So you want to be a psychotherapist? 11 Things to cultivate.

This is the list that I wish someone had given me when I began my journey as a therapist. I hope people considering the profession of psychotherapy will get something out of what I’ve chosen to pay forward, and that my colleagues will chime in on the comments with their own wisdom of what therapists need to cultivate. I’m speaking from my own experience. I’ve worked in the mental health field for 10 years, and have been a licensed Marriage and Family Therapist three. I speak not as a veteran professional, but rather someone who made it through the first three years of private practice, and has managed to stick around and continue to grow. At my level, I think it’s important to try to help to people who are just starting out, just as I think it’s important to try to be around and learn from people much more experienced. So here’s my list of what a beginner therapist should cultivate (which are fairly sound qualities to cultivate for anyone who works with people and values relationships).

1. Learn to sit with silence. It’s uncomfortable, and there’s the urge to fill silence with knowledge, help, advice. There are times for all of those things. But sometimes it’s best to be still and allow the person in front of you to process and mull things over without someone jumping in to rescue them. One of the best things you can do as a therapist is learn to control your own anxiety, and this means not rushing in to reassure, give advice, or anything else that diverts the client from feeling their feelings.

2. Become ok with people being upset with you or in your presence. The job of a therapist involves asking personal and sometimes impolite questions, asking people to look at things they don’t want to see, and asking them to change behavior that has become entrenched. If you are doing your job correctly, chances are someone is going to be upset now and then. If it is because of a legitimate mistake that you made, and you will make them, then you can apologize and be a model for someone who owns their mistakes. Apologize sincerely; do you know what a gift a sincere apology is? Work on whatever it is you did that was the mistake. If it has nothing to do with you, then it’s important to stay grounded in that, and allow the person to work it through, in their relationship with you. Taking it personally is making it about you.

3. Learn to keep a secret. Forever. It’s the law. It’s an ethical tenet. Know the laws and ethics of confidentiality in your profession and keep them. Honor your clients. This is not the profession where you get to brag about how awesome of a job you did on a project, unless you get to the point where people pay you to speak at workshops at conventions, and you know where the boundaries are.

4. Develop, maintain, and communicate boundaries. Know your position on hugs, gifts, running into clients in public, that extra five minutes at the end of the session, doorknob moments, secrets within couples, phone calls between sessions, forgotten checkbooks, missed sessions, and the clients that sometimes feel more like friends. Struggle with ethical quandaries when presented with them.  Behave in a way you consider to be highly ethical. Consult colleagues and your professional association on what is appropriate, what is ethical, and how to handle grey areas. Document.

5. Set goals, have hope, and remain unattached to outcomes. Show that you are going somewhere with the treatment, yet remain flexible to what comes up. See the potential and have hope it will flourish even if the client can’t yet. Know that there are some who you can’t help, whether you are the wrong therapist for them, or they aren’t ready to change. Don’t work harder than a client is willing to work for herself.

6. Resist giving advice. Start an advice column if you need to. But don’t give a lot of advice in sessions, and don’t give it the first time you are asked for it. Most of the time people need to find their own answers. Point out resources to help clients help themselves. Telling people what to do most often backfires. It also is a good way for you to get attached to your own advice and outcomes and then build resentment when someone doesn’t do what you told them. Learn it the hard way if you need to.

7. Be in the here and now. Most of the time, what is happening in this moment will lead you and your client on the path towards healing more than puzzling through a story that they are telling you about the past or sorting through their fearful future projections. Being present will bring you into a deep sense of yourself, and will be a powerful model. When you and your client are in the present, old beliefs die and new possibilities are born.

8. Contain the energy. Learn to be strong in the face of pain and tragedy, learn that sometimes there is nothing to say but just being there is enough. Allow someone their anger and petty feelings so they don’t have to be stuck there. Try not to be too awkward with rage, tears, sexuality, obsession, grave disability, psychosis, mania, depression, and grief. Learn to regulate your own emotions and learn to teach that skill.

9. Be ok with admiration. I said before that if you are doing your job well, you will probably have someone upset with you. The same goes for admiration. It’s a passionate business and we are an intimate confidante. Be ok with those times when someone looks up to you, quotes your words back to you, thanks you for all you have been to them. Allow yourself to really receive that, and let it wash through you. And don’t hold onto it or let your ego get too cozy. It will come again, or it won’t. The client may need to feel anger in the next session. Let the process happen.

10. Get out of the way. Let the client talk, no matter how clever the thing you wanted to say was. Be yourself and be present, but don’t self disclose unless it is therapeutically relevant. Don’t talk about your own problems, make the client need to care for you, or burden them. But don’t be a robot or feel like you can’t be human. Basically, let your client know that you have emotions that run deep, but that it’s your job to handle them and to handle what comes up for you on your own time. Listen deeply and respond when appropriate. Say less. Draw things out rather than preach. Keep your opinionated quips to yourself, or if you can’t, cop to making an opinionated quip. Do not go into this profession for the admiration. The less you interfere with the process, the more it will carry you both to a place of healing.

11. Do your own work. This is the most important of the whole pack. If you blow off everything else in this article as crap, humor me on this one. Get your own therapy, do your own soul-searching, understand your triggers, and deal with your baggage. If you don’t, I promise it will show up to haunt you in every day of your work. Note your strong reactions, get supervision, consult with colleagues. Take really, really, really good care of yourself, the best vacations you can afford, get massages, exercise, eat healthy, love yourself like nobody’s watching, because you are your own instrument in this work and you are useless when you’re sunk. You are so brave and important to want to help people, but you know you came to this to heal yourself. So give yourself permission, and never be afraid to ask for help.


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About Lia Salciccia Prusha

therapist and blogger
This entry was posted in Therapy, Uncategorized and tagged , , , . Bookmark the permalink.

9 Responses to So you want to be a psychotherapist? 11 Things to cultivate.

  1. Robin Barre says:

    Oh Lia, thank you, thank you, thank you. I knew all of this already, of course. Because I’ve read it in books or heard it from my professors. But this is the first time I’ve heard it from someone who started out right where I was. So it resonates even more. And what perfect timing. I hope to start seeing a client or two beginning in January as I begin a private practice. This is just what I needed to hear/read. And I’m going to come back to it many times, I’m sure.

    The great Winnicott said that the biggest mistake he made, and he made it for years before he caught on, was that he talked too much and interpreted *for* his clients. He said he wished he’d just shut up and let the client do the work.

    And lastly, have you ever seen “Two and a Half Men?” Not the most erudite of shows, but Jane Lynch plays the funniest therapist! Those quips you speak of above is what made me think of this.

    Again, thank you so much!

  2. Zoe Kunstenaar says:

    Extremely well put! My own details;
    1) The greatest thing I had to learn in grad school was _not_ giving advice! We go into this profession because we feel we have something to give-and we need to realize that this is our ability to be present, not to preach wisdom. Sometimes I do give advice, but I try hard to lead people to rational conclusions rather than tell them what they should be doing or thinking. My most often piece of direct advice: “You will be happier if you treat yourself more tenderly!”
    2) Not taking it personally for me (especially at the beginning) meant talking to other therapists about my experiences! I also learned over time that you can think you did a terrible session and they come back with great results, and vice-versa.
    3) You never know who may end up knowing whom! My roommate just ended up being hired by a client of mine-which none of us knew until she called the house number and heard my name.
    4) The hardest boundaries for me used to be ending a session-especially when things have gotten really intense. I deal with this in two ways. Firstly by having longer sessions as a norm, but mainly by having a policy of giving “homework” every week. My clients quickly learn that the being assigned hw signals the end of the session-and its a segway (sp?) for the next week.
    5) I’m a really good therapist, but that doesn’t mean I’ve been able to help everyone. I haven’t. I wish I could know if someone else was able to help them-but it’s really rare to find that out later. I need to remember both that I _am_ good, and that I don’t have to be perfect.
    8) I actually have met wimpy therapists-both that I’ve gone t0, and at workshops and conferences. I don’t understand how anyone could be an effective therapist if they aren’t comfortable probing into tender spots. Sometimes therapy is like surgery without anesthesia-no way around it.
    9) I love it when I get admiration and gratitude! It feels great. I temper it by turning it around and attributing the strength and change to my client’s work. This makes them feel good and work even harder. I also remember that my level of excellence by no means directly equates with their gratitude. I’ve done amazing work with people who haven’t been impressed, and easy work with those who’ve decided I walk on water! I have to judge myself by my own standards, foremost.
    10) Avoiding self-disclosure can be really hard! I try to test any of it out in my mind first, for relevance to the clients therapy. I hesitantly shared an emotional process with my client yesterday-how I had recently worked to overcome a defense mechanism that been really helpful for me but wasn’t helpful anymore. It turned out to work for her-she mentioned later in the session how her understanding of her own defensive mechanisms were making more sense to her-just like the “guard” that I had envisioned in my own process.
    11) I definitely agreed that this is the most important! Good therapy becomes next to impossible when I’m depressed or frightened by the world myself. I have to have a genuine belief in the goodness of existence! This sends me scrambling to get help if I ever do go through a hard period.

  3. Arah says:

    Thanks, Lia. I needed to hear this right now, as I have been struggling with some of these issues. Remaining unattached to outcome has proven more difficult in practice than in theory for me. I am continually working on the not taking things personally part. It is such a strange and wonderful profession.

  4. Lisa Palladino says:

    A really wonderful piece, Lia. I read this last night after another depressing day in community mental health. I could cry at the soul crushing nature of the system I work in and the dehumanizing aspects of it, and that this is where I have to be if I want to collect my hours without being more impoverished, so this was such an articulate reminder of the responsibility a therapist takes on. It also reminded me of the precepts to honor even when I’m not sure I am in an environment where many others do.
    Particularly, I liked that you include the here and now, because long tales seem to be very popular among my case load this year. After present centered awareness was met with such disdain, I thought am I crazy for thinking that works? Am I full of shit? It was very reassuring to see you refer to it, and it made me wish we were in a peer supervision group together. Keep up the good work, you’re an inspiration.

    • I think it is more difficult to do the kind of work we’d like to do in that setting. Your comment brought back my experiences in community mental health, especially the long tales part. It’s a place where people are encouraged to be victims and funding occurs only when people stay unwell enough. It is a fairly broken system, and I ended up just trying to be present myself and to not call attention to present centered awareness but just amplify it when it happened. I wish we were in a peer supervision group, too. I’d give you a hug. Thanks for your kind words.

  5. Bryan Prusha says:

    Excellent post. There’s a lot in here for the layperson to consider in their own lives as well.

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