Personal Psychotherapy as a Self-Care Strategy for Psychotherapists-in-Training

Numerous authors have highlighted the many challenges and stressors experienced by graduate students in clinical and counseling psychology throughout their training (e.g., Harder, 2024; Prakash et al., 2023; Sosoo & Wise, 2021) and that “given the multiple demands and expectations for students in professional psychology programs” some level of stress is an inevitable part of this training (Colman et al., 2016, p. 194).

Challenges, Demands, and Stressors for Graduate Trainees

For some, this may involve transitioning to a new city and academic environment, all while leaving existing support systems to cultivate new personal and professional relationships.

In addition to these social and environmental changes, trainees must manage financial burdens associated with pursuing their education. As a result, many students may need to maintain employment during their training, resulting in additional time constraints, or may be obligated to take out substantial loans. These pressures, coupled with academic and clinical demands and expectations, can create a very challenging and stress filled experience for graduate trainees. El-Ghoroury et al. (2012) found that graduate students report numerous stressors “that interfered with their optimal functioning” (p. 122). These include academic requirements to include both rigor and quantity, financial limitations and anxiety associated with increasing debt, and ongoing challenges with maintaining some semblance of balance in their lives between academic/work obligations and personal life/self-care.

Additional stressors experienced by graduate trainees include managing ongoing evaluation and feedback from supervisors, professors, and peers, as well as meeting supervision and research obligations (Harder, 2024). Shen-Miller et al. (2011) also describe program dynamics to be a potentially contributory factor to the stress trainees experience. These may include a “perceived need among trainees to uphold images of perfection” (p. 114), feeling that they are constantly being evaluated, lack of programmatic support, and what Barnett and Cooper (2009) describe as a lack of a culture of self-care within one’s graduate program. Many graduate students are reported to experience difficulty effectively coping with these challenges and stressors (Shen-Miller et al., 2011) and with all of the above in mind, it should not be surprising that graduate training is typically found to be the most stressful time period across the career span of psychologists (Schwartz-Mette, 2009).

As a result of these myriad considerations, trainees are especially vulnerable to stress, distress, and burnout, which may result in trainee mental health difficulties. While distress is a common experience in response to ongoing stressors in one’s environment, failure to adequately attend to and manage distress may result in the development of symptoms of burnout (Baker, 2003). Burnout manifests as a psychological syndrome stemming from chronic interpersonal stressors in the workplace, which leads to diminished well-being and compromised professional performance (Maslach & Leiter, 2016). Burnout results in various consequences, both personal and professional, including the possibility of physical deterioration, insomnia, interpersonal conflicts, reduced work efficacy, and escalated substance use as a maladaptive coping strategy (Stevanovic & Rupert, 2004).

Clinical Competence for Graduate Trainees: An Ethical Obligation

Due to the nature and significance of their work, graduate trainees must address their personal mental health needs. This tenet is outlined in the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (Ethics Code, APA, 2017), in which students attend to the possible impact of their “physical and mental health on their ability to help those with whom they work” (Principle A, Beneficence and Nonmaleficence) and the need to attend to “personal problems that may interfere with their performing work-related duties adequately” (Standard 2.06, Personal Problems and Conflicts). This ethical responsibility helps to ensure the maintenance of clinical competence, which is defined as the knowledge, skills, attitudes and values, judgment and decision-making, and the ability to access and apply them effectively for the benefit of the client (Elman & Forrest, 2007). Given that graduate students are providing professional services to clients, such as psychological evaluation and treatment interventions, they must maintain their competence. Consequently, they must engage in the ongoing use of effective self-care strategies to mitigate against the potentially negative effects various stressors and their impact may have on one’s effective functioning (Coleman et al., 2016).

Personal Psychotherapy as a Self-Care Strategy and Its Benefits for Graduate Trainees

Personal psychotherapy serves as a potentially beneficial self-care method for graduate students to decrease instances of burnout and increase their competence (Orlinsky et al., 2011). Among its vast benefits, psychotherapy can offer graduate students an invaluable outlet to process the extensive demands and responsibilities of their training. In a supportive, non-judgmental, confidential therapeutic space, trainees may feel especially comfortable to openly discuss their experiences. Research shows that personal psychotherapy increases an individual’s self-awareness and ability to moderate their emotions effectively, skills that are essential to being a capable and effective trainee and future psychotherapist (Baker, 2003). Moreover, personal psychotherapy can provide graduate students with firsthand knowledge of what clients experience, which has many advantages. For example, psychotherapy can serve as an exceptionally beneficial training tool, enhancing a trainee’s capacity for empathy and the ability to understand the client’s perspective (Jite-Ogbuchi, 2017). Thus, personal psychotherapy can enrich the development of both personal and professional competence of a psychotherapist in training.

Numerous studies highlight the promising outcomes of psychotherapy. A review of relevant studies can be found in the American Psychological Association’s statement on the recognition of psychotherapy effectiveness (APA, 2013). Bennett-Levy (2019) delved into pivotal practices, such as personal psychotherapy and self-reflection, that contribute to the cultivation of effective psychotherapists. Among the array of benefits, these practices have been shown to enhance interpersonal and personal qualities, refine and advance therapists’ technical skills, and foster improvements in well-being and enhanced conceptual skills—all of which are profoundly valuable to the work of a psychotherapist (Ziede & Norcross, 2022). These findings demonstrate the multifaceted advantages of integrating psychotherapy into the self-care practices of psychotherapists-in-training.

Recommendations for Alternative Self-Care Practices for Graduate Trainees

Acknowledging the potential barriers to accessing ongoing personal psychotherapy, including financial and time constraints, confidentiality concerns, and stigma surrounding mental health services, it becomes evident that graduate students may benefit from alternative practices. One such intervention is the Mood Lifter for Graduate Students (ML-GS), a novel biopsychological approach where students participate in weekly, peer-led psychoeducation meetings. Research has shown this low-cost alternative offers significant reductions in students’ depression, anxiety, and perceived stress ratings following this protocol, with results maintained at 1-month follow-up visits, underscoring the effectiveness of ML-GS as a suitable treatment for graduate students. Such an intervention should be seen as a valuable addition to other self-care practices engaged in by graduate students. It should not be seen as a replacement for other effective ongoing self-care practices such as spending quality time with friends and family, participating in physical activities, and leisure pursuits that can further support overall well-being (Stevanovic & Rupert, 2004).

Removing Obstacles of Self-Care for Graduate Trainees

As part of promoting a culture of self-care, graduate programs (through their administrators, faculty, and supervisors) can take concrete steps to support the use of personal psychotherapy by trainees and to reduce or remove barriers and obstacles that many trainees may experience.

Reducing Stigma

Educators and trainers may reduce stigma, as well as potential feelings of embarrassment and shame, through ongoing discussions about the role and importance of personal psychotherapy for trainees and practicing professionals alike. These discussions may occur in clinical supervision and in relevant courses such as ethics and psychotherapy courses.

Valuing Personal Psychotherapy

Through open discussion and appropriate self-disclosure, supervisors and faculty members may help normalize personal psychotherapy as a common, appropriate, valuable, and even essential practice for psychotherapists and psychotherapists-in-training.

Reducing Financial Barriers

Training programs should acknowledge financial barriers and constraints faced by students and offer access to reduced fee or free psychotherapy services. One method for doing this is to have past graduates of a program offer these services to current students with the understanding that these current student clients will ‘pay it forward’ by providing such services to future students in the program once they are licensed professionals. Graduate programs may also enlist practicing professionals in the local community to provide reduced fee psychotherapy to students and provide students with a list of these professionals, keeping this list updated each year.

Laying the Foundation for A Career as a Psychotherapist

Embarking on a career as a psychotherapist can be deeply fulfilling, yet it also presents significant demands and challenges beginning at the training phase. Therefore, it is crucial to proactively explore and adopt effective interventions to address potential adverse outcomes faced by trainees. While significant evidence exists to support the use of ongoing self-care activities in general (e.g., Colman et al., 2016), the use of personal psychotherapy as an important self-care activity should not be overlooked by graduate trainees. Beyond being an important strategy for meeting the ethical obligation to maintain one’s competence, it is essential that future psychotherapists see personal psychotherapy as care for oneself both personally and professionally. It is also hoped that attention to this important issue in graduate school will contribute to the establishment and development of the attitudes, values, and practices associated with of one’s professional identity as a psychotherapist.