Intimidated By Doctors?

Physicians and therapists are people, too. They may protect themselves by not getting emotionally attached to ill patients—but come off as cold and uncaring. Worse, when doctors fail to deal with personal problems—or are too busy worrying about the bottom line—it takes a toll on everyone's health.

Be Prepared: The First Therapy Session

How do you know you are prepared to work with clients?

As I was working at my desk today, a student came into my office. Every inch of her body was communicating fear and uncertainty. She asked if she could talk to me, so I invited her to come in. Sitting down, she looked at me and quietly whispered "I am not ready for this. I am not even sure I am in the right profession."

In the program where I train future psychotherapists, students have to complete a semester of pre-practicum before they start their internship. During the pre-practicum, students do not work with the "real" clients, but practice with each other instead. They role-play counseling sessions with their classmates, video tape them, and receive feedback after showing those tapes in class.

The student who was sitting in front of me had just come from her first attempt to role-play a session. Every time she sat down to begin the session, she felt awkward, confused, and unable to find the "right" words to start. Now she was holding the still-blank tape in her hands, softly repeating: "I am just not ready."

"How will you know that you are ready?" I asked after she calmed down and could listen.

"I will know how to help my client," she said quietly.

"What do you envision you will do to be helpful?" I continued.

"I am not sure. I guess that's why I'm paralyzed."

What sort of expectations do therapists set for themselves when clients come into the office? The answers usually include statements such as: help clients find solutions; empower them; and take their pain away. These are ambitious goals. No wonder new therapists feel pressure and confusion before their initial sessions. There is no formula that works for all clients.

The nature of the therapeutic process involves unexpected outcomes and the uniqueness of each session. No matter how many books new therapists read, or how many workshops they attend before starting their internship, once they find themselves listening to their first client they will often think: "we never talked about this in class, and I was never taught how to respond to this kind of problem."

All new therapists yearn to feel prepared when they begin their work with a client. But before new therapists attempt to create that feeling they need to ask themselves a question: what are they preparing themselves for? What goals are they trying to achieve? Preparation is not simply a matter of knowledge, or emotional availability, or good intention. It is all these-and more. Because therapists generally do not produce a tangible product, and clients do not always walk out with measurable changes, it can be difficult to define what "being prepared" means.

Therapy is more than a basket of techniques, questions, and home assignments. It is important to have knowledge of the techniques and interventions that can be used in session, but new therapists also need to develop the courage of just "being" with clients. They need to learn to connect with the person sitting in front of them before they start applying the techniques they have learned. They need to know how to manage their anxiety when they do not know how to respond. They need to realize that therapy is about more than simply taking clients' pain away.

It is human connection and acceptance that makes therapy special and productive. This is what allows clients to find their confidence and work on their problems. Of course, students need to know and follow one or more theories behind the counseling process. But they do not need to remember every single technique of a given model, or ask the perfect question when clients are sharing their story. When new therapists are sitting in session they need to be willing to trust themselves and be present. Whitaker once said: "my theory is that all theories are bad except for preliminary game playing with ourselves until we get the courage to give up theories and just live."

This is one of many things that makes the therapy process special - that in order to feel prepared, we need to give up what we have learned, and connect with the client-bravely and honestly, without knowing exactly what is going to happen.