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R E S E A R CH A R T I C L E

How therapists’ interpersonal behaviour is perceived by their
patients and close others: A longitudinal and
cross-situational study

Christine Wolfer1 | Peter Hilpert2 | Christoph Flückiger1

1Department of Psychology, University of

Zürich, Zürich, Switzerland

2Faculty of Social Sciences and Politics,

University of Lausanne, Lausanne, Switzerland

Correspondence

Christine Wolfer, MSc., Department of

Psychology, Division of Psychological

Interventions and Psychotherapy, University

of Zürich, Binzmühlestrasse 14/04, Zürich

CH-8050, Switzerland.

Email: christine.wolfer@psychologie.uzh.ch.

Funding information

Swiss National Science Foundation, Grant/

Award Numbers: PP00P1_163702,

PP00P1_190083

Abstract

Due to their predictive abilities, therapist interpersonal behaviour is of great

relevance for psychotherapy. However, there is a lack of knowledge about its

stability inside but also outside of the therapy room within and between therapists.

The current study investigates interpersonal behaviour of trainee therapists (N = 20)

as perceived by four patients each suffering from generalized anxiety disorder and

three closely related persons of every therapist (close others). Investigating repeated

measures, four patients per therapist completed the Impact Message Inventory (IMI;

Kiesler, 1987) three times over the course of their cognitive behavioural therapy.

Furthermore, the IMI was completed by three close others at one assessment time.

Therapist interpersonal behaviour was perceived as more friendly and less submissive

when evaluated by close others compared to patients. Using a multilevel approach,

our results indicate that therapists’ interpersonal behaviour was perceived

considerably stable across patients and over the course of treatment, and there is

considerable uniformity of the IMI evaluations in respect to the particular subscales

within and between therapists. Our results highlight the potential similarities of

observer-based habitual therapists’ interpersonal behaviour inside and outside of the

therapy room.

K E YWORD S

impact message inventory, perceptions of therapists, therapists’ effects, therapists’
interpersonal behaviour, therapy research

1 | INTRODUCTION

“… therapists were people before they were professionals, …” noted

Wolf, Goldfried and Muran (2017, p. 175) in respect of therapists’

negative interpersonal responses, opening up to the question of the

origin of therapists’ behaviours shown in treatment. Until today, it is

still mostly unknown whether therapist habitual interpersonal

behaviour is impacted more by a therapist’s personal characteristics or

professional attitudes and roles. Furthermore, there is a lack of

knowledge about the stability of therapists’ interpersonal behaviour

within and across life domains; therefore, the question arises if

therapists show comparable patterns when perceived by their

patients in comparison to the therapists’ close others. Current

literature shows that therapist effects explain about 5%–8% (Johns

et al., 2019) of treatment outcomes and that some therapists are

about 10 times more effective than others (Okiishi et al., 2003).

Received: 18 November 2020 Revised: 9 June 2021 Accepted: 9 June 2021

DOI: 10.1002/cpp.2634

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any

medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Clin Psychol Psychother. 2022;29:289–298. wileyonlinelibrary.com/journal/cpp 289

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mailto:christine.wolfer@psychologie.uzh.ch

https://doi.org/10.1002/cpp.2634

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However, only a few factors have been found to explain these effects

such as therapist personal burdens (Nissen-Lie et al., 2013), therapist

occupational burnout (Delgadillo et al., 2018), use of maladaptive cop-

ing strategies and self-doubt (Nissen-Lie et al., 2017), and therapists’

current alcohol-related and/or financial stress (Xiao et al., 2017).

Besides, therapists’ perceived social support and degree of comfort

with attachment (Dunkle & Friedlander, 1996) are associated with

better therapy outcomes. Recent reviews emphasize in particular on

therapists’ interpersonal variables (Heinonen & Nissen-Lie, 2020) next

to several interaction effects (Lingiardi et al., 2018). The alliance is

one such interaction between process and outcomes, where in an

analysis the therapists’ contribution to the alliance was found to be

correlated to outcome but not the patients’ contribution (Baldwin

et al., 2007; Del Re et al., 2021). Nevertheless, the personal character-

istics and/or professional skills that enable some therapists to estab-

lish better alliances and foster patient outcome have to be further

studied (e.g., Lingiardi et al., 2018).

Assessments of therapist abilities such as therapist interpersonal

skills have been found to predict psychotherapy outcomes of patients

up to several years (Anderson et al., 2015, 2016, 2009; Schöttke

et al., 2015). Those investigations of therapist interpersonal behaviour

refer to observer ratings in standardized assessment situations.

However, there is a lack of literature concerning the interpersonal

behaviour therapists habitually express while conducting psychother-

apy and its stability. Especially, literature about patients’ perceptions

of their therapists’ interpersonal behaviour is very limited. One of the

most prominent preexisting theoretical frameworks to understand

observer-based interpersonal behaviour in general is rooted in

Kiesler’s (1979) interpersonal communication theory: the basis for his

theory is the interpersonal circumplex model (Freedman et al., 1951;

Wiggins, 1979) with the two central dimensions of affiliation and con-

trol (for an overview of names for these dimension, see Horowitz

et al., 2006); where the affiliation dimension contains the opposing

poles of hostility and friendliness and the control dimension contains

the opposing poles of dominance and submissiveness. According to

Kiesler, interpersonal behaviour of an individual (‘sender’) can be

assessed by the perceived experience evoked in his or her counterpart

(‘receiver’; see Schmidt et al., 1999). Thereby, it is assumed that first,

the sender is not entirely aware of his interpersonal style of communi-

cation and especially, its influence on his counterpart; second, the

interpersonal style of a sender’s communication is experienced

similarly across different receivers; third, receivers are able to detect

their own internal response to the messages of a sender. Following

Kiesler (1979, 1983, 1987, 1996), it is a promising approach to

measure a sender’s interpersonal behaviour by the receiver’s internal

response. For this purpose, Impact Message Inventory (IMI; Perkins

et al., 1979) was developed, tested and translated into various

languages (e.g., Caspar et al., 2016).

Whereas Kiesler’s theory and the IMI measure primarily were

developed to better understand patients’ interpersonal behaviour,

some researchers expected that the interpersonal behaviour of the

therapists may be relevant as well (Goldfried & Davison, 1994;

Kiesler, 1979; Wolf et al., 2017). For example, in the Gloria Interviews,

the interpersonal behaviour of three prominent therapists could be

well differentiated using IMI assessment (Schmidt et al., 1999), dem-

onstrating a certain stability of an individual therapist’s interpersonal

behaviour. In line, a study investigating the material of one of the pre-

viously mentioned assessments found a high internal consistency

(Cronbach’s α = 0.94) of therapists’ reactions across different patients

(Munder et al., 2019). Furthermore, it is widely assumed that thera-

pists’ reactions are influenced by private experiences, indicating an

influence of personal experiences into the interpersonal behaviour in

therapy (e.g., Delgadillo et al., 2018; Gelso & Hayes, 2007; Rek

et al., 2018). Conversely, there is as well reason to assume that a

therapist’s interpersonal behaviour may fluctuate between different

patients over the course of treatment. Accordingly, Carson (1969) for

example proposed ‘symptom-free individuals’ to be able to flexibly

and appropriately vary across interaction partners, enabling

nonpatients such as therapists to adapt to their vis-à-vis.

Furthermore, there are several treatment approaches that postulate

a flexible responsiveness of therapists’ interpersonal behaviour

(e.g., Caspar, 2019).

Taken together, whereas the investigation of therapists’ interper-

sonal characteristics recently got a particular focus in psychotherapy

research, there is still little knowledge about the potential variability

or stability of the therapists’ habitual interpersonal behaviour as

perceived by their patients and their close others.

1.1 | Current study

The main aim of the current study was to investigate the therapists’

interpersonal behaviour in their professional as well as in their private

life (see Figure 1). More specifically, therapists’ interpersonal behav-

iour was evaluated, each by four patients and three therapists’ close

others using IMI measure. First, we tested the variability of the

therapists’ interpersonal behaviour across all evaluators (Question;

Q1a), and we contrasted the patients’ evaluations with those of the

close others (Q1b). Within the subsample investigating repeated

patients’ IMI assessments (three patients’ assessments during therapy,

Key Practitioners Messages

• Therapists’ interpersonal behaviour is differently per-

ceived by patients compared to close others.

• Therapists’ interpersonal behaviour is perceived as highly

stable across patients and over the course of treatment.

• A very low between-therapist variability of therapists’

interpersonal behaviour as perceived by their patients

emerged in this study, pointing to an unexpected high

homogeneity of interpersonal behaviour across the inves-

tigated therapists.

290 WOLFER ET AL.

four patients per therapist), we analysed the between-patient

differences (Q2a) and the within-patient variability over the three

assessment times (Q2b).

2 | METHODS

2.1 | Design

This study was a subproject of a larger randomized controlled trial

(RCT; study protocol: Flückiger et al., 2018). Cognitive behavioural

therapy in a 16-session format was provided for patients suffering

from generalized anxiety disorder (GAD). The therapy was delivered

according to the most recent Mastery Your Anxiety and Worry pack-

age (Zinbarg et al., 2006), which was developed to treat GAD and

entailed progressive relaxation or mindfulness, cognitive restructuring,

behavioural experiments as well as exposure (for more information of

the particular trial and the major outcomes, please see Flückiger

et al., 2021). Eighty patients who were randomly assigned to 20 thera-

pists were invited to evaluate the IMIs of their therapists at Sessions

5, 10 and 15. In addition, three therapist’s close others completed the

IMIs as well (see Figure 1). In the patient sample, 72 out of 80 (90%)

IMIs returned at Session 5, 70 (87.5%) at Session 10 and 60 (75%) at

Session 15. In the close other sample, 51 out of 60 (86%) IMIs

retuned. Overall, for 14 (75%) therapists, there was no missing data

(i.e., 7 IMI evaluations per therapist). Data for this subproject were

collected from January 2017 until January 2020.

2.2 | Participants

2.2.1 | Therapists

Trainee therapists were recruited via announcements of the principal

investigator in therapist trainings. Twenty trainee therapists agreed to

participate in the superordinate project. Inclusion criteria were: (a) a

Master’s degree in psychology and (b) being registered in an integra-

tive cognitive-behavioural psychotherapy-training programme. Of this

sample, 18 (90%) were female with an average age of 31.9 years

(SD = 6.9, range 28–56). The trainee therapists had been working as

therapists for 1.9 years (SD = 1.4, range 0–5), and their prior clinical

experience was on average 49 completed therapies (SD = 67, range

0–240).

2.2.2 |

Patients

Patients were recruited via public announcements and adverts on

mailing lists. Inclusion criteria were (a) diagnosis of GAD assessed with

DSM 5, (b) being 18 years old or older, (c) informed consent and

F IGURE 1 Illustration of the
study design and corresponding
research questions 1 and 2

WOLFER ET AL. 291

(d) speaking German. Exclusion criteria were (a) suicidal tendency as

indicated by a score of 2 or higher on the corresponding item of the

Beck Depression Inventory, (b) medication for current bipolar or psy-

chotic disorder, or (c) current psychotherapy from another therapist.

Comorbidities as well as prescribed medications for mood disorders

did not lead to exclusion from this study. Eighty patients (75% female)

met inclusion criteria and their average age was 31 years (SD = 9.5,

range 21–67)

2.2.3 | Close others

Close others of the therapists were recruited by asking the therapists

to hand the questionnaires to three self-selected close others such as

family members, partners and close friends. To guarantee anonymity,

only age and gender were assessed. Close others of the therapists

were on average 36.7 years old (SD = 13.1, range 21–66) and 53%

female.

2.3 | Measures

Impact Message Inventory

Impact Message Inventory (IMI; Perkins et al., 1979) is an indirect

measurement of the interpersonal behaviour of a target subject in

which the interpersonal behaviour is rated by their interaction part-

ners (raters). Usually, the target subjects are patients and the raters

are their close others. However, in the current study, therapists are

the target subjects and they are rated by their patients and close

others. Raters evaluate their emotional, cognitive, and behavioural

experience in reaction to the target subject on a 4-point Likert-style

scale from ‘not at all’ (1) up to ‘very much so’ (4). The IMI is based on

interpersonal theories enabling investigators to draw interpersonal

styles by arranging interpersonal behaviour along the

interpersonal circle (Schmidt et al., 1999) with the two distinct dimen-

sions, control (submissiveness vs. dominance) and affiliation (hostility

vs. friendliness). Fingerle (1998) translated the shortened version into

German (IMI-RD; Fingerle, 1998). For the IMI-RD, alpha coefficients

ranged from 0.68 up to 0.86 (Caspar et al., 2016).

For the present study purposes, patients rated their therapist’s

habitual interpersonal behaviour in therapy sessions. To take this par-

ticular situation into account, the IMI-RD was adapted. Items that

were unsuitable for therapy sessions such as “When I am with this

person, he/she makes me feel that… I should tell him/her to stand up

for himself” were not considered, and a total of 20 items were

retained. To ensure comparability, this adapted version of the IMI was

used for all participants. Psychometric properties of this shortened

scale were as follows: Cronbach’s α ranged from α = 0.68 (hostile) to

α = 0.77 (friendly-submissive) with a mean alpha of α = 0.74 for the

subscales. The Kaiser–Meyer–Olkin (KMO) index returns an overall

MSA = 0.81 which is considered as meritorious (Kaiser, 1974) and

indicates a given suitability of data for factor analysis. The factor anal-

ysis yielded a comparative fit index (CFI) of 0.81 and a root mean

square residual (RMSR) of 0.089 indicating an adequate model fit. In

the current study, we decided to focus on the four main scales

(dominant, submissive, hostile, friendly). We tested if therapists differ

in their interpersonal behaviour in comparison to a patient population

collected in a Swiss university outpatient centre: therapists are per-

ceived as being significantly more dominant (t = �5.56, df = 311,

p < 0.001), more friendly (t = �3.82, df = 317, p < 0.001), and less

submissive (t = 11.98, df = 310, p < 0.001) than the outpatients and

they are seen as similarly hostile (t = 1.44, df = 317, p = 0.152).

2.4 | Data analysis

A multilevel modelling approach was used to analyse the nested data

(Raudenbush & Bryk, 2002). First, we investigated the variability of

therapist’s interpersonal behaviour (Q1a) and tested whether thera-

pists’ professional interpersonal behaviour is perceived differently by

their patients in comparison with therapists’ private interpersonal

behaviour by three close others based on the four above-mentioned

scales (Q1b). These comparisons were tested using a multilevel model

where the group association (i.e., patients vs. close others) was added

as predictor at Level 1 and therapists as grouping variable at Level 2.

In order to test whether therapists’ interpersonal behaviour varies

between patients (Q2a) and within patients over time (Q2b), a hierar-

chical multilevel model was performed for every scale with fixed inter-

cept and fixed slope. Five predictors were integrated into the model:

time, patient and therapist as well as their interactions time * patient

and time * therapist. Thereby, time as the repeated measure t1–t3 was

nested in patient at Level 2 which was nested in therapists at Level 3.

We used R statistical software for data preparation and statistical

analyses (R Development Core Team, 2014). In order to evaluate the

psychometric properties, Cronbach’s α was calculated with the pack-

age psych (Revelle, 2018), and the package lavaan (Rosseel, 2012) was

used to compute factor analysis of the IMI. For hypotheses testing,

multilevel models were performed using the package lmerTest

(Kuznetsova et al., 2017).

3 | RESULTS

First, we investigated the variability of therapists’ interpersonal behav-

iour (Q1a). Overall, therapists’ interpersonal behaviour tends to be

perceived as friendly (M = 3.72, SD = 0.40, range = 1.8–4.0) moder-

ately dominant (M = 2.99, SD = 0.47, range = 1.0–4.0) and some-

what hostile (M = 1.57, SD = 0.39, range = 1–2.8); they may seem

somewhat submissive (M = 1.96, SD = 0.48, range = 1.0–3.3); the

standard deviations were noticeably low among patients and close

others and within patient at all three time points (a figure of every

therapists’ individual ratings can be found in supplementary material).

Then, we compared patients’ perceptions of therapists’ interpersonal

behaviour with the therapists’ close others’ perceptions (Q1b). Results

revealed that patients compared to close others experience therapists

as significantly less friendly (t = 3.8, df = 85, p < 0.001) and less

292 WOLFER ET AL.

submissive (t = 6.26, df = 19, p < 0.001), but no significant differ-

ences were found in the hostile and dominant scales (see Table 1 and

Figure 2).

Second, we investigated whether patients perceived their

therapists’ interpersonal behaviour differently (i.e., between-patient

differences; Q2a) and whether patients’ perception of their therapists’

interpersonal behaviour fluctuated over time (i.e., within-patient

variability; Q2b). Results indicated no significant differences between

patients in any of the four scales at any point of time (see Table 2).

These findings indicate that therapists’ interpersonal behaviour was

perceived similarly across patients. Finally, we tested whether

patients’ perceptions of their therapists’ interpersonal behaviour

varies over time (Qb2). Results did not show any significant main

effect for therapist nor a significant main effect for time in any of the

four scales. This indicates that patients experience therapists’ inter-

personal behaviour as highly stable over the course of treatment. But

we found significant interactions of patient and Time3, indicating that

for some patients the perception of their therapists’ interpersonal

behaviour changed from Time1 to Time3. Those patients perceived

their therapist as significantly more hostile, significantly more domi-

nant and significantly less friendly at Time3 compared to Time1. All

three effects were small as indicated by effect sized below Cohen’s

ds = 0.5 (Cohen, 1998).

4 | DISCUSSION

The current study investigated therapist interpersonal behaviour

evaluated with IMI by patients and close others. We found small but

statistically significant differences of patients’ and close others’

perception of therapists’ friendliness and submissiveness. Similar

differences in therapists’ interpersonal behaviour between personal

and professional relationships emerged when therapists rated

themselves: in a study conducted by Heinonen and Orlinsky (2013),

therapists reported showing more warmth, nurturance, protection and

intuition in personal than in professional relationships. Fincke, Möller

and Taubner (2015) found that therapists indicated being more

affiliated to and less controlling in personal compared to professional

relationships. There are several differences between patients and

close others that could have led to this result: first, close others are

relatives of the therapists as most therapists reported having asked

family members, partners and good friends, whereas the patients

knew their therapists from their therapy sessions only. Therefore,

close others could have rated the therapists towards social desirabil-

ity. Second, close others were self-selected by the therapists, whereas

the patients were randomly assigned by the study protocol. Hence, it

is possible that therapists chose only those persons of whom they

assumed to be especially positively inclined towards themselves.

However, there is little knowledge about whether these close rela-

tives evaluate the therapists differently from other relatives that are

not selected from the therapist. Third, the relationship qualities in

close relations can be assumed to be reciprocal (Patterson

et al., 1993) and driven by emotional needs (Heinonen &

Orlinsky, 2013), whereas, within therapy, the therapist is assumed to

be primarily focused on his or her patient (Norcross & Hill, 2002). Fur-

thermore, the therapeutic context itself may impact the IMI evalua-

tions. As therapists may have an active role in leading the process of

change, they may be perceived less submissive. Moreover, as thera-

pists may sometimes have to address uncomfortable, unpleasant or

painful topics which were avoided by the patients, they may be per-

ceived as less friendly and more dominant by their patients.

In respect to the therapeutic context (within- and between

patients), we found no substantial variation and significant differences

in the perception of the therapists’ habitual interpersonal behaviour. A

similar result was obtained in an investigation with depressive

patients, where therapist IMI change could not be assessed due to

restricted variability (Coyne et al., 2018). In our study, only a small

interaction effects with time emerged for a few patients, indicating a

change in their perception of the interpersonal behaviour of their

therapist. These patients rated their therapists as more hostile, more

dominant and less friendly at the end of treatment compared to the

beginning. One explanation could be that—as outlined above—

therapists had to address unpleasant topics to the patients, which let

the patients change their perception over the course of treatment.

However, similar deteriorations with slightly less friendly and more

hostile interpersonal behaviour have as well been documented in the

Vanderbilt II study, where these effects were attributed to the investi-

gated manualized psychodynamic training (Henry et al., 1993).

Most strikingly, however, the variances between all perceptions

of the therapists were noticeably low. Hence, the results seem to

TABLE 1 Therapists’ interpersonal
behaviour perceived by close others
compared to patients

Close others Patients
Difference

IMI scale M (SD) M (SD) Mdiff (SE) t (df) p

Hostile 1.56 (0.38) 1.46 (0.37) �0.10 (0.07) 1.47 (45.30) =0.147

Dominant 2.99 (0.42) 3.06 (0.47) 0.07 (0.09) 0.71 (21.76) =0.482

Friendly 3.73 (0.29) 3.51 (0.33) �0.22 (0.06) 3.80 (84.66) >.001***

Submissive 1.96 (0.52) 1.34 (0.36) �.62 (0.10) 6.26 (19.06) >.001***

Abbreviations: df, degrees of freedom; M, mean; SD, standard deviation; SE, standard error; t, test statistic

of the linear mixed model.
*p < 0.05. **p < 0.01. ***p < 0.001.

WOLFER ET AL. 293

speak for a relatively homogeneous perception of the interpersonal

style for all therapists rather than an individual therapist’s personal

style or individual adaptation/responsiveness (see Supporting Infor-

mation). We only can speculate about this unexpected high stability

of perceptions of the therapists across patients and time. Reasons

may lay in the therapists themselves, in the present study context as

well as in the IMI assessment: first, therapists decided to become a

mental health professional and they pursued this career for quite

a while. Next, they decided for cognitive-behavioural therapy post-

graduate training, were selected by the training centres and agreed to

participate in an RCT. Overall, this may have reduced the diversity of

interpersonal styles in the professional psychotherapy context.

Indeed, in the stereotype literature, it is assumed that people use ste-

reotypes of professions as guidance to their vocational choice and

that self-concepts are positively correlated to the stereotype of their

profession (Hollander & Parker, 1969). Furthermore, hiring decisions

have been shown to be influenced by stereotypes (e.g., Nadler &

Kufahl, 2014); that is, the training centres as well may have chosen

their trainees based on congruencies with a psychotherapists’ inter-

personal stereotype. Additionally, stereotypes affect subsequent per-

ceptions of people (Cohen, 1981). It is well known in the literature

that memory-based ratings are often relied on abstractions such as

stereotypes (Srull & Wyer, 1989). Therefore, the therapist stereotype

of patients and close others may as well have influenced IMI ratings.

Partly in line with our finding of therapists being perceived as moder-

ately dominant, friendly, not hostile and somewhat submissive, an

investigation by Levy (1988) found the stereotype of a therapist was

perceived more as leader than as a follower, warm, concerned with

others and relaxed. Moreover, one could even argue in the sense of a

déformation profesionnelle, a French term used to describe the effect

of an (over-) internalization of the professional role which leads to the

usage of professional perspectives and practices in everyday lives

(Rey, 2008). Indeed, an interview study investigating the effects of

practice on the personal life of therapists found that over 70% of the

investigated therapists perceived themselves to act therapeutically

outside practice (Farber, 1983).

Second, the study context could have influenced the results. All

therapy sessions were videotaped within a manualized cognitive-

behavioural therapy approach (Zinbarg et al., 2006). The videotaping

could have led to ‘controlled’ and less spontaneous behaviours in

respect to general therapeutic skills and cognitive behavioural inter-

ventions. However, close others’ perceptions of therapists were simi-

lar as well without those constraints.

Third, IMI assessment is based on Kiesler’s circumplex theory and

its underlying assumptions (Kiesler, 1979, 1983, 1987, 1996). The first

assumption presumes that the ‘sender’ is not aware of his influence

on others. However, many would expect therapists to be aware of

their influence and impact on others (Caspar, 2019; Fauth &

Williams, 2005; Jennings & Skovholt, 1999; Stiles et al., 1998) and

therefore may be responsive to the others’ perceptions in respect to

the therapists’ preferences of how they would like to be perceived by

the others. The second assumption is that the sender’s communica-

tion is experienced similarly across different receivers. This assump-

tion seems to be met by our results. The third assumption is that

‘receivers’ are able to detect their own internal response to a sender.

However, the receivers in this study were patients and therefore the

decoding of their therapists interpersonal behaviour may be distorted

by these individuals (Caspar et al., 2016), e.g., the shared characteris-

tics of patients that suffers from GAD. However, close others evalu-

ated the therapists as well, and (even if not tested) it is most likely

that these persons generally did not suffer from a GAD. Last but not

least, the perceived behavioural uniformity in the IMI assessment

F IGURE 2 Data distribution of ratings by close others and patients per IMI scale

294 WOLFER ET AL.

could represent an evaluative outcome rather than a behavioural indi-

cator. In other words, IMI evaluations could be a consequence of vari-

ous behaviours of therapists to get a favoured picture of themselves

in their patients, for example, via a therapeutic responsiveness. In any

case, it is unlikely that all therapists are just so responsive to individual

patients that eventually all patients come up with the same percep-

tion. Altogether, our results indicate an unexpected homogeneity in

the therapists’ interpersonal behaviour as experienced and perceived

by their counterparts. Borrowing Wolf, Goldfried and Murans (2017)

words, one could also state: therapists are those people that became

professionals.

5 | LIMITATIONS

This study has some limitations. First, this study may lack generaliz-

ability as the sample consists of only German speaking therapists in

their early career. Second, part of the uniformity of this sample may

be due to selection effects of the study itself. Therapists were

enrolled in Swiss CBT training programmes and participated in the

RCT. Furthermore, we had to adapt the questionnaire for patients as

well as close others. Therefore, inappropriate items for one of each

context were not considered. Differences in therapists’ interpersonal

behaviour may be found when assessed with more items and more

distinguished questions. However, we did find small effects. On the

one hand, a difference in friendliness and submissiveness between

close others and patients emerged and on the other hand an interac-

tion was found, indicating an increase in perceived hostility of some

therapist over the course of treatment. Last but not least, in the cur-

rent study, we used IMI assessment, which builds on the perception

of interpersonal behaviour. However, the behaviours themselves that

lead to a certain perception were neglected. Limitations notwithstand-

ing, results are compelling as they provide preliminary information

about potential variability of therapists’ interpersonal characteristics

across multiple evaluators. The results obtained showed a decrease in

the perceived friendliness of the therapist for some patients, implying

the possible occurrence of negative events or developments over the

course of therapy. Furthermore, a uniformity-like stability is indicated

TABLE 2 Therapist interpersonal
behaviour between and within patients

Patients

IMI scale Fixed effects γ SE t p Cohen’s ds

Hostile Time 1 1.296 0.884 1.47

Time 3diff �1.098 0.989 1.11 = 0.27

Patient �0.001 0.001 0.54 = 0.57

Therapist 0.001 0.007 0.26 = 0.79

Patient * time 3 0.002 0.000 4.28 <0.001*** 0.32

Therapist * time 0.006 0.008 0.75 = 0.45

Dominant Time 1 2.930 1.35 2.16

Time 3 diff 0.967 0.953 0.91 = 0.36

Patient 0.000 0.000 0.03 = 0.98

Therapist 0.001 0.012 0.10 = 0.92

Patient * time 3 0.002 0.000 2.6 = 0.004 ** 0.21

Therapist * time 0.006 0.009 0.67 = 0.49

Friendly Time 1 3.577 0.971 3.68

Time 3 diff 1.425 1.066 1.33 = 0.18

Patient 0.000 0.000 1.18 = 0.24

Therapist �0.002 0.008 0.22 = 0.83

Patient * time 3 �0.003 0.000 6.25 <0.001*** 0.20

Therapist * time 0.006 0.009 0.68 = 0.50

Submissive Time 1 0.584 0.862 0.68

Time 3 diff �0.353 0.894 0.40 = 0.69

Patient 0.000 0.000 0.07 = 0.94

Therapist 0.007 0.008 0.91 = 0.37

Patient * time 3 0.000 0.000 1.43 =0.15

Therapist * time 0.002 0.008 0.28 = 0.83

Abbreviations: Cohen’s ds, effect size after Cohen (1992) with pooled standard deviation; N, number of

participants; SE, standard error; t, test statistic of two-level hierarchical model; γ, predictor.
*p < .05. **p < .01. ***p < .001.

WOLFER ET AL. 295

by the finding of an unexpected low variability of perceived interper-

sonal behaviour across all therapists, which implies an interplay of dif-

ferent unifying mechanisms such as selection, stereotypes and

adaptations.

For future research, it would be promising to use a combination

of assessments to understand interpersonal behaviour from different

points of view and in order to replicate the results obtained in this

preliminary investigation. Especially the investigation of possible mod-

erators of patients’ perceptions of their therapists could add essential

information about therapist effects and may be an important link to

process research. Furthermore, studies with other patient and thera-

pist populations may provide estimates of the generalizability of the

effects. Thereby, studies with more experienced therapists may help

to get a more differentiated picture of therapists’ habitual interper-

sonal behaviour. Last but not least, studies combining patient out-

come with perceived interpersonal behaviour of their therapist may

help to deepen the understanding of therapist effectiveness. How-

ever, such future direction would be particularly relevant for those

samples where the IMI data indicates less within and between unifor-

mity than in the present study.

ACKNOWLEDGEMENTS

We would like to thank the therapists for their willingness to partici-

pate and their openness to let their close others and their patients

rate them.

DATA TRANSPARENCY STATEMENT

There is no prior manuscript that analysed this set of data. Further-

more, there is no manuscript submitted or in pipeline that is based on

the present dataset.

FUNDING INFORMATION

This study was supported by the Swiss National Science Foundation

(Grants: PP00P1_163702, PP00P1_190083; principal investigator:

Christoph Flückiger).

DATA AVAILABILITY STATEMENT

Based on the requirement for patient’s and therapist’s confidentiality

and data security, the ethical guidelines of the randomized clinical trial

require to keep the raw data on an interne data storage at the

university of Zürich for 10 years. Anonymized data (without

descriptive patients’, close others’ and therapists’ data to keep the

confidentiality) can be requested from the corresponding author.

ORCID

Christine Wolfer https://orcid.org/0000-0001-5804-7192

Peter Hilpert https://orcid.org/0000-0001-9424-3019

Christoph Flückiger https://orcid.org/0000-0003-3058-5815

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SUPPORTING INFORMATION

Additional supporting information may be found online in the

Supporting Information section at the end of this article.

How to cite this article: Wolfer, C., Hilpert, P., & Flückiger, C.

(2022). How therapists’ interpersonal behaviour is perceived

by their patients and close others: A longitudinal and

cross-situational study. Clinical Psychology & Psychotherapy, 29

(1), 289–298. https://doi.org/10.1002/cpp.2634

298 WOLFER ET AL.

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https://doi.org/10.1002/cpp.2634

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How therapists’ interpersonal behaviour is perceived by their patients and close others: A longitudinal and cross-situation…

1 INTRODUCTION

1.1 Current study

2 METHODS

2.1 Design

2.2 Participants

2.2.1 Therapists

2.2.2 Patients

2.2.3 Close others

2.3 Measures

2.4 Data analysis

3 RESULTS

4 DISCUSSION

5 LIMITATIONS

ACKNOWLEDGEMENTS

DATA TRANSPARENCY STATEMENT

FUNDING INFORMATION

DATA AVAILABILITY STATEMENT

REFERENCES

NAVIGATING DUAL RELATIONSHIPS IN RURAL
COMMUNITIES

Jennifer L. J. Gonyea and David W. Wright
The University of Georgia

Terri Earl-Kulkosky
Fort Valley State University

The literature examining dual relationships in rural communities is limited, and existing ethi-
cal guidelines lack guidelines about how to navigate these complex relationships. This study
uses grounded theory to explore rural therapists’ perceptions of dual relationship issues, the
perceived impact of minority and/or religious affiliation on the likelihood of dual relation-
ships, and the ways rural therapists handle inevitable dual relationship situations. All of the
therapists who participated in the study practiced in small communities and encountered dual
relationship situations with regularity. The overarching theme that emerged from the data
was that of using professional judgment in engaging in the relationship, despite the fact that
impairment of professional judgment is the main objection to dual relationships. This overall
theme contained three areas where participants felt they most needed to use their judgment:
the level of benefit or detriment to the client, the context, and the nature of the dual relation-
ship. Surprisingly, supervision and/or consultation were not mentioned by the participants as
strategies for handling dual relationships. The results of this study are compared with estab-
lished ethical decision-making models, and implications for the ethical guidelines and appro-
priate ethical training are suggested.

The authors’ collective experiences of practicing in small communities led us to question how
therapists in these communities handle the inevitability of dual relationships. As we discussed
anecdotes from our respective practices, it became apparent that tension exists between a client’s
desire to have a familiar therapist and the ethical standards of our field. We turned to the American
Association for Marriage and Family Therapy (AAMFT) Code of Ethics for answers about how
to navigate these delicate situations. Couple and family therapists are admonished to “make every
effort to avoid [dual relationships] at all costs” (AAMFT, 2001; p. 1); however, no mention is made
of how to accomplish this in settings with limited alternatives.

The issue of dual relationships in areas with limited alternatives is complicated by clients’
attempts to self-match. Self-matching occurs when clients select a therapist who shares their atti-
tudes, race, education, social class, and/or religion (Jones, Botsco & Gorman, 2003; Whalley &
Hyland, 2009; Willging, Salvador & Kano, 2006; Wintersteen, Mesinger & Diamond, 2005). Cli-
ents feel more comfortable discussing their lives and presenting issues when they believe their ther-
apist holds the same values or shared cultural experience. A large percentage of Americans living
in small communities may be able to achieve this owing to homogeneity in small communities, but
not without creating ethical challenges for the therapist.

The ethical challenges for rural therapists are compounded when they also belong to a minor-
ity group. In addition to the limited number of available therapists in a small community, there are

Jennifer L. J. Gonyea, PhD, is a Lecturer and Undergraduate Coordinator, Department of Child and Family

Development, The University of Georgia and in practice at Samaritan Counseling Center of Northeast Georgia,

Athens Georgia; David W. Wright, PhD, is an Associate Professor, Department of Child & Family Development,

The University of Georgia, Athens, Georgia; Terri Earl-Kulkosky, PhD, is an Assistant Professor, Department of

Behavioral Sciences, Fort Valley State University, Fort Valley, Georgia.

This research was made possible through consultation with Edwin Risler, PhD (Athens, GA) and the Georgia

Association for Marriage and Family Therapy Board and members.

Address correspondence to Jennifer L. J. Gonyea, Department of Child and Family Development, The

University of Georgia, Dawson 123, Athens, Georgia 30602; E-mail: jlgonyea@uga.edu.

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 125

Journal of Marital and Family Therapy
doi: 10.1111/j.1752-0606.2012.00335.x
January 2014, Vol. 40, No. 1, 125–136

far fewer minority therapists in general (AAMFT, 2004). Therefore, when minority clients attempt
to self-match, there is a strong likelihood that a dual relationship dilemma will be encountered.

This studyaims to exploreareasnotpreviously considered in the ethics literature, payingparticu-
lar attention to how therapists practicing in rural areas navigate these complex relationships. The
next section provides the foundation for this study by reviewing the unique set of circumstances and
community variables that increase the likelihood of dual relationships in rural areas and the ways
existing ethical decision-makingmodels fail to consider the challenges of rural practice.

CHALLENGES OF RURAL PRACTICE

Rural communities are partially defined by their isolation that forces residents to rely more
heavily upon one another. Smaller communities have increased potential for dual relationships, in
general, and those between clients and therapists in particular (Erickson, 2001). Although the lack
of boundaries may seem natural and is often used as fodder for sitcoms set in small communities,
in real-life, it sets the stage for dual relationship dilemmas.

For many residents, this closeness is positive and helps build identity and sense of belonging
to that community in terms of Us versus Them. Therefore, residents of rural areas are often hesi-
tant to seek services from an outsider (Murry, Heflinger, Suiter & Brody, 2011) because they are
not to be trusted, which can lead to multiple levels of personal and professional relationships. Fur-
ther, persons from rural areas may resent an outsider offering assistance (Erickson, 2001; Jesse,
Dolbier & Blanchard, 2008).

Similarly, those who belong to a religious community or a minority group may prefer profes-
sional services from someone within their group or at least from someone who may share familiar
values. Research has found that people want a therapist and they believe to be like themselves
(Jones et al., 2003; Wintersteen et al., 2005) and when clients’ ethnicity matches that of their thera-
pist, they attend more sessions and have a greater likelihood of treatment completion (Erdur, Rude
& Baron, 2003).

Competing Ethical Principles
The absence of attention to how therapists in rural settings navigate potential dual relation-

ships is compounded by the ambiguous and vague discussion of dual relationships in the AAMFT
Code of Ethics, which states:

Marriage and family therapists are aware of their influential positions with respect to
clients, and they avoid exploiting the trust and dependency of such persons. Therapists,
therefore, make every effort to avoid conditions and multiple relationships with clients
that could impair professional judgment or increase the risk of exploitation (American
Association for Marriage & Family Therapy, 2001; p. 1).

If one’s interpretation of the code is that when multiple relationship situations arise, MFTs
should ensure that these relationships do not impair professional judgment or increase the risk of
client exploitation, then the dilemma is not “how to avoid dual relationships,” but “how does one
tell when multiple relationships will impair professional judgment” and “what is the obligation of
the therapist in warning or explaining the dilemma to the client?”

It quickly becomes clear that the real problem is how to address inevitable dual relationships,
rather than how to avoid them. Some suggestions include openly discussing the inevitability and
potential of out of session contacts between therapist and client (Faulkner & Faulkner, 1997) or
having a preconceived plan to negotiate social contacts with clients and seek immediate consulta-
tion if boundaries feel threatened (Jennings, 1992).

Rural clinicians are likely to be professionally isolated, making it difficult to obtain supervi-
sion or consultation. These clinicians may be secluded from the mainstream of their profession and
may have limited colleagues from whom they can seek support, collaboration, or supervision.
Rural therapists’ sense of isolation is also compounded by fewer opportunities for professional
development, continuing education, and limited access to support services.

These collegial issues also create a challenge to maintaining client confidentiality (Weigel &
Baker, 2002). A client’s confidentiality can be compromised through the “grapevine” in small

126 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

communities when the client is seen leaving the therapist’s office, parked in front of it, or even while
sitting in the waiting room. The few therapists in a rural area often have regular contact with one
another, and informal conversations between providers can increase threats to client confidential-
ity. Rural therapists rely on one another for professional development and resources. Withdrawing
from such informal exchanges could alienate close colleagues and leave a rural therapist with even
fewer resources. Rural therapists are left with the choice between increased threats to clients’ rights
to privacy or alienation of a close colleague.

Models of Ethical Decision-Making
Many ethical decision-making models suggest the following for the resolution of ethical dilem-

mas: (a) consulting the ethical guidelines of therapy professions; (b) seeking supervision or consul-
tation with peers; (c) creating a pros and cons list to determine the possible consequences and/or
alternative courses of action; or (d) some combination thereof (Corey, Corey & Callahan, 1998;
Erickson, 2001; Forester-Miller & Davis, 1996; Smith & Smith, 2001; Steinman, Richardson &
McEnroe, 1998; Tarvydas, 1998; Welfel, 1998). As noted previously, these guidelines may not pro-
vide enlightenment because they are ambiguous and require interpretation, the very foundation of
the original dilemma!

Few existing models specifically refer to issues of power and maneuverability, that is, the roles
and positions therapists take with clients. The professional guidelines assume therapists hold the
position of power when interacting with clients. Yet, depending on the nature of the out-of-session
contact, the client may occupy a powerful position in the relationship. In a unique acknowledg-
ment of potential limitations to both sides of a dual relationship, Haas and Malouf (1995) suggest
therapists ask themselves and their supervisors specific questions prior to engaging in a potential
dual relationship. For example, how might engaging in the dual relationship inhibit clients’ ability
to make autonomous decisions; how might the therapist acknowledge his or her privileged position
in the relationship; will the dual relationship affect the therapist’s ability to intervene effectively
and congruently. The suggested questions imply that the therapist is able to conceive a number of
alternatives and have insight into multiple perspectives on the situation, yet the inability to do so
when interacting with friends and relatives is precisely why dual relationships are discouraged.

Most ethical decision-making models assume that therapists have equal access to professional
resources across community types (rural compared to urban). In fact, models ignore the existence
of barriers to obtaining supervision and consultation in rural areas even though the limited avail-
ability of these in small communities has been well documented (Weigel & Baker, 2002). None of
the models reviewed suggest alternatives to supervision or ways of navigating a dual relationship
if, indeed, it is unavoidable. The potential consequences to seeking consultation with peers or feed-
back from supervisors in rural communities are also not addressed in the ethical decision-making
models reviewed for this study.

Clearly, one model or set of ethical standards does not encompass all possible dual relation-
ship dilemmas or all the factors contributing to it. Therefore, a more comprehensive exploration of
the processes through which clinicians make ethical decisions is called for. To meet that goal, this
study specifically examines (a) the ways rural therapists perceive dual relationships and the result-
ing impact on clinical practice; (b) the strategies clinicians believe they employ to negotiate dual
relationships; and (c) the perceived influence of minority or religious affiliation on dual relation-
ship situations.

METHOD

Design of the Study
This study used a naturalistic paradigm to explore the experiences of therapists in rural set-

tings. Among Lincoln and Guba’s (1985) naturalistic paradigm axioms, several were relevant here:
(a) realities are multiple, constructed, and holistic; (b) the knower and the known are inseparable;
therefore, the participant and researcher influence one another; (c) generalization is only possible
through the formulation of working hypotheses that are context and time specific; and (d) unlike
traditional inquiry that is value-free, the naturalist paradigm states that inquiry is value-bound by
the choice of the problem, theory, and context.

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 127

This study sought to explore how rural therapists interpreted the AAMFT ethical guidelines
as they made decisions about whether to have dual relationships with the clients they served. Their
experiences then constituted multiple realities and, while tied professionally to the ethical guide-
lines, their interpretation of the guidelines allowed the therapist to construct their understanding
and approaches to ethical dilemmas of dual relationships. This qualitative approach allowed for
an emphasis on the participant’s view (Creswell, 1998) of their experience of dual relationships in
rural areas and how they navigate such situations. Specifically, the present study questions how
the experience of dual relationships decision-making is handled when the therapist’s professional
supports are limited.

Description of Participants and Selection Process
Participants were Clinical and Associate members of an AAMFT Division in the Southeast

practicing in rural areas. Rural areas were selected using the categories of urbanicity established by
Bachtel (2004) at the county level: Urban, Suburban, Rural Growth, and Rural Decline. Approxi-
mately, 50 members were in the pool of potential participants.

Once the purposive sample was drawn from the current listing of active members of the Divi-
sion, participants were contacted via telephone based on information provided in the Division
directory. After providing verbal consent, telephone interviews were conducted. Multiple research-
ers were involved in gathering the data through phone interviews, and this served as one of the
forms of investigator triangulation (Denzin, 1978). Attempts to contact the 50 members were
made, and six therapists participated in the phone interviews. Some participants expressed a desire
to have more time to reflect on the questions. The researchers experience confirmed that additional
data collection methods could provide more respondents and richer data. Therefore, researchers
decided on an additional data collection method, which would be to collect data at the annual
Division Spring Conference.

Conference attendees self-selected to participate in the study after hearing it described and
announced. An additional screening by the authors was used to ensure that participants met the
criteria established at the outset of the study. Attendees were provided consent forms and study
questions on the first day of the conference and asked to return both by noon on the last day. This
ensured that participants were able to reflect on their experiences and practices to give as detailed
explanations as possible. Participants provided information about the population size in their
practicing area and completed survey forms where they provided demographic information such
as age, race, type of practice, and length of practice. In addition, participants provided their
perception of the degree to which their minority or religious affiliation influenced requests for
therapeutic services from acquaintances in other settings, and how they make decisions in response
to these requests.

Between telephone interviews and the annual Division conference, fifteen therapists pro-
vided data for this study. Of these, five self-identified as African American, one self-identified
as racially mixed (Caucasian and Phillipina), and the remaining nine participants self-identified
as Caucasian. Participant ages ranged from 29 to 60; however, most participants reported
having been in practice for over 20 years. All practiced in areas designated as rural according
to Bachtel (2004). Participants practiced in either private (N = 6) or public settings (N = 6),
while three practiced in both types of settings. Seven participants practiced in catchment areas
whose populations were 20,000–50,000, six practiced in catchment areas whose populations
were 50,000–100,000, and two of the participant’s catchment areas were over 100,000 people.
Some worked in communities that served more than one county, or in counties that served
multiple cities.

A detailed description of participant demographics is provided to illustrate several consider-
ations regarding the results. First, the participants in this study represent very experienced clini-
cians, the majority having practiced more than 20 years. The perception of one’s ability to
navigate complex dual relationships may be related to a sense of clinical competency evident in an
experienced sample. Second, how long clinicians had lived in their rural community is unknown, a
factor that may influence the likelihood of dual relationships. And lastly, most of the participants
worked at least part time in public settings where they may or may not have control over the
decision to see the a client known in another setting.

128 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Data Analysis
An interview guide (see Appendix A) was developed with open-ended questions that invited

the participants to convey their experiences with dual relationships in rural communities. This
interview guide provided a common set of questions for all participants, and left room to explore
new areas that might emerge. Data were analyzed using a sorting procedure that calls for searching
for what Wolcott (1994) terms patterned regularities in the data. We looked for common themes
and patterns of behavior that would give an understanding of the experiences of the participants.
Participant responses were then compared with the suggested procedures for ethical decision-
making reported earlier.

Our analysis process was guided by grounded theory (Charmaz, 2002; Glaser & Strauss,
1967); a qualitative methodology used with the goal of finding new theory or emerging themes in
phenomena studied. This method seemed most appropriate to the limited understanding of how
dual relationship dilemmas are handled by clinicians when such dilemmas are frequent or inevita-
ble. Consistent with a grounded theory approach, data collected from the first interview were
compared with data from the second interview, and this process of comparison was repeated with
each data collection (Strauss & Corbin, 1998).

Each phone interview was transcribed by the research interviewer, and non-phone written
interviews were reviewed. The interviewers (J.G. and T.K.) recorded notes immediately following
the data collection. These process notes included clarification questions asked, information on the
date and type of contact, insights, questions, and connections to other responses.

The research investigators then carefully examined the data and completed the task of com-
parison, developing new categories relative to the answers. Open coding methods (Charmaz, 2002)
were used to organize the data, and initial categories were developed. Themes emerged from the
categories and subcategories as data analysis continued. These themes are discussed in detail in the
results section that follows.

Trustworthiness and Credibility
To ensure trustworthiness (Merriam, 1998) and credibility, qualitative terms that are similar

to reliability and external validity, we used detailed descriptions of the research methods and credi-
bility audits to review the research methods, interviews, and findings. A licensed marital and family
therapy (MFT), who has practiced for more than 20 years, served as an internal auditor of the data
to open code the data from the interviews and written responses. In addition, an external auditor
(2nd author) reviewed all drafts of the results to verify that the categories and themes were consis-
tent with the interviews.

Transferability, the degree to which a study can be applied to other contexts by different
researchers, was established by providing detailed information about the participants and contex-
tual factors that may be relevant to future research efforts. For example, the Appendix A reports
the guiding questions used and the demographic information, such as practice setting, catchment
population, and years in practice are reported in the following section.

RESULTS

Although interviews varied somewhat, participant responses reflected the inevitability of dual
relationships in rural areas, consistentwith the existing literature. As expected, a common experience
among participants was receiving referrals for persons that they knew in other settings on a frequent
or occasional basis. Also as expected, participants received referrals based on religious andminority
affiliation,althoughmost of thesewere basedon religious as opposed tominority affiliation.

Similar themes emerged across clinicians in terms of how they handled potential dual relation-
ship situations. The therapists who participated in this study universally referred the potential
client elsewhere when the referral was well known. Among those that made referrals to avoid the
dual relationship, they took care to explain the dual relationship dilemma to clients in order to
preserve the existing relationship and ease the transition to a trusted colleague. For example:

The most common type of referral comes from my church. I usually refer them on and
explain the problem inherent in dual relationships. Generally, people are clueless about

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 129

this [dual relationships] issue and appear disappointed but do okay once they get started
with a colleague.

Even among those who reported engaging in the relationship initially, all stressed the impor-
tance of evaluation and assessment at the beginning of therapy. For example, several participants
engaged in two to four sessions during which they assessed the clients’ needs, their own ability to
meet those needs, and the likelihood that the therapeutic relationship might violate the ethical
guidelines by potentially “exploiting the trust and dependency of such persons” or “impair profes-
sional judgment or increase the risk of exploitation” (American Association for Marriage &
Family Therapy, 2001; p. 1). One participant reported engaging in the relationship:

depending on my conversation with the referral, for a 3 or 4 session evaluation with the
clear understanding that I may make a referral, continue to see the client myself, or have
a professional consultant in the fourth session to help us decide the appropriate next
phase.

Strategies for Handling Dual Relationships
During the open coding procedure, responses developed into the overarching theme of profes-

sional judgment which contained three areas where participants felt they most needed to use this
judgment: (a) level of benefit or detriment to the client; (b) the context; and (c) the nature of the
dual relationship.

Professional judgment. Whether explicit or implied, participants’ approach suggested they
had used professional guidelines as the source of their decision-making. One participant discussed
the “limits of therapy,” while another came to an agreement that “boundaries will be kept” with
the clients with whom he or she entered into a dual relationship. Elaborating on how boundaries
were kept, one participant stated:

NOT discussing client info with staff. When necessary for support, speak vaguely to the
school counselor. Make it clear to students and any others I see in community that I do
not/will not identify them seek them out in public social settings. I also make it clear that
I do not/will not identify other clients—or talk about them any professional relationship
to anyone. Clarity around boundaries is extremely important in maintaining them.

Several participants appeared to use a strict interpretation of the AAMFT ethical guidelines
concerning therapy with persons known from other contexts, unequivocally stating that they
would refer the client elsewhere based on their understanding of “making every effort to avoid . . .
multiple relationships” (American Association for Marriage & Family Therapy, 2001; p. 1). These
participants did not disclose any conditions under which they would agree to conduct therapy with
persons known from other contexts.

Professional judgment is a broad category and precisely the aspect of navigating complex rela-
tionships that this study was undertaken to explore.When prompted about how they used their pro-
fessional judgment, participants elaborated on how they make the decision to refer the client or
engage in the dual relationship. Participants were aware of the people or groups with whom they are
most experiencedor those the therapist feltmost competent inhelping andwithwhomtheyweremost
likely to engage in therapy: one partipant reported, “I know Iwork best with couples, single adults of
adolescents, not children and not addictive adults.” Several noted the client’s need for treatment, the
severity of the presenting issue, intake information, or expertise in couples versus family work as
issues to consider when deciding to take the case. For example, when participants felt that the client
needed immediate intervention andmaking a referral might delay treatment, they were more willing
to engage in a dual relationship. In this case, ensuring that the client received timely therapywas tem-
porarily prioritizedover the admonishment to avoid adual relationship.

The remaining three emergent themes reflect specific aspects of the dual relationships decision-
making articulated by participants. Although participants used their professional judgment in each
of these areas, they were specific enough to warrant separate elements.

Level of benefit or detriment to client. Promoting clients’ well-being was a factor in most deci-
sions therapists’ decision-making in their clinical practice. Specifically, they used their judgment

130 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

about the degree of benefit to the client when deciding whether or not to engage in a dual
relationship: one stated “professional judgment and instinct regarding my ability to be helpful to
the client.” In the words of one participant, he or she was aware of the potential “negative impact
of a dual relationship” on the clients well-being and the existing relationship. Despite this senti-
ment, many participants specifically mentioned that the dual relationship was a lesser concern than
promoting client safety. For example, one therapist would “suggest another referral unless an
emergency or crisis is presented.”

Another aspect of benefit to the client used as a deciding factor in engaging in the dual rela-
tionship was whether or not the client would not have sought therapy. A participant provided an
example of such a circumstance:

I have made one exception and accepted a client who told me she checked me out care-
fully at church and would otherwise not go to another therapist. She disclosed a ritual
abuse history and indicated a need to feel safe first since some of her abusers were trusted
people in positions of authority.

For this therapist, engaging in the relationship meant the particular client was able to receive
services. Other participants’ responses suggest that they use their judgment about what the client
needs and what they can offer at that time as means of determining whether or not to pursue the
dual relationship.

Context. Participants indicated concerns about the context within which they knew the
potential client. One participant differentiated between contexts such as “church affiliate versus
friend,” while another made the distinction between “whether I know them personally or profes-
sionally” as influential factors in their decision to pursue a therapeutic relationship or refer a client
to another therapist. Participants were more willing to conduct therapy with a professional associ-
ate than with a personal associate. A few were very specific in their understanding of a need to keep
personal and professional relationships separate, responding “I would not see someone with whom
I have a personal relationship” or “I don’t see family members of friends or acquaintances.” Others
made decisions based on a more graduated sense of the personal acquaintance. One participant
considered taking the case of someone with whom he or she had a professional relationship to be
unlikely to impair professional judgment or exploit clients and therefore upholding the ethical
standards of the field. Another participant noted receiving referrals from a sister program and
would engage in the dual relationship in the interest of “continuum of care.”

Therapist participants were more likely to engage in the dual relationship if he or she has
expertise with a particular population or presenting issue that was otherwise unavailable in the
area, in part out of the belief that the particular treatment the therapist offers is unique and that it
would be an undue hardship to the client to pursue this unique help elsewhere. For example:

Trauma using Eye Movement Desensitization and Reprocessing (EMDR) is my specialty
—if it is a very slight acquaintance (i.e., plumber, workman, etc) I would have to think
about it as I am, to the best of my knowledge, the only one using EMDR.

Nature of relationship. The nature of the relationship was considered a separate theme from
that of context and was based on a distinction between type of relationship (context) and the level
of intimacy or closeness in the relationship with a client (nature of the relationship). Examples
from responses include the influence of “the degree of interaction outside therapy,” “if I do not
have an intimate relationship with them I will see them,” and “if I know we will socialize I will
refer” as more intimate levels of contact with potential clients that would preclude a therapeutic
relationship. Participants distinguished between a high level of intimacy (personal relationships)
and low levels of intimacy (professional relationships) and considered high levels of intimacy to be
a barrier to a successful therapeutic relationship. Participants defined knowing someone “well” in
one or more of the following ways: (a) persons with whom they socialized; (b) persons with whom
their children played; (c) friends; (d) family members/acquaintances of friends; (e) students where a
spouse works; and (f) sharing a specific activity.

Participants might engage in a professional relationship with someone known from the gym
or an exercise class owing to the low levels of intimacy involved, but they were aware of their influ-
ential positions and potential likelihood of their impaired professional judgment when the current

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 131

relationship was one where there was a high frequency of contact and a high degree of intimacy,
such as a through a Bible study group or book club.

DISCUSSION

The strategies participants used to determine whether or not to refer a potential client reflect
several aspects of the ethical decision-making models reviewed, although they did not use any
model in its entirety. The four strategy themes derived from participant responses are present in
some of the ethical decision-making models previously outlined. Conversely, seemingly, important
aspects of the models are absent from participant responses and discussed below.

Professional Judgment
Despite the underlying assumptions about the inherent risks to judgment in a dual relation-

ship, the primary tool for navigating the complexity of a dual relationship among our participants
was the use of their professional judgment. Consistent with the question posed in the conceptuali-
zation of this study, therapists practicing in small communities appear to be aware of this integral
conflict and ask themselves, “How do I tell when multiple relationships will impair my professional
judgment?” These results indicate that therapists are intentional in handling potential dual rela-
tionships to minimize the impact on their ability to effectively manage the therapy process.

Although not explicitly stated in any of the models reviewed for this study, virtually all of
them imply using professional judgment. Several advise generating a list of potential courses of
action along with the possible consequences of these actions (Corey et al., 1998; Forester-Miller &
Davis, 1996; Smith & Smith, 2001; Steinman et al., 1998; Tarvydas, 1998; Welfel, 1998). The
results of this study add to the ethical decision-making literature and supplement the AAMFT
Code of Ethics by indicating specific aspects of the therapeutic relationship therapists in practice
should consider when exploring courses of action and their consequences, for example, judgments
about client motivation, the therapists’ ability to be helpful to the client, the potential for triangu-
lation, and the three specific themes discussed below.

Level of Benefit or Detriment
It is clear that dual relationships are discouraged, yet therapists may engage in them anyway if

they believe it will yield more benefit than harm for the client. A therapists’ main goal is for clients
to grow, improve, and heal. Toward this end, therapists were intentional in assessing the potential
harm to the client and the probable benefits.

This theme reflects themodels that suggest therapistsweigh thepotential risks andbenefits to see-
ing the client. Only Gottlieb (1993) proposes discussing with the client the potential consequences or
what their relationship posttherapy might entail should they engage in the dual relationship. The
majority of attention is focused on how contact outside of sessions prior to and during therapymight
impede the therapeutic process. Posttherapy contact is particularly important for those practicing in
a small communitywhere the likelihoodof such contacts in the community is very high.

Haas and Malouf (1995) suggest therapists ask themselves to reflect on their ability to be help-
ful. It is a therapist’s obligation to best meet the needs of their client, but also their prerogative to
refuse cases when they are not able to meet those needs. For example, if a therapist realizes that
she would be limited in what issues she can address and how she can address them, she might not
be able to provide quality therapy and would consider discussing that with the clients. An impor-
tant point for consideration is that the results of this study indicate that therapists practicing in
small communities may not feel they have the same latitude to refuse a case when the assessment of
the situation suggests that the client would be more harmed by their refusal.

Kitchener’s (1988) model also addresses power, but through the understanding of the different
roles, one might have in dual relationships. For example, one partner in a couple’s session is the
principal of the school the therapist’s child attends. In session, the therapist may be perceived as
having power. During interactions with the school, the principal is clearly in a position of power,
not only with the therapist, but also her or his child. Therapists who practice in small communities
are well aware of these types of power dynamics and considered them in assessing the level of bene-
fit or detriment to the client as well as the context and nature of the relationship discussed below.

132 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Context and Nature of the Relationship
The models reviewed herein do not attend to contexts in which decisions are made about

ethical dilemmas. The lack of distinction between contexts may lead to the assumption that all out
of session contacts between client and therapist are equally problematic to the process and
outcome of therapy. The therapists in this study felt that there are differences between types of
relationships (context) and the levels of intimacy (nature of the relationship) inherent in the
different types.

Most therapists have encountered a client outside of therapy, either at the grocery store, the
dry cleaners, or a physician’s office. Usually these meetings are unexpected and spontaneous. In the
case of a dual relationship, the assumption is that meetings outside of therapy are expected and at
times may even be regular, as in the case of a fellow parishioner. A consistent theme in the responses
of the participants reflected an attempt to understand the context and the nature of the relationship
between therapist and client outside of the therapy room, or in other words, attempt to determine
the regularity with which they might see one another and the quality of their out of session relation-
ship, consistent with the models proposed by Smith and Smith (2001) andGottlieb (1993).

This is an important point because the limited number of couple and family therapists who
represent cultural or religious minorities is likely to present an increased potential for dual rela-
tionships as clients attempt to self-match. This is underscored by a survey of AAMFT membership
(2004), which reported that the overwhelming majority of their members reported being White/
NonHispanic (93%: n = 2236) with approximately only 2% of respondents falling in each of the
following groups: African American, Hispanic/Latino, Asian, American Indian, and Other/Prefer
not to answer.

The energy and attention necessary for handling a dual relationship is usually greater than
that of another client. The therapist participants acknowledged this additional investment by
considering whether or not they actually have enough time to handle such a case and its unique
circumstances. This very specific, and practical consideration is not present in the reviewed models.
In fact, a number of everyday impediments to rural practice are not mentioned in the models, but
should be added to the list of practical obstacles to rural practice.

Supervision and/or Consultation
The literature on ethical dilemmas in rural areas notes the increased likelihood of encounter-

ing dual relationships and limited access to supervision. Two points strongly reflected in the results
of this study; one through its prominence and the other through its absence. The rural therapists in
this study generated the same concerns and issues that are represented in the literature regarding
the increased potential for dual relationships. Study participants received referrals or were sought
out by persons known to them in other settings and that these referrals came from a number of
community sources: fellow church members, family members of friends, parents of children’s class-
mates, persons with whom spouse has a professional relationship, and persons with whom the
therapist has a professional relationship (e.g., dentist, plumber, other therapist).

Notably, absent in participants’ responses was mention of bringing these dual relationship
issues to supervision to reflect on the potential consequences; however, it is unclear whether the
availability of supervision is limited in the areas where participants practice or whether the partici-
pants do not consider supervision as one of the tools useful in navigating dual relationships. As
noted earlier, one participant did report using a consultant “in the fourth session to help us decide
the appropriate next phase.” This participant used consultation as part of the therapeutic decision-
making process rather than as a means of determining, a priori, potential problems associated with
the dual relationship or as feedback in maintaining healthy boundaries in an ongoing dual rela-
tionship. Although intended to clarify the dual relationship, it is equally likely that the use of a
consultant, a role different from a supervisor, may create an additional dual relationship that rural
therapists must navigate.

A lack of supervision and consultation opportunities may possibly contribute to ethical con-
cerns resulting from limited access to clinical resources. Suggestions for therapists to remedy this
concern and obtain supervision have included group, telephone, and Internet supervision, yet each
presents problems (Kanz, 2001; Weigel & Baker, 2002). For group supervision, practitioners from
rural areas may have to drive several hundred miles to receive supervision or risk discussing a client

January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 133

with whom someone else in the group has a relationship. Telephone supervision provides one
option for supervisees who may be geographically isolated, but there are still some ethical consid-
erations. Sending recorded sessions in the mail increases threats to confidentiality; cell phones are
an insecure method of discussing client information that could potentially be intercepted, and the
amount of time and expense to send recordings via postal service may be prohibitive. The availabil-
ity of Internet supervision is alluring, yet presents concerns about (a) divulging confidential infor-
mation over an insecure mode of communication; (b) the difficulty in obtaining informed consent
from clients for this type of supervision; (c) the importance of nonverbal cues of the therapist,
supervisor, and client; and (d) liability and licensure issues when Internet supervision takes place
across state lines (Kanz, 2001).

CONCLUSION

An objective of this study was to gather data to illustrate the complexities of dual relationships
in rural areas. The overwhelming majority of the rural therapists who participated in this study did
face the dilemmas of dual relationships. Indeed, most had fairly well-established strategies for han-
dling these relationships both before and during treatment.

The hope is that this research will foster a better understanding of the complexities of dual
relationships in rural areas as well as support further research in this area. The results of this study
may serve to clarify ethical guidelines around dual relationships in both the literature and practice.
The qualitative exploration utilized in this study allowed the researchers to begin to understand
the way therapists think about their process for ethical decision-making. Follow-up interviews with
therapists who are in the process of evaluating a dual relationship situation in their rural communi-
ties would greatly enhance our understanding of the practice of ethical decision-making. Also,
interviews focusing on the themes derived from this study would address the multiple obstacles to
confidentiality and maintaining therapeutic boundaries in small communities.

The implications of this study are significant: it seems clear that the nature of these relation-
ships is more than duality. Participants noted that whether a relationship is personal or profes-
sional, the types of boundaries regulating it, and the context of out-of-session contacts as
important factors in making ethical decisions. The consideration of these factors in decision-mak-
ing reflects the reality that dual relationships are inevitable in small communities and places more
emphasis on evaluating the process of therapy than on the duality. In the words of one participant,
“I live in a community of 5,000—if I am going to work, I must navigate these crossovers.”

This has implications for MFT training programs’ curriculum regarding AAMFT ethical
guidelines and the ethical guidelines in general. The current guidelines do not address the process
for decision-making with regard to dual relationships. Programs can help therapists in training
develop a more introspective and less legalistic decision-making process, which would address the
complexity of mitigating factors and provide an opportunity for them to explore their own biases
in a supportive environment.

Clients want to be in relationships with people like themselves and often look for therapists
that they believe have similar values or experience. Unfortunately, in rural communities where the
pool of available therapists is often limited, practicing therapists have little guidance in how to
make an ethical decision because of the ambiguity of the ethical guidelines and the neglect of the
challenges to rural practice in existing ethical decision-making models. These therapists may also
have difficulty navigating complex dual relationships because there are few opportunities for super-
vision in their communities. Instead, they learn to rely on their professional judgment about the
level of benefit or detriment to the client and therapeutic relationship and the context and the
nature of the relationship as they make their decisions about engaging in it.

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January 2014 JOURNAL OF MARITAL AND FAMILY THERAPY 135

AAPPENDIX

GUIDING INTERVIEW QUESTIONS FOR CLINICIANS

The following questions were used as a guideline during phone interviews and distributed to partici-
pants at the annual Division Spring Conference for review. The researchers gave a brief description of
the purpose of the study and a consent script, either at the beginning of the interview or in writing for
those recruited at the Division Conference.

1. I am interested in knowing more about your experiences as a family therapist practicing
in a small community. Do you receive referrals for clients that you already know from
another setting?
a. (If yes) Help us understand how you think about these referrals? (factors you con-

sider, type of relationships, specific examples).
2. What are the settings that you might know some of these referrals from?
3. Describe how you respond to these requests for therapy from people you already know?

(Appropriate follow-up questions as needed to understand the factors.)
4. What influences your decision to see the client? (Appropriate follow-up questions as

needed to understand the factors.)
5. What influences your decision to refer the client? (Appropriate follow-up questions as

needed to understand the factors.)
6. Tell us about a time you received a referral from your religious or minority community?

a. Which affiliation?
b. How do you think knowing the person/family impacts your ability to conduct ther-

apy with the person or family?
7. What is your perception of how often you get referrals based on this affiliation?

136 JOURNAL OF MARITAL AND FAMILY THERAPY January 2014

Copyright of Journal of Marital & Family Therapy is the property of Wiley-Blackwell and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder’s express written permission. However, users may print, download, or email
articles for individual use.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 3

Research

Received 09/06/12
Revised 02/12/13

Accepted 02/18/13
DOI: 10.1002/j.1556-6676.2014.00124.x

Julie M. Moss, Hand Middle School, Columbia, South Carolina; Donna M. Gibson, Department of Educational Studies, University of
South Carolina; Colette T. Dollarhide, Department of Counselor Education and School Psychology, Ohio State University. Donna M.
Gibson is now at Department of Counselor Education, Virginia Commonwealth University. This research was made possible through
partial funding provided by a grant from the Chi Sigma Iota Counseling Academic and Professional Honor Society International.
Correspondence concerning this article should be addressed to Donna M. Gibson, Department of Counselor Education, School of
Education, Virginia Commonwealth University, PO Box 842020, Richmond, VA 23284-2020 (e-mail: dgibson7@vcu.edu).

Counselor professional identity encapsulates the idea of con-
tinuous growth and development within a certified context.
Counselor growth and development is a continuous and lifelong
process (Borders & Usher, 1992). It begins as individuals enter
counseling training programs and continues until they retire.
Professional identity is part of being a counselor (Gazzola &
Smith, 2007; Gibson, Dollarhide, & Moss, 2010) and is the
integration of the professional self and personal self (including
values, theories, and techniques). Personal attributes combine
with professional training as a counselor forms his or her own
professional identity. Within an ethical context, counselors rely
on their professional identity as a frame of reference as they
make decisions regarding their work with clients (Brott & My-
ers, 1999; Friedman & Kaslow, 1986; Skovholt & Rønnestad,
1992). In essence, counselor professional identity includes
interpersonal and intrapersonal dimensions.

Interpersonal dimensions of professional identity involve
one’s relationship to society and the professional community
(Gibson et al., 2010). The professional community includes
professional organizations, licensing boards and credentialing
bodies, and accrediting agencies. Interpersonal aspects also
involve the professional community of counselors. Emerg-
ing counselors learn about the culture of the counseling
profession through supervision and experience (Dollarhide
& Miller, 2006).

Professional identity is also shaped from within a person
and comprises the intrapersonal dimensions of professional
identity (Gibson et al., 2010). Personal definitions of coun-
seling evolve, locus of evaluation changes, and reflection

Professional Identity Development:
A Grounded Theory of Transformational
Tasks of Counselors
Julie M. Moss, Donna M. Gibson, and Colette T. Dollarhide

The purpose of this qualitative grounded theory study was to investigate practicing counselors’ professional identity
development at nodal points during their career. Through the use of 6 focus groups of beginning, experienced, and
expert counselors, 26 participants shared their experiences, and 6 themes emerged to form a theory of transformational
tasks of professional identity development. Through these tasks, counselors encountered issues of idealism toward
realism, burnout toward rejuvenation, and compartmentalization toward congruency.

Keywords: professional identity development, practicing counselors

becomes increasingly important as counselor identity is
solidified. New professionals move from an external to an
internal locus of evaluation and from a reliance on experts
to a reliance on their own experience and training (Auxier,
Hughes, & Kline, 2003; Brott & Myers, 1999; Gibson et al.,
2010; Skovholt & Rønnestad, 2003). The majority of research
pertaining to counselors’ identity development centers on the
professional identity development of counselors-in-training
rather than working professional counselors (Auxier et al.,
2003; Howard, Inman, & Altman, 2006; Gibson et al., 2010;
Nelson & Jackson, 2003; Woodside, Oberman, Cole, & Car-
ruth, 2007). Theories of identity development of counselors-
in-training (Auxier et al., 2003; Gibson et al., 2010) showed
that through experience, course work, and a commitment to
the profession, identity develops over time.

However, there is limited research about counselor identity
development at various points in the career life span. Mellin,
Hunt, and Nichols (2011) found that counselors believe their
work to be different from other helping professions and that
counselors’ identity focused on a developmental, prevention,
and wellness orientation. Several studies cite the need for
greater information about the development of professional
identity during the professional life span (Bischoff, Barton,
Thober, & Hawley, 2002; Brott, 2006; Brott & Myers, 1999;
Dollarhide, Gibson, & Moss, 2013; Gibson et al., 2010; Howard
et al., 2006; Rønnestad & Skovholt, 2003; Skovholt & Røn-
nestad, 1992). Rønnestad and Skovholt (2003) provided a phase
model that described “central processes of counselor/therapist
development” (p. 5) from the novice professional to the senior

Journal of Counseling & Development ■ January 2014 ■ Volume 924

Moss, Gibson, & Dollarhide

professional. The postgraduate professionals interviewed in
their cross-sectional, grounded theory qualitative study had an
average of 5, 15, and 25 years of professional experience with
doctoral degrees in professional psychology. On the basis of the
data, the following themes emerged: (a) There is an increasing
higher order integration of professional and personal selves;
(b) continuous reflection is required for optimal learning; (c)
an intense commitment to learning drives development; (d)
professional development is continuous, is lifelong, and can
be erratic; (e) clients are influential to counselor development;
(f) personal life experiences are influential to counselor devel-
opment; (g) interpersonal sources (i.e., mentors, supervisors,
counselors, peers, family) are influential to counselor develop-
ment; and (h) thinking and feeling about the profession and
clients change over time.

Conceptual Framework of Current Study
Although many of the professional identity development
studies in the literature are focused on one specific type of
population and at one point in time, a few longitudinal studies
in other disciplines indicate that there are specific influences
on professional identity development over time (Dobrow &
Higgins, 2005; Monrouxe, 2009). Rønnestad and Skovholt’s
(2003) work provided a foundation for the current study.
Because Rønnestad and Skovholt focused on postgraduates
with doctoral degrees in professional psychology, for the
current study, we determined that more research including
participants who were professional counselors (with and
without doctoral degrees) could determine if similar themes
are experienced. Hence, we created a series of four separate
cross-sectional studies to examine the professional identity
development of individuals in the counseling profession. The
four studies investigate counselors-in-training (Gibson et al.,
2010), practicing professional counselors, doctoral students
in counselor education programs (Dollarhide et al., 2013),
and counselor educators. No data were used more than once
in data analysis and reporting across the four studies. The
cross-sectional design allowed us to determine what transfor-
mational tasks were occurring for these groups of participants
and if longitudinal research was warranted for further study.

Transformational tasks describe the work counselors
must accomplish at each stage of their professional life span.
Counselors’ professional identity is transformed in response
to completing each task. For example, Gibson et al. (2010)
found three transformational tasks that counselors-in-training
must accomplish to develop a firm professional identity:
defining counseling, transitioning responsibility for growth,
and integrating a systemic identity. They found that course
work, experience, and commitment were significant events
as counselors-in-training moved from external validation to
self-validation. These results led us to question if the trans-
formation of counselor identity is mirrored in practicing
counselors. Therefore, we posed the following question in

our study: What is the process of counselors’ professional
identity development at nodal points in their career life span
as beginning, experienced, and expert counselors?

Method
For the current study, we used a grounded theory approach to
generate an explanation of the process of professional identity
development as it was viewed by the participants (Corbin &
Strauss, 2008). A grounded theory approach was most ap-
propriate for this study because it focused on developing an
explanation of a process that involved many individuals. Other
qualitative approaches did not allow a focus on the process.
All participants in the study had experiences that related to
professional identity development, and the research sought to
explain the process (Creswell, 2007). The characteristics of
grounded theory include the theory being grounded in data, use
of a constant comparative method, the use of memo writing by
the researchers, and theoretical sampling (Heppner & Heppner,
2004). The constant comparative method found in grounded
theory enabled us to identify similarities and differences be-
tween school and community-based counselors’ experiences.

Researchers and Trustworthiness

We were the primary instrument in the data collection. It is
especially important to recognize our assumptions and biases
in qualitative research because the data were filtered through
our lenses (Heppner & Heppner, 2004). We controlled for
this by first recognizing the assumptions and biases we held
relating to counselors’ professional identity development.

All three researchers are women. The first author, a middle
school counselor and doctoral candidate, had participated in
previous research relating to professional identity develop-
ment. She has 7 years of experience as a school counselor at
the elementary and middle school levels. The second author
has 13 years of experience as a counselor educator and 8 years
as a licensed professional counselor (LPC), and the third
author has 20 years of experience as a counselor educator
and 10 years as an LPC and school counselor.

When designing this study, we attempted to make the
study more rigorous. Acknowledging biases, using multiple
researchers during the coding process, and member checking
helped ensure the trustworthiness of data analyses. Because
this was a qualitative study, researcher biases were inherent.
Among our biases was the belief that counselor identity is
important to counselors and counselor educators. One of
our central assumptions relates to professional identity and
its progression during the course of one’s career. That is, we
believe that interactions with clients and colleagues, continued
professional development, successes, and failures shape how
counselors view themselves and their profession and that these
ideas evolved from the beginning of graduate school until the
present time. We anticipated that these ideas will continue to
change as counselors’ professional growth occurs.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 5

Professional Identity Development

To control for biases and to embrace subjectivity, we took
field notes and wrote reflexive journals (Heppner & Heppner,
2004). After leaving the data collection sites, we used reflexive
memo writing to write about emotions and reactions during
the study. Memo writing was also used to write down ideas
about the evolving theory during the data analysis process.
Using three researchers during the coding process ensured
that the themes and process formed were grounded in data.
The use of multiple researchers added credibility by involving
multiple perspectives, opinions, and experiences.

Participants had the opportunity to review our preliminary
analysis and take part in member checking (Creswell, 2007).
Some participants who noted that they would be available
for follow-up questions were asked to review the initial data
findings. Preliminary data were presented to the participants
via e-mail.

Participants

We used stratified purposeful sampling to select participants
for the study. This type of sampling identified the subgroups
and allowed for comparison between the groups being studied
(Creswell, 2007). Using Rønnestad and Skovholt’s (2003)
stratified sampling method, we invited school and community-
based counselors (with an LPC or LPC intern credential) to
participate and divided them into groups based on years of
experience (i.e., 1–2, 5–15, and 20+ years). School counselors
were solicited through a state mailing list and through local
school districts. We obtained contact information for LPCs
in the area from the state’s Department of Labor and Licens-
ing. Also, we used contact information for graduates from a
local university.

Twenty-six participants met the criteria and were able
to participate in the study. Demographic information was
collected relating to participants’ ethnicity, gender, high-
est degree earned, and work setting. Of the 26 participants,
15 were school counselors and 11 were community-based
counselors. The majority of the participants were female (n =
21) and five were male. Twenty-two participants identified as
White and four participants identified as African American.
Their work settings varied among the groups. For the school
groups, four were elementary counselors, six were middle
school counselors, and five were high school counselors.
Among community-based counselors, four worked in private
practice; one worked in college counseling; two worked in a
hospital setting; and one each worked in a residential treat-
ment facility, a community college, a mental health center,
and an employee assistance program.

Data Collection

Questions were developed based on research on professional
identity development (Rønnestad & Skovholt, 2003) and
the focus group questions used in Gibson et al.’s (2010)
study. We designed questions to elicit participants’ experi-
ence of their professional identity development during their

career. The questions addressed the following: definition of
counseling and any changes over time, professional identity
and factors that influenced it (i.e., Define your professional
identity at the current moment), and needs to progress in
their professional identity (i.e., What do you think you need
to progress to the next level of development of your profes-
sional identity?). Data were collected through recorded focus
groups that were scheduled in advance. The goal of this
qualitative data collection was to capture rich descriptions
of the process of professional identity development that
accurately represented participants’ lived experiences. The
advantage of using focus groups for data collection is that
it is more “socially oriented, often creating a more relaxed
feel than individual interviewing” (Hays & Singh, 2012, p.
253). The combination of grouping participants by work set-
ting, years of experience, and focus groups promoted robust
exploration and processing of the topic. The processing that
occurred in a focus group was essential to spark additional
thoughts relating to professional identity. By hearing other
counselors’ experiences in similar work settings, participants
gained insight into the construct of professional identity and
could provide more meaningful answers to questions. Focus
group sessions lasted 60 to 90 minutes.

The focus groups were formed on the basis of participants’
experience and area of expertise. We avoided mixing people
with different expertise or work settings because the goal was
for all participants to feel comfortable sharing their thoughts
and feelings (Krueger & Casey, 2009). Being comfortable in
the group increases the likelihood of participant involvement.
The focus groups were formed and coded with letters A (for
school and community-based counselors with 1–2 years of
experience), B (for school and community-based counsel-
ors with 5–15 years of experience), and C (for school and
community-based counselors with 20+ years of experience);
this coding system is used in the Results section.

Data Analysis

After focus group interviews were completed, each session
was transcribed verbatim. We used manual line-by-line open
coding to focus on coding for differences based on years of
experience and work setting and looked for concepts, catego-
ries, and properties that characterized each level of experience
and setting. We agreed that participants did not differ on the
basis of work setting. The idea of professional identity was
conceptualized as a continuum (Strauss & Corbin, 1998).
The transcripts of counselors with 1–2 years of experience
and those of counselors with 20+ years of experience were
coded for concepts and categories to anchor the ends of the
continuum. Next, the transcripts of counselors with 5–15
years of experience were coded.

In axial coding, the categories were refined as we sought
to identify the causes, influences, outcomes, and conse-
quences of counselors’ identity development. Participant
transitions were noted that would be used in the construction

Journal of Counseling & Development ■ January 2014 ■ Volume 926

Moss, Gibson, & Dollarhide

of the grounded theory (Corbin & Strauss, 2008). Finally, we
used selective coding to develop hypotheses to connect the
ideas of professional identity development among counsel-
ors. A model or theory was developed from the information
gathered (Creswell, 2007) that suggested transformational
tasks specific to practicing counselors. These transforma-
tional tasks were different from the transformational tasks
discovered in the previous studies (Dollarhide et al., 2013;
Gibson et al., 2010).

Results
The findings from the analyses suggested that six themes were
influential to counselors’ professional identity development:
(a) adjustment to expectations, (b) confidence and freedom,
(c) separation versus integration, (d) experienced guide, (e)
continuous learning, and (f) work with clients. Within three
of the themes—adjustment to expectations, confidence and
freedom, and separation versus integration—there was move-
ment as counselors gained experience working. The other
three themes—experienced guide, work with clients, and con-
tinuous learning—were catalysts for the movement that took
place. Although the process was different from the process
for counselors-in-training (Gibson et al., 2010), there were
transformational tasks completed by counselors during nodal
points in their counseling career that developed their profes-
sional identity. Within each of the groups, or career life stages,
there was a transformational task that enabled the counselor
to continue to grow and develop professionally (see Figure 1).

The three tasks were idealism toward realism, burnout toward
rejuvenation, and compartmentalization toward congruency.
Counselors were able to accomplish these tasks through the
processes of continuous learning, work with clients, and help
from an experienced guide. In this section, the results of the
themes with counselors’ quotes are presented. The section
ends with an explanation of how the themes are integrated
into the transformational tasks in the professional identity
development of counselors.

Participants were identified with anonymous codes based
on the group they were in: A = beginning counselors with
1–2 years of experience; B = experienced counselors with
5–15 years of experience; and C = expert counselors with
20+ years of experience. As mentioned earlier, participants
did not differ by work setting; therefore, school counselors
and community-based counselors are combined. Within each
group, participants are assigned an identifying number (1, 2,
3, etc.). For example, C2 is the second counselor in the group
of expert counselors with 20+ years of experience.

Themes and Theory

Adjustment to expectations. This theme represented the
counselors’ perceptions of their own expectations as coun-
selors versus the expectations others had of them in this role.
Counselors, especially beginning and experienced counselors,
expressed frustrations about their work environment. Beginning
counselors found reality different from the idealized role they
had imagined. As years progressed, this frustration led to coun-
selors in the middle of their career life span feeling dissatisfied

FiGurE 1

Professional identity Development Model of the Transformational Tasks of Counseling Practitioners

External
Validation

Experienced
guide

TIME

Experience and
Professional
Development

• Continuous
learning

• Working with
clients

iii
Self-Validation

• Realistic sense
of work

• Rejuvenation
• Congruency of

work and life

AT
T

IT
U

D
E

T
O

W
A

R
D

W
O

E
N

E
R

G
Y

F
O

R
W

O
R

IN
T

E
G

R
AT

E
D

P
E

R
S

O
N

From idealism To realism

From burnout To rejuvenation

From compartmentalization To congruency

Transformational Tasks for Practitioners

Journal of Counseling & Development ■ January 2014 ■ Volume 92 7

Professional Identity Development

with their jobs. Counselors were asked how their definition of
counseling had changed for them, when it had happened, and
if working as a counselor was what they imagined it would be.

Beginning counselors grappled with the realization that
the realities of the workplace were different from graduate
training. One beginning counselor said, “It is one thing when
you are a student and there is someone actually kind of guid-
ing you but when you are out there doing it on your own, that
has definitely been an eye-opener” (A3). The idealized view
counselors had developed during training was different from
their actual job setting. Another beginning counselor stated,
“Now that I am actually in the school system, it is a little bit
different” (A2). These counselors reported feeling frustrated
as they recognized the difference.

Counselors expressed frustration with noncounseling
duties, administrative tasks, and paperwork. They reported
realizing how these other tasks interfered with their actual
counseling. As one beginning counselor explained, “I can’t
really get done what I want to get done and be as effective
as I can be because I am constantly doing other things like
paperwork” (A2). The counselors felt that these other or-
ganizations were dictating the services they provided and,
as a result, defined counselors’ identity. An experienced
counselor said,

Where I work it is almost like the establishments that we work
for really are defining our professional identity. . . . Insurance
dictates what kind of crisis a patient really needs to be having
in order to have the service they will pay for. (B13)

Experienced counselors were tired after years of confront-
ing the same struggles and were in need of rejuvenation. One
counselor shared,

I guess at this point in my career, I am feeling a bit I don’t
know if burned out is the word but I have gotten to where
I am used to doing the same thing. . . . I feel like I used to
have a lot more passion or hope than I do at this point. (B5)

After years of confronting these realities, expert counselors
felt continued frustration, which led to job dissatisfaction.

Confidence and freedom. As participants discussed how they
felt as counselors and what they needed to progress to the next
level of development in their professional identity, beginning
counselors expressed emerging doubts about their abilities and
desired more confidence. As these counselors gained experi-
ence, they felt more confidence and freedom in acknowledging
their limitations. A beginning counselor captured the insecu-
rities of new counselors by saying, “I feel like I have to put
up this, be as professional as I can be and you know talk as
technically as I can about what I do and what I am doing” (A4).
At the beginning stage of the counseling profession, there was
recognition that confidence struggles were part of the process.
Another beginning counselor said, “I almost think it is probably

a good place not to feel comfortable. . . . I definitely would like
to feel really confident. It’s all a process” (A5).

Whereas beginning counselors struggled to have confi-
dence within their professional role, experienced counselors
had gained confidence and felt freedom in recognizing their
limitations. One experienced counselor stated,

Early on when I was scared, I was fearful and not confident
. . . but for me now, I do think that it is probably, it’s really
awesome. . . . I still screw things up. I am just brave enough
now to own up when I do. (B11)

With an increase in confidence and freedom, counselors
also appreciated the community of counselors that they used
for client referrals. Instead of feeling that they needed to
know everything, they developed a network of people who
supported their practice and their clients. This idea was de-
scribed by an expert counselor:

I also am appreciative of a network of folks who have a wider
range of skills in their specialties than I do and I feel much
more comfortable in my own skin saying, hey could you work
with this person. . . . I think there is a little bit more confidence
I have in relinquishing and not thinking I have to have all the
answers for everybody, every case. (C6)

Separation versus integration. In this theme, counselors
actively separated and integrated both personal and profes-
sional aspects of their lives into their professional identities.
When beginning counselors talked about their identity, they
spoke of separating work from other areas of their life. Upon
gaining experience, counselors developed a sense of their pro-
fessional self and personal self integrating into one identity.
As counselors talked about their definition of counseling and
how they had imagined counseling to be, it was evident that
change occurred over their professional life span. A beginning
counselor reported how she compartmentalized her roles:

I am also a [sports team] coach so I am in an out-of-counselor
role. I am not a counselor on the court. . . . You can’t be both
all the time. . . . I kind of turn it on, turn it off. (A2)

This counselor viewed counseling as something she
could leave once she stepped out of her office to assume
another role.

Counselors reported that they believed that this idea of
separation was part of their training. One experienced coun-
selor stated, “In school they teach you to leave it [work] and
take care of yourself, but it is hard when you are in it. . . . It
is hard to leave that office and go home” (B13).

Through more experience, counselors viewed the differ-
ent facets of their job as part of a larger purpose for helping
clients. An expert counselor said, “I think when I first started,
it used to be really compartmentalized . . . then like you said,

Journal of Counseling & Development ■ January 2014 ■ Volume 928

Moss, Gibson, & Dollarhide

jack-of-all-trades, you do whatever it takes to get that child,
do whatever you have to do” (C3). There was a realization
that clients are important, and there was a desire to give extra
effort to best help them.

Expert counselors reached a level of congruency with their
professional and personal selves. They were able to reflect and
see how personal experiences affected them professionally
and how professional experiences affected their personal life.
One expert counselor shared,

I think the thing that has shaped my life as a counselor is
probably my son’s death . . . my own grieving journey just
really brought everything out and I went back, I went head
long into training for the grief and loss. (C5)

Experienced guide. Counselors at all levels expressed the
importance of having a mentor, supervisor, peer supervision,
or some form of experienced guide to help them in their pro-
fessional development. Participants talked about the need to
learn from an experienced counselor when discussing what
they needed to progress to the next level of development of
their professional identity, experiences that had contributed
most to their professional identity, and experiences that had
resonated most with them as a counselor.

A beginning counselor looked for “someone to say I expe-
rienced the same thing and this is what I did” (A3). Another
beginning counselor spoke about the impact that a mentor
had on her professional development: “I don’t know where I
would be had I not had that mentor which has probably been
the most beneficial thing as far as my professional identity
goes and learning about who I am professionally” (A1). Be-
ginning counselors look to counselors with more experience
to give them ideas, advice, and support.

Peer supervision is another type of supervision that coun-
selors found beneficial. Within the relationship, counselors
assumed roles of both supervisor and supervisee, and there
was a recognition that counselors with varying years of expe-
rience brought strengths to the relationship. An experienced
counselor talked about the power of peer supervision:

There are three other counselors, so we have a lot of time
to talk about cases and support each other, so I think other
professionals who have been in it longer than I have and new
professionals that come in and have a new energy and a dif-
ferent idea about things. (B10)

The value in continuing a mentoring relationship was also
reported by expert counselors. One expert counselor discussed
the impact his mentor continues to have on him as a professional:

Watching him present, watching him work with families and
demonstrations, having a chance to affiliate with him. That it
continues to be kind of like, boy that’s sort of who, that’s the
arena I’d like to be when I grow up. (C6)

Continuous learning. Each group of counselors recognized
learning as a lifelong endeavor and discussed ways to acquire
additional professional knowledge. Counselors were energized
as they talked about what they needed to progress to the next
level of development of their professional identity; they also
spoke of learning from classes, conferences, and trainings.

Beginning counselors expressed excitement about the
vast amount of information in the field. For example, one
beginning counselor said, “I think that is exciting about our
profession because we have to stay somewhat fluid and just
keep on changing” (A1). Participants were comfortable with
the idea that they would have to continue to learn to continue
developing as a professional.

As counselors gained experience, their learning became
more focused on their areas of expertise and interest. An ex-
perienced counselor said, “I study, study, study, study because
I am always interested in what is working, and I am always
searching out what’s going to help [clients], and I use every-
thing” (B12). Participants reported a desire to study specific
topics that would best help their clients and the populations
that they work with daily. An experienced counselor talked
about wanting “training on specific things, bullying, ADHD
[attention-deficit/hyperactivity disorder], autism” (B2).

Although they had many years of counseling experience,
expert counselors embraced the idea of continuous learning.
An expert counselor talked about his comfort level with
continuing to be a student at a conference:

They had all these labels and badges that you could attach
to your name tag, “Presenter,” or you know, “First Time At-
tendee,” and I don’t know whether it was what I wanted to be
as far as my next level, or if it was the contrarian in me, but I
picked up a “Student” badge and attached it to my name tag.
And actually I began to feel very, very comfortable with that.
There’s this, there is more for me to learn. (C6)

Conversations about additional educational experi-
ences energized counselors at all levels. For counselors,
learning was a lifelong endeavor because the f ield is
constantly evolving.

Work with clients. Clients provided the needed positive
reinforcements for counselors to do their job. A beginning
counselor stated, “I feel I am making a small difference and
constantly getting those reinforcers and motivators” (A4). Cli-
ents made the counselors’ learning, frustrations, and struggles
worthwhile. Participants were able to point to specific success
stories or instances of failure that had a lasting impact on
them professionally. Across all levels and work settings, work
with clients was most meaningful to counselors’ professional
identity development. Participants in every group discussed
their work with clients when asked about the experiences
that had contributed most to their professional identity, the
experiences that had resonated most with them, and how they
felt about themselves as counselors.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 9

Professional Identity Development

Beginning counselors were surprised at the strength people
showed despite their circumstances. Instead of being the ex-
pert, counselors found themselves learning from their clients.
One beginning counselor said, “I have been surprised, which
I am ashamed to say, that I just discovered more about how
people are strong and resilient . . . nothing seems to have gone
well but they were just incredibly strong” (A7).

Experienced counselors were pleased when they saw
clients grow and reach their counseling goals. Termination
was viewed as a graduation from counseling and a time when
both the client and counselor were proud of themselves. An
experienced counselor shared,

I terminated [counseling] a young college girl whom I had
been working with for about two and half years. . . . When we
finally met for the last time last week, it was mixed feelings.
I was almost sad because I was saying good-bye to her, but
then I was very proud of her work, but then I was proud of
myself because I stuck with her and saw her through. (B13)

Success stories involved clients in crisis and times when
counselors were able to help. The counselors realized that they
had made a difference in another person’s life. For example,
one experienced counselor stated, “It has been the children
who have been sexually abused, or the children who have
had physical abuse or witnessed you know things that were
traumatic for them and I know that those children really, re-
ally need me” (B6).

Emergence of Theory

In analyzing the current data, we determined that the themes
found in the participants’ experiences were part of the trans-
formational tasks associated with counselors’ professional
identity development. Counselors’ professional identity was
transformed in response to completing each task. The three
tasks the practicing counselors worked to accomplish were
idealism toward realism, burnout toward rejuvenation, and
compartmentalization toward congruency (see Figure 1).
These tasks served as a foundation to the process reported
by the participants within the themes of adjustment to ex-
pectations, confidence and freedom, and separation versus
integration. As counselors talked about each of these areas,
they reported factors that prompted their movement. These
factors were the catalysts for a changing identity. The same
transformational process was used at each stage: work with
clients, experienced guide, and continuous learning. In es-
sence, the grounded theory of this study was based on the
transformational tasks of professional identity development
of counselors.

Beginning counselors’ idealistic views were confronted
with the reality of the work world. This transformational task
involved the themes of adjustment to expectations and confidence/
freedom. The task at this stage was for new counselors to
reconcile their idealized visions with reality. Participants

reported entering the workforce unprepared, and new coun-
selors often experienced disillusionment with their graduate
training (Skovholt & Rønnestad, 1992). As counselors worked
to accomplish the task, they experienced self-doubt and con-
fidence struggles. Other studies found that new counselors
lacked confidence and needed external validation (Auxier
et al., 2003; Brott & Myers, 1999; Skovholt & Rønnestad,
2003). Participants reported that external validation came
from experienced guides and clients. As counselors received
external validation from an experienced guide or a client and
gained additional knowledge, they were able to accomplish
this task. The challenge of this task was for counselors to
become realistic about their abilities and their role.

Experienced counselors were challenged with the task
of burnout toward rejuvenation, which also addressed the
theme of adjustment to expectations. Participants reported
feeling dissatisfied with their jobs after years of dealing
with continual frustrations. As Gibson et al. (2010) found,
counselors reported that the public had misperceptions about
the counseling profession. Daily, counselors are advocates
for the profession to educators and insurance companies,
and these other entities influence counselors’ role and affect
their identity (Brott & Myers, 1999). Nevertheless, there was
a sense that counselors came to terms with these frustrations
and found a way to move forward professionally. The cata-
lysts for this movement were continuous learning, work with
clients, and an experienced guide. Counselors in this study
were energized by continuing to learn. They reported that
learning new techniques, taking classes, or making a change
in their counseling approach rejuvenated their professional
outlook. Successes with clients made the frustrations worth-
while. Knowing that they had made a difference or saved a
life was the reinforcement counselors needed to continue to do
their job. Participants also discussed how support from other
counselors helped them move forward during stressful times.

The third transformational task challenged counselors to
move from compartmentalizing counseling to having a con-
gruent view of the self. This task included the themes sepa-
ration versus integration as well as confidence and freedom.
The movement from compartmentalization to congruency was
a slow process fostered by experiences with others (clients,
experienced guides, and learning opportunities). Through
these interactions and personal experiences, counselors ex-
perienced a merging of their professional and personal selves
into a congruent identity.

Participants reported viewing counseling as something
separate from other aspects of their lives. They wanted to keep
their professional and personal lives separate in order to have
balance. However, congruency was observed in expert coun-
selors. Skovholt and Rønnestad (1992) found an authenticity-
to-self in experienced counselors in which role, working style,
and personality complemented one another. Expert counselors
in the current study accepted that being a counselor was a
core part of who they were as a person. They were confident,

Journal of Counseling & Development ■ January 2014 ■ Volume 9210

Moss, Gibson, & Dollarhide

were able to find balance, and experienced the freedom to take
professional risks. With the freedom to refer clients to other
counselors came a recognition of the professional commu-
nity. In contrast to Gazzola and Smith (2007) and Gibson et
al. (2010), in the current study, counselors did not consider
the professional community as comprising only counselors.
Instead, they seemed to include other helping professionals
in the professional community, such as psychologists, social
workers, and educators. This suggests a broader view of the
professional community as counselors looked beyond the
counseling profession for support and information.

The expert counselors were aware of their limitations and
experienced freedom in knowing their limitations. Their per-
sonal and professional selves had merged to create a congru-
ent self in which life experiences and professional experiences
were valued. Friedman and Kaslow (1986) found that coun-
selors became authentic and congruent as their professional
and personal selves merged. Participants in the current study
understood the value of their life experiences, including their
religious beliefs, values, interests, and personal losses such as
divorce or death in shaping who they were as a professional.

Discussion
The themes reported in this study were found to be important
to counselors’ professional identity development. They pro-
vided information about the process of identity development
over the course of the professional life span. The findings
are consistent with previous studies, which have found that
students developed an idealistic view of counseling during
training (Cave & Clandinin, 2007; Nyström, Dahlgren, &
Dahlgren, 2008; Swennen, Volman, & van Essen, 2008;
Troman, 2008) and that counselors entered the workforce
with unrealistic expectations (Rønnestad & Skovholt, 2003).
Participants in the current study discussed how their precon-
ceived view of counseling was challenged by the realities of
the workplace environment. Also, counselors with 1–2 years
of experience reported confidence struggles and feelings of
self-doubt that are consistent with previous studies (Bischoff
et al., 2002; Rønnestad & Skovholt, 2003; Skovholt & Røn-
nestad, 1992; Woodside et al., 2007). It was observed that
confidence grew as counselors gained experience. This is
consistent with previous studies that found counselors gained
confidence through experience, successes, and earning respect
from others (Magnuson, Black, & Lahman, 2006; Magnuson,
Shaw, Tubin, & Norem, 2004; R. G. Smith, 2007; Swennen
et al., 2008). As counselors gained confidence, they reported
realizing that they could handle their job, experiencing free-
dom to make mistakes, and understanding their limitations.

In addition, the data support how counselors become
congruent as their professional and personal selves merge
(Friedman & Kaslow, 1986). Three of the themes—work with
clients, experienced guide, and continuous learning—proved
to be change agents as counselors developed. Clients provided

positive reinforcements for counselors to do their job, and suc-
cesses and failures shaped the counselors’ identity. Findings
support previous studies that found that successes and failures
with clients had a profound impact on counselors’ identity
(Bischoff et al., 2002; Brott & Myers, 1999). When counselors
realized that they helped someone, they were empowered; this
led to more confidence and energy. Previous studies found
that work with clients validated new professionals (Bischoff et
al., 2002; Rønnestad & Skovholt, 2003; Studer, 2007). Also,
previous studies have found that supervision was helpful in
developing a strong identity as a counselor (Bischoff et al.,
2002; Brott & Myers, 1999). Other studies (Cave & Clan-
dinin, 2007; Dollarhide & Miller, 2006; Magnuson, 2002;
Magnuson et al., 2006) found supervisors to be important
to new counselors as they adjusted to the counseling profes-
sion. Positive feedback helped validate them as professionals
(Cave & Clandinin, 2007). The current data support these
findings in addition to suggesting that supervision affected
counselors at all experience levels. Each group admitted that
they needed help moving forward, which is consistent with
Gibson et al.’s (2010) findings. Previous research indicated
that new counselors wanted to fill in knowledge gaps and that
they had the desire and excitement to learn (Nyström et al.,
2008; R. G. Smith, 2007).

Limitations and Implications
The results of this study may not be applicable to all
counselors because of the limited number of participants
found within focus groups. The study investigated the
experiences of 26 participants in the southeastern United
States. Cultural limitations may exist (McGowen & Hart,
1990; K. L. Smith, 2007) because most of the participants
in our study were White women and were not representative
of all counselors. Also, the use of focus groups to collect
data limited the amount of in-depth exploration individual
interviews may have provided. If participants had sensitive
or threatening input, they may have been hesitant to share
their perspective with their peers in a group setting. How-
ever, the author who conducted the interviews made efforts
to create a welcoming and open environment in which par-
ticipants felt comfortable sharing their experience. Future
studies can strive to have a more representative sample of
the counseling population from various geographic areas.
Additionally, the use of individual interviews may elicit
more in-depth information from interview content and ob-
servation. Furthermore, longitudinal research is warranted
because of the transformational tasks and processes that
occur within each task at each nodal point. Future research
in professional identity development needs to consider the
years of experience not captured in the current study. The
results of this study have implications for counselors-in-
training, counselor educators, counselors, supervisors,
professional organizations, and future research.

Journal of Counseling & Development ■ January 2014 ■ Volume 92 11

Professional Identity Development

First, counselor educators have the responsibility to
foster and develop the professional identity of counselors-
in-training (Council for Accreditation of Counseling and
Related Educational Programs, 2009). Counselor educators
can use the information about transformational tasks and
how to accomplish the tasks to better prepare emerging coun-
selors. When counselors-in-training enter programs, they
can be given assignments such as interviewing or shadowing
practicing counselors to gain a more realistic perspective of
the workforce. Also, counselor educators can give practical
perspectives by inviting guest speakers who are practicing
counselors into all classes. Counselor educators who are also
practitioners can use examples in their teaching from their
current practice to illustrate a reasonable view of counsel-
ing. In addition, counselor educators can strive to ensure
that practicum and internship experiences are realistic and
are best preparing counselors-in-training for the realities of
the work environment. Therefore, counselors entering the
workplace will have more reasonable expectations of the
counseling profession. They can also know what to expect
as they grow and develop within the profession. Realistic
expectations can lead to less frustration, which would help
both counselors and clients.

Second, this study provides counselors with a process
of their professional identity development. Recognition
of the transformational tasks can normalize the counselor
experience. There can be comfort in knowing that others
are facing the same issues and frustrations. Knowledge that
counselors at each stage face a similar struggle can lead to
greater peer support. As counselors feel self-doubt, burn-
out, or incongruence, they will know the tools (continuous
learning, work with clients, and experienced guide) to help
them work through their struggles.

Finally, the results of this study reinforce the benefits of
supervision at all levels of counseling. Counselors should be
encouraged to seek out an experienced guide to help them
navigate their professional growth. Also, supervisors can use
the knowledge about the struggles at each stage of develop-
ment to better support their supervisees. Supervisors can
use the information about the need for continuous learning
to help their supervisees by providing additional learning
opportunities. Supervisors can tailor their trainings to the
developmental needs of their supervisees.

Conclusion
Results of this study indicated that six themes were important
to counselors’ identity development: adjustment to expecta-
tions, confidence and freedom, separation versus integra-
tion, experienced guide, continuous learning, and work with
clients. In addition, a process emerged that included trans-
formational tasks at each professional life stage. This study
highlights the process of counselors’ professional identity
development and how it changes during the professional life

span. Identity development is a lifelong process. As counsel-
ors gain awareness of this process, they can be more effective
and experience greater job satisfaction.

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