Even if you’ve done all that is required to become an educated and licensed clinician, if you are only a few years out of school, you are vulnerable to making beginners’ mistakes. This article is in the spirit of “forewarned is forearmed.” By learning about common mistakes, you can perhaps avoid committing them.
These “mistakes” are not necessarily terrible errors that will cause irrevocable harm to clients. Rather, they reflect issues that cause many new clinicians to fumble or lose their way for a time when they get anxious or when they are confronted with something new. I’ll venture that most senior clinicians had to wrestle with them to some extent as they gained enough experience to be sure-handed in their work.
1.Being too eclectic: A solid base in one theory provides the structure and guidance we all initially need to organize our thinking and give direction to our treatment. Even as an experienced therapist, the philosophy and practice that is your theoretical foundation will provide a starting point for understanding and managing a particularly difficult case. When we get stuck, it’s often helpful to go back to the basics of our original theoretical training.
As the years go by, most of us do add new ideas and new skills to our therapeutic toolbox but it’s important to integrate them thoughtfully, not to develop a grab bag of unrelated techniques.
2. Taking on clients without necessary training: As one of my colleagues joked, “We don’t need to have already talked to a five legged Martian to treat five legged Martians.” If that was the case, we could treat only people who are remarkably similar to others we’ve already treated. Fortunately, it’s a reasonable assumption that people are more alike than different.
That being said, there are special populations and problems that require skills that may be outside your initial training. Remarkably, for example, my graduate programs in the 70s did not include any information about alcoholism or drug abuse.
The first time I figured out that a client was drug-involved, I was at a loss. I therefore referred him to a more experienced therapist. The incident made me realize that there was a big hole in my education. I sought out the additional training I needed to offer good help to clients with addictions.
No one can know everything about everything. Of most importance is that we’re honest with ourselves about who we can and can’t treat effectively. We always have at least two options: We can decide to get more training. Or we can decide that we won’t treat certain people or certain diagnoses.
3. Over-identification with the client: I was surprised and dismayed when a supervisee who was recently divorced declared that he knew exactly what a new client was going through. The client was in the midst of a contentious divorce. My supervisee suggested that if only the client would do what he himself had done to weather his divorce, the client would feel much better.
In his eagerness to be helpful and perhaps to regain some sense of competence, this new therapist forgot to listen for the client’s unique experience of a similar life crisis.
We all search through our personal mental files of experience for a starting point of mutual understanding when talking with our clients. But our job as a therapist is to listen with empathy to how the client experiences the events of their life. Often enough, their interpretation or response is quite different from ours.
4. Too much self-disclosure: Self disclosure can be very helpful. Done well, it can facilitate client trust, normalize the client’s experience and even serve as an intervention by example. The flip side is that it can take the focus off the client’s issues or can indicate to the client that we don’t understand how they are feeling since our story doesn’t really quite match theirs.
It can even be interpreted by the client as a shift in the relationship to one of friendship or even romance.
One of my supervisees meant well when she shared with a client who was grieving an abortion that she had also had an abortion as a young person. She meant it as a show of empathy and support. What she hadn’t anticipated was the client’s request for a transfer.
When asked why, the client said that she didn’t think that someone who talked so openly about her abortion could possibly understand her grief and her sense of shame around it.
When another new therapist shared her struggle with her own two-year-old with another young mother, the client started calling her to make play dates for their kids. She thought the therapist was offering friendship because they had so much in common.
Knowing when and how to self-disclose is an art form. It needs to be done cautiously and strategically. Although some clients appreciate confirmation that the therapist is a real person with real, and perhaps similar, challenges, others want and need us to present a professional self that keeps the focus directly and solely on them.
5. Premature intervention: Therapy is often an exercise in personal distress tolerance for the therapist. It is very difficult to sit with someone who is in emotional anguish and to feel that there may be nothing we can do about it – at least in the moment. The pain in the room can push us to try to do something, anything, that shows both ourselves and the client that our help can be helpful.
But intervening without understanding can be useless at best, destructive at worst. We need to contain our own anxiety so we can listen carefully to the client’s story in its fullness. We need to empathize without becoming paralyzed. It’s our job to provide a safe holding environment that gives the client room to find their own strength and their own solutions.
Compassionate presence and empathic questions are often intervention enough. Thoughtful suggestions can be added if needed as the case unfolds.