A Novice Therapist

I remember my first session as a therapist. Walking into the waiting room and wondering if the blonde in the pink cashmere sweater was Susie. Meeting a patient for the first time felt — and sometimes still does — like a blind date.

I recall thinking to myself, she could be there for another therapist who shares the office suite. Do I awkwardly call out “Susie?” Or do I wait for the other therapist to retrieve her patient from the waiting room to prevent me from calling out Susie when in fact this may not be Susie but rather, the other therapists’ patient? I wouldn’t know — I’ve never met Susie before.


Who I saw that day in the waiting room matched the description of the individual on the screening sheet, a 19-year-old female. In that moment, I reminded myself that I was trained and also clinically-oriented toward not making assumptions. But I wasn’t trained not to doubt myself. Fast forward to the present era of telehealth when meeting a patient for the first time feels less like a blind date and more like a fifth date — when you are already invited to the persons’ home — even if just through a screen. There is a certain level of “intimacy” joining someone via telehealth versus in an office setting.

Working in an office feels more like a meeting at a neutral place, like a coffee shop, rather than over a digital medium, which creates the sense that you are picking someone up at their apartment. I gain entry into their life and can observe their decor, see books they read, notice whether or not they are messy or neat and if there are any pictures of family and friends nearby.

Therapeutic Alliance

In my career thus far, I have had patients’ parents say to me after I finish treatment with one of their children, “I think you’d be a good fit for my other child. I’d like for them to be in therapy with you.” As my supervisor has told me, finding a therapist is like dating. Some people shop around for a therapist until they find their match.

What works for one patient may not work for another, which is why there is no “one size fits all” approach to therapy. I’ve had another patient say to me, “I didn’t want to come to therapy today. I was upset after our last session, but then I realized you hit something within me.” I have also had patients blame me and “break up” with me due to transference or feelings about something explored in the therapy space.

I have had patients doubt my expertise and skills due to my age. Their questions about my competency trigger my own insecurities as a clinician. Patients who are older than me, and some who are parents themselves, have still chosen to work with me. Some have exhibited ambivalence regarding my skills and capabilities. I have utilized psychoeducation and have experience, schooling, and training to allow patients to understand that I have the tools to support their needs.

I have one patient, whom I have been working with for many months, who was skeptical of my age when we first began together. Now she embraces my age because she feels I am able to inform her on “the current generation” and allow her to better understand her children and their habits, behaviors, and thought processes in relation to herself.

On the other hand, I had a patient who was close in age with me who no longer wanted to continue sessions together due to wanting someone “older with more life experience.” This patient identified as Black and also wanted a Black therapist, which made sense to me.

I value patients’ wishes of working with someone with shared experiences. I also reflected on my own about how therapeutic alliances are formed. My thought is that therapy is not always a “been there, done that” relationship. Rather, therapy is about accomplishing goals and finding deep meaning and exploration through shared vulnerability.

I have also had male patients verbalize finding me physically attractive, which has made me uncomfortable. I even had a female patient who was around my age comment on my appearance during almost every session. While these moments were flattering, my focus with these particular patients remained on helping them to better process and understand their thoughts and feelings toward me, and their relationship with thoughts and feelings towards other significant figures in their lives.

I too have found a patient attractive and often ponder whether I show up in the treatment room in a different manner than clients who present as less attractive. I also wonder whether patients who admit to finding me attractive are doing so to curry favor with me. Even with complimentary statements from patients, I sometimes doubt the support I offer, the guidance I provide, and my clinical perspective — all while trying to figure out my own life.

Progress Notes and Clinical Supervision

I have always considered myself to be a writer, so I never anticipated that clinical documentation as a therapist would be a “skill” that I would need to acquire, let alone hone. I am grateful for my first supervisor who allowed me to learn clinical-case note documentation language. In the past, I’ve felt that I was unable to develop my own clinical voice due to needing to follow strict guidelines on what a “proper progress note” looks like. Another form of self-doubt and self-scrutiny came to fruition when told that I was not documenting in the “correct way.” Progress notes being professional, concise, and readable is more than sufficient.

Just as we do not conduct our therapy sessions in one way, why should all progress notes rely on the same verbiage? What about diversity in patient care and treatment? I once had a supervisor who required clinicians to draft progress notes several times until she approved them. While I understand that I was working under my supervisor, I also felt that time spent with patients was taken away by tedious paperwork. I doubted my intuition because the supervisor was more experienced. However, I sometimes wondered if I had more experience than the supervisor because I was the one who was working directly with the patient. To this day, I’m still uncertain as to what a “correct” progress note is.

As I have gained clinical experience and confidence, my priority sometimes shifts from meeting patients’ needs and working to understand and achieve their stated goals, to over-fixating on writing treatment plans that may or may not reflect the work that is done in the therapy space. While supervisors have an obligation to the agency or practice, they also have, or should have an equal commitment to the therapists that they supervise.

It is my hope that any future supervisor or mentor I have recognizes my strengths while simultaneously challenging me. I believe that supervisors and their quality of supervision can contribute as much to a therapist's negative self-talk and self-doubt as the therapist bestows upon themselves.

My Imposter Syndrome

When in session, I sometimes experience imposter syndrome, negative self-talk, self-doubt, or all of the above. As a new clinician, feeling uncertain, ambivalent and/or in disbelief of the work I am doing with a client or patient is normal — or at least I truly hope it is. Which therapeutic modality do I use? Which intervention am I using without yet being aware? Am I speaking enough? Am I speaking too much? Am I too gentle? Not gentle enough? Am I truly understanding patients’ agency, or am I asking them to consider what I think is right? I have so many blanks in my intake paperwork.

Being a new therapist feels just as vulnerable to me as patients letting us into their lives may feel. The negative self-talk and self-doubt that I may experience mirrors that of patients who may bring their own insecurities and uncertainties into session. Perhaps, my own internal voice, sometimes filled with ambivalence, mirrors those of my patients.

The parallel process of therapists and patients work in tandem. I often support patients in challenging their negative thoughts when I may be experiencing my own negative self-talk relating to the work that I do with patients. Therapists who demonstrate negative self-talk regarding their work with patients may be impacting the therapeutic relationship in a negative way. How can I support a patient with less negative self-talk when I am doing exactly what I am helping them not do?

If a patient and I discuss their negative self-talk and doubts, perhaps I will become more aware of my own both in and out of the therapy room. I must address my own ambivalence, negative self-talk and self-doubt in order to best support patients and myself. Patients may be able to sense when I am exhibiting self-doubt and negative self-talk, even if I am not articulating this.

My patients feed off my energy, and vice versa. However, I have learned, sometimes painfully, that it is my job as a therapist to take note of when patients’ experiences, doubts, and negative self-talk affect me. I continually attempt to be self-aware when these areas come to the surface for me. Being a new therapist comes with much to balance. Placing time to be with family and friends, clean and do chores becomes a juggling act.

***

As both a young person and novice therapist, I am simultaneously learning to “adult” and find my professional identity. I am grateful for the growing experiences that I have had in my career, and I look forward to more reflection, learning and time to come spent with patients!  


File under: The Art of Psychotherapy, Musings and Reflections