Therapy

Becoming a Clinician: Therapy, Supervision, Consultation

Mixing it up with the experts: Psychotherapy

Posted Jan 20, 2021

Psychotherapy

A psychotherapist’s career often begins with that frankly terrifying first appointment –as a patient. Walking into any new doctor’s office is frightening, and when the doctor is a “shrink’ it likely more unnerving than you expected. Where are you supposed to sit? There’s the famous “couch.” Are you going to be expected to lie down on it?  How are you supposed to start talking? Are you supposed to answer the questions she throws at you? The middle-aged woman sitting across from you –can she read your mind already? Neatly dressed in a pants suit, does she think you look exceptionally sloppy? The main question flying in the back of your mind: “Am I normal? Am I crazy? Are you going to ask me about my sex life?”

Rachel’s first encounter with psychotherapy seemed rather typical.

Therapist number one didn’t work out. She was a cold woman who seemed to have trouble speaking. A parody of Freudianism, the few words she’d utter in the course of an hour were delivered in a stiff monotone, feelings entirely absent and often, frankly incomprehensible. At least they had little or nothing to do with whatever Rachel was describing –admittedly, she said: “My tears may have made up for the chilly atmosphere.” Assuming the therapist had the best of intentions, Rachel reported: “She must have thought she was doing the right thing, at least she seemed entirely confident of her “interpretations” of my monologue. I saw her three times, leaving each session feeling more despondent than I’d felt beforehand.”

If reacting to that first exposure to the talking cure, Rachel were the kind who gave up on the whole endeavor, she never would have ended up in graduate school, heading for a career in psychology. But, stubborn and most definitely not a quitter, she collected names from a circle of friends and interviewed a whole string of therapists before settling in for another try at transformation. Rachel was well on her way to embarking on a career as a clinician.

 “I adored my second therapist, and within a few years, I’d turned myself into her mirror image, imitating her every move and determined to set the world on fire with my newly found confidence. An analyst by training, she’d long before dropped the frankly incoherent remains of the influence of the Institute from which she’d graduated. She mumbled through our sessions, her speech was usually blurred and I often couldn’t quite make out what she was saying, but it didn’t matter – I felt her support and compassion. I loved her intellect. I loved that with time, I knew she loved me.

“She was a radical feminist, she always wore, jeans, a navy jacket and a wild array of earrings and crystals. She taught me that I loved the mother I’d always thought I hated and she convinced me that my tendency to sweetness didn’t make me stupid –it just blessed me with the problem of sacrificing myself in my quest to save pathetic men who craved attention and affection from self-sacrificial women.”

According to Rachel, the therapy would have gone on forever, but for a deadly form of breast cancer that killed her beloved therapist, her role model. “It took a long time to recover from the loss, but she’d taught me enough about survivor guilt to eventually help me think and act my way out of the depression that fell upon me.” The whole experience was deeply moving and changed the course of her life. 

Ten years later

Ten years later, Rachel was beginning the first year of graduate school in counseling, and about to see her third psychotherapist. This one –a man—was balding and what was left of his hair was white. He was wearing baggy blue pants and a grey sport’s jacket. He sat there staring at her –she said it seemed like minutes, “but it was probably only a few seconds before, in a deep voice he said: “How can I help you?”

Stammering, I told him I was working on my MA degree in clinical psychology. It felt too arrogant, to say I was in training to be a shrink. I left that out.” Instead, Rachel explained, she’d been working as an advocate in domestic violence, accompanying women to court, helping them fill out the endless paperwork required when they’re going for a TRO (Temporary Restraining Order). “Not my own. I left that out too”. Continuing on with the story: “I told him how I’ve  wanted to deal with my “field” by helping people as individuals, instead of seeing them as political victims, the approach I’ve been taking for a few years now in my work in domestic violence.”

Watching his every move, she saw his interest rise when she mentioned her partner, an attorney working in the public defender’s office. “Sexist,” she thought, “why else was he obviously more interested in the guy I’d been living with than with my history.” Making it through the agonizingly dreadful hour –Rachel had decided to fire him before she heard the familiar: “Our time is over.”

 Finding someone to talk to...again...and again....

The following week, almost:  “Deja  vue” of what she’d gone through years before, when searching for a helpful therapist after that first miserable experience, Rachel got a list of names from the Field Placement office at school, “recommendations” the school offered, with their positions and their theoretical perspective. Seeing an analyst was still considered top of the line, so she picked out a few women who classified themselves as “Contemporary psychoanalytic, Feminist” and  “Sliding Scale.” Graduate of a local psychoanalytic institute. Memories of the therapist she’d loved, the reason she was here, embarking on her own career, flooded over her.

 Selecting three names, Rachel sent each an email, introducing herself and requesting a consultation appointment.  She’d learned from years of experience, years of trial and error in the world of clinicians; some therapists are great and some are awful. Until you meet and evaluate potential therapists, there will be no commitment. “Go meet her, see how you felt during the appointment, see how you felt afterward, Did you want to go back? Did she look like your perfect healer, the role model you’d lost years before? Did she make you feel competent, embarking on your career, or did she make you feel crazy?” Rachel knew how to find the right therapist, she’d been there before.   

And so it begins, the long road to becoming a psychotherapist. Most of us who end up devoting ourselves to the life of the clinician, begin our career path with a good experience in therapy, with someone we adored.  The heart of our field begins and ends with the relationship between two people. In the first round, you hire the therapist, you’re the patient and you hire her ostensibly to help you deal with your psyche, your irritability, moodiness, your unstable relationships with your parents and/or your partners., friends, and with your children, if you have any. You –or your parents or partner—pay the therapist for services rendered..

And then comes the Supervisor

A few weeks after finding a therapist she liked, Rachel, our first-year graduate student in clinical psychology, was nervously getting ready to meet yet another psychotherapist. "What should I wear" she worried, wondering what kind of impression she should try to make. This one, a young woman, had been assigned to her by her graduate program. Rachel was about to meet her first clinical supervisor, 

See Part II for "Becoming a Clinician, Part II: Supervision"