Between self-doubt and growth: how the capacity for self-reflection develops in trainee psychotherapists – a qualitative interview study with self-experience facilitators

Self-reflection is considered a core competence of psychotherapists and, according to new licencing regulations, should already be taught and assessed during undergraduate studies. However, little is known about how this competence develops during psychotherapy training. This qualitative pilot study explores core elements and developmental dynamics of self-reflection competence to derive implications for promotion, evaluation, and future research. Nine expert interviews with self-experience facilitators from systemic, cognitive-behavioural, and psychodynamic therapy were analysed using thematic analysis to identify and systematise relevant aspects of self-reflection development. Researcher triangulation was employed to enhance confirmability. We identified 5 main themes through our analysis: (1) thematic, interpersonal, and experiential engagement as components of self-reflection, (2) feedback effects on self-regulation, personal growth, and therapeutic relationship, (3) intra- and intersubjective irritations as triggers of self-reflection processes, (4) the inhibitory role of unpleasant emotions, and (5) conditions for the emergence and maintenance of self-reflection. The findings were consolidated into a heuristic model of self-reflection development. According to the interviewees emotional irritation within the therapeutic process could be utilized as a starting point for in-depth self-reflection. This could have implications for psychotherapy training and should be examined in further studies with larger samples and experimental designs. What is already known about this topic: Self-reflection is regarded as a core competence in psychotherapeutic practice and training.Despite diverse conceptualisations, it remains unclear how self-reflection develops and can be fostered.Studies indicate associations with empathy and health, as well as indications of the importance of structured support and potential barriers in training. Self-reflection is regarded as a core competence in psychotherapeutic practice and training. Despite diverse conceptualisations, it remains unclear how self-reflection develops and can be fostered. Studies indicate associations with empathy and health, as well as indications of the importance of structured support and potential barriers in training. What this paper adds: Based on reports from self-experience facilitators, a heuristic model of a possible developmental dynamic of self-reflection is proposed.From the perspective of the surveyed self-experience facilitators, there are supportive and hindering feedback processes in which emotions play an ambivalent role.The respondents considered openness, a safe setting, and sufficient time as prerequisites for vulnerability in self-reflection. Based on reports from self-experience facilitators, a heuristic model of a possible developmental dynamic of self-reflection is proposed. From the perspective of the surveyed self-experience facilitators, there are supportive and hindering feedback processes in which emotions play an ambivalent role. The respondents considered openness, a safe setting, and sufficient time as prerequisites for vulnerability in self-reflection.