Becoming a psychodynamic psychotherapist: a study of the professional development during and the first years after training

Abstract: Aim: The four studies reported in this thesis aimed to explore the professional development of psychotherapists from their training through the first few years after graduating by using longitudinal data from a Swedish training setting, and secondarily to develop and standardise an instrument measuring therapeutic attitudes. Instruments: The therapeutic identity questionnaire (ThId), the therapeutic attitudes scales (TASC-2), and semi-structured interviews. Material/Methods: A random sample of Swedish psychotherapists (n=325) and a pool of therapists with patients in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPPP) (n=294) were given the ThId questionnaire to develop and standardise an instrument measuring therapeutic attitudes. The study group, psychotherapy students (n=46) in advanced psychodynamic psychotherapy training programme, received the ThId at programme entry, after 2 years, at graduation and 3 to 5 yrs later. Only those who answered at all four occasions (n=21) were included in the analyses. Further, 18 of these students also completed a retrospective semi-structured interview of their development of the professional self. Results: Nine therapeutic attitude scales (TASC-2) were extracted from ThId and validated. During and after training, students rated clinical work, supervision and personal psychotherapy as the top three influences in their professional development. Conversely, the importance of personal experiences and theoretical study varied across time. Concerning assets as a therapist, most changes occurred after training, with a shift towards describing an ability to create patient contact and alliance as a greater asset than listening and containing, which predominated during training. Self-described limitations did not change substantially during or after training. Concerning the effects of training on attitudes and values, students stayed close to their teacher’s and psychoanalytical cluster’s profile during training then began developing an eclectic psychodynamic profile after graduation. Interviews identified a core category called ‘‘searching for recognition”, indicating their primary concern all along to become acknowledged as psychotherapists in their own right. During training, they sought their supervisors' acknowledgment of their pre-formed professional self. In their early professional careers participants experienced having achieved recognition and a resultant a sense of freedom to exercise independent judgment. Conclusions: The present work is the first to use a longitudinal design to study the professional development of psychotherapists during advanced training and the first few subsequent years. Student trainees had a rigid psychotherapeutic identity and were motivated by a desire to achieve acknowledgment from their supervisors. This led to conflicts in supervision, which students typically handled by conforming to the supervisors. Training had a conformative effect rather than encouraging the development of an individualised therapeutic style. However, soon after graduation, the former students experienced an increased sense of freedom and moved towards an eclectic psychotherapeutic identity. Training institutes, the teachers and supervisors, should acknowledge the students’ “attachment to the pre-formed professional self” and “search for recognition” in order to avoid a learning environment dominated by student complying as a least line of resistance.