Motivation and emotion/Book/2021/Wounded healer paradigm

Overview
Have you ever wondered why you have anticipation for a career in psychotherapy or why you are currently studying to have one? Maybe you are contemplating if a psychotherapeutic career is a unique calling? These are the questions this chapter answers by exploring the unique motivation of psychological health professionals' desire to help others given the emotionally taxing nature of the role.

Drawing from existing research literature this chapter explores how unconscious motivations arising from developmental trauma are instrumental in guiding career choices, that motivations can potentially change over time, and how one’s psychological wounds can contribute to effective therapy. To explain this occurrence and how unmet psychological needs affect motivation, Carl Jung’s wounded healer archetype, the object relations theory, unconscious processes of transference, and countertransference, including post-traumatic growth (PTG) literature and growth mindset are examined. Positive and negative implications of being a wounded healer are also explored and future directions are provided on the identification of gaps in the literature.

Learning outcomes:
 * Define what a wounded healer paradigm is;
 * How does it explain the motivations of psychological health professionals to pursue a career in psychotherapy;
 * How developmental trauma, unconscious processes, PTG and growth affect motivation; implications of being wounded healer and disclosing woundedness to others;
 * Familiarization with psychological theory of object relations and PTG literature associated with unconscious motivation driving behaviour;
 * Identification of gaps in the literature

What is the wounded healer paradigm?
The wounded healer paradigm holds that therapists with a developmental trauma history are motivated towards a career in psychotherapy as they possess a unique capacity to identify, empathize with and treat psychological trauma in clients (Zerubavel & Wright, 2012). It is understood following their own traumatic experiences, therapists can channel those experiences as a source of knowledge, and as a platform to progress effective therapy with their clients (Rice, 2011).

Origins
The origins of wounded healers are noted to date back to ancient mythology and traditions (Scruton, 2015). For instance, outside of Western psychological thought, wounded healers have appeared within various indigenous cultures where shamanism is practiced (Benziman, Kannai, and Ahmad, 2012). Shamans are regarded to possess skills and knowledge having endured both psychologically and physically wounding. Being wounded was considered as important training practice as it helped them to gain insights and skills necessary to become healers (Benziman et al.). Similarly, variations of wounded healers are also observed to have prevalence within the Hebrew folklore, Christian and Muslim traditions, including Eastern cultural sources (Nolte and Dreyer, 2010; Benziman et al.).

The wounded healer archetype


Within Western psychological thought, Carl Jung was the first psychoanalyst to have conceptualized the wounded healer archetype and explore its application to psychology (Newcomb, Burton, Edwards and Hazelwood, 2015). Jung’s wounded healer archetype was drawn from the ancient Greek mythology of Chiron- the immortal centaur, who was incurably wounded both psychologically and physically. First, with rejection at birth by his parents, and later by a poisoned arrow from Hercules’s bow (Crusalis, 2014).

The myth indicates that Chiron had vastly researched to heal his incurable wounds. In doing so, possessed great skills in medicine and healing, which later made him heal others while continuing to suffer from his own wounds. He is said to have renounced his immortality and died meaningful death later by healing and saving Prometheus’ life, thus, making him one of the fundamental archetypes within Western analytical psychology (Conchar and Repper, 2014).

This demonstration of wounded healers across different time and cultures indicates that the wounded healer is universal. Jung’s conceptualization of wounded the healer archetype seems noteworthy given its successful adaptation within the contemporary psychological communities, and amongst psychological health professionals trained under disciplines of psychiatry, psychology, social work, and nursing (Hadjiosif, 2021). This can be helped in understanding the motivation of psychological health professionals towards helping professions. For this book chapter, motivations of psychotherapists towards career in psychotherapy are considered and examined.

How does it explain the motivation of psychological health professionals?
The role of therapists is generally observed to be associated with therapy and treatment outcomes (Conchar et al.), but studies have noted these therapists are not immune to psychological wounds just like the rest of the population (Zerubavel et al.). Developmental trauma, unconscious processes of transference and countertransference, including PTG and having a growth mindset are noted to facilitate the motivation of therapists towards a career in psychotherapy.

Developmental trauma
From the trauma literature, it is known therapists are not immune to psychological crisis and wounding. One such study by Kern (2014) noted developmental trauma was prevalent in higher rates amongst the therapist population. Similarly, Dickeson’s (2017) review reported high rate of developmental trauma - 87.5% within their sample comprising of practicing psychotherapists and social work students. Trauma was reported to arise mainly from emotional abuse, physical and sexual abuse, harsh punishments, and psychological neglect in their childhood (Dickeson). Consistently, another study by Orlinksky, Schofield, Schroder and Kazantzis (2011), reported a similar high percentage - 75% to 87% of therapists receiving treatment for their psychological and interpersonal concerns.

These research findings seem to contradict the generally held beliefs that therapists are mostly wholesome and without any psychological concerns. In contrast, many seem to have lived experiences of trauma and mental illness (Elliott & Ragsdale, 2020). Such experiences are regarded to equip them with a unique capacity to empathize and sensitively understand distress in others, and thus, have motivations to pursue a career in psychotherapy that helped others.

However, other studies noted developmental trauma can be detrimental to neurological and psychosocial growth in childhood (Farina, Liotti and Imperatori, 2019), which then lead to impaired self-structures, attachments, emotional regulation, reflective functioning, and even trigger vulnerability to psychopathology later in adulthood (Siegel, 2012). Such impairments are noted to have negative implications while working with clients (Siegel, 2012). Therefore, it seems likely that therapists are motivated to pursue a role in psychotherapy in order to heal themselves unconsciously (Sussman, 2007). Object relations theory from the psychodynamic literature is examined to further explore this motivational construct.

Object relations theory
According to object relations theory, self-structure and relation to others gets damaged by cumulative parental misattunements, and lead to developmental trauma (Shahri, 2021). Parental failure in gratifying their child’s psychological needs is noted to make the child adapt to their stressful environment by internalizing their experiences (Barnett, 2007). In doing so form a false representation of self as unlovable or others as undependable.

Such cumulative trauma is regarded to cause narcissistic injuries and facilitate unconscious processes of either defensively avoid or seek others for constant external validation to meet fragile self-esteem needs (Sussman). Therefore, it is speculated therapists who have suffered object loss can have neurotic tendencies to heal others with similar trauma to experience vicarious validation for themselves, and so pursue a career in psychotherapy (Shahri).



Unconscious processes
It is also believed that all therapists experiences countertransference while supporting their clients (Abbott, 2018). Countertransference is noted to occur when clients make transference or draw therapists into enacting a role that reflects their unconscious world (Gabbard, 2020). From Jung's psychoanalytical perspective, this is seen as a useful tool for understanding the unconscious mindset of clients (Sedgwick, 2016). However, countertransference experiences are regarded to be challenging especially if therapists had unresolved trauma wounds. It is cited to trigger the therapists to be overly concerned for the client’s wellbeing, make over-identifications, projections, and personal-self disclosures (Richard, 2012). This can be detrimental to the therapeutic relationship.

Therefore, it is suggested that therapists with unresolved trauma have unconscious motivations to pursue a career in psychotherapy for re-enacting trauma wounds to gratify their unmet psychological needs, and so heal vicariously through their clients (Barnett).

Research studies exploring motivations of therapists seem to have pessimistic views. Despite concerns with negative countertransference experiences, lived experiences of trauma are still regarded to positively enhance self-awareness and capacity for self-reflection required within the psychotherapeutic role (Richard). Similarly, choosing a therapist role is also suggested to involve unconscious motivations towards PTG, to transcend the negative trauma trajectory.

Post-Traumatic Growth
The PTG literature has suggested growth and positive transformation can be achieved amongst trauma survivors following their traumatic experiences (Hernández, Gangsei, and Engstrom, 2010). PTG is predicted when individuals transcend their trauma wounds by reappraising traumatic experiences and reconstructing a coherent trauma narrative (Chowdhury, 2021). This seems to resonate with Tedeschi and Calhoun’s theory as cited in Jirek (2016), who defined PTG as a “positive psychological change experienced as a result of the struggle with highly challenging life circumstance,”; and explained growth as:
 * enhanced sense of gratitude for life altogether,
 * improved interpersonal relationships,
 * an increased emotional strength,
 * transformed priorities, and
 * greater spiritual connection.

PTG is also regarded to be advanced if individuals possessed a growth mindset. Participation in self-reflection and making appropriate disclosures within clinical supervisions and professional development groups appears to foster this growth mindset, and thus facilitate the PTG process (Jirek). This growth mindset may then act as a buffer to the consequences of traumatic experiences and thus, help the wounded therapist in formulating coherent a trauma narrative.

However, other studies have noted growth takes time to emerge, and so manifestation of PTG soon after traumatic incidents appears more as a coping strategy for reducing emotional distress, and as an attempt to paint a positive image of their lives (An, Ding and Fu,, 2017). Similarly, therapists’ motivation towards PTG is also argued to be influenced by certain personality traits. Traits like openness to experience and extraversion seem to make them more likely to experience PTG (Collier, 2016). Openness is noted to correlate with cognitive processing of trauma, and extraversion with having positive perceptions of trauma (Collier).

Taken together, all these studies on PTG appears to have inconsistent findings. It seems to fail in specifying if PTG is actual or illusory growth of self-protection (Sanki and O’Connor, 2021). Most studies appear to be quantitative that relied in non-validated self-report measures. This may contain social-desirability biases. Therefore, further in-depth studies exploring different motivation constructs may provide deeper insight into the motivation of therapists in choosing a psychotherapeutic career.

Case study of a wounded psychotherapist (fictional): Giovanni is a psychotherapist. She has recently graduated and started her career in psychotherapy, providing counseling to survivors of sexual abuse. During her clinical supervisions, Giovanni had made self-disclosure to her supervisor that she felt triggered within a therapy session with one of her client given she shared similar trauma wounds and felt she was "not being therapeutic enough!" Giovanni's supervisor then offered her validation and empathy with appropriate psychoeducation on the countertransference process specifying why Giovanni was feeling triggered during sessions. With this validation and awareness, Giovanni could self-reflect on her own responses and offer objective support to her client.

Implications of disclosing woundedness
Being a wounded healer within psychotherapeutic career is noted to have both positive and negative implications. From a positive viewpoint, being wounded therapists is perceived to possess greater capacity to understand emotional distress in others and empathize with them (Conchar and Repper, p.40). Witnessing lived experience of trauma or mental health concerns within therapists are regarded to inspire hope of healing and recovery (p. 40). This can be also seen in contemporary Alcoholics Anonymous groups, where alcoholics look up to fellow recovered alcoholics to achieve lasting sobriety and recovery (White, 2010).

However, other studies indicated being wounded healer has negative implications too. Working with clients with similar trauma wounds is cited to trigger and led to damaging countertransference re-enactments (Zerubavel et al.), and so increase the propensity for professional burnouts and vicarious traumatization (Newcomb et al.). Similarly, other studies noted personal self-disclosure of trauma wounds during clinical supervisions and PD’s afforded within psychotherapeutic career is community is regarded to be met with disbelief and judgement (Roots and Roses, 2020). This fear of stigma and misinterpretation of woundedness as mental impairment is noted to foster concealment of trauma wounds, and so, prevent wounded therapists from seeking help (Cvetovac and Adame, 2017).

This seems to clarify, simply being wounded healer is insufficient in healing others. Significant healing is required within the wounded therapists to strengthen therapeutic relationship and progress therapy with clients (Rice). Therefore, for future directions, other motivations like altruism may also help in understanding if motivation towards psychotherapeutic profession is genuinely driven by goals to increase welfare in others (Sutton, 2021).

Conclusion
The concept of wounded healer is universal and timeless. Jung’s conceptualization of the wounded healer archetype appears to be noteworthy given its advancement and applicability across contemporary psychological communities and within psychological health professionals.

Motivation to pursue a psychotherapeutic career seems to be impacted highly by factors like developmental trauma, unconscious processes of transference-countertransference, PTG and growth mindset. From a developmental perspective, lived experiences of trauma and mental instabilities equips wounded therapists with unique capacity to sensitively understand emotional distress, empathize with and progress therapy with clients. Unconscious processes of transference and countertransference seems to advance the therapeutic relationship. However, according to object relation theory, object loss in childhood leads to narcissistic injuries, internalizations of false-self, and compulsive care-giving tendency tendency. As a result, motivation towards psychotherapeutic career is speculated to re-enact developmental wounds, gratify unmet psychological needs and heal vicariously through clients. But, in doing so, therapists are noted to be more at risk or professional burnout and vicarious traumatization.

Research literature also appears to indicate PTG is experienced strongly by therapists who possess a growth mindset, including personality traits, openness to experience and extraversion. However, other studies seem to point that PTG literature fails in specifying if PTG is an actual or illusory growth for self-protection.

Moreover, wounded therapists are regarded to be challenged by issues of stigmatization. Personal disclosures often accepted within psychotherapeutic career appears to be ironically met with disbelief and wrongful interpretation of being impaired rather than wounded, and so foster concealment of traumatic injuries and prevent them in seeking help. For effective progress of therapy and strengthening therapeutic relationship between therapists and clients, significant healing within wounded therapists is deemed necessary.

Research exploring the motivation of therapists in pursuing a psychotherapeutic career appears to be constrained. There seems to be dearth in qualitative research studies, larger sample sizes and consistent empirical findings. Nevertheless, it is interesting to note, quantitative research techniques could be applied to wounded healer concept based primarily on ancient mythology and anecdotal evidence. Therefore, for future directions, other motivations like altruism are suggested to explore if motivation towards psychotherapeutic profession is genuinely driven by goals to increase welfare in others.