Title: Psychotherapy through a lens of courage
Description: A concept originating from the Ancient Greeks, courage has long held cultural definitions from literature, philosophy, and theology. However, the construct of courage has largely been neglected in the extant psychological literature despite a significant influence on the human condition. The Tri-Part Model of Courage (Geller, 2014) served as a primary guiding framework for the present study, conceptualizing courage as comprised of three subtypes: bravery, boldness, and fortitude. This study sought to contribute to the ongoing development of this model through examination of the experience and expression of courage by experienced psychodynamic psychotherapists so as to render the construct useful in clinical and psychotherapy research contexts. Participants were 16 experienced psychodynamic psychotherapists. In-person semi- structured interviews were conducted and analyzed using the Consensual Qualitative Research (CQR) methodology. Ten domains emerged from the CQR analysis and revealed courage to be a subjective experience consisting of private theories, as well common definitional elements.

Participants spontaneously endorsed the existence and importance of bravery, boldness, and fortitude in their role as psychotherapists, indicating the centrality of courage to their work. Authenticity, vulnerability, and staying present emerged as the most salient expressions of therapist courage. Specific patient presentations and therapeutic processes were identified as situations most requiring of therapist courage. Experience was the principal enabling factor to courage, and fear and avoidance were the principal obstacles to courage, while feelings associated with courageous acts ranged from fear, anxiety, and pain, to positive states of well being. Validation, confrontational techniques, modeling, and skills building were the most preferred clinical interventions to promote courage in patients. Gender analysis revealed that women make meaning of courage as having bases in fear and interpersonal relationships, while men understand courage as a set of abstract principles defined by existential anxiety and bold interventions.

Fortitude was highly endorsed across genders, and men were further more oriented to fortitude, while female therapists were more oriented to bravery and boldness. The results are discussed in terms of the empirical support provided for the expansion of the Tri-Part Model of Courage and recommendations for clinical practice and future research.