Most psychotherapy trainings in the UK require trainees to undergo their own personal therapy, often a fixed number of hours, paid for by the trainee. I wrote this article in the final year of my doctoral training to question that requirement. It was first published in the Hermeneutic Circular (Society for Existential Analysis), April 2025, pp. 6–7, as “Questioning the mandate for trainee psychotherapists: Can enforced therapy instil wisdom?” (view the original on ResearchGate).
Personal therapy can offer profound value and transformation for trainee psychotherapists. Professional bodies in psychotherapy maintain standards through training requirements, including mandated personal therapy.
But can self-development really be mandated; and is more necessarily better? How does mandated therapy fit with the core principle that clients are the experts of their own lives; does the mandate challenge existential values by restricting individual freedom, presuming trainees cannot determine their own development needs?
While it is acknowledged that some therapy is certainly valuable, the current one-size-fits-all, more-is-better approach contradicts fundamental principles of our profession and may even risk causing harm. When therapy becomes an imposed obligation, it can become a box-ticking exercise, rather than a genuinely transformational process. I argue that such growth cannot be decreed, and that trainees should be given the freedom and autonomy to determine their own developmental journey.
Questioning the mandate
Is it worth it? This question demands deeper consideration of what we mean by “worth”. The rationale given for mandation is that it offers professional development through mirroring an experienced therapist, personal growth through the therapeutic process, and the experience of being a client. But have these assumptions been sufficiently examined?
If the primary purpose is mirroring and integrating therapeutic approaches into our practice, wouldn’t engaging with multiple therapists be more valuable? In my experience, across the four years of my doctorate, I have worked with three different therapists. Each engagement offered fresh insights into therapeutic styles and helped me understand myself in varied contexts.
The counter argument is that by staying with one therapist, the relationship will deepen – which can certainly be true – but the quality and depth of any relationship cannot be measured by longevity. Time can be a factor in relational depth, but equally it can be entirely uncorrelated. You cannot judge the quality of a marriage or friendship by time alone; indeed, compared to other factors such as chemistry, connection and shared values, time may be the least important factor.
Most crucially, when considering mandating personal therapy for personal development, a fundamental contradiction occurs – the attempt to ‘force’ self-development. As therapists, we know that genuine insight and personal growth cannot be commanded or scheduled, but rather arises through voluntary engagement and an authentic desire for change. Self-development, by its very nature, cannot be enforced and certainly cannot be measured or quantified in mandatory hours.
Another argument for mandated therapy is that experiencing the client perspective helps trainees understand the vulnerability and dynamics inherent in the therapeutic process. However, this experience is inevitably limited to one’s own phenomenological perspective. The assumption that this translates into a universal understanding of the client experience is questionable: my experience will tell me little about how therapy feels for others, whose contexts and needs may be entirely different from my own. But beyond these questions, there are further issues that can arise through compulsion.
The problem
Problems arise when therapy is decreed as there is a risk of it becoming a totem, rather than a genuine opportunity for self-exploration. Mandates explicitly mean that people are not doing something of their own free choosing. Those under compulsion may feel trapped, beholden and resentful – natural responses to feeling compelled against one’s will. This lack of autonomy disrupts the essential therapeutic dynamic, which thrives on client-led voluntary engagement. True growth requires genuine willingness and autonomy.
The power imbalance inherent in any therapeutic relationship becomes particularly problematic when therapy is mandatory. In regular therapy, the client’s autonomy and ability to end the relationship serves as a natural counterbalance to the therapist’s professional authority. However, when freely discontinuing therapy is not an option, the client’s sovereignty and independence is lost, accentuating the imbalance and further distorting the dynamic.
Meanwhile, the therapist must navigate the ethically complex position of working with someone who may be present primarily due to obligation, and genuine engagement may be overshadowed by compliance.
As therapists, we know that we should always prioritise the client’s autonomy and respect their expertise on their life. Who, other than the client, should decide when is the right time for them to conclude therapy? Is more therapy always better? Overriding client self-determination entirely contradicts our professional axioms.
Personal experience
As a final-year doctoral student with over 130 hours of personal therapy completed, I recently experienced an uncomfortable session where my therapist inappropriately questioned and repeatedly challenged my spiritual beliefs.
In any other service area, like a restaurant or getting a haircut, poor experiences can be easily resolved by walking away or choosing not to tip – with no obligation to explain dissatisfaction in detail. However, mandated therapy creates a forced dynamic where leaving isn’t a simple option. With some 30 hours still required, an abrupt departure carries significant weight, especially between two practitioners in a shared field.
The compulsion to be there, plus my professional colleague being well aware of this, made it a far more complex situation than simply opting out of an ordinary service. Yet I could not treat the situation like a normal, real-life relationship, because it is not that either.
Therapy exists in a strange in-between space of part intimate relationship, part professional service – but not fully one or the other. Unlike close personal relationships, where conflicts can be addressed directly and immediately, therapy requires waiting a week for a 50-minute window to address an issue, while also paying the other person – in complete opposition to genuine intimacy. The dynamic also felt far removed from a typical customer-service interaction, where dissatisfaction doesn’t require justification or feedback. But, due to the mandate, in my recent experience, I did not feel I could simply disengage without explanation.
The professional response
I discussed my experience with my two clinical supervisors, but I was surprised by what felt like reflexive responses. I was told, without any sense of irony, to “bring it to personal therapy”; and was also asked, in a slightly insinuating way, whether my normal mode of action is to “brush things under the rug” and “try to avoid conflict.”
There seem to be assumptions or biases arising here that, as therapists, we have to be highly vigilant of: our role is to explore, not assume. Yet, when expressing my troubles with supervisors and professional colleagues, they automatically advised that I persist with the relationship, which led me to question, is there an assumption held within the profession that more therapy is always better?
If I had brought up leaving my job, moving house, or ending a relationship with a girlfriend, there would be no a priori position by the therapist – and there certainly shouldn’t be. A therapist’s role is to explore and expand the client’s thinking, not prescribe it. Endings, partings, and being discerning in relationships are essential life skills. Equally important is knowing when it is appropriate and beneficial to let something go without having to divulge everything. Even if I felt able to disengage with my therapist without explanation, the mandate would force me to engage another therapist immediately, thereby jumping straight into another ‘intimate’ relationship – something that feels completely unnatural and forced.
Of course, I have sympathy with the therapist’s predicament. As a practitioner myself, I inevitably evaluate their therapeutic approach, creating a dual relationship where I am simultaneously client and peer. If I were to detail all my dissatisfaction, how can they respond? The therapist cannot engage as an equal in an authentic human-to-human or peer-to-peer response. They must maintain their therapeutic stance and cannot authentically defend or deny the validity of my observations, as this would contradict their professional role.
Additionally, from my perspective, having to pay money to provide a kind of professional critique and rebuild a relationship that was, from my perspective, compromised by the service provider feels fundamentally wrong, and is something that surely wouldn’t occur in any other professional or personal context.
Compulsory therapy was creating for me a complex dynamic where the obligation to continue treatment, regardless of my dissatisfaction, was posing some ethical dilemmas.
Potential harm and concerns
The ethical issues surrounding the mandate for therapy become even more significant when we consider its potential to cause harm. Multiple studies have been published reporting the negative or harmful effects of therapy (Barkham et al., 2001; Crawford et al., 2016; Gerke et al., 2020; Hansen et al., 2002; Lambert, 2013; Yao et al., 2020). Surprisingly, a lack of awareness on this issue is common, with up to 28% of practitioners unaware of the potential negative effects caused by psychotherapy (Boisvert & Faust, 2003, 2006). Additionally, Rozental et al. (2018) report that there is no professional guidance for trainees regarding iatrogenic effects.
But what happens if the trainee feels therapy isn’t serving them, or worse, is actually harmful to them? Edwards’ (2017) review cites examples of trainees experiencing real difficulties – from psychological distress and relationship stress, to trainees describing the financial burden as “stressful” and “a nightmare.” The combined pressure of mandatory therapy costs and time commitments was said by some to paradoxically undermine the effectiveness of the therapy itself.
The monetary transactional aspect of personal therapy adds another layer of complexity and a potential burden. Psychotherapy trainees are often under quite significant financial strain, regularly juggling work and studies while accumulating tens of thousands of pounds in training debt. Forcing these students in addition to pay for personal therapy sessions they perhaps neither want nor have time for, introduces complications and frustrations that would not exist in genuine therapeutic relationships.
While the practical and ethical concerns of mandatory therapy affect all psychotherapy training, there are particular contradictions when viewed through an existential lens. How can we reconcile enforced therapy with existential philosophy’s fundamental emphasis on individual freedom and self-determination? As Nietzsche said, “No one can construct for you the bridge upon which precisely you must cross the stream of life, no one but you yourself alone.”
The mandate challenges existential values by restricting individual choice and presuming trainees cannot determine their own developmental needs. Sartre tells us that “We are our choices” and Nietzsche reminds us that “Freedom is the will to be responsible for ourselves.” Existential therapy aims to empower individuals towards autonomy, enabling them to become decisive and independently capable of navigating their life. Yet, by mandating therapy, are we not paradoxically undermining the developmental process we seek to nurture? Through enforcement of an intimate relationship, are we undermining the very qualities of self-determination we seek to cultivate in our clients?
A way forward
If personal therapy must be enforced, its primary aim should be made clear. If framed within the context of professional development, a more effective model might be to structure it similarly to supervision – for example, 20 hours spread across three terms, with different therapists for each year. This approach, paired with reflective essays analysing what worked, what didn’t, and how it influenced one’s practice, would more directly align with a goal of professional development while avoiding the inherent tension of mandating personal growth.
However, if the mandate is framed as personal development, aimed at self-discovery and emotional growth, more fundamental contradictions arise as well as ethical questions. Having undertaken the extensive commitment of psychotherapy training and demonstrated a clear commitment to their professional development, wouldn’t trainees choose to engage voluntarily in personal therapy if they deemed it beneficial to their professional and personal growth? Shouldn’t trainees be treated with the same respect and self-determinism as all other clients?
Lastly, the notion of a fixed quantity of sessions to achieve a qualitative outcome is erroneous, as therapeutic value lies in the quality of the experience, not the quantity. The quality and impact of therapy cannot be judged or determined by the number of sessions.
The mandatory requirement for personal therapy creates a tension within psychotherapy by attempting to enforce self-development, a process that by its very nature can only emerge through personal choice, self-determination, and authentic engagement. While the intention behind mandated therapy is understandable on the surface, deeper examination reveals how it undermines the foundational principles we work by and experientially recognise.
Moving forward, I suggest our profession recognise and respect that it is the trainee who is responsible for their own professional development and personal growth journey. This would better foster an environment where self-learning and growth is meaningful, voluntary, genuinely transformative, and commensurate with the values of our profession.
About the author: Lawrence Rook is a psychotherapist trained in existential psychotherapy, and has completed doctoral research in chirology and psychotherapy. He works online with individuals and couples. Read more about his approach to psychotherapy.
References
Barkham, M., Margison, F., Leach, C., Lucock, M., Mellor-Clark, J., Evans, C., & McGrath, G. (2001). Service profiling and outcomes benchmarking using the CORE-OM: Towards practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology, 69, 184–196. https://doi.org/10.1037/0022-006X.69.2.184
Boisvert, C. M., & Faust, D. (2003). Leading researchers’ consensus on psychotherapy research findings: Implications for the teaching and conduct of psychotherapy. Professional Psychology: Research and Practice, 34(5), 508–513. https://doi.org/10.1037/0735-7028.34.5.508
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