2023 - What Are The Experiences of The Female Body Modified Therapist in The Consulting Room - An Interpretive Phenomenological Analysis

British Journal of Psychotherapy 39, 3 (2023) 519–536 doi: 10.1111/bjp.
12849
WHAT ARE THE EXPERIENCES OF THE

FEMALE BODY-MODIFIED THERAPIST
IN THE CONSULTING ROOM? AN
INTERPRETIVE PHENOMENOLOGICAL
ANALYSIS
LUCY SNELSON
This article considers the position of the female tattooed body within the
context of the ‘caring professions’. Tattoos are increasingly popular
within these workplaces, but a stigma persists. The limited
psychoanalytic research on body modifications in the consulting room
concludes that tattoos are either a superficial fashion choice or an
indicator of deviance and/or self-harm. To initiate a conversation that
can move away from the current pathologizing paradigm, I have
considered the ways in which tattooing can be considered as a creative
‘working through’, distinct from an aggressive ‘acting out’. The
research utilized an interpretative phenomenological analysis approach
to examine the lived experiences of female therapists, with body
modifications, in the consulting room. All participants focused on their
tattoos as their significant body modification and experiences varied
depending on the specifics of the client work, professional environment
and beliefs about perceptions of tattoos from the wider population.
Identified themes were: appearance of self in the consulting room; the
perceived communication of one’s inner world through inked skin and
integration of the process of tattooing. Professionalism was emphasized
as an integral consideration for revealing or concealing tattoos in the
consulting room and specifically this was heightened in relation to
being female.
KEYWORDS: PSYCHOTHERAPIST, WOUNDED HEALER, TATTOO,

GENDER, FEMINISM, TRAUMA, INTERPRETATIVE
PHENOMENOLOGICAL ANALYSIS
INTRODUCTION
Tattoos are increasingly popular within the ‘caring professions’, but a stigma persists.
Despite reported adverse effects (Kalanj-Mizzi, Snell & Simmonds, 2019, p. 210),
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520 Lucy Snelson
tattooing has become more mainstream globally (Müller et al., 2017;
Sweeney, 2006) with an ‘expansion of body modification across the socioeco-
nomic spectrum’ (Roberts, 2015, p. 1096). In the UK, more women than men are
now tattooed (Statista Research Department, 2015). Tattooing is now defined as
‘mainstream’ because of the number of women and ‘educated’ people who wear
them (Irwin, 2001). However, a pressure to conceal body modifications seems to
persist in the counselling profession (Stein, 2011). My research makes apparent a
distinction between the way tattoos are experienced by clients in the consulting
room, as opposed to those within the profession who are immersed in academic litera-
ture and a professional culture that perpetuates the idea of tattoos as ‘acting out’.
Lemma (2010) describes body modification as a ‘mind/body split’, a defensive
tactic in which emotional pain can be denied because it is applied to the body. The
infant’s skin is understood as functioning as the primary experience of a container
for the incoherent self (Bick, 1968), achieved through the internalization of an expe-
rience of the ‘good enough’ mother (Winnicott, 1953). Without this experience,
there is a resultant feeling of disintegration that leads to omnipotent defending, split-
ting and projection—second skin defences (Bick, 1968). Tattooing is currently dis-
cussed only as an omnipotent defence against loss and fragmentation—‘a
replacement for what is lacking in the function of maternal containment’
(Aryan, 2006) in an adhesive identification (Meltzer, 1975). Tattooing utilizes the
muscles of the body to create a tension that stands in for a feeling of containment:
an inked replacement for the early containing function of the parent(s) literally car-
ved onto the person’s skin.
In sessions conducted with a young man in prison, Lemma (2010) presents a
limited cause and effect narrative—with the tattoo positioned solely as an acting out
of emotional inner pain stemming from very early lack of containment. From this,
she extrapolates that tattooing is unconsciously motivated by difficulties in childhood.
She states: ‘When the loving gaze and touch of the other cannot be found, the long-
ing for them can become perverted and the body is subjected to painful procedures’
(2010, p. 3). Willoughby (2004) elaborates on the two ways this motivation seeks
solace, with a clinging to ‘one’s own body as object’ (p. 188) which occurs in sec-
ond skin phenomena, or clinging ‘to an external object’ (p. 188) which occurs in
adhesive identification. The argument for externalizing an internal pain is well con-
sidered but pathologized rather than recognized.
Namir (2006) equates tattooing with self-harm, in which mental collapse from the
internal unconscious suffering is manifested in painful bodily attacks, in a bodily
experience that splits mind and body as it attempts to find expression for failures in
the earliest relationship. The assertion that ‘our bodies are made in relation to other
bodies, and body modifications affect these relations’ (Namir, 2006, p. 223) is pres-
ented only in the context of disruption, disembodiment and relational immobility.
Namir suggests that the tattooed person is in direct conflict with the ability to pro-
vide a containing therapeutic environment—a scathing view from which the tattooed
therapist could be seen in an ethically dubious position to the principle of doing no
harm (UKCP, 2019).
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British Journal of Psychotherapy 39, 3 (2023) 519–536
Female Body-modified Therapist in the Consulting Room 521
The tattooed person’s inner world is positioned in a fatalistic way, with an early
environment that disrupts the infant’s ability to self-contain, from a lost object sen-
sation that remains unconscious but motivates behaviours that seek solace (solace
being equated with pain). Getting tattooed is positioned as a rebellious and adoles-
cent developmental response. Furthermore, Mizen (2014) identifies the difficulty in
projective processes for those psychically stuck in this second skin rupture. Thus a
tattoo could be seen as an imaginative working through of psychic pain in an indi-
vidual healthy enough to project via body art, as a way of giving recognition to a
working through of internal world difficulties on the skin.
The dominance of a pathologizing viewpoint could be the reason for the lack of
professional consideration of the tattooed therapist’s body in the consulting room.
The limited research on body modifications in the therapy room considers tattoos as
markers of social deviance or self-harm when on the client (Romans et al., 1998;
Jeffreys, 2000; Craigen & Foster, 2009; Roggenkamp, Nicholls & Pierre, 2017);
and as markers of a deviance from the norms and traditions of the profession on the
therapist’s body (Stein, 2011). Stein elucidates the history of tattooing in the psychi-
atric and psychoanalytic field as being discussed in the context of an intimidating
exterior to distract from psychopathological tendencies (comparable with infant fae-
cal smearing, an indicator of sexual deviance, or a ‘warning sign’ of potential psy-
chopathic diagnosis). Stein’s decision, therefore, to conceal her tattoos in the
consulting room is unsurprising. Shaped by a theoretical tradition that defines a
tattooed person in such alarming ways, it is understandable that Stein shows limited
curiosity and analysis when her tattoo was ‘accidentally’ revealed to the patient.
The pathologizing of body modifications—which disregards any consideration of
an individual’s creative expression—serves to inhibit discussion, exhibition and
thinking about body modification in the psychotherapeutic setting. Does the tattoo
act as a visual display of the wounded healer archetype? The painful tattoo symbol-
izes the internal hurt which underpins many people’s route into the psychotherapeu-
tic profession (Jung, 1951). The pressure to conceal the tattoo from the shaming
associations made between tattooing and mental ‘disturbance’ could be understood
to be a pressure to deny the therapist’s trauma. More recent research considers the
function of tattooing as a ‘vehicle for promoting healing’ and considers how it
might be possible to encourage clients to share narratives of their tattoos as part of
the therapeutic process’ to explore self-identity (Alter-Muri, 2020, p. 139). The
research is conducted as a bridge in the current divide, to encourage the (non-
tattooed) therapist to consider the artistic, therapeutic and creative element of the
tattooed client. In doing so it recognizes and responds to a current negative bias
towards body modifications in the profession.
A clinical case study of two patients (one male, one female) who obtain tattoos
during therapeutic work (Karacaoglan, 2012) frames the patients’ decisions as ‘act-
ing out’ (Freud, 1914). Karacaoglan considers the Freudian interpretation given to
the historical context of the tattoo as taboo, stemming from the original totemic
function, which has highly sexual significance (Freud, 1938). The tattoos occur at
significant times of intense negative transference in the work, when the analyst’s
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522 Lucy Snelson
boundaries are experienced by the patient as rejection and abandonment, along with
a ‘penetrating interpretation’—the therapist becomes the emotionally absent or abu-
sive parent. Karacaoglan (2012) describes how the patient’s acting out serves to har-
ness control of both the lost object and the associated emotional pain by defensively
redirecting penetrative pain upon the skin. The tattoo cannot be understood as a cre-
ative transitional object, but instead as a defensive ‘patch’ to repair holes blown into
Winnicott’s potential space and to reconstruct it’ (2012, p. 25). This is most
pronounced in the case study with the tattooed female patient, whereby the tattoo is
referred to as a ‘wound’ and a thriving life (in which one is able to maintain positive
relationships with self and others with healthy separation) is only possible after
tattooing is no longer relied upon. The investigation is lacking with regard to the
potential for mutual enactment—there is often a parallel between acting out and the
analyst’s interpretive process (Joseph, 1985, 1988). This results in the patronizing
conclusion that a tattoo is ‘a veiled expression of individuality in the form of a fash-
ion statement’ (Karacaoglan, 2012, p. 25).
Body modification is discussed in binary terms. In contrast to the pathologizing
critique, there is a narrative of superficial consumption of popular culture. The latter
is often more prominent in discussion of female body modification. Kosut (2006)
positions the tattoo as a product consumed in an ‘ironic fad’. The consumer is
described as a rebellious person easily influenced by popular culture who bases the
decision of permanent change inscribed into their body on a ‘fickle’ decision. Cra-
ighead (2011) provides a feminist psychoanalytic voice, naming the reductive way
female modified bodies are presented either as a ‘commodification of’ or a
‘monstrous subversion of’ the idealized female body. In a patriarchal society, a fem-
inine aesthetic is one that takes up less space. The female tattooed or pierced body
represents deviance from social and cultural norms (DeMello, 2000; Sanders &
Vail, 2008), including traditional expectations of gender (Atkinson, 2002;
Pitts, 2003). Braunberger (2000) concludes that ‘on a woman’s body any tattoo
becomes a symbol of bodily excess’ (p. 1). This pathologizing narrative for body
modification decisions mirrors the narrative of bodily adaptation to harness control
over inner emotional pain used extensively and specifically about women in relation
to eating disorders (Friedberg & Lyddon, 1996; Henderson et al., 2019;
Heatherton & Baumeister, 1991; Polivy & Herman, 2002).
Orbach (2009) is critical of contemporary culture for promoting damaging mes-
sages that women’s dissatisfaction can be resolved through reconstituting their bod-
ies. ‘The making of a body’ (p. 139) can be through a misguided sense of autonomy
which is actually internalized self-hatred fed by a consumerist society intersecting
with the internalizing of earliest relationships. With this knowledge, Orbach
attempts to bring us back to our ‘authentic’ bodies as ‘both a statement and a site of
empowerment’ (2009, p. 136). I attended her talk ‘what do we do when the body
comes to therapy?’ at the Stockwell Centre in 2012 and she stated ‘don’t get me
started on tattoos’—though sadly she did not elaborate. With this in mind I under-
stood her to be critical of tattooing, positioning it as a narcissistic release that has
found a consumerist solution as a defence against bodily felt anxiety stemming from
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unconscious emotional pain. Empowerment, therefore, would mean not to body-
modify.
Anouchka Grose (2020) brings an irreverent voice to challenge ‘common sense’
beliefs that conservative attire equates to concealment of the therapist’s identity and
influence. She brings a more accessible perspective that challenges the culture of
conservatism, suggesting instead that ‘you could say there’s nothing more dis-
comfiting than dealing with someone who looks affluent and well-adjusted’
(Grose, 2020, p. 90). She critiques the notion that the therapist must ‘function as a
model of perfect psychic equanimity and social normalcy’ and asks ‘can they be
something more like a refreshingly abnormal co-conversationalist?’ (p. 87).
Although she doesn’t mention tattoos or piercings, she encourages psychotherapists
(female ones in particular) to question normalized class and gender assumptions that
privilege a mode of ‘invisible’ conservative dress that might actually make some
people more uncomfortable than more ‘deviant’ forms of clothing. By extension,
I would add body modifications to this ‘deviant’ dress code. Grose takes an encour-
aging approach which creates curiosity. I aim in my research to explore the tattooed
therapist in this context. The findings are limited to the Western tradition of
tattooing. The female experience is focused on due to the unique scrutiny and sig-
nificant gaze upon the female modified body in the current research. Specifically,
I asked: ‘What are the experiences of people who identify as female, who are body-
modified, in the consulting room?’
RATIONALE FOR THE STUDY AND RESEARCH QUESTION

This research employs interpretative phenomenological analysis (IPA) to explore
the lived experiences of female therapists, with body modifications, in the consult-
ing room. Phenomenology is attuned to the experience of being in a particular world
and this considers culture, society and history in order to understand conscious and
embodied experiences. This is clearly important in the investigative aims of this
research question when the body of work that comes before it highlights the patriar-
chal, societal and professional context of prejudices towards the female tattooed
body. The specific IPA approach of Smith, Flowers and Larkin (2009) was selected
because the research question was not focused on hypothesis testing, but on a
‘scientific process in which a researcher suspends … presuppositions, biases,
assumptions, theories, or previous experiences to see and describe the phenomenon’
(Gearing, 2004, p. 1430). The phenomenological research method engages with the
experience of body modifications from the perspective of the body-modified thera-
pist whilst being considerate of researcher reflexivity.
Design
Participation required identification as female; a counselling or psychotherapy quali-
fication; and at least one tattoo and one piercing. A purposive sampling method was
employed.
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524 Lucy Snelson
Semi-structured interviews were conducted on Zoom (video recorded on Zoom
and on a separate audio-recording device). Participants were asked six questions to
allow for a greater depth of enquiry (Smith, Flowers & Larkin, 2009, p. 60). Open
questions maintained the research focus on an inquiry (Bentz & Shapiro, 1998) that
was not hypothesis focused. Initial ‘warm-up’ questions had a dual function: make
participants feel comfortable and ensure the eligibility criteria were met. The final
interview question to all participants was ‘is there any more you would like to say?’
to ensure freedom to develop any statements (Silverman, 2001) and to capture the
nuance of each participant’s intersubjective experience.
Interview Schedule
An interview guide was used in all interviews to ensure consistency. Questions
focused enquiry on exploration of participant experience whilst maintaining study
aims. Questions focused participant sharing on their personal attitudes held about
body modification; perception of the views of others about body modification, con-
sideration of any uniqueness and significance of experiences of their body modifica-
tions in the consulting room setting compared with other spaces they occupy,
particularly in relation to perceived attitudes to body modification.
Ethical Approval
Approval was granted by the Psychology Research Ethics Committee at the University
of Exeter. Upon expressing interest in participation, each individual received an in-
depth information sheet. Written informed consent was sought without obligation to
participate and with the opportunity to withdraw (without reason) before, during and
up to 7 days after the interview. No participants withdrew. On receipt of a signed
and dated written consent form, the interview was conducted. A debrief form with
details of further sources of support was provided post interview.
Participants
Table 1 presents body modification details, therapeutic modality and professional
qualification information for all six participants. Participants were asked only the
total number of body modifications and were not required to be specific about body
parts, hence some disparity in this information. Names have been changed to ensure
confidentiality.
THE STUDY
The object of the study within the research project was the lived experiences of the
participants (Greene, 1997; Holloway, 1997) because they ‘have had experiences
relating to the phenomenon’. Participants reported tattooing as distinct from piercing
and more significant in terms of body modifications so this became the focus of the
data analysis. A systematic five-step data explication process designed by Hycner,
Bryman and Burgess (1999) was utilized:
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Table 1: Participant eligibility information
Name: Helen Cleo Emily Julia Danielle Alice
Approach: Humanistic Psycho- Humanistic & Integrative Humanistic & Integrative Person Centred Psychodynamic Integrative Counsellor
therapeutic Counsellor Counsellor Counsellor Counsellor
Counsellor
Qualified: 2010 2017 2017 2014 2013 2020
Piercing(s): 2 4 4 9 4 3
(1 tragus; 1 nose) (1 left ear lobe; 2 right (1 right ear lobe; 2 left (1 right earlobe; 8 (1 Nose; 1 tragus; (1 Nose; 1 septum; 1
ear lobe; 1 nose) ear lobe; 1 tragus) left earlobe) 1 in each daith)
earlobe)
Tattoo(s): 2 2 1 1 5 7
(1 shoulder; 1 back) (1 shoulder; 1 back) (left calf) (left ribs) (1 right ankle; 1 (1 foot; 4 arms; 2
left wrist) legs)
Female Body-modified Therapist in the Consulting Room
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1. Bracketing and phenomenological reduction—‘bracketing off’ the researcher’s
preconceptions and personal views in the data investigation (Miller &
Crabtree, 1992). I listened to each interview repeatedly ‘to become familiar with
the words of the interviewee … to develop the “gestalt”’ (Holloway, 1997;
Hycner et al., 1999). I conducted the transcription manually and adopted a natu-
ralistic method (Nascimento & Steinbruch, 2019).
2. Delineating units of meaning (Creswell, 1998; King, 1994; Moustakas, 1994)—
data explication process: ‘statements that are seen to illuminate the researched
phenomenon are extracted’ (Creswell, 1998; Holloway, 1997; Hycner,
Bryman & Burgess, 1999).
3. Clustering units of meaning to form themes—Identification of units of signifi-
cance (Sadala & Adorno, 2001) determined the central themes of the data.
4. Summarize each interview—a ‘validity check’ to determine if the essence of the
interview has been correctly captured (Hycner, Bryman & Burgess, 1999:154).
Participants (who had expressed an interest) were given the opportunity to give
feedback on accuracy of their coded and themed transcripts.
5. General and unique themes for all the interviews and composite summary—steps
1–4 (thus far been applied to individual interviews) applied to the entire dataset
to present the spectrum of the experiences described across all the interviews and
the subordinate themes were established (Pyett, 2003).
The research findings aim to contribute to a conversation which can broaden current
discussion of the tattooed person, which has been formulated from academic conjec-
ture focused on ‘the views of’ rather than ‘the experience of’ body modifications.
IPA ANALYSIS
Subordinate Theme 1: Appearance of Self
All participants considered body modifications one facet of presentation of self,
rather than a primary significance with regards to the professional presentation of
self in the consulting room.
Professionalism: All participants reflected on professionalism without it being a

direct question. Specifically, professionalism was not seen by participants to be in
direct conflict with body modifications. But it was experienced as of significance to
those without body modifications in the psychotherapy field. The perceived negative
views of others without body modifications, towards those with body modifications
introduced a sense of pressure to make adaptations in the appearance of self within
the consulting room.
No participants felt the need to conceal their tattoos per se in the consulting room
with clients. Instead the focus of concealment for participants was on parts of the
body that it was deemed unprofessional to expose. Tattoos and piercings were con-
sidered as part of wider consideration of professional choices for dress, hair and
make-up in presentation of a professional appearance. A more conservative dress
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code inside the consulting room, compared with outside it, was reflected on by all
participants, and particular considerations of being female had some influence
over this.
There were divergent views about body modifications from the participants, and
ambivalence within Helen. This seemed evident particularly in response to per-
ceived authority figures. Helen described specifically a consideration of her tattoos
with regard to supervision attendance:
How I am professionally, how I am in my supervision, I just sort of dress nor-
mally without consciously concealing anything, but perhaps unconsciously
concealing things. (112–15).
Julia considered them from the point of view of the client, a consideration about
how a painfully obtained marker on the skin might contrast with the ‘kindly, gentle’
expectations clients had of the therapist: ‘there is a kind of social expectation that
being a therapist, such a kind person, maybe people will be shocked that you [have
tattoos]’ (113–39).
All participants who had experience of working in health and education settings
had not chosen to apply the policies to their own private practice. Concealing tattoos
due to a concern they may hinder the view of their professionalism was more likely
to occur in relation to psychotherapy interview and placement settings. As Alice
explained: ‘I have never felt the need to conceal my tattoos really apart from per-
haps job interviews’ (75–6).
Body modification was seen by some participants as an additional statement about
oneself in the consulting room, communicating more of the self to a client than a
non-modified therapist would be. Participants described their tattoos as having per-
sonal meaning. The nature of having body modifications was felt to be communicat-
ing something in the presentation of self: ‘I am the sort of person who has body
modifications’. The ‘sort of person’ who would be tattooed was expressed by all
participants as, even without the tattoo being visible, communicating something
either more politically liberal, more open-minded, or more accepting of diversity
and overall less judgmental.
Fashion choices and body modifications: Some participants had experiences of

therapy training organizations where a conservative steer towards dress codes and
the concealment of body modifications was encouraged.
All participants expressed a need for the profession to diversify and be more rep-
resentative of the wider population. The stereotype of the therapist felt as though it
loomed large at times with a perceived critical voice of anyone who wished to pre-
sent themselves outside the agreed homogenized expectation. Danielle shared this
experience:
[I was] taught in the training to wear certain clothing, have a counselling
wardrobe and our own wardrobe, as I’ve progressed, gone off on my own into
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528 Lucy Snelson
private practice, I don’t feel that is something I want to take forward, for me,
I am me. (Danielle, 41–5)
More specifically, Alice gave this illuminating description of the ‘therapist’s’
appearance: ‘A white middle class woman, shawls, scarf, some kind of sandal, and
perhaps some plants or foliage around’.
Cleo gave a powerful example of the ways in which her appearance generally,
not significantly her tattoos, were a consideration in her clinical work.
I work with cancer patients and I have a lot of hair. If I know someone is
going through chemo and losing their hair I might think ‘maybe I’ll put it in a
ponytail today’. Theoretically we should have that conversation, if my hair is
causing a problem for them, but I know full well not all clients are confident
to raise that. (97–102)
The fact that ‘benign’ parts of ourselves can be provocative depending on the
clinical work being undertaken is clear. The significance of where on the body the
tattoo existed, rather than the tattoo itself, was described as the primary factor in
deciding not to reveal tattoos. Display of shoulders, ribs, parts of the back and the
thighs was seen as unprofessional. This was described as the primary factor in what
prohibited the revealing of tattoos in the consulting room. As Danielle explained:
‘I’ll show the tattoo on my wrist and ankle, but I wouldn’t show the one on my
shoulder purely because then I would be revealing more than I wish’ (22–5). This
issue of assessing placement on the body was identified by Emily as being a gender
issue: ‘It’s alright for male therapists because they can wear jeans and a
shirt’ (156–9).
This placement of tattoos was linked more generally to a question of suitable
attire and exposing certain areas of the body. Cleo stated:
I’m not really formal, but I also wear clothes that I feel are quite professional
so they are not hugely revealing. I don’t wear extremely short skirts or really
low-cut tops. (43–7).
For all participants there was consideration of their body modifications as part of
a wider picture of the overall appearance of self-expression that included personal
fashion choices and interior design decisions relating to the consulting room.
Subordinate Theme 2: Emotional Inner World: All participants said they would
not disclose the personal meaning of their tattoo(s) to their clients.
Visibility and self-disclosure: Participants considered a tattoo as a visual clue

that revealed something of one’s personal experience. It prompted consideration of
self-disclosure in the consulting room. Some therapists felt it was an invitation for
discussion and were unsure how they would respond. Helen, in particular, was
thoughtful about the deeper reasons for her consideration of tattoo placement that
would allow for concealment in the consulting room:
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Helen felt that tattoos contributed to the therapist not being a blank screen, as is
her therapeutic approach, because it makes something personal visible on the skin.
Danielle also described herself as working as a blank screen in her therapeutic
approach, but said her visible tattoos maintained this because they did not reveal
anything more about her inner world than any other item in her consulting room—
whether a picture, item of clothing, or chair.
Danielle shared her experience of having the same tattoo as a client. It was a tat-
too she felt communicated something more significant than her others because of its
links to mental health advocacy. She felt it communicated intellectual engagement
and dedication to professional conduct. Despite a shared tattoo being in the consult-
ing room, personal meaning for Danielle was still understood as distinct and sepa-
rate. The shared tattoo had a unique and individual meaning for each person, in
her view.
As the interviews progressed, Helen, Cleo and Emily began to reflect more deeply
on having chosen to tattoo parts of the body that they largely kept concealed. Ini-
tially they thought this positioning of their tattoo was insignificant. As they reflected
on a more emotional process of tattooing, they thought perhaps the motivation
behind concealment might be to do with their own fears of judgement and
prejudice.
Fear of judgement and prejudice: Participants expressed an experience of living

in a population in which tattoos are visibly common and noticeable—but that the
therapist population did not reflect this. Within the consulting room specifically, all
participants talked about judgement or prejudice without it being a direct question
from the researcher.
Consideration of judgement and prejudice ranged on a spectrum, from Helen’s
gendered experience that ‘a lot of men have a particular image of a woman who is
tattooed. And maybe write her off or think of her in quite a derogatory, belittling
way’ (118–23), to Cleo’s concern that ‘[tattoos] might put people off, they might be
bringing judgements about it’ (68). Julia casually accepted that ‘[there’s] people
who like them and people who don’t like them’ (108), while Emily and Danielle felt
that the tattoo was more mainstream and thus accepted:
I think it is becoming much more commonplace to see people with tattoos and
not make an assumption that they’re part of an alternative crowd. (Emily,
92–6)
I’ve just felt that it’s much more up to date with the times that we are now in
and that people find it a lot more approachable, somebody that looks every-
day. (Danielle, 10–13)
Alice described how she experienced her clients as more curious and less punitive
in their enquiries about her body modifications than psychotherapeutic colleagues
who could be felt to express ‘conduct’ rules that implied body modifications were
‘bad’. This was mostly the experience of the participants: that other professionals
rather than clients responded negatively.
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Criminality: All participants described the personal, meaningful nature of their tat-
toos. Some disclosed these personal reflections to me—a representation of strength
after leaving an abusive relationship, a celebration of something which brings joy, a
commemorative symbol, solidarity with mental health awareness.
All participants except Julia described experiences of judgement and disapproval
of their tattoos from older, senior therapists in their training organizations. There
was a shared belief from those that had experienced judgement that non-tattooed
people were less open-minded towards those with tattoos. Two participants were
concerned with the potential for deviant associations with their tattoos:
There’s something for me that’s important about coming across as approach-
able. This person needs to be comfortable talking to me and some people view
heavily tattooed people as maybe threatening or dangerous, as in that kind of
criminal element. (Cleo, 97–105)
… When I was a child I remember people who had tattoos. They were usually
people who came out of prison and they were the kind of people who had
some kind of criminal past. (Julia, 49–51)
Reflections on criminality could be understood as a way of making sense of the
overall feeling of disapproval that all participants had experienced in relation to
being a tattooed therapist.
Subordinate Theme 3: Integration: All participants were self-reflective about

their body modifications and integrated a consideration of the ways they may be
experienced by clients in their work. Most participants felt they would judge
responses to enquiries about their body modifications on a case-by-case basis.
Consideration about what being body modified means in a therapeutic relation-
ship with a client who does not have body modifications was more of a concern
than when the client was also body modified.
Generational difference: All therapists had a feeling, to a lesser or greater extent,

that body modifications meant they did not fit the stereotype of the way a therapist
‘should’ look. In the most benign experience, ‘I don’t look conventional’ to the
other end of the spectrum, in which there was a sense of ‘I fear I will be judged to
be unprofessional’. These were outliers and largely there was a sense of feeling that
having body modifications was diversifying the profession and that a main factor in
this was the fact there are increasingly younger people entering the profession.
Youth as a factor in the acceptance of body modifications was a firmly held belief
of all participants.
Self-harm: Self-harm was considered in relation to the modification of the client’s

body. Only one participant reflected on their own experience of body modification
in regards to considerations of self-harm.
Danielle and Julia utilized their personal experience of the body modification pro-
cess to provide implicit understanding on a process that can be used or misused.
Sons Ltd.
Julia considered the point at which she would work with a client’s tattoos in
the room:
Some people replace self-harm with tattoos and piercings. I would try to
explore that more with my clients. Some people can be addicted to it too and
won’t be able to stop body modification and that’s probably concerning for
me. (198–230)
Similarly, Danielle considered the pain of tattooing and piercing as having its roots
in a seeking of containment:
Some people chose to do piercings and tattoos in a contained self-harm. To
cause some pain and equally to contain it so that it’s got a reason behind
it. They will sometimes feel more able to discuss it because they know I will
understand the process of it, I’ve experienced the process of it. (61–5).
Julia had one tattoo and Danielle had five: perhaps the number of tattoos they had
was significant in their thinking.
Unconsciously attacking the body with modifications is marked as distinct and
different. Separated out was a process in which tattooing is used to integrate
emotional experience visibly onto the skin. While recognizing that the process itself
is painful and irreversible, the fact that the body-modified therapist has been through
the process and can understand it was of vital importance to Danielle:
It is a form of punishment to our bodies, whether we enjoy it and like the out-
come, there’s still that sense that we are putting ourselves through harm to get
that. Some people become very addicted to them. Some people, when they
have a hard time, will decide to get a piercing or tattoo. Some people will
have many of them. Some people use it as a mask. And so then it becomes
part of the work and I feel that by me having them, and not very many at all,
in comparison to some, that they feel there’s an opportunity to discuss that.
Because I get the process of pain. Equally the adrenaline of getting it done.
And the euphoria of having what you want. Then they are able to share with
me. So they bring it into the room. If I didn’t [have tattoos] would it become
part of the work?’ (69–78)
Alice was the only participant who had a tattoo that featured a script. This was
the tattoo she felt self-conscious about revealing in the consulting room because it
belied more information in her opinion than a ‘passing image’.
Consideration of the findings using a psychoanalytic framework An IPA method-
ology was utilized to identify themes. This subsequent analysis continues to main-
tain the authenticity of the phenomenological process.
Generational difference was reported as significant in relation to judgmental atti-
tudes to tattoos. We could understand this in the context of the psychoanalytic fram-
ing of the early infant’s feelings of rejection being behind the choice of painful
inking of the skin. Perhaps the experience of adrenaline which enables the tattooed
person to bear and even triumph over the pain during tattooing is a bodily memory
Sons Ltd.
532 Lucy Snelson
of the ‘patch’ (Winnicott, 2012) and a reparative attempt to self-soothe. The puni-
tive response to tattooing described by participants in their experience of senior
(and we may understand ‘authoritative’) colleagues in the profession could be
understood to reproduce the phenomenon described—in the present, the tattoo is
‘other’ and rejected. But the criticism or disapproval felt evokes an unconscious
recreation of the past caregiving relationship in which there was an unbearable
emotional experience of the abandoning mother (the trigger for the later decision
to tattoo the body). This punitive parallel to the early experience in how the tattoo
is responded to professionally, in both the current literature and the experiences
reflected on by participants, might have served to curtail curiosity and conversa-
tion about potential benefits of therapists’ tattoos to the therapeutic relationship.
The conversation currently resides in a binary relationship kept alive through crit-
ical projection built from a narcissistically defensive culture in operation—I’m
OK (because I do not have tattoos) and you are not OK (because you have
tattoos).
Perhaps the tattoo can signify that that therapist has utilized the inking process as
a relational home (Stolorow, 2007), where a more authentic part of the psyche is
available from the process of leaning into the pain and integrating it onto the
skin. Rather than a wounded healer (Jung, 1951), perhaps the self-reflexive tattooed
therapist has healed and integrated their ‘wounds’ and, in doing so, does not need to
utilize the client wholly for projective functions.
Early inter-relational space between mother and infant dominates the thinking on
tattooing motivations. Winnicott (1950) describes this fear of dependency as the
‘fear of woman … who was devoted to that individual as an infant and whose devo-
tion was absolutely essential for the individual’s healthy development’ (p. 252) and
a universal experience we must all overcome. Chamberlain (2022) recognizes that it
was nearly three decades previously that Karen Horney (1926) presented the idea of
men’s fear of dominance rooted in a woman’s ability to give birth, in response to
Freud’s (1908) assertion of penis envy. Chamberlain (2022) calls out the psycho-
therapeutic profession for a theoretical underpinning that focuses on a women’s
‘lack’ rather than dominance. Despite Winnicott’s assertion that fear that drives
this denial of women’s power is at the root of ‘an immense amount of cruelty to
women’ (1950, p. 252), it prevails. Given the misogynistic culture evidenced in a
patriarchal society and in the psychotherapeutic profession (Chamberlain, 2022),
how much is the changing face of the population of therapists, who embody the
changing and evolving ways of female self-expression, creating a nostalgic cur-
tailing of the way women are allowed to be experienced in the consulting room?
The female tattooed therapist could then be understood to threaten conventional
expectations of the ‘maternal’ in a misogynistic struggle between the societal
expectations of adult women, their sexuality and the perceived adornment of the
female body with tattooing.
A tattoo could be experienced as a transitional object. For the therapist who has
utilized body art in an integration of inner emotional processing and for the client
who, when they notice it on the therapist’s body, can have the opportunity to see
Sons Ltd.
their separateness and independence from the therapist. The baby’s separating out of
the world of objects from the self ‘is achieved only through the absence of a space
between [the infant and mother] the potential space being filled … with illusion,
with playing and with symbols’ (Ogden, 1985, p. 130). Could a tattoo not be con-
sidered a playful working through of this potential space? A symbol of this process?
It unifies, celebrates, despairs about and integrates the earliest experiences of free-
dom and separation.
DISCUSSION
While participants expressed some pressures to conceal in certain aspects of their pro-
fessional lives where colleagues’ prejudices might be an issue, they largely felt their
body modifications did not negatively affect their clinical relationships or professional-
ism within the consulting room. Other aspects of appearance were seen as equally if
not more important to consider—particularly ‘appropriate’ dress. This is interesting to
consider in relation to Grose’s (2020) assertions on the outdated pressures on women
in particular, in which excessively feminine fashion choices are perceived more prob-
lematic than tattoos and piercings (DeMello, 2000).
Professionalism, judgement and prejudice was reflected on by all participants without
it being a direct question from the researcher. Despite the mainstreaming of tattoos and
piercings, ongoing prejudice was an issue for participants. This was seen as being
directed from within the profession. Unlike Lemma’s (2010) focus on the considerable
negative effect on the therapeutic relationship in the consulting room of the tattooed
therapist, the participants considered their tattoos to at worst have no effect, and at best
to enhance the relationship with clients. It was, however, generally seen that visibly dis-
playing tattoos did bring an additional non-verbal communication into the consulting
room, expressing something personal about the therapist. These findings correspond
with Kalanj-Mizzi Snell and Simmonds (2019) in relation to the importance of tattoos
in symbolizing ‘strength and obstacles that they had overcome’ (p. 208).
In regards to issues of (intersecting) identities, I would identify class and generational
identity as having equal if not greater significance to participants in regards to their feel-
ings of experiencing judgement and prejudice. Whether having the same tattoo or pierc-
ing, or sharing the painful and exposing processes they represent, the participants felt
the connotations of simultaneous vulnerability and strength they evoked with their body
modifications strengthened the therapeutic relationship. Their tattoos and these connota-
tions were perhaps representative of the ‘refreshingly abnormal co-conversationalist’
considered the ultimate therapeutic alliance in the profession by Grose (2020).
CONCLUSION
The literature positions the tattoo as a meaningless symbol or marker of pathology.
What feels like a conciliatory alternative to being pathologized is that perhaps
tattooing is merely a superficial and passive cultural fashion. Lemma (2010), Stein
(2011) and Karacaoglan’s (2012) research pathologizes the mind of the tattooed
client and stresses the hyper-significance of tattoos within the consulting room. As
Sons Ltd.
534 Lucy Snelson
for tattoos on the therapist’s body, they attribute provocative meanings and insinuate
powerful effect, while perpetuating the idea of the idealized therapist as one with a
conservative appearance.
My research suggests that being a tattooed person in the psychotherapeutic pro-
fession is experienced as a divergence from ‘the norm’. All therapists had experi-
ences of prejudice, to some extent, from colleagues in the profession, and this was
recognized as distinct because they did not have the same experience of judgement
from clients. In some instances they recognized that tattoos enhanced the therapeutic
relationship in the consulting room.
What are the experiences of the female body-modified therapist in the consulting
room? An Interpretive Phenomenological Analysis
REFERENCES
Alter-Muri, S. (2020) The body as canvas: Motivations, meanings, and therapeutic implica-
tions of tattoos. Art Therapy: Journal of the American Art Therapy Association 37(3):
139–46.
Aryan, A. (2006) Body modification. International Journal of Psychoanalysis 87(3): 849–51.
Atkinson, M. (2002) Pretty in ink: Conformity, resistance, and negotiation in women’s
tattooing. Sex Roles 47: 219–35.
Bentz, V.M. & Shapiro, J.J. (1998) Mindful Enquiry in Social Research. London: Sage.
Bick, E. (1968) The experience of the skin in early object-relations. International Journal of
Psychoanalysis 49: 484–6.
Braunberger, C. (2000) Revolting bodies: The monster beauty of tattooed women. NWSA
Journal 12(2):1–23.
Chamberlain, M. (2022) Misogyny in Psychoanalysis. Oxford: Phoenix
Craigen, L. & Foster, V. (2009) ‘It was like a partnership of the two of us against the cutting’:
Investigating the counseling experiences of young adult women who self-injure. Journal
of Mental Health Counseling 31(1): 76–94.
Craighead, C. (2011) (Monstrous) beauty (myths): The commodification of women’s bodies
and the potential for tattooed subversions. Agenda 25(4): 42–9.
Creswell, J.W. (1998) Qualitative Inquiry and Research Design: Choosing Among Five Tra-
ditions. Thousand Oaks, CA: Sage.
DeMello, M. (2000) Bodies of Inscription: A Cultural History of the Modern Tattoo Commu-
nity. London: Duke.
Freud, S. (1908) One the Sexual Theories of Children. London: Hogarth.
Freud, S. (1914) The Standard Edition of the Complete Psychological Works of Sigmund
Freud. London: Hogarth.
Freud, S. (1938) Totem and Taboo. Middlesex: Penguin.
Friedberg, N.L. & Lyddon, W.J. (1996) Self-Other working models and eating disorders.
Journal of Cognitive Psychotherapy 10: 3.
Gearing, R. (2004) Bracketing in research: A typology. Qualitative Health Research 14:
1429–52.
Greene, M. (1997) The lived world, literature and education. In: Vandenberg, D. (ed.),
Phenomenology & Education Discourse. Johannesburg: Heinemann, 2008.
Grose, A. (2020) Shrinking clothes. Fashion Theory 24(1): 85–91.
Sons Ltd.
Heatherton, T.F. & Baumeister, R.F. (1991) Binge eating as escape from self-awareness.
Psychological Bulletin 110(1): 86.
Henderson, Z.B., Fox, J.R.E., Trayner, P. & Wittkowski, A. (2019) Emotional development
in eating disorders: A qualitative metasynthesis. Clinical Psychology and Psychotherapy
26(4): 440–57.
Holloway, I. (1997) Basic Concepts for Qualitative Research. Oxford: Blackwell Science.
Horney, K. (1926) The flight from womanhood: The masculinity-complex in women, as
viewed by men and women. International Journal of Psychoanalysis 7: 324–39.
Hycner, R.H., Bryman, A. & Burgess, R. (1999) In: Bryman, A. & Burgess, R. (eds), Quali-
tative Research, Vol. 3, pp. 143–64.
Irwin, K. (2001) Legitimating the first tattoo: Moral passage through informal action.
Symbolic Interaction 24(1): 49–73.
Jeffreys, S. (2000) ‘Body art’ and social status: Cutting, tattooing and piercing from a
feminist perspective. Feminism & Psychology 10: 409–29.
Joseph, B. (1985) Transference: The total situation. International Journal of Psychoanalysis
66: 447–54.
Joseph, B. (1988) Object relations in clinical practice. Psychoanalytic Quarterly 57: 626–42.
Jung, C.G. (1951) Phenomenology of the self. In: Campbell, J. The Portable Jung. London:
Penguin, 1976.
Kalanj-Mizzi, S., Snell, T. & Simmonds, J. (2019) Motivations for multiple tattoo acquisition:
An interpretative phenomenological analysis. Advances in Mental Health 17(2): 196–213.
Karacaoglan, U. (2012) Tattoo and taboo: On the meaning of tattoos in the analytic process.
International Journal of Psychoanalysis 93: 5–28.
King, N. (1994) The qualitative research interview. In: Cassell, C. & Symon, G. (eds),
Qualitative Methods in Organisational Research: A Practical Guide. London: Sage.
Kosut, M. (2006) An ironic fad: The commodification and consumption of tattoos. The Journal
of Popular Culture 39(6): 1035–48.
Lemma, A. (2010) Under the Skin: A Psychotherapy Study of Body Modification. London: Routledge.
Meltzer, D. (1975) Adhesive identification. Contemporary Psycho-Analysis 11: 289–310.
Miller, W.L. & Crabtree, B.F. (1992) Primary care research: A multimethod typology and
qualitative road map. In: Crabtree, B.F. & Miller, W.L. (eds), Doing Qualitative Research.
Research Methods for Primary Care. Thousand Oaks, CA: Sage.
Mizen, R. (2014) On the capacity to suffer one’s self. Analytical Psychology 59: 3.
Moustakas, C. (1994) Phenomenological Research Methods. Thousand Oaks, CA: Sage.
Müller, C.S.L., Oertel, A., Körner, R., Pföhler, C. & Vogt, T. (2017) Socio-epidemiologic
aspects and cutaneous side effects of permanent tattoos in Germany–Tattoos are not
restricted to a specific social phenotype. Dermato-endocrinology, 9(1).
Namir, S. (2006) Embodiments and disembodiments: The relation of body modification to
two psychoanalytic treatments. Psychoanalysis, Culture & Society 11: 217–23.
Nascimento, L.d.S. & Steinbruch, F.K. (2019) ‘The interviews were transcribed’, but how?
Reflections on management research’. RAUSP Management Journal 54(4): 413–29.
Ogden, T.H. (1985) On potential space. The International Journal of Psychoanalysis 66(2): 129–41.
Orbach, S. (2009) Bodies. London: Profile.
Pitts, V. (2003) In the Flesh: The Cultural Politics of Body Modification. New York: Pallgrave.
Polivy, J. & Herman, C.P. (2002) Causes of eating disorders. Annual review of psychology
53(1): 187–213.
Pyett, P.M. (2003) Validation of qualitative research in the ‘real world’. Qualitative Health
Research 13(8): 1170–9.
Sons Ltd.
536 Lucy Snelson
Roberts, D. (2015) Modified people: Indicators of a body modification subculture in a post-
subculture world. Sociology 49(6): 1096–112.
Roggenkamp, H., Nicholls, A. & Pierre, J.M. (2017) Tattoos as a window to the psyche:
How talking about skin art can inform psychiatric practice. World Journal of Psychiatry
7(3): 148–58.
Romans, S.E., Martin, J.L., Morris, E.M. & Harrison, K. (1998) Tattoos, childhood sexual
abuse and adult psychiatric disorder in women. Archives of Women’s Mental Health 1(3):
137–41.
Sadala, M.L.A. & Adorno, R.deC.F. (2001) Phenomenology as a method to investigate the
experiences –-93.
Sanders, C.R. & Vail, A.D. (2008) Customizing the Body: The Art and Culture of Tattooing.
London: Temple.
Silverman, D. (2001). Interpreting Qualitative Data Methods for Analysing Talk, Text and
Interaction. London: Sage
Smith, J.A., Flowers, P. & Larkin, M. (2009) Interpretative Phenomenological Analysis: The-
ory, Method and Research. London: Sage.
Statista Research Department (2015) United Kingdom (UK) tattoo popularity in 2015, by gen-
der. Available at: https://www.statista.com/statistics/530565/tattoo-popularity-by-gender-uk/
Stein, A. (2011) The tattooed therapist: Exposure, disclosure, transference. Psychoanalysis,
Culture & Society 16(2): 113–31.
Stolorow, R. (2007) Trauma and Human Existence: Autobiographical, Psychoanalytic and
Philosophical Reflections. New York: Taylor & Francis.
Sweeney, S.M. (2006) Tattoos: A review of tattoo practices and potential treatment options
for removal. Current Opinion in Pediatrics 18(4): 391–5.
UKCP (2019) Code of Ethics and Professional Practice. Available at: https://www.
psychotherapy.org.uk/media/bkjdm33f/ukcp-code-of-ethics-and-professional-practice-
2019.pdf
Willoughby, R. (2004) Between the basic fault and the second skin. International Journal of
Psychoanalysis 85: 179–96.
Winnicott, D.W. (1950) Some thoughts on the meaning of the word democracy. Human Rela-
tions 3(2): 175–86.
Winnicott, D.W. (1953) Transitional objects and transitional phenomena—A study of the first
not-me. International Journal of Psychoanalysis 34: 89–97.
Winnicott, D.W. (2012) Primary maternal preoccupation. In: Mariotti, P. (ed.), The Maternal
Lineage: Identification, Desire and Transgenerational Issues. London: Routledge.
LUCY SNELSON graduated with an Msc in psychological therapies from the University of
Exeter in 2021. In 2014 she qualified with a Diploma in psychodynamic counselling from
Catalyst, based in Lowestoft. She is an accredited member of the BACP and a member of the
planning group for the East Anglian Psychotherapy Network. She works in private practice in
Norwich and for a Norfolk eating disorders charity. Address for correspondence:
[lucysnelsontherapy@gmail.com]
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British Journal of Psychotherapy 39, 3 (2023) 519–536 doi: 10.1111/bjp.

WHAT ARE THE EXPERIENCES OF THE

KEYWORDS: PSYCHOTHERAPIST, WOUNDED HEALER, TATTOO,

RATIONALE FOR THE STUDY AND RESEARCH QUESTION

Name: Helen Cleo Emily Julia Danielle Alice

Professionalism: All participants reﬂected on professionalism without it being a

Fashion choices and body modiﬁcations: Some participants had experiences of

Visibility and self-disclosure: Participants considered a tattoo as a visual clue

Fear of judgement and prejudice: Participants expressed an experience of living

Subordinate Theme 3: Integration: All participants were self-reﬂective about

Generational difference: All therapists had a feeling, to a lesser or greater extent,

Self-harm: Self-harm was considered in relation to the modiﬁcation of the client’s

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