University of Worcester
Students as Academic Partners Projects 2010/11
Recognising and Supporting Wounded
Would-be Healers in Higher Education:
A literature review
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sally Jansen & Maddie Burton
October 2011
Sally Jansen & Maddie Burton
Students as Academic Partners
October 2011
Contents
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Table of Contents
Chapter 1
Introduction……………………………………………………………..
1
Chapter 2
Methodology..............................................……..…………………...
5
Chapter 3
Findings....................................………………………………………
7
Chapter 4
Discussion..................................……………………………………..
15
Chapter 5
Conclusions and Recommendations…………................................
23
References................................................................................................
28
Appendix
32
List of Tables
Table 1 Numbers of care leavers/people who have spent time in the looked
after system by Institute at the University of Worcester
32
Table 2 Number of undergraduate students in each Institute expressed as a
percentage of all undergraduate students at the University
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Chapter 1: Introduction
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“Nobody can meddle with fire or poison without being affected in some
vulnerable spot; for the true physician does not stand outside his work but
always in the thick of it.”
- Carl Jung
1
INTRODUCTION
In my final year as an undergraduate student in Social Welfare, whilst researching
material for an assignment on loss and bereavement, I chanced upon a few
paragraphs buried in a social work text. The discussion centred on “the experience
of loss as a factor in motivation for social work” (Lishman 2007:235) and the
difficulties associated with selecting suitable candidates for admission to social work
courses:
“We are familiar with applicants whose personal statements contain nothing
personal and where interviewers are unable to reach the applicants‟ personal
feelings about major life events and their work with clients. And we know too
applicants with a powerful desire to help, but whose life events have
swamped them with feelings which are all too readily amplified by the
experiences and feelings of clients…The recently wounded would-be healer
on the mend might be asked to re-apply.”
(Rochford 2007:239)
This was my first encounter with both the term and the notion of the wounded healer.
It immediately resonated with my experiences as a student and sparked my curiosity.
Rationale
During the three years I spent at the University of Worcester, I got to know the
people on my course on a personal level and formed some enduring friendships
along the way. Over the years, we shared our worries and woes and frequently
disclosed intimate details about our personal lives. The stories we shared were
about significant and sometimes traumatic life experiences: the death of a loved one,
relationship breakdown, illness, domestic abuse, mental health problems and
discrimination to mention but a few. For some these experiences had occurred
many years ago, whilst still in childhood, whereas for others these difficulties arose
(or continued in some cases) in the midst of their studies. Added to this was the
spectre of the subject matter of the course; throughout the duration of the course it
was not uncommon for students to become distressed or disturbed by topics that hit
a raw nerve, bringing a range of emotions to the fore. Selecting to study modules on
bereavement, disability or substance misuse indicates to students the issues they
may be expected to get to grips with and provides sufficient forewarning for those
students who may be affected by the subject matter to prepare themselves
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Chapter 1: Introduction
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accordingly. However, more often than not, greater upset seemed to occur when
students were least expecting it, for instance, as a result of a seemingly innocuous
ice breaker task or during a lectures on law or social policy. It seemed as if emotions
were triggered when students had no prior warning or opportunity to prepare
themselves.
Stumbling across the concept of the wounded healer led me to question the value
and the apparent contradictions of studying woundedness in others – the service
users, clients and patients we hoped to eventually work with in a professional
capacity – yet failing to attend to our own wounds. From beginning to end, our
motivations for choosing the course were not considered nor were our wounds
explicitly acknowledged or addressed. Hence, when the chance to work on the
Students as Academic Partners project arose it represented an opportunity to
investigate this anomaly further.
What is a wounded healer?
“The wounded healer is someone who works with (heals) others and is
informed by their own traumatic or difficult experiences (wounds) in the work
that they do”
(Vachon 2010:55)
A wound causes loss, pain or suffering (Martin 2011). The implication is that when a
wound heals the person is left with a scar which changes them from the person they
were before becoming wounded. Talking about his own experience of mental
breakdown, Peter Martin, a practising psychotherapist and university lecturer in
counselling psychology, reflects that "the experience of my own frailty had changed
me" (Martin 2011:14). Similarly, several of the contributors featured in Rippere and
Williams‟ (1985) collection of autobiographical writings about mental health workers‟
experiences of depression refer to their experiences as a turning point in their lives,
after which things were never the same again.
In this instance the term 'healer' will refer to those people whose work is primarily
concerned with helping wounded people. To clarify, the use of the term „healer‟ is
not intended to alienate those who reject the medical model (with its emphasis on
restoring people to „normal‟ health) nor is it used naïvely in the belief that all wounds
can or should be „cured‟. Instead, the term „healer‟ is simply used here as part of a
phrase and as a form of shorthand to express the wide range of professions and
occupations it describes: nurses, doctors, social workers, youth workers,
counsellors, therapists, psychologists, support workers, carers, etc. The „would-be‟
healers in higher education are those students enrolled on a course of study
associated with these helping professions. At the University of Worcester these
courses tend to be situated within the Institute of Health and Society (see
http://www.worcester.ac.uk/discover/health-our-courses.html for details of courses
currently available). Most, if not all, feature a core requirement for students to
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Chapter 1: Introduction
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participate in some form of work placement or work-based learning in their chosen
field of practice. Some courses lead to professional accreditation, i.e. nursing.
Historical and cultural background
The „wounded healer‟ has its roots in Jungian psychology where it is used to
describe the way in which “the therapist‟s wounds connect with patient‟s wounds”
(Vachon 2010:55). Carl Jung (1875-1961) was a practicing psychiatrist and
psychoanalyst who formed a brief alliance with Sigmund Freud before going on to
produce his own work on analytic psychology (Storr 1974). A common theme
running through Jung‟s work concerned the „reconciliation of opposites‟ ( Storr
1974:11). Jung himself experienced a mental breakdown in his late thirties and
spent several years analysing himself; his autobiographical case study became the
basis of his subsequent work in analytic psychology (Storr 1974). Jung posited the
idea of an archetype, describing it as an innate part of the unconscious mind,
underpinning a series of manifestations across different cultures and periods in time
(Storr 1974). An archetype is:
“…a hypothetical entity irrepresentable in itself and evident only through its
manifestations…Archetypal patterns wait to be realised in the personality, are
capable of infinite variation, are dependent upon individual expression and
exercise a fascination reinforced by traditional or cultural expectation”
(Samuels et al 1987:26).
In Jungian psychology, the wounded healer is a symbolic manifestation of an
archetype that contains two contradictory elements yet in Western culture the image
of the wounded healer is split; for instance, in medicine there is a clear divide
between the doctor and the patient (Samuels et al 1987). This split may explain why
wounds are perceived by some to compromise the status of the healer (Christie &
Weeks 1998; Graves 2008). In other cultures this is not always the case. For the
shamans found in tribal societies, woundedness is a rite of passage to becoming a
healer and is considered to be an indication of the shaman‟s ability to heal others
(Matthews 1998; Stone 2008). In this way, the archetype of the wounded healer
manifests in different ways in different cultures. For example, in Ancient Greece the
concept of the wounded healer found its expression through the medium of
mythology and the story of Chiron, an immortal centaur who is seriously wounded by
Hercules‟ arrow (McEwan 2011; Vachon 2010). Chiron endures pain and suffering
and searches in vain for a way to heal his wound. His quest to alleviate his own pain
gives him a great store of knowledge to heal others and enables him to mentor
others in the art of healing. Thus cultural representations in the form of Greek myth
and shamanism suggest wounds make for an effective healer.
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Chapter 1: Introduction
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Objectives and aims
This project sets out to investigate how to recognise and support the wounded
would-be healer in higher education. To quote from the Students as Academic
Partners Projects summary, the overarching objective of this project is to work in
partnership with academic staff “to strengthen the learning and teaching of the
University for the benefit of all”. Although there is a specific focus on the would-be
healers in the University, particularly in relation to the undergraduate Social Welfare
course, wider application extending across other courses and Institutes is
conceivable where the 'use of self' as a tool of practice (Hamer 2006) and the
creation of meaningful relationships with others forms a fundamental part of practice.
In this way, the project may have some relevance for academic teaching staff,
support staff and those undertaking courses in education, business, the arts or
sports coaching.
It is recognised that within the Institute of Health and Society there is a distinction
between those courses that lead to professional accreditation, such as nursing and
social work, and those that do not but it is argued that students graduating from nonaccredited courses may still go on practice in occupations where they have direct
interactions with clients and service users. Since multi-agency working is common
practice in health and social care the fact remains that the practitioners graduating
from the non-accredited courses may work with the exact same service users who
are also under the care of nurses and social workers. Hence it is reasonable to
expect students undertaking paraprofessional programmes to attain similar levels of
competency as those working toward professional accreditation.
Based on experiences taken from the student and teaching perspective, two
dimensions of the wounded would-be healer in higher education have been identified
to form the primary foci of this piece. The first is concerned with recognising
wounded healers in higher education in a manner that acknowledges life experience
as a form of knowledge. The second dimension relates to supporting wounded
healers to promote success, healing and fitness to enter practice. The project aims
to develop recommendations for change incorporating these two strands and it is
envisaged these recommendations will enhance teaching and learning “for the
benefit of all”. The remainder of the project is organised as follows: chapter 2
discusses the methodology selected for the project; chapter 3 reports on the
findings; chapter 4 discusses the debates and assumptions impacting on the project;
and chapter 5 concludes the project and makes recommendations for change.
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Chapter 2: Methodology
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2
METHODOLOGY
A literature review will be used to achieve the aims of the project. Primary research,
in the form of qualitative interviews with wounded students, was considered but
discounted because of practicalities and ethics. Sampling would prove to be difficult
since woundedness is a personal and private matter which is not ordinarily
discussed openly. Although there were some students who had been open about
their experiences in informal discussions or within the boundaries of a lecture, a
number of ethical implications suggest perhaps primary research would not be
appropriate. Anonymity and confidentiality would need to be assured and since the
students in question were known on a personal basis there would be a conflict
between the interviewer/interviewee relationship and the personal relationship
outside of the interview. Furthermore, maintaining anonymity would limit the extent
to which details from narratives could be used because specific examples would
make the students identifiable, at least to other members of the cohort and teaching
staff.
A major reason for discounting all forms of primary research, including a quantitative
study using a questionnaire survey, was the concern over student wellbeing. If
requesting information about difficult and traumatic life experiences were to trigger a
negative reaction in the participant no assurances could be given that these could be
dealt with appropriately by the interviewer due to lack of experience and training in
this field. If questionnaires were completed remotely and confidentially, for example,
using an email alias or internet survey tool, it would be rather more difficult to
determine if a participant had become distressed and offer the appropriate support.
Furthermore, in practical terms, the timescale for the commencement of the project
coincided with the end of the academic year meaning that many students who might
ordinarily have participated in the study would not be available on campus to
interview. However, this is not to say that empirical research in this area is wholly
impracticable or unethical but due to the practical limitations and ethical implications
associated with this particular project, at this particular moment in time, it was
decided that a literature review represented the most appropriate methodology to
utilise.
A literature review attempts to summarise the literature available on a specific topic
to gain an overview of the knowledge published to date (Aveyard 2007; Ridley 2008).
Before commencing research it was decided that only journal articles and academic
texts with some relevance to the helping professions would be included whilst all
other published literature (newspaper articles, fictional works, blogs) would be
excluded as it was judged these would be less reliable sources of information due to
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Chapter 2: Methodology
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bias, practical relevance or lack of rigour. The literature sample for this study uses
sources taken from social work, counselling, nursing, mental health, youth work,
domestic violence, substance abuse, medicine and education. To find relevant
publications two methods were used: a phrase search followed by snowball sampling
(Aveyard 2007; Ridley 2008). Initially, a search of academic journals and books held
by the library was generated using the search term "wounded healer". The
academic journal search returned a manageable quantity of no more than 50
sources hence no additional filters were applied. The initial results were recorded
and further exclusions were made on the basis of relevance to the helping
professions and education or where publications were produced in languages other
than English. These literature sources were then reviewed however a small minority
were excluded because they focussed solely on woundedness occurring as a result
of practice as opposed to woundedness being present prior to entering higher
education or practice.
Snowball sampling was used to access key studies and publications referred to in
these initial sources, using the same inclusion and exclusion criteria applied
previously. In an effort to obtain the most up to date sources a citation search was
carried out on several of the key empirical studies to emerge from the initial search in
order to find journal articles and research studies citing these key pieces of research.
Ideally, snowball sampling and citation searches would be continued until no fresh
sources are found however due to the time constraints of this project this stage was
not reached. As a result, although a systematic approach was adopted to gather a
broad sample of relevant literature it is possible that some publications have been
overlooked. In addition, some of the publications identified could not be obtained in
full despite efforts to secure them through inter-library loans in good time. Also
decisions to exclude publications lacking relevance to the helping professions were
subjective and it is possible that these publications may have gone on to inform other
works that were relevant to the topic. Despite these limitations, best efforts have
been made to access a range of literature in order to develop initiatives to recognise
and support wounded would-be healers in higher education.
A request for information was made to Registry under the Freedom of Information
Act 2000 in an attempt to connect the project specifically to the University. The data
requested pertained to undergraduate profiles collected over the last three years:
gender, age, ethnicity, disability, numbers of students who had spent time in care
and numbers of students withdrawing from studies. The information was broken
down by each academic department in order to compare and contrast the Institute of
Health and Society to the other academic departments at the University. The data
used in this project is presented in the Appendix: raw data is used in Table 1 and the
data in Table 2 has been calculated using raw data supplied by Registry.
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Chapter 3: Findings
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3
FINDINGS
The literature reviewed indicates there are a diverse array of approaches to
addressing the wounds found in healers in both higher education and practice
settings. For the purposes of this project the responses to woundedness found in
practice have been deemed transferable to higher education. The themes
concerned with recognising and supporting the wounded have been organised
against the following four categories: personal development; developing selfawareness through reflection; formal and informal support; and awareness raising.
Undoubtedly there is a considerable degree of overlap between the themes identified
and they ways in which they contribute to recognising and supporting the wounded
would-be healer.
Personal development
According to the psychodynamic perspective, experiencing trauma can lead to two
possible outcomes: positive change and development or harm to personal wellbeing
(Bell 2000). Studies (cited in Carr 2004:226) show one of the three positive
outcomes survivors of illness benefit from is enhanced personal development. Thus
when the wounded healer is depicted as a personal journey (Martin 2011) it is seen
as a journey of change and development that begins with the wound, followed by a
period of recovery to the point where the wounded eventually become models of
wellness and are able to heal others (Matthews 1998). This version of the wounded
healer correlates with the mythical and tribal representations discussed in chapter 1.
Viewing the wounded healer in this way is informed by recovery and wellness
models of health and wellbeing which use holistic approaches to treating the whole
person instead of focusing on symptoms and deficits (Matthews 1998). It also sees
the individual themselves as a resource to promote healing in others. However, with
particular reference to the wounded healer in higher education, courses will not
succeed in developing healthy and well adjusted practitioners unless they are
specifically designed to promote growth and wellbeing (Matthews 1998).
Educators cannot afford to concentrate solely on professional development since
professional development is inextricably linked to personal development (Lishman
2002; Miehls & Moffatt 2000). The following statement is taken from a social work
publication but has resonance for many other fields of practice:
"Personal development is essential to underpin professional development,
since our use of self is part of the service we offer to users and clients."
(Lishman 2002:98)
This concept of the use of self in practice is mentioned by several authors (Hamer
2006; Lishman 2002; Kidd & Tusaie 2004; McClendon 2005; Miehls & Moffatt 2000).
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It refers to the way in which the interpretation of knowledge and the application of
skills is mediated by the human characteristics and idiosyncrasies of the individual
helper; the self of the practitioner has the potential to influence practice delivery and
outcomes (McClendon 2005). Therefore, because the self is a significant part of
practice, Matthews (1998) proposes a shift in emphasis from teaching knowledge
and skills to facilitating personal and professional development and increasing selfawareness. In counselling education, strategies aimed at developing self-awareness
can enable students to develop an effective use of self in practice (Trusty et al 2005).
In addition, giving students the opportunity to work on self-awareness is a
development skill that can be carried forward from education into practice to
enhance mindfulness and promote self-care (Miehls & Moffatt 2000).
Self-care is important for students and practitioners - sowing the seeds of self-care
can start during education and training (Trusty et al 2005). In the nursing curriculum,
McClendon (2005) is keen to incorporate caring and healing workshops, self-care
classes, instruction about the importance of self-care for effective practice and
personal growth programmes. Consequently, education provides an opportunity to
train students to seek help when necessary (Trusty et al 2005) and provide them
with the skills to stay well (McClendon 2005; Morrison 2007; Niven 2008). If formal
instruction on personal wellbeing did form part of the curriculum, positive psychology,
the study of human happiness and psychological wellbeing, could be used as an
academic basis for teaching self-care (Carr 2004). To surmise, the literature
suggests there is a legitimate argument for incorporating personal development in
education as this is linked to professional development and achieving a sufficient
level of competency to enter and continue in practice.
Developing self-awareness through reflection
It is thought reflection enhances self-awareness and has the potential to help people
become more mindful of their fitness to practice (Niven 2008; Parker & Merrylees
2002). Furthermore, since reflective practice is a model of professional
development, self-reflection and self-awareness can enable students to achieve
growth and development (Lishman 2002). Reflective learning is an approach closely
associated with the work of Donald Schön (1987). Reflection provides a method of
formalising tacit knowledge (sometimes referred to as practice wisdom) gained
through practical experience. In the context of the wounded healer, tacit knowledge
is acquired as a result of experiencing loss and emotional pain (Martin 2011).
Consequently it is this sort of knowledge that wounded would-be healers bring with
them to their studies at university. Based on Carr‟s (2004) view that tacit knowledge
is culturally relative, perhaps knowledge acquired through personal experience ought
to be treated with caution since it is only relative to the individual.
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Schön (1987) describes two modes of reflection: reflection in action, which takes
place in the moment, and reflection on action, which occurs after the event. Once
students have spent time in practical settings then reflection on action can begin to
link practice experience back to academic theory (Schön 1987). Additionally, where
courses contain a practical or work-based element it is possible to use reflective
learning techniques to enhance self-awareness (Miehls & Moffatt 2000). Arguably,
the tacit knowledge the wounded healer has acquired from personal life experience
can be linked to theory using reflection on action. This same process can also
contribute to the development of self-awareness. Using reflection on action to
critically analyse past events is one way in which students can begin to understand
themselves and make sense of their personal experiences. Reflection on practice
and using experiences to influence future behaviour has been widely advocated by
the nursing profession. It encourages a holistic, individual, flexible approach where
all knowledge is useful for some purpose. Reflection results in changes to selfawareness, described thus:
“The process of creating and clarifying the meaning of experience (present or
past) in terms of self (self relation to self and self in relation to the world). The
outcome of this process is changed perceptual perspective.”
(Boyd & Fales 1983 cited in Andrews et al 1998:413)
The significance of recognising and attending to wounds is a recurring theme in the
literature (Freeth 2007; Jones et al 2009; MacCulloch & Shattell 2009; Mander 2004;
Niven 2008; Trusty et al 2005):
"Without adequate recognition of wounds what can be a rich source of
empathy, therapeutic relating and effective caring, can potentially be
disastrous for patients as well as the mental [health] professional...
Recognition is the key."
(Freeth 2007:165)
MacCulloch and Shattell (2009) believe people habitually suppress their
vulnerabilities to the point where they are no longer aware of them. Becoming aware
of one‟s own vulnerabilities and how this impact on the self and others is thought to
be a fundamental part of becoming an effective practitioner (Freeth 2007). The
literature suggests self-awareness performs a number of functions: it enables
individuals to understand themselves and others better (Christie & Weeks 1998;
Miehls & Moffatt 2000); it enhances empathy (May & Kilpatrick 1989; Matthews
1998); and if it is lacking there is a risk service users may be harmed (Matthews
1998). Developing self-awareness through reflection can contextualise tacit
knowledge gained through personal experience and highlight appropriate ways of
using it. It is therefore a key activity for the wounded healer to engage in.
Developing self-awareness through critical reflection can be an individual process.
Reflection can also be carried out in conjunction with others in a dyad or group.
Methods of reflection, as discussed in the literature, follow.
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Individual Reflection
In the literature reviewed, written reflection is frequently referred to as a method of
individual reflection. Written reflection can involve the use of reflective learning
journals (Cain 2000; Lishman 2002; Jasper 1999; McLeod 2009; Pates & Knasel
1989), autobiographical narratives (Christie & Weeks 1998; Meekums 2008;
Morrison 2006; Parker & Merrylees 2002) and creative writing in the form of stories
(Hunt 2004) and poetry (Kidd & Tusaie 2004). Written reflection can lead to a variety
of outcomes: deep thought (Freely 2004; Jasper 1999); therapeutic benefits (Freely
2004; Downie 2004; Kidd & Tusaie 2004; Pates & Knasel 1989; Trusty et al 2005);
personal and professional development (Jasper 1999; Pates & Knasel 1989);
transferable writing skills (Downie 2004; Jasper 1999); learning (Freely 2004; Jasper
1999); self-awareness (Christie & Weeks 1998; Downie 2004; Hunt 2004); the
integration of theory and experiences (Kidd & Tusaie 2004); the exploration of
identity (Christie & Weeks 1998; Meekums 2008; Parker & Merrylees 2002); and
empowerment (Freely 2004; Morrison 2006). Written reflection can also be used as
a basis for reflection involving others, for instance, in supervision (Lishman 2002;
Pates & Knasel 1989). Evidence (cited in Carr 2004:219) shows writing about
difficult experiences can have a positive effect on wellbeing. For example, Jobcentre
staff (i.e. non-accredited helpers) who used learning journals in counselling skills
training found the journals encouraged experiential learning, reflection, professional
and personal development and produced unintended therapeutic benefits (Pates &
Knasel 1989). Kidd and Tusaie‟s (2004) research into the use of reflective creative
writing in nursing education found disclosing personal experiences via poetry “helped
students integrate and heal past traumas” (Kidd & Tusaie 2004:413). The poetry
also provided a method of tapping into tacit knowledge and demonstrating positive
changes in self-awareness (Kidd & Tusaie 2004).
The main advantage of individual reflection is that if students choose to reflect on
personal issues which they would rather not openly disclose then they are free to do
so. Christie and Weeks (1998) speculate perhaps confidentiality and anonymity
encourage the disclosure of personal experiences. The disadvantage of individual
reflection, however, is that students who become destabilised by this process would
be unknown to academic staff. Connecting to emotions that usually remain hidden
can lead to vulnerability (Hunt 2004). Indeed, there is a risk to the self when
engaging in self reflection (Freely 2004; Hunt 2004; Jasper 1999; Kidd & Tusaie
2004). Using distancing techniques to write narratives about personal experiences
may alleviate the risk of opening old wounds. These techniques include: introducing
fictional elements (Hunt 2004); using different voices (Hamer 2006); or writing for
different audiences (Meekums 2008). Thus, individual reflection has the ability to
formalise tacit knowledge, increase self-awareness and heal the wounded. However
careful monitoring is required to ensure any detrimental effects on wellbeing are
addressed appropriately.
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Dyadic Reflection
Supervision is a recurring theme emerging from the literature (Barnett 2007; Cain
2000; Christie & Weeks 1998; Freeth 2007; Graves 2008; Lishman 2002; McLeod
2009; Martin 2011; May & Kilpatrick 1989; Regehr et al 2001; Trusty et al 2005).
Supervision usually takes place within a dyad, i.e. a relationship involving two
people, in the same way students and teaching staff engage in personal tutorials.
Whether used in the workplace or education different models of supervision have
different ends. Freeth (2007) and McLeod (2009) describe three models of
supervision: managerial, educational and supportive. Regehr et al (2001) cite three
different models used in the clinical supervision of social work students: traditional,
skills based and reflective learning. If a person-centred approach is used,
supervision can act as a managerial instrument and a forum for personal and
professional development (Lishman 2002). Hence holistic approaches to
supervision (incorporating managerial, educational and pastoral elements) have the
ability to promote reflection, self-awareness and personal and professional
development (Freeth 2007). May and Kilpatrick‟s (1989) literature review on selfawareness in social work education indicates that social work students particularly
valued developing self-awareness through the mechanism of supervision. In effect,
if personal tutors were to adopt holistic, person-centred approaches of supervision in
personal tutorial sessions then students would benefit from having access to their
preferred mode of developing self-awareness.
To be effective, supervision needs to occur on a regular basis and the objectives of
supervision need to be agreed at the outset (Freeth 2007). In addition to increasing
self-awareness, the outcomes likely to arise as a result of good supervision include:
the ability to monitor individual competency (Martin 2011); the opportunity to learn
counselling skills as modelled by the supervisor (Schön 1987): assistance with
reflecting on and reframing adverse life experiences (Christie & Weeks 1998; Regehr
et al 2001); and the reduction and prevention of stress in students (May & Kilpatrick
1989). According to Stone (2008) simply being given the opportunity to be heard
and understood within the boundaries of a trusting relationship is healing in itself.
In counselling education a different type of dyadic relationship is used to facilitate
reflection: the use of personal therapy seeks to promote the student's self-awareness
and heal wounds (Barnett 2007). In 2005, the British Association of Counselling and
Psychotherapy (BACP) removed the requirement for counsellors and
psychotherapists to undergo personal therapy to achieve accreditation (Barnett
2007). Instead, a less rigorous approach has been adopted where students are now
expected to engage in some form of activity or experience to enhance selfawareness (Barnett 2007). Studies on the use of personal therapy in counsellor
training have been unable to establish whether personal therapy is beneficial for
practice (McLeod 2009). All things considered, mandatory personal therapy for
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students on courses associated with the helping professions would be costly and
apparently unnecessary.
Group Reflection
Sharing experiences gives others the opportunity to learn from these same
experiences (Freely 2004). This is sometimes referred to as peer education.
Christie and Kruk (1998) advocate group discussion of student's motives influencing
their choice of course which may lead to some discussion and reflection on how
personal experiences have impacted on decision making. Small group discussions
are a practicable way for students to share anxiety and stress (May & Kilpatrick
1989). However, for healing to occur, educators need to create a safe environment
in which group work can take place (McClendon 2005). As Meekums (2008) points
out, sharing personal experiences that would not ordinarily be shared with others can
represent a risk to the self. Disclosing details about adverse life experiences also
has ethical implications for those who may feature in the stories but have not
consented to their identities being disclosed (Meekums 2008). Clearly, group based
reflection should be approached with care. For reflection in creative writing groups,
Hunt (2004) recommends students should be led by an experienced facilitator and
reflection should take place within small groups, using an agreed set of ground rules.
Support
Education and training can be therapeutic for the wounded healer (MacCulloch &
Shattell 2009; Mander 2004). Even so, education itself cannot be relied upon to
support and heal wounded students. Education can reopen old wounds (Lawrence
2004) so it is imperative that universities provide access to support services. Regehr
et al (2001) acknowledge students with difficult life experiences need opportunities to
reflect and highlight the need for support if this process triggers difficult responses.
Jasper (1999) also recognises students using reflective learning journals need
emotional support due to the vulnerabilities reflective writing can elicit. Besides,
since emotional pain may accompany personal growth and development there is an
obvious need to make support available to all students (May & Kilpatrick 1989).
Formal support
Formal support refers to support services provided „in-house‟ by universities or
through contractors employed by universities. Based on the literature reviewed,
formal support services are frequently referred to as a way of addressing wellbeing
(Barnett 2007; Dougherty et al 1996; Freeth 2007; Graves 2008; Jones et al 2009;
Lawrence 2004; Lishman 2002; McClendon 2005; May & Kilpatrick 1989; Morrison
2007; Regehr et al 2001). The formal support services discussed in the literature are
wide-ranging. The notable inclusions are: supervision (Freeth 2007; Graves 2008;
Morrison 2007); personal therapy (Barnett 2007; May & Kilpatrick 1989; Regehr et al
2001); peer support groups (Freeth 2007; Lawrence 2004; Lishman 2002);
workshops on self-care (Freeth 2007; May & Kilpatrick 1989); health and wellbeing
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services (McClendon 2005); one to one student support (Lawrence 2004); and
support to navigate university bureaucracy including, ironically, accessing support
(Dougherty et al 1996).
In order for students to benefit from these specialist support services there should be
formal referral policies in place for staff to guide students to sources of support
(Graves 2008; May & Kilpatrick 1989). It may be stating the obvious but if specific
support needs are identified then support should be made available (Lawrence
2004). It is with this in mind that Regehr et al (2001) recommend improving
communication between staff to identify vulnerable students sooner. Graves (2008)
considers there is value in staff acknowledging the challenges wounded healers
experience in education; Weiner‟s (1999) study on the meaning of education for
students with a serious mental illness reported on how some of the students did not
feel they were deserving of support whilst insensitive responses from staff were
perceived as unhelpful. Ideally, responses from staff would be compassionate and
seek to encourage students to obtain the support they need.
Perhaps the most unexpected strategy of „support‟ found in the literature revolved
around encouraging students to withdraw from studies, either on a permanent or
temporary basis (Regehr et al 2001; Weiner 1999). Contrary to normative beliefs,
dropping out of university can be a positive choice when students have other
opportunities to pursue outside of education (Smith & Naylor 2001). Furthermore,
students may have the option to return to their studies at a later date (Smith & Naylor
2001). Perhaps the most pragmatic suggestions concerning withdrawal come from
Weiner (1999) who recommends students experiencing ongoing difficulties should
delay decisions to permanently withdraw from studies until their situation improves.
Informal support
Informal sources of support are situated outside of the formal support services
provided by universities. The sources listed in the literature include peers (Christie &
Weeks 1998; Dougherty et al 1996; Freeth 2007; Lawrence 2004; Lishman 2002;
Morrison 2006) and family and friends (Dougherty et al 1996). Students with mental
health problems received informal support from other students some of whom were
mental health survivors themselves (Dougherty et al 1996; Lawrence 2004): the
students surveyed by Dougherty et al (1996) felt there was a strong commitment to
provide reciprocal support for one another whilst the students featured in Weiner‟s
(1999) study found peer support enhanced confidence as it represented integration
into mainstream social networks. Evidence suggests a lack of social integration can
be an influential factor for students withdrawing from studies, whether wounded or
not (Smith & Naylor 2001). Ostensibly, there is value in cultivating a sense of
cohesion amongst student cohorts as this may serve as a protective factor for
vulnerable students.
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Chapter 3: Findings
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Awareness raising
The literature suggests the wounded healer could have a stronger presence in
education (Cain 2000; Graves 2008; Jones et al 2009; Lawrence 2004; Roth et al
2000; Stone 2008; Carpenter 2002). Graves (2008) insists we cannot assume
students are not wounded and calls for “an educational paradigm shift” (Graves
2008:217) to include the wounded healer. The literature indicates several ways in
which courses can acknowledge the wounded healer and the theories underpinning
it: educating students about wounded healers (Cain 2000); using guest speakers
(Carpenter 2002; Cain 2000; Lawrence 2004; May & Kilpatrick 1989); using survivor
experiences as a resource for learning (Carpenter 2002; Lawrence 2004; Vachon
2010); and providing alternative understandings of the wounded healer from different
cultures (Stone 2008).
A by-product of bringing the wounded healer centre stage may mean there is less
stigma attached to the notion of the wounded healer in Western society (Cain 2000;
Lawrence 2004). Destigmatisation could be further enhanced if strategies to reduce
stigma become an integral part of education programmes (Dougherty et al 1996;
Lawrence 2004). This may involve the use of course content centred on antidiscrimination, service user movements and recovery approaches to wellbeing
(Carpenter 2002; Lawrence 2004). Alongside these initiatives the literature
discusses developing a culture to encourage openness surrounding woundedness
(Jones et al 2009; Roth et al 2000). In light of the significant number of substance
abuse counsellors in recovery who subsequently relapse, 38%, Jones at al (2009)
call for "proactive acknowledgement and discussion of the problem" (p.405) in
training to reduce the stigma of relapse. Openness about the possibilities of human
frailty amongst those in the helping profession might also encourage more help
seeking behaviour (Roth et al 2000). Martin (2011) found that being honest about
his own wounds helped to reconcile the opposite identities associated with the
wounded healer and gave other wounded healers the confidence to „come out‟ and
celebrate their woundedness. Prospectively, destigmatisation and recognition of the
wounded healer in education could instigate a change in attitudes across the helping
professions.
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Chapter 4: Discussion
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4
DISCUSSION
The findings from the literature review indicate there are a number of debates and
assumptions concerning the wounded healer on courses of study in higher
education. The issues discussed herein represent important pragmatic and
ideological considerations underpinning the principles and values informing the
thrust of this project.
Woundedness as a motivating factor
At the heart of this study there is an assumption that the wounded are attracted to
courses associated with the helping professions because of their life experiences. At
the University of Worcester, anonymous data on student characteristics obtained
under a Freedom of Information request shows students who identify themselves as
having been in the care system are disproportionately concentrated within the
Institute of Health and Society (see Appendix: Table 1). The 2008/09 and 2009/10
figures show 16 undergraduates disclosed the fact they had spent time in the looked
after system with 11 of these 16 found within the Institute of Health and Society. For
the academic year 2010/11, 20 undergraduates identified themselves as having
been in care with 12 found in the Institute of Health and Society. Over the entire
three year period which these statistics relate to, no other Institute at the University
had any more than four care leavers amongst its numbers even though the Institute
of Education has similar numbers of undergraduate students (see Appendix: Table
2). Assuming those who have been in care are very likely to have experienced
adversity and, despite the relatively low number of care leavers in relation to overall
student numbers, the higher distribution of care leavers in the Institute of Health and
Society does lend some support to the assumption that woundedness influences the
decision to pursue a career in the helping professions.
Choosing to work in human services is not necessarily financially driven (Christie &
Kruk 1998; Mander 2004). According to Graves (2008) personal experiences
influence career choice. By and large, across the helping professions, motivations
are influenced by complex and diverse factors (Bell 2000; Christie & Kruk 1998;
Christie & Weeks 1998; Lishman 2002; McLeod 2009). The following extract, taken
from a professional resource on user involvement in domestic violence services,
highlights the incidence of wounded healers in this field:
"Finally, an issue which emerged again and again in the study from which
this guide is drawn, and one which has rarely attracted attention previously,
is the indisputable fact that considerable numbers of practitioners,
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Chapter 4: Discussion
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policy- makers and activists working on abuse issues have personal
experience of domestic violence, either as adults or as child witnesses of
such violence in their original families.”
(Hague et al 2002:35)
Similarly, recovering substance abusers are common in substance abuse services:
estimates indicate that around half of all drug and alcohol counsellors practising in
the US today are themselves in recovery (Jones et al 2009; Matthews 1998). In
Rippere and Williams' (1985) collection of personal narratives, some of the mental
health workers describe how they were motivated to work in the field of mental
health as a result of their experiences of depression.
Wounded healers are common in the helping professions with evidence showing that
social work students have higher than average experiences of life trauma compared
to other students (Regehr et al 2001). Studies show life experiences are a
motivating factor in those people who choose to become social workers (Christie &
Weeks 1998; Furness 2007; Parker & Merrylees 2002). In Furness‟ (2007) study
only 6% of the sample indicated life experiences had influenced their career choice
whereas Christie and Weeks (1998) found 30 out of the 43 social work students
surveyed (70%) reported that a life event or experience had influenced their decision
to enter professional training. Whilst there was considerable diversity and overlap
between the particular experiences of each student, experiences of loss stood out as
a common theme alongside vulnerability, isolation, stigma and abuse (Christie &
Weeks 1998).
Vachon (2010) observes that former service users who choose to enter youth work
do so as a result of both good and bad experiences when using services
themselves. A similar picture emerged in Parker and Merrylees' (2002) and Furness‟
(2007) studies on motivations for career choice. However, as Christie and Kruk
(1998) point out, not everyone choosing to train as a social worker wants to be a
social worker; a social work qualification is seen by some as a gateway to other
professions and roles within welfare. As can be seen, students' motivations for
choosing particular courses of study have several implications: motivations impact
on how students are selected and how courses are designed and delivered (Parker
& Merrylees 2002); and understanding the factors influencing these decisions effects
learning and practice (Christie & Kruk 1998). Understanding and acknowledging
why students choose the courses they do should be a key consideration of the whole
course design but if, as experienced personally, "students rarely have the
opportunity to explore this dimension at any point during their training" (Christie &
Kruk 1998:21) then neither staff nor students will be any the wiser. Barnett‟s (2007)
research suggests timing could influence outcomes when exploring motivations: the
therapists interviewed reported that their motivations became clearer with the benefit
of hindsight and practice experience. Overall, the assumption that life experiences
attract people to study courses associated with the helping professions is supported
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Chapter 4: Discussion
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by the literature although these life experiences can be both positive and negative.
Understanding these motivations has wider implications for students, staff and
universities.
Effectiveness
Another of the main assumptions underpinning this project (and the concept of the
wounded healer) is that the wounded self impacts on practice. Goleman et al (2002)
write extensively about how mood and emotional intelligence have an influential
effect on outcomes at work; in the context of healthcare, Goleman et al (2002) report
the mortality rate of cardiac patients is higher than average when they are cared for
by nurses with a depressed mood. The suggestion is that if a practitioner‟s health
and wellbeing is compromised then they are less effective in the work they do.
Opinion appears to be divided as to whether wounded healers make for better
practitioners, reflecting the division between the negative and positive connotations
of wounded healers operating between different cultures (Stone 2008). Jung
believed woundedness enabled people to heal others effectively (Stone 2008).
Vachon‟s review of the literature on wounded healers indicates adverse life
experiences are an advantage for those choosing to work in the helping professions
(Vachon 2010). Matthews‟ (1998) literature review on counselling students‟
backgrounds and wellbeing is inconclusive: some of the studies indicate counselling
students are less healthy and have more problems, making them more effective in
practice, whereas other studies provide no evidence to suggest counsellors are any
different to anyone else in society, meaning family background and wellbeing do not
influence effectiveness (Matthews 1998). Interviews conducted with a small sample
of ten psychotherapists, all of whom have spent time as inpatients in psychiatric
institutions, reveal their experiences act as both assets and hindrances in the
therapeutic process with perceived gains somewhat offset by being constantly
reminded of their own experiences through their contacts with mentally distressed
clients (Cain 2000).
However, it is proposed helpers who re-connect with their wounds in the helping
relationship are healed in the process:
“Our woundedness is our vulnerability which is our key to opening the
flow of healing to the other and back again to ourselves”
(Stone 2008:49)
Nevertheless, this project is not principally concerned with assessing the merits of
woundedness, good or bad. Hence there is no assumption made that woundedness
is a help or a hindrance, just that it exists. Woundedness itself is not the issue - how
it is used is (Barnett 2007). As Vachon (2010) states, the question that needs to be
answered is how do wounded healers use their experiences in an effective way and
how can educators enable students to do this.
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Chapter 4: Discussion
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Empathy
Following on from effectiveness, another theme to emerge centres on the belief that
woundedness makes helpers empathic (Lawrence 2004; McLeod 2009). At its most
extreme some believe woundedness is a prerequisite for empathy (Martin 2011;
Stone 2008). In succinct terms, empathy can be described as “the ability to
vicariously experience another‟s feelings” (Kidd & Tusaie 2004:404). In Western
psychology the thinking is that empathy is required to recognise and respond to
wounds in others (Stone 2008). In humanistic counselling, empathy is believed to be
necessary for positive change to occur in the helping relationship (Hough 1998). For
the therapists interviewed in Cain‟s (2000) study, personal experience of mental
health problems was believed to foster greater empathy. Trusty et al (2005)
surveyed levels of emotional empathy and attachment in 143 postgraduate
counselling students and found that those with preoccupied patterns of attachment,
typified by high levels of anxiety in personal relationships and low avoidance of
personal relationships, had the highest levels of empathy compared to the other
three attachment styles (secure, dismissing and fearful). According to John Bowlby
and Mary Ainsworth‟s attachment theory (cited in Trusty et al 2005), patterns of
attachment form during early childhood and continue to exert their influence
throughout adulthood. The assumption is that if the child‟s main caregiver is
inconsistent or neglectful, intimate relationships in adulthood are likely to be avoided
and/or cause anxiety. Trusty et al (2005) believe their findings support the
assumption wounded healers are more empathic although the reliability of their
findings is compromised because students‟ self-reports were used to measure levels
of empathy. Empathy is a difficult skill to measure objectively hence conclusive
evidence to show wounded healers are more empathic is hard to come by.
Nevertheless, received wisdom tends to make a positive link between pain, suffering
and the ability to empathise.
The validity of tacit knowledge
The concept of the wounded healer raises issues about what counts as knowledge.
Jung advocated that the best way to understand and acquire knowledge about
human behaviour was through life experience not education or research (Jacobi
1986). Carl Rogers was also of the opinion that some forms of knowledge simply
cannot be taught and people can only really learn from their own experiences (Schön
1987). Christie and Weeks (1998) stress how life experience is often disregarded as
a form of knowledge; from the positivistic stance, tacit knowledge acquired through
personal experience is perceived as one of the least credible forms of knowledge
(Becker & Bryman 2004). Thus the values associated with positivistic approaches
are in conflict with the values associated with the recovery perspectives
underpinning the theory of the wounded healer (Carpenter 2002). For instance the
narratives of mental health survivors are empowering for other survivors because
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Chapter 4: Discussion
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they present an alternative truth which resists the definitions imposed on them by
professionals who purport to have expert knowledge (Morrison 2006).
In a variation on this same theme, Freud emphasised the importance of the
therapist‟s technical ability whereas Jung placed greater importance on the
therapist‟s personal qualities (Samuels et al 1987). It could be argued university
courses emphasising the acquisition of evidence-based knowledge and technical
skills over experiential knowledge and soft skills (empathy, personal development,
reflection and self-awareness) acquiesce to the idea that knowledge is hierarchical.
Conceivably, this idea is perpetuated in education if staff fail to recognise and
acknowledge the validity of students‟ tacit knowledge acquired through life
experience. Seemingly, courses underpinned by positivistic values risk alienating
the wounded healer.
The desire to help
The extensive literature review conducted by Parker and Merrylees (2002) suggests
the main reasons nursing and social work students give for entering professional
training are threefold: adverse or profound life experiences; altruistic sensibilities;
and a sense of idealism. However students with altruistic drives and values may not
be consciously aware of where their desire to help originates from (Barnett 2007;
Parker & Merrylees 2002). As Barnett (2007) warns, the origins of these motivations
can be healthy or unhealthy. Barnett (2007) carried out research into the
unconscious motivations acting on those choosing to train and work as counsellors
and psychotherapists. Two major themes emerged: loss, particularly in early life,
and the desire to have unmet narcissistic needs met. If normal narcissistic needs,
such as intimacy, go unmet during childhood then these needs continue into
adulthood (Barnett 2007). Evidently, if counselling students are unaware why they
might be attracted to a profession where they are able to engage in one-sided,
intimate relationships with others then this represents a risk to both the client who
might be exploited and the therapist who may re-open old wounds (Barnett 2007).
Students who state their desire to help influences their career choices should be
encouraged to reflect on where these motivations originate from.
Identifying the wounded
What is patently clear from the literature, particularly those featuring autobiographical
narratives, is that professionals working in the helping professions are certainly not
immune to experiencing vulnerability (Barnett 2007; Carpenter 2002; Kidd & Tusaie
2004; Martin 2011; Meekums 2008; Rippere & Williams 1985; Storr 1974). Yet,
identifying the wounded depends on how the wounded are defined. For example,
Buddhism assumes we are all liable to experience pain and adversity (Stone 2008).
And since pain, sorrow and suffering are felt subjectively it is surely a matter for
individuals themselves to determine whether they have been wounded in life rather
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Chapter 4: Discussion
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than focussing on specific life events that are likely to have inflicted scars. The
assumption is that, to a greater or lesser degree, everyone is wounded (MacCulloch
& Shattell 2009). However this position is unhelpful if we are to identify those
students who have not fully recovered from their wounds and are in need of support;
identifying vulnerable students is difficult to ascertain because of the barriers posed
by confidentiality and the stigma of disclosing private and personal experiences.
Disclosure
Although some choose to do so, individual students are understandably not ritually
required to disclose details of their difficult life experiences. The topic of disclosure
is brought up in several of the publications reviewed (Christie & Weeks 1991;
Dougherty et al 1996; Hague et al 2002; Jones et al 2009; Martin 2011; Meekums
2008; Rippere & Williams 1985; Roth et al 2000; Weiner 1999). Christie and Weeks
(1998) enquire how students work out what to disclose and to whom. As Meekums
(2008) points out, disclosure can be risky to the individual and those implicated by
association. Students with a history of mental health problems found disclosure
particularly troublesome to navigate (Dougherty et al 1996; Roth et al 2000; Weiner
1999). Indeed, reticence about disclosure seems to have a lot to do with the
negative connotations associated with the wounded healer in Western culture. In the
helping professions there appears to be a “denial of vulnerability” (Graves 2008:217)
because any form of weakness is seen as incompatible with professional
competency (Christie & Weeks 1991; Graves 2008; Rippere & Williams 1985).
However denying pain caused by wounds makes it incredibly difficult to seek help
(Rippere & Williams 1985): amongst the 38% of substance abuse counsellors in
recovery who relapse after qualifying, only 6% seek treatment (Jones et al 2009).
Hence presenting students with an alternative view of the wounded healer and giving
formal guidance on disclosure and help seeking would go some way to addressing
these issues.
Stigma
Denial might be one explanation for resisting disclosure but often the nature of the
wounds are stigmatised in their own right. Christie and Weeks (1991) refer to social
work students who enter the profession because of their experiences of abuse but
feel unable to voice these experiences openly in training. Hague et al (2002),
referring to survivors working domestic violence, have this to say on the matter:
“The fact that they may decide not to be open about their status as
survivors reinforces the points...that women continue to be silenced about
their experiences of domestic violence and that they may be regarded
negatively if considered to be still „in the experience‟, or speaking on
occasion from that experience, rather than from professional expertise”
(Hague et al 2002:35)
It is entirely feasible that increasing numbers of wounded and vulnerable students
will find themselves in this position as a result of widening participation initiatives and
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Chapter 4: Discussion
___________________________________________________________________
recovery models of health (Graves 2008; Lawrence 2004). If, as the literature
suggests, wounded healers became more visible in education and practice then
perhaps there would be fewer barriers to students voicing their experiences and
sharing their knowledge.
The role of higher education
Even so, this does raise questions about whether it is the job of education to change
wider attitudes or simply concentrate on teaching and learning. There is a similar
debate about whether education should be responsible for ensuring students and
graduates entering practice are competent (Graves 2008). There is a case for
making competency and fitness to practice a personal responsibility (Freeth 2007;
Hamer 2006; Jasper 1999; MacCulloch & Shattell 2009; McClendon 2005); if people
are the best experts on their own problems then perhaps they can be the best judge
of when and how these should be addressed (Hamer 2006). However, if students
are not aware of how their wounds may impact on practice or feel reticent about
seeking help then they may slip through the net. It is for this reason that it seems
prudent to actively address issues likely to affect competency (Graves 2008;
Matthews 1998). Not only does this approach have the potential to support students
in education but it also goes some way to preparing students for practice where they
may come into contact with vulnerable people. Matthews (1998) is adamant that if
problems arise after a student has been accepted on to a course then educators
have a duty to ensure competency is achieved to enter practice.
The value of higher education
Education serves a different purpose for different people. For instance, for mental
health survivors education performs a social function, improves confidence and
symbolises inclusion into mainstream society (Dougherty et al 1996).
“Education for such individuals is not just a doorway to employment,
it is an important part of acceptance into society”
(Lawrence 2004:188)
Based on interviews with eight mental health survivors at university, Weiner (1999)
refers to the purpose of education as a continuum, stretching from education as a
means to an end (i.e. to achieve career goals) to education as an end in itself (i.e.
enriching, fulfilling and pleasurable) (Weiner 1999). Clearly, for these wounded
healers succeeding and continuing in education is an important part of the recovery
process. Nevertheless, it must be recognised that students will be at different stages
in their journey on their way to becoming a wounded healer, with some students
more vulnerable and requiring more support than others (Weiner 1999).
Targeting support
Statistical data on dropping out of university could provide an alternative method for
identifying students in need of support. Using a data sample consisting of 75,000
students entering UK universities over four years, Smith and Naylor (2001) found
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Chapter 4: Discussion
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being male, older, living off campus and having lower prior educational achievement
are factors influencing the likelihood of dropping out. Furthermore, a longitudinal
study of students participating in social work programmes reveals older students and
students with lower educational attainment prior to starting their courses are more
likely to abandon their studies (Moriarty & Murray 2007). According to Regehr et al
(2007), social work students who are likely to experience problems during their
studies are often male, older, have lower prior educational achievement and more
social work experience. Smith and Naylor (2001) state the gender mix of particular
institutes does not influence the drop-out rate. If the remaining common
characteristics are considered in conjunction with the model of the wounded healer,
the likelihood is that older students will have a larger repertoire of life experiences
and students with lower educational achievement may include those who are
accepted on to courses by virtue of their work and life experience as a way of
formalising the knowledge they already possess. In this way there may be some
merit in targeting support at these groups to assist them to continue and complete
their studies.
Screening
At the admissions stage there may be indications that would lead to the conclusion a
particular student is not suitably healed to begin education. For instance, personal
information provided by the candidate about their background could be used as a
way of determining their suitability to study and practice (Christie & Kruk 1998). In
fact, nursing candidates are expected to undergo mandatory health and criminal
records checks to gain entry to the course (see University website). However,
research conducted by Regehr et al (2007) shows academic staff using information
contained in student personal statements only are unable to predict which students
encounter difficulties during their studies. And, if, as Barnett (2007) contends,
students mask their vulnerabilities in interviews, then judging a candidate‟s suitability
becomes a subjective process (Mander 2004). Ultimately, there is no escaping the
fact that those responsible for selecting candidates fulfil a regulatory function with
regard to who is deemed eligible to pursue their chosen career path (Regehr et al
2007). If candidates are not selected because subjective judgements have been
made about their background and personal wellbeing then justifications for these
decisions should be clearly communicated to the candidate. In Mander‟s (2004)
view, woundedness alone is not grounds to deny admission to a particular candidate
but the candidate who struggles to be open about their wounds might raise cause for
concern
.
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Chapter 5: Conclusions and Recommendations
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5
CONCLUSIONS AND RECOMMENDATIONS
In this section, the key findings, themes and debates arising from the literature
review will be summarised to form a conclusion. To complete the project, practical
recommendations for change will be outlined to give an indication of how the
strategies and methods identified could be applied to recognise and support
wounded would-be healers in higher education.
Conclusions
The discussion highlights the debates and assumptions operating beneath the
surface of the wounded healer. First, there is evidence to suggest wounded people
are attracted to pursue careers as healers and are influenced by positive and
negative aspects of their experiences. Second, it is commonly believed wounded
healers are effective in practice and are more empathic: evidence concerning
effectiveness is inconclusive however one piece of research found a link between
the wounded healer and the ability to empathise. Third, the concept of the wounded
healer challenges positivism with its hierarchies of knowledge; too much emphasis
on technical, rational approaches to learning risks alienating wounded would-be
healers. Fourth, it is in everyone‟s interests for students to explore the origins of
their altruistic drives. Fifth, using statistical data on dropping out of university may
help to target support at vulnerable students. Sixth, formal guidance concerning
disclosure and help seeking, coupled with strategies to reduce stigma, may
encourage vulnerable students to seek support more readily. Seventh, universities
should take the initiative if there are concerns about students‟ fitness to practice
even if students view education as an end in itself – at some later date they may
decide otherwise. Finally, screening candidates helps to eliminate the most
unsuitable candidates at the admissions stage although screening can be
ambiguous and subjective.
The findings indicate strategies to address the needs of wounded would-be healers
in higher education fall into four overlapping categories. First, an emphasis on
personal development contributes to continuing professional development; personal
development as a dimension of professional development prepares students for
practice and assists them to remain competent throughout their careers. Second,
developing self-awareness using reflection heals wounds, harnesses the tacit
knowledge acquired through life experience, contextualises it against theory and
modes of practice and, if carried out with others, reflection allows people to share in
these experiences so they might learn from them too. Third, support should be
made readily available for wounded would-be healers with staff occupying a key role
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Chapter 5: Conclusions and Recommendations
___________________________________________________________________
in identifying support needs at an early stage, showing compassion where needed
and directing students to sources of support in accordance with university policies
and procedures. There is also value in promoting good peer relations since informal
peer support can mitigate some of the difficulties students experience. Finally, it is
envisaged that in the context of education, raising the profile of the wounded healer
and the theories surrounding it will translate to greater openness about
woundedness and the validation of the wounded healer across the helping
professions.
Across the four strategies identified, two particular approaches stand out as practical
methods to recognise and support wounded would-be healers in higher education:
supervision and students‟ personal narratives. Supervision has the flexibility to
deliver all four strategies: it is a recognised method of developing self-awareness
through reflection and is therefore a personal development tool; it can provide
students with support in the form of pastoral care; and it can serve to raise
awareness of wounded healers through the transmission of information. Another
thread linking together all four strategies is the use of personal narratives: for
personal development, they may contain an element of „distance travelled‟ - for the
wounded healer this might relate to the journey from woundedness to wellbeing; for
the development of self-awareness, they can form the basis of self-reflection,
supervision and group reflection; in terms of support, they can be healing in
themselves or help to identify unmet needs and students in need of support; and for
raising awareness, they can be shared to promote group learning and give the
wounded healer a voice in education. The practical considerations of implementing
these methods are outlined in the recommendations at the end of this chapter.
The overarching aim of this project was to establish how best to recognise and
support wounded would-be healers in higher education: two mechanisms,
incorporating all the themes identified in the findings, offer some form of resolution to
overcome the contradictions of studying woundedness in others yet failing to attend
to our own wounds. This project has also served to highlight a number of other
pertinent issues related to the wounded healer: the wounded are attracted to work
and train in the helping professions and bring with them a store of knowledge, skills
and experience which is frequently not recognised, validated or capitalised on;
universities have a responsibility to ensure students are fit to enter practice and fulfil
an important role in determining the suitability of candidates; higher education
provides an opportunity to offer guidance and support to help students achieve
personal wellbeing and to reconcile the identity of the wounded with that of the
helper; and, finally, the consequences of failing to acknowledge and support the
wounded are potentially damaging for practitioners, service users and public trust in
the helping professions. Hence this project concludes higher education has an
24
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Sally Jansen & Maddie Burton
Chapter 5: Conclusions and Recommendations
___________________________________________________________________
obligation to attend to the wounded would-be healers - the opportunities are
available, the methods have been identified and the stakes are high.
Recommendations
Supervision
This report recommends holistic approaches to supervision should become a
mandatory component for all courses associated with the helping professions, if not
all courses at the University. On some courses, such as nursing, tutorials form a
mandatory component of the curriculum. It is understood that presently a new
system of academic tutorials is being implemented across the University to replace
the personal tutorial system. Whilst the emphasis on personal development, selfawareness and reflection are in line with the strategies identified in this project, some
thought could be given to making academic tutorials compulsory and a condition of
progression. It would be advisable to consult students and staff before proceeding
with compulsory tutorials to ascertain whether this policy would be agreeable. It is
also hoped that the shift from „personal‟ to „academic‟ tutoring does not preclude
personal content as this would belie the holistic approach advocated and narrow the
scope of the tutorial to a managerial function instead. In addition, the new Academic
Tutoring Arrangements issued to staff highlights the role of academic tutorials in
supporting vulnerable groups of students, such as care leavers, but does not specify
what form this support should take. In this way, the findings and recommendations
in this report may go some way to indicating how best to support and recognise
these particular students.
Supervision needs to be carried out on a regular basis to be effectual however what
constitutes regular is not specified in the literature. Currently, the Student Handbook
suggests a frequency of four per year implying students will see their academic
tutors every two months throughout the standard academic year. Monthly intervals
between tutorials would equate to greater regularity and possibly enhance the
effectiveness of the system however this recommendation has to be balanced
against the demands this would place on staff and other resources at the University.
To overcome this, academic tutorials could be supplemented by group supervision
sessions which would work toward the same goals as academic tutorials. Group
supervision could also provide opportunities for sharing experiences with others,
promoting group cohesion and peer education. The precautions relating to group
reflection in chapter 3 are transferable to group supervision: an experienced
facilitator should lead the groups and supervision should take place within small
groups, using an agreed set of ground rules. The main barrier to implementing
group supervision lies in finding suitably trained and experienced staff. Overall,
supervision delivered through the mechanism of mandatory academic tutorials and
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Students as Academic Partners
October 2011
Sally Jansen & Maddie Burton
Chapter 5: Conclusions and Recommendations
___________________________________________________________________
group supervision sessions represents a relatively feasible method of recognising
and supporting the wounded would-be healer.
Personal narratives
In addition to supervision, this report recommends all students on courses leading to
careers in the helping professions should be encouraged to write a personal
narrative. The functions these narratives serve will depend on when this exercise is
performed and who it is shared with. Possibilities include: a therapeutic exercise for
the self; a tool for screening at admissions stage; a starting point for self-reflection,
developing self-awareness and personal development during induction week; a basis
for reflection, developing self-awareness, personal development and identifying
support needs during initial academic tutorials; a way of sharing experiences,
knowledge and skills with others in group supervision; and a method for raising the
profile of wounded healers if shared with a wider audience (e.g. seminar readings,
blogs, publications). Similarly, the focus of the narrative will also determine the
practical applications it is suitable for. For example, if students are asked to write
about their personal motivations for selecting their course of study then the result will
serve to highlight factors influencing their decisions to pursue a career in the helping
profession. It may not be advisable to direct students to write specifically about their
childhood, difficult life experiences or wounds as this may destabilise vulnerable
students or be perceived as too intrusive. Before students begin to write their
accounts, guidance on distancing techniques, disclosure and the boundaries of
confidentiality can be given. Therefore it may be prudent to delay beginning this task
until induction week when formal guidance and support is readily available.
The plan proposed here is that during induction week students are given an
assignment requiring them to prepare a personal narrative detailing the influences,
motivations and reasons for choosing their course. The narrative is then submitted
to their academic tutor before the first individual tutorial and is used to assess current
competencies, establish support needs and provide a starting point for personal
development. Aside from the personal and developmental outcomes associated with
this sort of task, the student is quickly initiated into the practice of writing a coherent
assignment, working to deadlines and following the correct procedures for the
submission of work. Students who have difficulty completing this task would come to
the attention of their academic tutors earlier than would ordinarily be the case.
Similarly, students who make disclosures concerning trauma, pain and distress can
be identified as wounded would-be healers at an early stage whereby appropriate
strategies to acknowledge and support the student can be formulated. Students will
not be obliged to share their motivations or experiences with others (apart from their
academic tutor) at any point during their studies however those who want to will be
offered guidance and support in order to do this safely.
26
Students as Academic Partners
October 2011
Sally Jansen & Maddie Burton
Chapter 5: Conclusions and Recommendations
___________________________________________________________________
At the end of each course a closing day could be introduced where these original
narratives are returned to in order to capture the distance travelled in personal
development and review motivations with the benefit of hindsight. A closing session
would also give students and staff an opportunity to exchange feedback on the
whole course and bring teaching and learning to a symbolic and actual close. The
major reservation with this proposal is that a closing day at the end of the course
may not attract high attendance. Introducing the personal narrative initiative would
require some additional resources: training for staff, a workshop during induction
week to set the assignment, assessment of the assignment and, if deemed feasible,
an additional day in the academic year to close the course. This proposal can be
integrated into existing course arrangements and gives wounded would-be healers
the opportunity to explore their motivations, create an open dialogue with tutors,
make their voices heard and heal their wounds.
27
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October 2011
Sally Jansen & Maddie Burton
References
___________________________________________________________________
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October 2011
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Appendix
___________________________________________________________________
APPENDIX
Table 1: Numbers of care leavers/people who have spent time in the looked after
system by Institute at the University of Worcester
2008/09
2009/10
2010/11
Institute of Health and
Society
11
11
12
Institute of Education
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
<5
16
16
20
Institute of Humanities
and Creative Arts
Institute Sport and
Exercise Science
Institute of Science and
the Environment
Worcester Business
School
TOTALS
Notes:
 information obtained under a Freedom of Information Request
 Data Protection: numbers of students less than 5 not disclosed
Table 2: Number of undergraduate students in each Institute expressed as a
percentage of all undergraduate students at the University
2008/09
2009/10
2010/11
Institute of Health and
Society
23%
22%
26%
Institute of Education
26%
27%
25%
21%
21%
17%
11%
10%
11%
8%
8%
8%
11%
12%
13%
100%
100%
100%
Institute of Humanities
and Creative Arts
Institute Sport and
Exercise Science
Institute of Science and
the Environment
Worcester Business
School
TOTALS
32