Journal of Marital and Family Therapy

doi: 10.1111/jmft.12051
April 2015, Vol. 41, No. 2, 163176

PERCEIVED PROFESSIONAL GAINS OF MASTERS

LEVEL STUDENTS FOLLOWING A PERSON-OF-THE-
THERAPIST TRAINING PROGRAM: A RETROSPECTIVE
CONTENT ANALYSIS
Alba Ni~
no, Karni Kissil, and Florina L. Apolinar Claudio
Drexel University

The Person-of-the-Therapist Training (POTT) is a program designed to facilitate clini-

cians ability to consciously and purposefully use themselves at the moment of contact with
their clients in order to connect, assess, and intervene eectively. This qualitative study
explored the experiences of 54 masters-level students who were enrolled in an accredited
marriage and family therapy program in the United States and examined their perceived
professional gains following a 9-month POTT course. Content analysis of trainees reec-
tions which they wrote at the end of the training revealed 6 primary themes: (a) increased
awareness, (b) emotions, (c) improved clinical work, (d) humanity and woundedness, (e)
meta-awareness, and (f) factors that contributed to the learning process. Findings suggest
that key outcomes of this training curriculum are congruent with its stated goals. Clinical
and training recommendations are additionally provided.

The role of the therapist in therapeutic change has been an important topic since the beginning
of the eld of marriage and family therapy (MFT), with more or less salience depending on the
authors and their conceptual frameworks. Several aspects regarding therapists and their centrality
in clinical encounters have been considered, such as family of origin issues and levels of dierentia-
tion (Bowen, 1978; Titelman, 1995); capacity to be honest, congruent and whole (Satir, 1987; Lum,
2002); social location and dynamics of power and oppression (e.g., Bula, 2000; Hardy & Laszloy,
2002; McDowell, Brown, Cullen, & Duyn, 2013); and congruence between personal characteris-
tics/beliefs and therapeutic models (Goodell, Sudderth, & Allan, 2011; Simon, 2006), among oth-
ers. Phrases such as person of the therapist or self of the therapist have been generically used
in the eld to refer to who the therapist is, his or her personal characteristics, and the role he or she
plays in the delivery of therapy (e.g., Baldwin, 2000; Lum, 2002; Simon, 2006).
The prominence given to the person of the therapist by dierent MFT models, authors, or
schools of thought is reected in their respective training methods. Some institutions or models
make this area central in their training programs, whereas others consider it more tangentially.
The inclusion of what is commonly referred to as person/self-of-the-therapist work in MFT
training programs is based on the assumption that it will enhance the clinicians therapeutic poten-
tial and directly benet clients (e.g., Aponte et al., 2009; Satir, 1987).
As noted by Blow, Sprenkle, and Davis (2007), despite the important role that the therapist
plays in eecting therapeutic change, research literature on this topic is scarce. One area in which
research is needed is in assessing whether the work that training programs are doing on the self of

Alba Ni~no, PhD, LCMFT, Assistant Professor in the Couple and Family Therapy Program, Alliant Interna-
tional University; Karni Kissil, PhD, LMFT, Private practice in Jupiter, FL; and Florina L. Apolinar Claudio., M.A,
Doctoral candidate in the Couple and Family Therapy Department, Drexel University.
We thank our trainees who showed courage and persistence going through the intense process of POTT and
trusted us to help them grow. We admire them for stepping up to the plate when facing the challenge of embracing
their humanity. We also thank Dr. Harry Aponte for the once in a lifetime opportunity to train with him and for his
endless wisdom. We are grateful for his guidance and advice in developing this manuscript. Finally, we express our
gratitude to Dr. Maureen Davey for her continuous support and her feedback on drafts of this manuscript.
Address correspondence to Alba Ni~ no, Couple and Family Therapy Program, Alliant International
University.10455 Pomerado Road. Daley Hall-206C. San Diego, CA 92131; E-mail: anino@alliant.edu or
albaninotherapy@yahoo.com

April 2015 JOURNAL OF MARITAL AND FAMILY THERAPY 163

the therapist is actually improving the therapists clinical outcomes. Our qualitative study was
designed to begin lling in this gap in the MFT eld. In this article, we present the results of a qual-
itative exploratory study that examined the professional gains reported by masters level MFT
students after participating in a 9-month POTT training curriculum designed to help them make
purposeful use of who they are in their clinical work.

TRAINING OF USE OF SELF IN MFT: CURRENT ENVIRONMENT

To understand the extent to which existing training programs incorporate person/self-of-the-

therapist practices in their curricula, an informal poll was carried out. An e-mail was sent to the
primary contacts of all Commission on Accreditation for Marriage and Family Therapy Educa-
tion (COAMFTE) accredited masters programs inquiring whether and how they incorporate self-
of-the-therapist work in their MFT curricula. Of the 76 programs contacted, 24 responded
(31.6%). All the responses came from training programs in the United States. Their responses sug-
gest that personal work was an important part of these MFT programs either formally or infor-
mally. Some respondents described this type of work as essential or integral to their MFT
training. Most respondents stated that work on the person of the therapist was woven or infused
throughout their curricula, more specically, in supervision, practicum, or class exercises within
academic courses (e.g., reective papers, journals, family of origin work). Three programs indi-
cated that the work on the self of the therapist was addressed in a separate course. Based on these
responses, self-of-the-therapist work seems to be implemented at least in the one-third of MFT
programs who responded to our inquiry, although it may be operationalized dierently depending
on the mission and emphasis of the particular MFT program.
Under the current accreditation standards dened by COAMFTE (2005), graduate and post-
graduate programs are required to demonstrate that the training they provide helps students
achieve the level of knowledge and skills required to become competent MFT professionals. Yet,
work on the self of the therapist has not been specically identied as one of these essential skills
or required areas of knowledge. However, its importance for training master level family therapists
is evident as noted by several guidelines that are part of the Professional Marriage and Family
Therapy Principles (COAMFTE, 2005). For example, several competencies listed in the Marriage
and Family Therapy Core Competencies (American Association for Marriage and Family Therapy
[AAMFT], 2004) convey the importance of therapists own personal work in order to maintain a
professional stance and prevent possible misconduct. Thus, some competencies (e.g., 3.4.5, 4.4.6,
5.5.2) refer to the need of MFTs to monitor and evaluate personal reactions to clients and treat-
ment processes, and their possible eects on therapeutic eectiveness. Similar principles are found
in the Code of Ethics (AAMFT, 2012).
The output-based emphasis of the current accreditation standards (COAMFTE, 2005) now
requires programs to clearly dene the outcomes they are targeting and how those outcomes will
be achieved, operationalized, and measured. In this article, we are describing one model of person-
of-the-therapist work that is currently being implemented in an MFT masters program with the
explicit purpose of increasing therapeutic eectiveness (Aponte et al., 2009). Most importantly, we
are assessing the impact that this model has had on the clinical work of the students who completed
it over a 9-month period during their rst year of MFT training. This qualitative study, conducted
to enhance the congruency between goals, methods and evaluation of self-of-the-therapist work, is
timely and important in an academic environment that now requires that training programs show
to key stakeholders in MFT education (especially those who are interested in becoming therapists)
that they can indeed train competent professionals.

PERSON-OF-THE-THERAPIST TRAINING

The Person-of-the-Therapist Training (POTT) was developed by Dr. Harry Aponte (Aponte,
1992; Aponte & Winter, 2000; Aponte et al., 2009) with the goal of enhancing the therapeutic
eectiveness of clinicians by helping them purposefully use all of who they are, both strengths and
weaknesses, in their clinical work. Rather than emphasizing the resolution of the clinicians per-
sonal struggles as a condition for conducting eective therapy, POTT encourages therapists to

164 JOURNAL OF MARITAL AND FAMILY THERAPY April 2015

make use of who they are in the moment of the therapeutic encounter, while they continue working
on resolving their personal issues, or grappling with issues that may have no resolution. In fact,
special attention is placed in POTT on these lifelong unresolvable struggles, and the hurts, disap-
pointments and losses that are at their core. These ongoing struggles are known in POTT as
signature themes (Aponte et al., 2009; Aponte & Kissil, 2014).
POTT assumes that by identifying their signature themes and better understanding their
eects on relationships (most importantly, the therapeutic relationship), therapists not only
increase personal awareness of their shortcomings and vulnerabilities but also can learn how to
use them proactively during their clinical work. A premise of POTT is that we are all wounded
healers (Nouwen, 1979), and that it is through the experience, understanding and acceptance of
our own woundedness and vulnerability that we can better understand and accept the wound-
edness and struggles that others are facing (Aponte et al., 2009; Ni~ no, Kissil, & Aponte, in
press).
To the extent that therapists are grounded in the journey of understanding and tackling their
own signature themes, they can dierentiate themselves from their clients and their clients issues.
This dierentiation allows them to simultaneously relate intimately to their clients experience
while standing outside of their engagement with the client, with relative freedom to observe the
interaction and draw both insight and the ability to maneuver therapeutically (Aponte & Kissil,
2014). Therefore, therapists can relate to and appreciate their clients dicult journeys without
over-identifying or suering from compassion fatigue (Negash & Sahin, 2011). Although signature
themes are at the center of POTT, many other personal factors are also examined during this train-
ing, including personal and spiritual values, personal characteristics (e.g., being outgoing vs. being
reserved) and cultural backgrounds.
For approximately three decades, POTT had been used in clinical supervision and during clin-
ical consultations prior to its formal integration into a couple and family therapy accredited mas-
ters program (Aponte et al., 2009; Lutz & Spell Irizarry, 2009). In this particular academic
setting, POTT has been implemented as a two-hour weekly experiential class that runs through the
rst academic year (nine months, 60 hours of class time) of the masters program. This class is
taught by two instructors, one of whom is Dr. Harry Aponte, the developer of POTT. Next, we
present a brief outline of the POTT program.1
POTT includes several stages. First, students familiarize themselves with the main organizing
principles of POTT by reading published journal articles on the topic. They then begin their own
experiential work by identifying and understanding their signature themes (e.g., origins, manifesta-
tions in their personal and professional functioning, patterns of coping with these issues in their
lives).
The training is then directly applied to the clinical realm by discussing actual cases that the
students are seeing, and examining how personal factors can be used to enhance therapeutic eec-
tiveness. Additionally, each student receives a live supervision session of a simulated case per-
formed by actors. During these simulated laboratory experiences or simlabs, the eects of the
signature themes and other personal factors are directly observed in the students interaction with
clients and feedback is provided to the trainee in real time by the instructors.
Discussions about signature themes, clinical cases and simlab experiences are led by the train-
ers who work with one student at a time. Simultaneously, the rest of the class members observe the
process. It is expected that by being exposed to the stories and experiences of their fellow class-
mates, students learn to empathize with their plight and become more accepting of the normalcy of
their own human struggles, which in turn serves as a prelude to gaining the ability to empathize
with their clients issues. At the end of each class, the forum is opened up for student observers to
share how the experience resonated with them. In every step of the process, students are required
to write a paper describing their insights during the experience. Students also write weekly journals
to continue reecting on their personal and professional processes.
The year of POTT ends with a nal reection paper and class discussion of the professional and
personal gains that students have achieved during the 9-month training period. These nal reec-
tions are the data that were qualitatively analyzed in this exploratory study of the perceptions of
POTT trainees regarding the professional changes they experienced as a result of their participation
in the training.

April 2015 JOURNAL OF MARITAL AND FAMILY THERAPY 165

 METHOD

Participants
Participants included 54 rst year masters level students enrolled in a COAMFTE accredited
marriage and family therapy program in a northeastern U.S. city. This sample of students com-
pleted the Person-of-the-Therapist Training (POTT) program between 2010 and 2012. Fifty-two
participants were females and 2 were males. Ages ranged from 23 to 51 years old with the average
age 27 years old. Half of the participants were between the ages of 23 and 25. Seventeen partici-
pants identied as Black or African American, 27 identied as White, 3 as Asian, 1 as American
Indian or Alaska Native and the remaining 6 participants identied as mixed raced or other.
Regarding ethnicity, 49 participants identied as non-Hispanic, 4 identied as Hispanic or Latino,
and 1 participant identied as Asian or Pacic Islander.
Participants were part of two cohorts of rst-year MFT students. Each of these two cohorts
was divided in two sections. Both sections had Dr. Harry Aponte as one of the instructors. The
rst author was the co-instructor of one of the sections and the second author was the co-instructor
of the other one. The two sections had the same syllabi, assignments, schedule, teaching methodol-
ogy, and grading system. Additionally, the three instructors met regularly to ensure the consistency
and uniformity between the two sections.

Procedure
This study was based on archival data from two cohorts of the Person-of-the-Therapist Train-
ing (POTT) program. The nal reection papers that students wrote at the end of the 9-month
training were the source of the qualitative data for this study. In these papers, students were asked
the following two questions: (1) What personal changes have taken place in you and in your rela-
tionships as a result of the experiences that you had in this class? and (2) How have your clinical
practice and your perception of yourself as a therapist changed as a result of the experiences that
you had in this class? Even though the rst of these two questions is related to personal changes
and the second directly asks about professional gains, while reading the papers it became clear that
answers to the rst question also included statements about professional growth. Therefore, the
responses to both questions were included in this qualitative study.
After receiving approval for this study from the Universitys Institutional Review Board, the
authors compiled two documents, one included the 54 responses to question 1 and the other the
54 responses to question 2. Names of the students, names of third parties and all other identify-
ing information were deleted. These documents were then sent to a person not familiar with the
training program or the students to further de-identify the data by removing any other demo-
graphic information (e.g., ages, places, names of institutions, gender). Finally, the order of the
entries was randomized in each of the two documents. The resulting documents were then quali-
tatively analyzed.

Analysis
A conventional content analysis method (Hsieh & Shannon, 2005) was used to identify fre-
quent and notable themes. In this type of analysis, researchers allow the codes and themes to
emerge from the data, rather than using preconceived categories. To increase the trustworthiness
of this study via triangulation of investigators (Lincoln & Guba, 1985), three coders indepen-
dently analyzed the data. Two of the coders were class instructors, whereas the third was not
familiar with the course premises or materials, thus providing a fresh perspective for the data
analysis.
During the initial stage of open coding, the three coders independently analyzed the data
by reading every sentence in the two documents and deriving labels and codes from the partici-
pants ideas. Then, each coder organized these codes in a provisional hierarchy of themes and
subthemes related to professional growth. During the second stage, the coders discussed the
subthemes and themes they had independently identied, and by consensus created a master list
that only included those that all coders agreed upon. During the third stage, the coders went
back to the two documents, counted the number of students who mentioned each of the agreed

166 JOURNAL OF MARITAL AND FAMILY THERAPY April 2015

upon themes to reach an estimate of the prevalence and importance of each theme among the
54 participants.
In this study, all the stages of the process were documented, generating an audit trail (Lincoln
& Guba, 1985) that is open to scrutiny. This includes the two documents with the de-identied
responses from the students, records of the initial coding and provisional hierarchies of the three
coders, the master list of agreed upon themes and subthemes, memos and meeting agendas.
Another strategy used to increase trustworthiness in this study was member checking (Newman,
2003). An e-mail was sent to four participants with a copy of the study results, for their response
regarding whether they felt that the ndings reected their experiences. Three participants
responded to this request and expressed that the results reected their experiences.

RESULTS

Six dominant themes emerged from participants reections: (a) increased awareness, (b) emo-
tions, (c) improved clinical work, (d) humanity and woundedness, (e) meta-awareness, and (f) fac-
tors that contributed to the learning process. Below, we describe these ndings with illustrative
quotes from the trainees reection papers. In order to maintain anonymity of all participants, no
identifying information will be provided for the illustrative quotes.

Increased Awareness
A salient area of growth, reported by 48 of 54 participants, was increased awareness. This was
described as a twofold gain. First, students described getting used to practicing self-observation as
an ongoing task while performing their clinical work. Students mentioned becoming more con-
scious, insightful, or improving their capacities for self-exploration. Second, students noted
many areas that they became more aware of during the Person-of-the-Therapist Training (POTT).
These included strengths, values, limitations, and the manifestations of all these factors in their
work as therapists. An additional area of heightened awareness mentioned by most participants
was emotions and emotional processes. Given the salience of this theme, it is described in a sepa-
rate segment below.
Regarding strengths, students reported becoming more aware of personal characteristics that
served them during clinical encounters with their clients, for example, being caring, compas-
sionate, or committed. Even while discussing their ongoing struggles, students recognized their
tenacity and determination to overcome their fears and continue to push rather than back down.
Participants also reported becoming more aware that they were strong enough to carry the task
of being therapists. As stated by one student I have a core of strength inside me which I am learn-
ing to tap into at will.
Participants also reported reaching a higher level of awareness regarding their own personal
and cultural values, and how they manifested in the way they perceived and related to clients. Stu-
dents reported realizing that things do not mean the same for everyone and that to be curious
and ask more questions helped them to avoid imposing their values or to draw conclusions about
the clients based on their own frame of reference.
Students additionally described becoming more aware of their limitations, including their sig-
nature themes. Some examples of signature themes that students identied were as follows: feeling
inadequate or incapable, inability to trust others, need for approval, fear of failure, and fear of not
being taken seriously. In addition, students reported an increased understanding of how they pro-
tected themselves or coped with their own shortcomings in relationships. For example, students
mentioned using fake smiles, pretending not to care, avoiding taking risks, being perfectionists,
becoming peacemakers, or needing to be always in control. Furthermore, students described being
able to recognize the specic ways that their own limitations and signature themes manifested in
their relationships with their clients. The following are a few of the many quotes that illustrate the
level of awareness that students reached in this area:
In the last POTT simlab, I was told I was doing too much work. This is part of my over-
functioning in order to survive signature theme. I could not sit back and allow others to
do the work.

April 2015 JOURNAL OF MARITAL AND FAMILY THERAPY 167

Newman, W. L. (2003). Social research methods: Qualitative and quantitative approaches. Boston, MA: Allyn and
Bacon.
Ni~
no, A., Kissil, K., & Aponte, H. (in press). The next step of the person-of-the-therapist journey: The clinical case
instrument. In R. A. Bean, S. Davis & M. Davey (Eds), Clinical supervision activities for increasing competence
and self-awareness. Hoboken, NJ: Wiley Press, Inc.
Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical
practices. Psychotherapy, 48, 90102. doi: 10.1037/a0022161.
Nouwen, H. J. M. (1979). The wounded healer. New York, NY: Doubleday.
Satir, V. (1987). The therapist story. Journal of Psychotherapy and the Family, 3, 1725.
Simon, G. (2006). The heart of the matter: A proposal for placing the self of the therapist at the center of family ther-
apy research and training. Family Process, 45, 331344.
Sprenkle, D. H., Davis, S. D., & Lebow, J. L. (2009). Common factors in couple and family therapy. New York: Guil-
ford.
Storm, C. L. (1997). Live supervision revolutionizes the supervision process. In T. C. Todd & C. L. Storm (Eds). The
complete systemic supervisor. Context, philosophy, and pragmatics. (pp. 195216). Needham Heights, MA: Allyn
& Bacon.
Titelman, P. (Ed.). (1995). The therapists own family: Toward the dierentiation of self. Lanham, MD: Jason Aron-
son, Inc.

NOTE
1
A more detailed description of this training can be found in Aponte et al. (2009). For descrip-
tions of specic class exercises, please refer to Aponte and Carlsen (2009), Kissil, Ni~no, and Apo-
nte (in press), and Ni~no et al. (in press). A manual detailing POTT, its principles, and procedures
is currently being written.

176 JOURNAL OF MARITAL AND FAMILY THERAPY April 2015

students feel more at ease with the intensity in the room, to get in that dirty bath water, and
to not feel sucked in by the drama. Additionally, this helped students feel more present and
genuine during their sessions. As one participant stated:
I feel more and more comfortable asking my clients what they are feeling and recognizing
it because I am getting more comfortable in doing it with myself. I have allowed myself
to be more open with myself and others and it has allowed me to make more human
connections with my clients.
Acknowledging their own emotions, tracking them while with clients and better managing
emotions during their clinical work seems to be the foundation for using their own emotional expe-
riences during clinical encounters more purposefully; another professional gain reported by stu-
dents. For example, participants reported making use of their emotional experience in session as a
guide during the process, and as a way to inform their assessment and their interventions. They
also reported making use of their emotions to make therapy more human and genuine. As reported
by a student I can pause and address the emotional atmosphere as I am observing it, without
sounding clinical or supercial, but coming from a place of felt emotion. Students most frequently
used their own emotions to connect with their clients. They reported using their emotions to under-
stand the depth of the clients experience and struggle. They also described tapping into their own
experiences of anger, joy, loss, frustration, hope, or abandonment to better understand their
clients situation. As stated by one of the participants:
My client was feeling very betrayed and was getting very worked up. I found myself, even
though I had never been through something like that, being able to tap into my own feel-
ings and intuition. I was able to connect to his feelings of betrayal and his feelings of being
powerless and losing control.

Improved Clinical Work

The third area of professional growth, reported by 34 students, was improved clinical work,
which included the development of their clinical identity. In relation to this, participants reported
trusting themselves more, increased self-condence and higher sense of preparedness within their
role as therapists. In the words of one participant: Surprisingly enough, I feel ready and prepared.
I think that is what I got most from POTT as far as professional growth. I feel condent in who I
am as a therapist, aws and all.
Another key aspect of improved clinical work described by participants was learning new skills
and techniques. For example, one student said I do see my clinical skills improving tremendously
with regards to assessment and intervention. More specically, students mentioned better concep-
tualization of cases, requesting feedback from clients at the end of the sessions, or switching
communication styles according to the needs of the clients.
Taking control of the session, being vocal, and having more authority were also mentioned by
several participants in the study as examples of their improved clinical work. Participants realized
that as therapists, their role was to challenge clients by being more assertive and willing to suggest
things. As stated by one of the students: I went from not speaking and interacting in my sessions
to taking control of the sessions and having true interactions with my clients. Participants also
reported being better able to distinguish between process and content. In relation to this, one student
explained the following:
I give clients the opportunity to feel heard by their sharing the content, but I do not get
overwhelmed by or swamped in detail. It is this increasing ability to separate content from
process that is helping me become a therapist rather than just a person who has always
been a good listener and easy to talk to.
More dierentiation and better professional boundaries with clients and coworkers was an addi-
tional aspect of improved clinical work mentioned by the students. Not only did students state that
they were able to identify and connect with clients but they were also able to dierentiate from
them. This allowed students to be present during emotionally charged therapeutic moments while
maintaining a distinction from their clients, as evidenced by this student:

April 2015 JOURNAL OF MARITAL AND FAMILY THERAPY 169

 I am learning to dierentiate from my clients, it was hard for me at rst not to draw on
the similarities between my family of origin and my clients and therefore make conclu-
sions about the people based on my own upbringing.
Some students reported being better able to take risks or try new things in session as another
gain resulting from participating in POTT. For example, a student stated that she was previously
worried about making mistakes but later realized that therapists make wrong suggestions all the
time and just have to keep trying. It was this ability to take risks that allowed the therapist to
challenge the clients, while understanding that this process takes practice. Lastly, students also
perceived themselves as being more authentic with their clients. Participants stated that they origi-
nally struggled with wanting to be seen as professional but realized that being authentic
resulted in being able to relate to their clients pain and problems. Students found that being
authentic was a skill that improved clinical work. In relation to this, one participant stated the
following:
Not only has this helped me to work more eectively but it has also helped me to become
more condent with trusting my instincts because they are coming from a genuine place.
In fact, I have found that it is appropriate and in many ways benecial to simply be myself
and utilize what I oer naturally.

Humanity and Woundedness

The fourth most common theme, mentioned by 27 of 54 students was humanity and wounded-
ness. Students wrote about acknowledging their aws, accepting their painful life struggles, and
seeing their shortcomings as a normal aspect of being human. They noted that being imperfect was
a thought that they could bear, and the desire to hide their own shortcomings from the world or to
pretend they never existed decreased after completing POTT. They accepted that being human
meant having weaknesses or vulnerabilities, and that this was something they shared with others.
In the words of one student, I no longer see myself as an awful therapist in training. I have begun
to forgive myself for not being perfect, and I am beginning to comprehend my strength. Another
student wrote I think that this whole process has all in all helped me nally feel comfortable in my
own skin.
Students also reported having more empathy toward their own vulnerabilities and humanity,
which in turn, allowed them to humanize their clients. As a result, trainees were better able to
empathize with their clients and their ongoing struggles. Furthermore, students began perceiving
their own emotional wounds as assets that could help them become more eective therapists by
connecting better with their clients. One student, for example, wrote It never crossed my mind
that I can use my life experiences to emotionally walk with someone and experience in some way
the hurt and pain someone else felt. Another trainee stated the following:
I have been deeply hurt, but all my pain is a wondrous tool because my clients have been
deeply hurt as well. Every bad experience in my life can be turned around and made into a
tool for healing others.
As students became more comfortable experiencing their own humanity and woundedness,
they described actively using their vulnerabilities in their clinical work. One student wrote about
her experiences with a specic client, When I started to look at him (my client) with empathy,
compassion and reaching into the scared, abandoned part in me I begun to relate to him in a dier-
ent way. Another student wrote the following:
My journey throughout this course helped me understand that everyone experiences some
type of loss, trauma and happiness, but in various forms. And as a therapist it is up to me
to challenge myself to nd that moment in my life that will allow me to join with my cli-
ents because progress begins with joining.
Students reported that the ability to reach into their painful experiences enabled them to better
connect with clients from various backgrounds. Even though their clients may have stories that
were very dierent from their own, below the surface, their clients were struggling with similar

170 JOURNAL OF MARITAL AND FAMILY THERAPY April 2015

emotional pains and diculties. Students reported experiencing themselves connecting to their
clients through their shared humanity. One of the students stated the following:
I know that I can connect with clients whatever their story is. It is through POTT that I
have realized that our shared humanity is what connects us. So regardless of content I
can connect with the clients pain. Even if I do not agree with them I can use my own
experience of hurt, pain, anger to connect with the client and what they are feeling.

Meta-Awareness
The fth theme, mentioned by 17 students was meta-awareness. Students wrote about develop-
ing an ability to observe the therapy process from outside and to more clearly observe themselves
in this process. In addition, they wrote about an evolving understanding of what therapy was and
what the therapists role was. At the end of the training they perceived therapy as a process which
is meant to empower people, to help them take charge of their lives and to free themselves from
self-imposed burdens, rather than a process aiming at xing people and solving their problems.
One of the students wrote the following:
I no longer perceive myself as a therapist who needs to save people from their problems
because now I understand that problems are always going to exist. At this point in my
journey as a therapist, I no longer seek to save people, but empower them.
Another student wrote the following:
I realize I do not have to do the work for the clients but to be there for them to guide them
and to coach them. I am there to facilitate the process, be understanding and to remain
open and nonjudgmental.
Students also described a dierent understanding of their roles as therapists. They conveyed
an understanding of the importance of being versus doing, realizing that being fully present and
engaged with the client is more important than what they do or say, as one of them related:
Now I understand that therapy is not about doing. It is about being. When confronted
with pain I still have an overwhelming urge to make the pain go away, but I own that
response, understanding that the aversion and tending is my response to my own pain as
it is being triggered by my clients pain.
Furthermore, students reported acknowledging and accepting that the work on the self of the
therapist is important and experiencing a clear connection between this work and their eective-
ness as therapists. They indicated understanding that this is a life-long process, but that being in
the process and continuing to struggle with their issues can potentially help them become better
therapists. One of the students wrote the following:
That process was inuential to me because it helped me realize that I will continue to
struggle with my signature theme, but that the struggle does not have to keep me from
being a good therapist. I came to realize how my continuing struggle will only help me to
empathize more with my clients own struggles.
In addition, students commented on realizing that there was a reciprocal relationship between
their professional selves and personal selves and they reported noticing the interplay between the
two. One of the students wrote the following: I think that because of this class, I learned that who
I am as a person greatly aects who I am as a therapist. Another one stated the following: My
professional growth is interrelated to my personal growth.

Factors that Contributed to the Learning Process

Although the two questions students were given did not specically ask about aspects of the
training that facilitated their learning process, several students spontaneously wrote about factors
that helped them reach the reported professional growth. Participation in the simlab was reported
by 12 students as being an experience that helped them clearly see the eects of their signature
themes and other personal factors on their therapeutic work. By receiving direct feedback from the

April 2015 JOURNAL OF MARITAL AND FAMILY THERAPY 171

instructors in real time and processing this experience in class, students were able to see their
clinical strengths, identify areas of improvement and learn ways to address them during the simlab
itself and in their future clinical work.
The second most frequently mentioned factor that contributed to students learning was the
group context, which was mentioned by 10 students. In addition to feeling supported by their fel-
low classmates in this intense training process, students stated that hearing their classmates stories
exposed them to a variety of experiences that in turn helped them to better connect with their cli-
ents diverse realities. Furthermore, watching classmates in the role of therapist allowed students
to see dierent therapeutic techniques in action and assess whether these would t in their actual
work with clients. One student mentioned the following: Watching my classmates hold sessions
allowed me to see various styles and walk away with something new to add to my bag of tricks, or
something to remind myself never to do.

DISCUSSION

The goal of this qualitative study was to explore the perceptions of rst year masters level
marriage and family therapy students of professional gains following a 9-month Person-of-the-
Therapist Training (POTT) program. Our ndings suggest that participants experienced signicant
transformation in several areas related to self, including self-knowledge and self-acceptance of
struggles and vulnerabilities, access to self and increased ability to proactively use their selves in
therapy to connect, assess, and intervene. All three areas of change (self- knowledge and accep-
tance, self-access, and proactive use of self in therapy) are directly targeted by POTT. These nd-
ings suggest congruency among the training stated goals, the methods used to facilitate these goals
and the training outcomes, as perceived by the participants.
At the end of the POTT program, students perceived themselves as being more self- aware and
reported knowing themselves better both individually and interpersonally. Increased knowledge of
self is a specic goal of the POTT model (Aponte et al., 2009). Our ndings suggest that POTT has
been successful in promoting increased levels of self-knowledge and self-awareness.
Participants in our study not only reported better knowledge and understanding of them-
selves, but also wrote about the important changes in their level of self-acceptance. Students
described having more empathy and understanding toward their own shortcomings and struggles
in life. They accepted their own humanity and felt less ashamed of their own aws and imperfec-
tions. They reported feeling more comfortable with who they were and a decreasing need to hide,
deny, or reject parts of themselves they did not appreciate. Increased self-acceptance is viewed as
an important part of the training, allowing therapists to use more of their selves in therapy.
According to POTT, when the therapist accepts her vulnerable parts, she is then able to use experi-
ences, memories and emotions related to these parts, as needed, in order to connect with her clients
(Aponte & Kissil, 2014). Increased access to self is the second goal of the POTT training and
participants in our training clearly reported feeling more comfortable accessing more of their selves
as a result of accepting these unwanted and hidden parts of themselves.
The third part of the POTT training focuses on participants abilities to use themselves in ther-
apy, especially to tap into their own struggles and vulnerability, in order to connect, assess, and
intervene with their clients (Aponte & Carlsen, 2009; Aponte & Kissil, 2014). The students in our
program reported experiencing a clear connection between knowing and accepting themselves and
using themselves in therapy. Participants could vividly describe how they were able to use them-
selves in therapy with specic examples from their cases. First, participants reported that their abil-
ity to connect to their own vulnerability has allowed them to be more present in their sessions, and
has increased their ability to connect with clients from various backgrounds. Second, they reported
that they were able to use themselves to intuit where the clients were and therefore better assess
what the clients were struggling with, which then helped them to decide how to intervene. Develop-
ing this ability is the essence and the ultimate purpose of the POTT training. Our ndings suggest
that the POTT training has been eective in facilitating the development of this ability.
Therapists self-awareness in general and during the therapeutic process in particular has been
found to help them be more present in sessions and more engaged with clients, as reported by both
therapists and clients (Fauth & Nutt-Williams, 2005). Therefore, by helping the therapists become

172 JOURNAL OF MARITAL AND FAMILY THERAPY April 2015

more aware of themselves, POTT can contribute to strengthening the therapeutic relationship,
which is turn facilitates better therapeutic outcomes (Norcross & Wampold, 2011; Sprenkle, Davis,
& Lebow, 2009). Having more self-acceptance allows therapists to be more congruent and genuine
while interacting with their clients, qualities that were also found to be associated with positive
therapy outcomes (Kolden, Klein, Wang, & Austin, 2011).
A primary premise of the POTT training is the belief that we are all wounded healers and
our shared humanity is what enables us to connect to our clients. The POTT model emphasizes
that our long lasting struggles may never be resolved. Thus, we will always be wounded healers
and our work on our own self is a life-long process (Aponte et al., 2009). Being a wounded healer
is not viewed as a hindrance to eective therapy but rather allows us to truly understand our cli-
ents struggles and the dicult processes of growth and change. Participants in our training
reported realizing and accepting that becoming an eective therapist is a lengthy process that
requires work on self. They reported being more comfortable with the idea that some of their issues
will always be there to some extent and that the work on self is a never-ending process. They
expressed commitment and willingness to continue to work on their selves because they under-
stood and experienced the interconnection between their personal and professional identities.
Realizing that being imperfect is part of being human, participants reported feeling more com-
fortable with uncertainty. They reported a shift in their understanding of the therapists role from
the all-knowing expert, to a witness, facilitator, and co-participant in a journey. The students
developed a more humble view of themselves and their role in the therapy process. They came to
view the therapeutic encounter as a human-to-human authentic interaction and not as an encoun-
ter between a distant professional prescribing solutions to a helpless client. Consequently, some
students experienced less pressure to perform and were more able to be authentically present in the
moment and pay attention to the process in the room.
The POTT model is based on two primary assumptions: one, that we all carry within us a psy-
chological issue that is at the core of our human woundedness (signature theme/s); and two, that
for therapists to be able to relate most eectively to their clients, they must learn to work with and
through this core issue (Aponte & Kissil, 2014). The POTT model takes a unique stance regarding
the value of these core psychological issues by rst, suggesting that these signature themes are pow-
erful resources that can signicantly enhance therapists eectiveness, and second, by placing the
importance of learning to work through these signature themes at the heart of the training of thera-
pists in the use of self (Aponte & Kissil, 2014). Our ndings suggest that working through the sig-
nature themes and helping trainees acknowledge, access and use these emotional issues increase
their perceived eectiveness as therapists.
The participants reported two aspects of the training especially helpful in promoting their per-
ceived eectiveness; the opportunity to work with a simulated case and get live supervision, and
the group context of the training. The importance of live supervision has been extensively
addressed in the literature and is viewed by many in the eld as an eective modality of supervi-
sion, allowing the acceleration of learning and performance (e.g., Storm, 1997). Our ndings pro-
vide additional empirical evidence to the benets of live supervision even with simulated clients.
The other aspect of the training the participants viewed as benecial is the group context. This
nding supports our own anecdotal experience conducting the training. Although this training can
be done in individual supervision, our experience has taught us that the group amplies the power
of the experience exponentially, a phenomenon recognized by many trainers: The process of the
training group must be considered and used in order to develop a context that can maximize the
development of personal and interpersonal resources (Haber, 1990, p. 4).
The POTT class and the present study are examples of the type of work that we have to do as
a profession in order to connect the goals, methods, and outcomes of MFT education. As the
trainers of future generations of MFTs, it is our responsibility to our profession and our students
to show that we are oering person/self-of-the-therapist training models that are eective, tar-
geted, and have positive impact on therapeutic outcomes. The next step, following this study, will
be to assess its ecacy in improving therapeutic outcomes. Our study shows that it is possible to
reach higher levels of structure in the training of the person of the therapist, and at the same time
humanize the profession by helping trainees use all of who they are as persons in the relationships
that they establish with their clients.

April 2015 JOURNAL OF MARITAL AND FAMILY THERAPY 173

 LIMITATIONS

This qualitative study is based on the students perceptions about their own professional
growth, and their attributions about what contributed to it, which presents two limitations for this
study. Students were quite descriptive and profound in their written accounts of professional gains.
However, the ultimate test of whether the Person-of-the-Therapist Training (POTT) helped stu-
dents enhance their clinical eectiveness is to actually look at therapeutic outcomes for the clients,
and to evaluate students before and after the POTT training to examine change over time. For that
reason, future research needs to take into account the perspectives of clients and clinical supervi-
sors, and consider whether or not the changes reported by the students are also perceived by clients
and supervisors. Moreover, other research methodologies and sources of data should be included,
most notably, the direct observation of therapy sessions.
The second limitation of this study is that the methodology did not make it possible to clearly
discern whether the professional changes that students attributed to participating in the POTT
class are not due to other activities that promote personal and professional growth. Future
research needs to be designed in ways to ensure that the professional growth that students are
reporting is in fact due to the participation in POTT, and not related to other factors such as par-
ticipating in therapy, other classes or supervision. This would require comparing the clinical per-
formance of students before and after taking the POTT class, and having a comparison group that
is not receiving this self-of-the-therapist training. In addition, the methodology employed in this
study does not allow a determination of whether the reported changes will be sustained over time.
Longitudinal research is necessary to answer the question of the long-term impact of POTT.
When considering transferability of these ndings (Lincoln & Guba, 1985), readers are
advised to look at the description of the sample. Among the characteristics of the sample that need
to be highlighted is the fact that these are MFT master level students, who are starting their
careers, and who are mostly young adults. POTT might have dierent eects when implemented
with more experienced clinicians or when the training is not taking place in an academic context.
Also, the majority (52 of 54) of participants were women. It is possible that men or cohorts with a
dierent women-to-men ratio will have dierent experiences in the POTT program.

IMPLICATIONS FOR TRAINING

The results of this qualitative study have important implications for training therapists in mar-
riage and family therapy programs. Since we evaluated the perceived eects of the program as a
whole, we have no way of knowing whether adopting certain parts of the program, as opposed to
implementing the whole training (e.g., using parts of the training in individual supervision), is
likely to bring the same results.
This study provides evidence that it is possible to implement a structured person/self-of-the-
therapist class in a training program without sacricing the genuineness, emotional connection,
and the humanity for those involved. Similarly, the ndings suggest that implementing a person-
of-the-therapist class that focuses on acknowledging, accepting, and using the students core per-
sonal struggles can have positive benets in their professional development.
In addition, students reports suggest that models of person-of-the-therapist work such as
POTT can assist MFT programs in achieving several core competencies (AAMFT, 2004) that per-
tain to personal work to maintain professional competency and prevent misconduct. Therefore,
training programs could incorporate a model like POTT that can assist in the students personal
and professional growth while adhering to the professional marriage and family therapy principles
and accreditation standards (COAMFTE, 2005).
As the students indicated, there were aspects of the POTT format that assisted in promoting
its eectiveness, especially live supervision and the group context. Training programs can potenti-
ate the impact of self-of-the-therapist work by oering students the possibility of live supervised
sessions with mock actors. In these sessions, the focus can be placed on the students clinical
development, without concerns about the wellbeing of the clients. In addition, the supervisor
can provide timely feedback that the trainee can immediately incorporate in his or her work.

174 JOURNAL OF MARITAL AND FAMILY THERAPY April 2015

 Participants indicated that being in a group setting was benecial to their training, which
could have further implication. Training programs or supervisors themselves can provide a group
setting in which students can present, share, and receive feedback that focuses on personal issues.
An intimate setting like this can allow trainees to hear others stories to which they can connect,
providing the opportunity to connect to their own humanity, thereby promoting personal and pro-
fessional growth.

REFERENCES

American Association for Marriage and Family Therapy (2004). Marriage and family therapy core competencies.
Retrieved from http://www.aamft.org/imis15/Documents/MFT_Core_Competencie.pdf
American Association for Marriage and Family Therapy. (2012). AAMFT code of ethics. Retrieved from http://www.
aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx
Aponte, H. J. (1992). Training the person of the therapist in structural family therapy. Journal of Marital and Family
Therapy, 18, 269281.
Aponte, H. J., & Carlsen, C. J. (2009). An instrument for person-of-the-therapist supervision. Journal of Marital and
Family Therapy, 35, 395405.
Aponte, H. J., & Kissil, K. (2014). If I can grapple with this I can truly be of use in the therapy room: Using the
therapists own emotional struggles to facilitate eective therapy. Journal of Marital and Family Therapy, 40,
152164.
Aponte, H. J., Powell, F. D., Brooks, S., Watson, M. F., Litzke, C., Lawless, J., et al. (2009). Training the person of
the therapist in an academic setting. Journal of Marital and Family Therapy, 35, 381394.
Aponte, H. J., & Winter, J. E. (2000). The person and practice of the therapist: Treatment and training. In M. Bald-
win (Ed.), The use of self in therapy (2nd ed.) (pp. 127165). New York, NY: Routledge.
Baldwin, M. (Ed.). (2000). The use of self in therapy. New York, NY: The Hartford Press.
Blow, A. J., Sprenkle, D. H., & Davis, S. D. (2007). Is who delivers the treatment more important than the treatment
itself? The role of the therapist in common factors. Journal of Marital and Family Therapy, 33, 298317.
Bowen, M. (1978). Family therapy in clinical practice. New York, NY: Jason Aronson, Inc.
Bula, J. F. (2000). Use of the multicultural self for eective practice. In M. Baldwin (Ed.), The use of self in therapy
(pp. 167189). New York, NY: The Hartford Press.
Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) (2005). Accreditation stan-
dards: Graduate & post-graduate marriage and family therapy training programs version 11.0. Retrieved from
http://www.aamft.org/imis15/Documents/Accreditation_Standards_Version_11.pdf
Fauth, J., & Nutt-Williams, E. (2005). The in-session self-awareness of therapist-trainees: Hindering or helpful. Jour-
nal of Counseling Psychology, 52, 446447 doi: 10.1037/0022-0167.52.3.443.
Goodell, K. A., Sudderth, B. G., & Allan, C. D. (2011). The self of the therapist. In L. Metcalf (Ed.), Marriage and
family therapy: A practice oriented approach (pp. 2138). New York, NY: Springer.
Haber, R. (1990). From handicap to handy capable: Training systemic therapists in use of self. Family Process, 29,
375384.
Hardy, K. V., & Laszloy, T. A. (2002). Couple therapy using a multicultural perspective. In A. S. Gurman & N. S.
Jacobsen (Eds.), Clinical handbook of couple therapy (pp. 569593). New York, NY: The Guilford Press.
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research,
15, 12771288.
Kissil, K., Ni~no, A., & Aponte, H. (in press). The beginning of the person-of-the-therapist journey: Using signature
themes to facilitate greater therapists eectiveness. In R. A. Bean, S. Davis & M. Davey (Eds), Clinical supervi-
sion activities for increasing competence and self-awareness. Hoboken, NJ: Wiley Press, Inc.
Kolden, G. G., Klein, M. H., Wang, C. C., & Austin, S. B. (2011). Congruence/genuineness. Psychotherapy, 48(1),
65.
Lincoln, Y. S., & Guba, E. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.
Lum, W. (2002). The use of self of the therapist. Contemporary Family Therapy, 24, 181197.
Lutz, L., & Spell Irizarry, S. (2009). Reections of two trainees: Person-of-the-therapist training for marriage and
family therapists. Journal of Marital and Family Therapy, 35, 370380 doi: 10.1111/j.1752-0606.2009.00126.x.
McDowell, T., Brown, A. L., Cullen, N., & Duyn, A. (2013). Social class in family therapy education: Experiences of
low SES students. Journal of Marital and Family Therapy, 39, 7286 doi: 10.1111/j.1752-0606.2011.00281.x.
Negash, S., & Sahin, S. (2011). Compassion fatigue in marriage and family therapy: Implications for therapists and
clients. Journal of Marital and Family Therapy, 37, 113 doi: 10.1111/j.1752-0606.2009.00147.x.

April 2015 JOURNAL OF MARITAL AND FAMILY THERAPY 175

Newman, W. L. (2003). Social research methods: Qualitative and quantitative approaches. Boston, MA: Allyn and
Bacon.
Ni~
no, A., Kissil, K., & Aponte, H. (in press). The next step of the person-of-the-therapist journey: The clinical case
instrument. In R. A. Bean, S. Davis & M. Davey (Eds), Clinical supervision activities for increasing competence
and self-awareness. Hoboken, NJ: Wiley Press, Inc.
Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical
practices. Psychotherapy, 48, 90102. doi: 10.1037/a0022161.
Nouwen, H. J. M. (1979). The wounded healer. New York, NY: Doubleday.
Satir, V. (1987). The therapist story. Journal of Psychotherapy and the Family, 3, 1725.
Simon, G. (2006). The heart of the matter: A proposal for placing the self of the therapist at the center of family ther-
apy research and training. Family Process, 45, 331344.
Sprenkle, D. H., Davis, S. D., & Lebow, J. L. (2009). Common factors in couple and family therapy. New York: Guil-
ford.
Storm, C. L. (1997). Live supervision revolutionizes the supervision process. In T. C. Todd & C. L. Storm (Eds). The
complete systemic supervisor. Context, philosophy, and pragmatics. (pp. 195216). Needham Heights, MA: Allyn
& Bacon.
Titelman, P. (Ed.). (1995). The therapists own family: Toward the dierentiation of self. Lanham, MD: Jason Aron-
son, Inc.

NOTE
1
A more detailed description of this training can be found in Aponte et al. (2009). For descrip-
tions of specic class exercises, please refer to Aponte and Carlsen (2009), Kissil, Ni~no, and Apo-
nte (in press), and Ni~no et al. (in press). A manual detailing POTT, its principles, and procedures
is currently being written.

176 JOURNAL OF MARITAL AND FAMILY THERAPY April 2015