Existing research into work-related stress highlights that working as a therapist can be challenging. Evident across both qualified and trainee therapists, work-related stress can impact upon the quality of care provided. Practising psychotherapy can often result in difficulties for the therapist, which if unresolved can negatively impact upon therapist wellbeing and impede therapeutic process for the client. Ideally, therapists would have access to quality clinical supervision however literature suggests repeated evidence of a failure to adhere to best practice guidelines. Consequently, therapists are left to manage their difficulties independently, which may lead them to personal therapy. Reflective practice enables therapists to examine their experiences with clients and to consider the emotional impact of their work in order to gain insight into the self, the client and the overall therapeutic process. There is no existing literature related to therapists’ reflective practice in relation to their experience of therapist difficulties. Study aims This study aimed to explore therapists’ experiences of using a self-reflection tool (SRT) to reflect upon difficulties encountered in their clinical practice, their emotional experience and coping strategies, which may serve to increase therapists’ ability to manage difficulties in practice and reduce occurrence of work-related stress and associated negative consequences for client care. Page 3 of 241 Methods Informed by a pragmatic worldview this study utilised a mixed method, intrinsic (Stake, 2005), multiple case study design (Luck, Jackson & Usher, 2006). Opportunistic sampling recruited three qualified and three trainee therapists. Therapists attended an initial semi-structured interview before completing the self-reflection tool (SRT) as and when they experienced a difficulty within their clinical practice for a period of six weeks, alongside a measure of emotional impact and wellbeing, before attending a second semi-structured interview. Inductive and deductive qualitative and quantitative analyses were conducted. Results The qualitative and quantitative data was organised into two broad categories: 1) therapist experience, which included the themes therapist difficulties and therapist wellbeing and 2) therapist activity, which included the themes coping, reflective practice and clinical supervision. Discussion The findings yield implications for clinical practice in terms of reflective practice, clinical supervision and training courses. The SRT would benefit from further research to determine its practical use over a longer period of time, subsequent to revision following feedback obtained in the study. Furthermore, obtaining the client’s perspective of the difficulties would strengthen our understanding of the value of reflective practice in improving therapeutic outcome.