such conditions.
By asking many of the participants why they agreed to participate in the study, the
investigator learned that there is apparently a need in some to tell one’s analytic stoiy,
perhaps as a way to continue the therapeutic dialogue with one’s former treater.
Numerous participants noted their enjoyment of the interview experience, citing the
interview as a reconnection with their personal treatment. Several participants noted the
paradox o f their therapy feeling at once both a highly personal and solitary odyssey-
undertaken alone, yet with the help of their analyst-but also a practically universal
experience for psychoanalytically trained treaters. They noted that the interview offered a
generally pleasurable opportunity to partially reexperience the feeling tone of their
treatment. Also, by examining the meaning of their experience through telling their story,
several participants reported “updating” their synthesis of the influence o f personal
treatment on both their personal and professional identity. Several noted that this
reaffirmation was safely done within the context of helping a colleague conduct research
on a topic of mutual interest.
The researcher did occasionally observe “Pfeffer’s phenomenon” (1963), in which
the participants related to the interview process and to the interviewer as though back in
analysis. However, since the method of data collection called for a single, semistructured
interview, this phenomena was less pronounced than in studies in which a number of less
272
structured interviews were conducted, over time, thus more closely paralleling the actual
analytic situation (Kantrowitz, 1990; Shapiro, 1976).
In summary, in order to further understand overall effectiveness and subsequent
professional influence of personal therapy, it would be important to seek responses from
individuals who report less effectiveness of their personal therapy.
The fourth research question asked whether there is an association between
perceptions of the significance of the interpersonal relationship with the treater and the
other three domains o f the study-perceived benefits, perceived risks, and influence on
professional conduct. This question was changed slightly from the proposal question,
which sought specific examples of the participants’ reporting that consciously drew on
their personal treatment to inform their clinical work. Such discrete examples were quite
rare in the data, as respondents tended to experience the influence of their personal
therapy as integrated into their identity as a psychotherapist.
The decision to focus the data analysis on comparing levels of professional
influence with the other domains was also supported by examining the variability of
themes identified in the interpersonal relationship domain. Variations in subthemes of
responses were often quite subtle and would render less reportable data if the
interpersonal relationship questions were compared with the other domains. For example,
only one participant in the study ended treatment feeling that the interpersonal match with
his treater had not been good. The others either consistently, or over the course of
treatment developed a reportedly good match with their former treater. In addition, all
participants noted that they had felt liked by their former therapist by the end of treatment,
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and only one participant reported not liking his former therapist, when treatment ended.
All the respondents felt respected by their former therapist but only three participants
noted that their former treater might not have felt respected by them. Given this shift in
the data analysis plan, the fourth question, which examined associations between
perceptions of the significance of the interpersonal relationship with the former treater and
the three other domains of the model, was not ultimately pursued.
Reconfiguration of the model based on the current study findings suggests that
developing questions about the perceived interpersonal match with the treater might better
explore Kantrowitz’ findings (1990) about the interdigitation of the personal
characteristics o f the analyst with the particular difficulties and characteristics of the
patient as a crucial factor in determining a facilitating or an impeding match. The current
study found generally positive perceptions of match, based on factors o f mutual liking,
perceived professional competence, perceived professional convictions, mutual respect,
and perceived compatibility of personality styles. However, questions were not asked that
might better have explored aspects of whether there existed an impeding or facilitating
match, (e.g., whether the analyst was perceived as confronting or avoiding the negative
transference) as described by Kantrowitz (1990). The overall findings of the perceived
risks section in this study did support this aspect of Kantrowitz’ findings. However,
incorporating specific questions about how impeding or facilitating the match was, from
the former patient’s perspective could likely enhance the development o f a more accurate
model of character match in the domain o f the interpersonal relationship between
therapist-patients and their former treaters.
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The fifth research question concerned the relationship between continued
posttermination psychological involvement with the therapist and perceived benefits, risks,
and influence on professional conduct. The question was reworded slightly as the study
unfolded, to reflect the realities of the levels of influence identified rather than the specific
influences drawn on. Also, continued posttermination involvement was eventually seen as
a relative process, rather than as simply being present or absent.
As in the case of the previous research question, this final one was not analyzed as
originally planned, given the nature o f the unfolding data. There were two questions on
the interview schedule that explored posttermination psychological involvement with the
former therapist. One asked whether the participant thought about or wished to talk with
the former therapist. Only 20% of the sample expressed ambivalence in thinking about or
wishing to talk with their former therapist, with the others reporting clearly more positive,
less conflictual responses. Of the minority who expressed ambivalence, half included the
two respondents comprising the low level-of-influence group of personal therapy on
conducting psychotherapy. The participants who expressed ambivalence noted either a
premature termination from therapy or their analyst’s expulsion from the analytic institute
sometime after the participant’s termination.
The second question probing posttermination psychological involvement with the
former therapist sought to advance an understanding of whether engagement in an internal
dialogue with the former treater occurs while conducting psychotherapy. Geller (1994)
reported that this phenomenon was noted by 20% of his sample. The same frequency was
reported in the present study sample, with occurrences primarily during times of clinical
275
uncertainty, when guidance was needed. Half the participants noted other forms of
relatedness to their former treater while conducting treatment, although not in dialogue
form. The remaining participants had a dim sense of this phenomenon occurring in the
distant past. As noted previously, however, the study findings do not suggest an
association between internal dialogue and level of perceived influence of personal therapy
on clinical practice. The model could be improved by seeking further information about
the occurrence of reported “verbal memories” of the former therapist during sessions. In
addition, asking about other specific modes of internal representation of the former
therapist during sessions, as described by Geller’s work, might yield additional information
about the forms and functions these internal representations serve for therapists’ clinical
practice. In this area, the present study did not reveal clear findings, perhaps because the
questions were not refined well enough to capture the subtlety of nuance that may exist
regarding this phenomenon.
Limitations of the Study
Given the inconclusive patterns that developed in the data analysis, there is a need
to refine some of the questions in the fourth domain of the study. The two “process
variables” identified as important in the model (the interpersonal relationship with the
treater and posttermination psychological involvement with the former therapist)-could
not be adequately assessed with the questions that were asked. The design o f the study
could be improved by refining some o f the interview questions in the domain of the
interpersonal relationship with the former therapist. These would target the findings in
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prior work on impeding or facilitating interpersonal matches (Kantrowitz, 1990) and on
posttermination psychological involvement with the former therapist as evidenced through
a variety o f possible internal representations of the former therapist (Geller, 1994).
Drisko (1997) describes four general interpretive criteria for assessing the
methodology o f qualitative data analysis: credibility, contextualization, confirmability, and
comprehensiveness. The first area of credibility, believability, or truthfulness involves
providing a local context of interpretations and giving authentic and accurate descriptions
of the primary participants. Extensive reporting of raw data in the participants’ own words
is a strength of this study.
The second interpretive criterion is “placing meanings in context” and providing a
sense of the wholeness o f the situation. Establishing context aids in assessing the
transferability of findings. The inclusion of each participant’s treatment history variables
was intended to contextualize the findings in this study.
The third interpretive criterion identified by Drisko (1997) relates to
“confirmability,” which refers to the researcher’s efforts to corroborate data and to
challenge or affirm interpretation or theory. There are both strengths and weaknesses in
this study concerning confirmability. The strengths include the multiple, repeated instances
o f phenomena obtained from the reports of primary sources that were presented in Phase 1
of the data analysis. The researcher attempted to provide extensive original data and
illustrative narrative examples to allow readers to develop their interpretations o f data, to
gauge the suitability o f coding, to understand the data analysis, and to corroborate the
research findings.
2 77
The confirmatory activities in this study involved sharing the unfolding coding o f
categories with various dissertation committee members. A weakness in confirmability of
findings is that the researcher did not engage in “feedback sessions” with participants to
establish that the codes were accurate, which might have helped confirm the researcher’s
interpretation and enhance the study’s overall credibility.
The final interpretive criterion identified by Drisko (1997) relates to the
“completeness” or comprehensiveness o f both the data collection and analysis. This study
has both relative strengths and weaknesses regarding completeness. The reported data are
comprehensive and many of the descriptions are “thick” and broad. Given the limitations
with the interview schedule already described, the point of saturation was reached when
participants repeated details already provided and added no more to the development of
codes or interpretations. However, the study could have been improved had the interview
questions been altered in the fourth domain of the study to better explore Kantrowitz’s
concepts of impeding or facilitating match and to better assess other forms and functions
o f internalization of the posttermination therapeutic relationship, in addition to the internal
dialogue. Although the researcher did ask participants to say a little more when they
claimed to have said it all and did work on in the face of considerable repetition, adding a
few questions as described above may have resulted in advancing theoretical
conceptualization of the identification process. With respect to data analysis, the coding
scheme did strive for “saturation” to ensure that no data were omitted and that codes were
comprehensive.'
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Identifying Biases
Bias in qualitative research refers to influences that impair complete or accurate
sampling, data collection, data interpretation, and reporting. Qualitative researchers
attempt to limit bias through self-awareness, which includes reporting any potential biases
and noting what content areas might be influenced (Drisko, 1997). The inherent
subjectivity o f self-reporting through an interview process is an obvious source of
potential bias in this study’s design and subsequent results. The researcher attempted to
limit biases through self-awareness in sampling.
A possible source of bias in the sampling procedure may exist because of the
researcher’s prior professional acquaintance with 15 of the 20 participants. The researcher
did not interview anyone with whom she had worked closely. However, it is noteworthy
that all nine o f the individuals whose responses ranked in the high level-of-perceived
influence o f personal therapy on clinical work were therapists with whom the investigator
was at least slightly acquainted. Conversely, only five of the individuals in the middle level
and one of the two individuals in the low level groups were therapists with whom the
investigator had prior acquaintance. Whether participants who were acquainted with the
investigator experienced a greater pull to participate initially or to later provide “socially
desirable” responses is a legitimate question. They may have been aware that the
investigator had experienced a personally meaningful analysis that had been experienced as
having a very positive impact on her clinical work. The investigator is left questioning
whether she perceived the responses of acquaintances to be more positive than those of
the minority o f participants who were essentially strangers. There is evidence, however, in
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the narrative that those who were acquainted with the investigator were more open and at
ease about exposing their negative transferences and the working through of problems in
the therapeutic relationship, factors which were strongly associated with being ranked in
the high level group of perceived influence of personal therapy for clinical practice.
A bias in data collection existed toward maintaining a fixed interview schedule,
rather than flexibly improving questions in the fourth domain of the study. This bias
occurred in large part because of the novice researcher’s inexperience, which led to the
premature conclusion that probing the concepts of characterological match and internal
dialogue were yielding unclear responses, rather than that the specific questions that
probed these concepts were perhaps inadequate to assess such complex phenomena.
A possible bias in interpreting results may exist because the researcher chose to use
the high level-of-influence group’s integrated responses to illustrate patterns. This
standard was set because o f the relative clarity in observing and contrasting the findings by
emphasizing differences. Given the very small sample size of the low level-of-influence
group, compared with the two others, this comparability may strain the validity of the
intergroup findings. Seeking a larger number of participants who report low levels of
perceived influence of their personal therapy in their clinical work could remedy this
potential limitation. This size limitation was mentioned, however, in the report of study
findings.
On a more personal level, the researcher began the study with a bias that those
individuals perceiving the most influence of their personal therapy on their clinical work
would be able to provide the most vivid and specific examples of how and when they draw
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upon it to inform their clinical practice. This expectation was, in fact, not supported by the
data. The researcher had hoped that the participants’ memories o f their personal treatment
would provide data to better understand the context in which such memories are evoked.
Instead, the study results were that these memories occur only during moments o f clinical
uncertainty or perhaps when countertransference is evoked by the patient struggling with
issues familiar to the participant-therapist.
Although clarifying unique situations and specific events is central to the accuracy
and credibility o f a qualitative study, it was nevertheless personally difficult for this
investigator to hear some aspects of certain participants’ accounts of their personal
therapy experiences. For example, the several participants who were left with especially
negative transference manifestations evoked a reaction in the researcher to wish to
intervene “therapeutically.” It was difficult, for example, to hear about participants’ anger
and extreme disappointment in the treatment process when the negative aspects of the
treatment relationship had not become a central focus of the analytic work. Conversely,
one participant appeared to be left with a very idealizing transference. However, she was
ranked in the middle level-of-influence group in large part because of the apparent
countertransference enactment in which her former analyst avoided working through her
negative transference. The researcher experienced a pull with these individuals to provide
the missing experience in their analysis. This reaction stood in striking contrast to that in
interviews with participants whose treatments had been centrally concerned with working
through both transference and “real relationship” struggles in the analytic dyad. In those
interviews, the researcher felt satisfaction on hearing about the drama o f learning to safely
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use the treatment relationship as a vehicle for addressing both intrapsychic and
interpersonal conflicts. There was no pull toward engaging in “therapeutic activity” as a
part of listening, but rather a desire to conceptualize the various factors that comprise a
“good enough” personal therapy experience.
In general, the findings have application for the psychoanalytically oriented
treatment o f psychotherapists in which analysis of transference phenomena is central to the
therapeutic action. The results in the domains of benefits and risks generally support the
findings o f prior studies. The domain examining the influence of personal therapy on
clinical work was constructed from prior work and when analyzed for content with this
sample, was determined to provide rankable responses for comparison with the other three
domains. These findings may well have application for evaluating the personal treatment
experiences o f a larger population of psychoanalytic psychotherapists.
Generalizability o f the findings in the domain of the interpersonal relationship and
posttermination involvement is limited, however. Nineteen of the 20 participants had
elected to remain in the locale where they received their personal treatment. Half of the
participants’ former treaters reside locally and remain available for continued consultation
with the participant. These factors appear to influence posttermination psychological
involvement with the former treater and, hence, limit the generalizability of the study
findings to other settings. Perhaps these findings most clearly apply to psychoanalytic
institute settings, where there is a high likelihood of former analysands having
posttermination professional or personal contact with their former treater.
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Implications of Results for Clinical Practice and Future Research
Clinical Practice Implications
The findings of this study suggest several implications for the practice of
psychodynamic psychotherapy and psychoanalysis. First, they support common practice
wisdom that analyzing the transference is central to therapeutic outcome. The findings
suggest that therapists as former patients are acutely attuned to their treater’s analytic
attitude toward the coexistence of transference and the “real relationship.” The analysis of
the treatment relationship on both of these levels-as a two-person construction-supports
contemporary shifts in psychoanalytic thinking toward the intersubjectivity o f the analytic
enterprise. Respondents who reported the highest levels of perceived influence of their
personal therapy in their clinical work also experienced their former treater as being
authentic and as not hiding behind analytic neutrality or technique, yet maintaining an
analytic space for the unfolding of the treatment process.
Clinical implications for the personal psychotherapy o f patients who are
psychotherapists include the importance of personal treatment to support the professional
identity o f therapist-patients. Respondents who reported the highest levels of influence
rated this professional growth as a clear benefit of their personal therapy. Acknowledging
disappointments and limitations in oneself and others-including with the therapist-and
working through these disappointments within the treatment relationship, especially as
they involve narcissistic wishes to be perfected, are strongly associated with a high level of
perceived influence o f personal therapy for one’s clinical work. The former patients
appeared to identify with their perception of how their former analyst had resolved similar
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disappointments and accepted limitations. Acknowledging characterological differences
and developing a collaborative relationship despite these differences was also associated
with a high level of perceived influence of personal treatment on clinical work.
The findings suggest that the internalization of the treatment relationship is a
process which may change over time, as posttermination life unfolds. Although numerous
participants offered evidence o f a self-analytic function, the internal “therapeutic dialogue”
that several described remained vulnerable to ongoing events in the former analyst’s life,
particularly to traumatic losses represented by the former analyst’s physical or
psychological incapacitation and inability to work. These participants were ranked in the
middle or low level-of-influence group. Respondents in the high level-of-influence group
had largely maintained postanalytic contact with their former treater and continued to
draw on the internalized relationship to resolve ongoing developmental challenges and
crises in their lives. Four of the members of the high level-of-influence group had, in fact,
lost their former analyst-to an untimely death in three cases and to leaving the profession
altogether in another. However, unlike participants reporting lower levels of influence,
these four individuals continued to “internally dialogue” with their former treater as an
aspect of their ongoing self-analysis.
Findings also suggest that the termination phase of treatment has an especially
long-lasting influence on the fate of the ongoing internalization of the therapeutic
relationship. “Good” terminations were associated with a distinct phase of the work
characterized by mourning losses and reworking acceptance of the inevitability of
284
limitations. These tasks were most often described spontaneously by members of the high
level-of-influence group.
These findings suggest that most participants report an increased differentiation of
self and others consequent to their personal therapy. However, those who were ranked
lower in perceived influence o f their personal therapy on their clinical practice were left to
continue the psychological work of individuation with a less clear sense of the former
therapist as a helpful internal object on whom the participant continues to draw for help in
meeting personal and professional challenges. Those in the high level-of-influence group
offered evidence that their individuation was promoted by the therapy relationship as a
consequence o f focusing on interpersonal conflict within the treatment relationship. Those
in the lower level groups appeared to have less overt conflict in their treatment
relationships generally, yet it would seem that they were then left on their own, without
their treater’s help, to resolve issues of disappointment concerning their treatment.
The wider application of these findings to the general psychotherapy patient
population must be drawn cautiously. They generally suggest that subjectively perceived
benefits, risks, and aspects of the interpersonal relationship with the former treater may
interact to promote greater autonomy of functioning through identification. The extent to
which the former treater is seen as a positive role model may also be associated with the
extent to which the treatment relationship conflicts were actively addressed in a former
patient population o f nontherapists. However, attempts to apply these study findings to a
wider psychotherapy patient population are limited by the complexity of varying influences
285
and identifications o f being in the same versus a different profession than one's former
treater.
Implications for Future Research
The study findings raise several questions that might guide future research on
aspects of internalization of the psychotherapy relationship. Refinements of questions
related to the fourth domain of the model include incorporating inquiry to take better
advantage of Kantrowitz’s work regarding an impeding or facilitating interpersonal match
between therapist and patient, from the patient’s perspective. In addition, the study
findings suggest pursuing more knowledge about the reported “verbal memories” of what
the former therapist said that remains as a permanent intrapsychic representation for the
former patient. Doing so might involve further incorporating Geller’s work on modes of
representation of the former therapist, with specific questions to advance knowledge about
the functional use of these internalizations for the conduct of psychotherapy. When the
patient is also a therapist, the treatment relationship is presented with both unique
challenges and opportunities for growth through identification with the therapist as a
mentor. The dual functions of promoting both therapeutic and educational goals are
incorporated in the required training analyses of candidates in psychoanalytic institutes.
There are well-documented parallels in other mentoring relationships within the
psychoanalytic psychotherapy field, such as in the supervisory relationship. Could any o f
the findings in the current study be usefully applied to advantage to achieve a better
286
understanding of identification processes in the supervisory relationship? This question
might be fruitfully pursued.
Another question raised by the current study regards the potential
multigenerational themes or patterns of influence of personal psychotherapy on the clinical
work o f successive generations of psychotherapists. There is an apparent potential for
specific psychoanalytic theories to be passed from therapist to patient, within specific
psychoanalytic institutes. Do identifiable multigenerational processes occur within the
culture o f these psychoanalytic institute “families”? Psychoanalytic institutes are in a
unique position to investigate the potential of multigenerational themes or patterns that
might advance knowledge related to character match or to working through therapeutic
relationship problems that may contribute to overall knowledge about internalization of
personal therapy for therapists.
Finally, this study raises questions as to whether some individual therapists are
“identification hungrier” than others throughout life. That is, are some individuals
inherently more prone to, or more open to, being influenced by authority figures, such as
therapists, teachers, or supervisors with whom they work closely in adulthood? What
developmental processes might be associated with this need? Might specific therapeutic
techniques enhance the patients’ learning about conducting clinical work from their
therapist? These questions have relevance for therapists who treat therapists, given the
tendency for this relationship to reverberate deeply in the therapist-patient’s clinical work.
287
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294
A p pe n d ix A
I n it ia l C o n t a c t L e t t e r
(date)
(addressee)
Dear__________ :
I am a doctoral student at Smith College School for Social Work and am writing to inquire
if you would be interested in participating in a study that I am conducting for my dissertation.
The purpose of the study is to explore how psychotherapists feel about their personal
therapy and how it has influenced their professional practice as psychotherapists. I am seeking
participation of psychotherapists with at least five years of practice experience, who have in the
past engaged in individual psychotherapy or psychoanalysis. The intent of the study is to
understand how personal therapy experiences influence one’s own work as a psychotherapist.
I would like the opportunity to discuss your experiences, thoughts, and impressions on this subject
in a face-to-face audio-recorded interview.
The time required for the interview will be approximately 1-1/2 hours. I am aware that
your time is precious and would be willing to meet with you at a time and location most convenient
to you. Unfortunately, I am unable to offer financial remuneration for your participation.
I am very aware that I am asking you to share sensitive material. Your identity will be known only
to me, and all possible steps to ensure confidentiality of the taped material will be taken. Your
name will not appear on any records of the information and will be identified only by a code
number. Following transcription of the interview by a professional research transcriptionist, the
fully transcribed information will be securely stored and accessible only to this researcher.
Segments of the disguised interview results will be discussed with my dissertation committee,
which is chaired by Donald B. Colson, PhD.
I believe that the efficacy of the therapy process will be served by closer examination of
how psychotherapists’ personal therapy experiences inform their personal and professional
development. Your contribution to this effort will be greatly appreciated. If you are interested in
participating, please return the enclosed reply card in the envelope provided. I will then phone you
to further discuss the project and arrange for an interview.
I thank you for considering participation in this study. If you have any further questions, please
feel free to phone me.
Sincerely,
Karen Bellows-Blakely, MSW

Phone (785) 234-6844
295
APPENDIX B
M a il -I n R espo n se t o I n it ia l C o n t a c t L e t t e r
I am interested in participating in the research project entitled “Psychotherapists’ Personal

Psychotherapy and Its Perceived Influence on Clinical Practice,” being conducted by
Karen Bellows-Blakely, MSW. I understand qualifications for the study include having a
minimum of 5 years’ postgraduate practice as a psychotherapist and completion of one’s
most recent personal psychotherapy process or psychoanalysis.
Name:_______________________________
Phone #s:____________________________
Best times to call:______________________
296
A p pe n d ix C
I n f o r m e d C o n se n t F o r m : W r it t e n E x p l a n a t io n to P a r t ic ip a n t s
I am conducting a study that examines psychotherapists’ experiences o f their personal

treatment and how these have influenced their professional practice of psychotherapy. The
purpose of the study is to gain understanding of how personal treatment contributes to the
development of therapists’ use o f self in the psychotherapy enterprise.
Because you are a practicing psychotherapist who has engaged in personal therapy, your
insights into the nature of this experience are very valuable. I would like permission to
interview you and use the information you share with me in my research, which I am
conducting to complete my doctoral dissertation requirement at Smith College School for
Social Work.
If you decide to participate in the tape-recorded interview, you will be asked a number of
questions about your personal psychotherapy experience and what influences you believe
it has had on your personal and your professional development.
To ensure the confidentiality of the material you share with me, I will take the following
steps. After the interview is transcribed by a professional research transcriptionist, the
verbatim data will be accessible only to me. The typed transcriptions will be identified only
by a code number, and no institutional affiliations will be given. The material in the final
report will be disguised in such a way that it cannot be identified with you. Segments of
the disguised interview material may be shown only to the researcher’s dissertation
committee advisers, chaired by Donald B. Colson, PhD. The other committee advisers are
faculty members at Smith College School for Social Work.
Participation in this study should take approximately 1-1/2 hours of your time. At the
conclusion of the interview, I will ask you about any concerns you may have. You are, of
course, free to terminate the interview at any time. If you withdraw, all information you
have provided will be destroyed. Unfortunately, I am not able to offer financial
remuneration for your participation. I can, however, offer you the opportunity to
participate in what I believe to be a useful study on the efficacy of the treatment process,
and my sincere appreciation for doing so.
The information from this study is being used for educational purposes and may be used
for research publication in the future. You will not be personally identified in any way in
reports or publications that may come out of this research study.
If you have future questions regarding this research, please contact me, Karen Bellows-
Blakely, MSW.
Office address: 522 SW Washburn Ave., Topeka, KS 66606
Office phone: (785) 234-6844
297
APPENDIX D
S t a t e m e n t o f I n f o r m e d C o n se n t b y R e s e a r c h P a r t ic ip a n t
I am willing to take part in a research study described to me as “Psychotherapists’ Personal

Psychotherapy and Its Perceived Influence on Clinical Practice,” being conducted by Karen
Bellows-Blakely, MSW, as part of the doctoral dissertation requirements at Smith College School
for Social Work.
I have read the accompanying description of the study. The purpose of the research and the
procedures that will be used for data collection and analysis have been clearly explained. I have
been told that I will be asked questions about my personal psychotherapy experiences, its effects on
me and my professional practice of psychotherapy. I understand that this interview will be
audiotaped.
Any risks and/or benefits I can expect to experience from participation in this study have been
explained to me. Any further questions I may have during or after my participation in this research
study will be answered by the researcher. Also, it has been explained to me that I can discontinue
participation in this research project whenever I wish and without any disadvantage to me.
I understand that I will not be paid for taking part in this research project. 1 understand that if
I have any questions about my rights as a research subject, I can contact the chairperson of the
Menninger Institutional Review Board at (785) 273-7500.
I understand that all of the information I will provide when I take part in this research study will be
confidential. The information will not be shown to anyone except the researcher’s dissertation
advisers, unless it is ordered by a court of law. My name, initials, and institutional affiliation (if
any) will not appear on any records of the information given, even to the research advisers. Such
records will be identified by a code number only. I agree to the use of this information by the
researcher for educational purposes and for research publication, and I understand that I will not
be personally identified in any way in reports or publications that may come out of this research
study.
In signing my name to this form, I am certifying that I understand everything that I have been told
about my part in this research study and that I am willing to participate in it by being interviewed.
My signature on this form does not obligate me to complete the research study nor does it release
the researcher from possible legal responsibility. I understand that I will receive a copy of the
signed consent form for my reference.
(Investigator) (Research Participant)
Date Signed:________
I am interested in receiving overall results of the project. (Please check here):.
298
A ppe n d ix E
D e m o g r a ph ic Q u e st io n s
These questions followed a brief introduction of the researcher, further description of the
research study, and a review of the Informed Consent protocol. Participants were then
asked the following questions at the beginning of the interview.
Personal Treatment Processes

For what duration o f time have you engaged in an individual psychotherapy or
psychoanalysis process? How long ago did you terminate your most recent
psychotherapy?_______ Total number of hours of individual psychotherapy:__ .
Professional Training and Experience

Your professional degree: MD ____ PhD ____MSW
Year obtained:______How many years postgraduate practice experience do you have
treating individuals?____
Describe your current clinical practice:
Current Clinical Practice

Which modalities o f clinical work do you currently engage in practicing?
Individual psychotherapy:___ Hours/week:__ .
Psychoanalysis:__ Hours/week:___ .
Couples treatment:__ Hours/week:___ .
Family therapy:__ Hours/week:___.
Group therapy:__ Hours/week:___ .
Your theoretical approach

Please describe your theoretical approach to treatment (i.e., which theory/theories do you
find most informative to your clinical work?).
Your most recent psychotherapist’s theoretical approach

Please describe your understanding of your therapist’s theoretical approach to treatment.
299
APPENDIX F
I n te r v ie w Q u estio n s
analysis? This will be asked before prompting with the following questions:
a. How useful was your therapy in enhancing your awareness and understanding of
yourself?
b. How useful was your therapy in enhancing your self-esteem and self-confidence?
c. How useful was your therapy in improving your interpersonal relationships?
d. How useful was your therapy in enhancing therapeutic skills, for example, with
empathy, in using countertransference, in structuring treatment, in understanding the
process of psychotherapy?
e. How useful was your therapy in resolving characterological issues and alleviating
symptoms?
2. Please describe any disappointments, risks, or negative effects of your personal

therapy or analysis. This will be asked, before prompting with the following questions:
a. To what extent did you experience excessive stress or psychological distress as a

consequence o f your personal therapy?
b. Did you experience any problems with the working relationship?
c. To your way of thinking, did your therapist make treatment errors in your work
together? If so, please specify.
d. Do you think you have identified with your therapist in some way that has affected
you adversely?
e. In your view, was your effectiveness as a therapist blocked due to confusion in being
both a patient and a therapist at the same time?
Perceived Overall Effectiveness of Personal Therapy

1. Overall, how well do you believe your therapist understood you and communicated
his or her understanding to you?
2. Overall, how successful or satisfactory do you believe your psychotherapy or analysis

was?
300
3. Questions About the Effects o f Personal Therapy on Conducting Therapy

a. & b. Do you believe you work differently with your patients or clients as a consequence
o f having engaged in your own therapy? I f so, in what ways? Which aspects of your
therapy do you think you draw on?
c. (i) To what extent has your therapist served as a role model for you in conducting
psychotherapy?
c. (ii) What do you perceive as being your therapist’s limitations or mistakes which have
influenced your work with your own patients or clients?
d. (i) Do images or thoughts of your therapist ever come to mind while you’re conducting
psychotherapy?
d. (ii) Do you remind yourself o f your psychotherapist(s) or analyst(s) while working? If

so, can you describe any such moments, any particular clinical circumstances?
d. (iii) Which, if any, personal attributes of your therapist or analyst do you find yourself
most identifying with in your work?
Questions about the Perceived Interpersonal Relationship and the Process of

Continued Psychological Involvement with the Therapist
1. How would you describe the interpersonal match or fit between you and your most
recent therapist or analyst?
2. (“Goodness of fit” includes two components-the “emotional tone” or mutual liking

and compatibility of character style). To what extent did you like your therapist, or
feel fondness and affection for him or her and experience that your therapist liked
you? Did you sometimes dislike your therapist or feel disliked?
3. (Regarding character style as a component of the match:)

a) Did you think of your therapist as professionally competent? Do you think your
therapist thought of you as professionally competent?
b) How compatible were your professional convictions?
c) Did you feel respected by your therapist? Do you think your therapist felt
respected by you?
d) How compatible were your personality styles?
4. Do you sometimes find yourself thinking about your analyst or therapist, or wishing
to talk with your analyst or therapist? If so, under what circumstances?
5. In your'conduct of therapy, do you ever engage in an internal dialogue with your

therapist or analyst? If so, under what circumstances?
301
APPENDIX G
O r d i n a l R a n k i n g s o f Q uestions A ssessing P e r c e i v e d In f l u e n c e s o f
Pe r s o n a l T h e r a p y o n C o n d u c t i n g Ps y c h o t h e r a p y
3. a. & b. Do you believe you work differently with your patients as a consequence of
having engaged in your own therapy? If so, in what ways; which aspects of your
therapy do you think you draw upon?
(1) Uncertain that personal therapy informs my clinical work = 0

(2) Yes, personal therapy has influenced my work with patients = 1
(a) Enhanced awareness of importance of treatment structure
(b) Broader range of interventions
(c) Enhanced confidence in therapeutic process
(d) Deepened conviction about treatment relationship as important vehicle for
psychic change and growth
(e) Increased acceptance of realistic limitations of psychotherapy enterprise
3. c. (i) To what extent has your therapist served as a role model for you in conducting
psychotherapy?
(1) Significant and only positive identifications noted = 2
(2) Significant and both positive identifications and differences noted = 1
(3) Not a significant professional role model = 0
3. c. (ii) What do you perceive as being your therapist’s limitations or mistakes which have
influenced your work with your own patients?
(1) No limitations, just positives = 1
(2) Limitations that do influence my work = -1
(a) Theoretical biases
(b) Analyst’s technique
(3) Limitations were analyst’s human foibles or countertransference reactions, and
are benign to my clinical work = 0
3. d. (i) Do images or thoughts of your therapist ever come to mind while you’re
conducting psychotherapy?
(1) Not currently; probably not, in past = 0
(2) Not currently; but, yes, in past = 1
(3) Yes, currently and in past = 2
3. d. (ii) Do you remind yourself of your psychotherapist(s) while working? If so, can you
describe any such moments?
(1) Do not remind myself o f him or her while working = 0
(2) Yes, I do remind myself of him or her while working = 1
(a) analytic technique
(b) Interpersonal style
(c) Theories o f cure
302
3. d. (iii) Which, if any, personal attributes of your therapist do you find yourself most
(1) With how therapist conducts his or her personal life
(2) With therapist’s personal character traits
(3) With therapist’s capacities in conducting treatment
A p pe n d ix H
L e v e l o f I n f l u e n c e S c o r e s : P e r c e iv e d P o sit iv e I n f l u e n c e o f
P e r s o n a l T h er a py o n C o n d u c t in g T h er a py
Participant Score Influence Level

1 3 Middle
2 -1 Low
3 3 Middle
4 5 High
5 4 Middle
6 5 High
7 2 Middle
8 7 High
9 3 Middle
10 5 High
11 3 Middle
12 6 High
13 6 High
14 5 High
15 4 Middle
16 1 Low
17 5 High
18 4 Middle
19 5 High
20 2 Middle
304
APPENDIX I:
D a ta A n a ly sis : P h a se 2
M a t r ix o f F in d in g s : O u t l in e o f C a t e g o r ie s , T h e m e s , & S u b t h e m e s
Section I: Perceived Benefits of Personal Therapy

analysis.
(1) Enhanced self-understanding: [n=l 1] (2, 4, 7, 8, 9, 13, 14, 15, 16, 19, 20)
(a) Helped me trust in my ability to be introspective (4)
(b) Increased my comfort with my inner world and feelings (4, 8, 9)
(c) Deepened my awareness of how powerfully issues can affect people’s lives (15)
(2) Enhanced separation-individuation related to family of origin: [n=8] (1, 7, 9, 13, 14,
16, 17, 19)
(a) Promoted adaptation to traumatic childhood loss of parent(s) (7, 9, 13)
(i) Viewed self as resilient in eliciting care from substitute caretakers
(b) Helped me come to terms with who I am because of the family I came from
(i) Oedipal conflict with same-sex parent (17, 19)
(3) Improved interpersonal relationships with contemporaries, including intimate
relationships: [n=8] (1, 5, 11, 13, 16, 17, 18, 19)
(a) Deepened capacity for commitment (1, 16, 18)
(b) Increased tolerance for the humanness of others (11, 17)
(4) Symptom alleviation: [n=8] ( 8, 9, 10, 11, 15, 17, 18, 19)
(a) Resolution of depression, anxiety, guilt, and anger (8, 9, 10, 11, 15, 17, 18)
(b) Culture-specific context of meaning of symptoms (9)
(5) Enhancement o f professional work with patients: [n=7] (4, 5, 12, 13, 14, 16, 18)
(a) Personal therapy is one of the best things I’ve done for myself and my patients
(18)
(b) I use the skills and techniques in conducting therapy that I learned there (16)
(c) Enhanced awareness and attunement to multiple levels of the treatment process
with patients (4, 12, 13, 14)
(d) Value of engaging in personal therapy concurrently with clinical training (4, 5)
(6) Improved self-esteem and self-acceptance: [n=6] (6, 7, 10, 14, 15, 19)
(a) Learning to like myself, decreasing my self-criticism (10, 15, 19)
(b) Having a growing sense of my own competence and trusting in it (14)
(c) Feeling more entitled to whatever I feel (6)
(d) Graining an inner peace with the analysis since I became my own friend (7)
(7) Importance o f interpersonal relationship with the analyst: [n=4] (5, 9, 15, 19)
(a) Analyst as a model for male gender-role identification, in light of early loss of
father, or very conflictual relationship with father (9, 19)
(i) Therapist as role model for becoming a competent man and a competent
psychotherapist
(b) Valued the containing or holding function of psychotherapy (9)
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(c) Valued being treated like a colleague as vital to self-esteem and professional
competence (15)
(d) Valued the unique intimacy of the analytic relationship (5)
(8) No or few benefits: [n=2] (3, 10)
(a) First analyst didn’t like me; subsequent analysis much more helpful (10)
(b) Analyst misdiagnosed me; role reversal, with analyst seen as fragile and in need
of care (3)
(i) Analyst’s political problems at the psychoanalytic institute represented a
traumatic reenactment of my parents’ marital conflicts (3)
1. a. How useful was your therapy in enhancing your awareness and understanding
of yourself?
(1) Improved understanding of my psychodynamics: [n=13] (1, 2, 5, 6, 8, 9, 11, 13, 14,
15, 16, 17, 19)
(a) In the context of original, infantile objects (1, 5, 6, 16, 17)
(b) Based on contemporary ego functioning (2, 11, 13, 14, 15, 16)
(i) Increased awareness of narcissistic vulnerabilities (11, 13)
(ii) Increased competence, self-confidence (14, 15)
(2) Related to relationship with analyst: [n=6] (3, 4, 6, 16, 17, 19)
(a) Developing a negative transference important (6, 17)
(b) Identification with analyst as “new object” (16, 17)
(3) Regarding needs for connectedness and separateness of self and object or promoted
separation-individuation: [n=6] (2, 4, 12, 15, 18, 20)
(a) Enhanced my autonomy and ability to self-soothe, through self-analysis and
reading psychoanalytic theory, and enhanced my self-reliance through learning
how to carry out a procedure on myself to gain insight (15, 18)
(b) Powerful to put words to my experience, which validated it and led meto feel
less isolated in my own narrow understanding (12, 20)
(c) Psychoanalytic culture can lead to unhelpful, rigid idealization o f technique and
theory, or can promote further individuation of self (2, 4)
(4) Regarding effects on professional identity development: [n=5] (7, 9, 10, 12, 19)
(a) All human behavior is understandable (9,12)
(b) Increased differentiation of self and patients (7)
(c) Analyst’s implicit approval of me supported my belief in my analytic capacities
(10, 19)
(5) Regarding disappointments/ limitations in the enhancement o f self-awareness: [n=2]
(15, 20)
(a) The work felt unfinished in last treatment (15)
(b) Treatment didn’t change my life profoundly, but it helped me live deeper, less
superficially (20)
1. b. How useful was your therapy in enhancing your self-esteem and self-
confidence?
(1) Clearly enhanced: [n=12] (1, 4, 5, 6, 8, 9, 12, 13, 14, 17, 18, 19)
(a) Personally (1, 8, 9, 14, 18, 19)
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(i) Analyst’s confidence that I could have a healthy relationship with a man was
very important to me (1)
(ii) I became more relaxed, comfortable, less afraid of living, and had less need
to have control over everything (14)
(iii) I’m more comfortable with myself, have better self-esteem, and am less
negative, defeatist with myself (19)
(iv) Promoted my autonomy and competence that I could figure myself out (18)
(b) Professional identity or clinical practice (4, 5, 6, 12, 13, 17)
(i) She validated my perceptions of my clinical work, which nudged me along in
self-esteem (13)
(ii) It was powerful being validated by a male therapist whom I respected, when
I’d had a lot of transference to male authority figures as devaluing of me (5)
(iii) Enhanced my confidence in handling difficult clinical situations (6)
(iv) Issues of self-esteem are still incompletely resolved, but my analyst helped
me clarify who I am and my right to be doing this work and be able to see it
as valuable to other people (4)
(v) Analyst helped contain my anxiety about success and competition and fears
o f failure (17)
(vi) Acceptance of imperfections, when “good enough” is better than perfect is
what I got. It’s given me permission to be who I am and then try to help
patients do the same thing. “You don’t have to be perfect to be lovable or
accepted, or to have something meaningful to contribute.” Setting my own
standards for what I think is meaningful. (12)
(c) Emphasized therapist’s role in promoting self-esteem and self-confidence (1,5,
12, 13, 17, 18, 19)
(i) I felt totally respected, more than ever before (19)
(ii) Analyst’s flexibility in accurately perceiving how much to intervene, how
much to let participant struggle with her own resistance to treatment
promoted self-confidence (18)
(2) Mixed or equivocally enhanced: [n=8] (2, 3, 7, 10, 11, 15, 16, 20)
(a) Therapeutic mismatch with first analyst; second one excellent match; first analysis
left me with many self-doubts, second one helped me feel better about myself
( 10)
(b) Constraints in analyst’s method or technique (3, 15)
(i) Analysis not appropriate mode of treatment; later psychotherapy good (3)
(ii) Lack of structured termination phase (15)
(c) Self-esteem not particularly problematic, but it became more realistic with
treatment (11, 16)
(d) Limitations in the analytic process itself (2, 7, 20)
(i) Self-esteem eventually benefited, but it could have been faster had analyst
more directly confronted one o f her pathological beliefs about herself (7)
(ii) Analytic process very difficult, anxiety-producing in forcing you to face your
deepest fears (20)
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(iii) Analysis helped me to become more self-reflective, yet it can be a

doctrinaire, rigid religion. I subscribe to broader theoretical views as
clinician in practice. (2)
1. c. How useful was your therapy in improving your interpersonal relationships?

(1) Clearly helpful with: [n=12] (1, 2, 4, 5, 7, 9, 10, 12, 13, 15, 19, 20)
(a) Promoting the internal capacity for improved relatedness (2, 7, 9, 12, 20)
(i) Viewed self as less self-preoccupied, less self-referential, and better at
listening to others (2, 7, 12)
(ii) Analysis made me “lesssuperficial,” more introspective and reflective (9, 20)
(iii) It made me easier to live with, gentler, more tolerant of vulnerable people
and less tolerant o f pathological beliefs and behaviors. It made me more
honest, intellectually and emotionally. (9)
(iv) It helped me discover the defensive parts of my overfiinctioning in
relationships and to get a better balance with this (7)
(b) Actual improvements in interpersonal relationships with significant others (1,5,
10, 12, 13, 15, 19, 20)
(i) The quality o f my friendships have changed as a result of my analysis, and
it’s made a significant difference in my ability to approach my family
members, individually and collectively (5, 10, 20)
(ii) It was useful in helping me to clarify a lot of anger I ’ve had in relationship to
men and with my father. And it helped me feel like I could have a
relationship with a man and stay clear about who I was. (1)
(iii) My analysis helped me extricate myself from an “unhealthy’ relationship and
then develop a committed marital relationship with a mature partner (13, 19)
(c) Enhanced professional relationships with patients and colleagues (2, 10)
(i) I became clearer about who my professional mentors were. This led to more
differentiation of myself, professionally. (2)
(ii) I became more secure and confident about my professional abilities and the
analyst helped me learn to trust my intuition (10)
(2) Equivocally helpful: [n=8] (3, 6, 8, 11, 14, 16, 17, 18)
(a) For female participants, clarifying their boundaries in relationships created
interpersonal conflict (6, 8, 14, 17, 18)
(i) Positive changes in my relationship with my mother (6, 17)
(ii) It has disenhanced some of my relationships, because I am more assertive
now, more direct with my aggression, which at times can create conflict. I
have fewer friendships, but the ones I have are more mutual. (17, 18)
(iii) During the analysis, I was irritable with the distractions of my family
members’ issues. But, ultimately, I think my interpersonal relationships were
greatly enhanced, because I became less guilt-ridden, less neurotic, irritable,
impatient, and irrational in my relationships with others. (8)
(b) Spouses pleased with therapeutic results, but other interpersonal relationships
changed, due to less tolerance of others’ foibles (11, 16)
(i) However, a cost o f going through an intensive psychotherapy process is that
you don’t suffer a lack of insight in others, including your friends. Your
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threshold for friendships changes and is more exclusive, to a higher

threshold, which makes it a little harder to form close friendships. (16)
(c) Changes in professional relationships (11, 17)
(i) I ’m more direct in work situations and less fearful about telling people when
I disagree (17)
(ii) During my analysis, I had more conflicts with patients than before, but over
time, I think my analysis has significantly affected my capacity to establish a
therapeutic relationship with patients. (11)
1. d. How useful was your therapy in enhancing your therapeutic skills for example,
with empathy, in using countertransference, in structuring treatment, in
understanding the process of psychotherapy?
(1) Changes in oneself which have implications for clinical practice: [n=13] (1, 4, 5, 6, 7,
8, 10, 12, 14, 15, 18, 19, 20)
(a) Enhanced conviction and self-confidence as a therapist (1, 4, 10, 12, 14, 15, 18)
(i) Increased my self-confidence to take a clear position of hope with my
patients when I believe it, like my analyst did with me. (1)
(ii) Helped me to trust my intuition and what I was leaming-to think that I
might have something to offer and it didn’t have to be perfectly tailor-made
at the start to develop a working relationship with the patient that is safe for
both members. (12)
(iii) Through personal analysis, my conviction increased, at an emotional and at
an intellectual level, that the phenomena of transference and resistance really
do exist and that they carry some danger for both parties involved. (18)
(iv) Analysis has changed the way I think of myself-I know I am a crackeijack
with patients with poor self-esteem. (10)
(b) Enhanced self-acceptance (5, 6, 7, 8, 10, 12, 18, 19, 20)
(i) My perfectionistic tendencies were reinforced by my training, but my analyst
gave me permission to be myself (5)
(ii) I’ve taken a self-acceptance of my humanness from my analyst by seeing his
human vulnerabilities and that he could also do very good clinical work (8)
(iii) My analysis convinced me that parents do their best, and learning not to take
my parents’ imperfections as my failing has helped me work with patients to
likewise love themselves and their parents for who they are and whatever
their weaknesses are (7)
(c) Enhanced capacity to help patients with issues similar to one’s own (1, 4, 5, 6, 7,
10, 12, 14, 15, 18, 19, 20)
(i) The more I was able to explore about myself regarding shame about
competitive issues, the more I ’m able to help patients explore why their
feelings about competition makes them feel awful (6)
(ii) My therapy has helped me professionally by becoming more comfortable
with my own issues related to sexual material, trauma issues, shame, and
issues related to loss, mourning, and instilling hope (1,6, 10, 12)
(2) The importance o f the interpersonal relationship between the therapist and patient,
including: [n=13] (3, 5, 6, 7, 8, 10, 11, 13, 14, 15, 17, 18, 19)
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(a) The “real” relationship, for example, ’’objective” qualities o f the treatment
relationship, being treated with genuine respect (5, 13, 15, 19)
(b) Enhanced capacity to work in the transference (5, 6, 7, 10, 11, 15, 17, 18)
(i) Understanding the power of regressive experience (7)
(ii) Increased tolerance of negative affect from patients (6, 10, 17)
(c) Identification with the therapist (5, 8, 11, 12, 15, 18, 19)
(i) I have identified with my therapist as a thoughtful, rational person who is
also comfortable with affect (19)
(ii) For the first decade after my analysis, I could see that much o f what I did
was a copy of what my analyst had done, more in terms of attitude than
technique. I think that had a major impact in my relationship with patients.
( 11 )
(3) Learning about the therapeutic process: [n=15] (2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 16,
17, 18, 19)
(a) Growing patience with, and trust, in the process, respect for the complexities of
change and empathy for human struggles (2, 4, 5, 7, 8, 12, 18, 19)
(b) Structuring the treatment (3, 8, 16, 17)
(i) Learning about the framework, time management, fee arrangements which
promote the therapeutic goals.
(ii) I practice similarly to my analyst with regarding structuring the enterprise-
being late, ending hours like he did, calling vacations “interruptions” (8, 16,
17>
(iii) I practice differently from my analyst with regards to structuring-not all
work happens in just 50 minutes (3)
(c) Treatment technique (4, 5, 6, 8, 9, 10, 15, 17, 18, 19)
(i) I value the therapeutic activities of listening and understanding, interpreting
conflict and confronting defenses empathically, and modeling thoughtful self
disclosure
(d) Value of concurrent training and treatment (5, 9, 18, 19)
(i) Though risks exist, increased insight about self and others and growing
comfort with, and conviction about, the value of the therapeutic process
promoted my ability as a psychotherapist
1. e. How useful was your therapy in resolving characterological issues and

alleviating symptoms?
(1) Treatment helped alleviate symptoms and resolve characterological issues [n=7] (1, 5,
10, 12, 15, 16, 17)
(a) Less anxiety and depression, diminished conflicts with dependency and
perfectionism
(2) Treatment helped alleviate symptoms, but only modified characterological issues
[n=9] (2, 4, 6, 7, 8, 13, 14, 18, 19)
(a) I am not free o f anxiety and guilt, but they have been muted (18)
(b) Traits such as being overresponsible for others, overcontrolling, and
perfectionistic have been modified versus resolved; I’m better able to modulate
them, which is helpful to my clinical work (6, 7, 8, 14, 19)
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(3) Treatment produced positive changes in character traits, despite original “lack” of
symptoms [n=2] (9, 11)
(a) Analysis helped me make more creative and effective use of my aggression by
rechanneling it (11)
(b) Analysis softened the intolerant attributes of my character structure (9)
(4) Those who did not observe alleviation of symptoms or characterological change [n=2]
(3, 20)
(a) I regret not having been able to go deep enough into the work to enable more
character change (20)
(b) Psychoanalysis was “the wrong kind of psychosurgery for what ailed me.” (3)
1. f. Have you experienced any other benefits from your personal therapy that you
have not yet described?
(1) Valuing the treatment relationship and how it promotes change [n=5] (2, 4, 5, 8, 16)
(a) The relationship with my analyst is probably the most important in my life (5)
(b) There is always that other voice in your life to moderate or titrate situations. The
message of the analysis and the things that were helpful stay with you and you
step outside and consult with that. (8)
(c) There’s no question that I have a soothing internalization and one which is nice
to go through life with, especially professional life, because it’s the same work,
where there’s a legitimizing of doing it. (16)
(2) Graining a more realistic perception o f self and of significant others: [n=2] (10,12)
(a) I developed a real appreciation of the weaknesses and strengths of my most
significant others and believe I can see my relationships in a clearer, more realistic
way (10)
(b) Increased differentiation o f self and mother (12)
(3) Perceptions about the relative “completeness” of personal therapy or termination
issues [n=4] (1, 8, 16, 20)
(a) Cleanly terminated (1,8)
(i) He was very attentive to dealing with the issues that re-emerged at
termination (1)
(ii) I felt “cleanly terminated,” despite my analyst’s leaving the profession after
I’d terminated (8)
(b) Termination arbitrary, incomplete (16, 20)
(i) I was left wondering, “Am I done, yet?” (16, 20)
(ii) I did not get clear feedback from analyst about my readiness to end (16, 20)
Section H: Perceived Risks. Disappointments and Negative Effects o f

Personal Therapy
2. Please describe any disappointments, risks, or negative effects of your personal
therapy or analysis.
(1) Negative effects of personal therapy: [n=l] (3)
(a) Did not help me acknowledge my alcohol abuse (3)
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(b) Did not help with my resistance to exploring defenses against honesty and
exposing my vulnerability (3)
(2) Risks o f personal therapy: [n=7] (1, 5, 6, 8, 12, 16, 18)
(a) Anxiety about being able to complete the analysis (5, 6, 12, 18)
(i) Uncertainty about completing the treatment (5, 12, 18)
(ii) Ambivalence about having terminated; mourning the loss (6)
(b) Issues about the relationship with the therapist (1,6, 16)
(i) Over-identification with therapist’s working style (16)
(ii) Ambivalence about dual relationship with analyst (1)
(iii) Intensity of negative transference (6)
(c) Psychological distress as a consequence o f treatment (8, 18)
(i) The loosening of old defenses contributes to greater distress, temporarily
(18)
(ii) Great self-absorption contributes to feeling less connected to significant
others, during the treatment (8)
(d) Significant financial cost of treatment (6,16)
(3) Disappointments in personal therapy: [n=14] (2 ,4 ,6 , 7, 9, 10, 11, 13, 14, 15, 16, 17,
19, 20)
(a) Unresolved psychological issues not experienced as related to limitations in the
analyst (6, 9, 11, 13, 15, 16, 17, 19, 20)
(i) Feeling unfinished, due to not being able to go further or in more depth with
a number of issues (16, 19, 20)
(ii) Frustrations in working through issues o f preoedipal dependency (9, 11, 13)
(iii) Unresolved separation issues regarding an aging parent (6, 17)
(iv) Frustrations that treatment was not more helpful in improving sexual
functioning (15)
(b) Unresolved psychological issues experienced as related to personal limitations of
the analyst: (2, 10, 13, 14, 15, 17)
(i) Wishing for more “give and take” or mutuality in the human relationship
(15)
(ii) Perception of analyst as rigid and doctrinaire (2)
(iii) Perception of analyst as too free-wheeling, too “real” at times (13)
(iv) Perception of analyst as not helpful enough with a particular prolonged life
stressor or illness of significant other (10, 14)
(v) Wishing issues about sexuality had been dealt with differently by analyst (17)
(c) Unresolved psychological issues experienced as related to limitations in
psychotherapeutic technique (7, 14, 15)
(i) Analyst preserved technical neutrality, but at expense of patient, who felt
progress was slowed or who felt disrespected or misunderstood (7, 14, 15)
(d) Disappointments in the wish to be perfected (4, 6)
(i) Accepting self as imperfect (4, 6)
(ii) Benefits of accepting personal imperfection for self and for clinical work
(4,6)
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2. a. To what extent did you experience excessive stress/psychological distress as a

consequence of your personal therapy?
(1) Nothing excessively stressful/ no further elaboration [n=4] (9, 11, 12, 16)
(2) Nothing excessively stressful, but commented about “nonexcessive” stresses related
to personal therapy: [n=8] (1, 4, 7, 10, 13, 17, 18, 19)
(a) Wished to have been referred for antidepressant medications (1)
(b) Personal therapy initially “unbalancing” (7,17)
(c) Despite stress o f treatment, always able to do professional work (10, 17, 19)
(d) “Harmless” acting out o f transference (13, 18)
(3) Some “excessive stress or psychological distress,” yet seen as an inherent, essential,
or meaningful part o f treatment process: [n=6] (5, 6, 8, 14, 15, 20)
(a) Self-absorption of analysis had repercussions for interpersonal relationships (5, 6)
(b) Excessive stress related to distressing life events, for example, illness or death of
a family member (14)
(c) Excessive stress related to core psychological issues regarding separation and
loss (8)
(d) Excessive stress related to analytic relationship at termination (15)
(4) Treatment “excessively stressful or psychologically distressing,” but stress not viewed
as an essential, meaningful, or purposeful part of treatment process: [n=2] (2, 3)
(a) Fear of psychotic decompensation (3)
(b) Lack of mutuality in discussing participant’s readiness to terminate (2)
2. b. Did you experience any problems with the working relationship?

(1) No: [n=9]'(l, 9, 10, 11, 13, 16, 18, 19, 20)
(a) No qualifier, or only positive comments (9, 10, 11, 18)
(b) Qualified no; some reported complications in the working relationship (1, 13, 16,
19, 20 )
(i) Therapist’s flaw complicated a good working relationship (1, 16, 19)
(ii) Respondent’s flaw complicated a good working relationship (13)
(iii) “Dual relationship” complicated a good working relationship (20)
(2) Yes: [n= ll] (2, 3, 4, 5, 6, 7, 8, 12, 14, 15, 17)
(a) “Causes” related to:
(i) Perception o f analyst as vulnerable, in need of protection; “role reversal,”
due to life circumstances of treater (2, 3, 14)
(ii) Analyst’s personality traits: oversensitive or too focused and serious (2, 4,
17)
(iii) Therapeutic action or technique by analyst
(a) Non-adherence to time frame-chronic lateness (6, 12)
(b) Perceived “lack of neutrality” (5, 8, 15)
(c) Lack of understanding of a psychodynamic issue (7)
(iv) Respondent’s resistance to treatment (6, 15)
(b) Perceived effects o f problems with working relationship on identification with
analyst
(i) Led to positive identification with analyst’s working style. Discussion of the
issue in therapy led to acceptance of analyst’s way of handling something
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which had created conflict between patient and analyst, for example, fees for
missed sessions, or owning problem with lateness (5, 6, 12, 14)
(ii) Led to dis-identification with analyst’s working style. Analyst did not explain
why he did something which patient had long explored as problematic or
conflictual for her. (17)
2. c. To your way of thinking, did your therapist make treatment errors in your
work together? If so, please specify.
(1) No errors: [n=5] (1, 12, 18, 19, 20)
(a) Noted difference between human foibles and treatment errors (18)
(b) Observation: we were a good match (12)
(2) No errors, yet still questioning certain incidents: [n=7] (7, 8, 10, 11, 13, 15, 16)
(a) Did therapist understand the stressful impact o f chronic illness in my family?(10)
(b) Was a classical psychoanalysis the optimal choice of treatment for my narcissism?
(15)
(c) Did my analyst believe I was competent to be trained as an analyst? (11)
(d) Could I safely explore my sexual competence in the erotic transference? (16)
(e) Analyst took an unhelpful approach with my overfunctioning in relationships (7)
(f) Analyst’s management of the therapeutic frame (8, 13)
(i) “Looseness” with time management of sessions (13)
(ii) Moving away from neutrality at termination (8)
(3) Treatment errors made, but not substantively detrimental to participant’s process
[n=3] (4, 5, 9)
(a) Analyst encouraged limited exploration of variations in his schedule (4)
(b) Analyst liked me too much-I could have fooled or seduced him (9)
(c) Analyst owned too much in the intersubjective field (5)
(4) Treatment errors made and experienced as detrimental to participant’s treatment
process: [n=5] (2, 3, 6, 14, 17)
(a) Analyst failed to understand patient diagnostically (3)
(b) Analyst’s maintenance of neutrality during situational life crisis experienced as
harmful (17)
(c) Mistakes related to incompletely exploring psychodynamic issues (3, 14, 17)
(d) Harmful countertransference enactments (2, 14)
(e) Technical: timing of interpretations hurtful (6)
2. d. Have you identified with your analyst in some way that has affected you
n riv p rc p lv ?
(1) “No”: [n=7] (1, 6, 7, 9, 10, 19, 20)
(2) No, but some positive identifications: [n=5] (5, 8, 11, 12, 15)
(a) My analyst’s excellent therapeutic style and professional attitude (8, 15)
(b) Identification with analyst as an immigrant enhanced my self-esteem and
professional self-confidence (11)
(c) Analyst initially viewed as therapeutic ideal with all my patients, eventually
helped me learn to differentiate between myself and my patients and to consider
diagnostic questions (5)
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(d) Analyst as kindred spirit, mutual identification and good match (12)
(3) Dis-identification with negative aspects of therapist: [n=2] (2, 13)
(a) Analyst’s cultural insensitivity enhanced my cultural sensitivity (2)
(b) Analyst’s not taking good physical care of herself influenced my resolve to begin
regular exercise (13)
(4) Identification with analyst in some way that has affected me adversely: [n=6] (3, 4,
14, 16, 17, 18)
(a) Due to analyst’s neutrality (14, 16, 17, 18)
(i) I’m less playful, less spontaneous (16,17)
(ii) Identification with analyst’s reserved, cautious personality style has
contributed to more difficulty forming friendships (18)
(iii) Analyst’s neutrality limited his clinical effectiveness with an issue in
treatment. Respondent similarly limited in being helpful to her patients,
(stuck with unresolved personal issue.) (14)
(b) Similar distasteful personality traits as analyst’s (3)
(c) Identification with analyst’s annoying verbal mannerism, representing
presumptiveness: “multigenerational influence of the negative” (4)
2. e. In your view, was your effectiveness as a therapist ever blocked due to

confusion in being both a patient and a therapist at the same time?
(1) No perceived adverse effects and no details offered: [n=2] (4, 11)
(2) No perceived adverse effects, instead clinical work enhanced by being in personal
therapy concurrently: [n= 10] (1, 2, 3, 8, 9, 10, 13, 15, 16, 19)
(a) Personal therapy served a containing function-a place to explore and discuss
experiences as both a therapist and a patient in the context of a therapeutic
relationship
(b) Personal therapy enhanced my sensitivity, empathy, and identification with
patients. (2, 8)
(c) Personal therapy helped enhance my technical skills as a therapist (13)
(3) No perceived blockage in therapeutic effectiveness with patients, but some
complications with concurrent clinical work and personal treatment: [n=5] (5, 6, 12,
17, 20 )
(a) Engaged in personal therapy concurrently with postgraduate training (5, 12, 17)
(b) Despite complications, therapeutic skills were, in fact, enhanced by concurrent
clinical work and treatment (5, 6, 12)
(c) Complications
(i) Preoccupation with psychological issues made it difficult to attune to
patients (5, 6, 17, 20)
(ii) Related to transitioning from being the patient to being the therapist (12)
(iii) Related to anxiety about competition with one’s own analyst-being in the
analyst’s chair (17)
(4) Did perceive blockage in therapeutic effectiveness due to confusion with concurrent
clinical work and personal therapy: [n=3] (7, 14, 18)
(a) Engaged in personal psychotherapy concurrently with postgraduate training (18)
(b) Unaware o f adverse effects at time (7, 18)
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(c) Difficulty transitioning from patient to therapist because felt stirred up; difficult
to attune to patients (18)
(d) Countertransference enactment led to premature termination with patient (14)
Perceived Overall Effectiveness o f Personal Therapy

1. Overall, how well do you believe your therapist understood you and
communicated his or her understanding to you?
(1) Those who felt very well understood but offered no details: [n=3] (7, 17, 18)
(2) Those who felt very well understood and provided supporting details [n=9] (5, 6, 8,
10, 12, 13, 14, 15, 19)
(a) The therapist treated the patient as important; therapist seen as egalitarian, not
elitist or holding himself above patient (5, 10, 13, 14)
(b) Therapist had human flaws, didn’t always understand, but reliably strived for
understanding (8, 15, 19)
(c) The participant gave self some credit for developing a treatment relationship in
which she or he felt well understood (6, 12)
(3) Those who felt generally well-understood, but offered exceptions: [n=7] (1, 2, 4, 9,
11, 16, 20)
(a) The need for more direct communication from treater regarding his
understanding of the patient’s material (11, 16, 20)
(b) Certain aspects of the treatment were not explored in enough depth (4, 9)
(c) Analyst overvalued analytic neutrality, was too aloof and detached; treatment
lacked warmth & support which respondent needed in order to grow (2)
(d) Analyst befuddled by respondent’s unremitting depression, did not refer her for
antidepressant medication (1)
(4) Those who did not feel well understood by therapist: [n=l] (3)
(a) Analyst did not understand the role of traumatic separation and loss during
respondent’s adolescence and the role of ongoing substance abuse.
Psychoanalysis not appropriate treatment modality for me, just then! (3)
2. Overall, how successful or satisfactory do you believe your psychotherapy or

analysis was?
(1) Quite successful: [n=7] (1, 4, 5, 12, 16, 18, 19)
(a) No supporting examples (5, 12, 16, 18, 19)
(b) It was successful, in part because of respondent’s own clarity of goals (1)
(c) A great benefit to professional work (4)
(2) Quite successful, especially in regard to help with perfectionism: [n=6] (6, 8, 9, 13,
14, 17)
(a) Became less critical o f self and others (9, 14)
(b) Seeing “good enough” as better than perfect (6, 8, 13,17)
(c) Progress with perfectionism translates to clinical work (17)
(3) Quite successful, with one disappointing exception: [n=6] (2, 7, 10, 11, 15, 20)
(a) Related to perceived personal limitations (7, 10, 15, 20)
(i) Needing, but not pursuing continued treatment for relationship issues (10)
3 16
(ii) Conflicted about depending on analyst enough to deepen the work (20)
(iii) Given own personality structure, treatment quite satisfactory (7, 15)
(b) Related to perceived limitations in the psychoanalytic process (2, 11)
(i) Psychoanalytic theory limited as an explanation for understanding humans
(2 )
(ii) Premature termination due to analyst’s schedule, precluded continued
treatment progress of respondent (11)
(4) Personal treatment was unsatisfactory: [n=l] (3)
(a) Related to misdiagnosis of respondent, psychoanalysis was not the appropriate
treatment. (Subsequently, a supportive psychotherapy process was helpful.) (3)
Section HI. Perceived Influences o f Personal Therapy on Conducting Therapy

3. a. & b. Do you believe you work differently with your patients as a consequence
o f having received your own therapy? If so, in what ways: Which aspects of
your therapy do your think you draw on?
(1) Uncertain that personal therapy informs my clinical work: [n=3] (2, 16, 20)
(a) Clinical practice has been more influenced by experience doing the work itself, by
formal education and life experience
(2) Yes, personal treatment has influenced my work with patients: [n=17] (1, 3, 4, 5, 6, 7,
8, 9, 10, 11, 12, 13, 14, 15, 17, 18, 19)
(a) Enhanced awareness of importance of treatment structure (1)
(i) Attention to ruptures due to vacations-this is very important to patients with
a histoiy of inconsistent caretaking (1)
(b) Drawing on a broader range of interventions (1, 18)
(i) I validate reality more or am less “neutral” with my patients with trauma
histories than I would have been before my personal treatment (1, 18)
(c) Enhanced confidence in the therapeutic process (1, 8, 9, 11, 14, 15, 17, 18)
(i) Having confidence in the process leads to instilling confidence in patients (1,
18)
(ii) The importance of listening and understanding (9, 11, 14, 15, 17)
(a) The patient experiences that the therapist is actively listening and
making a sustained effort to understand, which is vital to the process
(11, 15, 17)
(b) Listening for latent not just manifest content (9)
(c) Understanding as “doing,” feeling less pressure to react immediately
(14)
(iii) Greater patience with the slow evolution of psychic change (8)
(d) Deepened conviction about the treatment relationship as an important vehicle for
psychic change and growth (1, 3, 4, 5, 6, 7, 9, 10, 13, 14, 15, 17, 18, 19)
(i) Enhanced empathy for the patient’s struggles to change, based on
identification with the role o f the patient (7, 14, 15)
(a) I tun more open about expressing empathic understanding than was my
analyst. I believe some people need to hear in words that they’re
understood. (14)
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(b) My analyst modeled a loving acceptance o f everything, which opened

me up to sharing my darkest secrets and helped me shift my perspective
o f myself. I try to do this with my patients, as well. (7, 15)
(ii) Using the treatment relationship to promote the patient’s self-esteem (15)
(iii) Understanding and using transference and countertransference to promote
the treatment (1, 5, 7, 9, 10, 14, 17, 18)
Regarding transference (1, 7, 14, 17, 18)
(a) Increased awareness of, and respect for, the power o f transference (1,7,
14)
(b) The most effective interpretations are not always transference
interpretations (18)
(c) Because o f working in the transference with my analyst on struggles to
separate and individuate, I am sensitive to my patients’ struggles with
me on this issue (17)
Regarding countertransference (5, 6, 7, 9, 10, 14)
(a) Drawing on how a sensitive issue was understood in their personal
analysis and using that as a way to explore what the patient might be
experiencing (6, 7, 10, 14)
(b) Analyst modeled sharing his countertransference reactions with
respondent and respondent uses this with patients (5, 9)
(iv) Promoted understanding of psychotherapy as a two-person psychological
process, an intersubjective experience (4,5, 13, 17, 18)
(a) My contributions as treater and the patient’s both are bathed in a
brighter light (4, 5, 17, 18)
(b) There’s nothing neutral about a therapist-it’s the studied use of one’s
subjectivity that promotes the treatment (5)
(c) I discovered in my analysis that I could be myself and be a good
therapist (17)
(d) The type of therapeutic relationship viewed as curative to patients was
experienced in my personal treatment (therapist as mother with child as
new developmental partner, “reparenting,” vs. therapist as collaborator
with rational part of patient’s ego) (18)
(v) Drawing on analyst’s personal qualities as model for clinical effectiveness (3,
6, 7, 17, 19)
(a) Helpful personal qualities include analyst’s humor, capacity to admit
mistakes, willingness to be corrected; his reveling in my successes,
thereby giving me permission to grow and surpass him; his
“thoughtfulness” (6, 7, 17, 19)
(b) Analyst as ego-ideal: “the first sane adult in my life”; “the committee of
helpers” (3, 6)
(e) Increased acceptance of the realistic limitations of the psychotherapy enterprise
(5 ,7 ,1 0 ,1 2 ,1 5 )
(i) Accepting the limitations in personal psychotherapy has positively influenced
my clinical work (5, 7, 10, 12, 15)
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(a) Greater compassion for the struggles and limitations of change for my
patients (7, 15)
(b) Greater acceptance of my own personal human foibles, while perceiving
self as a good-enough therapist (5, 10, 12)
3. c. (i.) To what extent has your treater served as a role model for you In conducting
psychotherapy?
(1) Analyst has been a significant role model and only positive identifications noted:
[n=12] (4, 6, 8, 9, 10, 11, 13, 14, 17, 18, 19, 20)
(a) Modeled good technique in conducting psychotherapy (4, 6, 8, 9, 11)
(i) Respondent uses similar phrasing of questions to explore the patient’s
dilemmas, which are similar to her own, and has greater confidence in the
value of exploration (6)
(ii) First analyst “loosened me up” in modeling therapeutic playfulness; second
analyst helped me learn the value of giving the patient room to struggle, not
rushing to comfort prematurely (4)
(iii) Respondent identified with treater’s capacity to attune to his own free-
associations, to promote the treatment (11)
(iv) Respect for how the analyst “went about his work” (8, 9)
(b) Respondent identified with treater’s capacities for human relatedness (10, 13, 14,
17, 18, 19,20)
(i) Admiration of analyst’s integrity in humane, respectful and dignified
relatedness with patient (14, 19, 20)
(ii) Admiration of analyst’s flexibility within neutrality and spontaneity to offer
support, including mirroring and feeling analyst’s affirmation (10, 17)
(iii) Admiration of analyst’s courage to engage on a human level, acknowledging
own human flaws (13)
(2) Analyst has been a significant role model and offers both positive identification with,
and differences from, how analyst practices: [n=6] (1, 5, 7, 12, 15, 16)
(a) Areas o f positive identification with analyst’s conduct (1, 7, 12, 15)
(i) Analyst’s sensitivity to exploring meanings of ruptures (1)
(ii) Valuing the analyst as a “well-trained, good human being” (5)
(iii) Valuing his acceptance, compassion and empathy for whatever the patient
experiencing (7)
(iv) Valuing his concepts and ways of thinking about patients (12)
(b) Areas o f differentiation from treater’s practice conduct (1, 5, 12, 16)
(i) Withholding conceptual thinking or feedback from patient (16)
(ii) Withholding emotional experience from patient (5)
(iii) Gender-based stylistic differences regarding level of reserve with patients 1,
12)
(3) Analyst not experienced as a significant role model in conducting psychotherapy:
[n=2] (2, 3,)
(a) Many other people have contributed as much or more to my professional ideals
(2, 3)
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3. c. (ii) W hat do you perceive as being your analyst’s or therapist’s limitations or

mistakes that have influenced your work with your own patients?
(1) No limitations or mistakes, instead noted positives: [n=4] (8, 12, 13, 19)
(a) The therapist was genuine and authentic (13, 19)
(b) The therapist modeled that “good enough” includes having human imperfections
and misfortunes (8, 12)
(2) Limitations or mistakes reported that influence respondent’s clinical work: [n=15] (1,
2, 3, 5, 6, 7, 9, 10, 11, 14, 15, 16, 17, 18, 20)
(a) Limitations due to theoretical biases (1, 3, 6, 9, 10, 11, 14)
(i) Analyst had a classical, phallocentric Freudian view-missed the meanings of
participant’s pregnancy (14)
(ii) Psychoanalytic blindness to cultural and class diversity in dyad (11)
(iii) Theoretical biases led to analyst not understanding a developmental or
situational issue (including need for medication, coping with chronic illness
of spouse, parenting stresses, and importance o f analyzing preoedipal level
material) (1, 3, 6, 9, 10, 14)
(b) Limitations due to analyst’s technique (7,15, 16, 17, 18, 20)
(i) Analyst placed technique over relationship (15, 17)
(ii) Analyst too directly confronted defenses around core issue, which increased
respondent’s resistance (7)
(iii) Analyst did not give respondent enough feedback (20)
(iv) Analyst did not take control of sessions, thus respondent has no model for
this in his work (16)
(v) I ’m strongly identified with my analyst’s views of neutrality and, hence,
don’t do well with, and don’t work with female trauma survivors who need
validation of their perceptions (18)
(3) Limitations perceived as related to the analyst’s human foibles: [n=5] (1, 2, 5, 6, 15)
(a) Analyst overly sensitive to personal criticism (2)
(b) Analyst allowed personal issues with separation and loss to color termination
process(15)
(c) Analyst habitually late for sessions (1,6)
(d) Analyst self-disclosed in ways that sometimes distracted from respondent’s
analytic work (5)
3. d. (i.) Do images or thoughts of your therapist ever come to mind while you’re
conducting psychotherapy or psychoanalysis?
(1) Do not currently have thoughts or images of treater during sessions and do not think
they have had, in past, during their treatment: [n=6] (2, 4, 9, 16, 19, 20)
(a) Perhaps an unconscious process-hence, not aware (2, 4, 9)
(b) Have thought about former treater outside o f sessions (19, 20)
(i) What would analyst have said to this client? (19)
(ii) Evokes “vicarious experiences” of relating to former analyst, helpful
personally and professionally (20)
(2) Do not currently have thoughts or images of treater during sessions, but have had, in
past: [n=4] (1, 11, 13, 18)
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(a) Two types of occurrences o f these images (8)

(i) Actively questioning what former therapist would say about patient (8) or
(ii) After-the-fact, noticing a similarity to, or an identification with what the
former analyst would have done (8)
(b) Directly modeling after my former analyst feels like a good thing, pleasant to me
and that it’s going to be helpful to the patient-not intrusive thoughts (13)
(c) Evoking analyst’s memory helpful in treating difficult-to-treat patients with
sexual boundary issues; analyst = an “ethical representative” (11)
(3) Continue to have thoughts or images of treater while conducting psychotherapy, now
and in past: [n=9] (3, 5, 6, 8, 10, 12, 14, 15, 17)
(a) What would former analyst say, ask, or do at a particular moment with a
particular therapeutic dilemma? (6)
(b) After-the-fact identification with analyst: “I find myself putting something exactly
the way he would have!” (8)
(c) Thoughts of former analyst related to technique (14, 15)
(i) Analyst drew on his free-associations with me and I do the same to
understand my patients’ “subterranean issues” (14)
(ii) When I’m too talkative, like my former therapist, I do as he did and remind
myself to be quiet (15)
(d) Thoughts of former analyst are associated with personal relationship with analyst
(3, 5, 12, 17)
(i) I make the same noises he made. I ’ve become more relaxed and casual, like
him-that’s good! (5)
(ii) My analyst was externally detached; I strive to be different with my patients,
to connect, to have a “personal encounter” with them (3)
(iii) When I’m perplexed, I think o f him, or when I sit a particular way, I wonder
if he did also. He really is the primal mother and I think he knows I ’m crazy
about him! (17)
(iv) I emulated his reserved style and then one day, when I made him laugh, I
knew he was emotionally really with me, that he resonated with me. And I
take to my work a question about how separate I am from my patients and
how much to actually join them in the experience of being human. And
having been in treatment, I ’m more comfortable with feeling very close. (12)
3. d. (ii) Do you remind yourself o f your analyst while you’re working? If so, can you
describe any such moments, or any particular clinical circumstances?
(1) Do not remind themselves of former therapist while working [n=2] (2, 11)
(a) Because I work with a different patient population than I fit into as a patient-
different countertransference reactions get evoked (11)
(2) Do remind themselves of former therapist while working: [n=18] (1, 3, 4, 5, 6, 7, 8,
9, 10, 12, 13, 14, 15, 16, 17, 18, 19, 20)
(a) Perceived similarity with former therapist’s therapeutic technique (1, 4, 6, 8, 9,
10, 15, 16, 17)
(i) Similar with handling structure of beginnings, endings, and interruptions in
the sessions (1, 17)
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(ii) Emulating nonintrusive body language with cross-gender treatment

relationships (16)
(iii) Drawing on the therapist’s strength, take it in when perplexed or starting
with a new case, or a developmentally difficult client (6, 17)
(iv) Emulating the therapist’s ability to restrain himself, to talk less and to listen
better (15)
(v) Using techniques that respect the patient’s pace for doing the work (4, 9, 10,
15)
(b) Perceived similarity with former therapist’s style of interpersonal relatedness (3,
5, 7, 13, 19, 20)
(i) The capacity to relate authentically with patients (3)
(ii) Enhanced self-acceptance after treatment led to enhanced acceptance of
patients (7, 13)
(iii) Appreciation for the complexity of feelings toward intimate objects (20)
(iv) Experiencing a unique kind of love with the therapist contributed to
experiencing similar feelings with a few patients, which anchors my work (5)
(v) Internalization of therapist’s interpersonal style as a developmental process,
“a family lineage” (19)
(c) Perceived similarity with former therapist’s theories o f what is curative to
patients (12, 14, 18)
(i) We both understood the patient’s need to regress “in the service of the ego,”
to promote psychic growth (14)
(ii) Importance of challenging patient to shift “from an experiencing to an
observing ego,” at times-to see their realistic choices, which can promote
psychic growth (18)
(iii) We’re similar in nurturing the patient’s attempts at mastery over despair in
even the most bleak conditions (12)
3. d. (iii) Which, if any, personal attributes of your therapist or analyst do you find
yourself most identifying with in your work?
(1) Respondents who identify with how the therapist conducted his or her life outside the
treatment relationship: [n=4] (1, 6, 8, 20)
(a) Therapist seen as differentiated from, yet connected with, others, thus modeling
the capacity to make changes proactively (1,6)
• (i) With regard to the changing work setting (1)
(ii) Publicly advocating for health-care reform (6)
(b) Therapist seen as having integrity in how he conducted his life, even in facing
death (20)
(c) Identified with therapist’s “comfortable style in the world” (8)
(2) Respondents who identify with admirable personal character traits of former therapist:
[n=4](10, 11, 13, 15)
(a) Therapist’s calmness and soft-spokenness (11)
(b) Therapist’s personal warmth, kindness and “caring from the heart”(10, 13)
(c) Therapist remains “ego ideal” for honesty, patience, hard work, dependability and
deep caring. “A first-class individual.” (15)
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(3) Identification with therapist’s capacities in conducting treatment: [n=12] (1, 2, 3, 4, 5,

9, 12, 14, 16, 17, 18, 19)
(a) Therapist’s capacity to respect the patient (5, 9, 12, 17, 19)
(i) Therapist maintained impeccable ethics (12)
(ii) Therapist acknowledged mistakes (5)
(iii) Therapist interpreted painful material without being sadistic (9)
(b) Therapist’s capacity to appreciate humor and laugh with the patient (4, 5, 12)
(i) Life is too sweet to take too seriously (12)
(c) Therapist took the work veiy seriously and was very absorbed in it (2, 16, 17,
18)
(d) Therapist very engaged in the work, yet kept good personal boundaries, keeping
work focused on patient (3, 4, 14)
IV. Perceived Interpersonal Relationship and the Process o f Continued

Psychological Involvement with the Therapist
4. (1.) How would you describe the interpersonal match or fit between you and your
most recent therapist or analyst?
(1) Initially felt good, later changed to not good: [n=l] (3)
(a) Psychoanalysis was wrong form of treatment; analyst in declining health and
apparent need for respondent’s care (3)
(2) Initially not a good match, but changed to a good match, over time: [n=3] (4, 5, 6)
(a) Second analyst’s style of reserve was a sharp contrast with warmth o f former
analyst. Over time, I discovered, apparent mismatches don’t have to be fatal. (4)
(b) Analyst too different from my oedipal father; I wanted a female therapist to help
with issues of feminine identity. He taught me about working with intensive
transference-based treatment with my patients. (5)
(c) Analyst initially too cold and calculated. Negative transference very important,
helpful to experience and “work through.” (6)
(d) None o f these participants chose their treater (4, 5, 6)
(3) Initially a good match and remained a good match: [n=16] (1, 2, 7, 8, 9, 10, 11, 12,
13, 14, 15, 16, 17, 18, 19, 20)
(a) Those who emphasized the similarities between themselves and their treater (7, 8,
9, 10, 11, 12, 13, 15, 16, 18)
(i) Comfort with having a perceived similar personality style with treater (8, 10,
11, 12, 13, 15, 18)
(ii) Admiration of the therapist’s personality traits and aspiration to be more like
treater (7, 8, 15, 18)
(iii) Perception of sharing certain values and life experiences with treater (8, 9,
11, 15, 16)
(iv) Only 3 of 10 participants chose their treater (8, 12, 18)
(a) Own personal style perceived as being similar to treater’s personality
style (8, 12, 18)
(b) Aspires to be like treater (8, 18)
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(c) Shares values and experiences in common with treater (8)

(v) 7 o f 10 participants did not choose their treater (7, 9, 10, 1.1, 13,15, 16)
(a) Similarity with treater’s personality style (10, 11, 13, 15)
(b) Admiring therapist, aspiring to be like him or her (7, 15)
(c) Shared values and experiences in common with treater (9,11, 15, 16)
(b) Those who emphasized the differences between themselves and their treater (1,
2, 14, 17, 19, 20)
(i) Differences are complementary and promote the treatment (1, 17)
(a) Both o f above chose their treater
(ii) Differences between self and treater due to inherent vulnerability of patient
role (2, 14, 19, 20)
(a) I resisted doing the work (20)
(b) I needed to idealize the therapist to preserve an image o f him as good
(19)
(c) Height difference between participant and analyst was initially
intimidating (14)
(d) Instability in analyst’s mood and behavior created unsafe therapeutic
environment (2)
(e) None o f above 4 participants chose their treater
4. (2.) To what extent did you like your most recent therapist, or feel fondness and
affection for him or her and experience that he or she liked you? Did you
sometimes dislike him or her, or feel disliked?
(1) Respondents who reported liking and being liked throughout their treatment and who
reported no disliking: [n=ll] (1, 3, 4, 7, 11, 12, 13, 16, 18, 19, 20)
(a) Felt genuine fondness and affection to be mutual (1, 3, 4, 7, 11, 13, 16, 18, 19,
20)
(i) reported loving feelings toward or from treater (7, 16)
(b) Negative emotions experienced toward treater (1, 4, 11, 12, 13, 16, 18, 19, 20)
(i) Felt angry with treater (11, 13, 16, 18)
(ii) Felt treater was bored with participant (12, 13, 19, 20)
(iii) Experienced distance and aloofness from treater (1,4, 11)
(c) Experienced conscious transference reactions toward treater, such as idealized
and eroticized transference (3, 16, 18)
(d) Fear of becoming disliked by treater (3, 12, 18)
(2) Respondents who reported liking and being liked by their treater, yet who sometimes
disliked their treater, although they did not believe treater ever disliked them: [n=6]
(2, 5, 9, 10, 14, 17)
(a) Felt fondness and affection to be mutual (2, 5, 9, 10, 14, 17)
(i) Reported a mutually loving relationship (5)
(b) Valued being able to safely “fight” with treater (5, 10, 17)
(c) Identified what specifically disliked about treater (2, 17)
(i) Treater’s narcissistic need for participant’s admiration (2)
(ii) Analyst’s neutrality and distance when participant was experiencing a health
crisis (17)
324
(d) Treater did experience negative emotions toward participant (5, 10, 14, 17)
(i) Irritation with the participant (5, 17)
(ii) Treater merely tolerating the participant’s negativity (14)
(iii) Treater returned participant’s anger
(3) Respondents who reported that by end of treatment, they liked treater, but earlier,
experienced mutual disliking: [n=2] (6, 8)
(a) Reasons offered for disliking treater:
(i) Treater experienced as cold and computer-like (6)
(ii) Treater not helpful enough, participant not gettingmoney’s worth (8)
(b) Reasons offered for feeling disliked by treater:
(i) Lack of personal relatedness from the treater (6)
(ii) Feeling withheld from, not helped enough through difficulttimes in the
treatment (8)
(4) Respondents who reported not liking their treater, but experienced being adequately
well liked by the treater: [n=l] (15)
(a) This contrasted with his earlier experience (15)
(b) Felt helped in both treatment processes, despite not liking his most recent treater
(15)
(c) Did not like treater’s tendency to manipulate and his glibness (15)
(d) This made it not possible to trust him folly (15)
4. (3. a.) Regarding the match between you and your most recent therapist: Did you
think o f your therapist as professionally competent? Do you think your
therapist thought of you as professionally competent?
(1) Respondents who replied affirmatively to both parts of the question: [n=16] (1, 2, 3,
4, 5, 7, 8, 9, 10, 11, 12, 14, 15, 17, 18, 20)
(a) Emphatically “yes” and no further elaboration (1, 4, 7, 8, 9, 11, 15, 17, 20)
(b) Saw therapist as professionally competent and elaborated on their sense o f
therapist regarding participant as professionally competent (2, 3, 12, 14)
(i) Analyst did not oppose the major decisions about life changes I made during
my analysis (2)
(ii) Analyst approved my professional competence when I was overwhelmed
with depression and briefly unable to work (3)
(iii) Analyst validated my work implicitly, when I spoke o f my work with patients
during my analysis (12, 18)
(c) Therapist credited me with more professional competence than I gave myself at
the time (5, 10, 14)
(2) Respondents who perceived therapist as professionally competent, but were uncertain
whether therapist regarded participant as professionally competent: [n=2] (16, 19)
(a) Both young, inexperienced graduate students, at the time, in same professional
discipline as therapist (16, 19)
(i) Anxious about wanting therapist’s approval (16, 19)
(ii) Felt they received no direct feedback about this from therapist (16, 19)
(iii) Acknowledged that anxiety about their professional competence colored
their perceptions (16, 19)
325
(3) Respondents who expressed uncertainty about the therapist’s professional

competence, yet felt treater viewed participant as professionally competent: [n=2] (6,
13)
(a) Treatment relationship issues involving highly transference-laden images of
primary objects (6, 13)
(i) Rigid and unbending (6)
(ii) Unavailable and inconsistent (13)
(b) Much of therapy work involved working in the transference on dynamic conflicts
regarding the capacity to trust in the steadfastness of authorities, which led to
eventually viewing self and therapist as professionally competent (6, 13)
4. (3. b.) How compatible were your professional convictions?

(1) Respondents who emphasized the mentoring role of their treater: [n=3] (3, 5,19)
(a) New trainees at beginning of analysis could talk about how de-skilled they felt
and saw therapist as a good role model (5, 19)
(b) Therapist’s existential view broadened participant’s analytic perspective (3)
(2) Respondents who described only similarities between their own and their therapist’s
professional convictions: [n= 11] (1, 4, 6, 7, 9, 10, 11, 13, 16, 17, 18)
(a) Participants who perceived their clinical approach to patients as being similar to
their therapist’s (4, 7, 9, 10, 11, 13, 16, 17, 18)
(i) Perceiving a similar treatment approach to therapist’s, or similar theory of
cure (4, 9, 10, 13, 16)
(ii) Holding similar theoretical beliefs as treater (7, 17, 18)
(iii) Sharing similar clinical interests with treater, including preferred patient
population (9, 11)
(b) Respondents who observed personal similarities with their former treater with
regard to holding high ethical standards, while living a full personal life (9, 13)
(c) Participants who perceived a similarity between their own and their therapist’s
professional convictions but gave no further elaboration (1,6)
(3) Respondents who described differences as well as similarities between their own and
their therapist’s professional convictions: [n=5] (8, 12, 14, 15, 20)
(a) Perceived similarities (8, 12, 14, 15, 20)
(i) Shared respect for, and belief in, the therapeutic process and an approach
that values understanding the patient and views a respectful therapeutic
relationship as curative (12, 14, 20)
(ii) Shared quest for seeking answers to existential questions (8, 20)
(iii) Shared convictions about usefulness of ego psychology as a model for
understanding psychic phenomena (15)
(b) Perceived differences between professional convictions (8, 12, 14, 15, 20)
(i) Less conviction than analyst about the usefulness of a classic psychoanalytic
theoretical approach (14, 15, 20)
(a) I’ve added a self-psychological approach (15)
(b) My convictions about the usefulness of psychoanalytic theory, unlike my
analyst’s, are unsteady, evolving, changing (20)
326
(ii) Less conviction that the practice of psychoanalysis is preeminent over

psychotherapy, compared with my former analyst (12)
(iii) Former treater emphasized a spiritual base to treatment, more than I do with
my patients (8)
4. (3. c.) Did you feel respected by your therapist and do you think your therapist
felt respected by you?
(1) Respondents who succinctly replied “yes” to both parts of the question: [n=l 1] (1, 7,
9, 10, 11, 12, 14, 16, 17, 19, 20)
(2) Respondents who replied “yes” to both parts and elaborated: [n=5] (3, 5, 8, 13, 18)
(a) Experienced an idealizing transference early in the process (3, 5)
(b) Termination phase very rich-importance of having my dignity and autonomy
respected (18)
(c) “Forgiveness,” even though I occasionally felt disrespected by analyst’s habitual
lateness, but she acknowledged her human foible (13)
(3) Respondents who replied “yes” to both parts, but qualified theirtreater’s feeling
respected by them: [n=3] (4, 6, 15)
(a) Early in process, analyst might not have felt respected by participant, due to
participant’s distress with analyst’s withholding style, but this changed over time (4, 6)
(b) Despite at times disliking and being angry with analyst, at termination, participant
respected analyst, although the analyst may have felt disliked or disrespected
beyond what participant actually experienced (15)
4. (3. d.) How compatible were your personality styles?

(1) Respondents who perceived that they were compatible because of similarities with
their treater’s personality style: [n=4] (9, 11, 15, 17)
(a) Similarity of character traits (11, 15, 17)
(i) Affective intensity (11)
(ii) Social gregariousness (15, 17)
(b) Similarity of professional practice (9, 11, 17)
(i) Clarity regarding ethics, boundaries, and the nature of the therapeutic
contract (9)
(ii) A shared love of the profession of psychotherapy and for [the place we
work] as an institution (17)
(c) Shared cultural interests
(i) In the performing or visual arts (11, 17)
(2) Respondents who perceived compatibility because of differences between their own
and their therapist’s personality style: [n=5] (1, 3, 5, 7, 16)
(a) Perceived complementarity of personality traits, which helped participant feel
more emotionally contained and better able to modulate intense affect
(b) Complementarity o f personality, which lowered participant’s inhibitions and
usefully encouraged exploring and expressing affects in treatment (5, 7, 16)
(c) Therapist’s quietness helped participants find their own voice (1, 16)
(d) Forcefulness of therapist’s character usefully modeled a self-assurance with
which participant identified (5, 7)
327
(3) Respondents who perceived that they were compatible, despite the differences
between their own and their therapist’s personality style: [n=10] (4, 6, 8, 10, 12, 13,
14, 18, 19, 20)
(a) The differences in personality style perceived as benign to the therapeutic
process: (8, 12, 13, 14, 18, 19, 20)
(i) Analyst perceived as extroverted, participant perceived as introverted (19)
(ii) Reserved, stoic analyst, participant perceived self as animated and self-
revealing (8, 12)
(iii) Analyst from different part of country, different ethnic culture from
participant (15)
(iv) Analyst perceived to be from wealthier, more culturally sophisticated
background than participant (18)
(b) The differences in personality style perceived as increasing the participant’s
resistance to the treatment enterprise (4, 6, 10)
(i) Therapist perceived as overly rigid, based on inexperience as an analyst (6)
(ii) Therapeutic techniques perceived as too withholding (4)
(iii) Therapeutic techniques perceived as too supportive (10)
4. (4.) Do you sometimes find yourself thinking about your therapist, or wishing to
talk with your therapist? If so, under what circumstances?
(1) Respondents who report ambivalence in thinking about, or wishing to talk with their
therapist: [n=4] (2, 9, 11, 16)
(a) Prematurely terminated (11, 16)
(i) Participant made career move; participant angry with therapist; unresolved
erotic transference (16)
(ii) Therapist made career move (11)
(b) Former therapist forced involuntarily from institution (2, 9)
(i) Resulted in conflictual feelings for participant regarding maintaining
postanalytic contact
(2) Respondents who reported thinking about and wanting to talk with their former
therapist, primarily about matters of professional practice: [n=6] (1, 3, 4, 5, 12, 18)
(a) During times of clinical uncertainty, wondering what would former therapist say;
drawing internally on a helpful mini-session with former therapist (4, 5, 12, 18)
(i) Only one participant in this group had, in fact, spoken with her former
therapist about clinical dilemmas, posttermination (5)
(ii) Have significant ongoing postanalytic contact with former treater (5, 12)
(iii) Returned for a one-time clinical consultation at time o f personal relationship
crisis (18)
(3) Respondents who reported thinking about and wanting to talk with their former
therapist primarily about matters of personal life: [n=10] (6, 7, 8, 10, 13, 14, 15, 17,
19, 20 )
(a) What respondents wish to talk with their former therapist about, posttermination
(6, 7, 8, 10, 15, 19, 20)
(i) Primarily, personal issues
(a) Marital relationship issues (15)
328
(b) Developmental stage issues, including child-rearing concerns, death o f

elderly parent (6, 8, 19)
(c) Situational crises, such as “emotional struggles,” health-related crises (7,
8, 20)
(ii) Secondarily, professional issues
(a) Reporting to former analyst how a legal problem got resolved (6)
(b) Career development or change issues, such as job changes, retirement
plans (7, 10,15)
(iii) Posttermination psychological change is a continuing process (19)
(b) What respondents did talk about with their former therapist, posttermination (7,
10, 13, 14, 17)
(i) Primarily, personal issues
(a) Marital relationship issues (10)
(b) Developmental “growth” issues, that is, becoming a grandparent,
purchasing a new home (7)
(c) Situational crises, such as difficulty with pregnancy (14)
(ii) Secondarily, professional issues
(a) Collaborating on clinical treatment of patients (13)
(b) Contacting former treater for informal consultation on systemic,
organizational issues at work (13)
(c) Being in a common analytic study group with former treater (17)
(iii) Posttermination relationship with former treater is an evolving process (17)
4. (5.) In your conduct of psychotherapy, do you ever engage in an internal dialogue

with your therapist? If so, under what circumstances?
(1) Respondents who replied that they have engaged in an internal dialogue with their
former therapist while conducting psychotherapy: [n=4] (3, 5, 12, 15)
(a) Dialogue occurs when feeling uncertain about patient’s material and wondering
what former therapist would say to patient (5, 12, 15)
(b) When patience is needed, with letting therapeutic process unfold, thoughts of
dialoguing with treater (12, 15)
(c) When patient’s material touches very closely to participant’s dynamic issues,
internal dialogue occurs (3, 5)
(i) Evoking therapist’s help “to say the right thing” to patient feels like a
spiritual, primary process connection of all three of unconsciouses (5)
(ii) In discussing now, I see a new connection between what my analyst was
trying to tell me about myself and what I’ve been telling my patients with
similar dynamics to my own (3)
(d) Thoughts of former analyst come to mind more when considering his ego-ideals
and who has influenced them versus when in sessions with patients (15)
(e) Internal dialogue as an evolving, only partially conscious process,
posttermination (15)
(2) Respondents who report not having consciously engaged in an internal dialogue with
their former treater while conducting psychotherapy, but describe other psychological
relatedness to former treater during sessions: [n=10] (1, 4, 6, 8, 9, 10, 13, 16, 17, 19)
329
(a) Identified with former therapist’s careful clinical listening and therefore do not
focus on a separate dialogue while with patients (16, 19)
(b) Self-analytic function of understanding transference-countertransference
paradigms is directly connected to former analyst (10)
(c) Experience “verbal memories” of former therapist during clinical sessions (1,8,
9, 13)
(i) Remembering what former analyst said; “using his words” (9, 13)
(ii) Content of memory: appreciating the power of the analyst’s simple
statements = a good clinical model (8)
(iii) Important that interpretations be made from a feeling o f support of patient,
versus critical of patient (9)
(iv) “It’s an experience of capturing the feeling tones of words, rather than
recalling concrete incidents-it’s interwoven into how I work and think” (1)
(3) Respondents who reported not presently engaging in an internal dialogue with former
therapist while conducting psychotherapy, but believe they might have in past: [n=6]
(2, 7, 11, 14, 18, 20)
(a) Left with no specific, subjective recall, but “a dim sense” (2, 7, 11, 14, 18, 20)
(b) Theoretically, it might have happened during times of clinical uncertainty (2, 14)

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Bell & Howell Information and Learning

A dissertation submitted in partial fulfillment o f the requirements for the

Smith College School for Social Work

UMI Microform 9945612

This microform edition is protected against unauthorized

The completed product of any dissertation is the creation of numerous

an awareness o f the often subtle, sometimes profoundly experienced influences of personal

proven personally enlightening beyond my expectations.

offered a universal resonance with the poignancy of struggling toward psychological

The dissertation committee members each provided an invaluable function.

psychological space to struggle productively with the essential aloneness of dissertation

research design, without ever imposing his ideas.

and her generosity are appreciated beyond words.

I wish to thank my therapist friends who have thoughtfully encouraged my

Ruggles, M.S.W., Nancy Jones, M.S.W., and Peg Donley, M.S.W.

and AnnMarie Glodich, Ph.D.

Thanks to Menninger colleagues who have provided invaluable input and

encouragement in reading parts o f the manuscript or advising about data analysis-Mary Jo

interest, my thanks also go to Kathryn Zerbe, M.D.

Appreciation is extended to Judy Kash and Marcy Schott of the Menninger

Aleta Pennington for typing near perfection.

To Gerry Schamess, M.S.S., Professor, Smith College School for Social

as a social work mentor in both clinical work and scholarship.

our work together-truly were “good enough.”

supporting me as I followed my dream, even when it meant sacrificing parts o f our

You are all invited to share in this moment.

Table 2: Perceived Benefits o f Personal Therapy Compared with

Table 3: Perceived Risks of Personal Therapy Compared with

Table 4: Perceived Overall Effectiveness of Personal Therapy

Table 5: Perceived Interpersonal Relationship and Posttermination

Table 6: Gender and Professional Affiliation of Participant and

Table 7: Professional Affiliation and Level of Perceived Influence................................ 254

Table 8: Variables Related to Time Conducting Psychotherapy,

This qualitative study explored psychotherapists’ perceptions of the influence of

oriented therapists were interviewed in single audiotaped interviews. Participants included

from their most recent personal therapy.

promoting psychological change, valued their former therapist as a professional role

high level-of-influence group. The working through of negative aspects o f both

termination phase of personal therapy was especially important to the fate of

internalization o f the treatment relationship. To contextualize the findings, clinical practice

characteristics and personal treatment history variables of participants are presented.

actively addressed by the treatment dyad.

Statement of the Study Issue

The purpose of this exploratory study was to examine psychotherapists’

practice as a psychotherapist. This project explored, through interviews, the personal

psychotherapy experience o f multidisciplinary psychodynamic psychotherapists. The intent

influential internalized relationship. Hence, aspects of the perceived interpersonal

evidence of enhanced professional effectiveness (Greenberg & Staller, 1981), to the

concepts and to measure change in therapists’ personal functioning as a result o f personal

for seeking help.

the personality and interpersonal adjustment of the psychotherapist or trainee.

personal psychotherapy process (Deutsch, 1985; Nierenberg, 1972). Impairments viewed

as potentially amenable to personal therapy include personality or intrapsychic difficulty,

symptoms o f addiction, sexual boundaty violations, interpersonal problems, and problems

reflective, insight-oriented group of individuals is not only a source of motivation for

psychodynamic psychotherapists (Prochaska & Norcross, 1983). Notwithstanding the

Controversy surrounds whether personal therapy affects the psychotherapist’s

professional competence. Do therapists who have sought personal psychotherapy function

evidence of a continuum o f influence of personal therapy in the therapist’s future clinical