An Unabashedly Unrealistic Wish List for theEducation and Training of Psychotherapists

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Alvin R. Mahrer and Donald B. BouletUniversity of Ottawa

Proposals for the education and training of psychotherapists are offered ina spirit of constructive good faith, yet they are unabashedly unrealistic indeparting from some common canons of education and training. Sevenprinciples are proposed as a suggested starting point for further discus-sion of the education and training of psychotherapists. © 1999 JohnWiley & Sons, Inc. J Clin Psychol 55: 393–398, 1999.

This wish list is admittedly personal and unrealistic. It is personal because it comes fromyears of trying to train psychotherapists in one kind of psychotherapy, namely experien-tial psychotherapy, within academic and internship programs whose much larger missionwas to educate and train professional psychologists and psychiatrists. This wish list isunabashedly unrealistic for at least four reasons. First, we are not dictators-for-life ofpsychotherapy education and training. Second, adoption of this wish list would require aspirit of willing cooperation among the many psychotherapy-related professions and theirprofessional associations. Third, serious consideration of this wish list would call for anunbelievable shift in our fundamental ways of thinking about the education and trainingof psychotherapists. Finally, the chances of this wish list being even mildly consideredmay be a little higher if it is offered in a spirit of unabashed unreality, playful fantasy, andwishful speculation. The question then is: What is an admittedly personal and unabash-edly unrealistic wish list for the education and training of psychotherapists?

SEVEN WISHES FOR PSYCHOTHERAPY EDUCATION AND TRAINING

Psychotherapy Training Would Take Place in Psychotherapy Training Programs

Picture a training program whose mission is to produce fine psychotherapists as practi-tioners, scholars, theoreticians, researchers, or some integrated combination. The pro-

This article is based on a symposium address at the annual meeting of the American Psychological Association,Toronto, Canada, August, 1996.Correspondence concerning this article should be addressed to Alvin R. Mahrer, Ph.D., School of Psychology,University of Ottawa, Ottawa, Canada K1N 6N5.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 55(4), 393–398 (1999)© 1999 John Wiley & Sons, Inc. CCC 0021-9762/99/040393-06

gram may be mainly pregraduate or postgraduate, but its job is to teach and trainpsychotherapists. Administratively, the program may be housed within any of thepsychotherapy-related professions such as psychology or psychiatry, or it may be aninterdisciplinary program that is fed by a number of psychotherapy-related professions(Holt, 1971; Keller & Baumann, 1986; Mahrer, 1992; Prokasy, 1986; Shakow, 1971).

Whether or not the psychotherapy program is housed within one of the psychotherapy-related faculties or schools or is more interdisciplinary, the teachers are first and foremostpsychotherapy scholars, practitioners, researchers, and theoreticians, whether they areaffiliated with psychology, psychiatry, social work, education, or any other psychotherapy-related profession.

This means that the field of psychotherapy is understood as a field in its own right,with its own foundations, its own philosophy, its own research, its own theories, its ownhistory, its own knowledge base. Psychotherapy is much more commonly thought of inits narrow sense as the relatively applied wing of larger and more foundational fields suchas medicine, psychiatry, psychology, experimental or general psychology, social work, oreducation. In the larger meaning, psychotherapy is understood as its own integral field ofstudy that includes the origins of personality, infant and child development, the structureof personality, theories and methods of change, pain and suffering, and optimal and idealdirections of change. Psychotherapy training occurs in psychotherapy training programswith psychotherapy as an integral field of study.

Whether or not the graduate receives a degree in psychology or medicine or anyrelated discipline, satisfactory completion of the psychotherapy training program isacknowledged by some sort of diploma or certificate containing the wordpsychotherapy(cf. Paris, Kravitz, & Prince, 1986; Sales, 1985; Sales, Bricklin, & Hall, 1983, 1984).

Psychotherapy Teachers and Trainees Would Come From Any of the Psychotherapy-Related Professions Rather Than Almost Exclusively From Psychology

Whether the psychotherapy training program is interdisciplinary or administratively housedwithin some profession or discipline such as psychology, the understanding is that thereare many professions and disciplines that contribute to psychotherapy, that train psycho-therapists, and that have legitimate claims to the field of psychotherapy (e.g., Belar,1987; Fretz & Mills, 1980). This means that the psychotherapy training program caninclude teachers and trainees from psychotherapy-related professions such as psychol-ogy, psychiatry, social work, nursing, education, counseling, philosophy, religion, andothers.

Psychotherapy Trainees Would Be Scholars of the Philosophy of ScienceRather Than True Believers in a Single-Truth Philosophy

Psychology emphasizes educating its trainees as both practitioners and scientists. Wepicture a training program that emphasizes psychotherapists as practitioners, as theoreti-cians, as researchers, and as scholars. Emphasizing a scholarly understanding of the phi-losophy of science would seem to be an alternative to an almost universal bathing ofpsychotherapists in a single-truth philosophy that characterizes most graduate educationand training programs (Mahrer, 1995a, 1996).

According to this single-truth philosophy, psychotherapists know that there are men-tal illnesses and diseases; the brain is a basic determinant of human behavior; there are

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universal basic needs, drives, motivations, and instincts; and many other truths in thesingle-truth philosophy. When it comes to psychotherapy, practitioners are taught to singthe chorus of truths such as: psychotherapeutic change is a function of the therapist-clientrelationship, insight and understanding are prerequisite to psychotherapeutic change,patients come to therapy for treatment of personal problems and relief of psychologicaldistress, and therapists should first diagnose the problem and then select and apply theappropriate treatment.

It seems that most trainees are selected, shaped, and molded into a machinelikephalanx voicing a uniform, single-truth mind-set (Mahrer, 1996). This is a problem becauseexperiential psychology and psychotherapy join with some other approaches that falloutside the single-truth mind-set, are easily perceived as violating the single truths, andtherefore are labeled as weird, unscientific, alien, thereby dangerously declining what isknown to be true (cf. Fuller, 1996). Students whose thinking is friendly to experientialpsychotherapy sense that something is fundamentally wrong with what they are supposedto know is fundamentally true, that most of their single-truth courses are either irrelevantor inhibitory to their own basic beliefs, and that there may well be alternative philoso-phies to the monolithic single-truth philosophy into which they are to fit.

Our wish is that education and training programs would value trainees becomingscholars in the philosophy of science (cf. Slife & Williams, 1997). Adopting this largerperspective would leave room for declining the single-truth’s dictum that students in allapproaches have to take required basic courses in biology, neurology, physiology, exper-imental psychology, learning, memory, perception, cognition, human development, andcourses in mental illnesses and diseases, psychodiagnosis and assessment of mental dis-orders, and supposedly basic courses in psychotherapy. Adopting this larger perspectivealso would allow trainees to have a scholarly foundation for being able to think aboutwhat they are told to think.

Psychotherapy Training Would Emphasize Research Internshipsand Deemphasize Book-Length Dissertations

Although psychotherapy research teams have been in university graduate training pro-grams since as early as the 1940s (Porter, 1943), it is rare that participation on theseteams has been used as a substantive part of training in psychotherapy research. Goingeven further, the proposal is that there be research internships built around psychotherapyresearch teams and that the psychotherapy research internship essentially replace most ofwhat typically occurs in the production of ordinary book-length dissertations.

The purpose of the research internship is for the trainee to acquire hands-on experi-ence in psychotherapy research, to gain progressively broader and deeper skills as apsychotherapy researcher. Trainees would gain experience on several different researchteams by working on different psychotherapy research projects, problems, and topics.Trainees would progressively gain experience and skills in figuring out what to study,what the aims and purposes of the study can be, how to study whatever the study is tostudy, how to weigh alternative methodologies and designs, how to learn from examiningthe literature on the topic, what data to gather and how to gather it, what to do with thedata that are gathered, what careful and rigorous ways can help make the study morerigorous and careful, how to arrive at sound conclusions, how to organize and word whatwas done in the study and what the study means, how to design graphs and charts andfigures, how to determine coauthorship, and many more research-relevant issues, com-petencies, and skills.

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With gradually increasing experience and skills, the trainee has gradually increasingresponsibilities that can culminate in a piece of work for which the trainee is largelyresponsible, and in which other members of the research team may participate. This pieceof work may be the trainee’s dissertation, whether it stands as an independent piece ofwork or has grown out of a series of studies in which the trainee had a large, responsiblehand. In general, the dissertation is the culmination of the trainee’s research internshipand stands as a research article, monograph, or book chapter, rather than as a book-lengthproject.

Psychotherapy Trainees Would Study and Learn From the Actual Workof Master Psychotherapists

Picture programs with rich libraries of perhaps 100–200 audiotapes and videotapes ofmaster therapists doing actual work with actual patients. The therapists are representativeof a wide variety of approaches and are high-caliber, seasoned, fine practitioners. Thetapes range from single sessions to most of the sessions with a particular patient, frominitial sessions to middle sessions to final sessions, from sessions containing impressivechanges to all sorts of illustrative sessions, to sessions containing common therapisterrors and wrong turns.

These tapes constitute an important focus of study in courses and seminars, in prac-ticum and internship, in postgraduate training, and in psychotherapy research. The tapesare studied carefully, in depth, and with emphasis on the learning of both psychothera-peutic theory and practice. The aim is to study the theory that is shown alive and presentin the actual sessions themselves. The complementary aim is to study and to learn fromthe actual working methods and procedures exemplified in the tapes of master practition-ers (Mahrer, 1996; Rogers, 1957). Such careful, teacher-led, intensive study and learningfrom the actual work of master therapists both precede and accompany the trainees’ owndeveloping experience doing psychotherapy. By the end of their training, trainees haveaccumulated a mandated number of hours studying master practitioners, including thoseexemplifying the trainees’ own currently preferred approach.

Psychotherapy Trainees Would Be Helped to Discover Their Own Personal, DeeperTheoretical Models of What Human Beings Are Like and What Psychotherapy Is

Most training programs favor their own department-represented brands of psychotherapyand push trainees to select from a stacked deck of professionally approved approaches(Task Force on Promotion and Dissemination of Psychological Procedures, 1995). Whatis almost uniformly ignored is helping the trainee to discover his or her own personal,deeper, well-hidden ideas about what human beings are like and what psychotherapy is.Our wish is that one part of course work, and an important part of practicum and intern-ship, is straightforward helping of each trainee to dig down inside his or her own thinkingto discover a deeper, personal approach to the basic issues and questions in the field ofpsychotherapy and to what psychotherapy is and how it works (Mahrer, 1995b; Mahrer &Boulet, 1997; Rogers, 1957; Shertzer & Stone, 1968). Here is where trainees can come toappreciate their own versions of some theory of personality and psychotherapy: “I thoughtI was a cognitive behaviorist, but it seems I think psychoanalytically!” or “I alwaysthought I was a strict eclecticist, but not really. I guess I’m more of a strict behaviorist!”

In most courses, trainees are taught what we believe we know about such age-old andfundamental questions as: what makes people act the way they do? how does a person

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come about in the first place? why do people feel bad, hurt, or anguished? what gets aperson to be activated to do things? how can a person change? what are the limits on howmuch a person can change? what makes one person so different from another? In additionto students learning the traditional answers given by popular approaches such aspsychoanalytic-psychodynamic and behavioral-cognitive, students would be shown howto probe their own personal thinking to help uncover and develop their own personalpositions on these more basic questions.

In practicum, internship, and hands-on actual learning of psychotherapy, a part ofteaching, training, and supervision would be helping trainees to probe their own think-ing to discover and develop personal positions on such issues as: what are the aims andgoals of an initial session? why do clients come to therapy? how do you arrive at theobjectives of therapy with this person in this session? what accounts for psychothera-peutic change? how can a therapist know what a patient is thinking, feeling, and expe-riencing? how can troubling or hurtful feelings be used to further psychotherapeuticchange? when the patient is talking, how does the therapist listen and what does thetherapist listen for?.

It is important, exciting, and helpful for trainees to come to know their own personalmodels of what human beings are like and what psychotherapy is and can be. We canmuch more easily teach experiential psychotherapy to trainees whose personal way ofthinking about human beings and psychotherapy has a smooth goodness-of-fit with expe-riential psychology and psychotherapy. If not, then the trainee is probably better suited towhatever psychotherapy has reasonable goodness-of-fit with the trainee’s own way ofthinking about human beings and psychotherapy.

Psychotherapy Trainees Would Gain Competence in Explicit PsychotherapySkills Through Skill-Developing Training and Practice

Psychotherapy is perhaps the only field where “practice” means doing it for real. Todevelop skills in nursing, playing the piano, surgery, dentistry, swimming, or tennis, thetrainee typically spends hours and hours in concentrated, repetitive, competence-developing practice. Psychotherapy is just about the only profession where students grad-uate with virtually no mandated hours of actual over-and-over-again practice to gaincriterion proficiency in the skills in which they are supposed to be proficient.

Maybe this is one reason why we can start with professional actors, show themvideotapes of the kind of therapist role they are to play, and in about 2 days of practice,not 5 years or so, their actual performance just might be indistinguishable from the actualin-session work of some of our licensed graduates, or perhaps even some of their super-visors. However, in experiential psychotherapy, as with some other psychotherapies, becausethe working unit is the single session, it can be reasonably clear whether or not the traineehas or has not attained working proficiency in the actual skills that are required. In ourwish list training program, there is concentrated, repetitive, learning of designated skills,and genuine proficiency is gained through real practice (Mahrer, 1996).

These are some of the major planks in our wish list education and training programfor psychotherapists. If these are already components of our education and training pro-grams, we think that is just fine, but we have serious doubts that these are well-worn andaccepted characteristics of many programs. If these planks are regarded as dismissablyunrealistic and impractical, this is what we said at the outset. If, however, these sugges-tions touch a friendly chord, then perhaps they warrant further discussion as more than amere wish list for trainees who might be drawn toward experiential psychotherapy.

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