PhD/PsyD Feeling insecure about therapy skills

[TiptoeConqueror]

I'm currently on internship and a goal of mine is to build up my confidence and get more therapy experience even though I plan on specializing in NP. I always felt insecure during grad school about the quality of my supervision experiences, therapy training, and class time dedicated to learning therapeutic orientations (very little). Now that I am on internship I really feel in over my head. In grad school, I did try to seek out these experiences but I was not getting a ton of guidance. I feel like I am the only one that feels this way. What can I do to improve? I am perfectly okay investing in books and I have been open with supervisors about my experience. I really want to do better for my patients even if I never do therapy after this year. Any help is appreciated.

---

Members don't see this ad.

 

[deleted106747]

Videos can be helpful, particularly from people whose work you admire. Read The Gift of Therapy. Getting therapy yourself from a skilled clinician can be helpful, always good to sit in the other chair.

 

[AbnormalPsych]

Getting therapy yourself from a skilled clinician can be helpful, always good to sit in the other chair.

I would recommend this, if OP has not had this experience yet. This was very helpful for me when I was first getting into therapy cases.

 

[WisNeuro]

Do you have supervisors on internship who can provide a rotation in therapy? That's your best bet.

 

[foreverbull]

I'm currently on internship and a goal of mine is to build up my confidence and get more therapy experience even though I plan on specializing in NP. I always felt insecure during grad school about the quality of my supervision experiences, therapy training, and class time dedicated to learning therapeutic orientations (very little). Now that I am on internship I really feel in over my head. In grad school, I did try to seek out these experiences but I was not getting a ton of guidance. I feel like I am the only one that feels this way. What can I do to improve? I am perfectly okay investing in books and I have been open with supervisors about my experience. I really want to do better for my patients even if I never do therapy after this year. Any help is appreciated.

In addition to what others have mentioned (all good suggestions), you might try a little self-reflective work. One thing I did in grad school was type out what I saw as my strengths and areas of growth in clinical practice, without taking into account feedback, just what I personally thought I struggled with and did well with. I then summarized feedback from supervisors as well, and compared the two to reflect on my growth and challenges. After that, you might address how you can improve in the areas you struggle with in a concrete way (i.e. if you tend to problem-solve too quickly, you can write down some suggestions for yourself before sessions in your session notes as a reminder to let the client explore the issue more fully before jumping in). You might ask to tape your own sessions to review them later if that isn't already happening as part of this self-reflective process.

 

[PsyDr]

1) Look into the common factors/contextual factors model. There's a 2015 update. Basically, setting goals, being empathic (yes that is the correct word, not empathetic), having decent people skills, being genuine (god help my patients), and having positive regard for your patient is like 70% of the job. Nail those normal human adult skills, and you need like another 30% of skills. Not bad, eh?

2) Read case studies from your preferred modality. Old books are almost literally a dime a dozen on ebay. Put the books in a ziplock, turn your freezer down to zero, and leave the books in their for a week to avoid bed bugs. I am paranoid about this crap.

3) Got insurance? Invest in your own psychotherapy, if only to see what others are doing.

4) Protip: "I feel like you want me to respond in some way, but I'm not sure what that is."

5) media that sorta accurately portray psychotherapy: sopranos, in treatment, huff. Netflix. Youtube the series that includes gestalat, behavioralism, etc.

 

[Kadhir]

First, I'm sure you're not the only one. Maybe you're the only one admitting it.

I always felt like I was wearing a mask/inserting a stick before going into the therapy room. My usual personality is characterized by a sometimes malfunctioning filter and a healthy dose of humor, and I was afraid that these things were inappropriate in the therapy room. Supervisors (and patients... "oh, that's the first time I've seen you smile..." oof, that one my first year of therapy burned me) hammered this out of me. People can tell when you're being disingenuous really quickly. I would second the advice on self-reflection. Reviewing therapy video of myself with supervisors really helped in this endeavor.

 

[AbnormalPsych]

being empathic (yes that is the correct word, not empathetic)

YESSSSS a thousand times YES.

 

[ExecutiveDysfunction]

For what it’s worth I’m just finishing internship (same boat, neuro track feeling like my therapy skills were a weakness). First off, cut yourself some slack! You’re still in training, it’s okay to have some areas of less experience! As someone who can be way too critical of myself, I know your pain.

Second, take all the experiences you can get! Internship may be the last time you’re in a trainee position and will have the flexibility to pursue other areas of practice. Consider what rotations can give you good therapy exposure. Go out of your comfort zone! If you feel weak in group therapy, try taking a group on! If this is important to you, pursue more opportunities than required (if feasible).

 

[Ollie123]

Videos are one way to go. For me, I actually found it somewhat counterproductive.

A big part for me was realizing most therapy is NOT like the videos. Watching them made me feel ratcheted in to a particular structure/style. My early therapy days I felt like I was trying to follow a script from those videos and got lost every time we deviated from it....which of course was literally every session. Obviously I'm in favor of a fairly structured, evidence-based approach. As others have said, experiencing therapy can be enlightening. Realizing that from the other side, you can't even necessarily tell what conceptualization the person has and that your sessions may be extremely tangential and unstructured...that even the best therapists are sometimes bumbling and unclear or say things that are off the mark/unhelpful...certainly made me more forgiving of my own minor "mistakes" in session.

 

[TiptoeConqueror]

Do you have supervisors on internship who can provide a rotation in therapy? That's your best bet.

Yes, I am building a solid caseload of patients and it is a big part of why I chose my internship site, plus we record our sessions.

 

[TiptoeConqueror]

Videos are one way to go. For me, I actually found it somewhat counterproductive.

A big part for me was realizing most therapy is NOT like the videos. Watching them made me feel ratcheted in to a particular structure/style. My early therapy days I felt like I was trying to follow a script from those videos and got lost every time we deviated from it....which of course was literally every session. Obviously I'm in favor of a fairly structured, evidence-based approach. As others have said, experiencing therapy can be enlightening. Realizing that from the other side, you can't even necessarily tell what conceptualization the person has and that your sessions may be extremely tangential and unstructured...that even the best therapists are sometimes bumbling and unclear or say things that are off the mark/unhelpful...certainly made me more forgiving of my own minor "mistakes" in session.

That is exactly how I’ve felt and I’m normally someone who learns well watching someone else do something.

 

[TiptoeConqueror]

First, I'm sure you're not the only one. Maybe you're the only one admitting it.

I always felt like I was wearing a mask/inserting a stick before going into the therapy room. My usual personality is characterized by a sometimes malfunctioning filter and a healthy dose of humor, and I was afraid that these things were inappropriate in the therapy room. Supervisors (and patients... "oh, that's the first time I've seen you smile..." oof, that one my first year of therapy burned me) hammered this out of me. People can tell when you're being disingenuous really quickly. I would second the advice on self-reflection. Reviewing therapy video of myself with supervisors really helped in this endeavor.

Thank you for that. It’s not a sentiment I’ve heard expressed from other NP hopefuls for sure. I’m hoping that recording myself more regularly and keeping in mind your advice to just be genuine will help me feel more comfortable with my skills.

 

[TiptoeConqueror]

Videos can be helpful, particularly from people whose work you admire. Read The Gift of Therapy. Getting therapy yourself from a skilled clinician can be helpful, always good to sit in the other chair.

Thank you! I’m going to try all of these methods.

 

[TiptoeConqueror]

In addition to what others have mentioned (all good suggestions), you might try a little self-reflective work. One thing I did in grad school was type out what I saw as my strengths and areas of growth in clinical practice, without taking into account feedback, just what I personally thought I struggled with and did well with. I then summarized feedback from supervisors as well, and compared the two to reflect on my growth and challenges. After that, you might address how you can improve in the areas you struggle with in a concrete way (i.e. if you tend to problem-solve too quickly, you can write down some suggestions for yourself before sessions in your session notes as a reminder to let the client explore the issue more fully before jumping in). You might ask to tape your own sessions to review them later if that isn't already happening as part of this self-reflective process.

Those sound like great ideas! Thanks

 

[TiptoeConqueror]

1) Look into the common factors/contextual factors model. There's a 2015 update. Basically, setting goals, being empathic (yes that is the correct word, not empathetic), having decent people skills, being genuine (god help my patients), and having positive regard for your patient is like 70% of the job. Nail those normal human adult skills, and you need like another 30% of skills. Not bad, eh?

2) Read case studies from your preferred modality. Old books are almost literally a dime a dozen on ebay. Put the books in a ziplock, turn your freezer down to zero, and leave the books in their for a week to avoid bed bugs. I am paranoid about this crap.

3) Got insurance? Invest in your own psychotherapy, if only to see what others are doing.

4) Protip: "I feel like you want me to respond in some way, but I'm not sure what that is."

5) media that sorta accurately portray psychotherapy: sopranos, in treatment, huff. Netflix. Youtube the series that includes gestalat, behavioralism, etc.

Thanks so much for this advice! I already feel more confident because I do think I have those basic skills (I’m sure they could use refinement). And you’re spot on about bedbugs. They love the glue/binding in books which is terrifying for a bibliophile. Plus, I like any advice that recommends Netflix.

 

[TiptoeConqueror]

For what it’s worth I’m just finishing internship (same boat, neuro track feeling like my therapy skills were a weakness). First off, cut yourself some slack! You’re still in training, it’s okay to have some areas of less experience! As someone who can be way too critical of myself, I know your pain.

Second, take all the experiences you can get! Internship may be the last time you’re in a trainee position and will have the flexibility to pursue other areas of practice. Consider what rotations can give you good therapy exposure. Go out of your comfort zone! If you feel weak in group therapy, try taking a group on! If this is important to you, pursue more opportunities than required (if feasible).

Thank you for that positive outlook! I am very self-critical. Glad to hear you made it out of internship unscathed.

 

[TiptoeConqueror]

To everyone who replied...

Thank you so much! I went out of town this weekend feeling very down and had been away from this site until right now. It was nice to come back to all these posts and see how supportive everyone has been. Seriously, I can thank you all enough. I feel like I have much more control over this situation and am more hopeful.

 

[PsyDr]

Here is a free resource. Some good, some bad.


Recently Added - Free Psychotherapy eBooks

 

[Sharewithme]

Thank you for that. It’s not a sentiment I’ve heard expressed from other NP hopefuls for sure. I’m hoping that recording myself more regularly and keeping in mind your advice to just be genuine will help me feel more comfortable with my skills.

I think that the sentiment NEEDS to be heard. People who disagree or are indifferent are probably receiving care and are unaware of it. I understand what you mean about being in places where sometimes it's stone cold. There's a difference b/w being logical (so no emotions b/c they just don't come up) and showing no empathy (which I think is somewhat of a failure in perception). The difference is subtle, so how you know when you're in a place where everyone's (practically everyone's anyway) simply focusing on logic or in a place where everyone's devoid of empathy? I think the places where logic rules, compliments and sentiments, however brief, are expressed now and then. Showing some care is just what you do as a human being, and the intelligent ones know and practice it. Thank you for starting this thread. You're benefiting from it and so are we