Episode 4: Five key tips for all new therapists

**Claire**: Morning, Isabelle.

**Isabelle**: Morning, Claire. Today, we're going to discuss what we wish we knew when we first started out as therapists.

**Claire**: Yes, I think this is a topic that will resonate with many listeners. There are several things I wish I'd known at the beginning of my career, but the most important one for me—and something I try to instill in the supervisees I support—is the significance of the therapeutic relationship. Research has consistently shown over decades and through various studies that this is the most crucial aspect of our work. Being present, available, and genuinely listening while using basic counseling skills—skills typically taught in university—is an excellent way to start.

**Isabelle**: Absolutely, Claire. I completely agree. When I was preparing for this episode, that was the first thing that came to mind. Reflecting on those early days, sitting with clients in a room by myself and suddenly being the one responsible for conducting therapy, I wish I'd known that just being there with a client, listening, and using those micro counseling skills—like reflecting and validating their feelings—was enough.

**Claire**: Yes, it's about holding space for the client. Often, clients come to us in distress or seeking support. Listening to them and understanding their needs helps build that therapeutic rapport and alliance early on. As research indicates, this relationship is the most crucial element for therapy and improving clients' well-being. If clients feel heard and understood by us, it can significantly impact their progress.

**Isabelle**: Indeed. There's so much pressure to have all the interventions and strategies ready to give our clients. Sometimes, we forget that our presence and giving clients the opportunity to express what's on their minds—often in a one-sided conversation where we are there to be receptive and reflective—is incredibly valuable.

**Claire**: Exactly. This brings us to another important point we wanted to share today about what we wish we'd known starting out. You mentioned the pressure to deliver interventions and provide skills and knowledge to clients. A valuable shortcut I learned during my training was the use of manualized interventions.

**Isabelle**: Claire, can you relate to this?

**Claire**: Absolutely. When I started, I was given a manual for supporting people experiencing agoraphobia, who often struggled to venture beyond their front door or even attend appointments. Having a structured guide was incredibly helpful because I didn’t have to develop or formulate the intervention myself. At that stage in my career, I didn’t yet have the skills or knowledge to do so confidently, having that laid out in front of me and having that structure was a really really helpful way for me to start.

**Isabelle**: Fantastic! For anyone just starting out in the therapy space, here's a small tip: there's a great resource called the Center for Clinical Interventions (CCI), a website funded by the government in Western Australia. CCI offers a range of evidence-based, usually CBT-based, interventions. You can find various programs for different presentations, and the best part is they are free to download.

**Claire**: That's right. The CCI website also includes a number of worksheets and psychoeducational booklets. These resources can be incredibly helpful, especially in the early days when you're providing psychoeducation and still learning the material yourself. You don’t always have to reinvent the wheel.

**Isabelle**: Yes, absolutely. And what's wonderful is that while you're using these materials, you're learning alongside your clients. It's perfectly okay to be reading and sharing this information during sessions. Clients understand that if you’re provisionally registered, you're still in training, and it’s perfectly fine to be learning and providing information simultaneously.

**Claire**: Exactly. It’s great to normalize this for everyone listening. Using these resources and shortcuts is fine—you don’t need to start from scratch. Over time, you might develop your own resources, but it's completely acceptable to rely on what's available, especially when it's freely accessible.

**Isabelle**: Most definitely. Moving on, another point we wanted to share is about individual differences among therapists. Regardless of your professional background or training, each of us will be slightly different. It can be easy—and sometimes unhelpful—to compare ourselves to other students or therapists we are learning with.

**Claire**: Oh, absolutely. That "comparisonitis," even though it’s not a real word, is something we all understand. We often look at what others are doing and feel we should be at the same point or doing things the same way. Even supervisors may have their unique approaches, and while it’s fine to take guidance from them, it's also important to add your own personal touch.

**Isabelle**: Yes, and initially, we do rely on structures provided by others. It’s okay not to reinvent things immediately. However, we must remember that each therapist brings something unique to their practice. Clients often come to us for that unique relationship and connection, which will vary with every therapist and every client interaction.

**Claire**: Exactly. Avoiding the trap of constant comparison is crucial. During internships, there are so many tasks to complete, and it can be overwhelming to keep up with what everyone else is doing. We all have different commitments—some work part-time, others full-time. It’s essential to find your own path and progress in a way that works best for you, without external pressures dictating how you should do things.

**Isabelle**: Absolutely. This ties in nicely with another important point: practicing the interventions and skills we teach. In the early days, I often felt awkward teaching mindfulness or CBT journaling if I hadn’t tried them myself. Understanding what it feels like on the receiving end makes a big difference. So, I encourage our listeners to practice the techniques they’re teaching.

**Claire**: Absolutely. When we ask clients to do something, having firsthand experience allows us to explain and explore it with much more conviction. We’re more confident in what we offer because we know it’s beneficial. For example, with mindfulness, many people say they find meditation difficult because their minds wander. Experiencing this ourselves helps us normalize it for clients, saying, “Yes, it is hard, but with practice, it gets easier.”

**Isabelle**: Right. Even if we don't disclose that we practice it ourselves, our verbal and nonverbal communication can convey authenticity. Clients can often sense when we genuinely believe in what we're suggesting, not just because research supports it, but because we've experienced it too.

**Claire**: Exactly. Practicing what we preach also means modeling healthy boundaries and self-care. We encourage clients to set boundaries and look after themselves, and it's important that we do the same. When we relate to the struggles our clients face, like setting boundaries, our own experience fosters empathy and compassion. We understand how challenging it can be, and this understanding helps us support them more effectively.

**Isabelle**: I completely agree. Having direct experience with these practices allows us to empathize deeply with our clients' struggles, which enhances our ability to support them. It's essential to model self-care and healthy boundaries ourselves, even though it’s not always easy to put into practice.

**Claire**: Yes, and that leads us to another point I wish I’d realized earlier: it's normal to feel some level of anxiety when starting something new. Feeling anxious shows that we care about doing a good job. It's common and can actually be a sign that we're taking our responsibilities seriously.

**Isabelle**: I can definitely relate to that. For me, it was feeling overwhelmed and insecure, not confident in my abilities. But I didn’t let that stop me from progressing in my learning and training. Having good supports around me made a big difference. I had a couple of lecturers I could reach out to safely, who reassured me that what I was feeling was normal and that I’d be okay.

****Claire**: Accessing support is crucial. Knowing there are people who can offer reassurance and guidance is immensely helpful. Remember, feeling anxious and uncertain when starting something new is completely normal. Every experienced therapist began exactly where you are now, not knowing as much as they do today.

**Isabelle**: Yes, we often forget that. We see experienced therapists and think they’ve always been confident and knowledgeable. We overlook the struggles and challenges they faced to get where they are.

**Claire**: Exactly. It’s important to recognize when normal feelings of anxiety and being overwhelmed might require more support. Just like practicing what we preach, taking care of our own needs is essential. If you’re feeling overwhelmed, it’s okay to reach out for help and talk to someone about what’s going on.

**Isabelle**: Absolutely. It’s about differentiating between normal jitters and when it feels like everything is too much. Feeling nervous is common and expected when doing something new. But when it becomes overwhelming and consuming, it’s a sign that you might need support or a change.

**Claire**: Yes, and this ties back to not comparing ourselves to others. We all have different capacities for learning and managing workloads. Some therapists can handle more clients than others. There’s no set rule for how many clients we should see, but it’s important to be mindful of our own limits. For example, in some placements, therapists might see three to four clients, while others see up to six or seven.

**Isabelle**: Right, and there’s a huge difference between those numbers. Ideally, a standard might be around four to five sessions, but that doesn’t exist yet. So, comparing someone seeing six or seven clients to someone seeing three to four isn’t fair. Different levels of overwhelm exist, and it’s crucial to recognize what is too much for you personally. Sometimes, this means making a change in your workload.

**Claire**: Exactly. It’s about looking after ourselves, especially in those early years. If you need help or need to make a change, it’s okay to raise your hand. We often aren’t modeled those boundaries and self-care practices in the workplace. Promoting and modeling self-care for our clients means we need to tune into what’s right for us and seek support when needed. It validates our own needs.

**Isabelle**: Definitely. This leads into another topic we wanted to share—something we wish we knew about when starting out: vicarious trauma and burnout. Claire, you had some insightful thoughts on this. What do you remember from when you were starting out, and what do you wish you had known about vicarious trauma and burnout?

****Claire**: When I started out, vicarious trauma wasn’t mentioned. There was no training at university or discussions in the workplace about it. My first experience with what was likely a mild form of vicarious trauma happened one afternoon. I came home to a house where I lived with several people. They noticed something was off and asked if I was okay. They knew I worked as a psychologist with clients who presented with trauma. It was interesting because I had just finished a particularly challenging assessment that day. The content was extremely graphic and traumatic. I felt tired and overwhelmed but hadn’t connected these feelings to my work.

**Isabelle**: Wow, that's so interesting. So, your housemates picked up on your mood before you even realized it yourself?

**Claire**: Exactly. They noticed I was subdued and quiet. After I submitted the report, my supervisor called and asked if I wanted to debrief on the case. That had never happened before. The content was so explicit and traumatic that they picked up on it right away and offered me debriefing. That was my first exposure to vicarious trauma, but I still didn’t have a name for it. I was already fully registered at that point.

**Isabelle**: When did you first learn the term "vicarious trauma"?

**Claire**: It was when I started doing more in-depth training in trauma. Although I had trauma-informed CBT training, it was focused on working with clients, not on our own experiences as therapists. Most of my early work involved assessments and report writing, so the training I received didn’t cover vicarious trauma. It wasn't until I sought additional trauma treatment training a few years post-registration that I learned about vicarious trauma and could connect it to my own experiences.

**Isabelle**: So, you had to seek out specialized training to understand vicarious trauma and its impact on you?

**Claire**: Yes. The basic training I received didn’t address it. It was focused on CBT and assessment-based work, not on the therapist's well-being. Understanding vicarious trauma was validating and helped me recognize the need for support. As therapists, we encounter all kinds of distressing information from our clients, and even if we aren’t explicitly trained in trauma, we can still be affected by it.

**Isabelle**: That’s a crucial point for our listeners, especially those just starting out. Even if you're not specifically trained in trauma, you may still encounter it in your clients. Knowing about vicarious trauma can help you recognize it and seek the support you need.

**Claire**: Absolutely. And while training sometimes mentions the need to look after ourselves, it often doesn’t provide explicit guidance on how to do that. We’re told to listen to our needs and practice self-care, but practical strategies aren’t always clearly stated because the focus is usually on treatment, not on us as therapists.

**Isabelle**: If you had to give a couple of suggestions on how to look after ourselves, what would they be?

**Claire**: First and foremost, it's essential to prioritize self-care. I always go back to the oxygen mask analogy: put on your own mask before helping others. If we aren’t supported and looked after, it’s challenging to support our clients, especially those in severe distress. We're not just absorbing content; we’re also absorbing a lot of emotion and stress.

**Isabelle**: That makes sense. What practical steps have you found helpful?

**Claire**: One thing that’s helped me is developing activities and hobbies that are completely separate from my identity as a psychologist. It’s important to have interests that fill your emotional cup and provide a different set of experiences, ideally joyful ones. This can give you something to look forward to at the end of a long day. It’s taken time to develop this, and I didn’t do it in the early stages of my training. But as I’ve gained more experience, I’ve learned the importance of having a life outside of work. This way, if I’m having trouble switching off after a challenging day, I have something positive to focus on and look forward to.

**Isabelle**: That’s excellent advice. Having activities outside of work can really help maintain a healthy balance and prevent burnout.

****Claire**: Exactly. It's about creating a space where you can recharge and feel fulfilled outside of your professional role. This is vital for sustaining your well-being in the long run. For instance, after a heavy day where a client has shared traumatic experiences, I use a mental strategy to notice if I’m having trouble switching off from work. I then make a conscious choice to switch into "Claire who isn’t a psychologist" mode. This can involve diving into hobbies or activities that are completely separate from my work identity.

**Isabelle**: That’s a great approach. It highlights the importance of having personal interests that fill your emotional cup. Like you said, Claire, everyone will have different strategies that work for them, but it’s about finding practices that are authentic and natural to you.

**Claire**: Absolutely. It’s about tuning into what you need. Some people may find solace in socializing, while others might need quiet time alone. Maybe watching a light-hearted movie or sitcom helps you unwind. For me, sometimes it’s about getting active because I’ve been sitting all day. Other times, I just need to relax and be still. It’s crucial to recognize what helps you switch off and recharge, and to understand that our emotional responses are a part of our work.

**Isabelle**: And it's also about paying attention to those responses and knowing when they might be signaling something more serious, like burnout. It's essential to listen to ourselves and also to feedback from those around us, whether they are family, friends, or colleagues.

**Claire**: Yes, because it’s easy to normalize holding onto stress and anxiety. Mild levels of these feelings are common, especially when doing something new. But when they become overwhelming, it's time to take stock and seek support. This is especially important when we think about burnout.

**Isabelle**: Right. Watching for signs of burnout and engaging in joyful, practical self-care that’s unrelated to our professional roles is key. These are important messages for our listeners today.

**Claire**: And don’t underestimate the value of supervision. Supervision isn’t just about discussing clients; it’s also about our reactions and how we manage our emotional responses. It can be a form of self-care, providing a space to debrief and process what happens in the therapy room.

**Isabelle**: Yes, and if you’ve had a particularly traumatic session, debriefing as soon as possible is crucial. Find someone in the profession who understands the ethics and confidentiality we adhere to, whether it's your supervisor or a colleague.

**Claire**: Exactly. Debrief with someone who is part of our professional community. They’ll understand and support you. While it’s okay to tell friends or family that you're tired, discussing specific content should be reserved for professional settings.

**Isabelle**: That’s a good point. At home, my family has become very attuned to recognizing when I’ve had a heavy day. We have practices that help me switch off and take care of my needs, whether it’s that evening or the following weekend. Finding what works for you and implementing it can make a huge difference.

**Claire**: It's wonderful that you’ve found practices that help you manage. It’s all about finding those personal strategies that truly support your well-being.

**Isabelle**: Thanks, Claire. Hopefully, our discussion today has been helpful for everyone listening. We look forward to seeing you next time.

**Claire**: Yes, thanks for joining us. See you again soon!

**Isabelle and Claire**: Bye!

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