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The Irish
Journal of Counselling
and Psychotherapy
formerly • Volume 22 • Issue 1 • Spring 2022
• Technology-assisted psychotherapy for
complex trauma Growth through
• Coming out as a survivor therapist
Understanding therapists’ motivation for
trauma-related disclosure within professional
and public domains
trauma
• Survived but not recovered
An exploration of psychotherapy and
counselling for people living beyond cancer
• Playing language games Irish Association for Counselling and Psychotherapy
IJCP Volume 22 • Issue 1 • Spring 2022
Contents
From the Editor 3 Our Title
In Autumn 2017, our title changed
Technology-assisted psychotherapy for complex trauma 4 from “Éisteach” to “The Irish Journal
By Julie Brown and Leanne Macken of Counselling and Psychotherapy” or
“IJCP” for short.
Coming out as a survivor therapist 9
Understanding therapists’ motivation for trauma-related Disclaimer:
disclosure within professional and public domains The views expressed in this
By Valerie Ballarotti publication, save where otherwise
indicated, are the views of
Florescence 16 contributors and not necessarily the
Poetry by members views of the Irish Association for
Counselling and Psychotherapy. The
Survived but not recovered 18 appearance of an advertisement in
An exploration of psychotherapy and counselling for people this publication does not necessarily
living beyond cancer
indicate approval by the Irish
By Dave Cosgrove
Association for Counselling and
Psychotherapy for the product or
Playing language games 25
service advertised.
By Alex Delogu
Next Issue:
Noticeboard 30 1st June 2022
Deadline for Advertising Submissions
for Next Issue:
1st May 2022
Editorial Board: For more information about
Mike Hackett (Chair), Hugh Morley, Kaylene Petersen, Annette Murphy, advertising please see
Terry Naughton, Lynne Caffrey, Eve Menezes Cunningham. www.iacp.ie/IJCP-back-editions.
Editor: Assistant Editor: Scripts:
Terry Naughton Kaylene Petersen Each issue of IJCP is planned well in
Design and layout: advance of the publication date and
GKD.ie some issues are themed. If you are
interested in submitting an article
ISSN:
for consideration, responding to
2565-540X
the Therapist’s Dilemma or wish to
Advertising rates and deadlines: contribute a book or workshop review
Contact the IACP for details. (Early booking essential) or Letter to the Editor, please see
‘Guidelines for Submitting Articles’
© Irish Association for Counselling and Psychotherapy – IACP
on the IACP website, www.iacp.ie.
All rights reserved. No part of this publication may be reproduced, stored in, or introduced
into a retrieval system, or transmitted in any form or by any means (electronic, mechanical,
photocopying, recording, or otherwise), except for brief referenced extracts for the purpose Contacting IJCP:
of review, without the prior written permission of the copyright owners. iacpjournal@iacp.ie
Irish Association for Counselling and Psychotherapy
Volume 22 • Issue 1 • Spring 2022 IJCP
From the Editor:
Ballarotti explores the therapist as
a survivor and their motivation for
trauma-related disclosure within
both the professional sphere and
the public domain. Adversity and
abuse in earlier years may often
be presented by clients in therapy,
but what of the therapists who may
have also experienced abuse? In
her contribution, Valerie presents
the insights of three therapists who
have embraced their dual identity
of survivor therapist and offers us
Dear Colleagues, timing, pace and titration, in order a window into their reasons for
to avoid overwhelm of traumatic disclosing.
A warm welcome to the Spring memories, is necessary when We are invited to consider the
2022 edition of the Irish Journal encouraging clients to express psychological supports that may be
of Counselling and Psychotherapy. their emotions. Offering validation required by our clients who have
A new year is upon us with one that their experience is reasonable survived a cancer diagnosis in our
of the most notable aspects so and acceptable is essential and third article by Dave Cosgrove.
far being the lifting of many of the psychoeducation focusing on Dave examines how this client
restrictions related to the Covid-19 trauma-related symptoms may population may be burdened with
pandemic. This may bring a mixture help normalise how clients are ongoing personal, psychological
of excitement and trepidation (and feeling, and allow them to see and existential crises. Included in
everything in between) for ourselves their symptoms are not unique. this article are the insights of five
and our clients. I wish you well as One intervention that may prove psychotherapists with experience of
your resource yourselves navigating particularly helpful is the teaching working with this client population,
this newness. of grounding exercises that promote presenting the primary identifiable
Trauma is the Greek word for safety. themes, the psychotherapeutic
‘wound’. Although the Greeks While the articles in this edition approaches employed by therapists
used the term when referring to of the IJCP vary in content, they are and their view of this work.
physical injuries, nowadays, as we linked through the theme of trauma. Our final article invites us to
are aware, trauma is just as likely Our first offering from Julie Brown consider the language we use in
to refer to emotional wounds. An and Leanne Macken outlines details therapy with our clients. Alex Delogu
ever-increasing body of research of a study undertaken by them on highlights the habitual patterns
suggests that experiencing behalf of ‘One in Four’, which is evident that are often repetitive and
traumatic events is linked to long- a registered charity that supports lifeless. Alex suggests that keeping
term psychological, physical and adult survivors of childhood sexual our language alive for ourselves
behavioural health risks and many abuse and their families. and our clients could be beneficial
of us support our clients to find In this article, clients’ and in clinical practice and he explores
ways of engaging with the world, therapists’ experience of the how language can become stuck
with trauma as part of their lived overnight transition to technology- and presents ways of ‘unsticking’ it.
experience. assisted therapy for complex We continue with contributions
As practitioners, we are aware trauma due to Covid-19 restrictions from IACP members of poems in our
that trauma manifests itself in many is explored. While elements poetry section entitled ‘Florescence’.
varied ways in the therapeutic space of safety, boundaries and the I hope you enjoy this edition of the
and offering a safe and welcoming therapeutic relationship were IJCP and would like to thank all of
environment and establishing a impacted, the ability to continue our contributors for taking the time
positive therapeutic relationship with therapy during restrictions was to submit their work. I wish all of our
may be experienced as particularly presented as the main advantage of readers a happy and healthy 2022.
supportive by our clients. Holding technology-assisted therapy.
an awareness of the importance of Our second article by Valerie Terry Naughton, Editor
Irish Association for Counselling and Psychotherapy 3
IJCP Volume 22 • Issue 1 • Spring 2022
Research Article
Technology-assisted psychotherapy
for complex trauma
By Julie Brown and Leanne Macken
• Understanding the ways
technology may influence the
therapeutic relationship;
• Informing decisions in relation to
programme delivery; and
• Providing a perspective on
technology-assisted therapy with
complex trauma.
The term technology-assisted
therapy is used to refer to real-time
client/therapist interaction using
telephone or video-conferencing.
Findings indicated that comments
on convenience and the lifeline
offered by technology-assisted
therapy aside, the majority of
participants preferred to return
to the in-office setting. Despite
the cyber security of online
T
telemedicine platforms, the office
echnological advances aimed at increasing setting’s containment, safety, and
accessibility to therapy have resulted in the privacy are not easily replicated
wide acceptance and normalisation of telehealth for those accessing therapy via
technology. The ‘whole body’
offerings. For clients who have experienced child presence in the room is felt to be
sexual abuse, balancing convenience with factors crucial for a majority of clients who
including safety, the whole body in trauma work, have experienced sexual abuse.
and the potential impact of interruptions and Telehealth offerings
intrusions is vital Notably, the literature on telehealth/
telepsychology and eHealth
comprises studies ranging from
Introduction a sexual offence against a child. apps amd asynchronous e-mail
O ne in Four is a non-government
organisation that provides
psychotherapy and advocacy
This article outlines a small,
mixed-methods study that explored
clients’ and therapists’ experiences
communications to real-time
therapist-engagement that most
closely mirrors the traditional in-
support services to adults and of the sudden and, for a time, total office setting (O’Connor et al., 2018;
their families who have survived transition to technology-assisted Sierra et al., 2018). The proliferation
childhood sexual abuse. The therapy for complex trauma, of telehealth offerings is propelled
organisation also delivers a necessitated by the Covid-19 by imperatives aimed at improving
prevention intervention programme pandemic. In particular, the study access, cost-effectiveness and
to people who have committed was interested in: reducing other barriers, such as
4 Irish Association for Counselling and Psychotherapy
Volume 22 • Issue 1 • Spring 2022 IJCP
A
stigma associated with attending anxiety for the respondent as they
therapy (Bennett et al., 2020; small number of did not have to request time off work
Morland et al., 2017). respondents linked were common and in keeping with
Findings of studies on telehealth being in their home the literature on accessibility (Maheu
and eHealth often include self-guided environment to increased et al., 2012). One respondent
treatments. Two meta-analyses comfort and ease commented: “The fact that I live so
studies that explored PTSD (post- far away, it is helpful as I don’t have
traumatic stress disorder) based on to pay for public transport and I can
CBT (cognitive behavioural therapy) 18 statements for clients and 11 get some work done.”
and IBI (Internet-based intervention) statements for psychotherapists. A A small number of respondents
models found some improvement in thematic analysis (Clarke & Braun, linked being in their home
PTSD symptoms compared to wait-list 2014) on the qualitative replies environment to increased comfort
control groups (Kuester et al., 2016; was conducted in conjunction and ease, which may, for them,
Sijbrandij et al., 2016). with statistical analysis using have created a sense of safety
Irrespective of the modality, most the Statistical Package for Social and relative ease. The physical
offerings utilise the principles of Sciences (SPSS). Data was therapeutic environment is accepted
empirically-guided interventions. analysed using descriptive and as important for trauma survivors
However, they do not address the frequency analysis and comparison (Smith & Watkins, 2008): “I was
therapeutic relationship itself (de of means data and screened able [to] surround myself with my
Bitencourt Machado et al., 2016). and coded for gender, age and own objects – tea, comfortable
This is curious given the general participant type. seating, being able to stare out a
acceptance within the psychotherapy A total of 64 responded and window while speaking. It felt super
literature that the relationship itself is 57 completed the survey in full familiar and peaceful at all times.”
not only core to treatment outcomes, (psychotherapists 11%, survivors Results showed that over 60%
but arguably more important than any 71%, prevention/offenders 13% of respondents felt comfortable
specific technique or modality (Carr, and family group 5%). Three themes using technology. This reflects
2007; Horvath et al., 2011; Messer emerged: therapeutic space the increased familiarity with, and
& Wampold, 2002; O’Connor et al., and trauma; connections and reliance on, technology for day-to-
2018; Wampold & Imel, 2015). While disconnections; and therapeutic day needs, such as shopping and
what constitutes therapy or treatment relationship and depth of work. online banking (Morland et al.,
under the eHealth definition is broad While all clients who responded were 2017). Regarding the therapeutic
and far-reaching, our study was grateful for the accessibility and experience itself, 46% agreed that
interested in ‘depth psychotherapy’ – lifeline offered by technology-assisted they felt more tired after their online
that is, moving beyond the focus on therapy, the vast majority wanted to session than they would in person.
symptoms to the relationally-based return to the in-house setting. The quantitative findings posed
exploration of all aspects, conscious The quantitative findings proved questions and offered a challenge
and unconscious, of the client’s important, offering challenge, to the apparent advantages of this
experience – across therapeutic difference and context to responses ease of accessibility. For example,
modalities. to the qualitative questions, figures showed that 34% did not
particularly in relation to safety, feel connected to their therapist and
Mixed-methods approach boundaries and the therapeutic 32% found it difficult to see their
For this article, a narrow and relationship. therapist in a different environment.
targeted literature review was In addition, nearly 40% of clients
undertaken to support analyses Therapeutic space and trauma stated they found it difficult to talk
and provide context to findings. This theme refers to the concept about painful issues online.
A mixed-methods approach was of therapeutic space and its There was a significant difference
adopted, comprising a survey of 41 constituents, external and internal, between men and women’s level
statements and seven qualitative influenced by trauma and shaped of comfort in talking about suicide
questions, which was circulated by the imposed restrictions of the and self-harm online, with men more
to the organisation’s clients and Covid-19 pandemic. Comments likely to talk about it than women.
therapists. Using a five-point Likert on the convenience and practical This is at odds with a meta-analysis
scale, participants were asked advantages of not having to leave by Breslin and Schoenleber (2015),
their level of agreement (‘Strongly home for sessions, saving time and which found that women were more
agree’ to ‘Strongly disagree’) for money and, in one case, reducing likely to report a history of self-harm
Irish Association for Counselling and Psychotherapy 5
IJCP Volume 22 • Issue 1 • Spring 2022
“I
than men. It was also found that or disconnecting from, the therapy
there was a more significant gender found it strange trying experience. Half of our respondents
difference in the clinical settings to disconnect from my reported they had time to prepare
than in the community settings. This therapy – when I brought it and reflect before and after the
difference might be accounted for into my home I didn’t feel session:
by our small sample size, the fact as safe”
that all female client participants I use the hour or so that it takes
were survivors of child sexual abuse, me to get into Holles St to
and that Breslin and Scoenleber’s left off. It would have been much mentally prepare for my session
(2015) meta-analysis was not harder to just stop therapy or to and the same to decompress on
exploring reports in online therapy keep putting off sessions until we the way home. Now, I go from
settings specifically. The Irish could return to face-to-face. therapy right back into normal
context might also be significant. life, and it’s a head wreck.
Figures varied across the sample Several commented on the screen
in response to access to a private itself. For some, the screen seemed Another respondent revealed: “I
space for their therapy, with 17% of to hinder connection and lead to a found it strange trying to disconnect
survivor clients saying they did not self-conscious engagement: from my therapy – when I brought it
have access to a private space and into my home I didn’t feel as safe.”
33% of prevention/offender clients I think in general with video calls Forty-three per cent of respondents
reporting they did not have access … it’s the same in a work setting referenced technical difficulties, and
to a private space. One respondent … that you feel much more therapists particularly linked this
noted that “being in the home observed/constantly visible than with concerns for the therapeutic
environment made it more difficult you might in an in-person setting. relationship. One therapist
for me to speak openly and freely for It can make you feel a bit more responded: “The Wi-Fi in my area
fear of someone else overhearing”. self-conscious in moments when is not great and I find that during
This respondent mirrored others in you’re very upset. sessions it is very distressing when
attempting what could be termed the PC freezes and you have to ask
a compromise, engaging in the Conversely, a couple of the client to say it again.” Another
session but in a self-conscious and respondents felt the screen allowed therapist noted that: “The pace of
constrained manner. a deeper engagement, increasing therapy is also skewed online, where
Approximately 18% reported their confidence and ease: “Better the time gap due to the Internet
experiencing someone from their sometimes in the separateness often results in therapist and client
home entering the room during their of online, giving confidence to say speaking over each other.”
session. These findings represent things that might not have been
a challenge to the concept of a said if face-to-face.” Therapeutic relationship and depth
therapeutic space, not solely on Group clients, in particular, of work
the external or practical level but commented on the importance of With few exceptions, therapists and
in relation to the internal – the initial in-house meetings as vital to clients missed the in-person therapy
importance of boundaries, the fostering feelings of connection with experience. Comments in Table 1 give
impact of intrusion, and the safety the group: examples of both the general view,
experience for abuse survivors. but also note alternative experiences.
I personally would have found it Therapeutic modality seemed to
Connections and disconnections extremely difficult to engage in influence the experience where those
This theme explored connections the program online from the start. practising bodywork in particular felt
and disconnections virtually as well Having met face-to-face with the the absence of the in-person contact
as inter and intra-relationally. The therapists and other members of most acutely. These quotes, taken
continued facilitation of therapy the group before helped me feel from the qualitative responses,
during lockdown was a frequent, comfortable enough to engage capture subtly and subjectivity in
almost unanimous response: online. relation to the experience of the
therapeutic relationship.
I think the most helpful thing Client respondents made
about technology-assisted important points about connecting Discussion
therapy was the ability to or transitioning into and, just as At the time of writing this article
continue therapy from where we importantly, transitioning out of, in September 2021, the Rape
6 Irish Association for Counselling and Psychotherapy
Volume 22 • Issue 1 • Spring 2022 IJCP
Crisis Network Ireland’s (RCNI’s) subcortically and that recurring It appears that people connect very
Clinical Innovation Project (Taylor activations of the traumatic memory differently in an online environment
& Walsh, 2021) had conducted a continues to create a sense of and there is much that therapists may
large survey with 645 survivors of threat: “Traumatised clients are need to consider. Contracting for the
sexual violence. The findings of our haunted by the return of trauma- arguably inevitable technical difficulties
small survey largely cohere with related sensorimotor reactions in and interruptions is vital to support
the findings of that larger study, such forms as intrusive images, safety and containment. Exploring
particularly concerning: the core sounds, smells, body sensations, the client’s associations to and
importance of the body in work with physical pain, constriction, experience of the screen(s) directly
trauma and implications on the numbing, and the inability to may provide insights and guidance
impact of its distance in technology- modulate arousal” (p. xxix). to both parties that might assist in a
assisted therapy; issues relating to The fact that 15 out of 51 deeper connection moving forward.
safety, privacy and confidentiality, respondents engaged in therapy in It may also be important to attend
and importantly, the need to the absence of any private space to the healthy disconnection from
balance convenience with safety; raises important safety questions. the session that facilitates clients
ubiquitous technical challenges; It also suggests that therapists in getting on with their day. Finally,
and, with the exception of a should not assume that the physical in-person contact for some is vital to
minority, the preference to return to frame provided through the private, establish the connection necessary to
in-person therapy. uninterrupted, in-house setting engage in therapeutic work.
Literature on trauma highlights has been internalised or can be
that the therapeutic relationship is replicated at home by clients. Conclusion
paramount in recovery. According to Reasons may relate to limitations The connection in relationship is
(Herman, 2015) “the core experiences in the environment and, perhaps, to core to creating safety, however,
of psychological trauma are normalisation of intrusion for abuse sadly this is an elusive experience
disempowerment and disconnection survivors: for many trauma survivors.
from others” (p. 133). Wallin (2007) The respondents for this study
describes the importance of a secure Traumatic events … shatter unanimously named the ability
attachment within the therapeutic the construction of the self to continue with therapy during
relationship, as it strengthens the that is formed and sustained lockdown – a time that increased
capacity for affect-regulation. The in relations to others … [it] strain on the already over-burdened
importance of the body in trauma destroys the victims’ fundamental nervous systems of trauma
therapy is the capacity to assimilate assumptions about the safety of survivors – as the main advantage
the traumatic experience. the world, the positive value of of technology-assisted therapy.
Odgen et al., (2006) argue that the self, and the meaningful order While a small number of
traumatic memories are encoded of creation. (Herman, 2015, p.51) respondents named feeling safer
‘‘
Table 1: Therapist and client experiences of working online
Therapists Clients
For me, personally, there is something that takes place within Some sessions I would not be fully engaged or present, but
the therapeutic space that just cannot happen online. It is all when in a room I would be calmer face-to-face.
the small nuances, the movement, pace and rhythm of therapy
that is missed online.
I feel that in-person, misinterpretations are easier to avoid
– you don’t have to concentrate so much and because of this,
you are more presence both mentally and physically.
The in-depth connection you get when in the room with the
clients, missing the feeling of the client, missing those
non‑verbal cues, missing helping the client regulate, missing
doing bodywork.
One advantage when working with deeply traumatised clients
‘‘
One-on-one therapy allows me to leave everything else outside
the room – I find that difficult in technology-assisted therapy.
The fact I haven’t met my therapist face-to- face. It feels weird
that I have disclosed so much of my life to her, yet have never
met her face-to-face.
Sessions were no different in any way, full support at all times.
is the disinhibition effect, and I have found that clients have I have felt able to talk, be validated and helpfully challenged in
been able to say more as the PC/ phone has allowed a space a therapeutic space.
to create a gap that they feel more comfortable in and able to
speak more freely.
Irish Association for Counselling and Psychotherapy 7
IJCP Volume 22 • Issue 1 • Spring 2022
in their home environment, for reasons surpassing convenience of One in Four. Julie is a training
the majority, this coincided with and accessibility, so it is important analyst with the Irish Institute of
increased interruptions and to continue this offering. In Psychoanalytic Psychotherapy and a
disconnections of differing types. addition, offering therapy online past Chairperson of the Irish Forum
Feeling less connected to their has increased accessibility to our for Psychoanalytic Psychotherapy.
therapist and struggling to talk Dublin-based service for those in Julie is in her final year of a
about difficult issues were named other parts of Ireland. Doctorate in Psychotherapy at
by respondents as challenges that Following the literature, there Dublin City University where her
could reasonably be assumed to be may be scope to use technology to area of research is a psychoanalytic
interconnected. augment psychotherapy for those exploration of online child sex
It is important to note that on the waiting list or as a step down offending.
this survey related to home in the transition to ending therapy.
environments during a lockdown However, the depth of therapeutic
situation, which may differ work, at least in the experience of
Leanne Macken
significantly from a home One in Four, is not easily achieved
environment at other times. via technology.
Therapists and clients with a Leanne Macken, BA Psych, Dip
preference for body work seemed Counselling & Psychotherapy,
to struggle most, feeling the MIAHIP, is a psychotherapist
Julie Brown
absence of the body in the shared working in the area of trauma for
therapeutic space most acutely. Julie Brown is a psychoanalytic over 10 years. Leanne is a senior
While grateful for the offering, psychotherapist and clinical psychotherapist on the Prevention
the vast majority of One in Four supervisor working mainly from an Programme in One in Four.
clients indicated the wish to return object relations perspective. She Leanne is currently doing a MLitt/
to in-person therapy when possible. has worked in the area of complex PhD in the School of Psychology,
A minority named a preference to trauma and sexual abuse UCD, where she is undertaking
continue working via technology for for 18 years and is Clinical Director research on female offenders.
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8 Irish Association for Counselling and Psychotherapy
Volume 22 • Issue 1 • Spring 2022 IJCP
Academic Article
Coming out as a survivor therapist
Understanding therapists’ motivation for trauma-related
disclosure within professional and public domains
By Valerie Ballarotti
‘go public’ about their childhood
sexual abuse (CSA) trauma.
The article reflects on how
therapists may experience being
CSA survivors as a ‘concealed
stigmatised identity’ (Weisz et
al., 2016), whilst also feeling
empowered as ‘wounded healers’
to embrace ‘public truth telling’
as part of what Herman (2015)
dubbed ‘survivor mission’.
Drawing on Chaudoir and Fisher’s
Disclosure Process Model
(2010), the research considers
the process of ‘coming out’ as a
survivor therapist as a sequence
of interrelated disclosure events
occurring in different contexts and
at various stages of therapists’
professional lives. These
include training, supervision
W
and workplace, and sometimes
hilst the psychotherapy field is arguably extending to more public
prone to view childhood trauma as something disclosures including press, social
affecting clients rather than those treating them, media, academic publications
and radio. Four emerging themes
more therapists have started to refer to their own are briefly outlined reflecting
experiences of early adversity and abuse. Three participants’ reported motivation
colleagues who have embraced their dual identity for salient disclosure events in
their careers.
of survivor therapists reflect on their motivation to
disclose and what influenced their decision-making Both sides of the couch
Childhood trauma has been
widely recognised as the common
Introduction Interpretative Phenomenological denominator for a plethora
D espite the incidence of
childhood trauma among
mental health professionals,
Analysis (IPA) study, conducted
as part of the author’s MA
dissertation, this article explores
of enduring mental health
difficulties in adulthood, including
depression, low self-esteem,
qualitative research on how trauma-related disclosure within suicidal ideation, anxiety and
individuals navigate their dual the psychotherapy profession, panic, borderline personality
identity as ‘survivor therapists’ focusing in particular on what disorder, dissociative identity
is scant. Derived from a larger motivated three therapists to disorders and eating disorders
Irish Association for Counselling and Psychotherapy 9
IJCP Volume 22 • Issue 1 • Spring 2022
S
(Knight, 2015). In Ireland, some psychotherapy profession, Adams
24,815 children were referred traddling the line (2014) has also suggested that
to Tusla – the state agency between human “psychotherapists don’t always
responsible for improving well- vulnerability and appear to trust other therapists
being outcomes for children – for professional competency, [and have] little faith that [their]
various forms of suspected abuse psychotherapy trainees human frailties will be valued rather
in 2018. Of these, 6,137 referrals than judged as proof that [they]
are required to ‘work on
were for suspected physical abuse should not be working” (p. 8).
and 3,548 concerned sexual self’ and to familiarise Given these concerns about
abuse (McMahon, 2019). themselves with self- professional stigmatisation, it is
Since the Covid-19 pandemic, disclosure in both not unreasonable to assume that
Women’s Aid support workers personal therapy and some therapists might experience
received more than 30,000 experiential work during their being CSA survivors as a
disclosures of domestic violence, “concealed stigmatised identity”
including 6,000 related to child
training – an “attribute that is stereotyped
abuse (Wilson, 2021). Hinting at and devalued by society, but that
the pervasiveness of childhood research on survivor therapists can be kept hidden” (Weisz et al.,
trauma, these recent statistics has mostly highlighted their 2016, p. 2935).
add to a sad legacy of historical increased vulnerability to vicarious
and institutional child abuse in the trauma and burn- out (Carr & Egan, Wounded healers in their own words
Republic. 2017; Schnittiger, 2017; Sodeke- Conversely, one might expect
Unsurprisingly, within the mental Gregson et al., 2013). Concerns that as a field predicated on the
health field “adult survivors of have also been raised about healing potential of talking about
childhood trauma account for a survivor therapists’ tendency one’s difficulties, psychotherapy
majority of individuals seeking toward over-involvement and would endorse openness over
… clinical services” (Knight, excessive self-sacrifice (Adams concealment and validate painful
2015, p. 25). Childhood trauma & Riggs, 2008). Some findings experiences as opportunities
among helping professionals, point to a greater propensity to for psychological growth.
including psychotherapists, may violate therapeutic boundaries Encapsulating this dialectic,
be a more controversial issue, with clients and to disregard the Jungian construct of the
arguably warranting further supervisory guidance (Dickeson & ‘wounded healer’ – referring to an
consideration within counselling Smout, 2018). Furthermore, since “individual who, after experiencing
and psychotherapy literature and “childhood trauma doubles the significant adversity becomes
education (Bamber & McMahon, risk of mental health conditions” motivated to assist others through
2008; Elliot & Guy, 1993; Fussell (Torjesen, 2019, p. 364), survivor similar experiences” (Dickeson,
& Bonney; 1990; Follette & therapists’ possible mental health 2017, p. 3) – offers an important
Milbeck, 1994). sequelae might lead to fears counterargument to concealment
of being pathologized by other as well as a rationale for therapists
Concealed stigmatised identity clinicians (Torjesen, 2019). to reclaim their trauma histories.
Unlike the substance abuse Within the psychiatry survivor Straddling the line between
treatment field, whose literature, survivor therapists human vulnerability and
endorsement of counsellors’ (including psychiatrists, professional competency,
lived experience gives them “the psychologists and other mental psychotherapy trainees are
unique opportunity for personal health workers) have highlighted required to ‘work on self’1 and
and professional identities to “stigma, discrimination, and to familiarise themselves with
align” (Curtis & Eby, 2010, p. misunderstanding from clients self-disclosure in both personal
2), mental health professions and colleagues alike” (Adame therapy and experiential work
appear to view therapists’ trauma et al., 2017, p. 57) as main during training. Since disclosure
histories more as a professional deterrents to “being ‘out’ about is so central to the psychotherapy
risk than a potential asset (Curtis one’s … personal struggles in endeavour, the “absence of
& Eby, 2010). With few notable the professional mental health
exceptions (Benatar, 2000; community” (Adame et al., 2017, 1
https://iacp.ie/files/file601c2c9541773.
Schauben & Frazier, 1995), p. 57). More specifically within the 202102041819
10 Irish Association for Counselling and PsychotherapyVolume 22 • Issue 1 • Spring 2022 IJCP
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discussion or research on process as beneficial (Chaudoir
navigating decisions about ince in our digital era & Fisher, 2010). This was
disclosure to other professionals or written or otherwise corroborated by participants in
‘going public’ about woundedness” recorded disclosures often this research, who foregrounded
is striking (Zerubavel & Wright, remain available on the ‘social contextual level goals’ to
2012, p. 488). Internet, their impact on challenge oppression and stigma,
Contributing to what Adams and reclaim their stigmatised
therapists’ online presence
calls the ‘myth of the untroubled identities, as main motivations for
therapist’ (Adams, 2014) this can be enduring and far- disclosing within professional and
lacuna may be particularly, but reaching public spheres (Chaudoir & Fisher,
not exclusively, detrimental to 2010).
survivor therapists. Fortunately, Counselling and psychotherapy
a spate of recent publications et al., 2009) was required in literature on therapist self-
has challenged this dominant participants’ inclusion criteria – disclosure (TSD) is generally
trend, featuring first-person all three participants are qualified confined to therapist-client
narratives of survivor-therapists. and practising psychotherapists, interactions (Danzer, 2018). Even
Particularly in relation to CSA, identify as CSA survivors and their though few in the field would
these include autobiographical written disclosures are available in unambiguously endorse the
monographs (Armstrong, 2010; the public domain (in print, online traditional ‘blank slate’ approach,
Murray, 2019) and chapters and/or both). Participants diverge consensus around TSD is that
within edited collections (Farber, in gender, cultural location, and therapists should err on the side
2017; Rech, 2019), with a recent levels of professional experience. of caution (Pinto-Coelho et al.,
book focussing specifically on Names and identifying details 2018). Especially with clients
therapists’ experiences of sexual have been changed to safeguard sharing a similar interpersonal
abuse (Lee & Palmer, 2020). anonymity. Keith and Neil identify trauma history, TSD is thought
In the review of the literature, as male and are both Irish-based to “strongly and inappropriately
the researcher gradually honed in therapists with 11 and three years shift the focus of therapy to the
on therapists’ personal accounts respectively of clinical experience. therapist” (Danzer, 2018, p.
of their trauma histories. Having Ella identifies as female, and 62), however, empirical research
located the contact details of she is an American clinical supporting this position is lacking.
some of these authors online psychologist, psychotherapist Furthermore, since in our digital
and through word of mouth, they and supervisor practising for over era written or otherwise recorded
were emailed directly with an 40 years. disclosures often remain available
invitation to participate in the on the Internet, their impact on
research. Three colleagues, all Disclosure Process Model and therapists’ online presence can
CSA survivors, kindly accepted the therapist self disclosure be enduring and far-reaching.
invitation to be interviewed. Each Aligned with Chaudoir and Exploring the ramifications of
interview lasted approximately one Fisher’s Disclosure Process ‘digital transparency’ for survivor
hour, with two taking place in the Model (2010), therapists’ trauma- therapists, however, lies beyond
author’s office and one online. related disclosure is viewed the remit of the current article
The chosen methodology, here as a complex and life-long (Zur, 2007).
Interpretative Qualitative process made of interrelated
analysis (IPA), is widely used in ‘disclosure events’. While positive Analysis of emerging themes
psychotherapy research (McLeod, responses to single disclosure Following repeated and immersive
2011). Whilst recognising the events influence subsequent readings of the audio-recorded
researcher’s involvement in the disclosure choices in a ‘feed-back interview transcripts, initial
interpretative effort, IPA’s focus loop’ of increasing openness annotations were made and then
remains firmly on participants’ or concealment, ‘ecosystem’ or distilled into emerging themes
meaning-making and subjective compassionate goals to promote recurring across participants’
experience with reference to connection and social support responses. Emerging themes were
relevant theorisations (Smith & (Crocker et al., 2008) increase then clustered into superordinate
Osborn, 2004). the likeliness that disclosers themes. Although the research
A degree of homogeneity (Smith will experience the disclosure from which this piece is derived
Irish Association for Counselling and Psychotherapy 11IJCP Volume 22 • Issue 1 • Spring 2022
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covered questions around Despite having been in therapy
perceived risks and obstacles, as ot only did she for many years, Keith’s first
well as participants’ experiences return to her disclosure was in his third year
of the reactions of colleagues previous interviewees to of psychotherapy training and
to their revelations, the focus introduce herself as an was linked to starting work with
here will be on what motivated incest survivor, but she CSA survivors in his placement.
therapists’ trauma-related Similarly, Neil and Ella identified
eventually chose to include
disclosure in the professional and turning points in their disclosure
public spheres. What follows is her own experience in her history, where hearing the stories
a brief overview of some salient publication of other survivors instigated more
themes emerging from the openness.
interviews. For Neil, who worked in youth
Whilst fearing that disclosing outreach before becoming a
1. Social support at work may “diminish” her in therapist, a conversation with a
Chaudoir and Fisher (2010, the eyes of her peers or cast young trauma survivor galvanised
p.17) note that for those with a doubts over her ability to maintain him to start therapy and his own
concealed stigmatised identity boundaries with clients, she also disclosure journey. Impressed
“disclosure is a necessary felt concealment “creates this by how this brave teenager “was
prerequisite to obtain social huge wedge between colleagues”. so able to talk about [her awful
support”. All three participants Her choice to selectively disclose childhood], talk about going to
highlighted that garnering social to a few trusted colleagues who counselling, talk about what
support informed their decision to knew her well and “wouldn’t worked for her, what didn’t work
disclose. think less of me as a clinician” for her” Neil remembered feeling
Finding group belonging was was driven by her need to feel “so ashamed of holding in all of
the dominant motivating factor supported in her therapeutic this”.
for Neil, whose public disclosure engagement with sexually abused Research has shown how shame
pre-dated and was instrumental children. Ella was also able to can be “a paradoxical double-
to his becoming a therapist. find support within an ongoing edged sword: It may both elicit a
Neil’s reason for speaking of his survivor therapists’ group that strong desire to change … and
experiences on the local radio was helped her normalise her struggle. simultaneously evoke avoidance-
to reach out to other CSA survivors She recalled: “We met weekly for oriented responses” (Lickel et
and legitimise the creation of a a while and a lot of us would talk al., 2014, p. 58). Relating to
peer support group in the area. about how strange it was to go disclosure, feelings of shame
Working with fellow survivors in through our own healing at the triggered by the openness of
this context eventually led him same time we were working with others may motivate but also
to train as a therapist “so that I survivors and how clients felt we inhibit disclosure for those with a
could get into it in a deeper way”. were so attuned to them, well, similar but concealed stigmatised
Mindful of the boundaries between yeah, we got it.” identity.
his ongoing facilitation role within Further research on support For her book project on CSA, Ella
the group and his more recent groups for survivor therapists and interviewed a number of people
therapeutic practice, he continues how they may foster therapists’ who were “completely identified as
his advocacy work online, where he positive self-transformation survivors”. Yet, when asked about
identifies as a CSA survivor and a (Benatar, 2000) and vicarious her interest in the topic, she had
psychotherapist. post-traumatic growth (Bartoskova, initially preferred to shelter behind
Ella had completed her PhD and 2017; Wheeler & McElvaney, her trauma specialist persona: “I
was a licensed psychotherapist 2017) would be a valuable addition began to feel more and more like
working in a hospital when she to counselling education. a fraud; I’m asking them to be so
recovered her memories of brave and I’m ... I wasn’t willing to
incest: “I had a horrible PTSD 2. Shame of concealment do that.”
going on with lots of flashbacks Being on the receiving end of It was when an interviewee
and somehow because I think I other survivors’ disclosures shared that she would not have
dissociated so well, I was able to also had a strong influence on taken “the courageous step”
do my work.” participants’ disclosure choices. had she not been “nudged” by a
12 Irish Association for Counselling and PsychotherapyVolume 22 • Issue 1 • Spring 2022 IJCP
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concerned family-member, that 4. Survivor Mission
Ella overcame her hesitancy: “I hilst the notion of In her seminal work on trauma,
felt safer somehow, like, oh I’m ‘survivor mission’ Herman (2015) highlighted
like you.” This led to a long and may sound strident, it that for some CSA survivors,
deliberate coming-out process. reflects an inner tension becoming therapists may be an
Not only did she return to her aspect of their ‘survivor mission’
previous interviewees to introduce (see also Eskreis-Winkler et al.
herself as an incest survivor, they tell me then, or fully own what 2014) – a way of redeeming their
but she eventually chose to it is they fear.” experiences by using it for the
include her own experience in Opposing us/them dichotomies benefit of others.
her publication, using it as “the and the reification of therapists’ According to Herman (2015):
glue” binding the interviewees’ professional expertise, “Many survivors seek the
stories together. “It makes me participants’ self-perception resolution of their traumatic
cry … that’s what it was … I met as therapists revolved around experience within the confines
all these brave people and then I values of ‘shared humanity’[Ella], of their personal lives. But a
became one of them. I never said equality and authenticity. All of the significant minority, as a result of
that before.” participants felt cautious about the trauma, feel called upon to
As their professional roles using TSD around shared trauma engage a wider world” (p. 207).
gave them unique access to in clinical work. “I won’t ever tell Whilst the notion of ‘survivor
other survivors’ disclosures, [clients] about it. I don’t know mission’ may sound strident, it
participants described an if that helps me in the work – it reflects an inner tension Keith
increasing discomfort about definitely doesn’t help if I think I was particularly sensitive to. He
concealment, and a growing moral am past all that, and I am better explained: “I do think that part
imperative to disclose, linked also and I am healed and you are of my public disclosure … there
to their values and professional broken … I don’t stand any way was a heroic element to it that
responsibility as therapists. above them, why would I pretend maybe wasn’t the best thing for
to?” Keith remarked. me… that I would tell the world
3. Therapists’ values Conversely, clients’ knowledge and I would do good and save the
Across participants, professional or questions about their public world, that’s bigging it up there…
values and theoretical concepts disclosures were not seen as a it was not as grandiose as that
within the psychotherapy field threat to therapeutic boundaries … but that I would do some good
were recurrent themes providing but, rather, something to be and that it was the right thing to
a rationale for disclosure. The unpacked and integrated in the do.”
Jungian construct of the ‘wounded therapeutic work. Similarly, in his training, Neil
healer’, mentioned earlier, Beyond the professional sphere, referred to being on a “sort of
validated for Keith “that someone participants’ motivation to go a mission to say ‘look, this is
who has walked the path is the public was linked to needing to the reality, things like this do
best guide”. For Neil, disclosing take a “moral standpoint” [Keith] happen’”. Whilst acknowledging
resonated with the core counselling and “tell the truth, even the ugly the need to remain within
value of congruence: “If I am hiding truth” [Ella]. ‘Public truth-telling’ one’s level of competence, Neil
parts of me [in training], then I am is identified in the literature as a wanted to encourage peers to
not being congruent.” common denominator of “survivor see survivors’ uniqueness and
Keith was also adamant about mission” (Herman, 2015, p. 207). resourcefulness as individuals,
needing to “flag” one’s abuse Related to the notion of ‘political rather than viewing them only as a
history with supervisors, to enable disclosure’ (Cain, 1991), going challenging client-group. “Several
them to watch for potential “blind public about one’s stigmatised people in the training would say
spots”. Concealment in supervision identity becomes a way “to I could never work with people
raised concerns about potentially contribute to the greater good of ... who had child abuse, and I’d
a harmful parallel process: “If I society by raising awareness … say, but would you work with me?
am afraid to engage with or speak helping to reduce cultural stigma And they’d say yes, but you’re
about something that’s happened … and serve as a role model for different. How am I different?”
to me, that’s communicated in others who are afraid to disclose” This echoes Ella’s experience
some way to the client … how can (Chaudoir & Fisher, 2010, p. 20). as a supervisor: “I talk about my
Irish Association for Counselling and Psychotherapy 13IJCP Volume 22 • Issue 1 • Spring 2022
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own personal experience with [my motivations to speak and/or
supervisees] when I want to make urther research on write about their survivor status
a point … I want to help them how intersectional are complex and subjective and
not identify survivors as damaged issues of race, ethnicity, need to be understood within the
goods.” class, disabilities, gender overarching disclosure process
Through public disclosure and sexual identity prior, during and after training as
participant Keith opposed therapists.
impact on survivor
prevalent notions that, as a CSA Further research on how
survivor: “You are broken or you therapists’ disclosure intersectional issues of race,
are a mess and that anyone who’s choices would be a ethnicity, class, disabilities,
been abused is a non-functioning welcome addition to the gender and sexual identity impact
addict. That still stops a lot of literature on survivor therapists’ disclosure
people seeking proper help and choices would be a welcome
I think of my own example. I was addition to the literature, as
years and years in therapy and I the burden of shame and secrecy” would be an investigation of
never told anyone [because] you that some survivors might be therapists’ choice not to disclose
think this is a strange, peculiar carrying and encouraging them “to to other professionals. Focussing
thing that doesn’t happen to many share the secret with somebody” on the disclosure journeys of
people.” [Ella]. three colleagues who publicly
Indeed, in particular with Finally, providing alternative embraced their CSA histories, this
male CSA survivors, recent narratives of healing that others brief contribution hopes to spark
research has shown that could “hold on to” [Neil] was interest and discussion about how
believing their experience to important to all participants. we may strive together towards a
be an anomaly stops men from Since becoming a therapist, professional culture that “values
seeking help or impairs therapy Neil remarked how his blog the expertise of lived experience,
outcome by inhibiting disclosure focused more on “recovery and where it is safe to use this
(Sivagurunathan et al., 2019). the therapeutic journey”. Keith experience, and where people are
For Keith, the need to confront a also mentioned not wanting supported to do so” (Perkins &
cultural legacy of silence, stigma the article he wrote about his Repper, 2014, para. 34).
and shame was particularly CSA experience to be all “doom
relevant in an Irish context, where and gloom”, ensuring that his
historical patterns of institutional narrative “didn’t dismiss the
Valerie Ballarotti
abuse are increasingly being horrible things that happened,
scrutinised partly on account of an but that the good stuff wasn’t
active survivors’ movement: overshadowed either … because Valerie Ballarotti is a Galway-
I got through it … so I wanted to based counsellor and
The Irish view on abuse [is] kind of portray that.” psychotherapist, accredited
don’t tell anyone about it, we’ll Similarly, Ella expressed her with IACP and BACP. Her
sort it out between ourselves, desire to challenge the “clinging therapeutic approach is rooted
shush … that’s exactly the to the lifeboat” views of surviving, in psychosynthesis and informed
same thing that the Church or which were prevalent when she by her further training in Jungian
the State does, or families do, started her book project in the Psychology and Internal Family
so therapists are doing it now. I 90s: “I wanted to show other Systems Therapy. She specialises
think that’s so prevalent in our ways of being that is possible to in trauma-informed psychotherapy
society, in our cultural psyche, heal. I wanted to show readers, with a focus on complex trauma.
and the profession buys into it, I wanted to show the world and I The current article is derived from
too. If it was a more accepting wanted to show me.” a larger research project she
culture, I don’t know if I would conducted as part of a master’s
have written about it. Conclusion degree in counselling and
Disclosure is an ongoing, multi- psychotherapy at the University
By going public, participants layered process, a shifting of East London. Valerie can be
also sought to model openness continuum between openness and contacted by email via her website
in the hope this may help “lighten concealment. Survivor therapists’ www.creacounselling.ie
14 Irish Association for Counselling and PsychotherapyYou can also read
