6The Call to Engage in Inner Work as Therapists

Toupey Luft, Nan Stevens

Imagine increasing your capacity as a therapist and maximizing benefit to your clients and society in general. This is what we are called to do by the ethical standards of the Canadian Code of Ethics for Psychologists (Canadian Psychological Association [CPA], 2017). The Code’s Principle II (Responsible Caring) speaks to the importance of enhancing benefit and minimizing harm to the people we serve. All helping professionals, regardless of discipline, would likely endorse the philosophy of this Principle. However, we also might struggle with how we can put this Principle into practice. Using our lived experiences, we offer some ideas about one important way of putting it into practice.

Introductions

Dr. Toupey Luft: I am a registered psychologist in Alberta and hold a PhD in counselling psychology from the University of Calgary. I am also an assistant professor in the Faculty of Education at the University of Lethbridge. My research program involves examining the practices of mindfulness and self-care for clinicians and how these are important for ethical practice. Like Nan, I identify as an integrative therapist and appreciate drawing from humanistic, feminist, family systems, cognitive-behavioural, and Jungian approaches.

Dr. Nan Stevens: Nan is a certified art therapist in British Columbia and holds a doctorate in education (EdD) from the University of Calgary. Nan is also an associate professor in the School of Education and Social Work at Thompson Rivers University. Her specialty area is teacher education, specifically inclusive and special education. Her scholarly work intersects with her passion for self-study, professional identity, diversity, and arts-informed research methods. Her art therapy background informs her present research and commitment to art-based methods.

Below we outline our initial experiences with inner work in our lives that influenced us to continue such practices in our graduate training and beyond. We also briefly identify turning points; that is, moments in our professional lives when things got real for us in terms of the link between inner work and our ethical responsibilities.

Becoming Aware of the Call to Inner Work

We entered the helping professions of counselling and art therapy because we wanted to help people transform and heal. This is a motivation we find echoed by almost all our colleagues. Early in our careers, we were less aware of how our own experiences in life and subsequent patterns of interacting with others may have driven our decision to become helping professionals. However, along the way, we came upon Jung’s notion of the wounded healer, which held that all therapists have their wounds, but that those wounds can be transformed through inner work in a way that provides personal healing and can be used to assuage the suffering of others (Cvetovak & Adame, 2017). In this chapter, we describe our personal journeys as wounded healers and the inner work processes that resulted and subsequently informed our service to others. We also outline how the habit of inner work is important for helping professionals at all points of development and how this work can contribute to our ability to uphold our ethical responsibilities. Below we define inner work and then outline how inner work has played a role in our personal and professional lives, including delineating some ethical standards unique to the practices of psychology and art therapy.

Defining Inner Work

Inner work, sometimes referred to as process work (Mindell, 2016), can be accomplished through many different forms. Essentially, inner work involves looking inward at the self, and includes such practices as guided meditation, individual or group therapy, personal counselling, art-making, dream work, journaling, spiritual ceremonies, and mindfulness training. Ratner (2015) describes inner work as leading to “the place of presence [emphasis added] and being both in psychotherapy and in one’s life as guiding principles” (p. 2). She refers to the power of presence as a way of being whereby one sits with one’s experience and can express caring for oneself and for another. Others have underscored the importance of various types of inner work for maintaining one’s self-awareness and competence as a therapist; including the importance of personal counselling or therapy (Loewenthal, 2019); prayer, meditation and other spiritual practices (Mensah & Anderson, 2015); the use of journaling (Gibson, 2018); and the relationship between art-making and self-care (Riedl, 2015).

Inner Work and Presence

Ratner is but one of many to write about the power of presence in the therapeutic environment. The idea, although somewhat hard to define (Geller & Greenberg, 2002), was first proposed by humanistic therapists as a fundamental component of therapy and the building block for all therapeutic change. Bugental (1978) wrote that the nature of presence was to be as attentive in the moment as one can be with another human being.

Rogers wrote about the core conditions of empathy, genuineness, and unconditional positive regard for building healing relationships with clients (Corey, 2017). In his later writings, he began to discuss the importance of the therapist’s presence for accessing these core conditions (Rogers, 2007). We are drawn to these ways of being in therapy as we have both seen the power of presence with our clients and believe that inner work has played a key role in facilitating our ability to engage this presence within the therapeutic relationship. These humanistic descriptions of presence resonate for us as we see how presence provides a connection to how we cultivate and express empathy and compassion for clients (presence in psychotherapy) as well as a way to show this empathy and compassion to ourselves and others (presence in life as guiding philosophy) (p.2). Most recently, Bourgault and Dionne (2019) defined psychological presence as “the capacity to bring one’s whole self into encounters with clients by being present on multiple levels” (p.50). We were encouraged to read this definition from 2019 as it brought together much of the humanistic descriptions we outline above.

Siegel (2010) also emphasized the need for presence in all our human interactions, not just our professional therapeutic ones. He calls presence a state of “being open and creative with possibilities . . . being aware of the present moment without grasping onto judgements” (p.1). Siegel posits that the practice of mindfulness is a cornerstone of developing one’s ability to be aware, open, and creative. For Siegel and for us, mindfulness is viewed as a practice that can cultivate a state of presence. We have found, in our experiences as therapists, that it is difficult to be present to what is unfolding at the moment with a client unless we are mindful of the moment. We also agree with Siegel’s idea that greater presence in our interactions with others, particularly our clients, can assist us to have reflective responses (where we can take a moment to decide what we want to do or say) instead of reactive responses (where we say or do something without thinking it through, which is more likely to harm others). In line with the notion of self-reflection, we also see the practice of mindfulness as an important component of inner work practices.

Inner Work and Ethical Practice

In addition to its connection to presence, inner work involves questioning and examining one’s life and oneself in an open manner (Bernhardt et al., 2019; Ratner, 2015; Salter & Rhodes, 2018). It also can include self-reflection via the means mentioned above (meditation, therapy, etc.), and can involve becoming aware of one’s biases, values, and identity (Andrews, 2009). Inner work fits well with the Principle II “Values Statement” of the Code (CPA, 2017, para 5), which emphasizes the key importance of self-knowledge and self-reflection to Responsible Caring. It also fits well, in particular, with Ethical Standard II.10, which emphasizes becoming aware of one’s own experiences, background, beliefs, and values, and integrating this awareness into our efforts to benefit and not harm others. The reader is referred to Table 1 below, which outlines relevant excerpts from both Principle I (Respect for the Dignity of Persons and Peoples) and Principle II (Responsible Caring). Principle I and its application will become relevant later in the chapter.

As Nan is a certified art therapist, Table I also contains some relevant standards from the Canadian Art Therapy Association’s (CATA) Standards of Practice (CATA, 2004), outlining art therapists’ responsibilities to maximize therapeutic benefit to their clients while minimizing harm, particularly the standards outlined in Section C. It also contains excerpts from CATA’s Educational Standards, which encourage students in training to be involved in their own therapy, with the aim of fostering “deep personal awareness and understanding of the therapeutic process” (CATA, 2015, Standard 2.3b).

We found that the process of personal therapy provided us both with a helpful vehicle to develop greater empathy and compassion for our clients. However, we acknowledge that personal therapy is only one of several options for engaging in inner work. Further, we maintain that personal inner work for the helping professional can be both preventative (helping us become more self-aware so we can integrate this with our knowledge and skills to be present and helpful to our clients) and responsive (helping us when something happens in the counselling hour that may overwhelm or trigger us). Overall, we see inner work in its many forms as the process of connecting to our mind, heart, and our body in ways that inform how we respond to others and ourselves. We believe that involvement in inner work has helped us to be less reactive to issues that arise with clients, as well as ultimately being better helping professionals. Consistent with the Canadian Psychological Association’s Mutual Recognition Agreement (CPA, 2004), we also believe that the self-knowledge that can result from inner work is a key component of competency for our interpersonal relationships as therapists, and that this helps increase our presence with ourselves and with our clients (Ratner, 2015).

Our Early Experiences with Inner Work

Below we outline key experiences with inner work in our lives that have influenced us to continue such practices in our graduate training and with our work as practitioners. We also briefly identify turning points; moments in our professional lives when things got real for us in terms of the link between inner work and our ethical responsibilities.

Nan Stevens, Certified Art Therapist (British Columbia)

One of the primary ways I have engaged in inner work has been through the art therapy process. I learned about art therapy when my younger brother, at the age of 20, was diagnosed with terminal cancer. At that time, my family explored numerous interventions to assist in his treatment, one of which was art therapy. While my brother was taking part in art therapy sessions, I became curious about the processes used in art therapy and began exploring art-making as it related to my own emerging feelings of grief and loss. I was so impressed by the impact that art therapy was having on my brother and me, that I enrolled in the two-year graduate training program at Vancouver Art Therapy Institute. During my time in the program, both my brother and father passed away.

Participation in group therapy was a requirement of the Art Therapy Institute training program. It proved invaluable in helping me to cope with my recent losses. Through the group process, I was able to work through the issues related to grief and loss, including my feelings of anger, sadness, and guilt. In retrospect, I realize that having such a supportive place to seek help was invaluable to my work as an emerging practitioner. As a result of the quality of my experience with the mandated group therapy, I decided to continue to engage in personal therapy after completing my training.

Turning Point

The importance of helping professionals engaging in some type of inner work during preparatory training became evident for me during my early days as an art therapist. A client came to me for help with processing her grief and associated conflicts regarding her dying mother. Having worked through conflicts in my personal situation (losing two close family members), I was better prepared to facilitate the client’s process. During art therapy training, I had become aware of the impact of my own life experiences and had the opportunity to process many of my feelings around these experiences. Rather than getting caught up in my feelings of grief, I felt confident that I could assist the client by focusing on her story, not my own. As CATA Standard of Practice C.5 (CATA, 2004) indicates, there are a number of ways to maintain professional competence, including ongoing self-evaluation and personal therapy, among other choices (See Table 1). For me, I found evaluating my reactions and drawing upon the learning I had done during group and personal therapy to be helpful to me during the above ethical challenge of my life circumstances interfering with my ability to be of benefit to the client.

Toupey Luft, Registered Psychologist (Alberta)

I came to inner work by seeing it modelled in my family of origin. My parents attended spiritual and self-awareness workshops and they were both in the helping field. Our family engaged in family therapy at one point due to a crisis when I was a teenager. At that time, I already knew I wanted to be a psychologist. However, I still felt somewhat uncomfortable with attending family therapy. I think I was embarrassed that my family and—by extension—I required help. Later, as a young adult, I sought personal therapy and worked through some of the stumbling blocks related to being more present (Ratner, 2015) with myself and others in my life. Despite encouragement from a select number of friends and family for engaging in inner work via therapy, I did not share this information with many others early in my undergraduate years as I thought I may be stigmatized and judged harshly. I was under the common misconception that therapists (and therapists in training) have all the “answers” and have worked out all of their issues; thus, to have to admit to inner work in the form of therapy felt like a failure. I eventually came to embrace talking about these issues, and this will be outlined further below.

Wounded Healer

Another important concept related to inner work for me is that of Jung’s wounded healer. I came upon Jung’s notion of the wounded healer when studying goddess spirituality as part of preparation for a paper in my graduate counselling theories course. I was inspired by the Greek myth of Asclepius, who after acknowledging his unconscious wounds, became a wounded healer who helped others heal (Jung, 1954/1966). Jung maintains that communication between patient and therapist (or analysand and analyst) is a balancing act for the analyst in terms of remaining open to hearing about the wounds of the analysand and monitoring their own wounds that may be activated during this interaction (i.e., counter-transference). This framing fit well for me as a developing clinician who was learning about counter-transference and the importance of self-reflection in interacting with clients and others.

Turning Point

The importance of inner work and how it can influence our ethical engagement with clients became more evident to me when I began to work with several people who triggered negative reactions in me. I noticed that these reactions were similar to those I had with several important persons from earlier times in my life. Drawing upon the foundation of inner work I had undertaken, I found I was able to manage these negative reactions and not get stuck in my counter-transference issues. My understanding of the wounded healer and monitoring one’s own wounds was helpful here as well. Although I do not have an objective way to measure the impact of this understanding on the clients I was working with, I feel confident that I was better able to assist them and provide responsible care after engaging in self-reflection about my initial reactions, and by monitoring these reactions to keep communication open during counselling sessions.

Encouraging Graduate Students to Answer the Call

Since we are both educators, and we are passionate about the importance of inner work in the development of helping professionals, we would like to share some key considerations and our own stories regarding how to broach and facilitate the topic of inner work with graduate students studying in the therapeutic helping professions. We also discuss some ethical considerations regarding implementing these ideas with students.

The Wounded Healer and Ethical Practice

Some research indicates that graduate students who enter the helping professions are drawn to help others because of their own distressing life experiences (Messina et al., 2018; Rønnestad & Skovholt, 2003). However, there also is some research that demonstrates there remains strong stigma regarding graduate students’ disclosure of their past or current struggles with distress or what Jung would call “wounds” (Spence et al., 2014). One of the ideas that we utilize in teaching graduate students, which seems to encourage consideration and discussion of inner work, is Jung’s notion of the wounded healer. Contemplating the idea of the wounded healer and counter-transference often requires graduate students to let go of the idea that therapists are the ones with all of the answers, and the belief that they can hold all of their past experiences at bay to assist their clients.

Jung indicates that clients may activate our own wounds, even if we have done some inner work regarding them. Thus, he cautions healers to remain conscious of their reactions and to what degree these are shared with others. For us, the others we might share with include both our clients and our students. In discussing the concept of the wounded healer, Zerubavel and Wright (2012) also acknowledge that, although we may be aware of our reactions, it may not always be beneficial, as therapists, to share our reactions with our clients, as this may detract from our presence, or our ability to focus on the client and be helpful. It is only when our wounds move from unconscious awareness into conscious awareness that we can truly assist in healing others’ wounds (Jung, 1954/1966). In our opinion, Jung’s description of this transformation is consistent with the notion of invoking psychological presence (Bourgault & Dionne, 2019; Ratner, 2015; Siegel, 2010). Further, we believe that these descriptions of being conscious of our “wounds” and taking time to reflect on what we will do with this information parallel nicely with ideas of self-awareness and self-reflection as key components of ethical practice (CPA, 2017).

Introducing Inner Work in Graduate Discussions

As mentioned above, we have engaged in inner work practices to both enhance our therapeutic work with clients, but also to minimize harming them. We believe that learning about inner work and the wounded healer is important to introduce with training helping professionals so that they might understand how these concepts can help build ethical awareness as a developing practitioner. We have witnessed students expressing relief at the direct addressing and exploration of these concepts in graduate training. We concur with Bearse et al. (2014), who indicate that these types of topics are important to bring up during graduate training of helping professionals.

We encourage students to discuss as well as document their reactions to the concept of the wounded healer; to examine the stigma that may surround admitting one has experienced mental distress in the past or currently; and to understand how professional ethics encourages self-knowledge and awareness of issues such as counter-transference and burnout, and how stress or a personal crisis might impact our ability to practice therapeutically. In a way, we are asking our students to begin or continue a form of inner work by reflecting on their responses to the above activities, and how their own experiences have influenced their thoughts and reactions to the topic. We also look at the relevant ethical standards of the Code (CPA, 2017) and/or the CATA Standards regarding maintaining competency (CATA, 2004). We have encouraged students to write reflections regarding how inner work and the concept of the wounded healer support the values statement and relevant standards for Principle II, as well as the CATA Standards C.3 and C.5 (please refer to Table 1). Toupey also has encouraged students to use the ethical decision-making model associated with the Code (CPA, 2017) to examine the benefits and risks associated with inner work.

Turning Point and Other Ethical Considerations

Our graduate students have shown us that discussing the overlap between our personal and professional lives is necessary for contemplating how inner work might be applicable. However, we also realize the essential need for creating ground rules and guidelines for safety, disclosure, and confidentiality for learning to be effective for those in training. Several of our students have shared over the years that they have sometimes felt “shut down” by the comments of others in the classroom or by a vague sense of not wanting to engage in conversations about inner work; sometimes due to fears of being stigmatized. We also recognize that, like our clients, students have a moral right to choose what is healthy and appropriate to share with their peers, as per the Code’s Principle I (Respect for Dignity of Persons and Peoples), specifically Ethical Standard I.38 (CPA, 2017).

In considering the rights of students to protect their own privacy, we have heightened our teaching practices to closely attend to ethical concerns in the classroom. Several writers in the field (Luft et al., 2016; Pope et al., 2006) maintain that a sense of safety is paramount for students to discuss sensitive topics such as how they might engage in inner work or how the concept of the wounded healer fits with their lives.

Ultimately, this sense of safety may be both difficult to establish and maintain in the graduate classroom. Students may state that they feel safe when in fact they do not. This may occur for a variety of reasons, including wanting to please the leader/instructor. Students may initially have a sense of safety, but have it eroded over time due to interactions in class or online. Students may fear an erosion of boundaries, a sense of shame, or both, in disclosing their experiences with inner work. They might begin to compare their experiences with others and determine they are not at the same level as their peers, which may be problematic. There is already a general sense of academic competition among students for scholarships, practicum placements, etc., and we find it takes delicate skill for us as instructors to be aware of this context in moving the conversation about inner work forward. In essence, we need to be mindful of how to responsibly care for our students. However, we believe that encouraging them to continue or begin inner work habits at this stage of their development will ultimately help them serve their clients-to-be more richly and responsibly, and this is why we continue to facilitate inner work as a focus for our students. We encourage our students to explore inner work practices by introducing them to the general idea as well as by utilizing reflection exercises and discussions such as those found at the end of this chapter to encourage critical thinking and decision making for each student.

One of the practical steps we have taken is to monitor our own statements and disclosures in the classroom or online very carefully so that we are balancing the principle of Responsible Caring with the principle of Respect for Dignity of Persons and Peoples. We do not wish the students to feel coerced into inner work (or disclosure around this). Contributing to that type of environment would represent poor ethical modelling on our part. Part of our monitoring includes deciding whether self-disclosure regarding having engaged in inner work will help the student group if we sense that they are struggling with some of the stigmas around helpers not having any personal struggles or issues. Furthermore, any self-disclosure on our part is not meant to pressure students to disclose their own inner work experiences or plans; rather, it is meant to model the fact that we as instructors and senior clinicians value inner work and its potential for helping us be ethical, reflective practitioners. We have found that co-constructing group guidelines around confidentiality and group norms for what people choose to share are foundational cornerstones for facilitating these important conversations and learning moments. Further, peer-to-peer sharing (such as the reflection questions at the end of the chapter) may help facilitate sharing within a smaller group compared to a larger group (e.g., the entire classroom).

Continuing the Practice of Inner Work Beyond Graduate School

Toupey’s Journey

One of the areas in which inner work helped me immensely as a newer therapist was in balancing impostor syndrome (Clance & Imes, 1978) with the limits of my professional competence. Early on in my career as a post-master’s degree therapist, I often suffered from worrying that I did not know how to help clients. In sessions, I frequently would run some of the scripts in my mind that Clance and Imes (1978) identify as associated with impostor syndrome. Some of my favourite scripts centred around being worried that I would be found out by my clients for not knowing what I was doing, and around my belief that at one level I was fooling them and, if they looked deeper, they might notice that I did not really have any business being a therapist. To say that this detracted from my ability to be present and helpful to my clients at the time is an understatement.

To help me with this issue, I sought the advice of a more senior therapist, who was also my supervisor. She objectively reviewed the issues and the methods I was using and indicated that she believed these were within the scope of my competence. She helped clarify that my self-doubt was probably getting in the way of my ability to serve my clients. She gently encouraged me to seek support through inner work practices and spoke openly about how engaging in her own therapy at various times in her life had helped her overcome roadblocks. I decided at that juncture to seek out further therapy (it had been several years since I had attended therapy as an undergraduate). The application of the Code’s Ethical Standard II.8 (CPA, 2017), regarding seeking supervision and/or consultation if one is concerned that client issues are beyond their scope of competent practice, became part of my lived practical experience.

Turning Point

Another situation where the helpfulness of inner work became very relevant was when I lived through a health crisis when practising as a psychologist full-time in private practice. I had to be hospitalized and was very worried about myself and my ability to function in the future. In reflecting, I realized that the situation represented, in a very real way to me, what the Code’s Ethical Standard II.11 (CPA, 2017) states:

Seek appropriate help and/or discontinue scientific, teaching, supervision, or practice activity for an appropriate period of time, if a physical or psychological condition reduces their ability to benefit and not harm others (p. 20).

It was not until I experienced such a personally impactful health event that I fully understood what this Ethical Standard meant. I had to take a break from seeing clients and to communicate this to them, as well as provide access to alternate resources. This was difficult for me to accept, as I perceived my inability to continue to see clients as a failing. I also experienced a great deal of worry about the future and how my health condition would affect my future in all realms, including the personal and professional ones. I engaged in many inner work practices to assist me with the personal healing process, and again attended therapy to deal with my anxiety about the future and to move through some trauma associated with the crisis. I also used meditative practices to help calm my fears, and journaling and art-making to help me make sense of what happened and to help me see more clearly the way forward as a person and as a helping professional. In reflecting on this health crisis, I am grateful for it now that several years have passed. Overall, I learned a lot about myself and even more about how the Code can be applied to ethical dilemmas in real life. It also affirmed for me, once again, the value of therapists engaging in their inner work so that they can continue to meet their ethical responsibilities.

Nan’s Journey

The helpfulness of inner work practices for facilitating effective therapy became evident for me during my early days of being an art therapist. One of the important take-away messages from the group therapy requirement of the art therapy program I attended was that grief, anger, and sibling rivalry are typically the big unresolved conflicts in people’s lives (M. Fischer, personal communication, 1999). I used inner work to focus on these issues during my two-year graduate program, particularly grief, as I outlined in the turning point section of my introduction.

Growing up as the middle in a family with five children, I dealt with my share of sibling rivalry. One of the significant realizations of my inner work during my art therapy training was that the sibling rivalry was still relevant and active in my adulthood.

As an art therapy student, I was committed to understanding more about my family of origin. The supervising psychiatrist (the late Dr. Martin Fisher) facilitated intense group retreats and brought to our learning the significance of attachment (or lack of) and its role in one’s sense of self and security. It became apparent through my inner work that the lifelong conflict with one of my siblings stemmed from an unconscious and unresolved conflict where the two of us were competing for parental attention and love.

Turning Point

I believe that the learning that came out of this early inner work has been extremely valuable in working with siblings and families in my practice. The early work on attachment by John Bowlby (1969), and the more recent work by Neufeld and Mate (2013), have been pivotal in informing my practice for helping clients. Attachment can be formed later in life and can provide a “corrective” experience for those who may not have had the essential bonding they needed earlier in their lives. Within a safe therapeutic relationship, the client can express needs, be vulnerable, and find the acceptance and love they need to feel self-love and self-acceptance. Neufeld and Mate posit that a therapist is a person who can promote the development of trust and create the space for a healthy attachment relationship.

I had the fortunate opportunity to work with a young woman in my private practice who had lived with an eating disorder since her youth. Through the art therapy process, it was uncovered that she did not have an attachment to either of her parents, and we concluded that the eating disorder was related to the lack of attachment which manifested in self-harm. I worked with this young woman for over two years, using art media (painting and clay) as a place to start expressing her needs, her anger, and her unresolved conflicts with her siblings and parents. Without my insight into my sibling rivalry and my own issues with lack of attachment, I may not have been able to be effective with this client. The significance of CATA’s (2004) Standard C.3 became very applicable to my experience (See Table 1). I learned on a very personal level that the process of engaging in my own inner work helped to prevent potential conflicts within my practice.

Coming Full Circle: Considerations for Continuing the Call

We believe that there is an increase in interest in inner work and its benefits for therapists and their clients. Discussions of inner work have come to prominence in the counselling psychology and art therapy literature, particularly in the past 10 years (e.g., Bamonti et al., 2014; Bernhardt et al., 2019; Hinz, 2011; Salter & Rhodes, 2018). Most professional graduate programs now include discussions of some types of inner work in the practical component of the program (practicum). Indeed, the master’s level counselling program where Toupey recently taught emphasizes self-care, self-reflection, and an invitation to consider engaging in one’s own counselling throughout the program. We have been encouraged by the increased frequency of discussions about the topics related to inner work at professional conferences in the past several years. During Toupey’s master’s-level studies in counselling psychology in the mid-1990s, there was little mention of inner work or its relevance to ethical practice. Although Nan’s art therapy program required the cohort to engage in mandatory group therapy, the ethical implications of this were not highlighted. We are encouraged to see that most art therapy programs now include mandatory ethics courses, as well as encourage inner work as per CATA’s 2015 standards, but not through mandated therapy with one’s cohort.

For early-career helping professionals, we recommend continued inner work as part of honouring the ethical principle of Responsible Caring, and specifically to assist with goals of being of benefit to our clients and minimizing harm. We believe recently licensed or newly registered art therapists or psychologists have a responsibility to continue to utilize inner work and its benefits, especially if transference and counter-transference concerns are relevant to their type of practice. This position is supported by Schwing et al. (2011). Their interviews with novice therapists indicated that participants’ inner work practices such as reflexive journaling helped them move through their feelings of anxiety about their role with clients, as well as bolstered their willingness to address transference and counter-transference concerns.

As our own experiences have shown us, we think it is very important for newer helping professionals to continue to self-examine and self-regulate. This commitment necessitates some type of continuing development through inner work. In many ways, the stakes are higher compared to being a trainee or student. When a person becomes licensed as a helping professional, that person has a direct personal responsibility to maintain the standards related to competence, as teachers and supervisors are no longer responsible.

We believe in a stronger call to incorporating different types of inner work as a proactive component of training and ongoing development. Part of this could entail faculty and student-led discussions of what inner work is, how it can help students and practising professionals be more effective and ultimately more ethical practitioners; and what some of the limitations and concerns are with respect to engaging in inner work. Perhaps as educators of counsellors or therapists, we could incorporate this topic into our course syllabi more frequently. Supervisors of newer therapists could promote the topic by discussing it in supervision. Of course, we must be mindful of standards (such as the Code’s Ethical Standard I.38) associated with privacy and the developmentally—and the culturally defined boundaries of the people who are our clients, students, and supervisees. This means we need to proceed with caution with these types of conversations and respect the needs of those who are most vulnerable in our interactions. We acknowledge this is important for us as educators and supervisors as we have influence and power over trainees and supervisees by virtue of our position. We must keep in mind that we need to broach conversations with our supervisees with caution, continuing to respect their dignity, and ensuring that such conversations are not harmful to the supervisee and that they remain in the realm of supervisory discussions so that the supervisor does not become a therapist to the supervisee.

Future Explorations

Our lived experiences and research for this chapter have made it clear to us that there is a great need to continue the dialogue regarding the ethical implications of inner work and its relationship to practitioners and trainees. We encourage ourselves and those reading to continue considering the following questions throughout one’s development as a therapist: What are the ethical implications for supervisors who mentor developing clinicians? How could newer clinicians in the field be encouraged to engage in inner work? What makes certain practices more fraught with ethical difficulty or a lack of safety? Further, as we have highlighted in this chapter, it is worth considering how enacting Responsible Caring might conflict with other Code (CPA, 2017) principles, such as Respect for the Dignity of Persons and Peoples. Overall, if we truly want to encourage growth for our clients, we might attend to explicating the link between inner work practice and how it may lead to being a more effective therapist. Although there is a great deal of research on therapists’ theoretical orientation and the effectiveness of therapy (Corey, 2017), much less is known about therapists’ various inner work experiences, ethical considerations, and client outcomes (Rousmaniere, 2019). We would thus encourage practice-focused research to explore this link. One of the ways this could be accomplished is to have various clients rate their therapists’ presence (Siegel, 2010) and helpfulness in sessions. Researchers could examine the link between how helpful and present a therapist is to the various types of inner work they have engaged in. In this way, clients need not know about the therapists’ current practices and/or past engagement in inner work. Dan Siegel (D. Siegel, personal communication, October 21, 2018) found that that certain types of inner work practices help therapists achieve empathic, compassionate, and less emotionally reactive states and traits and thus it is important to continue to elucidate this process.

We call on helping professionals at all stages of their development to consider the notion of the wounded healer and how inner work might allow us to embody presence for our clients and ourselves (Ratner, 2015; Siegel, 2010). There will be many opportunities for growth that present themselves in our journey as clinicians. We hope that the desire to help others and to remain healthy ourselves will motivate clinicians at all stages to continue to engage in inner work and to continue to reflect on their own development and efficacy with the people whom we are privileged to assist.

Questions for Reflection

1. What is or what would be your preferred way(s) of doing inner work over the course of your career?
2. What has signalled to you in the past that you need advice from a supervisor or consultant regarding your own well-being? What do you think might signal it in the future?
3. What would signal to you that you need mental health services or supports to continue your work activities or schedule?
4. How would you know if you have a need for a partial or full leave from your work activities in order to avoid harm to yourself or others? How would you know when you are ready to return? Would stigma play a role in either decision?

References

Andrews, P. E. (2009). The courage to explore the inner work of educational leaders. [Unpublished doctoral dissertation]. Lewis and Clark College.

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