Hands shaking, heart pounding, profusely sweating – these are some of the things I experienced when I was faced with my first patient ever.
I was sure she was going to judge me and think that I actually wasn’t supposed to be there; or that in the middle of the session, something would happen that would make me completely lose the grip of the situation.
But that didn’t happen!
Things went on great – not perfect, but certainly better than I expected!
And I’ll be sincere… this wasn’t even my first real patient; it was only a roleplay. So you can imagine how nerve-racking it was for me to get face to face with real clients.
In the middle of all this nervousness and insecurity, I try to keep one thing in mind: we’re simply humans connecting with other humans that need our help. This humanity lets us create meaningful relationships with the clients, and at the same time, it makes us open to mistakes and doubts – and that’s ok!
In this article, we’ll discuss how to keep this excruciating self-doubt as a therapist in check, and the ways that lead to a more confident practice.
Self-doubt is a deeply uncomfortable feeling and, even though it’s not restricted to therapists, it’s especially distressing to feel incompetent as a counselor. There are plenty of reasons to choose from on why we feel this way: pressure to deliver the right interventions, fear that we won’t make a difference, desire to see concrete change…
It can sometimes feel like we’re alone in suffering from self-doubt, but it’s much more common than we think. For beginners, the lack of experience can affect the person’s confidence and make them feel like what they’re doing is not enough. For more experienced therapists, they may come across a more difficult case or situation where the feeling of not knowing enough comes back.
For therapists who are just starting, self-doubt is concerning when perceived as permanent and out of their control. This can negatively impact their brand-new practice, promoting feelings of hopelessness, detachment from the patient, and isolation. However, if the therapist perceives this feeling as temporary and controllable, it can become a powerful tool during the learning process, serving as fuel to obtain more knowledge. This checks out with the study ‘Feelings of Incompetence in Novice Therapists: Consequences, Coping, and Correctives‘, which further discusses the novice therapist’s challenges.
Still, what matters most when tending to a client is not how much experience or training a therapist has or how many certificates they have on their wall. Rather what is important is their personal and interpersonal qualities, such as a capacity for affirmation, responsiveness, genuineness, and empathy. This means that novice and seasoned therapists alike must grow their confidence with their interpersonal qualities in mind, rather than accumulating knowledge detached from reality.
Another comforting idea to have in mind is that sometimes, your clients never had someone that listens to them as a therapist does – so the simple act of being there for them plays a huge part in their improvement. If you’re not breaking ethical guidelines or harming the client in any way, there’s a big chance that they’re benefiting from therapy already. Being supportive and connecting with the client is one of the biggest parts of the job.
Imposter Syndrome is real – even for therapists
One of the ways self-doubt can paralyze you is through Imposter Syndrome, a term coined in the 70s by psychologists Suzanne Imes and Pauline Rose Clance.
APA states that “imposter phenomenon occurs among high achievers who are unable to internalize and accept their success. They often attribute their accomplishments to luck rather than to ability, and fear that others will eventually unmask them as a fraud.”
Not everybody that experiences self-doubt as a therapist has Imposter Syndrome, but those suffering from this phenomenon deeply doubt themselves. Especially for therapists, it can take the form of feeling incompetent or not feeling up to the task, leading to a sense of unworthiness or numbness. In some cases, it can even be accompanied by anxiety or depression.
Whether you’re suffering from low confidence issues or Imposter Syndrome (or both), learning how to overcome your worries and grow your confidence is central to a thriving practice.
This is easier said than done, so how can we do this? Well, let’s get to it!
Therapists know better than anyone the difficulty of changing a belief that has been cultivated over time, and managing self-doubt is no different. When you’re suffering from low-confidence, you believe that you’re not enough or maybe not capable of making a difference. While these are beliefs that take time and effort to change, the result of changing them definitely pays off.
To achieve this result, here are the main ways that you can face your self-doubt and build your confidence.
Be self-aware
To start, understanding that it’s possible to help others and still have problems of your own is a valuable lesson. This helps you realize that, even though you’re dealing with your own issues, your abilities and knowledge provide you with all the tools necessary to do a good job.
This way, it’s not expected that you live a problem-free, unattainable life- but rather that you’re aware of your own blind spots and work on them the best way you can. Odds are, if you’re reading this article, you’re already on a good path!
For example, a twice divorced therapist is sought out by someone who’s looking to solve their marital problems. In this case, the therapist may feel incapable of helping this client because of their own personal problems and, consequently, doubt their professional abilities.
The therapist might wrongly think: “who am I to help this person if I can’t even help myself?”
Now, if the professional is aware of where these negative feelings are coming from, they’ll keep their problems out of the setting or manage them better when they appear. Taking the example above, the therapist would be aware that these feelings of incompetence, when faced with a patient’s marital problems, were triggered by unresolved issues in their past.
Once the therapist knows what their triggers are, they’ll focus on the patient and feel much more confident in their professional abilities. This relates to keeping boundaries between your personal and professional life, making it much easier to concentrate on patients’ demands.
Practice self-compassion
Self-compassion is a big part of building confidence, as it means having the same compassion for yourself as you have for others. It involves embracing imperfection as part of the human experience and understanding that you won’t stop making mistakes, but rather do the best you can in the situations you find yourself in.
Self-compassion can help reduce feelings of self-doubt because it gives you the perspective that it’s okay if you don’t say the perfect thing or know everything there is to know about the theory- you’ll learn from these experiences and come out stronger and sharper because of it.
And, even then, you won’t stop making mistakes! What kind of therapist would you be if you encouraged clients to strive for perfection, for example? If it’s not healthy for them, it’s sure as heck not healthy for you either. Both of you are human, after all!
As an exercise, when you’re faced with situations where you feel incompetent or are heavily criticizing yourself, ask: “What would I say to a friend or colleague if they came to me asking for advice on this?”. I bet you’d be way kinder to them, than yourself.
Let’s say, during a session, you accidentally call a client by the wrong name. At this moment, a million things go through your head – most of them bad and self-accusatory. You chew on this moment for days, replaying it over and over in your head, assuring yourself that your client will hate you for it as much as you hate yourself for it.
Now, if this had happened to a colleague and they’d asked for your opinion, you’d probably be way more forgiving. You could’ve said: “Relax, you were tired that day!” or maybe “It’s not that big of a deal, mistakes happen!”
If you’d say things like that to other people, why don’t you say it to yourself?
You’re only a human being that made a mistake – apologize, learn from it, and move on! A good amount of self-doubt is released when you begin to accept your errors and view them as an opportunity for growth.
Make friends with doubt
Being self-confident is an amazing feeling; I mean, that’s why I’m writing this article in the first place! However, beware of a therapist that is 100% sure about everything – this suggests an arrogance that isn’t compatible with a good practice.
Self-doubt, when experienced in moderation, can actually be a great asset for your practice, keeping a therapist both humble and attentive. The study ‘Love Yourself as a Person, Doubt Yourself as a Therapist?‘ shows that.
Therapists that reported having more professional self-doubt than others presented a better patient outcome, according to these findings. The patient presented an even bigger change if, along with self-doubt, the therapist showed a strong self-affiliation. We’ve covered self-doubt already, but self-affiliation is a feeling of tolerance and care towards oneself. It’s believed to come from how a person was treated by their primary caregivers, and it influences how a person treats others. In more than one aspect, it strongly resembles self-compassion.
Back to the study, if a therapist were to present a high level of self-affiliation combined with a low level of professional self-doubt, the outcome wasn’t as successful. The authors theorized: “The findings imply that a healthy self-critical stance is an ingredient of successful professional role performance but that treating oneself as a person with care and nurturance but lacking capacity to critically evaluate (i.e., doubt) one’s therapeutic work, is not.”
For example, I had a college colleague who never revaluated his work or second-guessed his actions; he was always right about everything as far as he was concerned. In turn, he never got nervous during internships or practices, whereas I constantly revised protocols, questions I had to ask, all sorts of things, in fear of making mistakes.
One day, we had to apply a complicated test on a patient. We did it, then corrected and interpreted. It turns out, my colleague was so sure he’d do everything right that he missed a bunch of important rules when administrating the test. As for me, I was so afraid I’d administrate the test wrong that I had the manual memorized from start to finish, so when the moment came, I did everything I was supposed to do.
In conclusion: make friends with your self-doubt! Don’t let it be that toxic friend that jokes about you and steals your clothes, but rather go out to lunch with it from time to time and listen to what it has to say, because you might actually learn from it!
Perform practical actions
Practicing self-compassion, self-awareness, and learning about self-doubt is essential. Still, to achieve a high level of confidence, there needs to be a constant exercise of these skills, which implies taking practical actions.
Next are some important steps to take in order to face your professional insecurities.
Get professional support
It doesn’t matter if you call it consultation or supervision – having a place you can get together with an experienced professional and discuss your practice is an invaluable resource to any therapist.
Besides being an impartial professional that will provide a different perspective on the situations you face, they’ll also help you reflect on your thoughts and feelings regarding patients and your experience.
Are you having trouble connecting with a client? Did a topic come up in therapy, and you felt uncomfortable? Did the patient tell you something, and you didn’t know how to respond?
These are just a few of the infinite situations that have the potential of shaking up our professional confidence. However, consulting on these matters and discussing them with someone else, without fear of breaking confidentiality or shaming, can bring a sense of relief and security that we wouldn’t be able to achieve alone.
That’s why you shouldn’t be afraid to ask for help in these consults! The professional is there to hear your concerns and feelings and help you work on them; they won’t be able to do that if you omit them. So, don’t keep your problems to yourself just because you’re embarrassed or apprehensive. Make the most of the space you got!
Having someone there to discuss your worries and rely on when things get difficult will make you feel much more stable and confident in your actions.
Get your own therapist
I don’t need to explain to you the benefits of therapy, but this should be said: go to therapy!
This definitely relates to becoming self-aware, but therapy is where you’ll actually put in the work to manage your own issues and demands. Identifying these blind spots and bringing them to therapy is an essential part of the work you do as a therapist since certain situations might trigger you in a bad way, harming the therapeutic relationship.
Additionally, therapy is where you’ll get the chance to address confidence and self-esteem issues directly! So not only will you be dealing with a variety of issues (which will ultimately lead to improving your practice), but you’ll also focus on minimizing your self-doubt, with the therapist as your guide.
Get in peer groups
For me, one of the problems of feeling like I’m not enough as a professional – or of any concern, really – is to feel like I’m all alone in this experience, and that I’m the only one who feels this way.
Fortunately for me (and unfortunately for other people who feel this way), this couldn’t be further from the truth!
By taking part in peer groups, both virtually and in “real life,” I feel extremely validated and comforted every time I see someone discuss problems they’re going through and that resemble mine. I feel like I’m not alone in this, and that if they do it, I can do it too.
However, this is only one part of the benefits of joining a peer group, as you can also get amazing advice from the people that experience the same things you do, making for a consultation group. You can learn a lot from your peers’ experience since everyone has a different background and brings a different perspective to the table, and they can learn a lot from you.
Some ways to enter peer groups are through social media, especially when you look for Facebook groups and Subs on Reddit (my own indications are Facebook’s Thriving Therapists and Therapists in Private Practice, and Reddit’s r/psychotherapy) and groups in your city, maybe from clinics that offer meetups, or even create one yourself by getting in contact with therapists you know!
Journal
We’re way more inclined to take notes on the things we did wrong than the things we did right, but journaling invites you to invert this logic.
After each session, or whenever you have the time, journal what you did well in your day or the things you like about yourself. Did you notice an improvement in a patient? Did the client give you positive feedback? Have you noticed anything about your style as a therapist that you appreciate? Put it all down on the page (physical or digital, your choice).
By doing this exercise, you’ll be able to identify your strong points and realize that, even if you think everything you did was wrong, there’s always something to be proud of.
After writing it, you’ll be able to go back to it whenever you need a boost. Thus being able to read about the good things you’ve done and that you’re capable of doing.
Do trainings
Attending courses or training is a great way to sharpen your skills as a therapist and gain valuable knowledge. Especially if one of the things that make you insecure in the practice is feeling like you don’t know enough, identifying your weak spots and looking to trained professionals to teach you will surely give you a much higher level of security.
And even if you think you know everything there is to know, I suggest you go back to the “Make friends with doubt” section! Psychology is a field that is forever evolving and reinventing itself, so seeking knowledge needs to be a continuous process in your career path. For therapists, settling is not an option.
In here, you can find a number of different free/low cost trainings for therapists.
Self-doubt, in the extreme, can suffocate us. It can make us feel unprepared, unable, unqualified – all the worst “un’s” we can think of. Even so, there are many steps one can take to minimize that feeling and build our confidence, as long as we’re willing to put in the work.
However, even if you take all the steps I presented you in this article, you won’t become some sort of unbeatable therapist that never gets anything wrong or always has the answers to every question.
Freud, Skinner, Beck, Rogers – none of them had all the answers. I believe that’s part of why they were so successful – they identified what they were doing wrong and the gaps in their knowledge, and went after it.
My point is, being a confident therapist is not a synonym for a perfect therapist. Being confident in your profession is much more a matter of humility, self-compassion, recognizing your strengths, and strengthening your weaknesses.
Above all, it’s connecting with your client and entering their world for 45 minutes a week, being fully present, exercising empathy and genuineness the best way you can.
In this section, I gathered a number of resources, from books to websites and podcasts, that may help you in building confidence.
