Society for Psychotherapy Research Collaborative

Research Program on the Development of Psychotherapists

David E. Orlinsky, Michael Helge Rønnestad, and Ulrike Willutzki

Psychotherapists are the trained professionals to whom large numbers

of individuals in our society turn for help when they experience significant
distress in their personal lives. We know a considerable amount about the
effectiveness and process of psychotherapy after decades of research, but we
still know relatively little about the trained professionals who practice their
skills on behalf of those who seek their help. Who are the people who work
as psychotherapists? What qualifications and qualities do they have as profes-
sionals? What kind of people are they as persons? How do they experience
their work? Which of their professional and personal characteristics influence
how they work with clients? What impact does the therapists’ work have on
them, professionally and personally? How do psychotherapists develop? What
work-related or personal experiences influence their development, and what
impact does their development have on their therapeutic work?
These questions have guided the Society for Psychotherapy Research
Collaborative Research Network (SPR/CRN) since its inception in 1989,
when members of the international Society for Psychotherapy Research
began working together to study the development of psychotherapists. The
SPR/CRN is a research co-op that consists of colleagues who collaborate vol-
untarily on projects of mutual interest. Aside from its substantive contributions
to knowledge, the SPR/CRN is noteworthy for representing an innovative
and perhaps unique model of research organization—one that is independent,
self-supporting, and self-governing; that is, free to pursue its own intellectual
interests because it does not depend on funds solicited from other sources.
Over the past 2 decades, some 70 to 80 doctoral-level colleagues and
students in more than two dozen countries have participated in varying degrees
as SPR/CRN members for varying lengths of time. They have mostly been
clinical researchers with considerable experience as practicing psychotherapists
and also trainers and supervisors of therapists. Together they designed a
wide-ranging research instrument, made careful translations of it into multiple
languages, and used it to collect data from an ever-growing group of pro-
fessional psychotherapists and counselors (nearly 10,000 so far) in North and
South America, Europe, Asia, the Middle East, Oceania, and Africa. Respon-
sibility for coordination and continuity of SPR/CRN research is vested in
a steering committee comprising approximately 10 or 12 of the most active
and committed members.
The Development of Psychotherapists Common Core Questionnaire
(DPCCQ) was created to survey the professional and personal experiences of

PSYCHOTHERAPY RESEARCH CENTERS AND GROUPS 375

clinical colleagues (Orlinsky et al., 1999). The original version of the DPCCQ
included 392 items organized in various sections according to topic. These
included questions about psychotherapists’
䡲 professional characteristics (e.g., professional training and
identity, theoretical orientation, amount and types of clinical
experience);
䡲 types of clients treated (e.g., ages, diagnoses, impairment levels);
䡲 experiences of therapeutic work (e.g., typical treatment goals,
skills, manner of relating, difficulties in practice, coping strategies);
䡲 current and overall professional development and the influences
on their development;
䡲 use and evaluation of their own personal therapy; and
䡲 personal characteristics (e.g., age, gender, marital status, levels
of life satisfaction and stress, personal self-concept in the context
of close relationships).
We tried to adapt the DPCCQ versions used in different countries to
the social, cultural, and professional situations where therapists live and work.
Most recently, the use of interactive, Internet-based versions of the DPCCQ
is being explored and evaluated.
What kinds of people are asked to complete the DPCCQ? The problem
of research design we encountered stems from the fact the universe of profes-
sional psychotherapists cannot be rationally defined, and, hence, a statisti-
cally representative sample cannot be collected. The world of professional
psychotherapists includes clinical and counseling psychologists, psychiatrists
and psychoanalysts, clinical social workers and counselors, and others in a
mix of professions that varies from one country to another. The diversity is
further compounded by the fact that therapists are divided into rival theoret-
ical camps. Given this complex situation, we chose to invite a large number
of people who self-identify as psychotherapists—of varied professions and
theoretical orientations in various countries—to voluntarily give an hour or
more of their time to reply to our questions.
Detailed reports of our findings and their interpretation are presented in
How Psychotherapists Develop: A Study of Therapeutic Work and Professional
Growth (Orlinsky & Rønnestad, 2005) and elsewhere (e.g., Ambühl, Orlinsky,
& the SPR/CRN, 1997; Bae, Joo, & Orlinsky, 2003; Elliott, Orlinsky, Klein,
Amer, & Partyka, 2003; Orlinsky et al., 1996, 1999; Orlinsky, Botermans, &
Rønnestad, 2001; Orlinsky, Botermans, Wiseman, Rønnestad, & Willutzki,
2005; Rønnestad, Orlinsky, Parks, & Davis, 1997; Schroder & Davis, 2004;
Smith & Orlinsky, 2004). Some of these are summarized in the sections
that follow.

376 ORLINSKY, RØNNESTAD, AND WILLUTZKI

 HOW DO THERAPISTS EXPERIENCE THERAPEUTIC WORK?

Analyses of multiple facets of therapeutic work demonstrate the pres-

ence of two broad dimensions named healing involvement and stressful
involvement. The experience of healing involvement was marked by personal
investment in affirming, receptive relationships with clients, high levels of
clinical skill, and use of constructive coping strategies when confronting dif-
ficulties in practice. By contrast, the experience of stressful involvement was
defined by frequent difficulties in practice, accompanied by defensive, thera-
peutically unconstructive coping strategies (e.g., withdrawal) and therapists’
feelings of boredom and anxiety.
Both healing involvement and stressful involvement are experienced
by all therapists, although to varying degrees. Nearly three fourths of approx-
imately 5,000 therapists studied experienced relatively high levels of heal-
ing involvement in their therapeutic work. Combining varying levels of
healing involvement and stressful involvement, therapists who were high
in healing involvement and low in stressful involvement were said to have
an effective practice—which included about 50% of all surveyed. Another
23% were high in healing involvement but also experienced comparatively
high levels of stressful involvement, producing a pattern of challenging
practice. Unfortunately, a small but significant minority (about 10%) of
therapists showed a pattern of distressing practice, marked by much stressful
involvement and not much healing involvement. These therapists did not
appear to be helping many of their clients, were somewhat at risk themselves,
and required special attention from supervisors and others responsible for
quality of patient care. Another small but significant group (about 17%)
appeared to have a personally neutral but unproductive pattern of disengaged
practice, in which there was little stressful involvement but not much healing
involvement.
The experience of healing involvement was most strongly predicted by
theoretical breadth (use of multiple orientations), feelings of support and
satisfaction in the primary work setting, and positive work morale, along with
breadth and depth of case experience across individual, couples, family, and
group therapy modalities. Thus, therapists who have broad-ranging experience,
have a broad understanding of how therapy can be done, and feel a strong
commitment to their work appear to be the most helpful to their clients.
Only a few therapist characteristics were associated with the experience
of stressful involvement, suggesting that this may be more determined by client
and caseload characteristics. However, it was clear that work stress was greater
for therapists who felt little support or satisfaction in their main work setting,
had no private practice, and were caught in a process of demoralization.

PSYCHOTHERAPY RESEARCH CENTERS AND GROUPS 377

 PROFESSIONAL DEVELOPMENT

The concept of psychotherapist development was the key idea and initial
stimulus for the SPR/CRN study, but the meaning of development was far from
clear at the outset. Analysis of the concept led to four observational frames
of reference: (a) cumulative career development, as reflected directly and
manifested indirectly in therapeutic work experience; (b) currently experienced
development, felt by therapists as present change for better or worse in ther-
apeutic activities; (c) comparative cohort development, based on differences
detected between therapists at successive career levels; and (d) sequential
individual development, based on repeated measures of therapeutic function
over significant periods of time.
Therapists’ cumulative career development was only modestly corre-
lated with the length of time therapists had been in practice and was actu-
ally more closely related to the breadth and depth of the therapist’s work
experience—suggesting that development depends less on the passage of time
in practice than on how much one has learned in that time. Two dimensions
of present change were found. Currently experienced growth reflected a sense
of enhanced skillfulness, deepening understanding of therapeutic process, an
enthusiasm for practice, and an awareness of overcoming one’s past limita-
tions as a therapist. Therapists on average had high scores on this dimension
at all career levels, contrary to expectations that the sense of current growth
would level out after many years in practice. This fact led to interpreting the
dimension largely as a reflection of the therapist’s positive work morale, in
addition to actual learning and improvement. By contrast, the second dimen-
sion of present change was one of currently experienced depletion. This
reflected a sense of deteriorating skills, loss of empathic responsiveness to
patients, routine performance in work, and a growing doubt about the effec-
tiveness of therapy.

A MODEL OF THERAPIST DEVELOPMENT

The empirical relations we discovered between therapists’ professional

growth and their concurrent experiences in therapeutic work led us to formu-
late a theoretical model of psychotherapist development. We called this a
cyclical–sequential model because it involves two simultaneous cycles, positive
and negative, each varying in intensity, that jointly shape successive periods
of growth (or decline) in therapeutic ability. The positive cycle reflects the
reciprocal influence that was found between healing involvement and cur-
rent growth. Therapists’ experiences of healing involvement with patients
gives rise to current growth, and that, in turn, imbues them with the assurance

378 ORLINSKY, RØNNESTAD, AND WILLUTZKI

and endurance needed to engage effectively with patients. This cycle also acts
over time to increase the therapist’s overall career development, expanding
the therapist’s confidence, resourcefulness, and flexibility with patients.
Concurrently, a negative cycle reflects the potential for a self-reinforcing
spiral of influence between stressful involvement in therapeutic work and
therapists’ currently experienced depletion. Therapists’ experiences of stress-
ful involvement with clients gives rise to currently experienced depletion,
engendering a loss of interest and optimism in therapists that further under-
mines their work with clients. The therapist’s demoralization thus reflects and
reinforces the patient’s own demoralization and, if it is not adequately com-
pensated by other factors (e.g., supervisory support), may lead to a state of
therapist burnout and diminish the therapist’s overall career development.
The model does not envisage a fixed sequence of developmental stages
through which all therapists pass. Instead, the pattern of development over
time depends on the relative balance between positive and negative cycles,
which are always present as potentials for development. The actual course of
a therapist’s development depends on contingencies that make one or the
other cycle more intense. When the positive cycle is dominant, there is a
period of positive growth in therapeutic ability; however, when the negative
cycle prevails for a time, therapeutic ability may decline, leading the thera-
pist to be awkward, insecure, and defensively rigid.
This empirically grounded model of therapist development has clear
implications for psychotherapy training, supervision, and practice (discussed
in detail in Rønnestad & Orlinsky, 2005a). The most important recommen-
dations for training are to ensure that (a) therapists have an experience of
healing involvement, especially in their initial work with patients, (b) stress-
ful involvement is kept to a minimum and constructively compensated when
unavoidable, and (c) adequate supervisory and peer support is available, espe-
cially for beginners. Provided there is appropriate training and supervision,
an early introduction to clinical work is recommended (Orlinsky et al., 2001).
Supervision is widely viewed by therapists as a very positive influence on their
current growth and career development, but there is also a potential for neg-
ative influence from supervision when supervisors are seen as critical and
unsupportive. This may combine with the supervisee’s experience of stressful
involvement with a client to create a situation of double traumatization for
the trainee (Rønnestad & Orlinsky, 2005b).
For therapists at all career levels, the cyclical relationship between
current development and therapeutic practice provides a strong argument
for continually monitoring one’s own development. Two brief self-rating
forms for work involvement and professional development were constructed
from the DPCCQ to aid therapists in this (see Orlinsky & Rønnestad, 2005,
Appendixes E and F).

PSYCHOTHERAPY RESEARCH CENTERS AND GROUPS 379

 The SPR/CRN program of research on psychotherapists continues to
add to its 20-year history with new studies. Additional data collections have
recently been completed in Australia, Chile, Portugal, and India. Data analy-
ses are currently underway to deepen our understanding of therapists’ per-
sonal characteristics, identities, personal lives, and spirituality in relation to
therapeutic work and professional development. Psychotherapists of different
theoretical orientations and professions are being compared. The SPR/CRN
remains an active and open voluntary association of clinicians–researchers,
and it will continue to exist as long as old and new members combine their
skills and resources in pursuing the shared goal of learning more about
psychotherapists.

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