More than 80% of therapists across disciplines and orientations seek therapy for themselves, often more than once, before, during and after their training (Orlinsky et al., 2011; Rønnestad et al., 2016). Reasons to undergo therapy for therapists could be to become better helpers to their patients, and/or to become more solid, integrated, and sound persons – the purpose of mastering sustainability and risk management in their therapeutic position, for themselves and their patients (Geller et al., 2005; Maroda, 2022; Nissen-Lie et al., 2021; Victor et al., 2022).

It has not been possible to show whether personal therapy has any impact on therapists work with patients (Gold & Hilsenroth, 2009; McIntyre et al., 2019; Moe & Thimm, 2021; Wigg et al., 2011). Conducting a stringent investigation of this question has proved to be genuinely challenging due to the multitude of influences on patient outcomes, many of which originate in the patients themselves (Constantino et al., 2021). Thus, it is hard to imagine how one could conceivably control for or randomize all those influences on the impact of the therapists’ own experiences to emerge. Nonetheless, many psychotherapy-training programs, for example, those offering psychodynamic therapy and emotion focused psychotherapy, include personal psychotherapy as part of the training process. Apparently, the inclusion of personal experience as part of the training must be based on pedagogical and integration purposes, as rationales based on outcomes are difficult to support by way of evidence. These purposes function as robust objectives, supported by experts’ experiences and qualitative studies (Bellows, 2007; Bennett-Levy, 2019; Bento & Sousa, 2022; Kumari, 2011; Moe & Thimm, 2021; Probst, 2015a, b; Råbu et al., 2021; Wigg et al., 2011; Willemsen et al., 2023).

However, the pedagogical and integration purposes also risk losing sight of one important distinction. They involve personal therapy in the training programs, in the context of the psychotherapist role. In everyday language between colleagues, this small detail might also show itself in the use of the words personal therapy to describe the practice of being a psychotherapy patient in the context of being a psychotherapist, as opposed to just being in therapy, like any other patient. However, psychotherapists are persons, with idiosyncratic life histories, vulnerabilities, pride, traumas, and victories in combination with being psychotherapists. It is our understanding that the implicit notion that psychotherapy for people who are psychotherapists is different from psychotherapy for those who are not, is not well substantiated. In fact, therapists seem to seek therapy for reasons that are similar to those of other people (Bike et al., 2009; Levitt et al., 2017; Norcross et al., 1988). Qualitative research on personal psychotherapy for therapists seems to cover the same experiential themes as the results of the same approach to being a (non-therapist) patient in psychotherapy do (Bellows, 2007; Bento & Sousa, 2022; Ciclitira et al., 2012; Kumari, 2011; Willemsen et al., 2023).

The central significance that personal therapy has had, and continues to have, within psychotherapy traditions is related to the type of activity that psychotherapy is. The idea of personal therapy may seem strange from a medical point of view - having your appendix removed is unlikely to have any bearing on your competence in performing appendectomies. Psychotherapy is not a treatment in the same way that purely medical treatment methods are. Its primary focus is not about curing diseases; it is about dealing with suffering (Binder, 2022a; Miller, 2004) and offering a cultural space for openness, understanding, and meaning making (McLeod & Sundet, 2022). Patients come to therapy when they feel stuck and overwhelmed due to suffering related to relationships, emotions, and life circumstances (Levenson, 2017).

Freud’s (1958) original recommendation was that the psychoanalyst should know himself deeply. This suggestion was intended to encourage analysts to develop the ability to relate to their own pain to avoid becoming trapped by blind spots in the face of the patient’s suffering. This recommendation resulted in the requirement for training analysis in psychoanalytic training programs. Yalom (2003) considers personal psychotherapy to be the most central part of psychotherapy training, in that therapy is primarily an interpersonal encounter between people who, deep down, must deal with the same existential dilemmas. Carl Gustav Jung made the point that the therapist’s ability to relate to suffering is an essential part of psychotherapy as an activity when he stated, “I learned [at Burghölzli] that only the physician who feels himself deeply affected by his patients could heal” (cited in Dunne (2015), p. 119). Healing involves being able to participate in the patient’s emotional pain. According to Jung, learning to heal would therefore require the therapist to learn ways of relating to suffering in their own lives.

In the present project, we were particularly interested in how persons’ experiences with being a patient in psychotherapy influenced them, as persons and as psychotherapists. However, it was paramount for the participants in the project to explore their experiences openly, without the restraints of the described contexts, as part of the data collection. To accomplish this, we used data collection strategies that allowed us to engage closely with participants’ lived experiences, and we let them share and make meaning of this experience with their peers. The research question we investigated was: How do individuals, who are now therapists experience being a patient in psychotherapy?

Method

We developed this study within a phenomenological and hermeneutic framework (Laverty, 2003; Gadamer, 1989). Therapists’ experiences of being psychotherapy patients is culturally situated, and its meaning is relative to varying contexts. Therefore, when we were planning the study, we acknowledged that the subject matter is necessarily a hermeneutic process, in which the approach to experiences is to see them as interpreted and constructed, rather than essential and universal. Consequently, the hermeneutic phenomenological framework guiding this project refers to two activities. Phenomenological refers to the measures taken to plan for inviting participants and exploring their experiences to be shared and collected as close as possible to their lived experiences. Hermeneutic refers to the process of interpretation that inevitably happens within and between participants as they formulate and share their experiences through language. Likewise, it refers to the process of interpretation that happens when we, the authors, analyze and represent the data in the form of narratives and constructs. Based on its hermeneutic aspects, a strong procedure for researcher reflexivity (Binder et al., 2012; Finlay, 1998; Lazard & McAvoy, 2020) was part of the projects’ implementation.

Participants

We wanted to include participants that (a) were active psychotherapists, (b) had experience with being in psychotherapy themselves, (c) were engaged and interested in the subject, and (d) were in the first half of their careers. These inclusion criteria were chosen to secure sufficient group cohesion in the focus group to explore intimate experiences openly, and to have participants that would be sufficiently engaged to use the open interview format for in-depth exploration. In summary, the inclusion criteria aimed to conduct purposive recruitment of information-rich participants (Malterud et al., 2021).

Participants were recruited through the following steps. Six psychologists in our professional network agreed to send a full description of the project to clinical psychologists who they knew were active clinicians and who they believed would be interested in participating in the project. We explicitly informed the recruitment partners that they did not need to know if the persons they forwarded the information to have any experience as a psychotherapy patient. The information described the project and underscored the full breadth of data collection activities. In addition to writing reflecting notes, this implied a full day seminar with focus groups, an artistic experience and lunch, but with no further remuneration. Participants who wanted to take part in this procedure contacted the first author on their own initiative. During the recruitment period, eight participants contacted us and consented to take part in the research project.

The eight participants included five women and three men. Their ages ranged from 30 to 40 years (mode 35). All were currently working as clinical psychologists, and they had from four to fourteen years (mode seven) of experience with clinical work. All of them described their theoretical orientation as psychodynamic, and some mentioned that they also integrated other perspectives, for instance, emotion focused therapy and mentalization-based treatment.

All eight participants submitted the initial reflective note. Due to seasonal illness, only five participants were part of the focus group day. Three participants submitted the post-interview reflective note.

The researchers are professors of psychology at different universities in Norway. They are clinical psychologists/PhDs with a particular clinical and research interests in psychotherapy processes and in qualitative research methods. All of them have long-standing experience as psychotherapy researchers, clinical supervisors, and psychotherapists, and all are affiliated with integrative, humanistic-existential, and relational psychodynamic approaches to psychotherapy.

Data Collection

First, participants wrote and submitted their initial reflective note (n = 8) to the first author. The reflective note was a response to the prompts: (1) Why did I go to therapy and what did I expect?; (2) How did my therapy experience affect me personally?; (3) What did I get out of it?; and (4) What effect did my therapy experiences have on my work as a psychotherapist? The eight reflective notes consisted of 14 pages of single-spaced text. We anonymized the texts and sent them, together with a research article about personal psychotherapy (Råbu et al., 2021), to all participants. Participants then prepared by reading and reflecting on the co-participants’ reflections in preparation for the focus groups.

Second, participants (n = 5) met for a full-day focus group (Barbour, 2007) workshop. The first and last authors were present during this phase of data collection, together with a research assistant who secured audio recordings. We conducted two focus groups with the group of participants and offered lunch and an artistic experience during the break. The initial focus group lasted 90 min. First, the participants were invited to discuss their experiences by writing a reflective note and reading their co-participants’ reflections. After the initial round of sharing, the group was invited to discuss how they had experienced being a patient in psychotherapy. We informed the group that we, as researchers, did not intend to contribute to the discussion with questions; instead, we wanted to listen carefully and hoped that the group would assume shared responsibility to explore each other’s perspectives and experiences. The purpose of this choice of strategy was to support their exploration process and joint engagement, and to avoid a group dynamic of researchers posing questions and participants giving flat answers. The second focus group after lunch was conducted similarly. This session focused on how participants experienced that their therapy experiences affected their own practice as psychotherapists. Both focus groups were audio-recorded and transcribed verbatim for analyses by the research assistant.

Third, participants who had been part of the focus groups (n = 5) were invited to submit a post-discussion reflective note by responding to the same prompts that were used for their initial reflective notes. Three participants returned their updated reflections that consisted of seven additional pages of reflective text. In summary, the written data material consisted of 58 pages of single-spaced transcribed interview material and 21 pages of participants’ reflective notes.

Data Analysis

We followed a systematic reflexive method of data-analysis (Binder et al., 2012), which proceeded through the following steps. First, the first and last authors read carefully through the full data material multiple times to acquire an overview and in-depth understanding of the participants’ accounts. During this step, both of those authors independently made notes in the margin that expressed initial ideas and recorded engagement and reactions to the data material. For example, one such note stated, “relatively minor disruptions were still felt years later,” Moreover, we discussed and eventually decided that the data from the reflective notes and those from the focus groups could be analyzed together. Second, the first and last authors met to discuss and align their initial readings and agreed on themes that were particularly well described and relevant to the participants. At this stage, eight such preliminary themes were highlighted as being present throughout the data material. One example was “the experienced warmth and body language of their therapists that made them aware of the importance of kindness in a way that exceeded what could be taught.” Third, the first author took the preliminary themes back to the data material and sorted the segments of data that contributed to each theme. Fourth, both authors independently wrote a preliminary narrative account of the included topics in our native language, and then they read each other’s narrative. We discussed how differences in our individual formulations could be resolved, and then we agreed on a final representative narrative. Fifth, we used the sorted text segments to select which text would be more helpful as examples to illustrate and elaborate the meaning of the different parts of the narrative, and therefore, would work to make transparent the interpretive process and its relationship to the data. Sixth, we concluded the process by writing the final findings section of the paper in a narrative form, with six highlighted thematic hooks that referred to selected quotes from participants. Furthermore, a first draft of this paper was sent to the five participants that took part in the focus groups for member checking. We arranged a meeting for them to be able to provide feedback on the reading that three of them completed.

To summarize the member checking, the participants responded that they felt that their views were well-represented in the article’s manuscript. A few months after the focus groups, they were not able to separate who had said what in most of the quotes we had used as examples. They approved our choice to analyze the questions related to personal and professional development as entangled rather than separate processes. They underscored their participation was because they were genuinely interested in the topic and wanted to develop their own understanding, both personally and professionally. They emphasized that therapists need to preserve hope, and that being a patient in therapy and taking part in the project contributed to a stronger believe in therapy as something that can truly help people. When it came to the content of the article, besides feeling well represented, the participants advised us to make a clearer statement of how they use an inner model of their therapist when they work as a therapist. We revised this point in the final version of the manuscript. The second author served as an independent audit of the analysis.

Reflexivity

We wanted to prime the participants to reflect deeply on their experiences from being patients, by writing notes prior to the interviews, and by reading an article analyzing a group of therapists’ experiences with psychotherapy. We wanted them to discuss their experiences together and to further explore and understand each other’s experiences from therapy. The results are, therefore, far from independent accounts of their various experiences, but, rather, based on shared meanings developed in the focus groups. For us as researchers, this strategy was also implemented to minimize the effect of our own presence on the discussion. We were conscious that our active participation, beyond supporting their exploration, involved the risk of dominating the narrative.

Ethics

The project was approved by the Norwegian Social Science Data Service and recommended by the Department of Psychology’s research ethics committee, at the University of Oslo. All the participants signed a standard consent form, and audio-files and transcripts of material were stored in a database developed for sensitive data at the University. To provide anonymity in a situation in which research participants have been drawn from a relatively narrow community of professionals, interview excerpts were not attributed to specific informants. We made sure that everyone knew the names of the other participants before we met for focus group interviews, and that nobody had been a therapist for another participant.

Results

The participants’ personal experiences of being a patient in therapy included one to five courses of psychotherapy. Their experiences were based on 19 therapy processes. Therapy formats they had experienced included individual therapy, group therapy, short term crisis intervention, family therapy, and couples’ therapy. However, all of them had experience in individual psychodynamic psychotherapy, which lasted from two to six years. Two of the participants were currently in psychodynamic individual therapy.

The two areas of focus of the prompts they responded to in the initial reflection note, which were iterated in the structure of the focus groups, asked them to reflect on personal experiences first, and, in the next prompt, on their professional development. However, these experiential domains seemed to be so integrated (as if one domain implied the other), that it seemed useful to discuss them together. We have chosen to avoid superimposing our apparent preconceptions on the analyses, and therefore, present the results of the analyses in line with the participants’ entangled and complex experiences. We have worked to capture and describe the essential meanings of their lived experiences. To exemplify and elaborate on the complexity of their stories, we have carefully chosen quotes from the material as illustrations.

The Suffering – Real Needs

As an overarching context, the participants underscored the belief that their need for therapy had been very much real to them at some point during the process. They had sought therapy because they suffered. However, two started out with a more rational idea: When they were students, they thought it would be useful to have experience with therapy since they knew they would become psychotherapists, “It was both genuine and learned.” One had been suffering and in therapy since she was a child and stated that she was “a patient who had decided to become a therapist.” Most participants had complicated and burdening experiences from important relationships early in life. The following quotes illustrate this point of departure: (1) “My father was an alcoholic and a gambler, and my experiences with him had an effect on my way of relating to others.” (2) “I felt that in many ways, I had a good life, but in other ways, I worried and felt insecure. I tried but was unable to establish a love relationship.”

When discussing their experienced needs going into or emerging through therapy, the participants described what their therapies were really like. They shared that they would misrepresent the experiences if they tied them too closely to their professional identity, as expressed by calling it personal therapy (connoting an instrumental educational purpose) rather than only psychotherapy.

Ambivalence of Sharing Vulnerability

The participants had felt some insecurity about what they were expected to share in the first note they wrote during the project. How should they make sense of their own experiences of being in therapy, and what could they tell about it? Furthermore, how do these experiences affect their work as therapists? This doubt about how much they should share was present, as it also had been during their therapy experiences. How much would the other participants share about their vulnerabilities? Many participants pointed out the difference between the inner feeling of vulnerability and real need for therapy, and their discussions about it when they were students. If a student called it personal therapy, it was a clue that they were primarily therapists, as if they went to therapy, not because they were suffering or miserable, but because it was recommended, expected, or a tool for their professional development. Personal therapy is easier to say. However, they knew that their suffering and therapy was for real. Therefore, they were not sure whether the project would focus on their experiences as real patients or on personal therapy. As it happened, they chose to share what felt was most real and true about their experiences: “So, it was good to realize that I could recognize myself in so much of what the others wrote.” They had been patients in therapy, and they were psychotherapists. They also met the other participants with expectations and some tension because what they were supposed to talk about was meaningful and real, and somehow difficult as well.

I dreaded to read what the others have written … but I felt that they had been brave and had written very lively and in detail about their own experiences. It was powerful and had an impact on me. I was moved.

The participants expressed that it was moving to read the others’ preparation notes. It was a relief that the others had also shared some of their real vulnerabilities, and the others’ stories served as affirmation of their own experiences. They could use the focus group to explore, together with engaged fellows, what their experiences meant (for them as persons and as psychotherapists). This issue was something they also had dealt with when they were patients: Am I in therapy as a (future) psychologist, or as the person I am? Will my therapist think that I am too vulnerable or too emotionally unstable to be someone that can help others? However, if I approach it the opposite way, such as talking to the therapist like a colleague (clever and well thought through), that would not be useful; it would most likely be boring. This conflict was experienced between surface formalities and role expectations, and their personal self, and ways of experiencing vulnerability and suffering on their own. This was something they had worked on and had come to terms within their own therapy. They felt able to work on processes they experienced as meaningful. Retrospectively, they were able to state this clearly: I was a real patient with real problems, and, more importantly and common: they experienced therapy as useful help for their real problems.

Living the Language of Psychotherapy

The experience of realizing that the words one articulates about something personally vulnerable reaches the other person (the therapist) was a significant one. It was a relief to be someone that was possible for another person to understand, and it became possible to make meaning together.

This experience exceeded the relief experienced by a friendly face expression. The friendly look was an external recognition: You are okay; it is okay that you have come here, but they would still feel insecure about whether they would be able share what they carried inside themselves. What they feared was not only whether it could be shared or accepted, but also whether it would be understood. Would the other’s gaze continue to be appreciative if they really knew what I have on the inside? To also share words and understanding contributed to a deeper recognition that it was possible to articulate painful experiences that could be understood. Recognition of the power of being understood seemed to be easier to generalize and was apt for giving hope for oneself and for the possibility of being able to help others. It was a distinctive experience, like a “to be or not to be” one, that psychotherapy could be helpful for real, also for themselves.

It was significant for participants to experience in real life some of the complex psychological concepts and phenomena that they had learned about and understood theoretically, such as transference. The lived experience made theoretical concepts feel more real and more useful. This counted for concepts like the idea of having a “false self”. It felt useful to explore it as something that might could be understood from inside.

The participants underscored the need to keep a belief in therapy as something worth working with, that can be meaningful for real: “It is as if I need to experience it in real life. I can easily read about effect sizes and such things, but it is completely different to really experience it for yourself”.

The experiences of moments of meeting through language were paramount, often because of the alleviation of the loneliness that it supported:

It is as if I can hear in the therapist’s voice that she has been there herself, in a way. There is a difference between psycho-educative and actual affirming interventions. It is like the bass line in music, or perhaps only the discant. It is the contrast between “I know this is normal because I have read it,” and times when I can feel that she tells me something that comes from someplace in her own feelings or life or experiences.

The participants seemed to have, and to have had, a nuanced set of linguistic hooks or concepts, that, in the experience of therapy, were vitalized and brought them closer in their relationship to the other person. This line of reflection also empathized with non-therapist patients: “So how do we convey that to them? Having the knowledge has been purely helpful for me. It gave me a sense of getting something more or getting it easier than most patients did because I was already experiencing it within a shared language.”

Therapists Become so Important that They can Easily Hurt

When the participants talked about therapy experiences that were frustrating, confusing, or painful, they became concerned with the importance of humility when it came to the impact of relational power. One told about a situation where a comment from the therapist was experienced as crass, and another talked about an experience where the therapist “sided with my mother” when the participant was in the middle of exploring an issue: “It made a huge impression on me. That is something I have kept in mind: how hard it can hit if you are a therapist, and you are crass or annoyed with a patient”.

Towards the end of therapy, another participant experienced that the therapist had expressed the view that the participant had difficulties with turn taking. These kinds of experiences were relatively small in time and extent, but the effects they had on the participants were lasting and painful. Therefore, they had brought important realizations to the participants: Can I have such an impact on my own patients? Can a thoughtless word, a bad day, or a hint of irritation hurt my patient this much? These thoughts did not necessarily make them more anxious as therapists, but they contributed to an awareness of the patient’s vulnerability and their own responsibility, and they were in awe of the potential power the therapist role implied:

It sometimes happened, with my previous therapist, that it looked like she was about to yawn. It was completely understandable, because I was there in the evening and so on, but what a strong impression it made on me. And it has made me aware of: How should I be, behave, look when I am with my patients?

The experiences from being a patient heightened the realization of how vulnerable you are when you trust another person, particularly in a situation where you reveal personal and vulnerable parts of your life.

Addressing Shame Together

The experience of feeling shame related to participants’ initial doubt about sharing their vulnerabilities, and their fear of being too much, or too troubled to work as a psychologist. An important experience was talking about addressing this shame and doubt together with their therapists. Examples of doubts were “Am I a burden?” “What does s/he - really - think about me?” and “Will I be able to help others when I am this vulnerable?” An important shared experience was that they turned out to be able to feel more vulnerable as a patient than they had imagined beforehand, and how important it was to be met with tenderness. Likewise, it was important to know that the patient may have much more on their chest than what they dare to tell. Participants also recognized a wish of their own, which was to be understood without having to tell the therapist. The following statements exemplify their experiences with addressing shame together with their therapists: (1) “I have had this feeling that there is something wrong with me, that I have worked on in all my therapies.” (2) “When I started therapy, I carried so much inside that I tried to hide; it was hard to be in therapy with all that silence and I was supposed to no longer cover it up.”

When you have someone beside you who can say something like, “Wasn’t that that feeling?,” and then it is as if something lightens up. Yes, it is! It is a feeling I carry, and not the only reality - a feeling that I was so filled up with and believed completely in one moment, only to realize that it is not like the eternal truth but only one perspective, or an old self concept, or something I carry in me that can be awakened in some situations to be experienced again and again.

The experience of being met by the therapist with an expression and tone, which conveyed that they were welcome and with an affirmation of their life struggles as something real and legitimate, was powerful. If it is possible for someone to appreciate my company, and if I can share my inner experiences in a way that can be understood, then we are together as fellow human beings. This seemed to be the participants’ experience of the healing function of togetherness. If we can be together this way, I can be together with others in the same way, and I can offer my own patients an experience that I know has the power to change how life feels.

Using Ones’ Therapist as an Inner Model When Working with Patients

The participants emphasized how their therapists have become role models that they “carry inside,” and to a large degree, can make use of in their own work with patients. However, this had failed when they used interventions that had once felt good for them when their therapist used them, “and I realized too late that perhaps I identified too much with a patient and heard myself say what I once needed to hear from my therapist.” However, the experience of using the therapist as an inner model was a good one most times:

The therapists have had an impact on me as a sort of model learning. I notice that what they have said to me has affected me, for instance, the metaphors they have used, that I keep and bring with me. Sometimes they are not that useful when I re-use them, but other times I have found them to be helpful. Then it feels like I have my therapist with me on my shoulder in the session, and that feels good.

The experience of meeting therapists who were open, patient, and curious, and who believed in the process, had been important. The participants felt that it had contributed to their openness and supportive attitude toward their own complicated developmental processes as a therapist. Likewise, their own therapists, who had been role models that they could carry with them continued to have an effect on their attitudes toward people they encountered in their role as a therapist.

Discussion

As other research participants discuss their experience as a patient in psychotherapy, the participants in this study talked about their meaningful relational experiences, moments of meeting with another human being, moments of insight, how significant relationships and important life themes were given space, and that therapy could also imply frustration. They had felt that their experiences from therapy had an impact on other relationships and on their ways of participating in larger contexts. All these various experiences resonate with the findings from other qualitative studies of psychotherapy patients’ experiences (Levitt et al., 2016, 2017). Psychotherapy seems to contribute to the potential for patients to experience relief, togetherness, and remoralization when they experience the processes of genuine relational warmth, acceptance, and shared symbolization of their inner lives. Experiences that patients relate to in contemporary studies of helpful therapy experiences are captured in Roger’s (1961) initial formulations of what is necessary and sufficient to propel therapeutic change.

The findings in our study underscore the contradictions associated with going to therapy as part of a professional role. Psychotherapy is an inherently personal matter. An essential element here is that the therapists had experienced this as actual therapy, where they dealt with real pain in their own lives. The idea of being a professional is linked to mastery and achievement. As a patient, you must first and foremost address life issues where you in some way feel that you are not coping. In this way, personal therapy involves a potentially embarrassing dimension, because not being in control is potentially shameful. We tend to think of the therapist as the healthy person and the patient as the sick one. If therapy goes well, it is possible to relate to vulnerability on a general or existential level that goes deeper than the dichotomy between healthy and sick (Lemma, 2023; Yalom, 2003).

The relational dimension of therapy touches on what can clearly be described as a vulnerability related to living life as a human being. In all relationships, but particularly when relationships become close and important, what others see, acknowledge, or reject in us will also strongly influence our self-definition and identity (Binder, 2022b). This is why we are cautious about who we allow to become close to us. A therapist is not a person you have chosen to be close to in the same way as an intimate friend or a partner. In therapy, you are at the mercy of someone who becomes close but at the same time remains a stranger. Perhaps this is one of the most important things to get to know to empathize fully with what it means to be a psychotherapy patient. The participants in our study underscore the importance of being understood. Råbu and Moltu (2021), who studied psychotherapy dyads, described this process as creating a space for the patient’s unbearable story. This is in line with the theories of Fonagy and Target (1996), who stated that the reflective aspect of therapy is understanding, and not simply empathy. Importantly, there seems to be an interplay between the processes of empathy and understanding, whereby in concert, they are more effective than they are as each individual process.

However, there are two important differences between the existing patient-centered literature and our study. First, since they were deeply engaged in their role as psychotherapists, the participants in this study had a rich language to talk about therapy, and an interest in exploring dimensions and variations in these experiences. Second, they had a commitment and a wish to build bridges between how experiences from seeking help for their own problems were relevant for how they could help others. Hence, these differences allowed this study to emphasize the processes that may have particular relevance for people who are therapists when they are psychotherapy patients.

Implications

The study suggests that if a person, who is a psychotherapist, experiences psychological and relational suffering, they might have support by virtue of their professional language in order to benefit more rather than less from therapy – when they participate as real patients. Our results also suggests that if going to therapy is a mandatory part of a training program, its therapists should be mindful of the potential for initial ambivalence about sharing vulnerability, with the danger of their patient remaining first and foremost a colleague. Last and maybe most important, our results suggest that if a person, who is a therapist, goes to therapy to work on real suffering with another person, something professionally important happens. They will likely find that their good experiences, the hurtful ruptures, humility, or togetherness will be experienced as a helpful guide when as therapists, they later meet their patients.

Limitations

The study is limited by the small sample size. Five of the eight participants who wrote the initial reflection note showed up for the focus group day. The three who cancelled the day before or the same morning, referred to seasonal illness. We have no reason to doubt that this was the case. The study was carried out post covid, and we had recently been used to strict restrictions if anyone had symptoms of respiratory tract infections. The participants who took part in this project were so interested in the subject that they actively initiated contact to sign up for the project. They spent one complete workday together with us on the day of the focus group interviews. In addition, they invested time writing and reading for preparation. Their only reward was a free lunch with a concert, and an opportunity to spend time reflecting on important personal and professional themes together with colleagues. Thus, this group is perhaps not likely to represent the broader group of psychotherapists.

Conclusion

We studied the experiences of psychotherapy in a sample of eight people who were psychologists and psychotherapists. To achieve engagement and depth during the collected experiences, we implemented an extended data collection procedure, aiming to establish safety, peer support, and adequate time for exploration. We found that the participants worked on real problems with real suffering in their therapies, rather than approaching them as purely a learning exercise for professionals. Their experiences from therapy were similar to what is often described in the patient-oriented literature, with some important differences. Most importantly, our participants seemed to have a distinctive opportunity to benefit from therapy due to the language they had available to share their experiences with the therapist. Second, they described how they used their experiences from therapy constructively when they were in the therapist role with their own patients.