research paper on personal training

Effect of supervised, periodized exercise training vs. self-directed training on lean body mass and other fitness variables in health club members

Affiliation.

• 1 1Division of Pulmonary Medicine, Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; 2Equinox Fitness Clubs, Los Angeles, California; and 3Division of Endocrinology, Diabetes & Hypertension, Gonda (Goldschmied) Diabetes Center, University of California at Los Angeles, Los Angeles, California.
• PMID: 24276303
• DOI: 10.1519/JSC.0000000000000331

Conventional wisdom suggests that exercise training with a personal trainer (PTr) is more beneficial for improving health-related fitness than training alone. However, there are no published data that confirm whether fitness club members who exercise with a PTr in the fitness club setting obtain superior results compared with self-directed training. We hypothesized that club members randomized to receive an evidence-based training program would accrue greater improvements in lean body mass (LBM) and other fitness measures than members randomized to self-training. Men, aged 30-44 years, who were members of a single Southern California fitness club were randomized to exercise with a PTr administering a nonlinear periodized training program (TRAINED, N = 17) or to self-directed training (SELF, N = 17); both groups trained 3 days per week for 12 weeks. Lean body mass was determined by dual-energy x-ray absorptiometry. Secondary outcomes included muscle strength 1 repetition maximum (1RM), leg power (vertical jump), and aerobic capacity (V[Combining Dot Above]O2max). TRAINED individuals increased LBM by 1.3 (0.4) kg, mean (SEM) vs. no change in SELF, p = 0.029. Similarly, significantly greater improvements were seen for TRAINED vs. SELF in chest press strength (42 vs. 19%; p = 0.003), peak leg power (6 vs. 0.6%; p < 0.0001), and V[Combining Dot Above]O2max (7 vs. -0.3%; p = 0.01). Leg press strength improved 38 and 25% in TRAINED and SELF, respectively (p = 0.14). We have demonstrated for the first time in a fitness club setting that members whose training is directed by well-qualified PTrs administering evidence-based training regimens achieve significantly greater improvements in LBM and other dimensions of fitness than members who direct their own training.

Publication types

• Comparative Study
• Randomized Controlled Trial
• Research Support, Non-U.S. Gov't
• Absorptiometry, Photon
• Body Composition / physiology*
• Body Mass Index
• Body Weight
• Fitness Centers
• Muscle Strength
• Muscle, Skeletal / physiology
• Oxygen Consumption
• Physical Conditioning, Human / methods*
• Physical Conditioning, Human / physiology*
• Physical Fitness / physiology*

The Current State of Research on Training Effectiveness

• First Online: 30 July 2020

Cite this chapter

• Thomas N. Garavan 11 ,
• Fergal O’Brien 12 ,
• James Duggan 13 ,
• Claire Gubbins 14 ,
• Yanqing Lai 15 ,
• Ronan Carbery 16 ,
• Sinead Heneghan 17 ,
• Ronnie Lannon 18 ,
• Maura Sheehan 19 &
• Kirsteen Grant 20  

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4 Citations

This chapter addresses the current state of research on training effectiveness in organisations. It summarises the key findings on what we know about training effectiveness, the research emphasis given to different components of the model, and how research informs the ways in which organisations should approach learning and development to maximise effectiveness. The chapter highlights the role of training needs analysis, the types of attendance policies that should be used, the most effective design of training delivery to maximise effectiveness, the relative effectiveness of training methods, the organisation of training content, the importance of learning or training transfer, and the types of outcomes that are derived from learning and development.

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Women’s Perspectives of Personal Trainers: A Qualitative Study

### Abstract

Personal trainers play an integral role in the day-to-day operation of the facilities in which they work. Research has identified a number of qualities and competencies necessary to be an effective exercise leader, but there is little scholarly work addressing clients’ attitudes related to the performance of personal trainers. Utilizing focus group methodology, female clients of personal trainers were recruited to provide viewpoints related to the desirable qualities of personal trainers, as well as opinions regarding trainer certification and academic preparation. Responses of the participants were transcribed, coded, and analyzed for themes. Four global themes emerged: Selection Rationale, Personal Trainer Rationale, Loyalty Rationale and Negative Characteristics. Selection Rationale consisted of qualities that influence a client’s decision to hire a particular trainer (e.g., physique, results observed in other clients, social skills). Personal Trainer Rationale referred to the clients’ reasons (e.g., frustration with current fitness level) for hiring a specific trainer. Loyalty Rationale referred to the credentials of a personal trainer that solidify the client/trainer relationship and Negative Characteristics referred to qualities considered unethical or unprofessional. The results suggest that undergraduate exercise science programs should devote additional time toward the development of future fitness trainers’ affective qualities and that clients would benefit from information about the credentials of personal trainers.

**Key words:** qualifications, certifications, credentials, licensure, attitudes, dispositions

### Introduction

Low levels of physical activity, like many other lifestyles activities (e.g., smoking), are strongly correlated with coronary heart disease, the leading cause of death in the United States (4). Lack of physical activity is also associated with asthma, type 2 diabetes, some cancers, impaired psychological status, bone and muscle problems, and decreased life expectancy (5). Despite this well-documented relationship, 37.1 % of adults have insufficient physical activity (6). Of those who do adopt an exercise program, it is estimated that 50% will discontinue it within the first six months (10), making exercise adherence a critical issue. Factors affecting adherence are complex, but an important one is a client’s perception of support from their personal trainer (28).

The significance of personal trainers has been demonstrated in several studies. Ratamass et al. (23) compared individuals trained by personal trainers to individuals working out on their own. Results showed that both1 Repetition Maximum and Ratings of Perceived Exertion scores were significantly higher in individuals who worked under the supervision of a personal trainer. Similar results were noted in studies by Maloof et al. (17) and Mazetti et al. (18). Quinn (23) suggests that part of the advantage of working with trainers relates to motivation, and that, “certified personal trainers can provide structure and accountability, and [can] help … develop a lifestyle that encourages health.”

Personal trainers, as well as club managers, believe that clients are more likely to stay with a program if the trainers exhibit the attributes of empathy, listening skills, and motivation skills (21). In addition, McGuire, Anderson, and Trail (19) report that important components of clients’ satisfaction with their fitness clubs relate to the leaders’ social support skills and instructional competency. Despite these findings, little is known about how a trainer’s qualities, including training and certification, are viewed from the client’s perspective. Several theoretical models explain the adoption and maintenance of exercise behavior (14), but little research has examined these factors in an applied exercise setting.

Finally, women are a growing majority of all health club members, accounting for 57 percent of the grand total in 2005 (13). Within the commercial club category, women constitute 60% of the national membership. In addition, studies have shown that the majority of those clients who hire trainers are female (25). Because these statistics indicate that women are primary consumers of health club memberships and training sessions, this study focused on female clients. The purpose of this study therefore, is to use an applied setting in which to systematically investigate attitudes of female clients toward the dispositions, certification, and education of personal trainers. To the authors’ knowledge, this study is the first scholarly examination of the current state of personal training from this perspective.

### Methods

#### Experimental Approach to the Problem

The data collection was qualitative and interpretive in nature. The study used the three key assumptions of the qualitative research paradigm: 1) there are no “wrong” answers; only diverse opinions, 2) there is a potential influence of the inquirer (see Limitations section of this paper) and respondent relationship, and 3) the goal is to describe findings within a particular situation (29). This interpretive perspective used grounded theory, or theory that emerges from the data (9). Therefore, this type of inquiry is not a critical or empirical comparison to existing theory.

The investigation used a focus group to examine the overarching question, “What qualities are important to be a successful personal trainer?” The focus group interview offered compatibility with the qualitative research paradigm, opportunity for direct contact with subjects, and the advantages of group format (29). This research was conducted with clients of personal trainers. Global themes, major themes, and sub-themes were selected from the transcriptions. Evidence of credibility, reliability, and trustworthiness was provided in several ways. First, three different readers were used, bringing their varying perspectives to the group. Second, the data presented represents consensus reached via thorough discussions among individuals (readers) with expertise in personal training, exercise physiology, health behavior, and qualitative research methods. Finally, the investigators sent a one-page summary (a member check) to the participants and asked for feedback and clarifications and/or additions they would like to make. The study design was identical to that used in two previous studies which examined the current state of personal training from a personal trainer point of view (20) as well as from a manager point of view (21).

#### Role of the Investigators

The primary investigator was a personal trainer for 10 years before devoting her time to teaching exercise science classes at the university level. She is a certified Health Fitness Specialist with the American College of Sports Medicine, and a Certified Strength and Conditioning Specialist with the National Strength and Conditioning Association. She is also a certified group exercise instructor with the Aerobics and Fitness Association of America (AFAA), as well as a certification examiner for their organization. She has developed and maintained close relationships with both clients and personal trainers and is very familiar with the issues surrounding this profession.

#### Subjects

Subjects included 5 female clients of personal trainers (M age= 36.2 years, with a range of 24-50 years). Detailed demographic information for the subjects is represented in Table 1.

#### Procedures

##### Surveys

Volunteers were randomly solicited from four health clubs in a small southeast community. This selection process involved recruitment through posted flyers as well as by word-of-mouth contacts. Subjects were either personally provided with or mailed a packet including: 1) a demographic/survey sheet, including name, address, age, occupation and education; 2) questions related to certification of trainers; 3) an informed consent form approved by the university Internal Review Board committee, explaining that the participants would be video- and audio-taped during the focus groups; and 4) a list of the questions that would be probed so that the participant could reflect on these prior to the meeting. Finally, in addition to the focus group interview and audiotapes, the surveys were used as a third method for triangulation of the data. After collecting all the demographic/survey sheets, participants were contacted via telephone and asked to participate in the focus groups.

##### Focus Groups

Subjects who agreed to participate were given a list of the questions that would be discussed prior to the focus group meeting. These questions were:

1. Why did you decide to hire a personal trainer? 2. What attracted you to a particular trainer? 3. What characteristics kept you coming back to the same trainer? 4. Do you know the qualifications of your trainer?

a. If you do not know, how do you know that you are getting what you paid for? b. Does it matter if they have certifications? c. Do you know which certifications are the most respected? d. If you knew that not all trainers had a nationally recognized certification, how would you feel about that? 5. Have you experienced any unethical behavior with a trainer?

a. If yes, what was the nature of this behavior? b. Even if you have not experienced it, what do you consider to be unethical?

The focus group comments were recorded using a Marantz audio-recording system and videography (60 Hz). In addition to the informed consent, participants also signed a confidentiality agreement within the group. The confidentiality statement included the investigator’s agreement not to disclose names, as well as the participants’ agreement not to disclose or discuss what was said in the interviews with other participants or individuals outside the designated focus group time. Furthermore, anonymity was assured by removing participants’ names on the final transcripts, and by replacing real names with pseudonyms (see Table 1). A moderator’s guide, (29) was used in each of the focus groups. The focus groups lasted approximately 2 hours with an emphasis on each participant getting equal amounts of speaking time (29).

#### Statistical Analyses

The focus group audio tapes were transcribed verbatim. The three investigators read and re-read each of the three transcripts and searched for key phrases emerging from the data. Key phrases were defined as those that occurred at least five times within the transcript, as the three investigators concurred that this arbitrary number was sufficient to denote a key phrase. The investigators converted the key phrases into codes and then examined the transcripts line by line, inserting the codes where appropriate. After consensus was reached concerning the coding of each line of transcript, the codes were entered into Ethnograph©, a computer program used for qualitative data analysis. In order to determine credibility and reliability, three different readers were used, bringing their varying perspectives to the group. All three read the transcripts, as well as reviewed the audio- and videotapes. This lessened the risk of allowing the primary investigator’s biases to strongly affect emergent themes. A bracketing interview was also completed to lessen this risk. In a bracketing interview, the primary investigator was asked the same questions her participants would be asked, and she answered them from her own perspective and in as much detail as possible. This was in order for her biases as a former personal trainer to be made clear to her and to the other investigators. Throughout data collection and analysis, the interview was referred to, so that her biases would not override the actual perceptions of the participants. Additionally, a member check was employed; the investigator sent a one-page summary to the participants and asked for feedback and any clarifications and/or additions they would like to make. Trustworthiness of data was established through two methods of triangulation: three data collection methods, and three different perspectives concerning the research question. The data collection methods were the focus group interview, the videotape, and the survey.

### Results

The results are reported by themes that emerged from each research question. Figure 1 depicts the hierarchical organization of the clients’ responses into global, major, and sub, and mini-themes. The global themes and their sub-factors are described therein.

#### Personal Trainer Rationale

The first global theme that emerged from the client focus group was Personal Trainer (PT) Rationale which refers to the clients’ reasons or motivations for hiring a personal trainer. Participants in the focus group provided a rich and detailed account of their motives for hiring a personal trainer. The discussion of PT Rationale produced two major themes, including Frustration and Motivation. The clients expressed frustration over their inability to achieve fitness and/or physical appearance goals, such as weight loss, muscular strength, or just the ability to fit into certain clothes. Lorraine stated,

> I just got sick of the way I looked in the mirror naked. I didn’t like the way clothes fit; I didn’t like becoming a plus-size girl at 21 years of age. And, once at the gym, I asked to use the body fat percentage machine. [As the trainer] gave it to me, I was voicing my frustration and he said something about, ‘Oh, you need to lift’ and I [said], ‘Great, I’ll be here in the morning’. And that’s how I got started.

The clients also reported a desire to work with someone who could help them sustain motivation. Clients felt they could not generate the motivation necessary to adhere to regular exercise, and wanted a trainer to motivate them to work harder during a workout session. To illustrate, Carla said that her biggest problem was just getting herself to the gym: “Motivation for me, and for probably most of the population that’s overweight, [is] what they need”.

In summary, it appears that the clients’ incentives for seeking a personal trainer originated from the negative effect or frustration associated with their failure to achieve fitness/physical appearance goals. Additionally, they sought personal trainers to maintain their motivation once in an exercise program. These major themes led to a sub-theme, Body. Clients were frustrated with their physical appearance, and they expressed the need to hire a personal trainer who would help to create the motivation required to change their bodies and to achieve results (e.g., lose weight, gain muscle tone). Once the decision to hire a personal trainer was made, the clients used certain criteria to evaluate potential trainers in order to select someone who most suited them. These criteria are considered next.

#### Selection Rationale

A second global theme for the clients of personal trainers was labeled Selection Rationale (see Figure 1). While PT Rationale examines the reasons clients sought a personal trainer, Selection Rationale refers to the attributes the client considered when evaluating a particular personal trainer. This theme includes first impressions and characteristics that clients would be able to readily observe prior to hiring the trainer. The major themes associated with Selection Rationale are Gender, Empathy, Physique Appearance, and Results of Others. Interestingly, four of the women preferred a female trainer because they felt a woman would be better suited to understand their struggles and comfort levels. Specifically, these women chose a female trainer because they felt that they would not be as self-conscious about their bodies as they might be while working with a male trainer. They also indicated that a female trainer would be prepared to understand their gender-role concerns (e.g., balancing a toned body with a feminine image). Cassie believed that a female trainer would not make her feel self-conscious in the beginning, while she was still at a body size that was undesirable to her. Alicia associated high volume weight lifting with male trainers and that this would “make her own body get too big”. [Both clients later hired male trainers and found that this was not the case]. Lorraine preferred a male trainer because she felt that she would feel the need to compete with a female trainer, though this individual did not elaborate on the meaning of “compete.” In light of the importance of physical appearance relative to reasons for hiring a trainer, it is plausible to suggest that Lorraine felt like she would compete with the trainer in terms of physical appearance. In summary, it appears that gender may play a major role when clients select a particular trainer. Female clients expressed a preference for female trainers because they believed female trainers would empathize with them more than a male trainer could. In fact, the clients discussed empathy to such an extent that it was designated as a major theme.

Empathy refers to the trainer’s understanding of the client’s experience and her skill in effectively listening to their difficulties. Several clients preferred trainers who have personally experienced the challenges associated with weight loss and adhering to an exercise program. Alicia commented, “I knew I wanted someone who had lost the weight, who knew what it felt like to struggle…I wanted someone who felt that [way] to train me”. Whitney commented,

> “I chose the person that I was with because of her [the trainer’s] own personal body change. I was watching her modify her diet and … all the training that she did and just seeing the difference in her own body… I just felt like she could achieve that with anyone who wanted to.”

These clients believed that if a trainer could feel what the client was going through (emotionally and physically), it would not only make the client feel more comfortable during the training session, but would also give the client confidence that they could achieve their own goals.

In addition to empathy and gender, the clients evaluated potential trainers based on the trainer’s physique. Physique Appearance, a third major theme, was discussed at great length and in much detail among all of the clients. The clients believed that a trainer who has a “good body” gave them confidence that the trainer “knew their stuff”. Furthermore, the clients believed that a trainer with an attractive physique must be motivated to be healthy, so they must possess the skill to motivate others. Whitney commented, “… how they look is important to me because I have to be able to put my faith in them and know that they know what they’re doing. . .”

The clients equated having a sculpted physique with competence. At the same time, several clients did recognize that mere physical appearance was not sufficient to indicate knowledge of personal training. Interestingly, the clients clearly identified empathy as a critical factor in selecting a trainer (i.e., the trainer feels or has felt the frustration associated with maintaining an exercise program), yet they also identified the appearance of the trainer’s physique as an important factor. After probing this issue, the clients concluded that for a first impression, the appearance of the trainer’s physique is important, but other factors may overcome this first impression. Clients felt that as long as they saw results with their own bodies, their trainer’s physique would become much less of a factor. Alicia commented,

> “I think that in the beginning, I would be apprehensive [with an overweight trainer]. But I wait and see what kind of change I get after working out with that person for, say, 3 months. In the long run, it’s the changes that I make and the goals that I reach …that’s going to keep me coming back- not their credentials, not what they wear, not what they look like”.

The interviews also revealed that the results that other clients achieved with a personal trainer were more important than the trainer’s physique. The major theme, Results of Others, refers to the results (e.g., successfully achieving changes in physical appearance or fitness) that other clients have achieved while working with a particular trainer. Three of the clients explained that this was one of the major reasons they chose their trainers. Carla commented, “I think that seeing the results that they’ve accomplished with someone else is as important to me as their credentials.”

#### Loyalty Rationale

Another global theme that emerged during the client focus group was Loyalty Rationale (see Figure 1), which refers to the credentials of a personal trainer that solidify the client/trainer relationship. These qualifications were not necessarily known before the client started working with her particular trainer, but they were the reasons the client stayed with the trainer. This global theme included the following major themes: Social Skills; Individuality; Education; Passion; and Results. Social Skills refers to the interpersonal and communication skills of the trainer, as well as the friendships that sometimes result with the one-on-one training. Effective interpersonal skills (e.g., charisma, sincerity) can lead to deeper, satisfying relationships (e.g., friendship) in one-on-one training. The clients noted that they like a trainer who could give them a good workout, yet who made it fun. They enjoy the camaraderie they have with their trainer, and it gives them the motivation to come every session. Carla commented,

> “…I think they should be enthusiastic, I think they should be fun. I mean, that hour is torture sometimes. And I think they have to encourage you…talking to him [trainer] and hanging out while we’re working out, is just as important probably- actually more- important than working out!”

Individuality was another major theme that emerged. It consists of two sub-themes: Full Attention and Documentation. Full Attention refers to the clients’ desire for the trainer’s complete focus and attention during their training session. Cassie commented, “I just think it’s very important to not only [oversee] training [for] the individual, but to make them feel special, make them feel that you want to be there”. Although the clients realize that their trainer has other people that she or he trains, during their hour they want to feel that they are the only client the personal trainer has.

The clients also preferred trainers who could listen closely to their concerns and make notes (e.g., programmatic changes) of what was accomplished during the session. Documentation was a sub-theme of Individuality. The clients felt very strongly that the trainers should keep formal records of what happened during each training session in order to keep track of the workouts so that they can differentiate among all of their clients. This theme also included effective listening skills, since it was believed that this would help avoid injuries. Avoiding Injury is a mini-theme that emerged from Documentation and Full Attention. These clients believed that it is important for trainers to listen to the client and document any injuries that occur so that the trainer remembers not to do that exercise again with that particular client. In addition, clients expected trainers to ask them for an update of the injured area at a later session. Some of the clients had encountered trainers who did not seem to listen when a particular exercise resulted in pain or injury, and some suggested that this was because the trainer had taken on too many other clients.

As one might expect, the clients valued the trainer’s knowledge of anatomy, physiology, and exercise program design, which was reflected in the major theme labeled Education. This theme was discussed in terms of college and certifications. College refers to any formal training at the collegiate level that clients felt should be required of trainers. Most of the clients believed that a trainer with a college degree has a broader understanding of the body than someone without a degree. Cassie, the client who had worked with six different trainers commented,

> “I find that if I have trained with people who had a B.S., the title [in] sports medicine or a related field, [instead of] a weekend course…they have a broader, general understanding of the body besides just, ‘this is the exercise, this is how you do this’. They can give you much more advice about your nutritional needs, you know, some lifestyle changes…”

It was clear that most of the clients were more comfortable with a trainer who earned a college degree, and that most assumed that their trainers had a degree since they were seeing results.

In regard to certifications (the other sub-theme associated with Education), the clients were asked whether they knew the names of any of the certifying organizations. No clients answered affirmatively. In fact, four had not known any of the qualifications of their trainers before they hired them. The exceptions to this were cases in which the trainer had won a bodybuilding or fitness show. Lorraine commented, “In the beginning, I didn’t know [what the qualifications of my trainer were]. I just assumed that everyone was certified”. When clients were informed about the fact that trainers at some locations are not required to possess a degree or have any formal training before they take many of the certification exams, they were surprised. Alicia remarked, “I didn’t ask for their qualifications. It was through our interactions that I found out what the qualifications were. I’m sitting here thinking…when I go to a doctor, I certainly want to see their qualifications.”

Another client had also been disappointed when she discovered how “easy” it can be to acquire some of the certifications. Carla noted, “I think that a lot of these groups that certify people, it’s become more of a money game than making certain people know what they’re doing. To me, it trivializes it somewhat.” Several of the clients also recognized that some trainers elected a quick certification and were training simply to make extra money. Whitney commented, “I think somebody…who’s spent the better part of her adult life working on this kind of stuff is preferable to someone who just got certified in a weekend class.”

The discussion regarding education prompted a wide variety of comments. In the absence of any probe directly concerning college, the clients noted that a degree must be an important quality for a trainer. Although the clients were disturbed by the notion of a trainer without a degree or certification, the clients seemed to quickly dismiss this opinion in situations where the trainer is clearly dedicated to the field and loves what she or he does, regardless of degree or certification. The clients called this passion.

Passion is a major theme that refers to the trainer having a love for what he or she does, including a dedication to the profession. In fact, some of the clients decided that since having a passion for your job will probably motivate a person to become better, the passion of a trainer may be more important to the clients than their education. Carla commented, “If you have a passion for it, you’re going to have a desire to learn more, read more, and to enrich your client’s life with that.”

Although social skills, individuality, education, and passion were clearly important to these clients, detectable changes in their bodies (e.g., weight loss, improved muscle tone), or results, appeared to be the most powerful factor influencing continued work with that trainer. Results refer to the changes that the clients saw in their bodies, which is consistent with their rationale for hiring a trainer in the first place (i.e., clients hired trainers in part because of the frustration that resulted from inability to achieve significant body change). According to these clients, the results that they get from working with a particular trainer may be more important than any other qualification or characteristic a trainer may possess. Alicia reported that her trainer never told her what his credentials were and that it bothered her at first, but since she was seeing results, it seemed to matter less over time.

Negative Characteristics Finally, the clients discussed and identified a number of negative characteristics or behaviors that might impair the personal training experience. The last global theme that emerged from the client focus group was Negative Characteristics, which consisted of the sub-themes, Unethical and Unprofessional. Negative Characteristics are characteristics that clients felt were inappropriate for trainers. These characteristics might cause a client to terminate her relationship with a trainer. In this study, Unethical refers to behavior that is sexual in nature, such as flirting and sexual comments directed at the client or any other members in the gym. Unprofessional behavior includes canceling appointments frequently, not calling to cancel appointments, cursing, and telling clients about problems with management. In addition, these clients considered inappropriate attire worn by the trainer as unprofessional. The clients expressed discomfort with female trainers who wear sport tops and bike shorts, since it seemed to make them feel self-conscious about their own bodies. Interestingly, the clients did not discuss male trainer’s dress at length, and when it was mentioned, clients suggested that the male attire should be “tasteful” and “clean”. Cassie felt that female trainers are more likely to wear inappropriate clothing. The female clients seemed to take it as a personal affront when their female trainers dressed in revealing clothing because it made the clients feel self-conscious about their own bodies. In other words, they want their trainer to have a great body, but they also want it covered. Additionally, the clients do not want to hear sexual comments made by their trainers, specifically male trainers. As Table 2 demonstrates, these clients were very clear regarding gender roles in the workplace; females should not show off their bodies, and males should not make sexual innuendos.

### Discussion

The purpose of the present study was to examine clients’ perceptions regarding the qualities of successful personal trainers. Using focus group methodology, four global themes emerged: Personal Trainer Rationale, Selection Rationale, Loyalty Rationale, and Negative Characteristics. Table 2 summarizes these results.

The clients in the present study identified several factors they considered when selecting a personal trainer. The clients preferred a trainer who could empathize with their struggles to adhere to an exercise program, help them lose weight, and improve their bodies. In addition, the trainer’s physique was important when selecting a particular trainer. These findings are in line with self-presentation theory (16), a process by which one monitors and controls how one is perceived by others. Research examining self-presentational processes in physical activity has typically focused on social physique anxiety, a perception that others are negatively evaluating one’s physique (12). The findings of the present study seem to indicate that self-presentational processes may influence the selection of a personal trainer. That is, clients’ perceptions of their own physical appearance in relation to that of a potential personal trainer may influence the selection of that trainer.

The finding that physical appearance was a major factor regarding the selection and hiring of personal trainers, as well as why people decide to exercise in the first place, mirrors contemporary society’s emphasis on the “body beautiful”. People want their bodies to emulate those seen on magazine covers and on television, and therefore seek out trainers who also have these sculpted bodies to train them. Additionally, because attractiveness is more central to women’s identity (11), women are more dissatisfied with their bodies than are men (26).

Although a trainer’s physique was an important factor in the selection of a personal trainer, the clients agreed that other factors may become more relevant (e.g., detectable changes in fitness level and physique) as they progress with their exercise program. The participants indicated that perhaps the most powerful factor when selecting a trainer is that of observing the results a trainer has accomplished with other clients. This is a factor that may lead to or be associated with false assumptions. First, it is possible that a trainer with a lean, athletic, muscular, and sculpted body has never had to worry about his/her weight. In light of the importance of genetics in determining body type, the trainer with the most attractive body may have always had a fit body, and never had to work to maintain or improve it. Thus, this type of trainer may not be necessarily empathetic to a client’s struggles with appearance. Moreover, a trainer may know how to train herself, but there is no guarantee that she can transform another person’s body. This may lead to unrealistic expectations for clients which may result in discontinuation of an exercise program.

Also, while people may see results from exercising (e.g., losing weight, toning muscles), there are incorrect ways to achieve these results. It is possible, for example, to severely dehydrate oneself in order to see more muscular definition, as some bodybuilders do prior to competition. Therefore, clients may obtain results, but they may not be using safe training methods. Finally, while factors such as noticeable results were important in the initial phases of evaluating potential trainers, they were not the factors that ultimately affected whether or not the client stayed with the trainer.

In regard to trainer characteristics, clients suggested that trainers should: 1) be educated; 2) recognize the individuality of each client; and 3) be able to help clients accomplish detectable body changes. In addition, they should have a passion for personal training, and make the workout enjoyable through the use of effective social skills. The importance of “fun” during a workout session corroborates Wankel’s findings (30) that the activity itself and the characteristics of the leader are significant factors that affect enjoyment and adherence to a program. One client mentioned that exercising is difficult, and that it is important for the trainer have the social skills to communicate as a friend and make the session as enjoyable as possible. Exercise is inherently a physically challenging activity. Therefore a trainer’s ability to use his or her social skills to make the training session comfortable is an important one. Clients are more inclined to continue with that particular trainer.

Thus, the clients want to work out in a socially friendly environment in order to sustain motivation. The importance of fitness professionals’ dispositions is critical. Studies examining the influence of disposition in service work (e.g., hospitality, retail) show that personality and social skills often outweigh a person’s technical ability (14,22). Collishaw et al. (7) also reported that an instructor’s genuine enthusiasm for teaching group fitness classes was perceived and appreciated by clients. Finally, clients report more positive affect and loyalty to a trainer as a result of positive body language. “Trainers should listen to [clients] and learn about who they are, what their lifestyle is like and what motivates them. This process will become easier with time and the personal trainers will develop a polished bedside manner.” (2). Clients also want to feel special during workouts and believe that the trainer has her full attention on the client, listening to them and documenting what worked and what did not in order to avoid potential injuries. This expectation for being treated as an individual (Individuality) is an example of the customer service that Americans demand from all businesses.

A trainer’s knowledge was important to the client. It did not necessarily have to be from a college degree or certification, however. As long as the trainer shows a passion for her occupation, and the client sees results with her own body, the need for other credentials may be minimized. If the clients recognize that a trainer is genuinely enthusiastic and shares continued education (e.g., reading) with her client, this may preclude the need for higher education. However, since the majority of the clients did not truly know what the qualifications of their trainers were, or any of the certification programs available, it is plausible to suggest that they also would not be certain that the information their trainer is seeking and distributing is from reputable sources.

While credentials are critical in the selection of a trainer and/or a facility, a trainer’s credentials (e.g., certification, college degree) may mean less to a client than the belief that the trainer can help the client achieve the desired results (8). Of course, this perception is based only upon what they observe (the body change of another). Clients may not recognize that people’s bodies change at different rates and in different ways due to genetic differences, time available for training, diet, and internal motivation.

The clients identified characteristics of personal trainers that they considered unprofessional and unethical. These negative characteristics may influence clients’ decisions to stay with a trainer. In some instances, this unprofessional behavior may result in a discontinuation of exercise altogether. As was previously noted, exercise adherence is quite low in the United States; unprofessional or unethical personal trainers only exacerbate this situation. While personal trainers who have sound knowledge and strong motivational skills inspire clients, those who do not possess these skills may be the reason why a person stops exercising. That is, if the client was frustrated before working with a trainer because she could not obtain desired results, or could not motivate herself to exercise, working with a trainer who displays negative characteristics may cause her to abandon exercise altogether.

Incompetent personal trainers may also hurt those trainers who are qualified and knowledgeable. Personal trainers who are not dedicated to the personal training industry or concerned with improving their skills severely damage the reputations of the qualified trainers who do an excellent job of caring for their clients and who make personal training a respected profession.

#### Limitations

Several limitations should be acknowledged. First, qualitative methods were used and therefore, the results cannot be generalized to other populations. Second, this study used only females and attitudes toward trainers may be gender specific. Third, focus group participants volunteered to be a part of the sessions, and this might have created a potential bias since these individuals may not necessarily represent all clients of personal trainers. Finally, all qualitative research is dependent on the biases of the authors that analyze the data. Although measures were taken to eliminate bias (the lead author completed a bracketing interview and three authors analyzed the data through consensus agreement), it is possible that preconceived beliefs may have influenced the analysis. Despite these limitations however, the authors believe that the results of the present study contribute to scholarly inquiry and offer some important practical applications for the fitness industry.

### Application in Sport

The findings of the present study have several implications relative to the personal training industry, including a discussion of the skills and/or qualifications necessary for successful personal training. First, if personal trainers are to meet the priorities of their clients, they must learn communication skills, motivation techniques, how to treat the client as an individual, and how to design various weight training programs according to the goals of the client. They must also recognize the importance of their clients’ perceptions of training results. Also, while students who do not necessarily have an ‘ideal’ physique should not be discouraged from pursuing this career, they should be cognizant that a trainer’s physique may be a deciding factor in the hiring process.

Second, the public needs to be better informed about exercise and nutrition. Clients would also benefit from information regarding the certifications associated with personal trainers. The majority of the clients in this study had not known the qualifications of their trainer when they hired them, assuming all were degreed and certified by reputable organizations. If fitness professionals can find effective ways to inform the public regarding the selection of a qualified personal trainer, clients may be less likely to have unrealistic expectations when hiring a trainer. In addition, they may be more wary of the trainers who proclaim to be able to change their entire appearance by in a short time.

Third, the authors believe that undergraduate and certification programs should include training in the development of interpersonal skills such as active listening, empathetic communication, and strategies to enhance motivation. The findings of the present study are consistent with research showing that these techniques will positively influence exercise adherence (3). Clients in the current study sought and stayed with trainers who exhibit these skills. The authors therefore, support formal incorporation of best practices into undergraduate programs. Research has shown that using such techniques will positively influence exercise adherence (3,27,28). Additionally, the findings of the present study suggest that personal trainers need to take a more client-focused approach, treating their clients as individuals and not simply as dollar signs.

A final suggestion to strengthen the current state of personal training is to move toward state licensure. The participants in the present study were largely unaware of certification procedures and the multiple licensing agencies. Currently, there are at least 19 different personal trainer certification organizations (1), and approximately 90 organizations offering fitness certifications (31). With so many organizations having their own criteria for membership and certification as a personal trainer, there has been little regulation or assurance that personal trainers working in the field are qualified. It is critical that present and future club members improve their knowledge of how professional personal trainers are educated and certified. Given the poor exercise adherence and high level of dropout rates in the United States, qualified personal trainers are in a position to help change these rates.

### References

1. Archer, S. (2004) Navigating PFT certifications. IDEA Fit J, 1: 50-57. 2. Bentkowski, F. (2002).Getting to know you. Club Industry, 18(8): 25. 3. Buckworth, J. (2000). Exercise determinants and interventions. Int J Sport Psychol, 31: 305-320. 4. Centers for Disease Control [Internet]. Physical activity and health [cited 2010 Sept 15]. Available from: <http://www.cdc.gov/nccdphp/sgr/pdf/execsumm.pdf>. 5. Centers for Disease Control [Internet]. Physical activity for everyone [cited 2010 April 30]. Available from: <http://www.cdc.gov/physicalactivity/everyone/health/index.html>. 6. Centers for Disease Control [Internet]. Prevalence of physical activity, including lifestyle activities among adults [cited 2010 Sept 15]. Available from: <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5232a2.htm> 7. Collishaw, M.A., Dyer, L., & Boies, K. (2008). The authenticity of positive emotional displays: Client responses to leisure service employees. J Leis Res, 40(1): 23-46. 8. Cox, J. (2009). Weigh the choices before signing up for a gym. McClatchy Trib Bus News. Washington: Dec 24. 9. Denzin, N.K. & Lincoln, Y.S. (2000). Handbook of qualitative research. Sage Publications, Thousand Oaks, CA. 10. Dishman, R.K. (1990). Determinants of participation in physical activity. In: Exercise, fitness and hhealth: A consensus of current knowledge. Bouchard, C., Shepard, R.J., Stephens, T., Sutton, J., & MMcPherson, B., eds. Human Kinetics, Champaign, IL. 75-101. 11. Gupta, M.A. & Schork, N.J. (1993). Aging-related concerns and body image: Possible future implications for eating disorder. Int J Eating Disorders, 14: 481-486, 12. Hart, E.A., Leary, M.R., & Rejeski, J.W. (1989). The measurement of social physique anxiety, J Sport and Ex Psychol, 11: 94–104. 13. International Health Racquet & Sport Association Web Site [Internet]. Boston (MA): [cited 2010 Sept 2]. Available from: <http://cms.ihrsa.org/index.cfm?fuseaction=Page.viewPage&pageId=18859&nodeID=15> 14. King, A.C., Stokols, D., Talen, E., Brassington, G.S., & Killingsworth, R. (2002). Theoretical approaches to the promotion of physical activity: Forging a transdisciplinary paradigm. Am J Prev Med, 23(Suppl 2): 15-25. 15. Korczynski, M. (2002). Human resource management in service work. Palgrave, Basingstoke. 16. Leary, M.R. (1992). Self-presentational processes in exercise and sport. J Sport Ex Psychol, 14: 339-351. 17. Maloof, R.M., Zabik, R.M., & Dawson, M.L. (2001). The effect of use of a personal trainer on improvement of health related fitness for adults. Med Sci Sports Exerc, 33(5): 74. 18. Mazetti, S.A., Kraemer, W.J., Volek, J.S., Duncan, N.D., Ratamess, N.A., Gomez, A.L., Newton, R.U., Hakkinen, K., & Fleck, S.J. (2000). The influence of direct supervision of resistance training on strength performance. Med Sci Sports Exerc, 32(6): 1175-1184. 19. McGuire, A.M., Anderson, D.F., & Trail, G. (2009). Examination of consumer differences on the importance and satisfaction with fitness service attributes. Int J Sport Mgmt, 10(1): 102-119. 20. Melton, D., Katula, J.A., & Mustian, K.M. (2008). The current state of personal training: an industry perspective of personal trainers in a southeast community. J Strength Cond Res, 22 (3): 883-889. 21. Melton, D., Dail, T.K., Katula, J.A., & Mustian, K.M. [in press]. The current state of personal training: Managers’ perspectives. J Strength Cond Res. 22. Nickson, D., Warhurst, C, & Dutton, E. (2004). Aesthetic labour and the policy-making agenda: Time for a reappraisal of skills. SKOPE Research Paper 48, Oxford and Warwick Universities. 23. Quinn, E. Do you need a personal trainer? 10 reasons a trainer may be right for you. About.com Guide. Available from: <http://sportsmedicine.about.com/cs/strengthening/a/012004.htm>. Accessed February 16, 2010. 24. Ratamass, N.A., Faigenbaum, A.D., Hoffman, J.R., & Kang, J. (2008). Self-selected resistance training intensity in healthy women: The influence of a personal trainer. J Strength Cond Res, 22(1): 103-111. 25. Redding, J.L. (1994). A descriptive study of personal trainers. Columbia University Teachers College. Diss Abst Intl 55(07A): 1871. 26. Rozin, P., & Fallon, A. (1988). Body image, attitudes to weight, and misperceptions of figure preferences of the opposite sex: A comparison of men and women in two generations. J Abnormal Psych, 97: 342-345. 27. Sallis, J.F., Hovell, M.F., Hofstetter C.R., Faucher, P., Spry, V.M., Barrington, E., & Hackney, M. (1990). Lifetime history of relapse from exercise. Addictive Behav, 15: 573-579. 28. Turner, R.D., Polly, S., & Sherman, A.R. (1976). A behavioral approach to individualized exercise programming. In: Counseling Methods. Krumboltz, J.D. and Thoresen, C.E., eds. Holt, Reinhart, and Winston, New York. 29. Vaughn, S., Schumm, J.S., & Sinagub, J. (1996). Focus group interviews in education and psychology. Sage Publications, Thousand Oaks, CA. 30. Wankel, L.M. (1985). Personal and situational factors affecting exercise involvement: The importance of enjoyment. Res Q Ex Sport, 56(3): 275-282. 31. Williams, A. (2009). Personal trainer certification. IDEA Fit J, 6: 2.

### Corresponding Author

**Deana I. Melton, Ed.D., CSCS, HFS** Human Performance and Leisure Studies Department North Carolina A&T State University 203 Corbett Center Greensboro, NC 27411 Phone: (336) 334-7712 Fax: 336) 334-7258 <[email protected]>

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Computer Science > Computation and Language

Title: openelm: an efficient language model family with open-source training and inference framework.

Abstract: The reproducibility and transparency of large language models are crucial for advancing open research, ensuring the trustworthiness of results, and enabling investigations into data and model biases, as well as potential risks. To this end, we release OpenELM, a state-of-the-art open language model. OpenELM uses a layer-wise scaling strategy to efficiently allocate parameters within each layer of the transformer model, leading to enhanced accuracy. For example, with a parameter budget of approximately one billion parameters, OpenELM exhibits a 2.36% improvement in accuracy compared to OLMo while requiring $2\times$ fewer pre-training tokens. Diverging from prior practices that only provide model weights and inference code, and pre-train on private datasets, our release includes the complete framework for training and evaluation of the language model on publicly available datasets, including training logs, multiple checkpoints, and pre-training configurations. We also release code to convert models to MLX library for inference and fine-tuning on Apple devices. This comprehensive release aims to empower and strengthen the open research community, paving the way for future open research endeavors. Our source code along with pre-trained model weights and training recipes is available at \url{ this https URL }. Additionally, \model models can be found on HuggingFace at: \url{ this https URL }.

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More Open Access Training For Academics Would Lead To More Open Access

from the need-to-lead-the-academics-to-water dept

Open access publishing, which allows people to read academic papers without a subscription, seems such a good idea. It means that anyone, anywhere in the world, can read the latest research without needing to pay. Academic institutions can spend less to keep their scholars up-to-date with work in their field. It also helps disseminate research, which means that academics receive more recognition for their achievements, boosting their career paths.

And yet despite these manifest benefits,  open access  continues to  struggle . As Walled Culture has noted several times, one reason is that traditional academic publishers have managed to subvert the open access system, apparently embracing it, but in such a way as to negate the cost savings for institutions. Many publishers also tightly control the extent to which academic researchers can share their own papers that are released as open access, which rather misses the point of moving to this approach.

Another reason why open access has failed to take off in the way that many hoped is that academics often don’t seem to care much about supporting it or even using it. Again, given the clear benefits for themselves, their institutions and their audience, that seems extraordinary. Some new research sheds a little light on  why this may be happening . It is based on an online survey that was carried out regarding the extent and nature of training in open access offered to doctoral students, sources of respondents’ open access knowledge, and their perspectives on open access. The results are striking:

a large majority of current (81%) and recent (84%) doctoral students are or were not required to undertake mandatory open access training. Responses from doctoral supervisors aligned with this, with 66% stating that there was no mandatory training for doctoral students at their institution. The Don’t know figure was slightly higher for supervisors (16%), suggesting some uncertainty about what is required of doctoral students.

The surprisingly high figures quoted above matter, because

a statistically significant difference was observed between respondents who have completed training and those who have not. These findings provide some solid evidence that open access training has an impact on researcher knowledge and practices

One worrying aspect is where else researchers are obtaining their knowledge of open access principles and practices:

Web resources and colleagues were found to be the most highly rated sources, but publisher information also scored highly, which may be cause for some concern. While it is evident that publisher information about open access may be of value to researchers, if for no other reason than to explain the specific open access options available to authors submitting to a particular journal, publishers are naturally incentivised to describe positively the forms of open access they offer to authors, and therefore can hardly be said to represent an objective source of information about open access in general terms.

What this means in practice is that academics may simply accept the publishers’ version of open access, without calling into question why it is so expensive or so restrictive in allowing papers to be shared freely. It could explain why the publishers’ distorted form of the original open access approach does not meet greater resistance. On the plus side, the survey revealed widespread support for more open access training:

First, only 27% of respondents answered that the level of open access training offered as part of their doctoral studies was sufficient. Second, there was widespread agreement with a number of statements presented to respondents that related to actions institutions could take to support researcher understanding of open access. There was widest agreement with the notion that institutions should provide Web resources about open access specifically for doctoral students, followed by optional training for these students. The statement that suggested institutions should require doctoral students to undertake open access training received agreement or strong agreement from almost half of respondents (45%).

Although the research reveals widely differing views on requirements for open access training, and who exactly should provide it, there does seem to be an opportunity to increase researchers’ familiarity with the concept and its benefits. Rather than lamenting the diluted form of open access that major publishers now offer, open access advocates might usefully spend more time spreading the word about its benefits to the people who can make it happen – new and established researchers – by helping to provide training in a variety of forms.

Follow me @glynmoody on  Twitter ,  Diaspora , or  Mastodon . Originally published to Walled Culture .

Filed Under: academic knowledge , open access , training

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Of course, any open access training is only properly useful if it includes knowledge about diamond open access, since that doesn’t cost educational establishments anything.

What is "Open access training"?

The study doesn’t really define it. The article here doesn’t define it. Is it just a quick class saying that arXiv is good and publisher open access fees are nonsense?

Also, if you’re a new researcher, you probably don’t have the funding to pay for publisher open access. You might be able to send work to open access journals/conferences/repositories. Most of the time, you’re just trying to get publications in as many good venues as you can and don’t have the luxury of choosing where you’ll send things based on access.

I agree that open access needs more attention and more work should be publicly accessible, but giving Ph.D. students more training (again, on what?) feels like giving people classes on how to navigate health insurance claims.

What is “open access training”? The study doesn’t really define it. The article here doesn’t define it.

You clearly have Internet access, so why not plug the term into a search engine? Double quotation marks are available if required, just hold down the shift button and press ‘2’ in the row of numbers above the letters.

Double quotation marks are available if required, just hold down the shift button and press ‘2’ in the row of numbers above the letters.

Follow the money

I would love to publish all of my work as open access but even with grant funding, I cannot cover the exorbitant fees many publishers charge (Elsevier charges over $3000 for multiple journals in my field). The biggest issue with open access publishing is that academics simply don’t have the funds to cover publishing costs. This is about to get worse as so many public universities are cutting costs.

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Counseling and Psychology Student Experiences of Personal Therapy: A Critical Interpretive Synthesis

Background: Committing to attendance at personal therapy sessions is frequently either mandated or encouraged in many different types of therapeutic trainings across allied health, psychotherapy, social work and counseling. The small number of published accounts have indicated that student experiences of personal therapy can be mixed.

Methods: The project examined contemporary interview based research about student experience of personal therapy during training using Critical Interpretive Synthesis method. Ten papers were found which met the search criteria. The papers included a total of 89 participants (75 F).

Results: The results comprised 12 themes derived from 89 meaning units gleaned from student experiences presented in the research studies. These were used to inform a synthesizing statement here truncated as follows:

Beginning therapy is challenging for some students, especially when attendance is mandatory. However, students can experience transformative change by the end of the process, even if they commence the work in a guarded way .

Multiple problems can arise in the process of attending therapy as a student, and it can be difficult for a student to know what to do if these challenges are overwhelming .

Attending personal therapy brings rich learnings which can be applied in clinical work but can also positively impact learning in the course, and lifelong personal development. The process can enhance the student's understanding of what the client may experience in the therapeutic journey .

Conclusions: Attending personal therapy during training is not a straightforward process for all students. Course leaders and trainers need to be mindful of the possibility that students will struggle with the personal therapy requirement. Course and professional bodies should regularly review personal therapy requirements, being clear about the aims; remaining attuned to the student experience.

Introduction

The requirement to undergo personal therapy during psychotherapy based training is the focus of multiple research and review papers (for example, Chaturvedi, 2013 ; Malikiosi-Loizos, 2013 ; Edwards, 2017 ; Moertl et al., 2017 ; So, 2017 ; McMahon, 2018 ; Bennett-Levy and Finlay-Jones, 2018 ). Committing to attendance at personal therapy sessions is an expectation of students in many counseling, allied health, and psychotherapy trainings throughout the world. For example, although the British Association for Counseling and Psychotherapy (BACP) dispensed with the mandatory requirement for personal therapy during training in 2005 (Malikiosi-Loizos, 2013 ), a review in 2013 showed that 50% of courses still required personal therapy attendance (Chaturvedi, 2013 ). Similarly the British Psychological Society Division of Counseling Psychology removed specification of required hours in 2015; leaving the mandated participation in personal therapy requirement but no longer referring to a minimum number of hours (Kumari, 2017 ).

The course or professional association requirement to attend personal therapy sessions ranges from mandatory attendance (Kumari, 2011 ; Ivey and Waldeck, 2014 ) to attendance that is optional but encouraged (Digiuni et al., 2013 ). In a presentation of the historic requirement for trainee engagement with personal therapy, Jacobs ( 2011 ) advised that in the early development of the practice of psychoanalysis, “…training analysis had one particular aim, that the trainee should acquire a working knowledge of their unconscious, so that there would be no blind spots when it came to them analyzing their own patient” (p. 428).

There is a strong expectation revealed in multiple theoretical and research papers that attending personal therapy sessions will enhance student learning and, in turn, develop the capacities of the professional body (Von Haenisch, 2011 ; Edwards, 2017 ). Personal psychotherapy during training is consistently presented as one way for students to learn about use of the self within therapeutic processes, with a view to positively impacting future therapeutic practice (Kumari, 2011 ; Von Haenisch, 2011 ). Trainees are expected to use personal therapy to develop insight about their capacities and limitations, learning to better manage their experiences in interaction with the client. This is achieved through enhancing students' capacity in being able to use a reflective stance (Rizq and Target, 2008a ), or the engagement of reflective function (Ensink et al., 2013 ).

A range of papers have reflected on problematic aspects of requiring students to attend personal therapy; including that decisions about self-experience requirements in training courses are self-referential, rooted in tradition rather than evidence, and unable to be challenged (Chaturvedi, 2013 ). The rationale for inclusion of self-development during training is strongly held but weakly conceptualized (Edwards, 2017 ). Often the student-as-customer environment of the university is not supportive of a self-experience requirement (Edwards, 2013 ).

Practicing professionals recalling their personal therapy during training, or reflecting on its value as a complement to their current practice, have indicated that the outcomes are not straightforward, and not all found the experience positive. For example, a survey of 95 senior psychiatric trainees across Australia and New Zealand in 2003 found only 22% of respondents considered personal therapy essential (Foulkes, 2003 ). A survey of 48 psychiatric trainees in London found that one third of respondents had attended personal psychotherapy and reported it as beneficial, and the majority of the remainder indicated they would consider attending psychotherapy in future (Sathanandan and Bull, 2013 ). Of 25 psychotherapy registrars in the UK who responded to a survey, 15 reported negative effects from their therapy (Macaskill and Macaskill, 1992 ). These negative effects included psychological distress (29%) and marital or family stress (13%).

The ethics of requiring all students to undertake personal therapy while training as a therapist has received attention. A survey of 170 clinical, and 88 counseling psychologists in Ireland found that more counseling psychologists emphasized the dangers of psychologists working with clients without having undergone a personal therapy experience, and more clinical psychologists questioned the ethics around mandated personal therapy during training (McMahon, 2018 ).

The principles that underpin student development through personal therapy can be difficult to examine. It is not known to what extent personal therapy enhances trainees' skills, and if these skills are enhanced, how they result in improved outcomes for clients (Bennett-Levy and Finlay-Jones, 2018 ). There is a challenge to the mandatory nature of the requirement during therapy training, given that the client's motivation for change is key to the outcomes (Malikiosi-Loizos, 2013 ).

Multiple studies have sought to understand what trainee therapists experience during personal therapy (e.g., Von Haenisch, 2011 ; Wilson et al., 2015 ). However, the total number of recent studies available is small, and usually engage survey designs or qualitative method interview-based approaches. Results indicate that for many students the experience of attending personal therapy as part of their training is positive. However, some mixed outcomes have also been reported (Moller et al., 2009 ; Rizq and Target, 2010 ; Kumari, 2017 ).

A Canadian study of 400 psychiatry residents indicated that the personal development opportunity provided through personal psychotherapy positively impacted the confidence of trainees in applying professional skills in practice with their patients (Hadjipavlou et al., 2016 ). Von Haenisch ( 2011 ) reflected that her participants' retrospective accounts of their experience of mandatory psychotherapy during training were similar to those of Rothery ( 1992 ) almost two decades prior; that is, with hindsight the participants were convinced of the benefits of attending individual psychotherapy during training even though at the time of their studies many admitted they had been somewhat unwilling to engage and use the opportunity (Von Haenisch, 2011 ).

This brief introduction and overview of the literature indicates some gaps in what we know about the experiences of students in courses which require or encourage personal development through therapy attendance. Prior work has identified that many training programmes have retained the long-standing personal therapy requirement without a strong rationale or evidence of effective outcomes (Edwards, 2017 ). Deepening an understanding of students' experience of this requirement is warranted.

Aim of the research

This study aimed to examine and synthesize documented experiences of students who have attended personal therapy during training. The guiding question for the research was: what did trainee therapists experience when they attended personal therapy?

Following on from the development of meta-analytic review procedures to gain superordinate findings from RCTs and other controlled studies, meta-synthesis has gradually emerged as a way to fuse outcomes from multiple qualitative method studies into a higher-order research statement (Edwards and Kaimal, 2016 ). There are increasing choices of methods available to conduct a meta-synthesis (Thomas and Harden, 2008 ). Critical interpretative synthesis (CIS) (Dixon-Woods et al., 2006 ) was chosen to conduct the meta-synthesis reported here. The methodology held the attraction of providing a way to engage the complexity of the topic, and to include criticality as a key driver of the findings.

Critical Interpretive Synthesis (CIS) method was first developed during a literature based study aimed at providing better understanding of the convolution of issues surrounding healthcare access (Dixon-Woods et al., 2006 ). CIS is a frequently used method of review in healthcare topics, especially reviews in which qualitative method studies are synthesized (Edwards and Kaimal, 2016 ). Critical is included as a descriptor in the method to signal the expectation that researchers will apply deep reflective strategies during the process of the research to ensure that normative assumptions are challenged (Dixon-Woods et al., 2006 ). Applying CIS method can achieve multiple goals, with the intent to translate existing findings into a new theoretical form (Dixon-Woods et al., 2006 ). In the review process the researcher examines and interrogates the underlying assumptions represented in the review materials, as well as their own beliefs and values (Dixon-Woods et al., 2006 ).

Selection criteria

Papers were included which met the following criteria:

• Published in a refereed journal
• Published in English
• Included qualitative method interview based research with current or former students relevant to relational therapy training programmes such as social work, creative arts therapies, counseling, psychiatry, and clinical psychology.

Only studies which explored experiences of personal therapy located during the time of being a student, whether retrospective interviews with practitioners or research conducted with students during training, were included. Research papers which explored other dimensions such as the impact or effect of personal therapy on quality of practice or other outcomes were not included (e.g., Rake and Paley, 2009 ). Papers which examined experiences of accessing personal therapy by current professionals were not included (e.g., Orlinsky et al., 2011 ), except where reflections on experiences as a student were the primary focus. A promising interview based study on motivations for deciding to become a psychotherapist was located (Barnett, 2007 ). However, although a short discussion on personal therapy appeared in the literature review, the analysis and results did not adequately explore trainee experiences of personal therapy.

It is recognized that personal development can be offered or required in multiple ways during therapy or counseling training. This synthesis focused only on interview-based studies evaluating students' experience of personal therapy. Examples of other types of personal development offerings during training that have been studied, and include; personal development groups (for example Payne, 2010 ), experiential groups (e.g., Viljoen and Gildenhuys, 2016 ), encounter groups (e.g., Brison et al., 2015 ) and interpersonal therapy training group s (e.g., Rees and Maclaine, 2016 ). There is no evidence that any one type of therapeutic offering can optimize personal development opportunities for trainee therapists.

Search criteria

The search commenced in January 2017 using EBSCO host. The search terms included: trainee “personal therapy,” therapy trainee; student “personal therapy”; mandatory “personal therapy”; personal therapy for counselors. A small number of relevant papers were found this way. Using google scholar to access citations of the papers yielded further papers, as did searching the reference list of each paper for further relevant work.

In undertaking a first look at the literature there was no time period indicated. As the number of papers grew beyond what might be usefully managed in the analysis it was decided to limit the time period to the years 2007–2017. However, on close reading of the papers although there were some 20 examples found, many of these did not meet the criteria for inclusion.

Although relevant studies using survey based findings were available (Daw and Joseph, 2007 ; for example, Bike et al., 2009 ; Digiuni et al., 2013 ; Byrne and Shufelt, 2014 ), only studies which presented findings from in-depth interview data were included. This was intended to ensure that the findings were grounded in personal narratives of students' experiences; with attention to in-depth exploration of students' personal accounts of engaging in therapy during training.

There is no minimum requirement for numbers of papers in a CIS. The goal in seeking papers for the synthesis is to engage adequate papers which can provide what is termed by the founders of CIS a sampling frame (Dixon-Woods et al., 2006 ). As an example, in a CIS study of application of concepts of continuity of care nine papers were included (Heaton et al., 2012 ). Ten papers were included in a CIS analysis of university students with mental health problems (Markoulakis and Kirsh, 2013 ).

Papers included in the CIS study

Following close reading of the 20 papers resulting from the search process 10 papers were found to meet the criteria for inclusion (see Table ​ Table1). 1 ). Two of these papers are presented in the table together (Rizq and Target, 2008a , b ) as the two reports use the same student sample. The total number of participants across the papers is 89 (75 F; 14 M). Most of the studies were conducted with trainees or graduates in the United Kingdom ( N = 7), with the remaining studies conducted with trainees or graduates in Austria, South Africa, and the United States of America.

Trainee experiences: summary of papers included in the analysis.

All of the statements in the papers reporting student self-experience during personal therapy were copied out in full (see the final column in Table ​ Table1). 1 ). These were then broken down further into 89 meaning units revealing multiple dimensions of experiences of students engaging in personal psychotherapy during training. In order to reflect more closely what students experienced during attendance at therapy, examining the meaning units to reveal experiential processes, not just outcomes, was undertaken. For example, the meaning unit “Personal therapy helped me understand endings” was further interrogated through re-reading the research report in the analysis phase. The statement was then re-written to more specifically reflect the student experience as follows: “During sessions I found it hard to think about or work with endings. The therapist supported me to understand how my past experiences contributed to this” (see final column Table ​ Table2). 2 ). The process of analysis was inductive whereby the materials for the analysis were drawn from the data rather than conceived a priori . The analysis involved moving back and forth between the synthesizing statements, reports of student statements presented in Table ​ Table1, 1 , and the original papers. The process required comparing concepts between papers, and describing in detail student experiences of personal therapy represented in the papers.

Themes and the meaning units which informed them.

In the first stage of the analysis meaning units were generated through extracting the key statements about student experiences of personal therapy from each of the papers (see Table ​ Table1). 1 ). These meaning units were then gradually corralled into groups by reflecting on statements which appeared similar. The steps taken were to; (1) Read the statements over and over, (2) Find and explore similarities between the statements, and (3) Group similar statements together. The groupings were constantly refined by returning to the original paper, and by comparing the statements in each of these groupings or categories. Once there were multiple statements grouped together the group was tentatively titled with reference to the predominant theme emerging from the statements. Each title was then further refined as more items were added (see column 1 in Table ​ Table2). 2 ). Each title reflected a theme that responded to the guiding question for the synthesis: what did trainee therapists experience when they attended personal therapy?

The following 12 themes were identified through the process of analysis. In the first instance they were group according to positive and negative experiences:

Positive experiences

• The support of the therapist was valued and transformative
• Personal therapy made it possible to be better informed about client role, and what the client experiences
• It was hard work but also valuable to work at a deep level
• Personal therapy was helpful in managing university and clinical work
• Experiences at the beginning and ending of therapy were different
• The need for self-knowledge of the therapist was heightened
• Learnings from observing the things the therapist did that were ineffective
• Enhanced learnings about the therapeutic role and techniques from the experience of the client; beyond the textbook

Negative experiences

• The start of therapy was explosive or guarded
• Personal therapy negatively impacted university, clinical work and other responsibilities
• Attending personal therapy was problematic and the course didn't help
• Encounters between the therapist and the trainee experienced as difficult cannot easily be addressed

Critical reflection fundamental to the CIS process was then undertaken by a. Further reflection on the 12 statements generated through the synthesis, b. Writing out responses to the statements, and c. Seeking further literature relevant to personal psychotherapy during training. For example, I initially wrote responses to the statements about personal therapy during training which were the most confronting for me. I felt especially strongly about student experiences of inadequate therapy, or of therapist behavior that was problematic, so this was the first topic addressed in the reflective writing tasks. I also felt sympathy for students who had difficulties in therapy and did not know what to do. I wondered if I had been adequately sympathetic on the very rare occasions when students came to me as a training director to discuss concerns about the personal therapy requirement. When reflecting on the behavior of therapists who engaged in actions the students found difficult, such as being too controlling, giving a shoulder massage, or starting the session with prayer, I explored feeling of being annoyed and astounded. I worried that students in programmes I had led might have experienced these types of interactions and not felt able to come to me or another team member with their concerns. As a response I sought out literature discussing therapists boundaries and role (e.g., Parry and Simpson, 2016 ), and found other related literature about student participation in personal therapy; some of which was then included in the literature review above (Malikiosi-Loizos, 2013 ; for example, Kumari, 2017 ). I reflected on enjoying some of the images of therapy, especially the diving analogy in the paper by So ( 2017 ), and wrote creative responses to these pleasurable descriptions.

The process described above resulted in a final synthesizing argument presented below, and elaborated in the following discussion section.

Beginning therapy is challenging for some students, especially when attendance is mandatory. However, students can experience transformative change by the end of the process, even if they commence the work in a guarded way.

Multiple problems can arise in the process of attending therapy as a student, and it can be difficult for a student to know what to do if these challenges are overwhelming. When negative impacts are experienced it is not always clear that the university staff are available to help. Some students can feel unable to provide competent clinical work because of the emotional intensity of their personal therapeutic work which they need time and space to process.

Attending personal therapy brings rich learnings which can be applied in clinical work but can also positively impact learning in the course, and lifelong personal development. Some of the processes experienced in personal therapy are completely new, and others seem familiar from course learnings; bringing textbook materials to life. The process can enhance the student's understanding of what the client may experience in the therapeutic journey.

The positive experiences reported in the CIS align with Kumari's ( 2017 ) description of positive outcomes from attending personal therapy during training. Personal therapy (1) Enhances students' understanding about their profession through personal experience/learning, (2) Allows students to explore any previously repressed issues, (3) Permits first-hand experience of clinical techniques, (4) Supports greater awareness of what it feels like to be the client leading to greater empathy with their client's challenges, (5) Improves comprehension of interpersonal dynamics which can then increase students' understanding of the aims of therapy, reducing the likelihood of transference reactions, and 6. Improves the trainee's emotional and intellectual functioning (Kumari, 2017 ).

In Kumari's earlier study ( 2011 ) she found that students experienced stress when attending personal therapy, some of which was caused by not at first realizing the personal therapy was mandatory, and then struggling to meet the financial expectation. Trainees also indicated that personal therapy was disruptive to their clinical work because it preoccupied them with their own issues (Kumari, 2011 ). Trainees could not give their clients full attention, and reported a negative effect on their personal functioning (Kumari, 2011 ). Some of the negative experiences reported in the CIS undertaken here also covered these aspects. However, there were additional negative issues reported in the further papers synthesized for the CIS, including that if interpersonal challenges arose between the trainee and therapist they could be difficult to address (Rizq and Target, 2010 ).

This CIS review reported that there is a lack of clarity about expectations as to the purpose and value of personal therapy by students, courses, and by professional bodies. There is a tacit understanding that personal therapy attended for training purposes and, by comparison, personal therapy sought out because of personal distress are not one and the same (Jacobs, 2011 ). However, the problematic belief that personal therapy for trainees would probably provide the same process and outcomes is evident (Rizq, 2011 ; Malikiosi-Loizos, 2013 ).

Student interview feedback about the experience indicated that the course and professional associations could do more to review and research the phenomenon of personal therapy during training. The personal therapy requirement needs a clear aim, and the work undertaken by students needs to meet these aims. Additionally, information given to candidates seems to be either given or heard as you have no choice you have to do this rather than a more enlightened communication process by which students are encouraged to ask questions and seek further information.

There is a concern about the lack of interest in the negative aspects of attending therapy during training (Malikiosi-Loizos, 2013 ; Kumari, 2017 ). In the absence of a critical, balanced viewpoint, unconscious bias may be present that continually reinforces the need for personal development of trainees to be achieved through personal therapy attendance (Kumari, 2017 ).

As an educator it was concerning to read that some students who were not happy with their therapist seemed to have no strategies about how to seek information as to whether the therapy they were attending was provided competently and had the potential to be helpful. It was also concerning that despite decades of research in teaching and practice the author had never previously heard of prayer used during counseling or psychotherapy sessions (Rizq and Target, 2010 ). In searching for further information it was found that there is an established literature about the ethics of pastoral counseling (Zust et al., 2017 ), and also advice in using prayer in this work (e.g., Weld and Eriksen, 2007 ). However, even if it was common for the practitioner or (perhaps) the Christian-based service to use prayer in sessions, the fact that the student did not like it raises questions as to why it was not possible to negotiate with the therapist, or change over to a service that was not faith-based.

Student learning gained through reflecting on ineffective strategies of the therapist does not seem an optimal use of therapeutic space, and time. Some examples were; the therapist providing a shoulder massage (Rizq and Target, 2008a ), and disclosing extensive personal information (Kumari, 2011 ; Ciclitira et al., 2012 ). Therapist behavior described by the student which went beyond the scope of practice, or violated widely held norms about professional conduct, seemed to have occurred without consequence in the trainee's accounts. At the same time it is useful to reflect on a review of 10 years of complaints brought against BACP accredited practitioners which found that 18% of complainants were trainees (Khele et al., 2008 ).

Although there were many positive opportunities and rich learnings gained through personal therapy there were also some reported challenges. Addressing these is not easy or straightforward. However, therapy professions must take at least some responsibility for the negative as well as positive dimensions of what is offered during training with reference to the student experience.

Limitations of the study

The process of CIS is not intended to achieve consensus across the research outcomes included from the various studies, but rather present a synthesizing statement that accounts for all of the findings. The trustworthiness of the outcomes is reliant on the procedures used to undertake the analysis and present the findings. Therefore, although informative and helpful for associations and training courses in developing their requirements, the direct applicability is moderate.

Each of the included studies involved a cohort of respondents with higher female numbers than male. Two studies included only female participants (Ciclitira et al., 2012 ; Wilson et al., 2015 ). Of the 89 interviewees across the studies, 18% were male reflecting statistics reported about the gender balance in some fields of psychotherapy (for example, Robinson et al., 2017 ). This gender ratio also reflects the male-female make up of respondents in surveys of therapy trainees (for example, Owen et al., 2016 ). However, there is no way to find out the gender balance in therapy training courses for the review period. Therefore, the absence of gender balance in the respondents reported for the studies could be considered a limitation.

Conclusion and author recommendations

The findings of this synthesis clearly indicate that attending personal therapy brings rich learnings that can be applied to clinical work in training and future professional practice. This growth opportunity can positively impact engagement in the training course, along with making a positive contribution to lifelong personal development. The process of attending personal therapy can enhance the student's understanding of the client's experience.

The synthesis also revealed that attending personal therapy during training is not a straightforward process for all students. Some students may need other options than attending one-to-one personal therapy to be available to meet course and professional association requirements. Course and professional bodies need to regularly review the evidence of value for the client of the trainee attending personal therapy. Staying attuned to the student experience is key. Students need a clear pathway to follow if they have concerns about the behavior of the therapist, or reject the requirement to continue with further therapy.

It is recommended, from the perspective of the author that courses must do more to engage with students in advance about the need for personal therapy. Course teams should provide information about the options available if therapy is perceived as difficult, persecuting, or negatively impacting on everyday life; what McMahon ( 2018 ) described as providing “consideration and protection” (p. 424) if therapy is not helpful. This information must be provided in written form, but also in face to face discussions about the experience, including potential value and benefits along with advice on how to handle difficulties. Providing a third party independent of the course with whom to discuss any issues arising about the value of therapy may support better outcomes for students who have difficulties.

There is ongoing need for further study about the benefits intended to be achieved by personal therapy, and the options available if personal therapy attendance is experienced by the student as not helpful. The effects of attending personal therapy on future competence requires information based in solid, well-conceived studies that deliver plain evidence.

Author contributions

The author confirms being the sole contributor of this work and approved it for publication.

Conflict of interest statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Francis Collins: Why I’m going public with my prostate cancer diagnosis

I served medical research. now it’s serving me. and i don’t want to waste time..

Over my 40 years as a physician-scientist, I’ve had the privilege of advising many patients facing serious medical diagnoses. I’ve seen them go through the excruciating experience of waiting for the results of a critical blood test, biopsy or scan that could dramatically affect their future hopes and dreams.

But this time, I was the one lying in the PET scanner as it searched for possible evidence of spread of my aggressive prostate cancer . I spent those 30 minutes in quiet prayer. If that cancer had already spread to my lymph nodes, bones, lungs or brain, it could still be treated — but it would no longer be curable.

Why am I going public about this cancer that many men are uncomfortable talking about? Because I want to lift the veil and share lifesaving information, and I want all men to benefit from the medical research to which I’ve devoted my career and that is now guiding my care.

Five years before that fateful PET scan, my doctor had noted a slow rise in my PSA, the blood test for prostate-specific antigen. To contribute to knowledge and receive expert care, I enrolled in a clinical trial at the National Institutes of Health, the agency I led from 2009 through late 2021.

At first, there wasn’t much to worry about — targeted biopsies identified a slow-growing grade of prostate cancer that doesn’t require treatment and can be tracked via regular checkups, referred to as “active surveillance.” This initial diagnosis was not particularly surprising. Prostate cancer is the most commonly diagnosed cancer in men in the United States, and about 40 percent of men over age 65 — I’m 73 — have low-grade prostate cancer . Many of them never know it, and very few of them develop advanced disease.

Why am I going public about this cancer that many men are uncomfortable talking about? Because I want to lift the veil and share lifesaving information.

But in my case, things took a turn about a month ago when my PSA rose sharply to 22 — normal at my age is less than 5. An MRI scan showed that the tumor had significantly enlarged and might have even breached the capsule that surrounds the prostate, posing a significant risk that the cancer cells might have spread to other parts of the body.

New biopsies taken from the mass showed transformation into a much more aggressive cancer. When I heard the diagnosis was now a 9 on a cancer-grading scale that goes only to 10, I knew that everything had changed.

Thus, that PET scan, which was ordered to determine if the cancer had spread beyond the prostate, carried high significance. Would a cure still be possible, or would it be time to get my affairs in order? A few hours later, when my doctors showed me the scan results, I felt a rush of profound relief and gratitude. There was no detectable evidence of cancer outside of the primary tumor.

Later this month, I will undergo a radical prostatectomy — a procedure that will remove my entire prostate gland. This will be part of the same NIH research protocol — I want as much information as possible to be learned from my case, to help others in the future.

While there are no guarantees, my doctors believe I have a high likelihood of being cured by the surgery.

My situation is far better than my father’s when he was diagnosed with prostate cancer four decades ago. He was about the same age that I am now, but it wasn’t possible back then to assess how advanced the cancer might be. He was treated with a hormonal therapy that might not have been necessary and had a significant negative impact on his quality of life.

Because of research supported by NIH, along with highly effective collaborations with the private sector, prostate cancer can now be treated with individualized precision and improved outcomes.

As in my case, high-resolution MRI scans can now be used to delineate the precise location of a tumor. When combined with real-time ultrasound, this allows pinpoint targeting of the prostate biopsies. My surgeon will be assisted by a sophisticated robot named for Leonardo da Vinci that employs a less invasive surgical approach than previous techniques, requiring just a few small incisions.

Advances in clinical treatments have been informed by large-scale, rigorously designed trials that have assessed the risks and benefits and were possible because of the willingness of cancer patients to enroll in such trials.

I feel compelled to tell this story openly. I hope it helps someone. I don’t want to waste time.

If my cancer recurs, the DNA analysis that has been carried out on my tumor will guide the precise choice of therapies. As a researcher who had the privilege of leading the Human Genome Project , it is truly gratifying to see how these advances in genomics have transformed the diagnosis and treatment of cancer.

I want all men to have the same opportunity that I did. Prostate cancer is still the No. 2 cancer killer among men. I want the goals of the Cancer Moonshot to be met — to end cancer as we know it. Early detection really matters, and when combined with active surveillance can identify the risky cancers like mine, and leave the rest alone. The five-year relative survival rate for prostate cancer is 97 percent, according to the American Cancer Society , but it’s only 34 percent if the cancer has spread to distant areas of the body.

But lack of information and confusion about the best approach to prostate cancer screening have impeded progress. Currently, the U.S. Preventive Services Task Force recommends that all men age 55 to 69 discuss PSA screening with their primary-care physician, but it recommends against starting PSA screening after age 70.

Other groups, like the American Urological Association , suggest that screening should start earlier, especially for men with a family history — like me — and for African American men, who have a higher risk of prostate cancer. But these recommendations are not consistently being followed.

Our health-care system is afflicted with health inequities. For example, the image-guided biopsies are not available everywhere and to everyone. Finally, many men are fearful of the surgical approach to prostate cancer because of the risk of incontinence and impotence, but advances in surgical techniques have made those outcomes considerably less troublesome than in the past. Similarly, the alternative therapeutic approaches of radiation and hormonal therapy have seen significant advances.

A little over a year ago, while I was praying for a dying friend, I had the experience of receiving a clear and unmistakable message. This has almost never happened to me. It was just this: “Don’t waste your time, you may not have much left.” Gulp.

Having now received a diagnosis of aggressive prostate cancer and feeling grateful for all the ways I have benefited from research advances, I feel compelled to tell this story openly. I hope it helps someone. I don’t want to waste time.

Francis S. Collins served as director of the National Institutes of Health from 2009 to 2021 and as director of the National Human Genome Research Institute at NIH from 1993 to 2008. He is a physician-geneticist and leads a White House initiative to eliminate hepatitis C in the United States, while also continuing to pursue his research interests as a distinguished NIH investigator.

An earlier version of this article said prostate cancer is the No. 2 killer of men. It is the No. 2 cause of cancer death among men. The article has been updated.

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