As experts in any field will tell you, the secret to honing your craft is practice, practice, practice. But a little advice doesn’t hurt either. Here, four therapists well acquainted with the ins and outs, highs and lows, and successes and challenges of practicing psychotherapy share the most valuable lessons they’ve learned during their years in practice, as well as what they wish someone had told them before they ever sat down with a client.
1) Be Open to Not Knowing
In graduate school, during my externships and working under a supervisor, the focus was always on knowing lots of things in order to better help my clients. My classes centered on knowing what to say or do in different situations, knowing an array of therapeutic approaches and frameworks, knowing how to diagnose, knowing how to create a treatment plan, knowing how to assess for risk, and knowing how to document. Just as they say real estate is all about location, my work up to private practice was all about knowing, knowing, knowing. My graduate degree framed on my office wall underscored this relationship, quietly proclaiming that I knew my stuff.
But in spite of everything I knew, I still felt a persistent anxiety before every session, even years into private practice. I scheduled extra time between clients to listen to relaxing music, repeated mantras, smelled essential oils, and did squats in my office as I rolled a small, rubber ball between my back and the wall behind me. I read and reread a laminated index card in my wallet with affirmations that said things like, You don’t have to know everything to help people and It’s okay not to know. Yet I still couldn’t shake the sense that I didn’t know enough. I read psychology books late into the night, pursued additional certifications, studied new approaches, and tried to keep up with the latest, ever-shifting psychological trends. But the more I learned, the more it reinforced how much more there was to know.
It’s taken me a long time to understand the importance of not knowing.
Ironically, because I’d always focused on knowing, I didn’t know how not to know. Setting aside everything you know when you’re with a client and momentarily not knowing any more than they do takes a particular kind of trust and allowing. It creates a holding space for whatever’s growing within the client to emerge without interference from the therapist’s predictions and impulses. Of course, being able to predict and intervene based on past experience is an invaluable asset for any clinician. But personally, I would’ve greatly benefited from more training earlier in my career about the art of not knowing, and not intervening based on all my knowledge. This would have alleviated the pressure, urgency, and zeal I’d long felt to know more, know better, and know faster.
Revisiting the popular misconceptions that good therapy is mainly about knowing and the best therapists are those who know the most has helped me reduce my pre-session anxiety. When I give myself permission not to know every clinical approach, or what a client will bring up in therapy, or what the outcome of treatment will be, or even what’s going on within me at certain key moments, I ground myself in something bigger, deeper, and more healing than knowledge alone.
Alicia Muñoz, LPC
Practicing for 13 years
Falls Church, VA
2) Walk Your Own Path
Take what your supervisors tell you with a grain of salt. If you’re having trouble fitting in, it may well be that the container is too small.
My first job out of school was working on a psychoanalytic inpatient unit for very disturbed children. The qualities of my therapy that I was repeatedly taken to task for—moving too quickly, being too confrontational, and not appreciating my clients’ fragility—are my current sources of strength. I never fit into analytic work. I was working inside the wrong system.
I’d also advise any new clinician to trust their instincts. Unless someone walks in with a placard that says I’m triggering you because I’m just like your mother!, you can safely assume that your reaction to your client’s behavior is more or less in line with everyone else’s. Use your feelings, don’t run from them.
Back when I was starting out as a therapist, I wish I’d known to be more detached from the outcome of therapy. Don’t ever be more ambitious for your clients than they are for themselves. You’ll wind up with a big headache at the end of the day. Stephen Porges, the creator of Polyvagal Theory, says that a sense of safety in connection comes from feeling that the person you’re with has no judgement and no agenda. To all the new clinicians out there, I want you to hold up a mirror to your clients and show them what you see unsparingly. But you can only do this if you aren’t pushing them in any direction. For instance, you might say to someone with a drinking problem, “Look, this is what I see as the most likely outcome if you keep drinking excessively, but in the end, it’s your choice.” If you find yourself in a power struggle with a client, you’ve already lost.
Last, I’d highly recommend that any beginning therapist get support from peers and supervisors, especially because we work in such isolation. Find a few people you can discretely talk to. Peer supervision is both empowering and clarifying.
Terry Real, PhD, LICSW
Practicing for 25 years
3) Don’t Apologize for Your Boundaries
When I was a graduate student, I worked hard to accommodate families as much as possible, particularly to get them in for research appointments. This often meant staying late and working on the weekend. At the time, evening therapy appointments were often mutually beneficial for work and class schedules. Now, as an independent professional, I realize I have more control over my schedule. When I graduated, I initially thought I should continue offering evening and weekend sessions to help potential clients fit therapy into their busy schedules. I thought that sticking to typical work hours and prioritizing myself and my family was selfish. As I sought peer supervision and discussed my concerns with friends and colleagues, I realized that self-care is not selfish. Taking care of yourself helps you be a more focused, compassionate, and dedicated clinician. This is consistent with the American Psychological Association’s first principle of the psychologist’s code of ethics.
I also learned that setting boundaries help clients and their families too. It mirrors what we teach parents about having structure and setting limits for their children. When we have boundaries, we’re modeling healthy self-care. Clients learn to value their own self-care and make time for therapy because it’s important to them. If you’re still concerned about not being available during evenings or weekends, find a colleague who prefers those hours and refer clients to one another.
Kristen Criado, PhD
Practicing for 7 years
San Antonio, TX
4) Specialize, Specialize, Specialize
Although many new graduates have limited job opportunities, either due to a lack of experience working with particular populations or not knowing what specific clinical issues to specialize in, growing as a clinician means knowing what you’re good at, so you can get the best results. When you specialize, it’s a win-win situation. You get an opportunity to do what you love, and you have the best chance at having a positive impact on the clients you serve.
I’ve also learned that, when used appropriately, self-disclosure isn’t as bad as it seems. In graduate school, my peers and I were encouraged not to give too much information about ourselves. Today, as a seasoned clinician, I know that while most clients are satisfied to know that you have credentials, they’re most impacted by the therapeutic relationship, which includes some degree of exposing your humanity. It’s hard to have a relationship with someone you don’t know, so when you find opportunities to self-disclose, know that it’s not only healthy, but helpful to the therapeutic process. You’ll usually find that, in return, clients will be less intimidated by you, more willing to disclose as well, and more fully trust that you’re an agent for change.
Connie Omari, PhD, LPC, NCC
Practicing for 13 years
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