Martha Nodar

Growing up in a thwarted relationship with a father perceived as lacking in meeting the basic nurturing needs of the father-son relationship disrupts a boy’s normative development and may leave him fixated in a regressive state. This also impacts the mother-son relationship. This paper uncovers obscure layers of the male psyche and argues that a regressive state renders the grown man highly susceptible to developing narcissistic tendencies in adulthood. These tendencies are likely to affect interpersonal relationships including impotence and sexual performance with women. Implications for psychodynamic counseling and clinical supervision are discussed.

Keywords: narcissistic tendencies, father-son relationship, impotence, psychodynamic counseling, clinical supervision

Holmes (1999) submits that the quality of the parent-child relationship tends to be the template by which the realm of other relationships would fall. The father-son dynamic in particular appears to have an impact on the relationships boys develop with themselves and others, including their adult male-female relationships (Goss, 2006; Herzog, 2001; Jacobs,

1977). Extensive research on this subject led Herzog (2001) to contend that the quality of the relationship a father or a

father figure may develop with his children is crucial in the children’s developmental landscape. Herzog (2001) coined

the term “father-hunger” to explicitly depict a child’s yearning for his or her father’s nurturing (p.21). Herzog (2001) adds that father hunger “is an affective state experienced when the father is felt to be absent” (p. 51). While Herzog concedes that this yearning for a father’s availability applies to both sons and daughters, he suggests this sense of longing is far more prevalent with and processed differently by boys. A plausible explanation may be found in how girls experience

their relationship with their fathers as separate from the one they have with their mothers—which is not the case with boys

(Gauthier, 2010).

Following Freud’s earlier arguments, Gauthier (2010) proposes that boys expect to be rescued by their fathers from what they perceive to be their mothers’ propensity toward engulfment, but they (the fathers) also lead the boys “back to mother, at a new relational level” (p. 116). This new relational level proposed by Gauthier should distinguish the mother’s self from her son’s self. It should be noted that girls do not need their fathers to rescue them from their mothers as they innately want to identify with them (Hall, 1954).

Gauthier (2010) extends Herzog’s (2001) arguments on father-hunger and argues that father-hunger in boys not only includes the quality of the relationship a son may have with his father, but also encompasses the relationship a boy perceives to be between his mother and his father as a couple, as well as his own place in the triad: father-son-mother. Moreover, a boy whose father or father figure is consistently absent (physically, emotionally, or both) is more likely

to perceive his mother as the responsible agent for his father’s absence, which would in turn impact the mother-son relationship (Gauthier, 2010).

In his successive work, Herzog (2010) came to recognize this phenomenon—how boys react to the relationship of parents together as a couple—and added this dynamic to his repertoire as “a father-hunger and a father-and-mother- together hunger” (p. 112). Although a father-and-mother-together hunger may be experienced by both boys and girls, it appears to have the most impact on boys’ development. The father-and-mother-together hunger refers to an emotional yearning for the metaphorical union of both parents and the fusion of the parents with the child (enmeshment). In

other words, with the help of fathers, mothers learn to appreciate their sons’ right to their own perspectives, which

may be different than their own. When fathers fail to help their sons separate from their mothers, boys tend to develop enmeshment with both parents (Gauthier, 2010). Enmeshment can be explained by the notion that clinging is typically a reaction to perceived distancing from a significant other.

Boys who have father-hunger tend to unconsciously enmesh with both parents as a couple perceiving their fathers as unavailable and their mothers as engulfing. Herzog (2010) suggests that how this “parental alliance” is perceived by boys plays a major role in the child’s “optimal development . . . of the concept of the self” (p. 111). The concept of the self refers to the level of differentiation children may develop with separate feelings and thoughts from those of their parents (Kerr & Bowen, 1988). Differentiation of the self exists on a continuum with the authentic self at one end of the spectrum and the grandiose (pseudo) self at the other end (Kerr & Bowen, 1988).

Father-Hunger Scale

Perrin, Baker, Romelus, Jones, and Heesacker (2009) measured the impact of father-hunger in young adults and assessed the validity and reliability of Baker’s (2000) Father-Hunger Scale by recruiting two different groups of participants, male and female college students. Their findings led Perrin and colleagues to deem the Father-Hunger Scale with a high level of construct validity and as an effective tool to assess the degree of father-hunger in an individual. Furthermore, the researchers concluded that the “Father Hunger Scale provides an empirical basis from which researchers can investigate the role that may be played by one’s psychological longing for a greater connection with a father” as it relates to one’s overall functioning (Perrin et al., 2009, p. 323).

In addition, grounded in his clinical work, Herzog (2001, 2009, 2010) found a correlation between father-hunger in boys and a propensity to develop narcissistic tendencies observed in adulthood as a defense mechanism to earlier unmet needs. Narcissism refers to the tendency for feelings of grandiosity and “is exemplified by the devaluation of others

and the idealization of oneself” (Luchner, Moser, Mirsalimi, & Jones, 2008, p. 2). Idealization of oneself is grounded in pseudo self-esteem versus genuine self-esteem. Someone with pseudo self-esteem has a propensity toward bestowing upon oneself attributes that may not be consistent with reality. Although both males and females may develop narcissistic tendencies as the result of father-hunger, Herzog (2010), Gauthier (2010), and Goss (2006) claim that there is a higher susceptibility and propensity for males to develop narcissistic characteristics in comparison to females. They speculate that the triggering point for this phenomenon (narcissistic tendencies) may be rooted in how boys process and experience father-hunger (intrapsychic phenomenon and fusion with parents), which may have lifetime effects. Feeling entitled to receive endless admiration from others as an adult is an example of a narcissistic tendency generated to compensate for having felt unloved during childhood. A man who holds unmet dependency needs (unfulfilled nurturing) is likely to be enmeshed with his family of origin and has a poorly differentiated self in contrast to having an authentic self (Kerr & Bowen, 1988).

For instance, a man who may be primarily driven by his unacknowledged and unmet dependency needs related to his family-of-origin may be unconsciously prompted to choose a profession or a mate likely to be approved by his family as the primary criteria while ignoring his own heart. Going against both the spoken and unspoken family rules may not be perceived as safe because it may threaten the status quo and may render the man feeling emotionally, if not physically, isolated from his family-of-origin. This is an example of enmeshment—a blur of boundaries between oneself and another person. This creates a gap within the grown man between wanting to please his family and ignoring his own feelings and thoughts, thus creating an internal vacuum that tends to be filled by narcissistic tendencies.

When being genuine does not produce the acceptance one needs from one’s family, there is a tendency toward

artificially generating a self that is perceived to be better than others in a futile attempt to increase the chances one would

feel accepted (Solomon, 1989). Pseudo self is the result of earlier narcissistic injuries. Narcissistic injuries refer to the losses and disappointments experienced or perceived at an early age, such as the loss of unmet expectations, approval, or unfulfilled dreams (Viorst, 1986). And, yet, Viorst suggests these are necessary losses that are called upon to be

reconciled in adulthood to achieve personal growth. Some men are not willing to accept the vulnerability that comes with experiencing losses. Viorst (1986) emphasizes that losses are inevitable and constitute “the course of a normal life” (p.

61).

Unhealthy compensation for the vulnerability to experiencing losses may involve certain behavioral patterns, such as feeling one is always right and others are always wrong; the inability to feel empathy for others, and feeling entitled to receiving admiration from others even when others are perceived as defective compared to oneself (Kealy & Rasmussen,

2012; Solomon, 1989). Narcissistic tendencies (pseudo self-esteem) are likely to prevent the development of an authentic self (genuine self-esteem) (Kerr & Bowen, 1988). Kerr and Bowen designed the Differentiation of Self Scale to assess where one falls in the differentiation of self spectrum, between genuine and pseudo self.

Differentiation of Self Scale

Jankowski and Hooper (2012) retested the efficacy of the Differentiation of Self Inventory (DSI; Skowron & Friedlander, 1998) using 749 male and female college students whose average age was 21, representing different ethnic backgrounds. Jankowski and Hooper found evidence of both construct and divergent validity in the concept of differentiation. Those who rate the lowest in the differentiation scale are more likely to develop a fragile self, have narcissistic tendencies, and engage in maladaptive coping strategies (Kerr & Bowen, 1988). Examples of maladaptive coping strategies include extreme self-centeredness, pervasive feelings of grandiosity, lack of empathy for others, and

blaming someone else for one’s own struggles in an effort to diffuse feelings of inadequacy, loss and rage (Jacobs, 1977).

Narcissistic Tendencies

To the extent that maladaptive coping strategies may be intended to protect one’s fragile self by diminishing others in the process, it is more likely that they would fall under the realm of pathological narcissistic tendencies (Solomon, 1989). Solomon suggests that narcissism exists in a continuum ranging from a natural, innate drive to look after one’s own self- preservation at one end of the spectrum to a pathological demand for admiration from others at any cost at the other end. It is the narcissism found toward this pervasive end of the spectrum that is considered pathological and tends to bring havoc to both intrapersonal and interpersonal relationships (Jacobs, 1977). Jacobs believes that pathological narcissistic tendencies coupled with a tendency to view one’s mother as a powerful figure capable of interfering in the relationship between a son and his father are the underpinning variables mediating secondary male impotence. Jacobs examines how this dynamic impacts the sexual relationship between a man and his significant female partner.

The Impotent King Syndrome

While some of the factors triggering primary male impotence may be the man’s age, illnesses, substance abuse or medications, secondary impotence is believed to be most likely triggered by psychological variables, such as feelings of inadequacy, revenge and grandiose self-concept (Jacobs, 1977). Jacobs has come up with the term impotent king to describe a man with psychic impotence whose narcissistic tendencies may be keeping him from emotional and sexual

maturity. Jacobs attributes the dilemma of psychic impotence to motivation in maintaining “sexual immaturity” (p. 97).

A man may secretly want to remain a child to recapture what he thinks he lost in his childhood—his uniqueness and own

sense of self-value (Jacobs, 1977).

Grounded in his clinical experience, Jacobs (1977) submits that the impotent king is typically involved in a “dominant- submissive relationship” with his female sexual partner—placing the man in the dominant role during coitus (p. 101). Fixated in a regressive state, he is now trying to recapture the powerlessness he felt growing up. While very concerned with his own needs, sexual and otherwise, the impotent king tends to disregard his partner’s needs. A woman needs to feel she is important to her man; that he is committed to the relationship. Blaming his secondary impotence on her takes a toll on her emotionally. In an effort to compensate for her unmet emotional needs she may cling to him, much like he may

cling to his parents’ approval.

Her clinging and compensatory over-functioning reminds him of his perceived engulfing mother. A man cannot

make love to his mother; thus, he develops impotence. Except that instead of focusing in his own issues with impotence, he turns his attention to his female partner, his wife in most instances, and blames her for it, paralleling the way he

might have blamed his mother for his father’s absence. Whereas the impotent king tends to be passive-dependent, he unconsciously pairs up with a woman who may be aggressive-dependent and have motherly overtones (Jacobs, 1977). He selects a woman with these characteristics because she reminds him of his mother, and at the same time, he resents her for the same reason (Jacobs, 1977).

No doubt, the impotent king may be aware of his female partner’s sexual needs. Thus, his impotence “may serve as an oblique outlet for the husband’s covert hostility triggered by the wife’s dominance” (Jacobs, 1977, p. 101). Riveting with metaphors, the bedroom becomes a torture chamber: his unconscious payoff is to diffuse responsibility for erectile dysfunction with his sexual partner and thus, blame her for his inability to perform. He punishes her for his own unresolved and unacknowledged dependency issues with his family-of-origin. Covered with rage, the impotent king syndrome depicts a man who covertly blames his mother for keeping his father away, and then overtly blames his female partner for reminding him of his mother: “These men perceive women as invasive and insatiable” (p. 99). The impotent king views women as insatiable because that is how he most likely experiences his own need for nurturing. The explicit rage against his female partner is actually a cover-up for the hidden rage he feels toward himself. He despises himself for his own human vulnerability. Viorst (1986) suggests this vulnerability to rage is “relentless” (p. 61).

Feelings of Rage

Jacobs (1977) suggests that “secondary impotence occurs within the context of the husband’s narcissistic rage elicited by their wives’ unwillingness to pay continued tribute to them” (p. 100). In his studies, Goss (2006) uncovered that feelings of rage are a welcome relief to the feelings of inner emptiness these men experience. Goss suggests this is most

likely the result of the detachment from the authentic self (differentiated self). This rage may be either clearly expressed or superficially withheld while manifested through acts of passive-aggression, such as seducing a woman and then having an unconscious desire to frustrate her sexually and blame her for his impotence (Goss, 2006).

Drawing from a similar paradigm as Jacobs’ (1977), Karpman (1933) referred to the phenomenon of psychic impotence as “sexual neuroses” (p. 275) and argued that sexual neuroses are manifestations of the emotional disturbance of the personality through the sexual organ, but these manifestations have very little to do with sex or sexual organs

per se and more to do with interpersonal relationships. Karpman posited that psychic impotence not only refers to the inability to attain or maintain an erection, but also to the inability to derive any physical or psychological satisfaction after reaching orgasm. Mostly detached from conscious awareness, the inability to perform in the bedroom may bring these men to counseling seeking relief for their sexual impotence. Jacobs (1977) cites scholars who report a high failure

rate in counseling these men with sex therapy, and suggests that “a refinement in the treatment techniques may reduce the failure rate in the future” (p. 97). In agreement with Jacobs, and based on their recent study Kealy and Rasmussen (2012) recommend applying the psychodynamic counseling approach to treat “narcissistic vulnerability” (p. 358). Kealy and Rasmussen assert this approach “would add to the understanding of narcissistic phenomena” (p. 357).

Psychodynamic Counseling

Kealy and Rasmussen (2012) emphasize that clients suffering from narcissistic vulnerabilities are a challenge

to clinicians because of their strong resistance to mourning their losses. With that in mind, Herzog (2009) proposes that helping these men calls for careful consideration of the counselor’s gender to facilitate identification. Ideally, a reenactment needs to take place in the therapeutic session with the male client projecting the feelings toward his (living or deceased) father onto a male counselor. A male counselor oriented in psychodynamic counseling would be most helpful

in triggering the client’s transference and tapping into his resistance (Herzog, 2009). In contrast with other counseling approaches, in psychodynamic counseling both transference and resistance are not only expected, but embraced. Transference requires a well-trained practitioner who would not give up in the face of a challenge and would continue to

work with the client’s expected resistance (Hill, 2011). Goss (2006) adds that through the transference process, the client would have the opportunity to experience his internal feelings of emptiness at a conscious level—which is an obstacle to him developing an authentic self. They have maintained their real feelings of early loss through the fragile self.

Psychodynamic counseling is about raising the client’s self-awareness and interpreting the client’s narrative by extracting meaning from the patterns and themes evolving from the narrative. In sum, psychodynamic counseling is the result of a well-educated guess based on the integration of the client’s history, the client’s response to the history, and the counselor’s clinical experience, training and knowledge. It is highly recommended that psychodynamic-oriented

counselors go through counseling themselves before counseling clients (Holmes, 1999). In psychodynamic counseling the question is not whether the past is infringing upon the present, but rather, to what extent. In the case of the impotent king, the issue to analyze is the man’s motivation for maintaining his resistance to vulnerability.

What is his outcome or payoff? It is conceived that during counseling the client is driven to protect himself from the anxiety triggered by intimacy (emotional and physical) (Jacobs, 1977; Kealy & Rasmussen, 2012). Resistance is the fuel behind the transference (Gabbard, 2009). There would be no transference if the client would be willing to speak directly rather than project those feelings and thoughts they deem unacceptable onto the counselor. Transference is a

psychological phenomenon that may occur during counseling sessions when clients react to the counselor’s interpretation of events. Psychodynamic-oriented counselors act as detectives, listening with accurate, empathic understanding, looking for clues, and detecting themes and patterns (Holmes, 1999). They submit their interpretation to their clients as a guess

or conjecture, not as solid fact, but rather inviting the client to fill in the gaps (Holmes, 1999). Nevertheless, clients may resist, which lets the counselors know they are on the right track to illuminating the core issue that brings them to counseling.

Rooted in education, the psychodynamic counseling approach offers a road map to unresolved issues that begin and end with the quality of the counselor-client relationship (Holmes, 1999). Hartmann (2009) suggests that part of the counseling approach must include guiding the client to learn how to view himself “excluded from the parental relationship” (p. 2336). Unacknowledged early wounds create a discontinuity of “ordinary growth,” which leads

to arrested development or acting out of a regressive state, such as withholding nurturing feelings from his wife to compensate for the deficits he feels he experienced growing up (Goss, 2006, p. 685). Emotional growth is necessary to develop a differentiation of the self that is separate from one’s parents (Kerr & Bowen, 1988).

The counseling goal is to help these men grow up emotionally. Attempting to address this phenomenon, Herzog (2001) suggests that working through this emotional separation from the parents means the “unraveling and reconstruction of the past as it is encountered in the present” (p. 2). Encouraging the client to do an autopsy with the counselor about his family dynamics may be a way of engaging his cooperation towards his own recovery. Bringing the material in the unconscious to conscious awareness is the tenet of psychodynamic counseling. Goss (2006) insists that the challenge for counselors is not only to have the client acknowledge and grieve the loss of a perfect father or an ideal mother, but also to prevent the

client from undoing the work achieved in one counseling session by returning to his fictitious self in the following session.

Implications for Counselors

In addition to the obvious challenges counselors face with some men who may harbor narcissistic vulnerabilities, Kealy and Rasmussen (2012) emphasize that clinicians are not exempt from narcissistic tendencies themselves, either overt or covert, which may be triggered during counseling sessions. As aforementioned, the psychodynamic counseling model recommends for counselors using this approach to go through counseling themselves before counseling their clients. Those counselors who might not engage in genuine self-awareness may unconsciously prevent their clients from engaging in transference during sessions, such as avoiding confrontations or “refusing to address the enactments” most likely because they may be unconsciously seeking approval or admiration from their clients (Luchner et al., 2008, p. 5). This desire for approval may be related to the supervisees’ narcissistic vulnerabilities, which may go undetected in some instances during supervision (Luchner et al., 2008).

Clinical Supervision

Pearson (2006) calls for supervisors to be “skilled practitioners” (p. 250) and integrate their major roles (teacher, counselor and consultant). This encompasses a combination of sharing information with supervisees regarding theory, indicating to supervisees how they may be reacting to their clients’ narrative, and assessing the efficacy of the supervisees’ strategies with their clients. For example, the supervisee’s tendency to rescue their clients and prevent them from expressing their most difficult feelings should be addressed during supervision. Pearson acknowledges this is not an easy task for supervisors who are either solely instructional-oriented or consulting-oriented. Pearson insists that “applying a psychotherapy-driven approach in supervision incorporates the best of both models [the instruction-oriented model and

the consulting-oriented model]” for the supervisee (p. 247). The psychodynamic-oriented supervision model is one of the supervision approaches, among others, that is consistent with Pearson’s integrated model of supervision (teacher, counselor and consultant).

Conclusion

Experiencing losses is part of living. Unacknowledged disappointments may lead to narcissistic vulnerability—the compulsive use of maladaptive defenses in a futile attempt to disguise the painful experience of loss. But the pain does not go away. Instead, resistance to grieving losses fosters more pain and isolation from oneself and others. When some men neither acknowledge nor begin to grieve their early losses, they increase the likelihood of remaining in a regressive developmental stage that includes sexual immaturity. As the result, children may be neglected; mothers may be perceived as the culprit to one’s inner conflicts, and female partners may be experienced as responsible for secondary impotence. The payoff for these men’s denial is quite attractive—to distract themselves from recognizing their wounds and their responsibility to heal their wounds. This secondary gain—the distraction to their vulnerability—may be difficult to resist

and may show up in counseling in the form of transference. Appreciating and using transference in the counseling session

for the client’s benefit remains the tenet of the psychodynamic counseling approach.

Implications for counselors include their committed efforts to be aware of their own unresolved issues, to grieve their losses, and to become comfortable with the dynamics involved in transference. It has been said that counselors cannot take their clients where they have never been.

The implication for supervisors is to stay focused and detect resistance among supervisees in exploring the supervisee’s issues and their tendency to bring those issues to the counseling session. This resistance may be either explicit or implicit. It is only through working on their own recovery that counselors may guide their clients through their respective journeys to mental health.

References

Baker, J. (2000).  The importance of finding one’s voice: Father-hunger, self-silencing, and eating disorders (Unpublished doctoral dissertation). University of Florida, Gainesville.

Gabbard, G. (2009). Transference and countertransference: Developments in the treatment of narcissistic personality disorder. Psychiatric Annals, 39, 129–136.

Gauthier, M. (2010). Comment on Herzog’s “fathers and play.” Canadian Journal of Psychoanalysis, 18, 113–118. Goss, P. (2006). Discontinuities in the male psyche: Waiting, deadness and disembodiment. Archetypal and clinical

approaches. Journal of Analytical Psychology, 51, 681–699.

Hall, C. (1954). A primer of Freudian psychology. New York, NY: World Publishing.

Hartmann, U. (2009). Sigmund Freud and his impact on our understanding of male sexual dysfunction. Journal of Sexual

Medicine, 6, 2332–2339.

Herzog, J. (2001). Father hunger: Explorations with adults and children. Hillsdale, NJ: Analytic Press. Herzog, J. (2009). Father hunger and narcissistic deformation. Psychiatric Annals, 39, 156–163.

Corrine Sackett, Gerard Lawson, Penny L. Burge

Researchers examined the experiences of a counseling session from the perspectives of counselors-in- training (CITs) and clients. Post-session phenomenological interviews were conducted to elicit participants’ meaningful experiences, and the analysis revealed both similarities and differences. Researchers found the following themes most meaningful for CITs: Counseling Relationship, Insight, Immediacy, Goals, Emotion, Nonverbals, Transference and Countertransference, and CIT Negotiating the Counseling Process and their Role. Themes of meaningful experiences that emerged for clients include: Counseling Relationship, Insight, Immediacy, Goals, Emotion, and Reflections on Counseling. Implications for counselor education and supervision are described.

Keywords: counseling process, counselors-in-training, supervision, counselor educator, counselor education, insight

Researchers have demonstrated empirically that counseling is effective (Nelson & Neufeldt, 1996), yet we still know relatively little about the counseling process (Paulson, Everall, & Stuart, 2001). The counseling process consists of at least a counselor and a client, each with their own unique perspective on the counseling relationship and what is happening of significance (Elliott & James, 1989); thus, it is important to elicit and consider each perspective to gain a whole picture of the counseling process (Blow et al., 2009; Elliott & James, 1989; Llewelyn,

1988; Sells, Smith, & Moon, 1996). Comparisons between counselor and client perspectives allows for a more thorough evaluation of the counseling process, yet few researchers have taken this on (Sells et al., 1996). Elliott and Sharpiro (1992) called for an examination of in-session subjective experience, and for a comparison of significant

in-session events among multiple perspectives. Recognizing discrepancies in counselors’ and clients’ experiences

of the counseling process may allow counselors to build stronger alliances (Elliott & Shapiro, 1992) and to provide counseling that is more effective by using participant experiences as a guide (Elliott & James, 1989; Singer, 2005).

Counseling is a dynamic process to investigate, consisting of interrelated and systemic entities of client variables, counselor variables, and what is happening between them (Henkelman & Paulson, 2006). If we hear directly from clients about their experiences in counseling, we can better understand the process (Blow et al., 2009; Elliott

& James, 1989) and better prepare counselors to be effective (Elliott & James, 1989; Singer, 2005). Since each participant has his or her own view of the counseling relationship and process, each perspective is important in understanding what is happening of substance (Paulson et al., 2001). Rather than one objective reality, there are multiple realities based on experience, presenting a need to hear from multiple perspectives (Sells et al., 1996). In the current study the authors examine what is meaningful to participants in counseling, and what is similar or different in those perceptions for counselors-in-training and clients.

Empirical Research on Participant Perceptions in Counseling

Historically, researchers examined the counseling process from the lens of the counselor, however more recently many researchers have studied client perceptions of counseling (Bowman & Marshall, 2000; Henkelman & Paulson,

2006; Paulson et al., 2001), and some researchers have explored the counseling process more holistically by eliciting client and counselor perceptions and by comparing these perceptions (Llewelyn, 1988). Martin and Stelmaczonek (1988) found, through post-session interviews for eight- or fourteen-session treatment, that clients and counselors identified the same occurrences as most important in counseling, and were only slightly different in their ranking of these occurrences. The most important occurrences for both clients and counselors were the expression of insight, providing personally revealing and significant material about self or interpersonal relationships, the expression

of new ways of being or behaving either in session or outside of session, and the description and exploration of feelings. These occurrences are listed in order of importance for clients; the order differs for counselors in that the final two occurrences are reversed in rank.

Lietaer and Neirinck (1986) conducted a study of client and counselor perceptions of client-centered/experiential counseling, using a post session questionnaire of open-ended questions, finding that clients perceive the therapeutic relationship as more helpful than counselors do. Clients specifically report a safe therapeutic relationship with

an empathic, accepting, and involved counselor as helpful in counseling. Clients and counselors agree that self- exploration and experiential insight were the most important aspects in their counseling sessions, with some degree of difference in emphasis.

Llewelyn (1988) and Lietaer (1992) both examined helpful and unhelpful, or hindering, events in counseling. Llewelyn (1988) utilized post-session questionnaires, and termination of therapy questionnaires, while Lietaer (1992) asked clients and counselors, through post-session open-ended questions, to write their perceptions and experiences of what was helpful and hindering in sessions. Llewelyn (1988) found that clients most often reported reassurance or relief, and problem solving as helpful, while Lietaer found that clients, twice as often as counselors, identified the counseling relationship as helpful. Counselors, on the other hand, most often reported events where clients gained cognitive and affective insight as helpful (Llewelyn, 1988), and self-exploration (Lietaer, 1992). As

for unhelpful, or hindering events, clients in Llewelyn’s study reported events related to disappointment as unhelpful,

whereas events related to misdirection were unhelpful for counselors. Counselors in Lietaer’s study identified lack of empathy, avoidance of the here-and-now of the relationship, lack of congruence, and a “flight to rationality” in both themselves and clients as hindering events in session. Clients identified either too much or too little happening in session as hindering. Clients and counselors agreed that useless self-exploration and resistance were hindering

in session (Lietaer, 1992). Notably, Lietaer (1992) discovered that many participants, twice as many clients than counselors, chose not to answer the question of what is hindering in session. This finding may indicate that clients experience fewer hindering occurrences in session than counselors, or it may support the idea that clients are hesitant to criticize counselors, which has been reported by Elliott and James (1989) and Thompson and Hill (1991).

Relatedly, Sells et al. (1996) interviewed clients and counselors on effective and ineffective moments over the course of counseling. Clients identified goal setting, rapport and counselor empathic qualities as important. Clients identified the following as ineffective in counseling: when counselors have their own agenda, when counselors do not understand or address the problem, unclear goals and direction, and lack of continuity of sessions. Effective

moments from the counselors’ perspective resulted in one theme, specific therapist techniques that were beneficial to the client, which includes techniques such as contracting, finding solutions or exceptions to the problem, reframing, and unbalancing. In a group interview, all counselors expressed surprise that clients did not identify therapist techniques as important in counseling.  Like clients, counselors also identified unclear goals and direction as ineffective. Overall, Sells et al. (1996) found that clients emphasize the counseling alliance more, while counselors emphasize techniques.

This review of literature illustrates a lack of recent research in this area, with relevant studies more than fifteen years old, and a need to know more about the counseling process (Paulson et al., 2001), specifically what is meaningful for participants. In addition, we need current researchers to both elicit participant perspectives of the process (Elliott & James, 1989; Sells et al., 1996) and compare perspectives of significant in-session events (Elliott & Shapiro, 1992), since relevant studies are dated. For the purpose of this study, the term process refers to the interactions and relationship between clients and counselors-in-training. The utilization of counselors-in-

training (CITs), rather than experienced counselors, had yet to be explored, and has produced worthwhile fodder for discussion for counselor educators and supervisors. More specifically, with awareness of similarities and differences between client and CIT perspectives, counselor educators and supervisors can better prepare CITs to build strong alliances and work effectively with clients. Therefore, the purpose of this study was to describe the experiences of CITs and clients in the counseling process and answer the following two research questions: (a) What do CITs and clients experience as most meaningful in counseling? and (b) What are the similarities and differences of what CITs and clients experience as meaningful in counseling? The results of this study will inform counselors, counselor educators, and supervisors about what is meaningful to participants in counseling and where clients and CITs are congruent and incongruent in their perceptions.

Method

The research questions were answered through the qualitative tradition of phenomenology by analysis of in-depth interviews. Phenomenology was chosen for the assumption that multiple realities exist and are relevant, as well as

a way to describe the meaning of participant experiences in counseling (Hays & Wood, 2011). Qualitative research is ideal for examining participant experiences in counseling, given the considerable similarities between qualitative research and counseling, such as identifying themes and patterns and attempting to understand the participant’s

or client’s experience (Singer, 2005). In addition, qualitative research allows for the process of making meaning of those participant experiences. As Kline (2003) asserts, “In brief, it [qualitative research] offers a contextually sensitive approach that gives voice to the persons who are researched” (p. 83). Researchers conducted data collection and analysis separately for CITs and clients, in order to examine each unique perspective, and to look for similarities and differences among the two. The single session unit, in the form of one counseling session, was used in this study, which allows for examining within-session events and session impact (Elliott & James, 1989), and

for participants to reflect on their most recent session, leading to more in-depth results and better understanding of experiences than if participants were reflecting on an entire course of counseling (Mehr, Ladany, & Caskie, 2010). In addition, significance sampling is used, which is the examination of units that have significant meaning to the client and counselor, or therapeutic impact (Elliott & James, 1989). Rather than looking at session impact from what is helpful or hindering, the authors approach session impact with what is meaningful in session, as illustrated by Mahrer and Boulet (1999), “The emphasis is on whatever touches you as something impressive happening here

rather than relying on your theory, your knowledge, and your being on the lookout for particular kinds of traditional significant in-session changes” (p.1484). For the purposes of this study, meaningful experiences in a counseling session are specific to each participant, and are defined as experiences that are important, significant, or moving to the participant. Meaningful experiences may be cognitive, emotional, relational or behavioral in nature.

Participants

Participants in this study consisted of CITs and clients from a counselor education training clinic at a satellite center for a large mid-Atlantic public university. The CITs were master’s degree students in a counselor education program and were completing their practicum experience in the clinic at the time of the study. Practicum students wholly staff this training clinic. The clients in the study were students enrolled in a Human Services Associates Degree program at a local community college. Human subjects research approval was obtained from the Institutional Review Board at the institution where the study was conducted, followed by participant solicitation and the

informed consent process. The practicum class consisted of 14 students, all of which were approached for this study. The resulting sample consisted of 12 CIT-client dyads, totaling 24 participants, including 12 CITs and 12 clients.

The CITs ranged in age from 22 to 29, with an average age of 23, and included 10 White females, one Hispanic female, and one White male. The clients ranged in age from 18 to 40, with an average age of 25, and included eight White females, and four White males. Participants were given a five-dollar gift card to a coffee shop as a token of appreciation for participating in the study.

Data Collection

Data were collected following each dyad’s second counseling session. The second session was chosen because in our experience with this particular clinic, many clients come to three sessions, meaning the third session would often be the closing session. As described earlier, the researchers gathered data at a single point in time. For some, the counseling relationship is well developed by the second session, while for others this is too short of a time frame to have developed trust. The first author (CS) conducted interviews with each client immediately following the session and then with CITs. Interviews were conducted in private rooms that were in the same building and on the same

floor, but separate from the clinic. Interviews were audio-taped and transcribed. A demographic questionnaire was completed by each participant and included name, gender, age, ethnicity, e-mail address, and a pseudonym chosen by the participant. Following the description from Patton (2002), interviews had a standardized framework, which

allowed for structure and for follow-up exploration when desired, creating a conversation around the interview topic. Interview questions were consistent for each group and targeted what participants believed was most meaningful in that particular counseling session. Interview protocol was slightly different for clients and CITs; the client protocol contained a few additional questions at the beginning related to the client’s goals and expectations for counseling. Interview protocol can be seen in Appendix A for CITs, and in Appendix B for clients. An example question from

the CIT and client protocol is: What stood out for you in today’s session? Which of those things stood out the most for you? Clients were assured that their answers to interview questions would not be used in evaluation of the

CIT. Interviews ranged from 10–45 minutes in length. The average interview length was between 20–30 minutes. Although the interview protocol was consistent across interviews, they varied in length and depth depending on the participant, the amount of time they had available, and their willingness to elaborate on their answers.

Data Analysis

A constant comparative method described by Anfara, Brown, and Mangione (2002) was used in analyzing the data. This method consists of a first iteration of assigning open codes, in the form of emergent words or phrases, from reading the data broadly and noticing regularities and what stands out among participant interviews, and a second iteration of comparison within and between codes in order to combine codes into categories and identify themes. This system of analysis provides a way to make sense of large amounts of data by first organizing it into manageable parts, and then identifying patterns and themes. Iterations for client and CIT interviews were completed separately, which resulted in themes for clients and themes for CITs.

Research Credibility and Rigor

As suggested by Anfara et al. (2002), several methods were used in this study to establish credibility and demonstrate rigor. Member checks were implemented through e-mail and allowed each participant to review their coded interview transcript and make comments or ask questions of the researcher. No one availed himself or herself of the opportunity to make comments or ask questions. To ensure the ongoing practice of reflexivity, peer debriefing and a community of practice served as forums for discussion for issues that arose throughout the data collection and analysis processes. Finally, the researcher detailed the steps of the research process in an audit trail.

In qualitative research, the researcher is the tool; how the first author (CS) was positioned in this study was a point of continual examination, and is stated here to give the reader an idea of the lens through which this data was gathered and filtered. At the time of this study, CS was a doctoral candidate in the same counselor education

program as the master’s students in the study. She had been practicing in the counseling profession for eight years post-master’s, and is licensed as a Marriage and Family Therapist. CS was keenly aware when interviewing the client participants of the differences between an interviewing relationship and a therapeutic relationship. Following

Seidman’s (2006) distinction between the two relationships and their goals, the first author was present with the participant to learn, rather than to treat. In addition, CS served as a clinical supervisor of counseling students in this master’s program for three years. Thus, she also was cognizant of the differences between an interviewing relationship and a supervisory one. CS purposefully had no teaching or supervisory contact with this cohort of master’s students prior to the study and had only met them as a group on two occasions. She relied heavily on colleagues in her community of practice for reflexivity work given her position in the study. The second author is an associate professor in this counselor education program, and did know the potential participants in the study.

However, the second author had no knowledge of which students in this cohort chose to participate in the study. The third author is a professor specializing in graduate research, and did not know the participant pool for this study. All data collection and initial analysis for this study was completed by the first author; however, all authors participated in reviewing the code and theme development throughout the analytic process.

Results

Findings from this study resulted in themes for CITs and clients. Eight themes, with many subthemes, emerged for CITs: Counseling Relationship, Insights, Immediacy, Nonverbals, Transference and Counter Transference, Emotion, Goals and CIT Negotiating the Counseling Process and their Role. Six themes emerged from the client participant interviews: Goals, Counseling Relationship (with many subthemes), Insight, Immediacy, Emotion and Reflections on Counseling. The CIT themes are presented first, followed by the client themes. Many of the same themes emerged for clients and CITs, as is shown in Table 1. Nonverbals and Transference and Countertransference were additional themes specific to CITs, and although the final themes shown for CITs and Clients in Table 1 are labeled differently, they seem to parallel each other for the respective perspectives.

Table 1

Themes of Meaningful Experiences

CITs                                                                                Clients

Counseling Relationship                                               Counseling Relationship

Insight                                                                                        Insight Immediacy                                                                                        Immediacy Goals                                                                                        Goals Emotion                                                                                        Emotion Nonverbals

Transference and Countertransference

CIT Negotiating the Counseling Process and their Role

Reflections on Counseling

CIT Themes: Counseling Relationship

The interview protocol contained a broad question regarding the counseling relationship, prompting the CIT to describe the relationship they have with their client. Therefore, discussion of the relationship was inevitable, however the way participants spoke about the relationship resulted in the various subthemes. The theme of the Counseling Relationship consists of five subthemes describing meaningfulness in the relationship according to CITs including Depth of Connection, Trust, Depth of Understanding, Boundaries, and Collaboration.

Depth of Connection represents CITs’ descriptions of how connected the counselors-in-training are with their clients. Some experienced feeling very connected, while others portrayed their relationship as improving and

building, and still others reflected on not feeling very close with their clients, not having developed much of a relationship yet, or not having really connected. Sarah describes not feeling connected to her client, “It’s definitely not like, well, I don’t feel very connected to him. He feels very guarded, and I feel like I’m pushing him in doing a lot of the work. So, it’s a hard relationship.” When answering a question about what her client might say was most meaningful in the session, Sarah also had this to say about their connection, “I feel like there’s this wall between me and him so, yeah, so I honestly don’t know what part like would stand out for him.” Although these quotes vividly illustrate a lack of connection in this particular counseling relationship, many CITs reported feeling very close and

connected to their clients. Michelle describes her feelings of connection to her client, in spite of the many differences between them:

I mean I feel connected with her. I feel like I can, . . . it’s weird because . . . I’m similar to her in a lot of ways and, you know, gender . . . but also different in age and . . . responsibilities and where we’re at in our lives,

but I seem like I can understand her . . .

Many CITs also described the counseling relationship as meaningful in terms of the quality of trust. The sharing and honesty exhibited by clients was directly related to the trust present in the relationships according to CITs. Some of the sharing included the client admitting that they were sharing information with the CIT that they had never shared with others, sharing information that seemed deep to CITs, and showing emotion. Other examples were of clients sharing that either the CIT or something in the session made them feel uncomfortable. Kerry describes here how the client’s behavior translated to evidence of trust:

Being our second session, and I think a way that kind of signified it, was that she was able to become emotional and let some things out, and I think that kind of let me know that she had somewhat of a trust built up with me.

Other CITs reported clients being guarded in session, not wanting to discuss certain topics, or that they were working on building greater trust. Annie shares here how the trust was building, but not quite at the level she hoped for yet in her relationship with her client:

So, it seemed like at times she was trying to share those with me but she wasn’t quite sure, ready to do it. So, that seemed pretty important for me to kind of recognize and realize that she did seem like she was trying

and that maybe it was difficult.

Trust was a subtheme of the Counseling Relationship that was present in many of the CIT interviews and one that they seemed to place great importance on.

Another prominent subtheme for CITs is Depth of Understanding. CITs spoke to being on the same page as their clients, experiencing moments of clarity with their clients, showing understanding through validation and reflection, obtaining a grasp of the client’s experience, or a lack of these characteristics. Sam describes her experience here of a moment of clarity and understanding between she and her client:

He described it as the noise in his head was quieted and it was just very meaningful, a metaphor that he used, and it was a very meaningful moment for both of us because it was like this connection like he really hit the nail on the head of what he was trying to explain about how he can’t interact with people. And I feel like he accepted that I understood that….

Regarding this same moment, Sam says, “The way I felt was that we were both just, like all the muddy waters were cleared. It was like this perfect moment of communication.”

A few counselors spoke about the relationship in terms of boundaries. They described feeling that the client understood the boundaries of the relationship, the boundaries were clear, or that the two of them were trying to figure out the boundaries. Annie described the meaningfulness of the clear boundaries in this way:

[My client] mentioned that she had talked with a classmate afterwards and they had been discussing their relationship with their counselor and [the classmate] had said that they weren’t really getting a lot out of it because she felt like the counselor was friendly and it felt like a friend relationship. So that felt meaningful to me because it felt like she understood our boundaries and she could kind of respect what my role was and what her role was and she was, while it could be awkward and she was still somewhat in process that she understood those boundaries, and that was meaningful I think.

The fact that this relationship resembles no other relationship that many of the participants have experienced, though they have studied it, is significant as they negotiate what that looks like. It is not a friendship, yet is very intimate in its own way.

Several CITs portrayed their counseling relationship as a collaborative one. CITs described the relationship as equal, collaborative and balanced. Further, in these relationships, mutual respect, mutual investment, and working collaboratively together are pillars. Reflecting on her relationship, one CIT, Susie, had this to say, “I would think that our relationship is equal. I don’t see me in a powerful position. I try to keep it on a level playing field where I don’t offer advice or make anything a power differential session.” It is evident that Susie, and other CITs, valued that they were able to create a non-hierarchical environment for the counseling relationship.

Insights

Meaningful experiences for CITs also included Insights. This theme is made up of three subthemes: Client

Insight; CIT Insight; and Questions, Reflections, or Discussion that led to Insight.

CITs described clients gaining insights or having “ah-ha moments” in session as meaningful and often spoke about this in a way that portrayed feeling honored to be a part of these moments with clients. Kerry was particularly struck by a client’s insight:

and she brought up the relationship with her father, which has been strained for some time and she actually tied some things together where she was able to correlate the insecurities with her father towards her problems with loneliness. So I think that was a big key thing for her…it was awesome for me to see that and…being part of it, and I don’t think I did it, like I don’t think I waved a wand and like she was able to realize this, which was more, it was more beneficial for her to be able to come to the realization.

Many more CITs described instances similar to Kerry’s experience.

Other CITs described their own insights in session as meaningful. Some CITs gathered information from clients and then drew parallels or shed light on areas of which clients were previously unaware. Grace experienced sharing her own insight with her client as powerful in session:

I had insight and I don’t know how I worded it now but it kind of made her cry and I realized that what I said made her cry…I felt like it kind of meant that I hit what she really meant and what she was feeling and that really stood out to me.

Several CITs expressed clients gaining insight following CITs asking pertinent, sometimes difficult questions, making reflections or discussing deep or uncomfortable topics. Annie asked her client a difficult question about how her relationships with men affect her relationship with her son, and describes here that occurrence and the client’s reaction:

At the beginning…we were talking about the resentment that she felt towards men, and I asked her how that relationship impacts her relationship with her son and she really paused and she was like, “I don’t know if

I’m going to come back after three sessions.” [CIT laughter]  So I wonder if maybe that could have resonated

because it was something she hadn’t thought of before.

CITs felt proud of prompting or being part of insights for clients and perceived insight as meaningful in session.

Immediacy

Immediacy emerged as a strong theme in CIT interviews. CITs’ experience of Immediacy in session fall into three subthemes: CIT-Initiated or Desire to Initiate, Client-Initiated, and CIT Disclosure of Their Experience of Client.

CIT-Initiated, or Desire to Initiate, includes happenings in session where CITs initiated immediacy with their clients, and moments where they wish they had taken the opportunity to be immediate with clients. Experiences of

Immediacy in this subtheme include processing the here-and-now of the counseling relationship, of the counseling process, and broaching gender differences. CIT Annie describes initiating a conversation with her client about the counseling relationship and how that may have been significant for this particular client:

I just kind of opened it up by saying…”how are you feeling in this room? How is our relationship? Are

you feeling comfortable in our relationship? Are there things that I could do to make that relationship more comfortable for you?” And…I think that because she puts up that intimidation sometimes as a front that that’s probably one of the first times someone has ever said that to her and kind of put the ball in her court and tried to mutually, you know, invest in a relationship.

There also were instances of immediacy that were client initiated. Susan was pleased that her client brought up her discomfort with Susan’s positioning:

I was sitting up close, I’m kind of working on my, where it feels comfortable for me to sit. I scooted up more to the tip of my chair and was leaning towards her and that made her feel really uncomfortable and she felt that she could address me about it, which really I …was, I shouldn’t say flattered by it but I appreciated that she felt that comfortable that she could say, “wow, you’re making me feel really uncomfortable by being that close.”

When clients initiated immediate moments, CITs felt this indicated clients’ trust and comfort level in the counseling relationship.

Still other CITs found it meaningful when they were able to talk with their clients about how they were experiencing them in session. Exhibiting CIT Disclosure of Their Experience of Client, Sue describes both her urge and hesitance with this:

…there was a point at the end when I was able to validate her…but she worries that people don’t value her opinions so I stepped a little outside of my comfort zone and disclosed like, ‘I really am valuing what you’re saying in here’…I have a fear of self-disclosing and it’s just because I don’t have a lot of practice with it so it’s always like am I doing this for the right reasons? Will it be meaningful to her? But in that moment it felt like I needed to tell her…‘in this relationship [I] really value what you’re saying.’ So it was uncomfortable because there’s always that second guessing, is this appropriate? How should I phrase it?

Nonverbals

Many CITs were in tune to the nonverbals exhibited in the room. This theme includes all of the interactions between CITs and clients that are not spoken out loud, including how present CITs and clients were with each other, silent moments, and body language. Presence, or how present CITs and their clients were in the moment with each other, was something some CITs were very in touch with. Alex describes her process with this and her client’s response well:

…when I stopped thinking, what am I supposed to be doing, and just was more myself, it seemed like I was able to do what I was supposed to be doing and then also being myself.

…So, yeah, and I wonder like did he notice I wasn’t being myself? Because when I was, he was definitely more engaged as well so.…Like we started joking and it just seemed like things were actually clicking instead of me doing, ‘uh-huh, uh-huh’ and like up here [in my head] trying to figure out what was going on.

Alex describes what other CITs also experienced, a difference in the counseling process when they and their clients were present and engaged. Nonverbals, specifically how present and engaged CITs and their clients were, silent moments, body language, and other intuitive observations made by CITs were important in CITs’ experiences of what was meaningful.

Emotion

CITs experienced emotion in session, or the lack of emotion in session, as important in the process. For avoiding

or lack of emotion, CITs reflected on their own actions that led the client away from experiencing their emotions

deeper in session, their unsuccessful attempts to explore clients’ feelings, and clients keeping the content at a surface level, rather than emotional. Alex experienced her client’s avoidance of processing emotion:

I think the same thing that’s important is that there are things that he’s not talking about, mainly his feelings, and then when I did ask him I think directly, like “how does smoking make you feel” or “tell me about the anxiety or something,” he went to how does it physically make me feel, which brings up even more to me that whole, “you’re not experiencing emotions very much.”

Many CITs also reflected on the emotional climate in the room and found it important that they elicited emotions from clients, and that their clients and sometimes even the CITs experienced emotions in session. Kerry was struck by a client’s release of emotion in session:

I would absolutely have to say I believe that it was…the release. It was like when she became emotional it was like she was, it was her finally getting a chance to release these things and guessing I think that she kind of had to hold these feelings in for quite some time so being okay with letting them out and I imagine that was probably a great feeling.

It was clear from the interviews that CITs found emotion, or the lack of emotion, as critical in counseling.

Goals

Some CITs experienced goals as a meaningful theme in counseling. Setting goals, making a plan, and assigning homework were important to these CITs. Sue picked up on her client’s desire to be challenged and used this opportunity to challenge the client with a homework assignment that was directly related to the client’s goal of speaking up in class more often:

So there was an opportunity at the end for me to, she said “I want to be challenged, I want my teacher to call on me” and I said, “well, I would like to challenge you to step a little outside of your comfort zone and speak up just one time in class and, you know, if you have time jot down how it felt before and during, after, your thoughts about it”…we kind of concluded that next week we would focus on what that experience was like.

Setting goals is one of the more concrete meaningful happenings in session that appealed to some CITs.

Transference and Counter Transference

CITs dealt with some transference and counter-transference in session as well that stood out to them. Kerry describes the meaningfulness of this in session:

There was some transference there with her issues with her father are really similar to issues I have with mine, so it was something that I was kind of battling myself and so, yeah, it was emotional for both of us.

CITs experienced clients reminding them of people in their own lives, sometimes of parts of themselves, and other times noticed that they were representing someone else for the client.

CIT Negotiating the Counseling Process and their Role

CITs often reflected on their own performance in session, clearly attempting to negotiate the counseling process and their role in it. CITs described how they felt the sessions had gone; how well they felt they performed, and things they wished they would have done differently. They reflected on their own learning process of when to give more time to certain things, when to elicit more from clients, when to step in, what to do when clients want them to have answers, how to be more present, and how to manage their own feelings in session, among other things. Kerry describes the journey of growing as a counselor through this session:

I think today’s session was really important for not only the client, but for me. Like I was telling my supervisor going in that there was a different feeling with this client and I think today I learned that all clients have different feelings, and that I think I finally came to the realization that they’re all unique and all different and to try to fit so many into the same circle if you will, but it’s just impossible. So, I think it was good for me and it was, as much as progress as the client made, I probably made more as a counselor.

Since seeing clients is new to CITs, negotiating the counseling process and their role is at the forefront for them. They receive live supervision that includes a briefing before the session, a mid-session supervision break, and a debriefing with their supervisor immediately following the session as well that accentuates this development.

Client Themes: Counseling Relationship

As was the case in the CIT interviews, clients were asked in the interview protocol about the counseling relationship, making a discussion of the relationship inevitable. The way clients experienced the relationship and what they found meaningful in the relationship is how the subthemes for Counseling Relationship emerged. Clients reflected a great deal on the relationship and many subthemes emerged including: Descriptions, CIT Contributing Characteristics and Behaviors, Depth of Understanding, Trust, and Someone to Talk to and Focus on Self.

Clients portrayed a wide range of Descriptions of their counseling relationships. Some described having trouble even calling it a relationship since it was new, some described the relationship as different or odd, or had difficulty describing the relationship. Others portrayed the relationship as respectful, comfortable, or easy. Heather illustrates here the uniqueness of the counseling relationship:

Really that it’s so odd to have a one-sided relationship almost. I come in and I say all this about myself and don’t know anything about her at all, you know, it’s just so odd. It’s strange to me still.

Other clients were focused on CIT Contributing Characteristics and Behaviors, in how they experienced the counseling relationship. Frank illustrates how he experiences his CIT well here:

My counselor is very open individual. She doesn’t seem to be guarded. She didn’t seem to be judgmental at all. She always greets with a smile, welcomes me into the office, that’s very important. There is, even today, there is still a stigma to seeing a therapist, there’s still a lot of anxiety around going to see a therapist. So when she greets me and invites me into her office with a smile and a truly inviting nature about it, that makes the session go a lot better because it takes a lot of that load off of me right from the get go. You don’t feel

like she’s going to sit and judge you the whole time and she’s very good with eye contact. She doesn’t bore a

hole in your head. [laughter]

Clients expressed many other behaviors and characteristics such as the gender of the CIT, their body language, listening skills, social skills, empathy exhibited, and genuineness that were meaningful to them.

Depth of Understanding was important to clients in how they experienced their relationships with their CITs. Often clients were able to determine whether and how much their CITs seemed to understand them by CITs normalizing clients’ experiences, by their paraphrases and reflections, and by asking for clarifications. Clients could tell whether or not they and their CIT were on the same page, and when their CIT wanted to understand them. Carol’s reflection of her CIT being able to understand her story is a good illustration:

Just that I guess I feel like I’ve never been able to explain it to where somebody understood how I was feeling, but she understood exactly what I was trying to say and how I was feeling…and I guess I’ve never really had that before so that kind of stood out that she even though sometimes I felt like I was just babbling, you know, but she understood. She could bring it in and be like, you know, “this is what I’m hearing” and I go “you know what, yeah”. So I mean, that kind of stood out to me that she just really could understand even if I felt like I was all over the place

Trust was another important element to the counseling relationship for clients. Many clients felt they were revealing, or would be revealing, intimate parts of their lives in session, making trust critical. The depth of sharing was related to the amount of trust clients felt with their CITs. Wanda explains how the trust she feels with her CIT will be crucial in the future work they will do:

I trust her. I feel like I’m going to be able to tell her, you know, there’s other things that I haven’t told her yet that we’re going to probably discuss, and I feel like I’ll be able to tell her that and it’ll be, you know, I don’t feel like she’ll judge me on it. I feel like she’ll listen just from knowing her two sessions. Wow.

Wanda’s “wow” demonstrates her awe of the trust she feels. On the other hand, Heather is not as sure about the trust in her counseling relationship: “I don’t distrust her. I don’t know if I trust her, but I don’t distrust her.” Trust can take some time to develop and some clients felt two sessions was not a sufficient amount of time, while others felt trust immediately with their CIT.

Some clients emphasized that having Someone to Talk to and Focus on Self was important in the counseling relationship. This was unique for these clients and they valued being able to vent and open up to someone that is not in their everyday lives. Ava portrays this well:

It’s nice to have a person to sit there and listen to you and to help you through the issues that you have because you just don’t want to sit down and talk to your friends or someone tell them “oh, I’m alone and I’m unhappy with this and this” because a lot of people don’t, it’s just a comfort thing. You don’t want people to know what your insecurities are in life, your weakness I guess. So it’s nice to have someone that I can talk to and to help me.

The Counseling Relationship was significant for clients and they paid great attention to what CITs did and did not

do, as well as what was between them that contributed to the relationship.

Goals

Many clients experienced goals as very significant in counseling. Clients appreciated having a direction for their sessions and something to work toward, and in some cases, experienced frustration when they did not have this focus or a plan of action. Frank speaks to his need for a plan here:

What seemed most important to me was actually sitting with my counselor and coming up with the homework that I’ll be doing this week. It’s a completely different feeling. It actually felt like rolling up the sleeves and, you know, getting your heads together and coming up with a plan of action and that’s still,

you know, a part of I guess it’s the old Marine in me. You can sit down and do a situation report and start planning that mission the better off you are and that was very important to me to actually sit down and get moving.

It was clear that clients were focused on goals and wanted to use session time to productively work towards their goals.

Insight

An even more prevalent theme for clients than goals was insight. Clients experienced new insight as meaningful in session through their CITs asking questions, reflecting, reframing, and drawing parallels that made them think of things in new ways and come to new realizations. Johnny demonstrates here how a question his CIT asked led to an insight:

The reason why it’s a good question is I don’t think there’s a really good answer for it. It also really just makes you feel like well, it doesn’t really make sense that I think, to allow myself to think that way.

Carol illustrates the impact of insight for her in session:

…I’ll think about it, you know, probably for the rest of the day. I’ve got to just come to terms with everything that happened, you know, in my head or whatever and, yeah, I think it probably is going to make a really big difference so…Because I mean I wasn’t expecting anything out of this, but I’m getting like life-changing stuff out of it, so it’s pretty crazy.

Clients, like Carol, consistently spoke about insight as requiring further thought and reflection, and as expecting it

would sink in more over time, and would impact their lives.

Immediacy

A few clients experienced immediacy as meaningful in session. This included processing the here-and-now of the counseling relationship and the counseling process, broaching gender, and CITs sharing their experience of the client

with them. Carol thought it was important that her CIT invited her to openly talk about her comfort level in their relationship:

I think what I felt like was important, is that she kind of stressed the point that she wants me to feel comfortable. Like, if she makes me uncomfortable or says something that I don’t feel comfortable talking about, that just to let her know, you know…I thought that was important to make me, I think it was important for her to let me know that.

Another client, Heather, had this to say about an immediate moment where her CIT asked how she felt in the room: “It was strange, but it was meaningful. I remembered it.”

Emotion

Some clients focused on emotions exhibited in session as important. Clients felt a variety of emotions in session including the following: nervous, anxious, relaxed, exposed, and vulnerable. Ava, when responding about what her CIT may say was most meaningful in their session, reflected on her vulnerability with him:

I’m hoping opening up the way I did to him. It’s not very often that I can sit down and talk about issues with a parent, your mom and dad, to open up. To be able to cry in front of him and all of that I kind of hope that makes him realize that “this is important to her, that she is talking to me about it” where I don’t really have anybody else I talk to like that.

Reflections on Counseling

Clients had much to say about the counseling process in general, coming together in a theme of reflections on counseling. Some clients had expectations about counseling that were either met or not met. Other clients described how they felt about this session and about counseling in general. Still others described the process as odd or different. Wanda, in reflecting on her experience had this to say:

That this shouldn’t be a one-time thing; that I, you know, I should probably do it again, you know, in about a year or two, you know…It really makes you question yourself and things like that. So that’s important. I think it’s important to realize, you know, what you do and how you affect people around you and I feel like, you know, boy, couldn’t everybody just use that, you know?

Many similarities, as well as some differences, emerged in the themes and subthemes generated of meaningful experiences among CITs and clients in this study. The two perspectives shared the themes Counseling Relationship, Insights, Immediacy, Emotion, and Goals, varying somewhat in the subthemes. Meanwhile, Nonverbals and Transference and Counter Transference were themes specific to the CIT experience. Finally, two themes from the different perspectives, CIT Negotiating the Counseling Process and their Role (CIT theme) and Reflections on Counseling (client theme), seemed to parallel each other.

Discussion

The results of this qualitative study are significant to furthering our understanding of the counseling process with views from both the client and CIT perspectives. Eliciting both client and counselor perspectives have been shown to help broaden our knowledge of the counseling process (Blow et al., 2009; Elliott & James, 1989). Many themes emerged from both participants’ lenses, and reveal some overlap, as well as some differences among CIT and client themes. Llewelyn’s (1988) work shows that some differences in participant perceptions are to be expected, even when counseling has a positive outcome.

All participants were asked about the counseling relationship, and the results add to the depth of what we know about how the relationship is experienced by CITs and clients. Both CITs and clients experienced the counseling relationship as meaningful, which also is supported in the literature (Lietaer, 1992; Lietaer & Neirinck, 1986),

and there were similarities in the aspects of the relationship they each found meaningful. Trust and Depth of Understanding were subthemes for both clients and CITs. Singer (2005), when qualitatively examining clients’ perspectives in counseling, also found that clients valued feeling understood by their counselor.

While both CITs and clients experience the counseling relationship as meaningful, with some similarities, there also are some differences in the aspects of the relationship they emphasized. Subthemes for CITs include Boundaries, Depth of Connection, and Collaboration. On the other hand, different subthemes that emerged for clients include Descriptions, CIT Contributing Characteristics and Behaviors, and Someone to Talk to and Focus on Self. In examining these differences in subthemes among CITs and clients, it is fitting that they would emphasize different aspects of the relationship. For example, it is reasonable that CITs would be aware of and experience boundaries as important in the counseling relationship, while clients may not be in tune with this characteristic. In the training of CITs boundaries are emphasized, and CITs, who are new to practicing, need to be especially vigilant in establishing and maintaining appropriate boundaries. Likewise, it makes sense that clients would emphasize CIT Contributing Characteristics and Behaviors in the relationship, because CITs may not be as focused on what they themselves

are bringing to the relationship to make clients feel comfortable. One of the CIT Contributing Characteristics and Behaviors valued by clients in this study, being non-judgmental, is also supported in the literature by findings of Singer (2005) and Bowman and Marshall (2000). Another CIT characteristic found in this study, genuineness, also was evident in Bowman and Marshall’s findings. Further, having Someone to Talk to and Focus on Self is something that although very important for clients, would not be a factor CITs would be cognizant of necessarily, as this is not their experience of the relationship as CITs.

Both CITs and clients experience Goals, Insight, Emotion, and Immediacy as meaningful in counseling.

These themes are supported in the literature. For example, Martin and Stelmaczonek (1988) found insight and the description or exploration of emotion among the most important occurrences in counseling for both clients and counselors. Llewelyn (1988) found insight to be most helpful from the counselors’ perspective, while problem solving or action related to goals, was most helpful from the clients’ perspective. Sells et al. (1996) also found goals to be among the most effective moments for clients in session, but not for counselors. Rhodes, Hill, Thompson, and Elliott (1994) found that when clients and counselors are able to openly discuss the here-and-now of the counseling relationship, in other words, practice immediacy, the therapeutic bond is strengthened.

Goals, although a theme for both clients and CITs, showed up much more often for clients than for CITs. As noted above, this is consistent with the findings of Llewelyn (1988) and Sells et al. (1996). Clients often thought of setting and reaching goals as the focal point of counseling, and therefore found it meaningful when the focus was on this.

While Insight and Immediacy are also themes for both CITs and clients, a difference lays in how detailed

the breakdown of these experiences were described from each perspective. CITs reflected on insight in terms of whether the insight was their own, what they did to elicit insight, and what was client insight, whereas clients only reflected on their own insight. For the common theme of Immediacy, similarly, CITs were more aware of whether this originated from themselves or their clients, when they wanted to initiate immediate moments, and when they

shared their experience of clients with them. Clients did not experience this level of detail in moments of immediacy. Further, Immediacy was a stronger theme for CITs than for clients, showing up much more in their interviews.

Another common theme, Emotion, was broken down from CITs into experience of emotion in session and avoiding or lack of emotion, while clients only described emotion that was present. It is reasonable that CITs would be looking for deflecting and avoiding emotion from clients, while clients would likely not think of their own absence of emotion.

Nonverbals is a theme for CITs and not for clients. CITs are more focused on nonverbal happenings, as they are trained to attend to this, whereas clients may be experiencing these nonverbals without much awareness of them. Similarly, Transference and Counter-Transference are aspects of counseling that CITs have learned about and are hopefully considering, while clients may not even be aware of these concepts.

The CIT theme of CIT Negotiating the Counseling and their Role, and the client theme of Reflections on

Counseling, although different, seem to be somewhat parallel for the different perspectives. CITs are attempting

to figure out the counseling process with respect to their own role and performance within the process. Meanwhile clients are less likely to reflect on their own performance and role, but more on the process of counseling in general.

Implications

The findings of this study indicate that CITs and clients experience much of the same things as meaningful in session, such as the counseling relationship, goals, insights, immediacy, and emotion. The findings also indicate where CITs and clients differ in their perspectives, such as in meaningful aspects of the counseling relationship,

and the level of importance placed on goals and immediacy (for example goals are more meaningful to clients, and immediacy is more important to CITs). These similarities and differences have implications for practice and for clinical supervision.

It is encouraging to see how much overlap there is in what CITs and clients find meaningful in a counseling session. However, the differences are important to be cognizant of, so that CITs and their supervisors may tend more to the areas that are meaningful to clients. For example, goals are clearly important for many clients, and if goals

are not as meaningful to CITs, they may be missing an opportunity to be productive with their clients. Further, CITs and supervisors would do well to tend to the aspects of the counseling relationship that clients found meaningful,

but were not present for CITs, such as the characteristics and behaviors of CITs that contribute to creating a positive

counseling relationship. Most importantly, the findings indicate a need for CITs to elicit client experiences of the process and to check that against their own experience of the process to see where they match up and where they differ. Supervisors can help CITs see the value in doing this, possibly by even modeling this conversation in supervision between themselves and CITs. Along these lines, the findings indicate a need for live and video

supervision to be sure we are not only hearing the CITs account of the session, and missing an important piece of the picture. Finally, CITs would benefit from reading the results of this study to encourage reflection of their own development, the experiences of other CITs, and of what their clients may be experiencing in counseling.

There are limitations to this study that are important to identify. The sample of CITs and clients who are fulfilling a course requirement create some limitations. There is limited transferability to experienced counselors, the variety of clients they serve, and to the larger field of counseling. In addition, the first author’s role as a doctoral student in the same program the study was conducted is a limitation, and was managed through reflexivity work and with a community of practice. Further, the single session used for data collection in this study is not representative of the entire course of counseling. In particular, collecting data on the second session when the counseling relationship is still new is a limitation. Finally, the data in this study is self-report of participants’ subjective experience, and it is possible that participants have withheld information, or have relayed experiences in a socially desirable light.

Future researchers looking at meaningful events in session within CIT-client pairs, along with the perspective of an observer who is an experienced counselor or supervisor, would help to more holistically understand the counseling process. Observers can pick up on subtleties, unconscious occurrences, and experiences that clients may be less willing to report and of which counselors are unaware (Elliott & James, 1989).

References

Anfara, V. A., Brown, K. M., & Mangione, T. L. (2002). Qualitative analysis on stage: Making the research process more public. Educational Researcher, 31(7), 28–38. doi: 10.3102/0013189X031007028

Blow, A. J., Morrison, N. C., Tamaren, K., Wright, K., Schaafsma, M., & Nadaud, A. (2009). Change processes in couple therapy: An intensive case analysis of one couple using a common factors lens. Journal of Marital and Family Therapy, 35(3), 350–368. doi: 10.1111/j.1752-0606.2009.00122.x

Bowman, L., & Marshall, F. (2000). Client perceptions of couples therapy: Helpful and unhelpful aspects. American

Journal of Family Therapy, 28, 295–310.

Elliott, R., & James, E. (1989). Varieties of client experience in psychotherapy: An analysis of literature. Clinical

Psychology Review, 9, 443–467. doi.org/10.1016/0272-7358(89)90003-2

Elliott, R., & Shapiro, D. A. (1992). Client and therapist analysts of significant events. In S. G. Toukmanian & D.

L. Rennie (Eds.), Psychotherapy process research: Paradigmatic and narrative approaches (pp. 163–186). Newbury Park, CA: Sage.

Hays, D. G., & Wood, C. (2011). Infusing qualitative traditions in counseling research designs. Journal of

Counseling & Development, 89, 288–295. doi: 10.1002/j.1556-6678.2011.tb00091.x

Henkelman, J., & Paulson, B. (2006). The client as expert: Researching hindering experiences in counselling.

Counselling Psychology Quarterly, 19(2), 139–150. doi:

10.1080/09515070600788303

Kline, W. B. (2003). The evolving research tradition in Counselor Education and Supervision. Counselor Education

& Supervision, 43, 82–85. doi: 10.1002/j.1556-6978.2003.tb01832.x

Lietaer, G. (1992). Helping and hindering processes in client-centered/experiential psychotherapy: A content analysis of client and therapist postsession perceptions. In S. G. Toukmanian, & D. L. Rennie (Eds.), Psychotherapy process research: Paradigmatic and narrative approaches (pp.134–162). Newbury Park, CA: Sage.

Lietaer, G., & Neirinck, M. (1986). Client and therapist perceptions of helping processes in client-centered/

experiential psychotherapy. Person-Centered Review, 1, 436–455.

Llewelyn, S. (1988). Psychological psychotherapy as viewed by clients and therapists. British Journal of Clinical

Psychology, 27, 223–237.

Martin, J., & Stelmaczonek,  K. (1988). Participants’ identification and recall of important events in counseling.

Journal of Counseling Psychology, 35(4), 385–390. doi: 10.1037/0022-0167.35.4.385

Mahrer, A. R., & Boulet, D. B. (1999). How to do discovery-oriented psychotherapy research. Journal of Clinical Psychology, 55(12), 1481–1493. doi: 10.1002/(SICI)1097-4679(199912)55:12<1481::AID- JCLP6>3.0.CO;2-#

Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2010). Trainee nondisclosure in supervision: What are they not telling you? Counselling and Psychotherapy Research, 10(2), 103–113. doi:

10.1080/14733141003712301

Nelson, M. L., & Neufeldt, S. A. (1996). Building on an empirical foundation: Strategies to enhance good practice.

Journal of Counseling & Development, 74, 609–615. doi:10.1002/j.1556-6676.1996.tb02300.x

Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.

Paulson, B. L., Everall, R. D., & Stuart, J. (2001). Client perceptions of hindering experiences in       counselling.

Counselling and Psychotherapy Research, 1(1), 53–61. doi:10.1080/14733140112331385258

Rhodes, R., Hill, C. E., Thompson, B. J., & Elliott, R. (1994). Client retrospective recall of resolved and unresolved misunderstanding events. Journal of Counseling Psychology, 41, 473–483. doi: 10.1037/0022-0167.41.4.473

Seidman, I. E. (2006). Interviewing as qualitative research: A guide for researchers in education and the social sciences (3rd ed.). New York, NY: Teachers College Press.

Sells, S. P., Smith, T. E., & Moon, S. (1996). An ethnographic study of client and therapist perceptions of therapy effectiveness in a university-based training clinic. Journal of Marital and Family Therapy, 22, 321–342.

doi: 10.1111/j.1752-0606.1996.tb00209.x

Singer, M. (2005). A twice-told tale: A phenomenological inquiry into clients’ perceptions of therapy. Journal of

Marital and Family Therapy, 31(3), 269–281. doi: 10.1111/j.1752-0606.2005.tb01568.x

Thompson, B. J., & Hill, C. E. (1991). Therapist perceptions of client reactions. Journal of Counseling & Development, 69, 261–265. doi: 10.1002/j.1556-6676.1991.tb01500.

Corrine Sackett is an Assistant Professor at Western Kentucky University. Gerard Lawson, NCC, is an Associate Professor and Penny L. Burge is a Professor, both at Virginia Polytechnic and State University. Correspondence can be addressed to Corrine Sackett, Western Kentucky University, GRH 2019, 1906 College Heights Blvd.,

#11030, Bowling Green, KY 42101, Corrine.sackett@wku.edu.

Appendix A:

Counselor-in-Training Interview Protocol

1.  Can you describe the relationship you have with your client?

2.  Do you feel counseling has been effective with this client? In what ways?

3.  Are you planning to continue past three sessions?

Now I’d like you to think specifically about today’s session . . .

4.  Was today’s session similar to session one? How so?

5.  Can you tell me about today’s session?

6.  How do you feel about today’s session?

When you think about today’s session, I want you to think about what was meaningful to you . . .

7.  What stood out for you in today’s session? Which of those things stood out the most for you?

8.  What things seemed most important to you? What of those seemed most important?

9.  What things felt most meaningful to you in today’s session? Which of those things felt the most meaningful?

10.   What do you imagine your client might say was most meaningful in today’s session?

11.    Is there anything that you wish would have come up in today’s session that didn’t?

12.   Is there anything else that you would like to tell me about today’s session?

13.   What is your theoretical orientation?