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Psychological Reports, 1976, 39,491-498.

@ Psychological Reports 1976

TRAINEES' IMPRESSIONS OF PSYCHOTHERAPY


AND PSYCHOTHERAPISTS
WILLIAM G. HERRON
St. John's Uniuersiry
Summary.-128 advanced graduate students in clinical and school psy-
chology programs were administered incomplete sentences to determine their
impressions of psychotherapy and psychotherapists. The main concern of the
psychology students was improving the results of the psychotherapies. They
considered the therapist's personality the major vehicle for doing this, though
attention was also given to cognitive factors. Some comparisons were made with
practicing psychiatrists. Psychologists tended to have negative attitudes toward
institutional work and positive attitudes toward private practice. T h e consistent
concern with the effectiveness of the psychotherapies suggested a need for prac-
tical research and for opportunities for emotional growth and self-understanding,
as well as the probability that one major learning experience i n their training
has been to question and seek better ways of doing their professional activities.

Emphasis has frequently been given to the need for awareness and under-
standing of attitudes about psychotherapy and psychotherapists on the part of
actual and potential therapists, though documentation of such attitudes has been
limited. Recently, Daniels ( 1974) focused on the concerns of 152 psychiatrists
using 18 incomplete sentences as the measuring instrument. She hypothesized
that three major problems would be reported: Feelings of isolation, concern
about image or status and concern about effectiveness of treatment. She also
thought there would be a difference between private and organizational psychia-
trists in regard to these problem areas. In order of greatest frequency the five
major themes that emerged were negative personal characteristics of colleagues,
personal strains caused by the work, status and image problems, isolation, and
worry about the effectiveness of treatment. Contrary to expectations, no themes
differentiated between the two types of psychiatrjsts, and effectiveness of treat-
ment was the least frequently mentioned of the five themes.
The present study expanded the area of coverage from a discipline, psychia-
cry, to rhe area of practice, psychotherapy. The purpose was t o discover what
are the attitudes of potential psychotherapists regarding psychotherapy and
psychotherapists. Also, since the sample was composed of graduate students in
psychology, some comparison with practicing psychiatrists was possible.
METHOD
The attitudes were measured by a 20-item modification of the incomplete
sentences used by Daniels (1974). The differences from the Daniels' stems
consisted of substituting the words "psychotherapist" or "psychotherapy" for
"psychiatrist" or "psychiatry" and the addition of two items, Nos. 6 .and 19.
Otherwise the intent and language is the same as the original. These were
administered to 128 advanced graduate students in clinical and school psychology.
492 W. G.HERRON

There were 76 men and 52 women. Their average age was 28 yr., and 92 of
them were currently in therapy and 72 were currently doing psychotherapy.
All declared their intention of ultimately practicing psychotherapy. The average
amount of time they had been practicing was 1 yr., while their average time in
therapy was 2 yr. Thus they were newcomers to the field, both in terms of being
therapists and patients. None were in private practice.
Each subject was required to answer all the items. Where more than one
idea was expressed, the first one only was counted in the tabulation. Every
item was then classified in terms of the themes expressed by the responses. In
the classification an attempt was made to establish general categories and so
limit the number of themes. Two raters were used, and where there was doubt,
a third so that the themes represent a consensus of judgment though some of
the subtlety of the responses has been lost. The items and the number of re-
sponses according to theme are presented below.
RESULTS
1. T h e most important thing for the future of psychotherqy . . .
Three themes appeared. The most frequent ( 5 2 ) was a concern with
getting better results, closely followed by improving training (40) and political
issues (36) as regulation of the field. These three themes are related and tend
to focus, both in training and political issues, on achieving good or better results
through psychotherapy than are gotten currently. These responses set a pattern
for what followed, a consistent concern about effectiveness.
2. A psychotherapist shozlld be careful . . .
Three themes appeared. By far the most prevalent was a concern for
therapists' personality characteristics (80) which would interfere with effective
therapy. Then, there was mention ( 3 2 ) of correct application of theory as well
as possible problems presented by some patients (16). The therapist was most
often cautioned against "countertransference" and the three themes again re-
lated to achieving effective results.
3. Most patients think of the psychoth,~ rp'aat a s . . .
Four themes occurred. The major one (84) was the belief chat most pa-
tients see their therapist as a powerful helper, followed by a warm friend ( 2 8 )
and a parent (12, and interestingly never a mother specifically). Four people
had the minority theme of the therapist as "weird," but the overwhelming image
was positive. While these images are distinct, they would not have to be ex-
clusive of each other. The frequent mention of the powerful helper theme
reiterated the concern with results.
4. Compared to what I thought a career in psychotherqy would be like, I hnue
found o u t . . .
Four themes appeared. The first was that the career was harder, more
complicated than expected ( 4 8 ) , followed by it being better than expected ( 4 4 ) ,
IMPRESSIONS OF THERAPY/THERAPISTS 493

as more rewarding and exciting. Twenty people experienced it as they had


expected, while 16 were disillusioned. The major impression was that the career
is indeed worthwhile though exacting. Disappointment was the least frequent
reaction.
5. One thing yo% never get i n psj~chotherapy.. .
The most prominent theme was that therapy is a partial solution (72)
rather than a panacea. Following this, specific positives were stressed ( 3 6 ) , as
excitement and truth, and then negatives were mentioned ( 2 0 ) , as cost and
length. Despite the loading of the sentence stem in a negative direction, psycho-
therapy was perceived positively, though emphasizing the limits of its power.
6. One thing that psychotherapists have i n common. . .
The major theme was insecurity and uncertainty ( 6 0 ) , followed by moti-
vation to help others ( 32 ), effectiveness ( 2 0 ) , and some negative characteristics
(lG), as grandiosity. The uncertainty pertained to the ability to be effective,
as did the other themes in varying ways.
7 . One thing that psychotherapists practicing i n institzrtional settings seem to
have in common. . .
The overwhelming theme was that such therapists are inadequate ( g o ) ,
including both their ability and their attitudes. Following this were criticisms
of the system (28) which contributes to the first theme. Then some mention
( 2 0 ) . was given to positive characteristics, including both the opportunities for
particular learning experiences as well as therapists giving of themselves in
special ways. While all of the current students who were therapists practiced
in such settings they were negatively impressed and saw institutions as expedient
way stations to a different mode of practice, illustrated in the next item.
8. One thing thdt psychotherapists i n private practice seem to have i n com-
mon. ..
Private practice was pictured as the desirable goal for most of these students,
who stressed both the positive aspects of freedom and money ( 7 2 ) as well as
considering such practitioners better trained and more effective ( 4 0 ) . Prob-
lems were mentioned by 16 respondents, and isolation as a problem by only four
of these. The lure of money, while definitely there (32 of the respondents),
was secondary to the attraction of being free to practice as one saw best.
9. Psychotherapists would perhaps be better o f f . . .
Reassessment of their therapeutic abilities was the most frequent theme
(48) followed by improved training ( 2 4 ) , personal therapy (20), development
of a better public image (20) and then finally, the development of interests
outside of therapy ( 1 6 ) . The major concern, then, appeared to be with thera-
peutic effectiveness, though this involved supervision and discussions with col-
leagues as some of the means for improvement ( l o ) , which relates to the
problem of isolation found in the study of psychiatrists.
494 W . G. HERRON

10. Being a psychotherapist i s like . . .


The concept of a relationship was most frequently mentioned, either as a
transference figure ( 4 0 ) , or in a special sense, as a friend ( 3 6 ) . This was
followed by a focus on therapeutic objectives ( 2 4 ) . Then doing therapy was
pictured either as a struggle ( 2 0 ) , or, less often, fun ( 8 ) . The transference
figure was seen as a father or parent, but never as a mother, and the sex of the
friend was not designated. It appears that regardless of the sex of the patient
(or the therapist), therapists are most often pictured as men.
11. T h e trouble w i t h most psychotherapists . . .
The major reaction was to personal characteristics ( 7 6 ) , as a lack of self-
understanding. This was followed by technical errors ( 4 0 ) , as being too
directive, many of which are related to the first theme. Two other minor themes
appeared; that therapists have no problems ( 4 ) and that they treat only middle-
class patients ( 8 ) .
12. T h e nature of t h e psychotherapy profession is such that . . .
The major response was that the work is both demanding and rewarding
at the same time (44). However, there was considerable emphasis on the need
for more stringent requirements to be a practitioner ( 3 6 ) , the lack of clarity
and precision in the work ( 2 8 ) as well as the limited number of training oppor-
tunities ( 1 2 ) . A minority ( 8 ) saw the field as unproductive.
13. My colleagues . . .
The main themes represented positive impressions of colleagues. These
included personal characteristics (45), as dedication, professional competence
(20) and sharing similar views ( 2 0 ) . The theme of isolation was relatively
infrequent ( 12 ) as were negative attributes ( 1 6 ) .
14. I n order t o get t h e most out of being a psychother@ist . . .
The major theme here was further development of the therapist, most of it
focused on the therapist's personality ( 104), such as self-improvement without
specifying the method ( 4 0 ) , personal therapy ( 32 ) , and personal experiences
(32). The secondary emphasis was on intellectual improvement (24), as
further scudy.
15. It i s important t o b e the kind of a psychotherapist . . .
The major attributes that were considered important were that therapists
have feelings for their clients ( 5 2 ) and be competent ( 5 2 ) . While these
appeared as separate categories they implicitly overlap. A lesser theme was
utilizing freedom to practice as one desired ( 2 4 ) .
16. T h e most influential people in psychotherapy
Six themes were apparent. Personal competence as a therapist was con-
sidered the major influential factor ( 4 4 ) , followed by particular orientations
( 3 2 ) , as psychoanalytic. The other categories were political activity ( 2 0 ) ,
IMPRESSIONS OF THERAPY/THERAPISTS 495

patients ( 12 ) , personal models ( 12 ) , and finally the pessimistic impression


that the influential people in the field have not contributed much that is new or
useful ( 8 ) .
17. W h a t alznoys m e about psychotherapy . . .
The limitations of the process were stressed (56) as its length, followed
by therapist inadequacies ( 3 2 ) , as disinterest. Then mention was made of the
difficulties in learning to do it ( 2 0 ) as well as public misunderstanding of the
process ( 20).
18. In psychotherapy it is best t o be thought of a s . . .
The focus here was on effectiveness, the most frequent and consistent gen-
eral response pattern to all the items. Emphasis was given to personal charac-
teristics of the therapist ( 5 2 ) , as acceptance, followed by taking a particular
role ( 4 4 ) , as father figure, and then competence ( 3 2 ) , as well-trained.
19. 1%psychology it i s best t o be thought of as . . .
The major theme was intellectual capability ( 5 6 ) , then research ability
( 4 0 ) . Minor themes were particular identities ( 2 0 ) , as a clinician, and a real
person ( 1 2 ) .
20. W h e n a psychotherdpist seems extremely interested and concerned about t h e
welfare of a particular patient . . .
Responses here were almost evenly split between the concern that counter-
transference was operating ( 6 8 ) to harm the therapy, and the belief that the
therapist was acting in a way that would ensure success ( 6 0 ) .
DISCUSSION
The respondents' primary attitude toward psychotherapy is that it needs to
be more effective. Apparently as they perceive and experience it, the process
is a help rather than a cure and has its share of failures. In the light of research
evidence on the effectiveness of the psychotherapies (Strupp & Bergin, 1969),
their view seems to be markedly realistic. For some of the patients, some of the
time, it works (Herron, 1974, 1975), but the students want more than thac.
There is little pessimism in their responses, but instead a concern for how
the results of psychotherapy could be improved. Problems are mentioned, as
length, cost, and the demanding nature of the procedures on both therapist and
client. However, the respondents are both interested in and committed to h e l p
ing people through the diverse procedures that make up the psychotherapies.
The personality of the therapist is seen as the most vital feature for facili-
tating the process. Therapists are urged in turn to improve themselves through
gaining greater self-understanding, personal analysis, and peer review. While
other aspects of psychotherapy are not ignored, the principal burden of achieve-
ment is placed upon the person of the therapist. The attitude seems to be thac
it is the person more than the theory or the method that is the essence of suc-
cessful psychotherapy. The impression is that therapists need to have (or de-
velop) and maintain characteristics that facilitate an emotional atmosphere for
a relationship useful to both patient and therapist. This is in line with the
recent conclusion of Raskin (1974) that, while different experts do practice in
different ways, there is agreement as to the greater importance of experiential
as compared to cognitive aspects of therapy, and that personality characteristics
of the therapist are more vital than techniques.
At the same time, attention is given to features such as training, technique,
type of patient, and theory so that the students appear aware that an integrative
learning process is a probable answer to increasing the efficiency of psycho-
therapies. The respondents' emphasis is at the moment on the therapist's per-
sonality, much in the tradition of valuing classical positives as warmth and
empathy. Yet there is sufficient concern with additional parts of the process
to suggest a tendency toward a complex solution to the question of how do we
make psychotherapy better. This is congruent with the complexity of the sug-
gestion that comparisons of therapeucic effectiveness should take into account
the interaction of variables such as therapist type (A-B), amount of experience,
location and type of treatment program, therapeucic modalities and durations,
desired changes, patient types, symptoms, socioeconomic status, and sex (Heaton,
Carr, & Hampson, 1975).
A striking finding here is that, while none of these students are in private
practice and those who work are employed by institutions, they have a strong
negative response to both people who work in institutional settings and the
settings. In contrast, they picture private practitioners as the most competent
and successful therapists. Part of the attraction is financial, but most of it is the
perceived freedom of the private practitioner. In the Daniels (1974) sample
where there were both private and institutional practitioners, no attitudinal
differences appeared.
Also, in the Daniels study the most frequent theme was negative personal
characteristics of colleagues. The subjects in the present study viewed their
colleagues favorably. For them it seems that colleagues are more often fellow
students rather than other workers at thzir institutions. The students are going
through many similar shared experiences and have a limited awareness of what
may lie ahead of them. Major personal problems in doing psychotherapy are
seen as uncertainty and insecurity, and coupled with their concern about thera-
peutic effectiveness, they may be reflecting the questioning process that is part
of training as well as a lack of the complacency that can creep in after doing
therapy for a time.
The subjects in the Daniels study were more experienced practitioners who
showed concern with image, status and personal strains that are more apparent
after some years of practice. They could have felt themselves in competition
with their colleagues as workers more easily than the students, some of whom
IMPRESSIONS OF THERAPY/THERAPISTS 497

were not even working in the field as yet. Also the lack of negative feelings
about institutions and institutional work among the psychiatrists, and the
presence of such feelings among the psychologists, could reflect a better role in
institutions for psychiatrists. The psychologists appear to view such work as
a temporary situation to be tolerated, until a private practice is established,
while the psychiatrists may see it more as an integrated part of their permanent
occupacional situation.
Several issues in regard to the perception of the therapist bear further in-
vestigation. One is the degree of power a therapist actually has and what are
the ingredients of this power, for here the frequent image of the therapist is as
"the powerful helper." Then, there is the sexual role assigned to the therapist.
When given a sexual identity, it is always male. This may be cultural stereo-
typing or the fact that there are more male than female therapists in the field.
Another possibility is an unexplained but consistent tendency to see therapists
as males regardless of the sex of the client or therapist.
Another concern is the degree of congruence between the role of the
psychologist, which is the students' pathway to work, and the role of the psycho-
therapist, which is the desired specialty. The effectiveness of the psychologist
is thought to rest upon intellectual and research capabilities, while the stress in
regard to therapists' effectiveness is on personality characteristics. This creates
the possibility of dissonance which results, in my opinion, in many graduate
students in clinical and school psychology wanting more professional preparation
but enduring an academic atmosphere. A large part of what is desired, and
seems to be missing from current training, is ways for the student to learn about
his or her self and to apply this learning by interacting with clients.
Ac the same time there is an overwhelming concern about the effectiveness
of therapists and therapy, both obvious research questions that have been probed.
W e are not without research in thcse areas, but it is difficult to do considering
the number of variables involved. Consequently answers are often tentative
(though not always so stated). A further problem is that many if not most
practitioners do not bother with research in the formal sense, although they are
constantly seeking answers. My impression is that approaching the research
aspect of training in ways other than the usual (and I do not necessarily mean
developing more sophisticated designs or teasing out one more number) would
increase involvement by practitioners.
REFERENCES
A. K What troubles the trouble shooters. In P. M. Roman
DANIELS, & H. M. Trice
(Eds.), The sociology of psychotherapy. New York: Aronson, 1974. Pp. 191-214.
HEATON,R. K., CARR,J. E, & HAMPSON. J. L. A-B therapist characteri5tics vs. psy-
chotherapy outcome. Journal o f Nervous and Mental Disease, 1975, 160, 299-309.
HERRON,W. G. The power of psychotherapy: a reply to Hurvitz. Joimzul of Con-
sulting and Clinical Psychology, 1974, 4 2 , 298-300.
498 W. G. HERRON

W. G. Further thoughts o n psychotherapeutic deprofessionalization.


HERRON, Journal o f
Humanistic Psychology, 1975, 15, 65-73.
RASKIN,N . J. Studies of psychotherapeutic orientation: ideology and practice. Re-
search Monograph o f the American Academy of Psychotherapists, 1974, 1, 3-44.
STRUPP, H. H., & BERGIN,A. E. Some empirical and conceptual basis for coordinated
research in psychotherapy: a critical review of issues, trends and evidence. Inter-
national Journal o f Psychiatry, 1969, 7, 18-90.

Accepted June 25, 1976.