Am I A Good Therapist Yet?

Sweating, iPad in hand, you’re frantically searching for a “therapist near me” when a photo of Marcella Smith, LMHC, pops up. Her head is tilted sideways, her expression kind and welcoming. “With over a decade of experience under my belt,” her profile informs you, “I can say with great confidence that I’m slightly successful with many clients.”

Wait—did I read that right? Who would spend $200 an hour for a slightly successful therapist?

You shrug off your discomfort and keep scrolling. A middle-aged man—a social worker named Andrew Gold—appears next. “I specialize in grief and life transitions,” his profile reads. “Work with me, and we’ll take a half-step toward one of your goals within a few months.”

A half-step in a few months? Is this site a prank? Part of a dark money campaign to undermine and delegitimize therapy? What’s going on here?

You sit up suddenly, your arms and legs thrashing. You look for your iPad amidst crumpled sheets, but all you see is a clock on your night table. It reads 6:55 a.m. Exhaling, you feel a mixture of gratitude and disbelief. You’re in bed. It was just a bad dream.

Later that day, you begin an actual search for a therapist. You’ve been anxious lately, and it’s time to get help. You type a therapist directory into the search bar. Mark Carter, PhD, appears in a slim-fit, navy-blue suit. “The evidence-based treatments I’m trained in transform lives—together, we can transform yours.” Next, your cursor hovers over Felicia Way, LPC, who sits on a bench under cherry blossoms. “I specialize in EMDR for trauma resolution,” she’s written. “Are you ready to let go of the past and become your best self?”

But what if they’re exaggerating? you find yourself wondering. What if change takes time and isn’t guaranteed? What if quantum leaps in therapy are the exception, not the rule?

Useful Delusions

At the beginning of our careers, most of us look forward to one day having therapy profiles that sound like Mark’s and Felicia’s, ones that reflect how good we are at being therapists. But there seems to be a pervasive misconception in our field—and in our wider culture—about what it means to be a good therapist.

Do good therapists rapidly catalyze transformation and healing in most sessions, with most clients? When we’re just starting out, a lot of us hold this lofty vision of the work we’re learning to do in our minds. Of course, many of us who pursue therapy as a career have been in some form of therapy ourselves, so we know—on a cognitive level—that meaningful, enduring, overnight changes in humans aren’t realistic. Yet something deep within us holds tightly to the conviction that we can, against the odds and despite the statistics, help most clients, in most sessions, in spectacular ways. Even if our rational minds dismiss this belief—I know I can only do my best and therapy is a two-way street—a potent faith in our own benevolent omnipotence may still persist, for years or even decades, fueling a fantasy that with enough training and experience, we can fix, rescue, heal, transform, and liberate our clients.

Dreaming big is a superpower. It helps fledgling therapists draw on critical emotional resources, like courage and grit. Our outsized clinical dreams about our ability to help clients can sustain us when the harsh realities we encounter along our path—no-show clients, disappointed clients, unremarkable clinical outcomes, confidence-shaking supervisory sessions, mountains of session notes no one reads, the desperate pleas of people in crisis on six-month-long waitlists—take the wind out of our sails. Maybe overestimating our clinical abilities—and what’s realistically possible in our profession—serves a positive function. Maybe it inspires us early on in our careers when we’re at our most overwhelmed.

Shankar Vedantam, author of Useful Delusions: The Power and Paradox of the Self-Deceiving Brain, proposes that our minds aren’t actually designed to see the whole truth of things—instead, we view our realities selectively, in ways that propel us toward the goals we’ve set while buffering us against disappointments. Think of what it would do to the morale of beginning therapists if someone told them, “Here’s the truth: even decades into your career, you won’t help as many of your clients as you want to, and when you do help someone, it’ll likely be in small, undramatic ways. Then, hopefully, if the stars align, these small shifts will lead to lasting change.”

The pressure in our field to provide reliable, rapid solutions to complex psychological problems doesn’t just come from our well-meaning, personal ambitions and altruistic goals. It’s been shaped by the high value our culture puts on quickly satisfied desires. Fast food, same-day shipping, miracle diets, quick Uber pickups, rapid returns on investments, 5G technology—speed is a prized commodity that’s been baked into all aspects of our consumer appetite, along with affordability. Is it any surprise, then, that our culture expects therapists to do their work not just well, but as fast as humanly—or inhumanly—possible?

“We’re addicted to quick fixes,” says author and couples therapist Linda Carroll. “Look at the hype around ketamine. It used to be blue-green algae, the keto diet. It’s been Internal Family Systems, EMDR, Polyvagal Theory. These approaches can help us develop resilience, manage feelings, and change bad habits over time. They can help us learn skills, so when stuff happens, we’re less reactive and more curious. But we all have generations of shocking stories in our DNA. We bring decades of trouble and angst to therapy—immigration, persecution, mental illness, addiction. There’s no reliable, quick fix to the human condition.”

On my screen, Carroll sits by a window in a nondescript room. Behind her, I notice a photo of her with one of her dogs and Tim, a veterinarian and painter she married 40 years ago. I’ve read Carroll’s books, so I know some of her personal history: she was given up for adoption and abused in her adoptive family, and she has a complicated relationship with her famous, rock-star daughter. It’s clear she’s experienced her fair share of apparent quick fixes and twists of fate.

“Even if there were a quick fix to being human,” Carroll continues, “it wouldn’t last, because when you solve one issue, something else happens. You finally go on a great vacation, and then you get covid. You celebrate a promotion, and then your company goes bankrupt. You spend years in couples therapy learning to listen to your spouse, and then you get hearing loss. We think if we do therapy right, our clients will be happy. But that’s not how life works.”

Transference

Many years ago, I strode purposefully across the open-air lobby of the hospital where I was interning as a therapist-in-training and graduate student. I’d been studying, practicing, taking extra classes, attending lectures, and doing my own individual therapy in an attempt to fast-track my professional development. I was desperate to close the gap between the clueless newbie I still was and the skilled, competent professional I desperately wanted to become.

Luz, a Peruvian woman in her mid-20s I’d been working with for several weeks, was my first appointment of the morning. She’d been suffering from anxiety for years, but her panic attacks had worsened after the birth of her first child. When I stepped out of the elevator, she was standing in the waiting area.

“Hola, doctora,” she said.

“I’m not a doctor, Luz,” I reminded her gently in Spanish as I gestured for her to follow me into the cluttered, makeshift office all the interns used. “I know, sorry doctora,” she shrugged. We squeezed ourselves into metal chairs on opposite ends of the closet-sized room.

“I tried the mindful breathing practice you taught me, and I’ve been doing it every single day,” she said, beaming. “On the subway, at work, at the grocery store, whenever I take my daughter to daycare. I do it like you told me, when I notice my heart beating faster or if I start to worry. I’m feeling so much better than I was! My anxiety is gone. Thank you, doctora.”

My supervisor at the time was a severe-looking woman in her mid-40s who always dressed in a gray or black suit. All the interns gossiped about how hard she was to impress, but hearing Luz’s words, I couldn’t wait for our next consultation. After diligently writing my SOAP note (the acronym for “subjective, objective, assessment, plan”), I knocked on her door.

“Come in,” a terse voice called out.

“Luz is doing really well,” I said, the words tumbling out of me the moment I sat down. “She got here early again—she’s highly motivated to work on herself.” My supervisor raised an eyebrow, tenting her fingers at her chin. Today, her suit was black. “She keeps calling me ‘doctor,’ but her anxiety seems to be pretty much gone—she’s been using the mindful breathing techniques we’ve been practicing in session.”

“What clients say in session is content.” My supervisor spoke slowly, as if I was a child who might not understand her otherwise. “I’d like you to think more about process issues. What’s really happening between you and Luz? Is she putting you on a pedestal? She arrives early, calls you ‘doctor,’ says she’s cured. Are you sure you’re picking up on what’s going on, Alicia? Is there some transference here?”

Her tone was sobering. My eyes stung. I looked out the window.

“I know you want to help.” My supervisor untented her fingers, a telltale sign that our meeting was coming to an end. “That’s commendable. But being a ‘good patient’ won’t improve her life. What does she hope to gain by seeing you as her rescuer? More importantly, is there a part of you that wants to rescue her? And if there is—why?”

The Reckoning

For several weeks after that session with Luz, I wondered if I’d made a big mistake in my career choice. What was I doing? Had I decided to become a therapist to compensate for my own feelings of inadequacy? Did I want people to idealize me? What if more of my clients turned out to be like Luz—people harboring a rescue fantasy, whom I’d just be pretending to help?

My reckoning had begun. Most therapists go through a reckoning, at some point in their careers. This happens when internal and external expectations collide with reality. Maybe you’re sitting with a client who hasn’t been able to stop thinking about their ex, and suddenly, you realize they’re still stuck in the same place they were in when you first started working with them. Or maybe, despite your rigorous approach and many certifications, a client tells you, “You said I’d feel worse before I felt better, but I’m tired of feeling worse after our sessions. What’s the point?” Usually, though, our reckonings can’t be reduced to a single moment. They happen gradually, the cumulative result of hundreds of moments where our intentions for the work and the actual results diverge in ways we couldn’t have predicted.

Carroll describes her reckoning as a shift from viewing herself as a healer to a trained professional doing something practical—mundane, even. “I remember studying holotropic breathwork with Stan Groff. There was a lot of talk among trainees in his community about how we were all becoming these incredible healers. But when you believe you’re a healer, it implies you have certain powers you don’t actually have. It’s a cult mindset. In therapy, it keeps transference going. We do our best to support healing—we don’t cause it. Therapy isn’t magic any more than antibiotics. You can take antibiotics for an infection at one point, and later, when you have the same symptoms, the antibiotics may not help. What works for one client might not work for another client—or even for the same client later on.”

“These days, when I prepare for a session, I’m not thinking, I’m going to transform someone’s life. I’m thinking, I’m going to work. I don’t romanticize it. I listen, pay attention, ask questions. Sometimes, I talk. When things go well with a client, it’s tempting to think we’re special, or we’ve got the miracle cure. But there’s nothing I’m going to say that’s going to change a client’s life until they’re ready to hear it. I told a new client recently, ‘The fact your mother wasn’t able to love you wasn’t personal. It was about her inability to bond with you.’ It changed her life: she felt liberated. But what I’d done wasn’t magic. It wasn’t even me. It came on the back of seven other therapists before me who my client supposedly got nothing from. Hitting the mark doesn’t mean I’m a healer. It means my timing was right. It means it was a good day.”

Learning Goals

All therapists are vulnerable to feelings of inadequacy. What am I missing? How do I get better at this? What do I do now? These questions can haunt us, whether we’re fresh on the clinical scene or have been seeing clients for decades. Marketers know this. My own inbox populates daily with trainings on creating breakthroughs with difficult clients, resolving complicated grief, reconnecting estranged partners, rewiring brains, increasing access to ventral vagal states, and healing childhood trauma. It’s no coincidence that many of the most popular therapeutic frameworks today highlight rapid change with words like short-term, accelerated, time-limited, and solution-focused. Whether we’re therapy consumers, providers, or administrators at managed-care companies, we all seem to want the same thing: rapid, life-changing shifts in most of our sessions with most of our clients.

Diane Byster, a therapist, trainer, and supervisor who specializes in Intensive Short-Term Dynamic Psychotherapy (ISTDP) and a Psychobiological Approach to Couples Therapy, has nothing against new therapists aspiring to be highly skilled and competent. Nevertheless, she says that focusing too much on how well we match up to our ideal of a good therapist, particularly in session with clients, can come at a cost, affecting the quality of our clinical work.

“Do you know Jennifer Crocker’s research on self-esteem at the University of Michigan?” she asks. I shake my head. In California, where Byster practices, it’s three hours earlier than where I am in Virginia, but we’ve coordinated a morning interview on Zoom. “Basically, when new therapists get absorbed in how well they’re performing, rather than on listening to the client in front of them, their goal becomes performance-based. When you don’t meet performance-based goals, this can become fodder for self-attack. If you’re busy attacking yourself for something you did or didn’t do in session, then you can’t take in new information. Even if you’re thinking, How do I shift this client’s perspective? or How do I get them to connect with their feelings? you’re not really present, attuning to the client’s moment-to-moment experience. Most clients want fresh, new experiences of being seen, heard, and known, but you can’t give them that if your attention is in multiple places.”

Byster continues, “In my training groups, I focus on healthy alternatives to performing: learning and being fully present. One of the first things I ask trainees is, ‘What do you want my help with?’ This orients a new therapist toward their own learning goals. I encourage presence by helping them focus on the information revealed by clients—what we call “response to intervention” in ISTDP. When trainees get curious about what’s happening moment to moment with their clients in the session videos they present in our supervision groups, the focus naturally shifts away from performance. With practice, they start picking up on data revealed by clients. It’s not about copying me and throwing out statements without knowing why the things they say or do affect clients in certain ways. It’s about helping them find their own words for interventions in their own voice. We’re optimizing the best of the therapist and the best of the client. That’s what brings results. Therapy is a cocreated experience.”

As new clinicians, we’re striving to accomplish two seemingly antithetical things at once: trying to get better at our craft in the trenches of our own learning while accepting ourselves as we are in each session, with each client. But how do we get better at something without striving to meet an ideal? And how do we strive if we’re simultaneously trying not to strive so we can be fully present? I can’t help wondering whether new therapists are, in fact, the ultimate clinical acrobats: determined, resilient, and creative. Maybe their motivation to excel is what keeps them driven while their hunger to learn is what keeps them receptive.

“It takes courage to be a new therapist and directly share your work with a supervisor and a group of other therapists,” Byster notes. “I normalize this from the start with trainees. I say, ‘My goal is to create a culture of compassion where mistakes are welcome.’ Then I ask, ‘How many of us here make mistakes with clients?’ Everyone raises their hands. And I show parts of my own clinical videos with mistakes in them. We need to give ourselves permission to learn and make mistakes in sessions—it’s how we bring our humanity into the work.”

Twenty years after my session with Luz when I thought I’d cured her anxiety, I’m sitting in a café chatting with my web designer. We’ve spent weeks discussing logo concepts, color palettes, and photo options, but it’s been hard to finalize anything because we can’t seem to agree on my website’s message—or as my designer likes to call it, my “digital first impression.”

“What do you want someone who stumbles on your homepage to think about you? What’s the first word that pops into your head?”

“Good therapist,” I say. The words have left my mouth before I can stop them. “You know—good at what I do.” I raise my voice in the hopes that a little bravado will make me sound stronger and smarter—or at least less insecure.

Even in the wake of my own professional reckoning—in which I eventually accepted that I can be a skilled, supportive therapist who also gets things wrong and isn’t always effective—there’s a part of me I can’t deny that wants, after all this time, to master the impossible art of helping all my clients dramatically, efficiently, every time. Maybe I’ll never stop wanting this.

“No, no, good, okay,” my web designer says halfheartedly, no doubt picking up on a hint of embarrassment in my body language. She raises a cup and drains the last of her coffee out of it, throwing her head back like she’s doing a final, desperate shot of vodka at the end of a disappointing night out. “Let’s try this—could you describe what it means to be a good therapist? Are you saying, helpful? Wise? Caring? Emotionally attuned? Knowledgeable?”

“Sort of,” I tell her. “But what makes being a good therapist complicated is that being good also means not being good—failing, making mistakes, missing the mark.”

“Approachable?” she says enthusiastically, scribbling on her notepad. “Does that capture it?” From the way she’s perked up, I’m guessing she has a color palette in mind.

“Sure,” I say, reaching for my own coffee cup. “I can live with approachable. Let’s go with that.”

MAIN PHOTO © ADOBESTOCK/ALOTOFPEOPLE

ILLUSTRATION © MEGA PIXEL

SECOND PHOTO © KRAKENIMAGES.COM