A recent study has found that psychotherapy trainees often experience a mix of positive and negative emotions in their work, highlighting the dual challenges of stress and engagement during their training. Researchers explored the contrasting dimensions of “healing involvement” and “stressful involvement” in trainees, revealing complex patterns of their experience. The findings were published in the journal Counselling & Psychotherapy Research.
Healing involvement (HI) refers to the level of positive engagement a trainee experiences while working with patients. It reflects their ability to interact effectively, maintain interest in the therapeutic process, and navigate difficulties constructively. In contrast, stressful involvement (SI) indicates the extent to which trainees struggle with therapy-related challenges, including feelings of anxiety, boredom, or frustration, which can lead to non-therapeutic coping behaviours.
The study, conducted as part of the SPRISTAD project, surveyed 454 psychotherapy trainees from various countries, primarily in Europe. The trainees’ experiences of providing therapy were assessed, and the findings revealed that these two dimensions – healing and stress – are both intrinsic to the therapeutic journey, although they manifest to different degrees across individuals.
Four distinct patterns of therapeutic involvement were identified among the trainees. Half of the participants were found to have an “effective practice” profile, characterised by high healing involvement and low stressful involvement, suggesting that they were effectively managing the demands of therapy while remaining positively engaged.
On the other hand, a significant proportion of trainees faced challenges. About 12% experienced a “Challenging Practice” with high levels of both Healing and Stressful Involvement, indicating they were highly engaged but also under considerable stress. Another 12% fell into the “distressing practice” category, which involved low healing involvement and high stress – reflecting significant struggles without the reward of feeling effective. Finally, 26% had a “disengaged practice”, experiencing low levels of both healing and stress, which may point to a lack of engagement in their therapeutic work.
The study also examined factors that influenced the levels of Healing and Stressful Involvement. Personal characteristics like age, life satisfaction, and attachment style were linked to how trainees experienced their work. Younger trainees and those with insecure attachment styles were more likely to report higher levels of Stressful Involvement. In contrast, those who reported higher levels of life satisfaction tended to have more Healing Involvement.
Work setting factors also played a significant role. Trainees who felt supported in their professional environment and experienced more autonomy in their practice were more likely to report higher Healing Involvement. On the other hand, those in critical or judgemental supervisory relationships reported higher levels of Stressful Involvement, highlighting the impact of supervision quality on trainee well-being.
These findings have important implications for psychotherapy training programmes. Recognising the diverse patterns of trainee experience can help trainers tailor their support to individual needs, ensuring that those struggling with stress receive the appropriate help to mitigate its impact. Providing a supportive supervisory environment and fostering professional autonomy could enhance the therapeutic experience for many trainees, helping them to develop more effectively into competent therapists.
