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The Person of the Therapist Training Model

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Abstract

The main thrust of the POTT model has to do with a use of self that emanates from the personal depths of the individual who is conducting the therapy. This is more than a strategy about how therapists use themselves. This is about us, as clinicians developing a conscious, purposeful and disciplined access to our humanity within our professional role in the therapeutic relationship. This means that as therapists we view the therapeutic process, at its core, as a person-to-person human encounter. The POTT approach assumes that the more of both therapist and client are experientially present in this living process of therapy, the greater the access the therapist has to self and to client to do the work of therapy. POTT’s concept of being “present” in the therapeutic relationship implies a professionally purposeful personal engagement with the client (individual, couple or family) that lends clarity of insight, depth of sensitivity and potency of effectiveness to the therapist’s clinical performance.
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1.1.
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© Springer International Publishing AG 2017
Jay Lebow
,
Anthony Chambers
and
Douglas C. Breunlin
Encyclopedia of Couple and Family Therapy
10.1007/978-3-319-15877-8_544-1
The Person of the Therapist Training Model
Harry Aponte 1 and Karni Kissil 2
Drexel University, Philadelphia, PA, USA
Private Practice, Jupiter, FL, USA
Harry Aponte (Corresponding author)
Email: harryjaponte@verizon.net
Karni Kissil
Email: kkissil@comcast.net
Without Abstract
Introduction
The Concept
The Person of the Therapist Training Model represents a concept within the province of the use of self in
therapy that contains a combination of certain particular features:
Although the training goals consider the personal growth and development of the therapist, the model’s
primary emphasis is on the therapists’ ability to make purposeful and skillful use of their personal
selves and life experiences within the professional role of therapist – the therapeutic relationship, the
assessment process, and the implementation of interventions.
The personal use of self includes all aspects of what the therapist brings of the personal self into the
therapeutic process with the clients but with special attention to therapists’ own emotional
“woundedness,” which enables empathy and resonance with clients’ “woundedness.”
The training aspect of the model evinces itself through a systematic process and structure that aims to
have therapists:
Recognize who they are and what they bring of their personal selves, good and bad, to the
therapeutic encounter, enabling them to be open and vulnerable within themselves while
(b)(b)
simultaneously well-grounded and differentiated when engaged with clients.
Not only gain insight into themselves but also develop an acceptance and comfort with themselves,
especially with their personal emotional vulnerabilities, that frees them to make positive, selective,
and active use of all aspects of self as needed to lend depth of the presence, perception, and sensitivity
along with self-possession and power to their technical skills.
Theoretical Context
Attention to work on the emotional life of the self of the individual who is conducting therapy started with
Sigmund Freud’s ( 1910) expectation that aspiring analysts undergo their own psychoanalysis as part of their
training. With the birth of systemically based therapies, Murray Bowen ( 1972) and Virginia Satir ( 2000)
stand out as proponents of working on nascent family therapists’ resolving personal issues and differentiating
themselves as a basic part of their training. Aponte and Joan Winter in their “person practice” model (Aponte
and Winter 2013) put their focus on bridging the work on self with the mastery of the technical or “external”
tools of the trade. Aponte (Aponte et al. 2009), in Drexel University’s Couple and Family Therapy
Department in Philadelphia, developed a systematized approach to the training of beginning therapists in the
use of self in couple and family therapy, the Person of the Therapist Training (POTT) Model, that prioritizes
clinicians’ making the fullest use of their personal selves, in particular of their emotional vulnerabilities, in all
aspects of the therapeutic process – the relationship, assessment, and interventions. While the work on self in
the training of therapists has traditionally focused primarily on helping therapists resolve personal emotional
issues that interfere with their clinical effectiveness, the POTT Model emphasizes therapists’ in the present
therapeutic moment making purposeful and strategic use within their therapy models of their personal core
emotional issues, life experiences (good and bad), and their values/world views.
The special attention to therapists’ use of their emotional vulnerabilities is based on the premise that it is
through these personal issues of theirs that therapists are best prepared to relate to the emotional struggles of
their clients. Thus, their training aims at therapists’ coming to better know themselves, to have ready access to
their inner experiences when engaged with clients, and to gain greater mastery in the purposeful use of their
personal selves in the moment when actively engaged with clients. While the experience of this POTT
training commonly leads to personal change and growth in therapists, the thrust of the training is to enrich,
enliven, and power the technical skills of the therapist with the personal resources of the therapist’s whole
person. The training is model neutral and serves as foundation to the core formation of the person who
aspires to connect with clients, understand and intuit their feelings and relational dynamics, and reach in and
touch their pain and hurts along with their potential to change.
Description
The POTT Model is based on the premise that at its core the therapeutic relationship is a personal process that
takes place between the therapist and client within a therapeutic context. POTT further assumes that
therapists are capable of developing an expertise in how they purposefully and proactively use themselves
personally within the therapeutic process in order to provide competent and effective care to their clients
(Aponte and Kissil 2016). POTT trains therapists to selectively use all of themselves with particular attention
to their signature themes, which are the central pillars of the model. The idea of the signature theme is based
on two assumptions: One, we all carry within us a particular psychological issue that is at the heart of our
human woundedness, coloring our emotional and relational functioning throughout our lives. Two, for
therapists to be able to relate most effectively to their clients, they must be able to selectively open
themselves up in judicious vulnerability so they can feel and experience something of their clients’ pain and
struggles.
Therapists’ signature themes with their derivatives (other personal issues that spin off from the original core
issue) are the media through which therapists make these connections with their clients’ struggles. We all live
with our unique struggles with ourselves and with life. The signature theme has an underlying core, such as
feelings of low self-esteem with derivatives like a fear of vulnerability and defensive derivatives such as the
need for control in relationships to avoid being rejected. These core themes are universal enough to enable
therapists to identify and empathize with most clients. Social factors such as race and ethnicity may
contextualize these issues, but the underlying universal feelings such as fear of rejection may allow a
therapist to still bridge emotionally with clients who have different life experiences due to their particular
social locations.
The POTT Model takes a unique stance regarding the value of core issues by not just suggesting that
signature themes are resources that can enhance therapists’ effectiveness but also by placing learning to work
through signature themes at the very heart of the training of therapists in the use of self. The signature themes
are not narrowly viewed as hindering therapy but rather, whatever challenges they present are potentially
valuable resources, enabling therapists to work effectively by identifying with and differentiating from their
clients (individuals or families). Accepting their personal vulnerabilities opens therapists to empathize with
their own selves. This then facilitates their reaching within themselves to connect through a wound of their
own to their client’s wound, which in turn allows for a cognitive and emotional identification that may enable
them to better understand and empathize with a client’s woundedness and understand the hurt from within –
the common painful human element therapist and client share. It is that common human factor that allows the
therapist to intuit what clients may not even be conscious of in their painful experience. The therapist may
have insight about some core aspect of his/her own analogous experience that throws light on the clients’
experiences even when many of the surrounding circumstances differ significantly for each party. The more
self-accepting and knowledgeable therapists are about the underlying dynamics of their own life-struggles,
the more adept will they be at discovering where to connect with their various clients’ differing experiences.
Moreover, therapists’ expertise about their clients’ challenges derives not just from the common woundedness
itself, but also from the dynamically evolving life journeys of confronting and wrestling with ups and downs
of those challenges. The implication, of course, is that therapists who commit to contending with their
personal challenges bring to the therapeutic encounter not just empathy but also the wisdom derived from the
failures and successes of their struggles with their own demons. Throughout the training, therapists work on
learning to master the use of their core issues and related struggles with their issues in all aspects of the
therapy process: from connecting empathically, to understanding at vulnerable depths, and to intervening
with intuitive timeliness, sensitivity, and appropriateness.
As previously stated, the POTT approach is not tied to any one model of therapy. It considers the human
connection and process through which all therapies are implemented a common factor of the therapeutic
method (Sprenkle et al. 2009); however, the models of therapy vary how they value the relevance of the
human connection to therapeutic outcomes. POTT posits that all therapists work with clients from within a
relationship that elicits trust and cooperation and that therapists need to be accountable for how they relate
and conduct themselves with clients, which requires self-awareness and self-discipline. The POTT Model
encourages therapists to work towards resolution of personal issues because of the insight they gain about
themselves and the freedom they achieve to access more of themselves for use in their work. However,
realistically speaking, our clients get who we are today, flaws and all, and not who we aspire to be when our
issues may no longer be such limiting and crippling “issues” for us. Therefore, therapists are called to reach
deep within themselves to be prepared to use the whole of who they are today, resolved and unresolved, to
the benefit of their clients.
Application of the Concept to Couple and Family Therapy
The POTT program has been integrated into several couple and family therapy programs in the USA and
abroad. This section describes its integration into the Drexel Couple and Family Therapy graduate program as
this is the longest-running academically based POTT program. Since its inception in this particular academic
setting in 2005, POTT has been implemented as a 2-h weekly experiential class that runs through the first
academic year of the master’s program. This class is typically taught by two instructors, one of which is Dr.
Harry Aponte, the developer of POTT. Ideally, there are no more than 12 students in class. The approach to
the training is that it is a boot camp – the intense attitudinal and emotional preparation of the would-be
therapists to best prepare them to evolve into individuals who have the self-awareness, self-access, and self-
discipline to master the use of themselves within the demands of the therapeutic process, whatever their
chosen model of therapy.
The training includes several stages, transitioning from the personal to the clinical:
1.1.
2.2.
3.3.
4.4.
Trainees become oriented to what it means to do therapy through their own flawed and vulnerable
human selves in the personal connections they make with clients in the therapeutic process through
readings and discussion but also by observing videos of therapists’ strategically and purposefully using
themselves in clinical situations.
Trainees start the active component of their training by working individually in the presence of their
cohorts with the course leaders on identifying and exploring their signature themes, the lifelong
struggles permeating various areas of their life. They look to understand the origins and actual
manifestations of their personal issues in their personal lives and hypothesize how their core issues may
affect their clinical performance. Conducting these explorations in the group context helps to normalize
their life struggles and create a sense of shared humanity among the class cohort, which promotes self-
acceptance and reduction of shame. In addition, taking turns exploring their issues in the group contexts
facilitates the students’ abilities to empathize with their fellow trainees’ struggles, which in turn hopefully
translates into their gaining the ability to better empathize in the future with their clients and their clients’
issues. They struggle as their clients struggle. The common human bond between them and their clients
becomes more evident, understandable, and accessible.
The next phase of training moves into the clinical application of the insights the students gained and
their emotional reorientations about themselves and their issues. Trainees present on actual cases from
their internships through video and discussion, and also receive feedback about themselves through
supervised in-the-moment role plays of clinical situations performed by fellow students. With the help of
the course leaders, the students glimpse ways their signature theme(s) and other personal factors play out
in interchanges with their “clients” and also how their own issues and life experiences may be used to
enhance therapeutic effectiveness. In the last phase of the training, each student receives a live supervision
session using a mock case performed by actors in a simulation lab (simlab). During these simlab sessions,
the effects of the signature themes and other personal factors are directly observed in the student’s
interaction with clients, and the instructors provide live feedback to the trainee throughout the session. The
students take turns being supervised with the mock family while the rest of the class observes the process
through closed-circuit TV. At the end of each session, the actors provide feedback to the therapist-student
about how they experienced the student in relating to them, understanding them, and intervening with
them. After that, the trainees who observed the session share how/what they witnessed in that clinical
experience resonated with them. Students also journal weekly after every class from the beginning of the
year to the final class, reflecting on how/what they observed and experienced in the class affected them
personally as well as their clinical thinking. The journals, with the use of the ongoing feedback on their
journals from their instructors, are meant to train the students to observe and reflect on themselves – on
their personal reactions and their thinking from a professional perspective.
At the end of the 9-month training, students are asked to write their reflections on the professional and
personal changes they have undergone over the course of their training. The goal of this assignment is to
help trainees articulate for themselves what changes they have experienced personally and professionally
during the 9-month training.
Evidence Supporting the Model
Three recent qualitative studies on POTT support the perceived effectiveness of the training (Apolinar
Claudio 2016; Niño et al. 2015, 2016). The first study, conducted by Niño and her colleagues ( 2015),
explored the professional gains that first year master level MFT students reported following the completion of
a 9-month POTT training. Findings suggest that students experienced significant transformations in several
areas related to self, including increase in self-knowledge and self-acceptance of flaws and vulnerabilities,
access to their inner selves, and increased ability to purposefully use themselves in therapeutic encounters to
connect, assess, and intervene. All three areas of change (self-knowledge and acceptance, self-access, and
intentional use of self in therapy) are directly targeted by POTT. The second study, conducted by Niño and
her colleagues (Niño et al. 2016) explored the perceived effects of POTT on MFT students’ ability to create
positive therapeutic relationships with their clients. Participants in the study reported having a clear pathway
for creating positive therapeutic relationships, which in turn contributed to their feeling confident and skilled
in their ability to do so.
The third study, conducted by Apolinar Claudio ( 2016) used grounded theory to explore the perceived
impact of POTT on clinical effectiveness in a sample of POTT postgraduates. The generated theory revealed
that postgraduates developed a purposeful therapeutic presence; participants believed that their presence, way
of being, and the way that they provided therapy had been transformed. The therapeutic stance they embodied
was self-accepting, self-aware, compassionate, empathic, and grounded. Therefore, they believed that the
therapy they provided was decisive, thoughtful, compassionate, self-aware, and connected to self. These
findings suggest that the gains students make as a result of the training carried over to their clinical work
postgraduation. Additional studies on POTT are currently being conducted; POTT is being studied as a
training that promotes self-care in therapists, and there is also an outcome study on its way (supported by a
grant from the American Foundation for Suicide Prevention).
Case Example
A student’s final paper written at the end of the years training helps to bring to life the concept of the POTT
Model. Portions are quoted here with accompanying commentary. The student is a single Caucasian woman
in her 20s, called here Victoria, who evolved from a quiet, retiring presence at the beginning of the academic
year into an intensely involved and articulate participant in the class dynamics by the end of the course. Her
clinical practicum was in a medical setting. Some aspects of her paper are altered to protect her identity. With
respect to this paper, she wanted to give voice to her words for reasons that will become evident. For the
purpose of this end-of-the-year assignment, students were asked to identify their signature themes and to
provide a clinical example of how they used their emotional vulnerabilities and life experience to lend
humanity, sensitivity, and power to their clinical work as specifically related to the therapeutic relationship,
assessment, and interventions. Victoria’s voice is presented in italics.
This week’s [class] presentation [observing the supervision of a student’s session with a family
simulated by actors] related to my signature theme of not being “good enough,” as well as my
derivative issue of unintentionally withdrawing from situations. . . Given that over the years I
have become much more accustomed to being silent, I have realized [during the POTT course]
that I withdraw during two extremes: when I am completely overwhelmed or when the session is
moving somewhat slow. . . I know this default to silence is the result of years of being forced to
accept what is happening to me, as well as being criticized by my family for standing up for
myself. Therefore, I have been almost crafted by my family to be “seen and not heard,” which
has certainly transferred into my abilities as a therapist. I feel as if my voice has been lost, and I
am slowly taking it back, which is uncomfortable for most people, and scary for myself. . .
Growing up, I did not have a voice. I was worthless because when I was not being raped by my
cousin, I was being criticized/verbally abused by my parents. I learned quite early to not make a
sound, not have any emotion, and to do whatever was necessary to protect myself. Therefore, I
essentially learned to be a “robot” – do as I am told and do not question it. The only difference,
though, is that I did have emotions, I did have things I needed to say, but I kept it all inside. . .
This default, therefore, seems to be one of the main struggles I have when trying to connect with
individuals, as well as when I assess and intervene. I am so used to being criticized, taken
advantage of, and truthfully, hurt, that my body keeps itself quiet in order to protect itself from
what could happen.
At the beginning of the course, Victoria did not reveal the extent of her childhood trauma and abuse. As the
class process progressed, she felt safer to share more of her story. Students are told up front that they should
only reveal what they feel comfortable sharing and what they think about themselves that may have an
impact on their clinical work. As students take turns presenting to the class leaders on their signature themes,
they have a chance to experience their issues treated as “normal” to the human condition and as potential
assets to their capacity to understand and relate to their clients’ “woundedness.”
In terms of relationship [with clients] in my clinical work, I know I have to believe in myself,
trust my instincts, and believe my voice is important and has meaning if I am going to work
through this self-inflicted silencing. . . I know I can obviously talk with anyone, but actually
making the connection and being vulnerable is quite another story. . . As for assessment and
intervene [sic], I still struggle at times with knowing what to do with all of the intense emotions I
feel during sessions. Again, I have a difficult time putting what my mind is thinking and what my
heart is feeling into words. . . I am constantly doubting my knowledge, thereby silencing myself
because that is all I have ever known – defeat, silence, violence, criticism.
Victoria was in personal therapy during the time she was in class, but here she is addressing her issues in the
context of her clinical work. She grappled with her issues in class with the support and understanding of the
class leaders, along with what she reflected about herself when witnessing other students in the small class
(ten) speaking to their personal pain and struggles. All this gave her perspective and helped normalize her
own sense of what it means to struggle with personal issues, even extremely sensitive and painful ones within
the context of the therapeutic process with her clients.
The clinical example I will provide is of an 82-year-old African American woman, who came to
the surgery clinic to discuss getting a biopsy of her right breast. This woman is divorced, has one
living son. . . as well as one deceased son, who was a firefighter and died during service. [She] is
receiving social security, although she does work from time to time. If I had to describe [her] in
one word, it would be sass – then maybe passive aggressive – but I love it because she certainly
put the one resident at the clinic (who is extremely condescending) in his place. This woman was
extremely vocal, suspicious of [these] two white individuals coming into the room . . . and
certainly did not like to be asked a question more than once. To be completely honest, I was
incredibly intimidated at first – I seriously thought I was just going to leave the room when the
resident left, and not engage my usual routine of joining, assessing, intervening, etc., but I
caught myself wanting to withdraw, and therefore forced myself to try to build a connection with
[her], which I think I was able to do successfully.
Victoria, whose most difficult challenge is to engage and speak up to a powerful individual, was able to
confront the racial tension in the room and force herself not only to stay in the room with her client but to be
genuinely, personally present with her. She dug further within herself and discovered a deeper level of
personal challenge to her desire to form a real human connection with her client. She was mobilizing all she
had learned about opening herself within herself as she strove to achieve a real human connection with her
client.
As for the [therapeutic] relationship, I felt myself wanting to keep this woman at a distance
because she seemed rather abrasive, and uncomfortably like my father. . . But [she] asked me an
interesting question that honestly took me by surprise and seemed somewhat out of the blue. . .
“Why are you doing this [therapy]?” In the few, brief seconds it took me to respond, I asked
myself if I should be vulnerable – tell the truth – if I should just give some made-up answer to
quell her concerns. And I chose the former – be vulnerable. Considering that [she] is much older
than me, I felt that out of respect (and that perhaps she was looking for a human connection in
the hospital), I literally said this to her: “I have danced with the darkness most of my life, and
left myself feeling hollow through silence, so I decided to be the lighthouse the Ramsays are
searching for” (Virginia Woolf reference). And this woman understood – she happened to be a
Virginia Woolf fan. I know that I may have been disclosing too much, but I thought knowing why
I wanted to be a therapist would enable [her] to trust me, which it did. That moment also
enabled me to trust myself, which helped the conversation to blossom. . . [Her] anger completely
melted, and it was a beautiful thing to see. I saw [her] this past week, and once again, while she
was short with everyone else, we held hands, checked in real quick (because her biopsy results
were supposed to have been completed by pathology and they were not), and wished each other
the best with a hug.
Victoria allowed herself to come in touch with the social and personal walls within her that stood in the way
of her risking an authentic relationship with her client and had the will and courage to selectively risk sharing
something profoundly personal of herself, which she intuitively felt would touch this woman. She was well
aware of her learning in class that the relationship is the sine qua non condition to engage the therapeutic
process. It is the door that opens the therapist to reliable assessment and effective intervention.
As for assessment and intervention, I did not feel like my voice was not valued, internally or
externally, which made it easier and more motivating to speak and just discuss the client’s life. I
did not feel the internal battle that surrounds being vulnerable and using my voice. . . I just felt –
freedom. Freedom to speak what I was thinking, even if I was fuzzy and unsure about certain
things, freedom to ask questions about her life, freedom to infuse some of my sense of humor
during the session (which worked – she laughed). Ultimately, just freedom to be myself as a
therapist who is wounded, but wants badly to help others. . . This was an incredible experience
because I was able to track my emotions during the assessment (which surprisingly did not
include feeling overwhelmed), as well as attain great confidence when intervening.
The intervention that felt most natural and genuine was when I normalized this woman’s fear of
having cancer. Given what I have previously said about [her], about being aggressive and
confrontational with the resident, one would not imagine fear being underneath. However, I
know this game very well because I play it myself. With certain individuals, such as my parents . .
., anger, frustration, and confrontation are the visible feelings, while fear – fear of abandonment,
fear of being hurt, fear of being genuine – are the issues that hide deeper. And I saw this woman.
I saw in her eyes, because I have seen those same eyes in the mirror staring back so often. I tried
my best to normalize this fear, and I told [her] that she needs to have compassion for herself
because even though she is in her 80s, cancer is still frightening. When I said that, of course I
was thinking of my own shortcomings in having compassion for my younger self, but instead of
thinking of the situation negatively (which I normally do), I saw it in a positive light because I
honestly (and finally) believe that I deserve and am worthy of that compassion. So, I truly believe
I was genuine when I said that statement to [her]. I felt it inside of me, that it came from my soul,
as opposed to my head – I believed and finally felt it – which I think is another step in removing
the chains that have paralyzed me for so many years. Little by little, the layers are opening and
embracing recovery, which is a step in the right direction, I think. This woman, without even
knowing it probably, pushed me to be vulnerable, which I truly appreciate and am grateful for.
Victoria was able to put into practice what we had worked for all year that “therapy is not a conversation, but
an experience.” She had achieved a level of comfort with herself, with all of her past pain and hurts, that she
could be so selectively vulnerable that she could see herself in this woman who was so different from her, in
age, race and temperament. While well-grounded in her own journey, she could see elements from it that
opened her eyes and heart to the woman’s own vulnerability, enabling the therapeutic process to reach deeply
into a powerful experience for both therapist and client.
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ResearchGate has not been able to resolve any citations for this publication.
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