Qualifying as a counsellor is a huge achievement. We all know the hard work, sacrifice, time and monetary investment involved in the training process.
The feelings of pride and jubilation can often be tinged with anxiety too. We can no longer safely hide behind the “in training” label. We are counsellors now and with that comes all of the responsibility and expectations associated with this important role. Add in the new layer of taking money for your services and the apprehension is real!
Here accredited psychotherapist, Sharon Zucker, offers her advice on managing anxiety as a newly qualified counsellor.
I remember the first time I heard the words “It’s time to look for suitable placements.” I was only a few months into my counselling training and this sentence caused my body to tense and my stomach to stretch up into my throat. When I was able to look up again, I noticed my classmates sitting calmly with pen to notebook, simply absorbing the information. We seemed to be in two different worlds.
I asked myself the familiar question, “Is it just me?” Soon followed by, “Isn’t anyone else anxious about this? Do we really feel ready?” The class became quiet, turned to me and stared, which is when I realised that these weren’t thoughts but more words being blurted out.
I followed this up with, “This is an awesome responsibility. Someone depends on us for help, for answers. I don’t have all the answers.” I looked around the class, “Do you?” “We don’t have the right to do this because we are not ready! I’m not ready!”
My tutor looked at me with her calm smile and quiet voice, tilting her head and breathing in before answering, as if I wasn’t the first person to voice these concerns. She agreed about it being an “awesome” responsibility, one that must be taken with seriousness and with an understanding of our ethical obligations. Then, she followed up with the line, “You will be ok.” She went on to discuss the training and support etc… but it became white noise. It took me almost two more years before I felt confident enough to look for a placement.
During the proceeding break, everyone shared their fears, I wasn’t alone. Throughout my career, I continue to realise it’s normal to have some level of anxiety. Catherine Pittman says on her online course Applied Neuroscience for Treating Anxiety, Panic, and Worry that we come from a long line of worriers, which is needed for our survival. She illustrates that if our ancestors did not worry, they may have tried to pet the pretty tiger in the jungle, and we simply would not be here.
Many times since then, I have experienced this familiar anxiety and I remind myself I am not alone. Most often, I simply need to sit and explore the anxiety, allow the vulnerability to exist without judgement. It could be that I have been triggered by something in the room so I reassure myself that it will peak and then it will calm and then I will be ok. Or, sometimes, the anxiety is communicating a message such as a skill, resource and/ or plan that needs developing.
Oftentimes, when we gain our qualifications there is an excitement that all our dedication and years of work (and money!) has finally come to fruition. I felt a freedom of choice: choice of what I do with my extra time and money; choice of how I schedule my day, choice of the books I read; choice of a supervisor etc…
However, as I held my certificate in my hand that familiar stomach in mouth feeling rose again. As a student, I was answerable to the learning institution and directed by them, but as a psychotherapist, I had a great deal more autonomy and different, somewhat heavier expectations attached themselves to my new role. That is when I realised how much I depended upon my training facility and the title of student to hold me.
In many forums, I hear the newly qualified counsellor ask, “Am I a good enough therapist? Am I giving the client what they need?”
We often ask ourselves these questions even before the client has walked through the door. I want to reassure you that you are not alone. In fact, your supervisor will probably give you the same knowing smile that my tutor gave me because they will have answered this question many, many times before.
There are some universal scenarios we find ourselves in as counsellors that can trigger this universal anxiety and I hope I can offer you some useful advice on how to manage it.
Preparing for a client
In private practice particularly, we meet our clients with very little prior knowledge of them or what they’re looking for support with. This creates an atmosphere of uncertainty, which is a wonderful trigger for anxiety.
We may try to imagine the client’s appearance and behaviour and how the introduction will go. People like to predict the future as it can give a feeling of safety, but anxious thoughts are rarely accurate and only serve to exacerbate worry. The predictions we make can really get in the way, influencing the initial session and affecting how you perceive what is actually happening in the room.
Practicing mindfulness, helps me to ground myself in the unknown and uncertainty I feel before meeting a new client, and keeps me attuned to my thoughts, so I can make sure I’m not getting ahead of myself.
If you’re really feeling unsettled, it can be helpful to try to expend this energy physically. For example, I’ll sometimes stand up, feet hip-width apart and firmly rooted into the ground. I’ll raise my arms to a full body stretch while I inhale deeply and then spread my arms out wide with my exhale.
Here are some other suggestions to calm yourself before a session:
- Expending some energy through activity helps us to relax before a session.
- Breathing techniques can calm the nervous system and reengage that thinking part of our brain.
- Pre-session rituals may help work with anxiety as the practice gives certainty to an uncertain situation.
- Reviewing and rehearsing how you’ll start the session helps us feel prepared.
During the session
Our anxieties as therapists are not always self-created, we might feel anxiety within the therapy session in response to our client’s anxiety or defences, unrealistic expectations of what therapy is and what we can offer them or an implicit (or explicit) demand to deliver a desired outcome fast.
There is an initial positioning within the therapeutic session. We recognise and encourage the equality between client and therapist, and trust in their capabilities. However, this feeling may not be shared by the client, who wants relief from their issues and wants you to give them that relief as quickly as possible.
This is further heightened by the fact that they have invested money and time in the appointment. You may feel the “value for money” pressure motivating you to rattle off your training, all the theories you know, and all the insights you are gathering etc… Stop and breathe! Remember, you are not there to fix but to empower, support and guide them through their journey.
Ground yourself in what you know. You have invested countless hours and money in training, and you are supported by a community of therapists as well as your supervisor.
You have worked hard for many years with incredible dedication. You have something to offer and the time and attention that you are giving to your client has value in and of itself.
To be put in this position, where answers and fixes are expected immediately can be daunting. Therapy has lots of grey areas and real change doesn’t happen within an hour.
Gently acknowledging your client’s understandable wish for quick relief as a universal human desire, whilst also reminding them that it’s just not how it works, can go a long way in relieving tension and building rapport.
We sometimes feel overwhelmed by the gravity of our client’s situation, resonating with their pain or feeling lost within their depression. It is understandable that we can be tempted to escape the discomfort by offering resolutions.
However, engaging in problem solving typically only leads to the “yes but” game where a therapist makes suggestions, only to watch each one be batted away. Finally, the therapist gives up and both parties sit staring at each other in deep disappointment.
Remember, the suggestions that you offer have probably been offered before and the issue usually isn’t that the client doesn’t know what to do, it’s that for some reason they are not doing it.
Be mindful of the games that can play out in the counselling room. Therapists can be wonderful receptors for client’s defences. We can very quickly move from rescuer to persecutor in the drama triangle and, especially when first starting out, we can readily feel criticised.
In The Making of a Therapist by Louis Cozolino, it is noted that many therapists have historically played the role of rescuer, so when we find ourselves unable to rescue, our self-worth can take a battering.
So, what should we do?
- In the initial consultation explore and clarify your client’s expectations
- If during the session you are experiencing anxiety remind yourself that anxiety peaks and then recedes, and you will be ok
- Explore your strong or atypical feelings to determine the origin
- If the client feels stuck, overwhelmed etc., state, validate and normalise those feelings. The therapeutic process is challenging and brings up lots of different emotions.
- In supervision, reflect and explore if there is a skillset or resource needed for you and/or your client
- If it is coming from them, trust in their capabilities to work with it. They have experiences and insights into their psyche that we do not, with support, they will develop the necessary awareness.
- If the working alliance is strong enough and it feels appropriate discuss the counter-transference. Is this what they are experiencing outside of the therapeutic room? Are you playing out a role from their past?
- And finally, it’s always possible that you and your client may simply not be a good fit for each other. Though difficult to acknowledge, it’s really important you find a way to appropriately verbalise this, referring the client on to a more suitable counsellor wherever possible. Again, take it to supervision for guidance.
Handling disengagement
Therapy is a daunting process and so early disengagements and DNAs are not uncommon, particularly in private practice. In spite of this knowledge, it can be very easy to feel insecure or unsettled when a client suddenly terminates counselling with us.
Why do clients prematurely finish therapy or DNA?
- The client had expectations that may not match the reality of what is available.
- You weren’t a good fit. A therapeutic relationship is a relationship and it has to work for both of you.
- The client wasn’t ready to engage in therapy. The therapeutic process can be daunting, exposing and painful. With the client’s desire for change comes hesitancy and fear of what the change may bring. Change means stepping into the unknown, so it makes sense that some people disengage and run away.
- You made a mistake. There may have been a misattunement that caused a rupture in the relationship. In my experience, a client rarely shares when this happens so it’s important to honestly reflect on the session to see where there may be learning opportunities for you.
- If the client is able to voice this, work with it because “rupture and repair” is a powerful experience and strengthens the working alliance.
- The client simply needed to “off load” and doing this in the consultation or a couple of sessions was sufficient.
What to do when this happens:
- Reflect on the last session to see if you have any instincts on what might have caused the client to disengage. Conducting a comprehensive assessment at the start will help you with this, as it means you’ll have an understanding of any attachment issues defences that could be triggered. It also opens a discussion about the potential for disengagement.
- It’s not always about you. Remind yourself that you are only with this client for one hour a week. There are things that are happening in this person’s life that you have no control over and they may influence their engagement with therapy.
- USE YOUR MISTAKES! Mistakes are potential for growth. This field grows and changes rapidly and we are constantly learning. Sometimes our decisions in the moment will be affected by what is brought into the room and the pressure to perform. Allow yourself the same compassion you give your client.
- With DNA or premature endings, it is always important to communicate to the client that you wish them well and there is an open door if they choose to reengage.
Give yourself time. Let yourself evolve
Before becoming a therapist, I was a teacher and in my early years, I looked for role models to shape my own classroom persona. I remember one teacher who seemed to float instead of walk and the children danced around her like the flying animated birds from a Disney movie. She was professional, organised, and creative. I wanted to be her, but I didn’t love crafts, my handwriting wasn’t great, and I certainly couldn’t float. She developed these skills during her 20 year career, they fit her natural way of being. In time, I honed my own skills and found what worked for me.
As therapists, we too may subscribe to the image of the “perfect therapist” and strive for it by modelling the culture of our training facility or mannerisms of our supervisor. Although this mimicking gives us a safe framework to work within, we dismiss the importance of our authentic self and the spontaneity it brings.
In being comfortable in our own skin, the client is more comfortable in theirs and we are both able to sit in the here and now, holding all those very strong emotions together. There is truth in the expression, “trust in the process” and it is also important to trust in your desire to do well and be well.
So go easy on yourself. You’re just starting out, let yourself learn and go your own way; trusting that your natural interests will guide you to become the therapist you were meant to be.