Day 1: Seeing My First Client

On the morning of my first day of therapy externship, I felt nervous. Not merely that flutter of butterflies lightly brushing against your stomach at the start of any new job, but a deeper, well-rooted fear that had taken hold shortly after I received my acceptance into my PhD program two years back and had continued to ebb and flow through those two years until that first day of therapy externship.

The fear had multiple components, some more benign (“Will I be able to find the ideal words to tell my clients?”), others a little more concerning (“Will I be able to connect?” “What if my mind drifts because I'm anxious and I can never remember what the clients said?”), and still others inching closer and closer to a full-blown existential crisis (“What if I discover I don't care about people or their stories after all?” “What if I find out I'm bored, hate it, realize this was all a mistake, and end up being trapped there for a whole year?”)

I believe that part of training to be a therapist is learning to be your own therapist. Applying the things you learn about therapy to yourself, as if you were the client. Becoming mindful of your fears, noticing your thoughts, watching them unfold, and then learning to question them, to respond to them in ways that are more reasonable and more reflective of the whole truth – ways that acknowledge how you got to be this way and why it’s okay to be this way while all the while striving to respond to life in new ways that help you move forward. I had been making progress on this front in the past two years, and particularly in the last year, thanks to my own personal therapy, which had allowed me to get to know my own blind spots, my patterns in perceiving and interpreting the world, rooted, of course, as these things tend to be, in past learning from the environments I had been in.

One of the greatest changes in this past year had been to understand that when the “what if” thoughts began to flood my mind, I was headed for trouble. I was beginning to catastrophize, anxiously anticipating the worst. One of the benefits of “what-if’ing” was that it would get me to work hard to prepare for whatever the situation was that scared me. But the detriment was that the “what ifs” kept me on guard, always on my toes, no matter the preparation. After all, no amount of preparation could ever prepare you for every single possible terrible outcome that could occur.

And so here I was: After months of some amount of “what-if’ing” and lots of reading and preparation, Day 1 of externship had arrived. Despite the what-ifs, I was also excited -- a feeling I had felt all along too, along with the fear. After all, this was an accomplishment. The process of attaining the externship had not been easy – it involved mailing lots of detailed applications to various settings, from hospitals to private practices, going through multiple interviews, competing with students from the various clinical psych programs in this city, and all of that culminating into match day, the day where you hoped the places you ranked as top would also rank you just as high and it would be a “match” and you’d end up training there. This particular externship had been a “reach” site for me; I had applied to it on a whim, thinking the chances of ending up there were low, given their stated preference for more experienced students. But then the interviews went well, and on match day, I delightfully received their email in my inbox, inviting me to train with them for a year. I had been delighted. And looked forward to it in anticipation for months, despite the fears.

So back to Day 1. I walked into the private practice and waited in the quiet little waiting area, where one other guy sat. The guy turned out to be the other extern. How are you feeling, I asked? “Nervous,” he said. I appreciated the vulnerability already. I almost wanted to calm his own fears, along with mine, to tell him that Day 1s were usually harmless and we likely wouldn’t be doing anything difficult. But I chose to respond by agreeing that I was nervous too instead and leave it at that. That way it was all into the open, and we were on the same boat. Not feeling alone in your fears always helps.

Still, I was certain Day 1 would be easy … Day 1s always were, wherever I had been before. And I had experienced several Day 1s in my life because I was doing my PhD at 32. Clinical psychology had been a career change for me, after spending almost a decade in publishing. Day 1s in my publishing jobs and Day 1 of PhD had all been easy … sitting through orientation, filling out paperwork, going home early, luxuriating in the fact that hey, here you are, you made it, it’s a new beginning and everything will work out and you don’t even have to do any work yet. I expected the same. But I was in for a treat. Fast-forward to an hour later, and we were both in my new supervisor’s office, and he was uttering those fateful Day 1 words: “Your first patient will be here in two hours. She has ADHD … here is the treatment manual. Good luck!”

Having had some experience with anxiety teaches you to hide your anxiety well. And I was thankful for that trick in that moment, because the last thing I wanted for my glorious Day 1 was for my supervisor to see how freaked out I was in that moment. So I smiled in that moment, nonchalantly reached for the manual, and thanked him. Inside, I was in a panic … the thought that I’d be seeing someone already (today! in just two short hours!) made my stomach twist in a cruel knot. I felt my heart racing, my breath ebbing into my throat, giving rise to a single instinct: escape.

After being shown into my therapy office and being left alone to set up my email and browse through the treatment manual, I let my thoughts drift to escape scenarios. I looked at my watch. It was 3 p.m. “I could say I’m going to grab a bite and walk outside … and then keep walking. I could be like Forrest Gump. Keep walking … never come back. I could quit this whole grad school thing. Go back to publishing. Perhaps it was all a mistake after all. A quarter-life-crisis mistake,” I thought to myself.

The thought of walking away gave me relief, as escape and avoidance often has a way of doing. I could walk to safety, my mind told me, a place where you didn’t have to see clients who came to you with real problems and expected real solutions that perhaps you didn’t have … and what if you couldn’t help them and they saw that and felt disappointed … and then your supervisors too felt disappointed for taking a chance on you over some other, more experienced student. A place where you didn’t have to risk finding out whether you were truly terrible at all this after all. Didn’t risk hurting other people.

I did walk out in the end. As in the fantasy, I stood up, walked to my supervisor’s office and said, “I’m going to grab a bite,” and within a few minutes, I was outside, breathing in the fresh air. I reached the deli across the street, and before stepping in, I paused and looked north, to freedom. I imagined myself continuing to walk north, reaching public transportation, perhaps getting on, falling asleep, head against the window, lulled by the afternoon traffic, away from all of this anxiety and the potentially impending disaster that was about to happen at 5 p.m. when the client arrived.

And then, something in me, another part of me – perhaps that part that had first whispered in my ear 6 years back, that my purpose in life perhaps was not “to entertain people” with lifestyle content as I had all those years in publishing but “to help people heal” after all – kicked in. And then I began to talk to myself, to answer the what-ifs. A bit of back and forth later, I had come to a new conclusion about what success would look like that day: I wasn’t going to do any healing quite yet, the goal would not be to fix any problems, or to make my client's impending therapy experience a life-changing one.

The goal … was to stay.

To tolerate the anxiety, as we often tell clients to, and stay. To go right back to that little therapy room and to wait for my client. To sift through the manual, get some ideas, recall some of the things I learned in the past 2 years about what to do in therapy and in that first session, to speak to my supervisor and ask for advice. And then to greet my client, sit down with her for 45-minutes, and listen and talk. That was that. The goal was to stay. Get through the day. That would be success.

Good coping in the end is what is most effective in the moment, what helps you do the things that scare you and yet allow you, through the process of doing them, to meet your long-term goals.

To meet my long-term goal of becoming a skilled and effective therapist, I had to take my first step of having a therapy session. And so, I talked to myself, and I stayed.

I walked back to the office, sushi and chocolate in hand (because there’s nothing like a good reward to motivate behavior), and I looked through the manual. I asked my supervisor for help. (Which was a risk too for me that day because another one of my fears was that perhaps they had forgotten I had not done therapy before and expected me to know way more than I actually did. And in taking that risk I also got to see for the first time how generous with time and feedback my supervisors were. I didn’t feel stupid for asking. I felt relieved and empowered.)

And then I had my therapy session.

In a word, it felt surreal. Something instantly kicked in … what Carl Rogers called “unconditional positive regard.” All my shoulds regarding what I should be doing in therapy dissipated, and were instead replaced by a renewed focus on seeing the person in front of me, hearing her descriptions of the problems, perceiving the accompanying feelings, reflecting and responding as I had learned from readings and the therapy classes, and letting myself get a sense of who she is. And in that session, my fears were disconfirmed: It was second-nature for me to care. It was second-nature to listen and remember. And even when my mind drifted for a moment to let me know that “omg this is surreal, it’s really happening, you are finally sitting in front of someone who is telling you some of their greatest struggles in life, and she has NO idea this is your first time, ok back to what she was saying, go, good job, you’re doing iiiiiit …” even then, I was able to come right back, get the gist of the story, and clarify when needed.

The world did not end. The therapy was not terrible. The girl did not dislike me. In fact, she seemed to like me. She came back. Week after week. And maybe because she was my first one, she was and continues to be my favorite client. And she also has no idea about that, and that is another part that delights me. Some things that happen in therapy, how much you care about them and think of them after, they don’t know. And they don’t need to. Just as my supervisors had no idea just how terrified I was that day. Just as my professors and fellow students and mostly everyone else in my life who I wasn’t very close to up to that point had no idea how scared I had been all that time of starting therapy training.

And the thing is, they didn’t have to. No one has to. Only I had to. I had to be so mindful of what was going on, I could swoop in and regulate it. Talk to myself, play funny little games with myself (“you stay and you win, little girl!”) and dispense rewards for my good behavior. And at the end of the day, just recognize that, like our clients, we therapists have to do the hard, tiring, scary stuff. Notice our emotions, be mindful of our thoughts, evaluate and challenge them. Approach our fears, stay through the hard stuff, practice what we tell our clients. And yes, when all else fails, break down the task at hand into even smaller parts, and just stay. In short, we have to walk the walk.

We don’t need to be perfect. We just need to keep moving forward, keep taking those imperfect little steps that one day add up to our long-term goals.

And that day I did. And for that, I am grateful.