Patients’ Experiences of Psychotherapy for Psychological Distress Attributed to Attendance at Boarding School “The Denial, Shame, and Privilege Double Bind”

Background: ‘Boarding school syndrome’ is a term used to describe psychological distress linked to the experience of attending boarding school. Psychotherapy has been used to treat patients who relate their psychological distress to attending boarding school, however there is little evidence of research into the therapeutic process and patient experience. Aim: This study aims to investigate adults' experiences of psychotherapy who have experienced psychological distress related to attending boarding school. It makes an original contribution to the literature by providing in-depth analysis with a qualitative methodology and expands the understanding of participants' experiences of psychotherapy. Method: A qualitative approach was used to investigate in depth the experiences of participants who had experienced psychotherapy. Twelve participants took part in semi-structured interviews. Interviews were analysed using thematic analysis. Results: A total of six themes and corresponding eighteen sub-themes were developed from the data: (1) A therapist who provides validation of the boarding school distress experience in the therapy process after emotions are shut down in boarding school; (2) Finding oneself in therapy after the loss of identity in boarding school; (3) The double bind of denial, shame, and privilege as a barrier to therapy, and overcoming this barrier by recognising and accepting the boarding school distress; (4) A therapeutic process of transforming relationships after loss of intimacy in relationships in boarding school; (5) Trauma based therapeutic and specialist interventions and expert therapist to process the boarding school trauma; (6) Acceptance from others through group therapy and online forums. Conclusion: Overall, participants reported that therapy can be complex and challenging, which appears to relate to the double bind of denial, shame, and privilege. The distress from the boarding school experience is often denied in childhood and in society, and the boarders can experience prejudice and shaming of their distress, so they shut down their emotions. Consequently, this can lead to denial of the boarding school distress and trauma in the therapy room, leading to barriers such as limiting identification, diagnosis, and therefore appropriate treatment. Participants conveyed it is helpful to receive expert therapist knowledge on boarding school trauma, and to have the boarding school distress and trauma believed and validated. Additionally, it may be helpful to receive specialist trauma intervention, together with peer support such as online or group intervention, to normalise and process the distress and trauma experience. It seems this expert therapist knowledge aids in counteracting the boarding school experience of emotions being shut down, denial of the distress, loss of identity, and loss of intimacy in relationships. Participants expressed treatment can lead to change, such as increasing acceptance of the boarding school trauma, expressing emotion, rebuilding relationships, and re-forming self-identity. Clinical Implication: The study informed an understanding and the development of psychotherapy for people with boarding school distress for clinical practice. The study also provided insight for other trauma clinical presentations, such as looked after children (LAC), child sexual exploitation, and child sexual abuse, by understanding the theory of the denial, shame, and privilege double bind. Moreover, it provided awareness of the impact of emotional neglect, and the separation of young children from caregivers in general, and the importance of fostering children’s emotional development, which informs social care practices, education institutions, and Government policy.