The Journey of The Counselor and Therapist: Research Findings and Perspectives On Professional Development
The Journey of The Counselor and Therapist: Research Findings and Perspectives On Professional Development
The Journey of The Counselor and Therapist: Research Findings and Perspectives On Professional Development
This article summarizes a reformulation of the main findings and perspectives from a cross-sectional and longitudinal qualitative study of the development of 100 counselors and therapists. The results are presented as a phase
model and as a formulation of 14 themes of counselor/therapist development.
The following six phases are described: The phases of the lay helper, the beginning student, the advanced student, the novice professional, the experienced professional, and the senior professional. The themes describe central
processes of counselor/therapist development. The themes are addressing different issues such as shifts in attentional focus and emotional functioning,
the importance of continuous reflection for professional growth, and a life-long
personal/profession integration process. Sources of influence for professional
functioning and development are described. The results show consistently
that interpersonal experiences in the personal life domain (early family life
Address correspondence to Michael Helge Rnnestad, Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317 Oslo, Norway; e-mail: helge.ronnestad@
psykologi.uio.no.
This article is a reformulation and condensation of: Rnnestad, M. H., and Skovholt,
T. M. (1991). En modell for profesjonell utvikling og stagnasjon hos terapeuter og radgivere. Tidsskrift for Norsk Psykologforening. (A model of the professional development
and stagnation of therapists and counselors. Journal of the Norwegian Psychological
Association, 28, 555567.); Skovholt, T. M. and Rnnestad, M. H. (1992/1995). The
evolving professional self: Stages and themes in therapist and counselor development.
Chichester: Wiley; and Skovholt, T. M. and Rnnestad, M. H. (1992a) Themes in therapist and counselor development. Journal of Counseling and Development, 70, March/
April, 505515.
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0894-8453/03/0900-0005/0 2003 Human Sciences Press, Inc.
and adult personal life) and the professional life domain (interacting with clients, professional elders, and peers) are significant sources of influence for
professional development.
KEY WORDS: career development; counselor development; professional development;
psychotherapist development; burnout.
There is growing interest in studying the development of the professional counselor/therapist (Neufeldt, 1999). This interest flows from
multiple areas of inquiry such as studies of professions, career development, supervision, expertise, wisdom and adult developmental psychology. Parallel to the increased interest in studying the development of the
counselor/therapist has been research which points to the competence of
the practitioner as key to a successful outcome. With a more nuanced
understanding of the complexity of the helping relationship, researchers
within the field of counseling and psychotherapy have convincingly demonstrated the influence of the individual counselor/therapist on qualities
of the counseling/therapy relationship, on the change process, and on
outcome (Orlinsky, Rnnestad & Willutzki, 2003).
Counseling and psychotherapy is often effective, with most effectsizes of differences in outcome varying between .75 and .85 when comparing treatment groups to control groups (Wampold, 2001). However,
individual counselors/therapists do not obtain equal results (CritsCristoph et al., 1991; Henry & Strupp, 1994; Lambert, 1989; Luborsky
et al., 1985, Orlinsky & Howard, 1980; Ricks, 1974). Given the enormous efforts of many psychotherapy researchers to minimize the effect
of the individual counselor/therapist, when studying a specific intervention, it may be surprising that variation in outcome across methods is
smaller than variation in outcome among counselors/therapists within
methods. From critical inquiries into a large body of research on the
relative effect of counseling/therapy methods (Wampold, 2001), the
conclusion is that it makes a bigger difference who the therapist is
than which method is used. Collectively, these results join to suggest
more research on counselor and therapist development.
About fifteen years ago, we initiated our study on counselor/therapist development. We wanted to know if counselors/therapists develop
as they gain more experience. The concept of development dates back
to the Enlightenment era of the 18th century. It denotes a progressive
[Latin: pro = forward; gradi = to go] (Oxford English Dictionary, 1997)
change in human functioning. The Enlightenment ideas of growth,
advancement, and the value of science and education form a context
for understanding the concept of development. There are certain minimal features to the concept of development regardless of philosophical
and theoretical orientation (Lerner, 1986). These are: (a) development
always implies change of some sort, (b) the change is organized systematically, and (c) the change involves succession over time. The elements of change, order/structure and succession are thus basic elements
of a concept of development.
One may argue that the question of whether counselors/therapists
develop as they get more experience can only be answered by comparing counseling/therapy results of practitioners at different experience
levels. Then, to the extent that more experienced practitioners obtain
better results with their clients, one may claim that counselors/therapists develop. However, there is limited research to support this position of therapist development. Dawes (1994) found no relationship between experience level and outcome. We note that he has been criticized
for using poorly controlled studies to support his claim. Two metaanalyses in the 1990s (Crits-Cristoph & Mintz, 1991; Stein & Lambert, 1995) have demonstrated a statistically significant, although
weak positive relationship between experience level and outcome.
One may argue that the approach above does not demonstrate development per se, but rather possible consequences of development.
Another approach to the study of counselor/therapist development, is
to study changes in how practitioners experience themselves as counselors/therapists on a wide variety of parameters related to their work
over time. This is the approach we used. The longitudinal research
design is the ideal design for such an approach. As our interest is the
life-long study of counselor/therapist development, we initially chose,
for practical purposes, a cross-sectional design. We later extended the
study into a longitudinal one.
By learning more about the changes that counselors/therapists
encounter during their professional lives, we hope to contribute to
the advancement of counselor/therapy education and improve the
quality of supervision. We hope that a clearer understanding of the
developmental process will be helpful in establishing realistic demands in graduate education. If professional developmental paths are
better understood, supervisor and supervisee will be able to establish
more effective learning contracts. Also, if a more accurate and comprehensive conceptualization of therapist/counselor development is
attained, we can better arrest the negative avenues of professional
development such as incompetence, impairment, burnout, and disillusionment.
Method
At the time we started our investigation, there was little empirically
based knowledge on counselor/therapist development in the field.
There were some conceptual contributions on developmental supervision (e.g., Loganbill, Hardy & Delworth, 1982). From the study of the
training and supervision literature and from our own experience as
counselors/therapists, supervisors and teachers, we asked very general questions such as: Do counselors/therapists develop? Do all develop? What is the nature of changes therapists go through during
their career? If there is change, how do therapists perceive the changes
that have taken place? If a developmental perspective is relevant, is
development continuous, erratic, cyclical, or can it be described otherwise.
In order to answer these questions, we chose an interview approach
and were inspired by the inductive logic of grounded theory (Glaser &
Strauss, 1967). We did, however, deviate from the stringent structure
of this approach as we were not ignorant of the topic of the investigation.1 The questions for our interview guide were developed from our
knowledge of the professional literature and experience. Based on the
pilot interviews and further reflections on the topic, we selected eight
topics of inquiry which guided our initial data-analysis. The topics of
inquiry were: Definition, Central Task, Predominant Affect, Predominant Sources of Influence, Role and Working style, Conceptual Ideas
used, Learning Process, and Measures of Effectiveness and Satisfaction. These topics of inquiry, which may be regarded as analytical categories, were thus developed early in the research process and are not
results as such. Semi-structured interviews were carried out by the
authors and graduate students.
We interviewed 100 American counselors/therapists at different experience levels, i.e., two student groups, beginning and advanced
graduate students of counseling or psychotherapy, and three postgraduate groups of practitioners with the average of 5, 15 and 25
years of professional experience with doctoral degrees in professional
psychology. In the initial data-analyses, research groups used the selected eight topics as categories to organize the interview transcriptions within experience cohorts. Other researchers checked for precision and comprehensiveness of initial descriptions. The process was
comprehensive as it also consisted of validation and feedback from all
respondents, continuous rewriting and restructuring of the material
10
We repeated the procedure of individual selection and consensus agreement for the themes. We revised and renamed, where appropriate, the
different themes of counselor/therapist development. We appreciate
the opportunity to again analyze and hopefully better understand the
rich material that our generous colleagues provided through their
willingness to participate in the study.
11
12
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methods and using them may give a sense of calm for the beginning
student. With more experience, the practitioner may experience disillusionment with these easy to learn methods, but for the time-being,
they serve their purpose.
Since completing the task of developing professional mastery takes
years, many students search actively for ways to speed up the process.
Finding models to imitate is a long desired popular approach for the
beginning student. As one student expressed it: I wanted to absorb
from counselors I observed. Students want to know how perceived
experts act, think and feel in clinical practice. Although they are also
curious about how seniors negotiate issues of private life, most attention is given to how they concretely act and behave in the professional
role. If students identify intensively with a method and model, we
have used the term true believer (Hoffer, 1951) for this student. We
cannot emphasize enough the intensity by which students search for
viable models. Students want as much as possible to perform like international experts (Freud, Rogers, Frankl, Beck) or local experts (i.e.,
ones supervisor in practicum). Classroom material used to teach
methods can have a major impact if they present easily understood
material. The classic Three approaches to psychotherapy films with
Rogers, Perls, and Ellis edited by Shostrom are an excellent example
of this as are the multiple new films made in recent years that demonstrate actual counseling/therapy.
As we will describe more extensively later, an attitude of openness
to new learning is imperative to enhance professional competence.
Openness to learning and an ability and willingness to recognize the
complexities of professional work is crucial for growth. Many students
need to simplify the task at hand and many choose easy to learn
methods, a simplification process which may enhance or impede professional development. The issue here is whether or not the student
is having an open attitude versus a closed or restricted attitude to the
complexities and challenges encountered. An open attitude facilitates
professional development, while a restricted or closed attitude fosters
professional stagnation. Complexities need to be mastered. We differentiate between a developmental and non-developmental approach to
mastering the complexities that students/counselors encounter. The
developmental approach has an active, searching, exploratory, tryingout quality. The students/counselors are guided by a long term developmental goal. The non-developmental (stagnant) approach has a defensive, experience-limiting and anxiety-reducing quality. Focus is not
on a long-term developmental goal, but on short-term impression
14
management, a face saving maneuver (Goffman, 1967). The achievement orientation of the academic culture, the power differential between professor/supervisor and student, and the magnitude of challenges encountered fuel such maneuvers.
Although some students feel competent throughout training, this is
not the rule. Typically students feel threatened and anxious (Skovholt & Rnnestad, 1992b). Student anxiety seems to be very present
in graduate programs across countries and cultures. From the survey
research of the International Study of the Development of Psychotherapists (Orlinsky & Rnnestad, in press) we know that inexperienced
therapists frequently feel overwhelmed and highly challenged in client sessions. Compared to functioning at later phases of development,
Norwegian therapists (Rnnestad & von der Lippe, 2001) reported
more frequently to experience the following difficulties6: (a) Lacking
in confidence that you can have a beneficial effect on a client, (b) Unsure how best to deal with a client, (c) In danger of losing control of
the therapeutic situation to a client, (d) Distressed by the powerlessness to effect a clients tragic life situation, (e) Troubled by moral or
ethical issues that have arisen in your work with a client, (f ) Irritated
with a client who is actively blocking your efforts, (g) Guilty about
having mishandled a critical situation with a client.
Also, research on supervision within counseling/therapy confirms
how threatening training experiences may be for students. The works
by Gray, Ladany, Walker and Ancis (2001), Moskowitz and Rupert
(1983), and Ladany, Hill, Corbett, and Nutt (1996) in particular have
demonstrated the counterproductivity that may result from a nonoptimal supervision relationship.
Phase 3: The Advanced Student Phase
Towards the end of training, the modal student is working as a
counselor/therapist at settings such as internship, practicum, clerkship or field placement, and is receiving regular and formalized supervision. We will use the term intern for this role at this phase. The
central task at this phase is to function at a basic established/professional level. Many students, however, have higher aspirations for
their functioning and want not only to avoid making mistakes, but to
excel in their work. Many feel pressure to do things more perfectly
than ever before. A consequence is that interns usually act in a conservative, cautious and excessively thorough fashion. They are typically
15
not relaxed, risk-taking or spontaneous. There is little natural playfulness or sense of humor in their work.
The internalized high standards for professional functioning contribute to the tendency towards excessive and misunderstood responsibility. A female student at this phase said: I do a good job of letting
myself feel responsible for everything. Another said: I thought I
could and should help everybody, while and a third expressed it this
way: Every single request for consultation I wanted to do. I wanted
to learn things and to prove to the director of training that I could do
the job.
When comparing ones own professional competence to that of beginning students, the advanced student appreciates that professional
training has made an impact. As one intern said: I have gone from
being petrified to being comfortable. But if the reference point for
evaluating ones own competence changes to that of the advanced professional, the advanced student realizes there it is still much to learn.
The advanced student as practitioner may still feel vulnerable and
insecure and actively seek confirmation and feedback from seniors
and peers. There is still considerable external dependency.
Supervision of beginning practicum students can be a powerful
source of influence for the advanced student. One female, reflecting
on her internship, said: It was a concrete realization of what I had
learned. It was really valuable. The contrast between them and me
helped me see my own style and how far I had come in my development.
At this phase, experiences in supervision have particular significance. Non-confirming supervision experiences are powerful, possibly
even more powerful than for the beginning student. More is at stake,
as the student is further along in training and is supposed to master
professional tasks at a higher level. Although it seems that the advanced student experiences supervision as mostly positive, conflicts
in supervision may nevertheless peak at this phase of professional
development. The dependency of the intern, and the need to meet the
expectations of the graduate program combined with the aspirations
to be autonomous, may contribute to the ambivalence that many advanced students report. These dynamics may also increase the tension
and constant self-evaluation reported by the advanced student during
the internship.
Modeling is still an important learning process. Defined broadly,
modeling includes activities such as watching supervisors and profes-
16
sional staff work, hearing how supervisors and professional staff conceptualize cases, and observing the professional behavior of supervisors
and professional staff. To a greater extent than earlier, the advanced
student is critically assessing and evaluating models. In addition to
accepting or rejecting models totally, such as one advanced student in
our sample who said My God, I dont want to be like that, interns
are now engaging in the modeling process of differentiating, accepting,
or rejecting model components. One advanced student said: I take
what I like.
Also at this phase of training, the advanced student is often frustrated by the lack of opportunities to observe senior practitioners at
work. One female intern said: I wanted more opportunities to observe
senior practitioners work. Another said: I had very little opportunity
to observe experienced practitioners, even after repeated requests of
a supervisor. The only model of an experienced person I had was the
Gloria films. Supervisors and experienced people were unwilling to
demonstrate skills.
Although the advanced student has typically an external focus, i.e.,
looking to models for how to be a professional, there is simultaneously
an increased internal focus. Both foci might find their expression in
supervision. As one intern said: Supervisors are important to me both
as role models and in helping me identify how my personality influences my work both as a resource and as a hindrance. The supervision literature has also conveyed a similar preference in the advanced
trainee for an internal focus. McNeill and Worthen (1989, as cited in
Worthen & McNeill, 1996), wrote: Advanced trainees prefer to examine more complex issues of personal development, transference-countertransference, parallel processes, and client and counselor resistance and defensiveness (p. 26).
After our analysis of students descriptions of attachment to theory/
conceptual systems, we identified four distinctly different orientations. They were (a) no conceptual attachment (which we also called
laissez-faire orientation to theory), (b) one theory, open (which indicates preference for one theory but with openness to others), (c) multiple serial attachments (which indicates a serial monogamy type orientation), and (d) true believer (which indicates a strong belief in one
theory in combination with active rejection of others). The one theory
open and multiple attachment were the most common, and may,
from a perspective of research on the professional development of psychotherapists, be most beneficial.
Inferentially assessed from therapists endorsement of question-
17
18
titioner formulated it: Having less guidance from professors and supervisors was scary. Another said, People werent protecting you
from taking on too much anymore. Many will look for workplace mentors who will offer guidance and support, thereby easing the transition
to autonomous professional functioning.
The novice professional is usually not prepared for the felt disillusionment. The individual had hoped that graduate training and all
the work and anxiety that went into it had been adequate preparation
for what was to come. One female looked back and said: I realized
that graduate training had real gaps. There was much I had to cover
that was not offered in graduate school. I remember writing letters to
the director of the program, pointing out things that should have been
addressed.
The practitioner who earlier had relied exclusively on a single conceptual system often feels disillusionment particularly when confronted
with heterogeneous client populations. A male practitioner reflecting
back to this phase said: I went through a stage of being depressed
about work, feeling it was too much work trying to fit people to the
model. I found out it didnt turn out for clients the way theory said it
was supposed to. Even though the novice professional is typically not
actively eliciting client feedback to measure success, client feedback
nevertheless constitutes a powerful message about what works. Here
is an example of disillusionment: An individual with a math and science undergraduate degree entered a graduate program with a strong
research-based empirical approach. As he applied what he had learned,
an approach with an emphasis on precision and rationality, to patients with spinal cord injuries, he was overwhelmed by the emotional
anguish and pain of these patients. He said: Sometimes you feel like
you were trying to fight a forest fire with a glass of water.
The recent graduate is still struggling with precision in boundary
regulation like issues of responsibility and how to determine what are
realistic goals for professional work. One female counselor said: I think
I become more disillusioned when I have expectations that I need to
do it all; it is my responsibility or fault if this person isnt getting better.
Disappointments with self and with inadequate client progress can
fuel a sense of inadequacy. A male counselor/therapist described his
reactions this way:
I used to think that my doubts about me and my despair would go away
with the degree . . . Now people look at me, call me doctor and want
more and expect more. But what am I going after? It is a disorienting
19
process because I don know anymore now except that there are more
expectations. It is great to be done, but what do I really want to be?
Where did I really want to go? I didnt expect the formal training would
lead to feeling adequate until I felt inadequate and then realized how
much I expected to know by now. My professional training was over and
I lacked so much.
20
21
22
23
sional development (theories/research, clients, professional elders [professor/supervisors/mentors/therapists], peers/colleagues, ones own personal life, and the social/cultural environment) continue to play an
important role for the professional functioning and development of the
experienced professional. As previously described, counselors/therapists report that interpersonal experiences impact them strongly throughout their career. With increasing experience, however, this is even
more the case. Specifically, the experienced professional reports that
much learning comes from their direct experience with clients and
from their personal life. In addition, there is a broadening in what
influences the more experienced professional. Some report that typical
senior activities such as mentoring others in roles such as supervisor
and teachers is a valuable source of learning. Increasingly, the experienced counselor/therapist reports understanding human behavior
through professional literature in related fields such as anthropology
or religion or through reading prose, poetry, biographies, or through
movies, the theatre and other artistic expressions. We will briefly comment on this change in emphasis.
The experienced counselor/therapist learns primarily through reflecting upon interpersonal experiences in the professional and personal life domains. Theoretical/empirically based concepts serve an
important but nonetheless secondary function in the sense that they
are accepted or rejected depending on the degree to which they assist
meaningful interpretation of experiences. Untested ideas are only useful when the individual approaches a new area where experience is
lacking. Extensive and varied experience, generated through thousands of hours of client work and life experiences, described by an
informant, as I have lived through a lot of hell and lot of pleasures,
have contributed to a contextual sensitivity in the process of abstracting or generalizing knowledge. We call this contextually sensitive
knowledge development a central process toward the attainment of
wisdom. We may express this by stating that the epistemological center for the experienced professional is experience based and contextually anchored generalizations. A therapist expressed it this way:
With a new client I think about cases Ive had. I think about how they
have gone. Themes come in a case and this stimulates a memory in me.
The memory is in the form of a collection of vignettes, stories and
scripts. It isnt fully conscious but new cases do kick off the memory
the memory of how things went before provide a foundation to begin the
current case. Interestingly, most of the stories come from the early days
of my practice; they are the most embedded. Later cases dont stand out
24
As suggested by the above quote, it is not every client, but clients who
have profound experiences and particularly successful or unsuccessful
counseling/therapy work that provide the most significant learning for
counselors/therapists at the experienced professional phase. Even quite
experienced counselors/therapists are typically deeply moved if one of
their clients experiences a profound event, either positive or negative,
when they are working together.
As we interviewed therapists/counselors with more experience, we
increasingly heard stories of the interrelationship between adult personal and professional life. Although some talked about how the fatigue from overburdening work could negatively influence family life,
or how professional knowledge and competence could be transferred
into ones personal life, there were more tales of traffic in the other
direction, i.e., of how personal life was seen to influence professional
functioning. One said: You learn a lot from your kids just like you
learn a lot from your clients. Another talked of her divorce being the
most difficult experience of her life. She found it forced her to see
herself as separate person and not a daughter or wife in relation to
others. She said: It really shocked me to my core. I had to tap into
some dark places and look at things about me. The whole experience,
she said, increased her connections with human pain, made her more
intellectually curious, and ultimately helped her be a better therapist.
We heard many similar stories of the long term positive influence of
adverse experiences in therapists/counselors adult personal life.
The immediate influence of adverse personal experiences is often
negative. One senior therapist told us her story that moved us deeply.
She told that after losing her husband and her only daughter within
a two-year period, it took two years before she could breathe again.
It was not until after a long period of intense grieving that she could
use the traumatic experience constructively in her work.
There were several stories of negative experiences in early childhood and family life exerting an adverse, and not positive, influence
on professional functioning (Rnnestad & Skovholt, 2001). This was
surprising as it runs counter to a common perception of the wounded
healer (Henry, 1966), where healed early wounds are understood to
contribute to the formation of a more effective helper. Early wounds
are not necessarily healed, and may find their expression in adult professional functioning.10 However, from our interviews, there were sev-
25
eral stories indicating that wounds acquired late (i.e., in adult life)
can, if they are reflected upon, understood, and assimilated (see Stiles,
1997) contribute to more effective helping.
Emerging with more hours of practice at the experienced professional phase is a strongly felt belief that there is not much new in the
field. One person said: Ive recently stopped going to workshops. They
seemed to be geared to Freshman English and to be old stuff. For
example, assertiveness training was done long ago under a different
label. Im especially uninterested in workshops on new little techniques. This disinterest is contrasted with the continued influence of
earlier role models, influences which for many have been internalized.
One of our informants, for example, talked about John, his supervisor
twenty years ago: I have been running around in my mind words,
phrases, quotes that I periodically pull back to . . . and sometimes I
say to myself, how would John handle this situation. These fantasy
mentors were often recalled with great fondness and appreciation.
Phase 6: The Senior Professional Phase
At this phase of professional development the practitioner is a well
established professional who is regarded as a senior by others. Although some attain this senior status in mid-career, the modal senior
professional has practiced for 20 to 25 years or more and many are
approaching retirement.
The transition for the experienced counselor/therapist to become a
guide for novices in the field was hesitantly welcomed by some and
actively embraced by others. One male describing the transition to
being seen differently by others, said: Suddenly I was seen by others
as a leader, but I didnt see it that way. I didnt feel I belonged. Another individual talked of the stimulation of interacting with younger
colleagues. Talking about supervising younger interns, one said: They
get brighter all the time: I feel that I learn as much from the interns
as I teach them. They have become my teacher.
The most experienced group in our sample, was on the average 64
years when we interviewed them the first time, and 74 when we interviewed them again.11 This has provided us with a unique opportunity
to learn about experiences and reflections of counselors/therapists in
the very mature professional years. Some are similar to what we have
just described for the experienced professional. Some are different,
emerging from the reality of loss that is common for the senior professional phase. A few of our informants took early retirement and many
26
27
The above quote also illustrates the high work satisfaction that are
typical not only for the senior professional, but for therapists/counselors at all phases of professional development.
28
29
30
31
32
33
34
35
36
37
38
39
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Endnotes
1. For a more detailed description of method, the reader is referred to: Skovholt,
T. M. & Rnnestad, M. H. (1992/1995). The evolving professional self: Stages and
themes in therapist and counselor development. Chichester: Wiley.
2. We are fully aware that this is not possible to do, as our foreknowledge (Gadamer/
Heidegger) will necessarily constitute a horizon which influences our perception.
3. The stage concept denotes an invariant ordering of universal changes. It entails a
hierarchical, sequential and invariant ordering of qualitatively different functioning/structures (Lerner, 1986). We discussed replacing the concept of stage with the
concept of level (Libella, diminutive of libra, meaning in balance; Oxford English
Dictionary, 1997), but finally chose the concept of phase, thus emphasizing the
gradual and continuous nature of changes therapists go through. However, as previously described, some changes may appear as discontinuous, particularly those
occurring after critical incidences in counselor/therapists lives.
4. In the reformulation for this paper, Stage 1 is renamed the Lay Helper phase; Stage
2 and 3 have been collapsed and renamed The Beginning Student phase; Stage 4
is renamed the Advanced Student stage; Stage 5 is renamed the Novice Professional phase; Stages 5, 6, and 7 are collapsed and renamed the Experienced Professional phase; Stage 8 is renamed the Senior Professional phase.
5. Informant quotes are taken from the following source unless otherwise noted: Skov-
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
41
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