Theory and Practice of Contemporary Psychotherapies

Becoming a Therapist: Inside the Learning Curve Video Transcript

Melissa Miller: My first session I was really, really, really nervous. I remember standing outside and sweating palms and anticipating, "What if he doesn't come, what if he doesn't like me?"

Michael Wong: In that first interview I was anxious as hell.

Diane Wall: It's burned in my memory. I thought it was the worst ever.

Lisa Rasmussen: It was just my gut. It was kind of just churning and it was more my body. I think my mind— I just really didn't know— All I could think of was, "I don't know what to say."

Ron Benham: There was nothing about my program that prepared me for this.

Narrator: Becoming a therapist is a gradual process. It doesn't happen all at once. Step by step, this process involves reading books, attending classes, and writing papers. But the real work begins with seeing clients, doing therapy, and getting supervision. We wanted to get an insider's perspective of how students go from feeling anxious and uncomfortable to feeling more and more comfortable and confident to becoming a therapist.

We asked five student therapists to give us their firsthand experience. What's it like seeing your first client? What helps build confidence? What are some of the challenges during your first year of doing therapy? Many training programs show videotapes of the Master Therapists. They make it look easy and they've seen clients for many, many years. But they, too, were once just starting out. Each of these student therapists has had different training experiences and seen clients in different settings. But they all share similar experiences—the experiences you'll face on your path to becoming a therapist.

Miller: My biggest fear about being a therapist and starting in general was being—let's see, was I 24 at the time? A 24-year-old female looking brand spanking new. I really had a fear of looking stupid.

Wong: My worst-case scenario probably would have been my client flipping out on me, a client threatening suicide in front of me.

Wall: My worst fear was getting a client that didn't talk. And then what was I supposed to do and what was I supposed to say?

Rasmussen: Probably just ask me a lot of questions like what do I do, and me not having the answers for…

Miller: And I guess I had the idea in one hour that you could really mess up somebody's mind—that I could really do some damage and harm someone.

Benham: What to do when things get heated up was my biggest fear. And would I freeze up, and kind of be like a deer in the headlights?

Wong: I remember getting that first voicemail, and kind of opening up that voicemail on the phone with a little bit of trepidation and anticipation. "Oh my gosh, is this person going to say no or yes?"

Rasmussen: That first appointment we had scheduled, she cancelled, and I remember feeling relief and disappointment all at the same time.

Wong: I just remember that mixture of kind of jubilation and anxiety. You know, I was listening to this guy call back and say "Yeah, I'd love to come in, and I'll be looking forward to seeing you on X date." And it's almost like, on one hand, "Yes, I've got my first client. I'm going to get rolling. I'm going to learn how to be a therapist." And the other side is just like, "Oh my God, what am I going to do?"

Miller: I've really done a lot to get to this point, and this is what I think is my dream job. And what if I suck?

Wong: I remember that walk. That was just a nervous feeling. Not knowing what this person is going to look like. Not knowing how they are going to respond to you. And just not knowing how it's all going to pan out.

Wong: Hi there, Adam?

Adam: Yep.

Wong: Mike. So nice to meet you.

Adam: Nice meeting you.

Wong: Ready?

Adam: Yep.

Wong: There's like a million things just going through your head as you make that walk down.

It was a constant battle for me balancing trying to be real and trying to be intentional or relational with this guy who is here for the first time and probably, in my mind, doesn't have much of an idea of what therapy is going to be about and doesn't know what to expect. At the same time, I really don't know what to expect either.

Miller: "Oh my God! I'm about to go in."

Rasmussen: Hmm. It was very anxiety provoking.

Benham: It was kind of unnerving. Unnerving.

Wall: You know, we talked about it in class that everybody— It's common to be nervous and feel that way. But it wasn't until you actually experienced it that I really felt how bad it was.

Miller: He was a 54-year-old male, so that added to the pressure right there. I just felt so new and so inexperienced and nervous because I didn't really know what therapy was like yet.

Wong: I remember being so rigid and just so awkward with trying to ask him questions about his personal history and some of his presenting symptoms.

Wall: I thought it was the worst ever, and it pretty much threw me into therapy because I was like, "I don't think I can do this."

Rasmussen: I mean, she just came in there and spilling her guts to me and acting like I was a therapist. And so, "Okay, she thinks I can do it. I better sit here and do it."

Wong: So, yeah. Prognosis wasn't good for me at that point.

Miller: He came in. He was really— I guess I was lucky, I was really fortunate. I addressed it straight on, saying, "I'm going to be your therapist. I'm supervised—this is my first year. How do you feel about that?" And he was pretty great. He was like, "Yeah I know, heard it all on the phone. I know you're a student. I think it's great that you're young." And he just kind of went with it. So it kind of put me at ease. And then it wasn't hard—it was just like talking with someone.

Ah. Just this enormous sense of relief. Like, yeah, "I liked that. That was good. That wasn't hard."

Wall: When she got up to leave the room and I had to go back behind the mirrors and I was afraid to face my classmates, that's when it really hit me.

Miller: Yeah, it felt really good. It felt natural.

Wall: Well, I walked slowly. I was just afraid to face them, afraid of the comments, because I thought they were going to say the same things that I was saying to myself: "That was terrible, that was awful." And I remember I started crying. I got real emotional.

Wong: It was like the maiden voyage. It was over, it was completed. I was like, "Whew. Got through it, wasn't as bad as I thought."

Interviewer: What did they say?

Wall: Pretty much what you'd expect. "Oh, that was fine. You did good. It was your first time."

Miller: So it was an easy hour but it was really scary going into it. I didn't feel like I had any tools yet.

Wall: I think I had a hard time believing them. Yeah, they were trying to make me feel better.

Rasmussen: So I'd say the anxiety lasted probably for the first couple months. And how I coped with it? I mean, I think you just kind of sit with it and go in anyway. There's not too much you can do. I mean, it wasn't all-consuming. It's not like I was really absorbed in my anxiety periods before I saw clients or after. It was just kind of those 15 minutes when you're waiting for them to show.

I think my supervisor played an integral part in helping my confidence grow. I think I was very vulnerable with her and expressed a lot of doubts. And so she really supported me and would point out things I did well. And when she was helping me, it wasn't in a critical nature—it was more suggestions.

Wong: I think what was most helpful was being reminded that I didn't have to know everything at once. I didn't have to learn everything now. And that it's part of a process. And if you make mistakes that's just part of the learning curve. And that— I think the big one from my Seminar Leader was that "If you knew everything, you wouldn't be here now."

Rasmussen: We had a small-group supervision, so listening to other students' experiences, and everybody was just as anxious as I was. And everybody was making mistakes.

Miller: I think that what's helped build that confidence, is going into supervision and putting out all my bad stuff. Not trying to always cue the tape of where I'm doing my good job and I can't wait to show it off. It's putting it at the really bad parts. Or coming in with a problem and saying, "My God! Am I wrong here? Am I stupid? What's happening? I need help."

Benham: What has taught me the most is probably hard to answer because the theory I learned in the classes, I found useful in sessions in my practicum. And then what I learned in practicum was useful to my internship. So I couldn't be having the insights and the connections I'm making now if I hadn't done that stuff.

Rasmussen: I think it would be getting the feedback from the videotapes. Because, I think, it gives supervisors and other students a view into what you're doing. You really receive feedback on what you're doing in the room, versus when you don't have the videotapes and kind of when you explain what you said, it always sounds better than how it actually went in the room. But on the same token, a lot of times my impressions of things that I didn't do well, when other people watch them on the tape, they see them in a different light. "Well, I like how you did that."

Wong: There were so many times when I just wanted to say, "I quit." There were so many times when there were those crises of confidence. Those "oh, shit!" moments like, "I can't possibly do this. I can't get through all these classes. I'm not going to know how to do all these assessments properly. I'm not going to be able to handle the stress of working with clients."

Miller: I had a fear that they wouldn't trust me in the relationship or that they wouldn't want to work with such a young, inexperienced girl. And I held onto that fear for a long time, probably a year and a half. Especially once I started doing couples work.

Benham: In my internship I haven't had much free time at all. It's the one thing, it's this process, you're supposed to be teaching mental health but it kind of forces us to go off on the edge here where we're pushing the envelope—where we're really kind of dysfunctional, being overworked and trying to keep schedules that are just ungodly.

Miller: It's hard when you have to report child abuse and suicide thoughts. It gets sticky and it feels bad having to do that kind of stuff. So as important as I know the ethical limitations are when you reach some of them, it's really hard to deal with them. And it feels really bad. It makes you feel that your hands are tied. You don't want to do it, but you have to. And it feels like you are really violating that trust. It can feel like you are betraying your client.

Wong: The most challenging part of being a therapist is dealing with your own stuff. It's not always pretty. Having to deal with how your own experiences and your own beliefs and hopes and dreams and hurts come to play into the therapeutic conversation. And having to address those, and having to make sure that those have their place in your life but they don't cross over into the therapeutic realm.

Wall: I was like, "I don't think I can do this," or, "I'm going to be terrible." So, I had to go and work some things out. I definitely remember it.

Benham: I had not expected to be sitting here hearing the very same things I have said to counselors years before. And going "This is like déjà vu." I can't believe I'm sitting in this chair and they're sitting in that chair. I'm going, "This is really strange, just being on this side of it."

Wong: What helped my confidence the most was probably a combination of mere experience—just going through something enough times and seeing a wide range of experiences and clients and scenarios—that, plus probably having people in your corner who support you and validate you. And be they professionally or personally, people who know you, people who get to know you, and people who are able to remind you of who you are as a person, no matter what.

Rasmussen: Probably going into my second year, by that time I had three different individual clients and had picked up a couple. So I think I just felt, "I can make conversation now, I'm used to this. Worse comes to worst, I could probably pull something out of my head."

Wall: Probably just getting in there and doing therapy and getting positive feedback from the clients. It wasn't enough to get it from other students or from professors. I had to actually do it and then get some kind feedback from the clients.

Rasmussen: I think a real turning point for me actually would be going into my second year and talking to first-year students who had never seen a client before and how anxious they were. I mean, that really put it in perspective of my progress and how far I had come.

Miller: My confidence has— It was pretty low to start off with. And I wouldn't say it's extraordinarily high now, but I feel confident walking into the room.

Wall: I was a travel agency manager. And I did that for about 13 years.

Rasmussen: I think I knew I wanted to go into psychology as soon as I started college.

Miller: Growing up, one of my best friends' mom always would call me "the counselor," because whenever there was a problem I would always kind of wiggle my way in and wanted to talk about it and want to process.

Wong: What I thought I'd grow up to be was definitely not a therapist.

Benham: I'd been a pilot for the last 18 years. I just got more and more miserable flying. I mean, especially when I was flying nights, going and getting body parts for surgery, you know, for heart transplants and bone transplants and all that stuff. You know, I'd be flying at three o'clock in the morning and I just hated it. Hated it, hated it, hated it. There was one night I was taking off out of Salt Lake City and I just remember the sun was rising and we were light, so the airplane was climbing like a banshee and I'm like, "This is really cool and I'm not really enjoying it. There's something wrong here." And that's when I thought, "You know, I really do need to be more aggressive about getting out of this."

Miller: Yeah, so just to take a big deep breath. And that it might not go real smoothly, but it's all about being in a relationship and we've all done that. It's not that much different than meeting someone out and striking up a conversation. If you care about what they have to say, it's going to happen naturally in the room.

Wall: Don't be afraid to make mistakes, because you're going to.

Rasmussen: But I think with the anxiety, you just kind of have to sit with it and deal with it. If you weren't anxious, I think I'd be a little worried.

Benham: They survived my blunders. You know, actually some of my blunders have turned out to be good interventions. I mean, it was useful to talk about it. So what has given me more confidence is just to know that, you know, we are human, we can mistakes, and good things can come out of those mistakes.

Wong: The most helpful thing anyone's ever said to me in the course of my training is, one time when I was being supervised by a senior student in our program, the piece of advice he gave me was, "It's not what happens, it's what happens next." That stuff doesn't just end in the present—see what emerges.

Benham: I would like to encourage people who are learning to take the risks and to share things because that's the only way you learn stuff. I see a lot of people, my fellow interns who, when we're having discussions, holding back and not wanting to share. I think it reflects well on somebody if they are out there willing to skin their knees in public.

Miller: And I think just asking for help and showing the worst and really talking about it makes the learning curve jump up so much higher. Because you're really facing the problems head on.

Benham: It's like, things just keep reappearing. If you don't get to it, it's going to come back in. I've been really surprised how things are repetitive. You don't have to catch it the first time.

Miller: It would've been really helpful had someone said before my first session, "You know, you don't do all therapy in one session." It's such an intimate thing that goes on in the room. To be able to experience that, and see the changes that happen, I like that. And I like working so close with people.

Rasmussen: The part that I enjoy the most about being a therapist, I think it's a real honor to go, to progress with people. And the client that I've had the longest just came in with so much anxiety and depression and self-doubt. It's amazing now to hear her talk about how confident she is. Just the way she interacts with people is so different. And to be able to go that journey with her and sharing that with her I think is so rewarding.

Wong: I realized how much the simple act of just being able to be present and just relax and kind of let things unfold—how much of that is such a significant ingredient in building rapport and getting the therapeutic process going.

Miller: It's not an issue anymore. I feel a little more confident in myself, that, yeah, I'm young, but I can work with people. I can relate to people. I can try to get them. I can put myself in their shoes and maybe see their side.

Rasmussen: For me a good therapist, I think, first and foremost, is just someone who is genuine and present in the room. One of my supervisors, that was our first session together, I was like, "What do I do?" And he said, "Forget about theory. Go in there and just be you." And I think that's really important, because whatever technique or theory you want to use, if it doesn't come out being genuine and being real, it's not really going to be effective.

Wong: The biggest compliment I ever received was from a supervisor who told me I had a great future as a therapist—that my clients are very fortunate to have me as their clinician. If that doesn't do wonders for boosting the confidence, I don't know what will.

Wall: It was one day, this lady I had in session, she was talking about talking to her friends and husband and saying that she wanted to go and talk to her therapist. And it just kind of hit me: "I'm her therapist." And I never called myself that—I'd always thought of myself as a student, you know, and I'm an intern. But to her, I was her therapist. And that just gave me a really good feeling to be somebody's therapist.

Miller: I love what happens in the room. I love, I like being connected with people and feeling like I'm a part of their journey.

Benham: You know I've done other jobs, done other careers, and just never felt like I was suited or was made up for that type of work. And here I'm like, "Yeah, this is the chair I'm supposed to be sitting in."