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2026: Online Advance Publication

Relational skills and self-awareness outcomes in psychotherapy trainees

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Published: 31 August 2026
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Relational skills and self-awareness are important aspects of psychotherapy training, shaping how trainees relate to clients, reflect on their experiences, and develop professionally. Despite their importance, little research has examined how these aspects are related during training. This cross-sectional study investigated the associations between relational skills and self-awareness outcomes in psychotherapy trainees and explored whether these variables differed according to stages of training, age, engagement in personal therapy, and self-reported mental health difficulties. The sample included 105 trainees (75.2% female, M age=29.71 years, SD=10.77), of whom 46% were in the beginning stage and 54% in the advanced stage of training. Relational styles were identified using exploratory factor analysis, and associations were examined using Pearson correlations and analyses of variance. Self-awareness outcomes were assessed with the Self-Awareness Outcomes Questionnaire (SAOQ). Exploratory factor analysis identified four relational styles: Warm, Guarded, Directive, and Intense. Warm, Directive, and Intense styles were positively associated with several self-awareness outcomes, whereas Guarded was associated with higher emotional costs of self-awareness. Older trainees (43+) reported greater emotional engagement, lower emotional strain, and higher scores on the Intense style than trainees aged 18-24. Trainees engaged in personal therapy tended to report lower emotional costs of self-awareness. Self-reported mental health difficulties were associated with higher emotional costs and more guarded, less warm relational styles. The results contribute to an understanding of how relational styles, self-awareness outcomes, and personal factors are interconnected in psychotherapy trainees and may help inform psychotherapy training by emphasizing individual differences in relational functioning.

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Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23(1), 1–33. doi: 10.1016/s0272-7358(02)00146-0
Andela, M., Auzoult, L., & Truchot, D. (2014). An exploratory study of self-consciousness and emotion-regulation strategies in health care workers. Psychological Reports, 115(1), 106–114. doi: 10.2466/20.16.PR0.115c17z4
Anderson, T., Crowley, M. E. J., Himawan, L., Holmberg, J. K., & Uhlin, B. D. (2016). Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome. Psychotherapy Research, 26(5), 511–529. doi: 10.1080/10503307.2015.1049671
Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65(7), 755–768. doi: 10.1002/jclp.20583
Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. doi: 10.1037/0003-066X.55.5.469
Bearse, J. L., McMinn, M. R., Seegobin, W., & Free, K. (2013). Barriers to psychologists seeking mental health care. Professional Psychology: Research and Practice, 44(3), 150–157. doi: 10.1037/a0031182
Bennett-Levy, J. (2006). Therapist skills: A cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34(1), 57–78. doi: 10.1017/S1352465805002420
Bennett-Levy, J. (2019). Why therapists should walk the talk: The theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133–145. doi: 10.1016/j.jbtep.2018.08.004
Bhola, P., & Mehrotra, K. (2021). Associations between countertransference reactions towards patients with borderline personality disorder and therapist experience levels and mentalization ability. Trends in Psychiatry and Psychotherapy, 43(2), 116–125. doi: 10.47626/2237-6089-2020-0025
Bike, D. H., Norcross, J. C., & Schatz, D. M. (2009). Processes and outcomes of psychotherapists’ personal therapy: Replication and extension 20 years later. Psychotherapy: Theory, Research, Practice, Training, 46(1), 19–31. doi: 10.1037/a0015139
Brown, J. D. (2009). Choosing the right type of rotation in PCA and EFA. Shiken: JALT Testing & Evaluation SIG Newsletter, 13(3), 20–25.
Charles, S. T., & Carstensen, L. L. (2010). Social and emotional aging. Annual Review of Psychology, 61, 383–409. doi: 10.1146/annurev.psych.093008.100448
Chigwedere, C., Bennett-Levy, J., Fitzmaurice, B., & Donohoe, G. (2021). Personal practice in counselling and CBT trainees: The self-perceived impact of personal therapy and self-practice/self-reflection on personal and professional development. Cognitive Behaviour Therapy, 50(5), 422–438. doi: 10.1080/16506073.2020.1846608
Clark, L. A., & Watson, D. (2019). Constructing validity: New developments in creating objective measuring instruments. Psychological Assessment, 31(12), 1412–1427. doi: 10.1037/pas0000626
DaSilveira, A., DeSouza, M. L., & Gomes, W. B. (2015). Self-consciousness concept and assessment in self-report measures. Frontiers in Psychology, 6, 930. doi: 10.3389/fpsyg.2015.00930
de Felice, G., Giuliani, A., Gelo, O. C. G., Mergenthaler, E., De Smet, M. M., Meganck, R., Paoloni, G., Andreassi, S., Schiepek, G. K., Scozzari, A., & Orsucci, F. F. (2020). What differentiates poor- and good-outcome psychotherapy? A statistical-mechanics-inspired approach to psychotherapy research, part two: Network analyses. Frontiers in Psychology, 11, 788. doi: 10.3389/fpsyg.2020.00788
de Felice, G., Orsucci, F. F., Scozzari, A., Gelo, O., Serafini, G., Andreassi, S., Vegni, N., Paoloni, G., Lagetto, G., Mergenthaler, E., & Giuliani, A. (2019). What differentiates poor and good outcome psychotherapy? A statistical-mechanics-inspired approach to psychotherapy research. Systems, 7(2), 22. doi: 10.3390/systems7020022
Dennhag, I., & Ybrandt, H. (2013). Trainee psychotherapists’ development in self-rated professional qualities in training. Psychotherapy, 50(2), 158–166. doi: 10.1037/a0033045
Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy, 55(4), 399–410. doi: 10.1037/pst0000175
Erikson, E. H. (1968). Identity: Youth and crisis. W.W. Norton & Company.
Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519. doi: 10.1037/pst0000185
Evers, O., Schröder-Pfeifer, P., Möller, H., & Taubner, S. (2019). How do personal and professional characteristics influence the development of psychotherapists in training: Results from a longitudinal study. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(3), 389–401. doi: 10.4081/ripppo.2019.424
Evers, O., Schröder-Pfeifer, P., Möller, H., & Taubner, S. (2022). The competence development of German psychotherapy trainees: A naturalistic, longitudinal and multidimensional outcome study. Psychotherapy Research, 32(4), 539–553. doi: 10.1080/10503307.2021.1950939
Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43(4), 522–527. doi: 10.1037/h0076760
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. doi: 10.1037/pst0000172
Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M. B., Collins, F. L., Jr., & Crossman, R. E. (2009). Competency benchmarks: A model for understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology, 3(4 Suppl.), S5–S26. doi: 10.1037/a0015832
Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. American Psychological Association.
Geller, S. M., Greenberg, L. S., & Watson, J. C. (2010). Therapist and client perceptions of therapeutic presence: The development of a measure. Psychotherapy Research, 20(5), 599–610. doi: 10.1080/10503307.2010.495957
Gelo, O., Braakmann, D., & Benetka, G. (2009). “Quantitative and qualitative research: Beyond the debate”: Erratum. Integrative Psychological and Behavioral Science, 43(4), 406–407. doi: 10.1007/s12124-009-9107-x
Gelo, O. C. G., Lagetto, G., Dinoi, C., Belfiore, E., Lombi, E., Blasi, S., Aria, M., & Ciavolino, E. (2020a). Correction to: Which methodological practice(s) for psychotherapy science? A systematic review and a proposal. Integrative Psychological and Behavioral Science, 54(1), 249–250. doi: 10.1007/s12124-019-09502-6
Gelo, O. C. G., Lagetto, G., Dinoi, C., Belfiore, E., Lombi, E., Blasi, S., Aria, M., & Ciavolino, E. (2020b). Which methodological practice(s) for psychotherapy science? A systematic review and a proposal. Integrative Psychological and Behavioral Science, 54(1), 215–248. doi: 10.1007/s12124-019-09494-3
Gelo, O. C. G., Ziglio, R., Armenio, S., Fattori, F., & Pozzi, M. (2016). Social representation of therapeutic relationship among cognitive-behavioral psychotherapists. Journal of Counseling Psychology, 63(1), 42–56. doi: 10.1037/cou0000104
Gelso, C. J., & Hayes, J. A. (1998). The psychotherapy relationship: Theory, research, and practice. John Wiley & Sons Inc.
Gennaro, A., Gelo, O. C. G., Lagetto, G., & Salvatore, S. (2019). A systematic review of psychotherapy research topics (2000–2016): A computer-assisted approach. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(3), 464–477. doi: 10.4081/ripppo.2019.429
Gergen, K. J. (2009). Relational being: Beyond self and community. Oxford University Press.
Giordano, F., Guidotti, S., Salerno, C., Pruneti, C., & Gelo, O. C. G. (2025). Impact of personality traits, coping styles, and anger on psychological symptoms of patients with arterial hypertension. Research in Psychotherapy: Psychopathology, Process and Outcome, 28(2), 867. doi: 10.4081/ripppo.2025.867
Greenberg, L. S., & Pascual-Leone, A. (2006). Emotion in psychotherapy: A practice-friendly research review. Journal of Clinical Psychology, 62(5), 611–630. doi: 10.1002/jclp.20252
Hatcher, R. L. (2015). Interpersonal competencies: Responsiveness, technique, and training in psychotherapy. American Psychologist, 70(8), 747–757. doi: 10.1037/a0039803
Hayes, J. A., Gelso, C. J., & Hummel, A. (2011). Managing countertransference. Psychotherapy, 48(1), 88–97. doi: 10.1037/a0022182
Heinonen, E., & Nissen-Lie, H. A. (2020). The professional and personal characteristics of effective psychotherapists: A systematic review. Psychotherapy Research, 30(4), 417–432. doi: 10.1080/10503307.2019.1620366
Heinonen, E., & Orlinsky, D. E. (2013). Psychotherapists’ personal identities, theoretical orientations, and professional relationships: Elective affinity and role adjustment as modes of congruence. Psychotherapy Research, 23(6), 718–731. doi: 10.1080/10503307.2013.814926
Heinonen, E., Orlinsky, D. E., Willutzki, U., Rønnestad, M. H., Schröder, T., Messina, I., Löffler-Stastka, H., & Hartmann, A. (2022). Psychotherapist trainees’ quality of life: Patterns and correlates. Frontiers in Psychology, 13, 864691. doi: 10.3389/fpsyg.2022.864691
Hill, C. E., Sullivan, C., Knox, S., & Schlosser, L. Z. (2007). Becoming psychotherapists: Experiences of novice trainees in a beginning graduate class. Psychotherapy: Theory, Research, Practice, Training, 44(4), 434–449. doi: 10.1037/0033-3204.44.4.434
Hill, K., Wittkowski, A., Hodgkinson, E., Bell, R., & Hare, D. J. (2016). Using the repertory grid technique to examine trainee clinical psychologists’ construal of their personal and professional development. Clinical Psychology & Psychotherapy, 23(5), 425–437. doi: 10.1002/cpp.1961
Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16. doi: 10.1037/a0022186
Jennings, L., & Skovholt, T. M. (1999). The cognitive, emotional, and relational characteristics of master therapists. Journal of Counseling Psychology, 46(1), 3–11. doi: 10.1037/0022-0167.46.1.3
Knapp, S., Gottlieb, M. C., & Handelsman, M. M. (2017). Enhancing professionalism through self-reflection. Professional Psychology: Research and Practice, 48(3), 167–174. doi: 10.1037/pro0000135
Kunzmann, U., & Grühn, D. (2005). Age differences in emotional reactivity: The sample case of sadness. Psychology and Aging, 20(1), 47–59. doi: 10.1037/0882-7974.20.1.47
Kuyken, W., Peters, E., Power, M. J., & Lavender, T. (2003). Trainee clinical psychologists’ adaptation and professional functioning: A longitudinal study. Clinical Psychology & Psychotherapy, 10(1), 41–54. doi: 10.1002/cpp.350
Levinson, D. J. (1986). A conception of adult development. American Psychologist, 41(1), 3–13. doi: 10.1037/0003-066X.41.1.3
Lohani, G., & Sharma, P. (2023). Effect of clinical supervision on self-awareness and self-efficacy of psychotherapists and counselors: A systematic review. Psychological Services, 20(2), 291–299. doi: 10.1037/ser0000693
Longley, M., Kästner, D., Daubmann, A., Hirschmeier, C., Strauß, B., & Gumz, A. (2023). Prospective psychotherapists’ bias and accuracy in assessing their own facilitative interpersonal skills. Psychotherapy, 60(4), 525–535. doi: 10.1037/pst0000506
MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84–99. doi: 10.1037/1082-989X.4.1.84
Macran, S., & Shapiro, D. A. (1998). The role of personal therapy for therapists: A review. British Journal of Medical Psychology, 71(1), 13–25. doi: 10.1111/j.2044-8341.1998.tb01364.x
Macran, S., Stiles, W. B., & Smith, J. A. (1999). How does personal therapy affect therapists’ practice? Journal of Counseling Psychology, 46(4), 419–431. doi: 10.1037/0022-0167.46.4.419
Malikiosi-Loizos, M. (2013). Personal therapy for future therapists: Reflections on a still debated issue. The European Journal of Counselling Psychology, 2(1), 33–50. doi: 10.5964/ejcop.v2i1.4
McWilliams, N. (2004). Psychoanalytic psychotherapy: A practitioner’s guide. The Guilford Press.
Messina, I., Gelo, O. C. G., Sambin, M., Bianco, F., Mosconi, A., Fenelli, A., Curto, M., Gullo, S., & Orlinsky, D. (2018). Trainees’ self-evaluation of their development as psychotherapists: An Italian contribution to an international collaborative study on psychotherapy training. Clinical Psychology & Psychotherapy, 25(2), 338–347. doi: 10.1002/cpp.2165
Messina, I., & Trimoldi, G. (2024). Shaping psychotherapy trainees’ potential: insights from training program directors. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(2), 799. doi: 10.4081/ripppo.2024.799
Mikulincer, M., & Shaver, P. R. (2019). Attachment orientations and emotion regulation. Current Opinion in Psychology, 25, 6–10. doi: 10.1016/j.copsyc.2018.02.006
Mikulincer, M., Shaver, P. R., & Berant, E. (2013). An attachment perspective on therapeutic processes and outcomes. Journal of Personality, 81(6), 606–616. doi: 10.1111/j.1467-6494.2012.00806.x
Nissen-Lie, H. A., Monsen, J. T., Ulleberg, P., & Rønnestad, M. H. (2013). Psychotherapists’ self-reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychotherapy Research, 23(1), 86–104. doi: 10.1080/10503307.2012.735775
Norcross, J. C. (2005). The psychotherapist’s own psychotherapy: Educating and developing psychologists. American Psychologist, 60(8), 840–850. doi: 10.1037/0003-066X.60.8.840.
Norcross, J. C., & Lambert, M. J. (2011). Evidence-based therapy relationships. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed., pp. 3–21). Oxford University Press. doi: 10.1093/acprof:oso/9780199737208.003.0001
Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy: Theory, Research, Practice, Training, 55(4), 303–315. doi: 10.1037/pst0000193
Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy —Noch einmal. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behaviour change (4th ed., pp. 270–376). John Wiley & Sons Inc.
Orlinsky, D. E., & Rønnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. American Psychological Association. doi: 10.1037/11157-000
Orlinsky, D. E., Rønnestad, M. H., Hartmann, A., Heinonen, E., & Willutzki, U. (2020). The personal self of psychotherapists: Dimensions, correlates, and relations with clients. Journal of Clinical Psychology, 76(3), 461–475. doi: 10.1002/jclp.22876
Orlinsky, D. E., Rønnestad, M. H., Willutzki, U., Schröder, T. A., Heinonen, E., Löffler-Stastka, H., Messina, I., Pirke, J., & Hartmann, A. (2024). Healing involvement and stressful involvement experienced by psychotherapy trainees: Patterns, correlates and perceived development. Counselling and Psychotherapy Research, 24(4), 1442–1453. doi: 10.1002/capr.12788
Orlinsky, D. E., Schofield, M. J., Schroder, T., & Kazantzis, N. (2011). Utilization of personal therapy by psychotherapists: a practice-friendly review and a new study. Journal of Clinical Psychology, 67(8), 828–842. doi: 10.1002/jclp.20821
Orlinsky, D. E., Strauss, B., Rønnestad, M. H., Hill, C. E., Castonguay, L. G., Willutzki, U., Hartmann, A., Taubner, S., & Carlsson, J. (2015). A collaborative study of development in psychotherapy trainees. Psychotherapy Bulletin, 50(4), 21–25.
Podolan, M., & Gelo, O. C. G. (2024). The role of safety in change-promoting therapeutic relationships: An integrative relational approach. Clinical Neuropsychiatry, 21(5), 403–417. doi: 10.36131/cnfioritieditore20240505
Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. doi: 10.1037/0021-9010.88.5.879
Robinson, N. L., Schweitzer, R. D., & O’Connor, E. L. (2019). Early reflections on becoming a therapist: Development of reflective practice in clinical training programmes in an Australian context. Counselling and Psychotherapy Research, 19(4), 388–398. doi: 10.1002/capr.12255
Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30(1), 5–44. doi: 10.1023/A:1025173508081
Rønnestad, M. H., & Skovholt, T. M. (2013). The developing practitioner: Growth and stagnation of therapists and counselors. Routledge.
Schöttke, H., Flückiger, C., Goldberg, S. B., Eversmann, J., & Lange, J. (2017). Predicting psychotherapy outcome based on therapist interpersonal skills: A five-year longitudinal study of a therapist assessment protocol. Psychotherapy Research, 27(6), 642–652. doi: 10.1080/10503307.2015.1125546
Strauß, B., & Taeger, D. (2021). Untersuchungen zur „Wirkung“ von Selbsterfahrung in der Psychotherapieausbildung – Ein systematisches Review [Effects of personal therapy during psychotherapy training—A systematic review]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 71(12), 489–498. doi: 10.1055/a-1499-8115
Sutton, A. (2016). Measuring the effects of self-awareness: Construction of the Self-Awareness Outcomes Questionnaire. Europe’s Journal of Psychology, 12(4), 645–658. doi: 10.5964/ejop.v12i4.1178
Tilkidzhieva, E., Gelo, O. C. G., Gullo, S., Orlinsky, D. E., Mörtl, K., & Fiegl, J. (2019). Self-concept of relational skills in psychotherapy trainees: A pilot study. Counselling and Psychotherapy Research, 19(3), 311–320. doi: 10.1002/capr.12217
Tilkidzhieva, E., Gullo, S., Fiegl, J., & Gelo, O. C. G. (2026). Trajectory of change of relational skills in psychotherapy trainees: A longitudinal study. [Manuscript in preparation].
Trapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-factor model of personality: Distinguishing rumination from reflection. Journal of Personality and Social Psychology, 76(2), 284–304. doi: 10.1037/0022-3514.76.2.284
Trimoldi, G., Sambin, M., Spataro, P., Gagliardini, G., & Messina, I. (2026). Developing relational competence in psychotherapy training: a qualitative study of trainees’ perspectives. Research in Psychotherapy: Psychopathology, Process and Outcome, 29(1), 890. doi: 10.4081/ripppo.2026.890
van Rijn, B., Wild, C., Fowlie, H., Sills, C., & van Beekum, S. (2011). Impact of transactional analysis psychotherapy training on self-awareness and ability for contact. International Journal of Transactional Analysis Research & Practice, 2(1), 16–24. doi: 10.29044/v2i1p16
von Haenisch, C. (2011). How did compulsory personal therapy during counselling training influence personal and professional development? Counselling and Psychotherapy Research, 11(2), 148–155. doi: 10.1080/14733145.2010.485693
Zimmermann, P., & Iwanski, A. (2014). Emotion regulation from early adolescence to emerging adulthood and middle adulthood: Age differences, gender differences, and emotion-specific developmental variations. International Journal of Behavioral Development, 38, 182–194. doi: 10.1177/0165025413515405

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Relational skills and self-awareness outcomes in psychotherapy trainees. (2026). Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2026.898