PROCESS

Walking in Sacred Spaces in the Therapeutic

Bond: Therapists Experiences of Compassion
Satisfaction Coupled with the Potential for
Vicarious Traumatization
SALLY V. HUNTER, PHD*

The therapeutic bond is at the heart of effective therapy, yet few studies have examined therapists experience of this bond. Using a qualitative study design, this exploratory study examines the experiences of couple and family therapists in relation to
their perceptions of the satisfactions and risks involved in the therapeutic bond. The
research was conducted using grounded theory methodology and eight in-depth interviews were conducted with therapists working in five counseling agencies in Sydney,
Australia. Therapists described the importance of the 3 component parts of the therapeutic bond: the empathic connection between therapist and client; the role investment
of the client; and the mutual affirmation experienced by both therapist and client in
the therapeutic process. Walking in sacred spaces with the client was seen as both
enriching and challenging for the therapist. The therapeutic bond gave therapists
intense satisfaction and posed risks for them, especially when working with traumatic
client experiences. However, the findings suggest that the experience of compassion
satisfaction and the development of vicarious resilience counter-balanced the intense
difficulty of bearing witness to clients traumatic experiences and the potential for
vicarious traumatization. The implications for sustaining couple and family therapists in their work are discussed.
Keywords: Therapist; Therapeutic bond; Vicarious traumatization; Compassion
satisfaction; Qualitative research
Fam Proc 51:179192, 2012

School of Rural Medicine, University of New England, Armidale, New South Wales, Australia.

Correspondence concerning this article should be addressed to Sally V. Hunter, Ph.D., Senior
Lecturer School of Rural Medicine, University of New England, Armidale, NSW 2351, Australia.
E-mail: drsallyvhunter@gmail.com.
This paper was developed as part of a Master of Counselling (Honours) degree at the University of
New England. The author would like to acknowledge the help and support of the agency management
and the therapists that she interviewed.
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INTRODUCTION

he quality of the relationship between the psychotherapist and the client has long
been understood as the core of the psychotherapeutic method (Freud, 1912; Rogers, 1957) and a key factor contributing to psychotherapy outcome (Asay & Lambert,
1999; Martin, Garske, & Davis, 2000). Efforts to define and operationalize the
therapeutic relationship in research have largely focused around the concept of the
therapeutic alliance and exploring the interplay between therapist, client, and therapist-determined therapy factors that contribute to the alliance (Bordin, 1979).
Orlinsky and Howard (1987) identified 3 components of the therapeutic bond:
empathic resonance; role investment; and mutual affirmation. Empathic resonance
related to the clients sense of being understood by the therapist. Role investment
related to the clients emotional investment in the process of therapy. Mutual affirmation related to the clients sense that therapy was being conducted in an atmosphere of
respect, mutual liking, and acceptance. In a quantitative study of voluntary clients at a
US teaching hospital, clients who felt motivated and invested in the work of therapy,
and believed that the therapeutic environment was friendly and affirmative, were more
likely to rate the session as being helpful and productive (Saunders, 2000, p. 215). In
other words, role investment and mutual affirmation were seen as important predictors
of the outcome of an individual session. Empathic resonance, on the other hand, was
seen as more relevant to ultimate treatment effectiveness than to the outcome of an
individual session (Saunders, 2000, pp. 215216). These components of the therapeutic
bond are widely endorsed as essential features of good therapeutic practice. However,
working intimately with these constructs is not without risk to individual therapists.
There is a danger of vicarious traumatization for therapists, particularly for therapists working with trauma cases (McCann & Pearlman, 1990; Neumann & Gamble,
1995; Pearlman & Mac Ian, 1995; Saakvitne & Pearlman, 1996). Vicarious traumatization has been thought to result in a permanent disruption to the therapists belief
system (Saakvitne & Pearlman, 1996). It was originally predicted that therapists who
suffered from vicarious traumatization would experience disruptions to their cognitive schemas in five psychological need areas, namely: safety, trust, esteem, control,
and intimacy (Neumann & Gamble, 1995).
The evidence relating to vicarious traumatization is variable. Some studies show that
therapists are vulnerable to vicarious traumatization, compassion fatigue, or secondary
traumatic stress (Moulden & Firestone, 2007; Pulido, 2007; Steed & Bicknell, 2001). By
contrast, other studies suggest that therapists can experience vicarious posttraumatic
growth (Linley & Joseph, 2007) even when working with sexual offenders (Carmel &
Friedlander, 2009), and that the potential benefits of working with trauma may be far
more powerful than the potential negatives (Arnold, Calhoun, Tedeschi, & Cann, 2005).
In a move away from deficit models, practitioners have argued that therapists can be
influenced by their clients in positive ways and can experience personal growth as a
result of their work (Kottler & Smart, 2006; OLoughlin, 2006; Tedeschi & Kilmer, 2005).
Radey and Figley (2007) described a model for compassion satisfaction among social
workers and Calhoun and Tedeschi (2006) defined posttraumatic growth as a threefold
process of growth in relation to: sense of self; philosophy of life; and interpersonal relationships. The term vicarious resilience has also been used to describe how trauma
work can sustain and empower therapists (Hernandes, Gangsei, & Engstrom, 2007).
The authors suggest that it may be specific to trauma work and represents a transformation
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in the therapists inner world, as a result of working with traumatic client material, that
counteracts the normally occurring fatiguing processes (Hernandes, Engstrom, &
Gangsei, 2010, p. 67). Weingarten (2010) argued for the importance of witnessing and
proposed the concept of reasonable hope as a useful framework for therapy.
These are thought to be specific issues faced by trauma therapists. An Israeli study
(Ben-Porat & Itzhaky, 2009) showed that there was no significant difference in terms
of vicarious traumatization between a group of family violence therapists and other
therapists not working with violence. In a recent study of 105 therapists working with
sexual offenders, Carmel and Friedlander (2009) argued that therapists gain comfort
from knowing of the importance of their work and, as they become more experienced,
learn how to cope with symptoms of burnout and vicarious traumatization. The current qualitative study was designed to explore Australian therapists perceptions of
the satisfactions and risks involved in the therapeutic bond, and to understand how
the qualities of the therapeutic bond might relate to the danger of vicarious traumatization and the potential benefit of personal growth for therapists.

METHOD
This qualitative research study used in-depth, individual interviews to explore
therapists experiences of the therapeutic bond. Grounded theory methodology was
used (Strauss & Corbin, 1990), thereby allowing participants to describe their
experiences in their own words. Agencies were contacted by the researcher to discover if they were willing to be involved in the study. In a follow up phone call,
agency managers were invited to recommend a therapist who fulfilled the recruitment criteria, in relation to the therapists years of experience and percentage of
difficult cases in their workload. In this manner, a purposive sample (Strauss &
Corbin, 1998) of eight therapists from five general counseling agencies in Sydney
was recruited. The sample included a range of therapists with differing levels of
experience and proportions of difficult cases in their caseload, since these factors
had been previously identified as potentially important in determining how therapists cope with trauma material and the risks involved in their job (Steed & Bicknell, 2001). However, it should be noted that, in practice, it was difficult to
recruit therapists with less than 2 years experience working in agencies, with a
high percentage of difficult cases.
The sample consisted of 1 male and 7 female therapists aged between 30 and 66, all
of whom were given pseudonyms. Five therapists had a Masters level degree in counseling or a related area, one had an undergraduate degree, and two had diplomas in
therapy. Three therapists had over 10 years experience as therapists, three had
510 years, and two had less than 2 years experience. Six therapists worked mainly
with families and two worked with individuals and couples, but not with families.
Most experienced therapists reported considerable counseling experience with difficult or traumatized clients, including those who had experienced child maltreatment,
sexual assault, domestic violence, suicidal ideation, family breakdown, and clients
with mental health issues. Six therapists had over 50% of cases in their workload that
they viewed as difficult.
The face-to-face interviews lasted for about 90 minutes and were at a convenient
location, usually at the participants place of work. The interview covered participants work experiences and both the enjoyable and challenging aspects of the work.
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Therapists were able to describe key concepts in their own words, without being
biased by the researchers use of language or constructs. Within 24 hours of each
interview the researcher wrote up a personal file, recapturing details of the interview,
the setting, facial expressions and body language, the researchers assumptions, questions asked and not asked, etc. This enabled the researcher to analyse her potential
impact on the data collected.
The interviews were tape-recorded and transcribed by the researcher, and the transcripts were coded and analysed using grounded theory methodology (Strauss & Corbin, 1998). The analysis was conducted simultaneously with the data collection
process. First, the researcher studied each transcript and personal file and prepared a
brief summary of each interview. The initial coding for each transcript was conducted
line by line, using descriptive codes arising from the data, and significant statements
were highlighted. Having developed initial codes, these were grouped together to form
axial codes (or categories) and these were grouped into overall themes (Strauss & Corbin, 1998). This was a gradual process and the categories and themes became more
refined and focused as the study progressed. The researcher simultaneously analysed
the data and wrote up an analytic file that demonstrated the development of emerging
concepts and consistent themes. These were developed through a systematic process
of interrogating the data, that is, by asking questions such as who said what, when,
how, and why, and by comparing the answers for consistency within and across participants. The themes were examined by two additional researchers, and any differences in interpretation were discussed until consensus was reached. Propositions
were developed from the categories, that is, assertions about possible links between
concepts expressed as if ... then .... These were then checked against the data. For
example, do more experienced therapists find it harder to be empathic to the same
sorts of clients as less experienced therapists?
Lather (1986) argued that we need to build reflexive subjectivity, face validity, and
catalytic validity into qualitative designs. In this study, the personal file detailed how
the researchers assumptions had been affected by the data (reflexive subjectivity),
participants were shown a draft report and were invited to comment on it before publication (face validity), and the analytic file detailed how the research process had led
to insight (catalytic validity).
This paper focuses on therapists experiences of the therapeutic bond, and the joys
and challenges of their work. Findings in relation to coping mechanisms were
reported separately (Hunter & Schofield, 2006).

FINDINGS
Four important themes emerged from this study: the empathic resonance of the
therapist; the role investment by the client; the sense of mutual affirmation between
them; and the satisfactions and risks of working with trauma.

Empathic Resonance
Empathic resonance related to the clients sense of being understood by the therapist. All the therapists viewed empathy as a basic building block in the therapeutic
bond. They believed that it was important both to be empathic and to communicate
this empathy to the client. The client needed to feel understood by the therapist. This
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understanding was achieved by giving non-judgmental and empathic responses and

by helping the client to feel safe and accepted.
I go in there very non-judgmental and very open to what they are bringing in and very open
to accepting them for who they are. And I think that helps them completely feeling safe in
the relationship (Anna).

Participants believed that the empathic resonance that they offered clients had a profound impact because they were able to do what family and friends often found impossible, namely to be with people who are experiencing pain, distress, anger, guilt,
shame, or hopelessness.
I think she knows shes really being heard and her pain is being acknowledged. And her pain
is real and she knows that I feel it I can share with her in that pain (Helga).

The metaphor of the mirror was used to describe the mechanism of empathic resonance. The clients could see themselves more clearly by looking at the reflection.
What Im there for is like a mirror. I think that really works for a lot of my clients. Really if I
show them a picture of whats going on for them, its like a mirror and they see themselves
for the first time (Anna).

Different therapists admitted to finding it easier to empathise with certain clients.

These were usually the clients that they particularly identified with, such as single
mothers, children or adolescents, people who were marginalised by society, and so on.
I particularly enjoy working with younger people and adolescents and I think thats partly a
self-fulfilling thing, because I wish someone had done that for me when I was that age (Cathy).

It was particularly easy, and enjoyable, to empathise with clients who were invested
in the process of therapy. It was more difficult to empathise with unmotivated clients
who were not open to change or who were aggressive, as described in the next section.

Role Investment
All participants enjoyed working with clients who were emotionally invested in therapy and were, therefore, motivated to work hard at the process. These clients were usually willing and able to form a good working relationship with the therapist, able to
gain insights into their own behaviour and to make the desired changes in their lives.
Alternatively they were struggling with issues, but willing to continue doing so.
The clients who come in and they are quite motivated to make a difference in their lives. I
suppose they are the easier ones to work with. I also enjoy working with clients who are
really struggling and, at some point, it seems to make some difference in their lives that they
are coming here (Elle).

Many of the therapists used the word privilege to describe how they felt to be working
with clients that really wanted to change. They felt a deep sense of satisfaction from
being involved in the clients recovery process and in helping clients make a difference
in their lives.
Just being there during the process for them, while they make these changes and while they
make a difference to their lives, I find that really rewarding (Elle).

Perhaps not surprisingly, most therapists interviewed found it challenging to work

with unmotivated clients, or those who were closed to the idea of change.
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I dont particularly enjoy working with clients that are physically intimidating, or who are
very, very defended. clients who are not open to changing, who dont come because they want
to change themselves, but they come so that their partner will be told what to do (George).

Working with perpetrators of domestic violence, for example, was difficult because of
the lack of motivation shown by many men to change their violent behaviour and their
tendency to become threatening or intimidating in the therapy sessions.
If there is aggression in the session, I mean I find that very confronting and Im not very good
with that (Bella).

Perhaps it was the lack of mutual affirmation between the clients and the therapist
that made certain circumstances more difficult than others, as discussed in the next
section.

Mutual Affirmation
Most therapists acknowledged the importance of mutual affirmation, that is, they
believed that the clients needed to feel that therapy was being conducted in an
atmosphere of respect, mutual liking, and acceptance. The main tools used to create
mutual affirmation were validating, normalising, and affirming the clients emotional
world.
Theres a lot of validation, a lot of affirmation and normalisation affirming people and normalising things is an enormous intervention thats what I try to do with my clients, validate their story and try to help it make sense (Helga).

Some therapists acknowledged that, in sharing in such an intimate way with clients,
they themselves felt validated. The opportunity to connect with other people in a
meaningful, and hopefully healing, way was valued by these therapists. Within the
confines of the therapeutic bond, they offered their clients the experience of being
accepted in a nonjudgemental way. In return, the therapists felt respected and
validated by their clients.
I feel very privileged and humbled to think that clients actually share with me some of their
deepest thoughts, feelings, experiences. That does something to me I suppose it has some
sort of validation of the self, not only as a therapist but as a human being, like a reflection
sort of thing (Cathy).

Sometimes clients went out of their way to affirm the therapist, for example, by writing a letter of appreciation. For one therapist, the experience of validating her clients
spirituality had helped her to validate her own belief system as well.
My whole sense of spirituality is different. Its about valuing peoples experience and their
life and their story. And valuing my own (George).

When therapists had to work with personally challenging clients, such as separating
couples and their children, they experienced a lack of affirmation in their work. One
therapist, who felt ideologically committed to working to improve and strengthen relationships, described her difficulty when working with such families.
Seeing people work it out, thats nice. I suppose the thing is that you feel that youre achieving something, that youre doing good work. As distinct from if youre seeing clients all the
time and all that they are doing is separating. I suppose my core belief in that then is that
relationships are what are important (Bella).

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Having described the positive aspects of the therapeutic bond, the next section looks
at the satisfactions and risks of working with trauma.

Satisfactions and Risks of Working with Trauma

Several of the therapists derived their deepest satisfaction from working with
trauma. The expression walking in the sacred spaces was used by one therapist to
describe the sacredness of sharing the clients journey toward healing.
Its that profound privilege and honour of walking in the sacred spaces of peoples lives that I
find very enriching, and often challenging. Being able to sit with people at depth and seeing
the change at depth occurring in peoples lives, its just a wonderful thing the kind of privilege of walking in peoples lives, hearing stuff they wouldnt ordinarily share with other people, the creating of a safe place where people can discover their own truth. And just
marvelling at just how people do that, the creativity of people, I find that incredibly awesome
(George).

These therapists understood the risks involved when clients talk about parts of themselves that they are frightened or ashamed of. All but one believed that they were, in
some way, affected by the traumatic stories that they had heard in therapy. They
described feeling emotionally and relationally drained of energy by some of their
clients, and even becoming clinically depressed.
I find that [working with highly anxious clients] emotionally draining, because they
take energy from you its just like vultures, like somebody just drinking you dry
(Fay).

At times therapists experienced feelings of inadequacy, low self-esteem, or questioned

their personal relationships and their ability to be intimate with others. They attributed these emotions to the effect of their work with clients, particularly those with
whom they identified and felt that intense empathic connection.
And then other couples where you just see the pain after an affair. Im in a relationship
myself and I often look at people and think how quickly they can go from loving each
other to hating each other. And thats sometimes quite disturbing as a human being
(Elle).

Several therapists admitted to feeling less safe than they had done before they became
therapists, feeling less trusting, and more acutely aware of their lack of control over
certain situations. They described being more aware of the potential dangers in life
and of feeling protective toward their families.
We try not to be so over protective that they cant go anywhere, but if my kids want to go and
have a sleepover at a friends place, then I have a sense of hesitation having worked with
hundreds of clients, literally, where theres been so many experiences of sexual assault,
where theyve been unsafe with people theyve trusted (George).

Through their work with clients, some therapists felt that they had had to face
uncomfortable truths and could no longer believe in the world as a safe place, or that
there was a God who protects the good.
I can actually remember coming out of a session and speaking to a co-worker and saying
there is no God having just had an interview with a little child who had been subjected to
extreme sadism and abuse of every kind and had been rejected by her own parents as well
(voice catches) (Delia).

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There were particular difficulties for young therapists working in the sexual assault
area. The following comment related to the difficulty experienced when the therapists
personal experience leads her/him to identify and empathise strongly with the client.
Young women have debriefed with me saying you know I cant, I can no longer accept a sexual
partnership with my partner, because all day Im hearing what is done to children (Delia).

The two therapists who had had the most experience and passion for working with
abused clients described how they had become desensitised over the years. They were
no longer shocked by anything, and believed that this enabled them to listen to horrific client stories and manage their own emotional response, thereby helping the
client to feel safe and contained. They showed their empathy for their clients by being
unshockable.
You get to that point of being desensitised, but part of being desensitised is why I like doing
therapy with it, because kids need to feel that youre tough enough to hear it. So, in a sense, I
need to be (Fay).

Therapists described their struggle when their legal responsibility to make a report
conflicted with their clients need for confidentiality to be respected. The thought of
destroying the empathic connection and the clients role investment was anathema to
these therapists.
She stared me in the face and said I want to be six feet under and theres nothing that you
can do and theres nothing that anyone can do. And she was sold on dying, you know. She
was probably the most, and Ive seen some pretty suicidal kids, but she was probably one of
the most suicidal kids that Ive seen. And she was dead certain. And I knew what I had to do,
was to ring her parents, and do some stuff that in some ways betrayed her (Fay).

Despite these challenges, all but one of the therapists interviewed loved their jobs and
believed that they were indeed privileged to be working in the field. For them, the satisfactions seemed to far outweigh the challenges or risks. They experienced a deep
sense of satisfaction from the work, particularly when working with those clients who
were invested in the process and with whom they felt a natural empathy.

DISCUSSION
The Therapeutic Bond
This study provides rich data on the therapists experiences of the therapeutic bond
and adds support to the importance of the 3 elements of the therapeutic bond:
empathic resonance; role investment; and mutual affirmation (Orlinsky & Howard,
1987). The therapists focused on the emotional aspects of the therapeutic bond, rather
than the agreement or contractual aspects of the working alliance (Symonds &
Horvath, 2004). This may reflect the interviewing process, since therapists were not
specifically asked about the goals and tasks of therapy. Alternatively it may reflect a
greater focus on, and interest in, the emotional aspects of the therapeutic relationship.
All the therapists were trained to be empathic and believed it to be the cornerstone
of good therapy. These therapists opened themselves up to be influenced by their
clients through emotional resonance. This concept suggests a deeper level of connection between the therapist and the client, where the therapist reverberates to the
clients story, thereby amplifying and acknowledging it. By demonstrating empathic
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resonance, the therapist honours and witnesses the clients story. However, the impact
of bearing witness in therapy has begun to be recognized, in much the same way as the
impact of a child witnessing acts of violence is now recognized (Weingarten, 2007).
Client characteristics are known to have considerable impact on the outcome of therapy (Asay & Lambert, 1999). Not only did these therapists report the importance of the
clients role investment, but they also identified the increased satisfaction and sense of
mutual affirmation that they gained from working with such clients. It is important for
therapists to be aware of this and to monitor their responsiveness toward their clients,
particularly toward those with whom they might be inclined to over-identify.
Although practitioners have only recently begun to talk about reciprocity in the therapeutic relationship (Andrews, 2001; Kottler & Smart, 2006; Sandmaier, 2003), the
therapists interviewed responded well to a sense of mutual affirmation within the therapeutic bond. They actively affirmed their clients, but also felt affirmed in the encounter. The clients level of role investment and the therapists identification with the
client appeared to add to the satisfaction and personal affirmation that the therapist
experienced. Given that therapy is a relational process that requires responsiveness
from the therapist (Norcross, 2002), this can affirm the therapist as well as the client.
The process of mutual affirmation needs to be monitored in supervision, to ensure
that it does not mean that the therapist puts her or his own needs before that of the
client. We know from research studies that some psychotherapists do fall into this
trap. In a qualitative study of 127 sessions conducted by eight experienced psychologists, it was found that therapists did place their needs ahead of their clients needs
on occasion, including the need to be needed, to control, to be right, for approval, to
be a good therapist, for gratification, to be important (Hayes et al., 1998, p. 477).

Two Sides of the Coin When Working with Trauma

Its that profound privilege and honour of walking in the sacred spaces of peoples lives that I
find enriching and often challenging (George).

This expression encapsulates both the powerful satisfaction for the therapist and the
potential risk, for both the client and the therapist, of embarking on a healing journey
together. The experience can be both enriching and challenging for the therapist. The
therapists sense of privilege stems from the experience of being trusted by the client,
and of being afforded the right to enter into the therapeutic relationship. As with any
right, this carries a responsibilityto behave respectfully and to bear witness to the
clients story. Attuning carefully to the familys needs allows the therapist to use the
therapeutic relationship to meet those needs.
Thus the therapeutic bond can be seen as:
a two-edged sword for therapists. The intimacy associated with therapy is often what draws
us to this work in the first place as one of our greatest rewards. However, such intense relationships, often scheduled back-to-back, also create a number of problems (Kottler & Schofield, 2001, p. 430).

This can be the price that therapists pay, especially since they will inevitably be
exposed to secondary stress or the possibility of vicarious traumatization within the
therapeutic bond (Munroe, 1995). These therapists demonstrated some signs of experiencing psychological difficulties which reflected disruptions to their cognitive
schemata predicted by Neumann and Gamble (1995), that is, disruptions to safety,
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trust, esteem, control, and intimacy. For example, some felt emotionally and relationally drained by their work and admitted to feeling inadequate, or to feeling less safe
in their personal lives as a result of their work. However, they did not believe that
they had experienced vicarious traumatization. It is also possible that these therapists had moved through a period of disruption to their beliefs (Neumann & Gamble,
1995) to a new, stronger, more deeply satisfying belief system. This conceptualisation
also fits with the construct of vicarious resilience (Hernandes et al., 2007), described
as an inner transformation of the therapist that may be a unique consequence of
trauma work.
The intense satisfaction that therapists felt in their work seemed to counterbalance
the intense difficulty of bearing witness to clients traumatic experiences, and to demonstrate compassion satisfaction rather than compassion fatigue. This is important
since compassion satisfaction, at least among therapists working with sexual offenders, has been demonstrated to predict the quality of the working alliance (Carmel &
Friedlander, 2009). Although there were identifiable risks involved in working with
client trauma, these therapists seemed willing to take those risks and to grow from
the experience. According to Hernandes et al. (2007, p. 229), empathic engagement
with clients trauma material leads to the complex potential of therapeutic work to
fatigue and to heal through the development of vicarious resilience. More research
needs to be conducted for us to understand which experiences are more likely to be
growth experiences for both therapist and clients.
Just as a systemic, resilience approach can be useful lens for viewing a communitys response to a traumatic event (Walsh, 2007), it can also be used to view the
experience of therapists who work with family trauma. Perhaps there is some form
of strengthening process occurring in therapy. Just as a sword is tempered by fire to
create the right combination of strength and flexibility, perhaps the therapist is
tempered by the intensity of the therapeutic bond. Walshs (2003) framework for the
development of family resilience may be applicable to therapists, in particular the
importance of developing belief systems that help to make meaning of adversity,
adopting a positive outlook, and finding transcendence through spirituality.

Implications for Sustaining Family Therapists in Their Work

Without the use of personal and professional coping strategies and organisational
support (Hunter & Schofield, 2006), couple and family therapists can be vulnerable to
vicarious traumatization. However, on the other side of the coin, many family therapists find their work deeply rewarding and sustaining, despite working with couples
and families who have experienced traumatic events in their lives. While educators
and employers have a responsibility to warn therapists of the potential risks involved,
these warnings should be counterbalanced with a discussion of the potential for compassion satisfaction, vicarious resilience, and posttraumatic growth.
Many family therapists work with trauma every day and they need to be supported
through supervision to examine their own responsiveness to their clients. The following questions could be used in supervision to stimulate a worthwhile discussion:


Which clients are you able to be deeply empathic with? When are you able to experience mutual affirmation with each member of the family, even with those who are
not invested in the therapy process?
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Which family members do you find yourself over-identifying with? Which are hard
to identify with?
 How are you able to stay present in the therapeutic bond and open to witnessing
the familys experience of trauma? When is it most difficult for you to remain present?
 How can we support you better to remain present?
 Which sessions leave you feeling satisfied and uplifted? Which sessions leave you
feeling exhausted, relationally drained, inadequate, or depressed?
It is important that family therapy agencies offer their staff both formal supervision
and informal debriefing with a trusted colleague, as this can be invaluable (Hunter &
Schofield, 2006). Informal debriefing enables the therapist to discuss the distressing
aspects of a session with a colleague, who listens empathically without giving any
advice or constructive criticism. It is also important that therapists who work in agencies without adequate supervision, or in isolation in private practice, proactively seek
out both good supervision and debriefing opportunitiespossibly through peer supervision groups.

SUMMARY
The therapists interviewed in this study believe that establishing a good therapeutic bond with their clients is important. They aim to create an empathic connection,
and believe that the familys investment in the role and their experience of mutual
affirmation are vital components of good therapy. The therapeutic bond gives these
family therapists intense satisfaction and poses risks for them, especially when working with traumatic client experiences. Coupled with the potential for over-identification with the client, therapists can become vulnerable in the face of client trauma. In
this study, this appears to result in therapist growth, rather than in vicarious traumatization.

Suggestions for Future Research

Given the evidence that trauma work can lead either to a high level of compassion
satisfaction or to vicarious traumatisation among therapists, further quantitative
research is needed to determine which experiences in therapy are more likely to lead
to growth for both the therapist and the family. Future quantitative research also
needs be conducted to examine the extent to which therapists characteristics (e.g.,
level of experience, training, gender, etc.) may influence their ability to create a good
therapeutic bond with their clients, and to determine the relationship between
mutual affirmation, over-identification with clients, and the potential for breaches of
the ethical code.

Limitations of the Study

There are some important limitations to this study that need to be kept in mind.
First the study is based on a small sample of therapists in Sydney, Australia. They
were recruited from five general counseling agencies and their experiences may not
represent those of family therapists more generally. These therapists were self-selecting, which may have influenced the findings. Given the small sample size, it is not
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possible to determine the extent to which therapists training, level of experience, gender, or other characteristic might influence the way they develop the therapeutic bond.
Qualitative research does not require representativeness, but rather internal validity in terms of depth of data, analysis, and interpretation. The interviews, analysis,
and interpretation were conducted by one researcher and checked by two other
researchers, potentially leading to researcher bias. A further limitation was the lack
of gender balance in the sample that prevented us from examining possible gender differences in therapist experiences of the therapeutic bond, and of the impact of working with traumatic material. The study did not explore the role of training in the
development of the therapists views and experiences of the therapeutic bond and this
may be a fruitful area for future research.
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