Letter to the Beginner Therapist:

I’m writing this three years after my very first therapy session - and yes, I still very much feel like a beginner.

The first thing you need to know is that it is okay to be as nervous as you are. We all were. We put a lot of effort into hiding our insecurities - therapists are profoundly anxious people - but the nervousness is normal. More than that, the nervousness is good. It means that the work is meaningful and important to you, and if it wasn’t I’d be worried about why you want so badly to do it. My advice is to appreciate the nervousness, even embrace it. Trust your instincts, let them guide you, but don’t let them control you. Confidence will come, and you’ll have to work at that, but if there isn’t room for doubt too then you’re going to be much more likely to make mistakes, and much more likely to fail to mend them when you do.

Secondly, everyone is going to ask you what your specializations are: “What are your populations? What are your therapy approaches and stances?” We have an almost neurological need to sort each other into boxes. We do this because it makes our jobs a little easier - It helps us know who to refer our clients to and which clients to accept ourselves. It also helps us feel less intimidated by each other when we’re inevitably comparing ourselves to our coworkers and peers. And as we already covered, this is nerve-wracking work! It’s natural to respond to anxiety by drawing comparisons, which often leads us to subconsciously scout out information on eachother. 

It can be important to remember that these distinctions aren’t real. You're going to see a little bit of everything. And the client’s that stay are the ones that find you the most helpful, not the ones who meet your website description perfectly. I promise you don’t need to work so hard at looking for your client’s - your clients are looking for you, too. And if you specialize, it’ll happen naturally, not because you made the decision when you were a student deciding exactly what the rest of your career is going to look like.

Number three: Be aware that there’s often a long process of unlearning what we’re taught in our education programs. The educational system, by nature, likes a lot of protocol and structure. It makes it easier to grade students who are, essentially, learning a skill that can’t be graded. I also notice that more structured therapies are more popular in older generations. And if that works for you, great! But it doesn’t work for everyone. Which means that once you start practicing independently you're going to find yourself questioning everything from the way you write session notes (the CRPO only cares if it’s clear and demonstrates that you’re doing your job - point form is allowed!) to the way you introduce interventions (self-disclosure is a much more prevalent part of my practice then most professors would encourage). 

Number four: Practice what you preach (as much as you can). Get your boundaries in order. Avoid conversations about how many client’s you’re seeing in a week or a month. Leave some questions (like who you’re going to be in 5 years) open-ended and unanswered. Allow yourself to experiment and change your mind. Be inconsistent! There’s no right way to do this job except what works best for you. And most of us burnout within the first year or two (I did) so respecting your limits is crucial. It’s going to take you years to find the thing that works, and then that thing is going to change. And that’s ok! One of the best things about this job is how fluid it is. Remember, you can’t help others if you aren’t helping yourself. But by doing it your way you can make yourself more reliable and more available then by trying to follow everyone else’s rules.

Number five: Use acceptance. I believe we’re at a crucial time in psychotherapy history where we’re starting to question and think critically about the approaches we use. You may notice that you have one professor that swears by CBT and a supervisor that only talks about Freud. You may think that DBT holds all the answers or that it’s totally trash. It can be overwhelming, feeling simultaneously like you need to know everything and like none of it is going to give you the answers you’re looking for. Well, guess what? They can’t give you the answers you’re looking for. No book or lecture is going to magically give you the confidence and certainty that comes only with experience and honing your therapeutic instinct. It takes time (and journaling and therapy and peer support) to learn to trust yourself with this job. This isn’t a task you can complete by studying it. Your relationships with your clients depend in a big way on your relationship with yourself.

Number six: Go back to basics. Always. Research shows that the only thing that makes the CBT or DBT or ACT or Psychodynamics effective are the same 3 qualities. You know them - they're the ones Rogers taught us. The first thing you learned in your psychotherapy introduction course. The ones we all immediately forgot about in the storm of acronyms that took over shortly after: Empathy, Congruence, and Unconditional Positive Regard. If you’ve got those down (a rather difficult task by itself) you’re golden! (If you need a refresher, Roger's Becoming a Person is a great resource to have.)

Number seven: Be realistic. If all else fails, remind yourself that you’re not some all-powerful genie who can magically bestow miricales. There are going to be factors at play that you can’t control that will inevitably make or break the therapeutic alliance. That can be a depressing realization, for sure. We all want to help. But it isn’t really your job to help: Just like it isn’t your job to save your client or take responsibility for them. And it isn’t your job to have all the answers or fix all the problems. Thinking this way can distract you from providing the thing your client is looking for in you. We can’t protect our clients from suffering, and they don’t want us to. Powerlessness is going to hit you like a punch in the gut again and again. But that’s because you care - just like you should. Your job is just to be there, everything else is icing. And that means tolerating all the discomfort that comes with it - including the discomfort of doing less.

That brings me to my last point: Don’t worry so much about being a ‘good therapist’. The more invested we are in creating a professional persona, in always having the needed information and saying the right thing, the less of a good therapist we’ll be. That’s because as long as you're worried about being a good therapist, you’re paying more attention to yourself, and less attention to your client. You’re making it about you, and that can be distracting. You may find you have to actively and mindfully lower ‘being a good therapist’ on your priority list, and replace it with things that better align with your values. Consider what being a ‘good enough’ therapist means for you. For me, that means being authentic with myself and my clients. Embracing the mistakes – and you will make mistakes – and the awkwardness and the nervousness. Showing my clients that it’s ok for them to show up imperfect and afraid, because I am too.

I got a lot of inspiration for this post from my sessions with beginner therapists, discussions with my own professors and supervisors, and from Yalom’s The Gift of Therapy. Check it out if you think you need to be exploring how to build confidence and what a genuine therapist looks like.