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Emotional competence for therapy, as described by Pope and Brown (1996), reflects our awareness and respect for ourselves as unique, fallible human beings. It includes self-knowledge, self-acceptance, and self-monitoring. We must know our own emotional strengths and weaknesses, our needs and resources, our abilities and our limits for doing clinical work.

Therapy can stir strong emotions in both therapist and client. Some clinical work places great emotional demands on us. For example, working with people who survive torture can evoke intense reactions that can lead to secondary trauma, despair, helplessness, and burnout (Allden & Nancy Murakami, 2015; Comas‐Diaz & Padilla, 1990; Long, 2020; Pope, 2012; Pope & Garcia-Peltoniemi, 1991).To the degree that we are unprepared for the emotional stressors and strains of therapy, our attempts to help may be futile and perhaps even harmful.

Table 6.1 presents research findings about intense emotions experienced in therapy. The numbers indicate the percentage of therapists in each study who reported at least one instance of each behavior. Readers who have had experience as therapists or patients may wish to compare their own experience to these findings.

Table 6.1. Percentages of Intense Emotions and Other Reactions in Therapy.

Behaviors	Study 1a	Study 2b	Study 3c
Crying in the presence of a client	56.5
Telling a client that you are angry at them	89.7		77.9
Raising your voice at a client because you are angry at them			57.2
Having fantasies that reflect your anger at a client			63.4
Feeling hatred toward a client			31.2
Telling your clients of your disappointment in them	51.9
Feeling afraid that a client may commit suicide			97.2
Feeling afraid that a client may need clinical resources that are unavailable			86.0
Feeling afraid because a client’s condition gets suddenly or seriously worse			90.9
Feeling afraid that your colleagues may be critical of your work with a client			88.1
Feeling afraid that a client may file a formal complaint against you			66.0
Using self-disclosure as a technique	93.3
Lying on top of or underneath a client			0.4
Cradling or otherwise holding a client in your lap			8.8
Telling a sexual fantasy to a client			6.0
Engaging in sexual fantasy about a client	71.8	28.0*
Feeling sexually attracted to a client	89.5	87.0	87.3
A client tells you that they are sexually attracted to you			73.3
Feeling sexually aroused while in the presence of a client			57.9
A client seems to become sexually aroused in your presence			48.4
A client seems to have an orgasm in your presence			3.2
aA national survey of 1,000 psychologists with a 46% return rate. bA national survey of 585 Division 42 (Psychologists in Independent Practice) members. cA national survey of 600 psychologists with a 48% return rate. *This question asked about fantasizing about sex with a client while engaging in sex with somebody else. Source: Study 1 from “Ethics of practice: The beliefs and behaviors of psychologists as therapists,” by K.S. Pope, B.G. Tabachnick, and P. Keith-Spiegel, 1987, American Psychologists, 42, pp. 993–1006. Study 2 from “Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system,” by K.S. Pope, P. Keith-Spiegel, and B.G. Tabachnick, 1986, American Psychologist, 41(2), pp. 147–158. Study 3 adapted from “Therapists’ anger, hate, fear, and sexual feelings: National survey of therapists’ responses, client characteristics, critical events, formal complaints, and training,” by K.S. Pope and G.B. Tabachnick, 1993, Professional Psychology: Research and Practice, 24, pp. 142–152. Copyright 1986, 1987, 1993 by the American Psychological Association.

Therapists, of course, bring something to the work they do. Each of us has a unique personal history. Table 6.2 presents national survey results showing therapists’ self-reports of their experiences of various kinds of abuse during childhood, adolescence, and adulthood (Pope & Feldman-Summers, 1992). These results suggest that almost one-third of male therapists and over two-thirds of female therapists have experienced at least one of these forms of abuse over their lifetimes.

Table 6.2. Percentages of Male and Female Therapists Reporting Having Been Abused.

Type of Abuse	Men	Women
Abuse during childhood or adolescence
Sexual abuse by relative	5.84	21.05
Sexual abuse by teacher	0.73	1.96
Sexual abuse by physician	0.0	1.96
Sexual abuse by therapist	0.0	0.0
Sexual abuse by nonrelative (other than those previously listed)	9.49	16.34
Nonsexual physical abuse	13.14	9.15
At least one of the above	26.28	39.22
Abuse during adulthood
Sexual harassment	1.46	37.91
Attempted rape	0.73	13.07
Acquaintance rape	0.0	6.54
Stranger rape	0.73	1.31
Nonsexual physical abuse by a spouse or partner	6.57	12.42
Nonsexual physical abuse by an acquaintance	0.0	2.61
Nonsexual physical abuse by a stranger	4.38	7.19
Sexual involvement with a therapist	2.19	4.58
Sexual involvement with a physician	0.0	1.96
At least one of the above	13.87	56.86
Abuse during childhood, adolescence, or adulthood	32.85	69.93
Source: From “National survey of psychologists’ sexual and physical abuse history and their evaluation of training and competence in these areas,” By K.S. Pope and S. Feldman-Summers, 1992, Professional Psychology: Research and Practice, 23, pp. 353–361. Copyright 1992 by the American Psychological Association. Adapted with permission.

While these experiences may—or may not—affect emotional competence for any of us as individuals, it is important not to assume a one-size-fits-all theory about how forms of abuse (or any other experience) may affect an individual therapist. No research supports the notion that all those who have a history of abuse are more competent or less competent as therapists, or that those who have no history of abuse are more or less competent as therapists. Each instance must be evaluated on an individual basis, with the full range of available information and without stereotypes. What is key is for us to be aware of how such events affect us and what role, if any, they play in our emotional competence and our ability to respond effectively to clients.

Our work requires continuous awareness to prevent compromised performance, especially when we go through hard or challenging personal times. Chapter 17 discusses common consequences when a therapist or counselor is distressed, drained, or demoralized. These common consequences include disrespecting clients, disrespecting work, making more mistakes, lacking energy, using work to block out unhappiness, pain, and discontent, and losing interest.

Emotional competence includes the process of constantly questioning ourselves. Consider the following: Do the demands of the work we do as therapists, or other factors, suggest that the we need therapy in order to maintain or restore emotional competence? For many of us, creating self-care strategies that fit us as unique individuals and that sustain, replenish, and give meaning are an essential part of our work to maintain competence (see Chapter 17), particularly to maintain “emotional competence for therapy” (Pope & Brown, 1996; Pope, Sonne et al., 2006).

The psychology profession emphasizes the ethical aspects of self-care. General Principle A, Beneficence and Nonmaleficence, and Standard 2.06 of the APA Ethics Code (APA, 2017a) encourage psychologists to be aware of the possible effects of their own physical and mental health on their ability to help those with whom they work. The new proposed General Principle of Beneficence and Nonmaleficence also encourages psychologists to safeguard, protect, and contribute to the well-being, welfare, and rights of Persons and Peoples. Psychologists are also encouraged to maximize benefit and avoid or minimize harm in ways that respect the dignity of Persons and Peoples (APA Ethics Code Task Force, 2020, July 31).

The Canadian Code of Ethics for Psychologists, Standard II.11 (CPA, 2017a), states that psychologists “seek appropriate help and/or discontinue scientific or professional activity for an appropriate period of time, if a physical or psychological condition reduces their ability to benefit and not harm others.” Standard II.12 states that psychologists “engage in self-care activities that help to avoid conditions (e.g., burnout, addictions) that could result in impaired judgment and interfere with their ability to benefit and not harm others.”

The National Association of Social Workers (2017) and the American Counseling Association (2014) are among the other major mental health professions whose ethics codes highlight the role of self-care in supporting competence and preventing impairment.

Table 6.3 presents the results of a national study of therapists as therapy patients (Pope & Tabachnick, 1994). Eighty-four percent of the therapists in this study reported that they had been in personal therapy. Only two respondents indicated that the therapy was not helpful, but 22% reported that their own therapy included what they believed to be harmful aspects (regardless of whether it also included positive aspects).

Table 6.3. Therapists’ Experiences as Therapy Patients.

Item	Never	Once	Rarely	Sometimes	Often
In your own personal therapy, how often (if at all) did your therapist (N = 400):
Cradle or hold you in a nonsexual way	73.2	2.7	8.0	8.8	6.0
Touch you in a sexual way	93.7	2.5	1.8	0.3	1.0
Talk about sexual issues in a way that you believe to be inappropriate	91.2	2.7	3.2	0.5	1.3
Seem to be sexually attracted to you	84.5	6.2	3.5	3.0	1.5
Disclose that they were sexually attracted to you	92.2	3.7	1.0	1.3	0.8
Seem to be sexually aroused in your presence	91.2	3.7	2.2	0.8	1.3
Express anger at you	60.7	14.3	16.8	5.7	1.8
Express disappointment in you	67.0	11.3	14.8	4.7	1.3
Give you encouragement and support	2.5	0.8	6.2	21.8	67.5
Tell you the they cared about you	33.7	6.7	19.5	21.8	16.3
Make what you consider to be a clinical or therapeutic error	19.8	18.0	36.2	19.0	5.5
Pressure you to talk about something you didn’t want to talk about	57.5	7.5	21.3	8.8	4.0
Use humor in an appropriate way	76.7	8.8	10.0	2.2	1.5
Use humor in an inappropriate way	5.2	2.5	12.5	35.0	43.5
Act in a rude or insensitive manner toward you	68.7	13.0	12.0	4.0	1.5
Violate your rights to confidentiality	89.7	4.5	2.7	1.3	1.8
Violate your rights to informed consent	93.2	3.2	1.3	0.3	0.3
Use hospitalization as part of your treatment	96.2	1.8	0.5	0.5	1.0
In your own personal therapy, how often (if at all) did you (N = 400):
Feel sexually attracted to your therapist	63.0	8.0	14.0	7.5	6.5
Tell your therapist that you were sexually attracted to them	81.5	6.2	5.5	3.0	2.7
Have sexual fantasies about your therapist	65.5	8.0	12.8	7.0	5.2
Feel angry at your therapist	13.3	9.5	32.7	28.5	15.0
Feel that your therapist did not care about you	49.5	13.0	19.0	12.3	5.5
Feel suicidal	70.0	8.5	9.5	8.3	3.0
Make a suicide attempt	95.5	2.5	1.0	0.0	0.0
Feel what you would characterize as clinical depression	38.5	15.8	16.0	16.5	12.5
Note: Rarely = two to four times; sometimes = five to ten times; often = over ten times. Source: From “Therapists as patients: A national survey of psychologists’ experiences, problems, and beliefs” by K.S. Pope and B.G. Tabachnik, 1994, Professional Psychology: Research and Practice, 25, pp. 247–258. Copyright 1994 by the American Psychological Association. Reprinted with permission.

This research suggests that most therapists experience, at least once, deep distress. For example, 61% reported experiencing clinical depression, 29% reported suicidal feelings, and 3.5% reported attempting suicide. About 4% reported having been hospitalized. Readers may wish to consider their own experiences in the light of these findings.

Emotional competence in therapy is no less important than intellectual competence, and it is for that reason that we have included, beginning with Chapter 15, clinical scenarios at the end of each chapter. These scenarios describe hypothetical situations that this book’s readers might encounter. Each is followed by a handful of questions designed to provide practice in the processes of the critical thinking explored in detail in Chapters 10–14. The first question in each sequence is a variant of “What do you feel?” Emotional competence leaves little room for denying, discounting, or distorting how we respond emotionally to the challenges of clinical work.

To the extent that these scenarios and questions form the basis of class or group discussion in graduate school courses, internships, in-service training, continuing education workshops, or other group settings, their value may be in direct proportion to the class’s or group’s ability to establish as safe an environment as possible in which participants are free to disclose responses that may be politically incorrect or “psychologically incorrect” (Pope, Sonne et al., 2006) or otherwise at odds with group norms or with what some might consider the “right” response. Only if participants are able to speak honestly with each other about responses that they might be reluctant to speak aloud in other settings and to discuss these responses with mutual respect, will the task of confronting these questions likely prove helpful in developing emotional competence (Pope, Sonne et al., 2006).

Learning to discuss these sensitive topics and our personal responses to them with others can help to strengthen our emotional competence and develop resources for maintaining competence throughout our careers (see Pope, Sonne et al., 2006, for a more thorough discussion of understanding taboos that hurt therapists and clients). Our colleagues also constitute an invaluable source of help to avoid or correct mistakes, identify stress or personal dilemmas that threaten to overwhelm us, and provide fresh ideas, new perspectives, and second and third opinions. A national survey of psychologists, in fact, found that therapists rated informal networks of colleagues as the most effective resource for prompting effective, appropriate, and ethical practice (Pope et al., 1987). Informal networks were seen as more valuable in promoting ethical practice than laws, ethics committees, research, continuing education programs, or formal ethical principles. Our colleagues can help sustain us, replenish us, enrich our lives, and play an important role in our self-care (Chapter 17).