The 'magic' revealed

: therapist stories of therapy

Abstract

Section A
Background and Aims: Therapists occupy a unique epistemological position as both participants in, and observers of therapy. Despite this, research has largely prioritised clients’ narratives. This review synthesised clinician first-person accounts of therapy to develop a higher order interpretive model of what therapists’ narratives reveal about therapeutic work, with implications for training, supervision, and service provision.
Method: A systematic search of MEDLINE, PsycINFO, and Web of Science identified 11 papers, representing 52 participants. Quality appraisal used the Critical Appraisal Skills Programme (CASP), findings were synthesised using meta-ethnography, and an explanatory model was developed.
Results: Three third-order constructs were developed: Therapeutic Relationship, Self of the Therapist, and Navigating Complexity and Constraint. Clinician narratives positioned the therapeutic relationship at the centre of therapeutic work, characterised by embodied presence, attunement, relational warmth, openness, and the ability to hold difference and sameness. Therapists’ stories also highlighted the emotional impact of therapy, the importance of reflexivity and self-awareness, and the challenge of working within client complexity and service constraints.
Conclusion: Findings emphasise the importance of clinician presence, reflexivity, and viewing therapy as dynamic and co-created. Policy implications include protected reflective practice, structured supervision, manageable caseloads, and adequate clinical time.

Section B
Background: Dominant psychiatric narratives frame ‘psychosis’ as a brain disease, while trauma-informed perspectives view it as a response to adversity. This has increased interest in EMDR for ‘psychosis’, yet research has focused on efficacy, with little attention to when it is unhelpful. Exploring non-helpfulness is key to safe, evidence-based practice, and narrative analysis helped illuminate how these limits were constructed in therapeutic work.
Aim: This study explored clinician narratives of when and why EMDR for psychosis was unhelpful and how dominant psychiatric and trauma-informed narratives were depicted.
Method: Narrative analysis was applied to interviews with 12 EMDR clinicians, attending to dominant, community, personal narratives, narrative themes, and structure.
Results: EMDR helpfulness was depicted as inhibited by “survival responses in the therapy room” (e.g., shame, dissociation), substance use, and medication. EMDR was also depicted as “magic” or “mysterious”, reducing helpfulness when adequate preparation was absent. “Neurodiversity is just totally in the way” highlighted the need to adapt standard protocols for ‘neurodivergent’ clients. Tensions between dominant psychiatric and trauma-informed narratives were evident throughout.
Conclusion: Non-helpfulness was rarely attributed to EMDR as an intervention, but instead to a perceived misalignment between the demands of EMDR and the need for adequate preparation and adaptation to the client and their context.

Date of Award	2026
Original language	English
Awarding Institution	Canterbury Christ Church University