The 7 Deadly Sins of the Rookie Therapist
If you’re a rookie therapist, the bad news is you probably suck.
The good news is you’re exactly where you should be.
You’re new, after all.
But new only lasts for so long.
You know you’re “too new” when…
The same issues repeat themselves in the therapy room, and clients leave treatment in frustration.
So what about you?
Are you guilty of any of these seven deadly sins on the couch?
1. Hubris
This one is as huge.
Maybe even bigger than Freud’s fascination with all things phallic.
Here’s how difficult it is to be a competent psychotherapist:
Step 1: obtain advanced counseling degree.
Step 2: struggle through the process of gaining licensure hours.
Step 3: finally reach that magical number of 3,000+ in supervised clinical work.
Step 4: (eventually) pass the oral and written state boards.
Step 5: “do time” on the community-based organization’s burned out rung for a couple of years to boost clinical chops.
Step 6: wait a few more years and open a private practice.
Except for That Guy.
The hombre with a different interpretation of “paying your dues.”
As in foundation year placement:
“Man. These clients should be paying me for all the awesome help I’m dispensing.”
Upon licensure:
“Check out my new tricked-out office. My clients are gonna love me and pay a handsome cash-only sum for the privilege of my psychological insight and clinical brilliance. No need to bother with EAP panels or any other insurance based reimbursement system for this guy. Hell-to-the-no.
I was the star grad student, the one who refused to be placed in a middle school setting because, well, “no offense, but I’m going into private practice and I won’t learn anything in an academic setting.”
Or so you thought, dude.
You totally suck.
Oops, was that a Freudian slip?
Tip: Check out #7.
2. Tardiness:
Even though it’s customary to begin the 50-minute hour when the big hand is on the twelve and the little hand points to some specific hour, this gal doesn’t seem to understand that clients have been waiting all week to discuss their issues.
Prolonging the session start time raises anxiety.
Not to mention reinforces the client’s core belief that their time and mental energy are not valuable.
Tip: Check out your local bookstore for time management strategies.
3. Impatience:
All therapists get frustrated at the slow pace of “getting it” when it comes to theories/direction/pace/modality/competence while in training.
It takes time to build your confidence, and patience is your friend. Most therapists don’t start off running the Boston Marathon straight out of the Master’s gate. We take the process in stride, and show gratitude and humility for the opportunity to be of service.
Tip: When you find your heart racing because you’re not connecting during the psychological intake, ask yourself:
- Am I reviewing the questions thoroughly before I meet my client?
- Do I focus on building rapport before launching into medical history?
- Is there someone I can consult with to provide constructive feedback regarding my interview skills?
4. Research Paper-itis
Being in the therapy room and relating to your client 1:1 is not the same as writing about The Theory of the Narcissistic Personality Disorder for your DSM class.
If your personality is as limp as a wet ramen noodle, your clinical insight doesn’t translate. You may love Research Methods in Counseling Psychology. Your client could care less.
But when you rock those social skills, opportunities for change are endless.
Tip: To paraphrase some former president, it’s the relationship, stupid.
5. Anxiety-lessness
(Yeah, I know that’s not really a word 
).
As a clinical supervisor to Master of Social Work interns, I have my favorites.
It’s not the most clinically astute.
Nor the guy with the balls-to-the-wall approach when trying new interventions.
“I was up last night worried about seeing my client for the initial appointment.”
I love that person.
Bottom line:
The over-taxed central nervous system may contribute to a less then Zen-like existence, but at the end of the stressed out day, anxious people get the job done, baby;).
Tip: If you’re not nervous before the majority of your sessions, you may want to increase your mental health consultation hours/join a Rookie Therapist support group.
6. Sloth:
Here’s why I took a five year sabbatical from clinical supervision.
The hundredth time I heard a counseling intern say, “I hate those process recordings–it’s too much work and my hands hurt from typing,” I wanted to jump off the proverbial ledge.
You want to know what hurts? Being a middle-aged man who just lost his job and health insurance, and discovered he has Stage II prostate cancer.
In comparison, the privilege of possessing an advanced degree with the opportunity of earning multiple income streams, while not yet in your third decade, is something to appreciate.
Tip: Check out Viktor Frankl’s Man’s Search for Meaning.
7. Narcissism:
Narcissism is usually related to one or more of the other deadly sins. Hubris being the kissing cousin.
You know that clinician who shamelessly promotes his blog posts ad nauseam on Twitter? Or Ms. Motormouth, MFT who hijacks everyone’s time during the Best Practices in Marriage and Family Counseling conference, because apparently the ACA hired the wrong presenter?
Tip: Don’t be that therapist.
***
Got any sins or tips to add?
Thanks for stopping by,
~Linda
*BONUS* Rookie Therapist School is in session.
Have you registered? Let’s face it, we’ve all been in the wrong class, but nobody likes a repeat offender–Sign-Up for the Zen of Anxiety Newsletter and get free rookie tips every month + check out How to Think Like a Shrink so you can Rock Your Clinical Badass!
I'm an Anxiety Saboteur who loves to help people resolve their emotional baggage. As a therapist in Los Angeles, CA for the past 13 years, I've seen too many lovely people suffer needlessly. I believe healthy boundaries are the key to happiness, and every parent should be BFF with the word 'no.' If you are looking for honest, straightforward anxiety solutions, you’ve come to the right place.
I love this post – especially #7 – don’t be that therapist! And my pet peeve is therapists who don’t start their sessions on time. We sure want to get out on time, so we have to give them the whole hour…from the top.
I would also add a “bonus” deadly sin to #7 – don’t be the clinician that talks mostly about themselves or their problems during session. Tip: Don’t be a therapist. At all.
Stephanie–
Great point. Many clients wonder why the therapy ‘hour” is 50-minutes to begin with, so yeah, we’re really short-changing the session when we don’t start punctually.
OK–you get the #8 spot on the deadly sins list: It’s not your therapy, it’s the client’s. Bottom line.
Thanks for sharing!
This information is right on time for as a graduate intern (pre-graduate hours). My biggest challenge has been finding my voice and asserting myself among some of the other staff. I can’t count the times I would drive home and be sad that I didn’t speak up on behalf of the clients when some of the staff was not responding to their needs. So finding the balance of when to say something vs when to just be a student has been a challenge. After all I don’t want to appear to be a know it all, I have seen other people get that label and I don’t want it.
Brittany–
That’s a huge hurdle to overcome as a newbie therapist. And yes, sadly, speaking up sometimes labels you are the ‘know it all rookie.’ I suggest making a list of what you want to say and rehearse it. Sometimes when we read something aloud, we gage the tone and intent with more honesty and clarity. Maybe talk with other grad interns in your agency? I imagine others feel the same way.
As long as your advocacy/opinions/suggestions come from the heart, and you have the client’s best interests in mind, I would speak on it, girl!
Thank you for sharing what many rookie therapists are likely experiencing. I know I was back in my rookie days
.
Not having a sense of humor should be a sin.
Tip: Remember I’m nervous and I’m scared. Please tell me I’m not a. damaged individual. Not looking for slapstick, just a chuckle or two.
Beth-
Word.
Humor helps any situation. Period.
Linda, great post as always!
Being a new therapist is rough. I struggled with having “all the answers” when clients would come in. This has gotten better over the last couple of years though.
A comment on #1: You don’t want to be “that guy” but I do think you need to believe in yourself. So, to a degree, you have to believe that you are awesome (maybe not as awesome as you will be) and that you can help. Otherwise, clients sense that you are scared shitless and they won’t come back.
Like my supervisor told me: Fake it till you make it.
Sean Stanek would like you to check out…The End of a Journey…
Sean–
Thanks for the kind words:).
And your are so right: Being a new therapist is HELLA hard. I relate to the struggle of the pressure to know “all the answers.” And this will become less of an issue with experience. I shudder when I think of some of the clinical issues that came through my rookie therapist door in the early days.
Great counter to THAT GUY. Because yeah, in a sense you have to fake it till you make it. Clients (especially those mandated for counseling) can sense the fear, and this will make the session much more difficult to handle. I think the line in the sand is confidence vs. cockiness. There’s nothing wrong with “I don’t have the answer to that right now, but I can find out and get back to you next session.”
Also, a newbie therapist would’ve title his website “rockstarcounselor.com”, and wouldn’t think the (aptly titled) word “neophyte” applied to him/her.
Thanks for sharing:).
Haha! This one is a fun read. And I’m not laughing at you therapists, I’m laughing with you.
I admit to Twitter-stalking every now and again, and I’ve noticed a few therapists with “Freud-Syndrome.” How can you interact on social media if you have 1,000+ followers, yet you limit yourself to following 4?
Narcissism squared for those types. Not that all industries don’t have THAT GUY?GAL, but a helping professional should reconsider their career choice.
Thanks, Dave.
oh, how there’s a part of me who wants to out the narcissistic therapists on social media sites. There’s this new thing, call the RT and the share button.
Ugh!
Great post! I also think that learning about yourself (and your personal issues) is very important, along with self-care. It’s too difficult to guide clients down a path when you don’t want to go that way yourself or you don’t have the energy to help them.
Hey Tanya–
Oh! That’s a crucial deadly sin–therapists who do not undergo their own therapy before being a clinician. I mean, how can you help others when you haven’t experienced the process?
We all have issues.
We all need therapy.
Wow, you do it again Linda
I’m going to add to the points mad by people about not being too hard on oneself. Starting out is tough and it’s important for us all to find support from friends and colleagues. Especially during these tough times economically. I think many of the
I love this post, tongue in cheek and great delivery.
I particularly love the personality insight… I recall a client once relaying to me how the psychologist he had just seen had the personality of a brick wall!
My pet peeve. Punctuality. You’re a grown up now, you shouldn’t have to be told, that being prepared to start you day’s sessions means not turning up 5 minutes after your first client has arrived, and then rushing to the bathroom and taking 10 minutes to prepare!
No brainer
kathyjames would like you to check out…Which Way You Lean—Physically—Affects Your Decision-Making
Hi Kathy–
It’s so nice to see a new face–welcome!
A psychologist with the personality of a brick wall–now there’s a first. Oh, how awful-ugh! It sounds like they found you, and that’s a good thing.
I agree with the pet peeve on time. I will not start late, and that’s because I prep the day before. Oh, and make sure I have sufficient time to run to the bathroom, etc.
No brainer, indeed.
Thanks for sharing!
oops hit the the return button too soon!
I am going to add to the points made by people about not being too hard on oneself.
The work is a challenge and especially at times like these. It’s important for folk to get support and avoid getting caught up in situations that might well be anxiety responses. Additionally support allows us to check in with another and ground ourselves in social-interpersonal reality rather than our own defences.
It’s funny that as therapists we encourage our clients to form mutually sustaining relationships to others and in our own lives may forget to do that.
The beginning of a practice can also be a time of great creativity and fun and joy and I think folk need to find time to explore that aspect as well.
Building a practice takes time and it also involves making mistakes and acknowledging that might make a little more kind to our clients.
Although there is little justification for making one’s clients feel unimportant it’s maybe useful to distinguish between thoughtlessness and someone who maybe needs to find another career.
Love the way you tell it Linda
Thanks Noel. And yes, some therapists are too hard on themselves, while others…hmm, they leave the anxiety responses to their clients.
I completely agree about the need to form mutally sustaining relationships–we take in a hell of a lot of toxicity. It has to go somewhere, and if we can’t turn off the emotional switch, that stress is going to go somewhere and we’ll likely end up ill.
Thanks for adding the fact that yes, the beginning is fun! I remember being so excited for my first private practice case that I barely slept the night before.
I’m sensing that others agree that certain therapists should not work in a counseling capacity. And that is sad. Think of the clients who may never return to the couch, or worse, feel more anxious and depressed than when they presented for therapy.
Thanks for the kind words, too
.
*Hugs*
I’m trying to make the most of my “rookie” experience: finding the balance between being a learner and feeling free to take risks because I’m the new kid on the block.
Oh, I hope my clients do not find me lacking in personality. I have a penchant for research, and writing papers is one area that I excel.
I like the suggestions from the others and will add some of them to my therapist toolkit
.
Hey Janice–
It sounds like you’re on the right track. It takes time, experience, and sometimes, epic faiures to find your voice and style.
Thanks for stopping by:)
Loved what you had to say in this blog! My schooling has been all online, but we had one student who fit the bill for both #1 & #7 and nobody wanted to deal with him. I’m not sure he ever realized how off-putting his enthusiasm in himself actually was.
I haven’t done any actual fieldwork with clients yet (waiting for my site to be approved as I type) but I have loads of emotions about it. Excitement and nerves are tending to be the two big ones. To add to what has already been said – it is most definitely the client’s time when they walk through your door. As a counselor you have a tremendous need for self-care….but you need to focus on the client’s needs when it’s their time with you. Afterwards if you’re having issues go and speak to your site supervisor.
At this point in my career I don’t consider myself an expert on anything. As long as I can manage not to screw any client up anymore than they were before they enter my counseling doors, then I’ll take it as a good sign
@MilSpouseCouns–You’re cute, Jennifer. Love your attitude. And yes, you will never screw up your client, nor make things worse as long as your heart is in the right place:).
I LOVE that you mentioned your lack of expertise. After 12 years post-grad I still question a lot of my interventions, interpretations, abilities, and timing…
You’re on the right track, baby!
Good luck in your fieldwork. As I said in the post, nerves are a sign that you care
.
Reading the comments, you’ve hit a nerve Linda and a good one.
I agree with your points and all the comments. Cherry
Cherry Woodburn would like you to check out…Becoming Strong Even When You’re Scared | Confidence Chronicles
Great read and comments!
When I started my private practice I thought that I could help anybody that came to my door. Not so. Now I specialize in helping couples and even then there are those that I can’t help. Not because I don’t know what to do to help the couples, but because they don’t like my style. I have learned that “a good fit” goes both ways. I prefer to work with people that benefit from the way I work.
irenesavarese would like you to check out…The # 1 Secret To A Positive Couples Therapy Experience.
Irene–
Yes, finding a niche is essential, as is choosing to work within a certain model/framework/theoretical orientation. I just added a “How Does Therapy Work” page to my blog in the hopes of avoiding unnecessary stress from and to potential clients who may have a different interpretation of what it is to be a client.
You’re a wonderful couples counselor. Not that I do couples, but I find your blog spot on and super helpful!
Thanks for sharing:).
Hey Linda! Another post with good points made with humor! You have a distinctive style! I remember the anxiety of being a rookie therapist, and how long it took me to feel confident, and yet there are still clients I know I cannot work with. I try to ferret this out on the telephone, and have a short list of great therapists in the community to whom I refer out. I also maintain my membership in a monthly (oniste) peer supervision group and have a personal supervisor whom I pay top dollar to see. This job has alot of requirements. ty, K
Kathy Morelli, LPC (@KathyAMorelli) would like you to check out…Infant Sleep Methods Part Five – Dr. Sears
Thanks Kathy–
Wonderful points. It takes so long to feel confident as a therapist. I mean, look at the task at hand–being entrusted with someone’s precious mental energy. I shudder to think how crucial to get it right. I have tremendous guilt and misgivings about the many times I did not get it right. Oh yeah, the screen. I think of screening clients as one surefire method for preserving my sanity and saving them from a frustrating clinical experience.
I don’t know what I’d do if I didn’t have my clinical consultation with Reevah Simon. She is my former clinical supervisor, and she really taught me how to think like a shrink. Not that I’m “there” yet, but I’m indebted to her.
Thanks for sharing:).
It’s hard to add to that list of sins. As usual Linda, funny yet dead on. BTW…love the Freudian slip bit!
First I would advise the rookie therapist to follow the basics and trust in the process. Yes I know every Yoda of therapy tells you the same thing…it sounds so basic…but you know what? That Carl Rogers guy actually knew what he was talking about. The best way to work with your clients is to build a relationship with them, and the way you are going to to do this in the clinical sense is to listent to them like nobody ever has. Not only are you going to do this, but you are really going to work to understand their point of view and then communicate to them that you get them. Hmmm…this sounds like really basic stuff..I know, but trust me, once you get to the point that you are actually seeing clients you will be so ready to unvail your CBT, EMDR, DBT & CBT skills. Or do your best psychoanalytic in depth personality assessment that you will completely miss the opportunity to do what is most basic to the profession..”start where your client is.”
Second, I would like to piggy back on Linda…because I mean how could I go wrong there? Impatience is a killer in the field. Trust me, after watching episodes of In Treatment on HBO, I too am ready to set the world on fire with my clinical saviness. However, the real deal is, therapy can be really boring. It is tedious work. You have to sit there, day after day, and hear the same things over and over. Sometimes you look at the clock after what feels like an hour and half to find that you have only been in the room for 12 minutes. Yikes. Or sometimes you sit there and think “where the heck do I go from here…what do I do.” Well in these times patience is king. Ask your open ended question, or refelct and then sit back and shut up. Shutting up is such an amazing intervention, and when you feel anxious it is almost always a better intervention then saying something. Give the client time to process. Now I’m not saying you Goodwill Hunting and wait three minutes, but trust me…30 seconds of silence will work wonders, and if you can stand it, you will be surprised at what the client comes up with.
Lastly, I would like to add, as a therapist, our bodies, emotions, and thoughts are our best tools. So one, keep them tuned. Go to therapy. Get rest. Get exercise. Eat well. Mostly be mindful of how you are feeling and know that will affect how you intrepet what is happening in the room. Second, use yourself as a barometer. Feeling bored…check in with that. Feeling like you want to strangle your client…check in with that. Feeling as if you are disassociating…check in on that. Get a good clinical superisor and tell them what is coming up for you and have them help you process what that means. As you get better at this, you will be able to use it in session. This can be powerful, especially when you can put a name to sense in the room with the client.
So, good luck rookies. Us therapists can be an elite and snotty bunch, but don’t be afraid to ask questions. Not all of us bite. You are needed out there!
Marco Prospero in da house!
Wow. When you sent me a Tweet re: needing to think on this before you responded, I wasn’t expecting the dissertation–talk about bringin’ it!
As I was reading through you amazing clinical POV I thought a) how can I spin this into a blog post?;) and b) when rookie therapists/grad students send email about why they cannot afford my upcoming eGuide “How to Think Like a Shrink…” I’m gonna refer them to your comment. You covered the main points, anyway…:).
I love that you touched on the nuance of building a relationship–I mean how many people get 50 minutes of anyone’s uninterrupted time these days? I remember a supervisor telling me that when I was in grad school, and floundering big time. At the time, I thought she was trying to appease me, but several years later I get it.
I really appreciate your honesty, too. Yeah, at times therapy is eye-scratchingly boring, and once in a while you’ll feel angry at your client. But the seasoned clinician knows how not to project crap back onto his/her client; how to bring those uncomfortable feelings back into the room; and how to deal with the countertransference in the name of preserving the client-therapist relationship and doing good clinical work.
We do need more therapists out there. And we need more honest, straightforward, clinically astute men like you to spread the word.
Where’s the blog, Marco?
You rock. Thank you. In this internet day and age, I feel privileged that you took the time to leave such a heartfelt and helpful message here
.
Linda would like you to check out…Why Anxiety Doesn’t Suck
Nice site and it sounds like you are a good supervisor. Generous with your knowleged and funny just to mention a few qualities. I am done with my hours and have set upon private practice, thank god I have very little hair other wise I would have been given a dianosis by my peers from all the hair pulling it can cause. Can you recomend a good source dealing with the business aspects of our profession. As a therapist I’ll have a life time to learn as a business person its always the here and now! Thank you ahead of time.
Hi Giovanni–
Thanks for the kind words
. Congrats about your impending private practice–woot!
There’s many awesome resources out there for setting up a private psychotherapy practice.
Two great people who come to mind are:
Dr. Susan Giurleo @ http://drsusangiurleo.com/
Dan Franz, LMHC @ http://ANewDirectionCounseling.com
Good luck, and thanks for stopping by!
Here’s some random thoughts from my 21 years…
1) Striking the balance between under-confidence and over-confidence can be hard when you start out. You need to build an inner-supervisor to keep a check on where you are and get a perspective on yourself. Of course a good supervisor should help you with this too. From there you need to adjust yourself. Its a constant task.
2a) Therapy sometimes is therapy about the obvious. Deal with the obvious.
2b) We can’t mind read and nor can clients. That thought you have might be a good one – consider saying it.
3) Dont be afraid to ask about suicidality. Talking about it doesnt make someone more suicidal. The converse can.
4) First sessions can hold a wealth of information, seeds of what was before and what might come to be. Get your rabbits ears on (as Irvin Yalom says). Make good notes.
5) Therapy isnt for everyone. It isnt a panacea.
6) Know the limits of your skills. Really can you work with someone with a personality disorder?
7) Have therapy. Knowing yourself will aid clients enormously.
@Psyclyst–
I love you. These are more than tips–they are gold nuggets that only come with 21 years of experience.
My favs–
~ “Striking the balance between under-confidence and over-confidence…”
~”…build an inner-supervisor to keep a check on where you are and get a perspective on yourself.” <–is that like keeping tabs on your inner-child, and kicking its ass once in a while?
.
~"Dont be afraid to ask about suicidality. Talking about it doesnt make someone more suicidal. The converse can." <–WHOA.
~"Know the limits of your skills. Really can you work with someone with a personality disorder?" <–Good God. On most days, no.
You rock, Psyclyst. I wish I could come up with a Yalom-worthy quote of gratitude, but please know how appreciative I am. It's the awesomeness of therapists like you and the others (new and seasoned) that share in the name of good clinical work.
Linda would like you to check out…What John Wayne Can Teach Men About Depression
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