Psychotherapist who abstain from personal theraphy

Brief Report

Psychotherapists Who Abstain From Personal Therapy: Do
They Practice What They Preach?
m

John C. Norcross
University of Scranton
m

Denise H. Bike
Loyola College in Maryland
m

Krystle L. Evans and Danielle M. Schatz
University of Scranton

The authors examined the attitudes and reasons of 119 American
psychologists, counselors, and clinical social workers who had never
sought personal therapy. Nontherapy seekers, compared to therapy
seekers, expressed less-positive attitudes toward its value as a
prerequisite for clinical work and for ongoing professional development.
Women, men, and members of all three professions were equally likely
to have sought therapy, but cognitive–behavioral therapists and
academics were significantly less likely to do so. Top reasons for not
undergoing personal therapy entailed dealing with stress in other ways,
receiving sufficient support from friends and family, believing coping
strategies were effective, and resolving the problem before therapy
was needed. The likelihood of seeking personal treatment in the future
as well as reasons for doing so are discussed. & 2008 Wiley
Periodicals, Inc. J Clin Psychol 64:1368–1376, 2008.

Keywords: personal therapy; psychotherapists; clinical psychology;
social workers; counselors

‘‘But where and how is the poor wretch to acquire the ideal qualification which
he will need in this profession? The answer is in an analysis of himself, with which
his preparation for his future activity begins.’’ Thus Freud (1937/1964, p. 246)

The authors gratefully acknowledge the participation of the 727 psychotherapists who made this study
possible.
Correspondence concerning this article should be addressed to: John C. Norcross, Department of
Psychology, University of Scranton, Scranton, PA 18510-4596; e-mail: norcross@scranton.edu

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 64(12), 1368--1376 (2008) & 2008 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20523

Psychotherapists Who Abstain From Personal Therapy 1369

asked—and answered—in Analysis Terminable and Interminable. Following his
exhortations, at least 75% of mental health professionals in the United States
(Norcross & Guy, 2005) and in Europe (Orlinsky, Rønnestad, Willutzki, Wiseman,
& Botermans, 2005) have undergone personal therapy on one or more occasions.
Several studies (e.g., Dearing et al., 2005; Gilroy, Carroll, & Murra, 2002; Holzman,
Searight, & Hughes, 1996) suggested that the prevalence may be even higher among
contemporary graduate students in clinical and counseling psychology. And the
impact of personal therapy is typically profound: More than 90% of clinicians report
considerable personal improvement, and more than 75% relate a strong professional
influence on their development as therapists (Orlinsky, Norcross, Rønnestad, &
Wiseman, 2005). In fact, personal therapy has been consistently found to rank
among the top three sources of positive influence on professional development, only
following direct experience with patients and formal case supervision (Orlinsky,
Botermans, & Rønnestad, 2001).
The centrality of the psychotherapist’s own psychotherapy and its ubiquity in
psychology training programs have led many to wonder about those psychothera-
pists who have not undergone the experience themselves. Do they practice what they
preach? Researchers have consistently found that 20–25% of therapists abstain from
personal therapy. This percentage remains stable across training levels (Farber, 2000;
Holzman et al., 1996) and across professions (Gilroy et al., 2002; Liaboe, Guy,
Wong, & Deahnert, 1989; Mahoney, 1997; Pope & Tabachnick, 1994) with one
possible exception: Marriage and family therapists may be significantly less likely to
seek personal therapy than therapists in other professions (Norman & Rosvall,
1994).
In the past, women, psychoanalytic, and humanistic therapists were more likely to
seek personal therapy than their male and cognitive–behavioral counterparts.
Studies of American psychotherapists have typically, but not uniformly, found a
higher prevalence of personal treatment among female therapists than among male
therapists (e.g., Mahoney, 1997; Norcross, Strausser-Kirtland, & Missar, 1988; Pope
& Tabachnick, 1994), but studies among international samples suggested that any
differences between genders were small and inconsistent (Orlinsky et al., 2005).
Reviews of personal therapy studies conducted in both the United States (Norcross
& Guy, 2005) and internationally (Orlinsky et al., 2005) arrive at similar conclusions
regarding theoretical orientation: Psychoanalytic clinicians had the highest
prevalence and cognitive-behavioral the lowest.
Fewer studies have intentionally sought specific information unique to
psychotherapists who abstain from personal therapy. The handful of studies that
have probed further, examining the factors affecting the decision to not undergo
personal therapy, have been largely restricted to small samples and interview studies.
Nontherapy-seeking psychotherapists and graduate students most commonly
reported that they either have no need for therapy or that they receive adequate
support from other sources (Gilroy, Carroll, & Murra, 2001; Holzman et al., 1996;
Liaboe et al., 1989). For others, concerns about credibility, confidentiality, and cost
keep them from seeking personal therapy (Farber, 2000; Norman & Rosvall, 1994).
These reasons remain consistent among student trainees (Holzman, et al., 1996;
Liaboe et al., 1989; Strozier & Stacey, 2001) and seasoned psychotherapists
(Deutsch, 1985; Gilroy et al., 2002; Norman & Rosvall, 1994).
This study was designed to investigate, in a larger and multidisciplinary sample,
additional questions about psychotherapists who do not seek personal therapy
themselves. How do psychotherapists who abstain from personal therapy differ from
Journal of Clinical Psychology DOI: 10.1002/jclp

1370 Journal of Clinical Psychology, December 2008

those who do undergo therapy? What are their reasons for not using personal
treatment? How likely are they to seek therapy in the future? What circumstances, if
any, would lead them to consider seeking personal therapy?

Method
Questionnaire
We adapted a 6-page questionnaire used in a 1987 study (Norcross, Strausser, &
Faltus, 1988; Norcross, Strausser-Kirtland, et al., 1988) for the present study by
retaining most items, reducing it to 5 pages by reformatting the document and
removing many questions on professional activities, and adding a few new questions.
Page 1 covered demographic, training, and professional characteristics. Pages 2–4
were devoted to personal therapy in detail (see Bike, Norcross, & Schatz, 2005, and
Norcross, Bike, & Evans, 2008, for those results). We addressed the final page of the
questionnaire to therapists who had never sought personal therapy. These
psychotherapists rated 17 potential reasons for not seeking therapy (derived from
Deutsch, 1985; Farber, 2000; Holzman et al., 1996; and Norman & Roswall, 1994)
on a 5-point, Likert-type scale. Participants who had never sought personal therapy
were also asked to indicate the likelihood of seeking it in the future and to cite one
circumstance that would probably lead them to do so.

Procedures and Participants
We mailed the questionnaire, a cover letter, and a stamped return envelope to 2,100
randomly selected American mental health professionals: 700 psychologists from the
National Register of Health Service Providers in Psychology, 700 social workers
from the National Association Social Workers (NASW) Register of Clinical Social
Workers, and 700 counselors from the American Counseling Association (ACA).
One month after the initial mailing, we mailed a follow-up to nonrespondents. We
received responses from 736 participants; however, 9 did not complete the
questionnaire. We secured usable returns from 727 psychotherapists—261 psychol-
ogists, 234 clinical social workers, and 232 counselors—for a response rate of 35%.
Our samples appeared demographically representative of their respective
populations with the exception of an underrepresentation of ethnic/racial minority
psychotherapists. The National Register reported 42% women, the NASW Register
82%, and the ACA 73%; our samples contained 45%, 82%, and 79% women,
respectively. Our respondents’ age distribution corresponds closely to the published
information for the three professional organizations as well. The National Register
reported 45% of its members were 61 years and older, NASW 23%, and ACA 12%;
our samples contained 42%, 24%, and 13%, respectively. As a final example, the
National Register reported 9% ethnic/racial minority members, the NASW 11%,
and ACA 11%; our corresponding samples contained 5%, 6%, and 5%.

Results
All told, 119 or 16% of our sample had never obtained personal therapy. Table 1
summarizes the respondents’ characteristics, comparing those who underwent
personal therapy and those who did not. Therapist age, race, profession, degree,
and employment site did not differ significantly between those who had used
personal therapy and those who had not. Although men (19%) appeared slightly


Table 1
Comparison of Psychotherapists Who Have and Who Have Not Sought Personal Therapy

Variable Nontherapy Seekers (n 5 119) Therapy Seekers (n 5 608)

Age (M, SD) 52 (12.2) 53 (10.1)
% %
Gender
Female 62 68
Male 38 32
Ethnicity
Caucasian/White 87 93
African American/Black 6 3
Multiracial/Other 6 3
Asian American 1 1
Profession
Psychology 33 36
Social Work 35 32
Counseling 33 32
Terminal degree
PhD 36 36
MSW 29 29
MA, MS 24 25
PsyD 7 6
Other 4 4
Theoretical orientation
Cognitive 36 24
Eclectic 23 24
Behavioral 15 9
Systems 9 9
Humanistic/existential 7 9
Psychodynamic 2 12
Interpersonal 2 3
Psychoanalytic 1 4
Other 5 6
Professional self-view
Clinical practitioner 68 81
Administrator 9 6
Academician 10 4
Consultant 2 2
Other 11 7
Employment site
Private practice 40 45
Community clinic 10 10
University 10 8
Hospital setting 8 7
Other outpatient setting 8 6
Other 24 24

more likely to have abstained from personal therapy than women (15%), this was
not a statistically significant difference.
Therapy seekers and nonseekers did differ significantly in terms of theoretical
orientation and professional self-view. Fully 26% of all cognitive–behavioral
therapists in our sample did not seek personal therapy. This percentage
differs significantly, w2(2, N 5 701) 5 28.51, po.001, from both humanistic and


psychodynamic/psychoanalytic therapists, of whom only 15% and 3% did not seek
therapy, respectively. In addition, a greater percentage of self-identified academi-
cians (32%) and administrators (22%) did not seek therapy. Clinicians and
consultants were far more likely to have sought personal therapy, w2(7,
N 5 723) 5 17.19, po.01.

Attitudes Toward Personal Therapy
The groups differed robustly in their attitudes toward the value of personal therapy.
We asked participants to rate on a 5-point scale (1 5 very unimportant, 3 5 neutral/
undecided, 5 5 very important), the importance of personal therapy under three
conditions: as a prerequisite for clinical work, as a source of ongoing development
during a clinical career, and as a condition of continuing or resuming practice for
clinicians disciplined by licensing boards. In each case, nontherapy users’ ratings
were consistently lower than those of therapy users. Specifically, therapists who have
never sought personal therapy gave a significantly lower rating of the importance of
therapy as a prerequisite for training (M 5 2.78, SD 5 1.09) compared to therapists
who had sought personal therapy (M 5 4.23, SD 5 1.04), t(720) 5 13.57, po.001.
Nontherapy-seeking therapists rated therapy as a source of ongoing development
during one’s career a mean importance of 2.85 (SD 5 1.09) compared to their
therapy-seeking counterparts’ rating of 3.81 (SD 5 1.00), t(720) 5 9.30, po.001.
They also devalued personal therapy as a condition for discipline by a licensing
board, rating it at 3.28, compared to 3.87 for therapists who had sought therapy,
t(718) 5 4.45, po.001.

Reasons for Not Using Personal Therapy
As captured in Table 2, nonseekers rated the importance of 17 reasons for not
pursuing personal therapy. Among the highest rated reasons were ‘‘I dealt with my
stress in other ways’’ and ‘‘I received sufficient support from friends, family, or
coworkers’’ (both M 5 4.04). Coping effectively with challenges, resolving problems
before therapy was undertaken, and having no need for personal therapy were
ranked third, fourth, and fifth, respectively. The lowest-rated considerations
pertained to the inability to find a therapist with whom they would feel comfortable,
inability to locate a good therapist, and discouragement due to peers’ unsatisfactory
experiences.
Table 2 also presents the results of previous studies for comparative purposes. As
shown there, several of the top reasons for not initiating therapy were not even listed
in the previous studies. The most frequent reasons in two previous studies were
ranked fifth and seventh in this study.
Profession and gender related to the reasons that psychotherapists did not seek
personal treatment. Psychologists were significantly less concerned about the cost of
therapy, F(2, 109) 5 5.33, po.01, than were social workers and counselors. Women
were significantly more likely to report the lack of time, F(2, 109) 5 5.62, p 5 .02,
whereas men were significantly more likely to cite their ability to cope effectively on
their own as a reason for opting out of personal therapy, F(2, 109) 5 5.59, p 5 .02.

Circumstances Under Which Therapists Might Initiate Treatment
We asked nontherapy-seeking psychotherapists to answer an open-ended question:
What one circumstance would lead you to probably seek personal therapy?


Table 2
Factors Affecting Therapists’ Decision to Not Seek Therapy

Rank Order

Mean Present Deutsch Norman & Gilroy et al.
Factor (SD) study (1985) Rosvall (1994) (2002)

I dealt with my stress in ways other 4.04 1 (Tie) NR NR 2
than therapy. (0.86)
I received sufficient support from 4.04 1 (Tie) 2 NR NR
friends, family, or coworkers. (1.00)
I coped with challenges effectively on 3.87 3 NR 2 NR
my own. (0.89)
I resolved my problems before therapy 3.49 4 3 NR 1
was undertaken. (1.25)
I did not need personal therapy. 3.42 5 NR 1 NR
(1.28)
No one recommended therapy to me. 2.79 6 NR NR NR
(1.66)
I knew all of the acceptable therapists 1.90 7 1 NR 4
in my locale. (1.28)
I lacked the time for personal 1.89 8 NR NR NR
therapy. (1.16)
I thought personal therapy was too 1.69 9 6 (Tie) NR 8
expensive. (1.02)
I was not sure personal therapy 1.64 10 12 NR 10
would be helpful. (1.09)
I did not want to invest the energy in 1.50 11 6 (Tie) NR 7
the undertaking. (0.91)
I believed that, as a therapist, I 1.49 12 6 (Tie) NR NR
should work out my own problems. (0.90)
I was afraid of exposure. 1.47 13 4 (Tie) NR 6
(0.93)
I had concerns about confidentiality. 1.44 14 4 (Tie) 3 5
(0.85)
I was unable to find a therapist with 1.37 15 NR NR NR
whom I could be comfortable. (0.87)
I was unable to locate a good 1.34 16 NR 5 3
therapist. (0.90)
I was discouraged from seeking 1.10 17 NR NR NR
personal therapy due to my peers’ (0.37)
unsatisfactory experiences.

Note. NR 5 not reported.

Ninety-four percent (112 of 119) of the psychotherapists responded. They listed a
total of 112 circumstances. Two trained undergraduates constructed 13 mutually
exclusive categories (including Other) by reviewing all responses, creating and
revising the categories in a recursive process, and obtaining 90% or better intercoder
reliability on category assignment.
The most frequent circumstances under which these therapists would seek
personal treatment are shown in Figure 1. Six circumstances recurred: personal or
professional dysfunction (n 5 37), death of a loved one (n 5 26), stress overwhelming
their coping (n 5 10), marital difficulties or divorce (n 5 7), perception that therapy
would be useful (n 5 2), and requirement of a licensing board (n 5 2).


Personal dysfunction

25% Death of a loved one
33%
Perception that it would be
effective
Training requirements

9% Marital difficulties

Stress overwhelm coping
6%
2% Other reasons
23%
2%

Figure 1. Future circumstances under which psychotherapists may seek personal treatment.

Participants also rated the likelihood of their seeking personal therapy in the
future. On a 5-point, Likert-type scale where 1 was very unlikely and 5 was very
likely, the mean rating was 2.66 between somewhat unlikely and undecided. Only 31%
indicated that they were somewhat or very likely to seek personal therapy in the
future. Younger participants, r(109) 5 .543, po.01, and concomitantly those with
fewer years of clinical experience, r(109) 5 .472, po.01, were more likely to indicate
that they would seek personal therapy in the future.

Discussion
Our results were generally consistent with previous research on the relations of
therapist gender, theoretical orientation, and professional self-view to abstaining
from personal treatment. Male therapists were as likely to avoid personal therapy as
women were, a finding corresponding to recent conclusions of small and inconsistent
gender disparities (Orlinsky et al., 2005). Behavior and cognitive therapists were less
likely to enter personal therapy than therapists endorsing other theoretical
orientations, including psychodynamic, psychoanalytic, interpersonal, humanistic,
and eclectic.
Academicians were far less likely to engage in personal therapy compared to
clinical practitioners and those with other professional self-views. Parallel findings
emerged in a study of 88 training directors of clinical psychology programs and 231
clinical practitioners; sharp attitudinal differences were found between the
academicians and practitioners on 22 of 26 survey items concerning the value of
personal therapy (Voigt, 1998). These patterns hark back to the original Henry,
Sims, and Spray (1973) study that found academics and administrators were less
likely to seek personal therapy than practitioners—be they psychiatrists, clinical
psychologists, or psychiatric social workers.
Academicians and training directors can exert substantial impact on graduate
students’ attitudes and behaviors—both as models through personal interaction and
as standard setters though program requirements. Graduate students have cited
stigma and the potential for negative ramifications among their top reasons for not
seeking personal therapy (Farber, 2000; Holzman et al., 1996). As seen in our results,
therapists who did not seek personal treatment placed far less value on it as a
component of training.


Past research suggested that the primary reasons psychotherapists give for not
entering therapy were confidentiality concerns, financial expense, fear of exposure,
time constraints, and difficulty locating a skilled therapist outside their network
(Gilroy et al., 2001; Liaboe et al., 1989; Norman & Rosvall, 1994; Pope &
Tabachnik, 1994). By contrast, our research, with a larger, multidisciplinary sample
using structured ratings, demonstrated other, higher-ranking concerns. Expense fell
to a ranking of nine, and fear of exposure, confidentiality concerns, and finding a
therapist to be comfortable with dropped to 13, 14, and 15, accordingly. Perhaps the
more widely accepted use of personal therapy as a self-care strategy for mental
health professionals has reduced its stigma, resulting in less fear of exposure and
fewer confidentiality concerns. Time constraints, sufficient coping skills, and other
sources of adequate support topped the reasons for not initiating personal treatment
in the present study.
Mental health professionals hold respectable reasons for not seeking personal
therapy as well as the presence of mind to acknowledge the circumstances that may
prompt them to seek it in the future. Perhaps their belief that they cope well without
psychotherapy sheds light on why Stevanovic and Rupert (2004) found that men
were significantly less likely than women to identify the contribution of personal
therapy (as a career-sustaining behavior) and why fewer depressed male
psychotherapists (61%) in Gilroy et al.’s sample (2001) sought personal therapy
than did women psychotherapists (73%).
Past behavior is not entirely predictive of future choices in our sample of
nontherapy seekers. Almost a third (31%) of our respondents who had never entered
personal therapy, particularly the younger psychotherapists, related that they may
seek therapy in the future. We then asked a question never, to our knowledge, asked
before in the research literature: What one circumstance would lead you to probably
seek personal therapy? The anticipated circumstances all centered around loss: loss
of adequate functioning, loss of a loved one, loss of necessary coping, or loss of close
relationship/marriage. These reasons are nearly identical to the presenting problems
of psychotherapists actually receiving personal treatment (Bike et al., 2008), with the
exception of grief, which was less prevalent in the present study of nontherapy
seekers.

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