“A person's success in life can usually be measured by the number of uncomfortable conversations they’re willing to have” ~Tim Ferris

Fear and anxiety are rampant among early career therapists: will I ever not suck at this? Is this client going to die due to my incompetence? Can they tell I have no idea what I’m talking about? 

Therapists frequently choose not to act due to personal discomfort, rather than not knowing how. E.g., How do I interrupt clients? How do I deal with a talkative client? How do I redirect a session? Yes there is some skill involved but, in my experience, once I share the relevant skill with students they still have to confront how uncomfortable the attempt seems. 

There’s a difference between preparation and mere reassurance. Often newer therapists are seeking reassurance via worksheets, learning one more theory or special intervention, etc—I’d encourage you to keep in mind the common factors research though. 

However, I’ll offer a few things that may be reassuring:

- You don’t need to figure everything out for day one; this is about your whole career rather than just today

- If you’re stuck, all you have to do is get through the rest of that session then consult. In the meantime, you could consider focusing on, in order: safety, support, self-care

- (Healthy) professional self-doubt is common among expert therapists, even late in their careers

- Just because you feel something doesn’t mean anyone else can see it

- Be authentic. It's okay to not know, and it’s even better to ask. You’ll get through this.

Tim Ferris has a great exercise called “fear setting” that you can google. In it he defines risk as “the likelihood of an irreversible negative outcome”. If that’s not the case, then it’s not really a risk and I could more openly consider the action. This exercise is healthy for us and sometimes the perfect intervention for clients.

It’s okay to feel discomfort. We can feel off and still be present with our clients, and we’re not going to die from feeling mild anxiety. For most of us, the therapist development process is fraught with mistakes and fear. If I’m further ahead, it’s only because I’ve made more mistakes than you. “The master has failed more times than you have even tried”, not that I’m a master!

I strongly recommend Louis Cozolino’s book “The Making of a Therapist”. His articulation of the role of therapists’ inner experience being at the forefront of training good therapists is spot on: this process is not merely cognitive; our judgement, empathy, and maturity are tested. Yes, there is knowledge and intervention involved, but facing our inner experience is not typically a requirement of grad school: 

“Over the years, I have had many students who desired to become therapists while sealing off their inner worlds. They tried to stay “above the neck” in the hope of avoiding their own feelings and emotions. I often felt sadness when interacting with these trainees because I could sense the pain beneath their need for disconnection. Unfortunately, this intellectualizing defense handicaps both personal growth and the development of good therapeutic abilities. For most students of psychotherapy, the primary challenge is not mastering the academic material, it is summoning the emotional courage to move through the inner space that leads to knowing oneself. The more fearless we become in the exploration of our inner worlds, the greater our self-knowledge and our ability to help our clients” 

Humility

We’re continuously, and have only ever been, at the centre of our own perceptual universe. This is why authentic and effective empathy is so powerful—why people are so rarely witnessed and understood. Therapists being patient and humble enough to work through this with each client is invaluable. 

Maintaining a beginners mind is foundational to good therapy and strong therapeutic alliances. Few things are as disconnecting as arrogance, a rigid expert stance, or making assumptions about your clients. Each of us is responsible for reigning in our own ego and the disconnecting effect it has on both client progress and therapist growth. We’re also responsible for our ongoing development as therapists, particularly after we exit initial training.

Not asking questions about how to improve due to fear of looking foolish is dangerous territory. Institutional and social prejudices etc aside, when something in our life isn’t working out we need to give real thought to responsibility taking: “What have I actually done to improve this? What’s in my control and what isn’t?” This question can represent quite a bit of privilege, so I do mention it carefully. 

Tip toeing aside, I hope you find the courage and the right people to ask your questions to. You may look somewhat uninformed for a moment, but you’re rectifying it by asking. I hugely respect that, and my overwhelming experience is that the people who are humble enough to ask become better therapists more quickly and usually carry less discomfort. See Brene Brown’s work on vulnerability.

I encourage you to have ongoing enthusiasm for learning, and to take opportunities to move in directions you find meaningful. When potential mentors see you as passionate and humble they’re far more likely to help. 

Engagement: 

• What is one fear or concern you have that you have already overcome in your therapy practice? What do you think others would notice about the changes you made? 

• What fear-based decisions have you made in the last while?

• Try Tim Ferris’s fear setting exercise above

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