Top Three Things Every New Therapist Should Know

“Do you think you could tell me the 2 or 3 most important things to remember when I start working with my clients next week?”

This is a text from my amazing writer friend, Kim Knutsen, who is a graduate student in counseling and just starting her first practicum at an outpatient facility. 

“Sure,” I texted back. “But I’m going into session. I’ll get back to you.”

Ever since I started teaching graduate students, I have loved questions like this one. Most students experience their graduate training as a firehose of academic information and complex (and interesting!) research articles, often worded in abstract ways with a generous amount of jargon. They begin to talk like wizards intoning spells in an ancient language. But when you open the door for a client’s session, you have to figure out how to ground yourself in the moment. Where is your mooring when you go out to this particular sea? As I moved into my next client meetings that afternoon, I tracked the concrete things I did to prepare for each session.

Two hours later I answered Kim’s text. Here’s what came to me:  

  1. Go to the bathroom first.
  2. Be human. 
  3. Read your notes.

Go to the bathroom first. This one might seem silly. When I went through graduate school, no one told me how important it is. (They also never told me how important it is to hydrate throughout the day.) But the only things worse than needing to pee during a session is your stomach growling,  hiccups, or farting. I was many years into the profession before I realized that in many ways doing therapy is physical work. Not only are we listening closely to the client’s story–both the actual words and the unspoken meanings–but we need our bodies to feel alongside them, to tune into our gut responses, intuitions, and empathic resonances. Like a drum head feeling vibrations in the air. It’s easier to tap this visceral resource if there are no other distractions in our bodies. And it’s essential to have this resource.

Be human. In both graduate-level and continuing education classes, I often share this lovely passage from the mid-century psychologist Carl Rogers (language adapted by me to be more inclusive):

Before every session, I take a moment to remember my humanity. There is no experience that this person has that I cannot share with them, no fear that I cannot understand, no suffering that I cannot care about, because I too am human. No matter how deep their wounds, they do not need to be ashamed in front of me. I too am vulnerable. And because of this, I am enough. Whatever their story, they no longer need to be alone with it. This is what will allow their healing to begin.

It’s not that knowledge and expertise and diagnosis and best-practices-informed interventions aren’t important for success. But they are the backstage props to be brought to the front of the stage judiciously, when the timing is right, when the client is ready. No therapist should lead with expertise (i.e. ego). Presenting a smart persona doesn’t matter to clients who are suffering. Looking at someone with an expert’s microscope gets in the way of appreciating the client’s story of who they are and why they struggle. And it often just makes them feel badly. What matters is that they feel safe.

Read your notes. What happened the last time you met with this client? What were your curiosities about them and the challenges they are tackling? What were the questions you didn’t get to ask? Most importantly, what are the themes at the heart of their struggle? I am reminded of an poem by William Stafford called “The Way It Is.”

There’s a thread you follow. It goes among
things that change. But it doesn’t change.
People wonder about what you are pursuing.
You have to explain about the thread.
But it is hard for others to see.
While you hold it you can’t get lost.
Tragedies happen; people get hurt
or die; and you suffer and get old.
Nothing you do can stop time’s unfolding.
You don’t ever let go of the thread.

One of my jobs with my clients is to find the thread, see it, articulate it, and to hold onto it, as if we’re both travelers in the same mythical labyrinth. Often our clients come to us with a fragmented, disjointed, jumbled narrative and we help them to find the coherent story under the confusion, by listening closely, following our curiosities, asking about missing pieces, sharing our gut responses, and trying to resolve our own confusion about what’s going on.

What are your top three things? Please share in the comments.

Good luck, Kim (and everyone going into their first meetings with clients). Here’s the last thing I’ll share with you: You are going to be terrific at this work!

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Kathry Ayers - May 9, 2023

Some of the things I try to remind myself before meeting a client are:
1. Remain humble.
2. Be aware of both my strengths and my areas of weakness.
3. Prepare by reviewing the information I already have.
4. Put away any judgements.
5. Remember we are all humans capable of mistakes, but we must “own” them.

Jen - May 9, 2023

You can’t solve all their problems! The system is a mess, so help them decide where they want to focus efforts. Same goes for you as the helper – you alone cannot dismantle the system, so focus on the things you CAN do to improve things.

Linda - May 9, 2023

I love yours, and get a kick out of the bathroom! It took until that last 10 years of my 22+ years in the field to 1. really write good notes and 2. systematically review the last note before session. It saves me, and clients even feel it’s helpful to do it in session to keep the thread of or our work connected and running.

So my current 3 would be:

1. review notes

2. ask the universe to work through me (but be human, not brilliant)

3. when the door closes after client enters, the rest of the world goes away

    Wayne Scott - September 4, 2023

    Linda, can you email me the name you use professionally? I love that last sentence.

Julie Farnam - May 18, 2023

Thank you. My 3 are:
Have some ideas for where to go and what to do but don’t be attached.
Remind myself that I’m a vehicle.
Review previous session outcome with the client as part of checking in.
(If I have kids, start with snacks.)

Angelina Davis - June 13, 2023

Really, really listen. Don’t think about what you want to say next. It will flow if you are truly in the moment with your client.

Suze Gadol Anderson, LCSW - June 13, 2023

Here are some of the wisdom that was passed down to me as a therapist:

Be sure to schedule lunch. When I started my private practice was sparse, this seemed superfluous. Practices get busy, & it is easy to forget our needs.

When in doubt, reflect what you hear, validate & empathize. You may not always have answers or insight to share, & that’s okay. If we’re present & are listening, that helps a lot!

When someone succeeds, it’s not because of us. If someone is struggling, it’s not because of us. Check our ego.

Countertransference is grist for the mill. If we have a reaction to our client, it can be good information about how they function in the world.

All of us felt concerned that we would harm someone when we started. We can learn from our mistakes to be better therapists. We’re human & imperfect.

Hillary - June 13, 2023

1. breath and connect to the other ~ its all about the energy and emotion they bring, and you are a vessel to carry and reflect
3. invite them to step back from the energy/emotion and develop a narrative, name, place, etc. in various spaces of their life
4. track progress, set backs and their mastery of the back and forth between thoughts, actions and feelings – classic CBT.

Elissa - June 13, 2023

The best advice I got from a clinical supervisor when I was in practicum was simply “do less.” It is so easy, especially in the beginning, to feel that to be successful in our role and help the client, we need to “do” something. But when we are in that state, we end up distancing ourselves, acting “upon”, instead of being with and allowing. Whenever I find myself stuck in a session, not sure how to proceed, I always start with “do less”, which inherently allows me to be more: be more present, more aware, more compassionate, more empathetic, more insightful, more patient, more genuine, more loving…

And yes, going to the bathroom before a session is also great advice!

MaryBeth Hernandez - July 5, 2023

1. Stay curious, ask questions. As Aristotle said, “The more you know, the more you know you don’t know.”

2. Your presence is powerful and can be very healing. Don’t feel pressured to fill every moment of silence with words.

3. Don’t forget to check your teeth if you just ate! A little pesto in your grill can be so distracting!!

Henry Killingsworth - August 4, 2023

I thought it was interesting when you explained that it is important to be human when you are trying to be a better therapist. I would think that it would be important to try to continue to further your education when you are trying to be a better therapist. Working with a mentor could be a good way to become a better therapist.

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