Trainee difficulties with therapeutic engagement: a qualitative study of in-session critical incidents

Abstract

Trainee therapists or psychologists starting to practice psychotherapy are met with a number of inherent difficulties in engaging their clients in the treatment process. Using interpersonal process recall and interpretive phenomenological analysis, 18 counselling/clinical psychology trainees were interviewed about core difficulties they faced in engaging their clients in a therapeutic process. Interviews look place after 10 weeks of training and trainees were asked to self-select a single video-taped session for the interview. The analysis uncovered seven main themes: (1) difficulties with ‘personal material’; (2) difficulties with certainty, control, and idealized intentions; (3) frustrations with the client’s presentation; (4) difficulty in becoming the focus of attention; (5) reactions triggered by perceived exclusion; (6) anxieties about difference; and (7) interpersonal strategies to manage intense emotions. Findings are understood to be organized around the trainee’s struggle for self-definition and agency at the expense of empathic relating.