My children have the blessing/curse of having two psychotherapists as parents. We used to joke that one them would take up the family business but when they went off to college, both of them were history majors and it didn't look like there would be heirs to the family trade. But last fall, my son began an MSW program with the intent of becoming a therapist so it seems the joke was spot on.
It is delightful to talk with him as he moves into the field. He is coming to it from a different direction -- social work -- and so he has a different initiatory process to undergo than his dad and I had in clinical psychology. He chafes at courses that seem irrelevant, a focus that doesn't match his and I tell him that this part of becoming a therapist is about getting his ticket punched. Because part of the process is first taking on the identity of the profession and then refining that into something else, because psychotherapy does not belong to any of the disciplines whose members practice it. He must first become a social worker before he can discard those parts that don't belong. Many years ago, in one of the core courses in the clinical psychology program I was in, I was told by the professor that I lacked identity as a psychologist. I was angry when he said it, but in fact he was right because being a psychologist was not important to me as I knew all along I wanted to be a psychotherapist. My son is in this same place with social work.
Talking with him makes me think about the things I have learned along the way and after getting his permission, I decided I would write these Notes to a Young Therapist periodically as they grow out of our discussions.
I used to tell new therapists that I supervised that it takes ten years to become a therapist. In fact, I wish sometimes I could issue recall notices to the people I saw in my first years when I was really feeling my way and in a pretty constant state of uncertainty and anxiety about what I was doing. I am amused to see that Malcolm Gladwell's latest book, Outliers, takes up this same idea with his assertion that it takes 10,000 hours of practice to become great at something. I figure that is about equal to carrying a pretty full caseload for ten years so my rule of thumb was well founded. In those ten years, the therapist builds her own database to begin to know what is expectable and what falls outside the range of usual. It takes time.
I would tell these supervisees that what graduate school does is give you just enough to start seeing people, just enough to sit across from someone who has come to you and dare to believe you and the patient can survive this journey together. The real learning comes in the doing and in getting really good clinical supervision. By clinical supervision, I don't mean the kind of oversight new clinicians get in new jobs. I mean finding the best clinician you can and buying supervision time from that person -- because supervision is as much about the therapist as it is the patient. In supervision we have a chance to see where we tend to make errors, begin to understand why we make those errors, and get support for the work we are doing. A good supervisor should challenge us, critique us, support us and teach us. It's not CYA for risk management.
I also tell supervisees they should give serious thought to finding a good therapist for themselves if they don't already have one. Because the errors we make arise from our own internal conflicts and history and the more conscious we can become, the better we are able not to fall into these potholes.