IJHC (The International Journal of Healing and Caring) - Through the Eyes of a Young Therapist: A Psychotherapy Internship

My anxious, shallow breath caught in my throat. I walked into my dimly lit office eagerly awaiting my very first client. I carefully screened my office to ensure that I had enough tissue, that my chair was positioned directly across from the clock on my desk and from the chair where my client would later sit. I was interrupted by the over head page announcing my name, hurried down the hall and turned the corner to introduce myself to a tall middle-aged man, with striking blue eyes, which were slowly tearing up as we walked back to my office. I remember feeling slightly arrogant and walking with a confidence in my stride. I was sure that I had the skills to ’heal’ this man. After all, I did ace my first Basic Clinical Skills exam where I conquered the techniques of open-ended questions, close-ended questions, transference, and crisis intervention. Clearly, I was defending against how powerless and fearful I truly felt. I made it through our initial session with no battle wounds other than my bruised ego from realizing that I was just beginning with my first client and that I did not have all the answers. My next client came and went, and the next, and the next was my schedule for the next seven months of my internship.

I laugh to myself as I recollect this memory. I laugh because I am aware of my naiveté and embrace the innocence in my initial belief that therapy was supposed to be a cerebral experience. Since then, I have welcomed my place as a young therapist and realized that what we truly need to learn about therapy in order to be competent to help people is not taught in the classroom of graduate classes, but rather from the human connection and experience shared between therapist and client. There is a synergy between both that invites the healing process to unfold. Essentially, we all have potentials to be good therapists if we let go of the idea that we will one day know everything. In reality, when we sit with a client we know nothing. Each client holds their own answers, the skills to build safety and the power to heal, which is a profound testament to the human spirit. Yet many therapists, particularly early in our careers, live with the idea that we will not know what to say or do or that we will ultimately fail our clients. As a young therapist, I have come to realize that healing occurs when we as therapists embody the simple experience of sitting with a client rather than trying to “do” therapy. If we can tolerate feelings of inadequacy and imperfection we create more room within ourselves to interpret and understand a client’s joy, anger, sadness and pain. Allowing this to happen results in a better understanding of our clients needs.

As a young therapist, I’ve learned that to sit in front of a client is to also sit in the face of my own truth. This is the innate gift that each client unknowingly offers to their therapist. If you are a therapist, can you remember the first session that you had with a patient suffering from Borderline Personality Disorder? Or the client you were seeing during an uncontrollable manic episode? I do. I remember chaos stirring in my body as if I was the one suffering, and thinking that I would never be able to make it as a therapist since I did not have the “magic wand” to alleviate my client’s symptoms.

I later realized, after wrestling with my counter-transference, that this client invited me to explore my own embedded defenses, and how they too saved me as a child. This is ultimately why I chose this career and a token of how important it is to stay aware of our own personal process as healers. . Making a connection like this allows us to remember as professionals that we can deepen our relationships with clients, allowing empathy and compassion to flow naturally through our own emotional experiences rather than a premeditated technique. Our clients can remind us that we too desire intimacy, love and connectedness. In this unique relationship our inner spirits are embraced and honored. This makes our work more real, more alive.

I’ve learned as a young therapist that boundaries are essential in this work. The boundaries we establish create an atmosphere of safety in which clients can explore freely without fear that they will be chastised, like a young child beginning to develop a secure attachment with a caregiver. If children have the freedom to explore the world while maintaining their connection with a caregiver, they learn independence and a sense of self. They know that they are loved even if they are faced with negative reactions or punishments from their caregivers. I’ve learned that the same principle holds true in a therapy session. Clients need compassion and empathy for their feelings along with the freedom to act out and project their feelings onto someone else who has the capability of creating a container for their experience. In this interaction, old behaviors are challenged and new ones fostered. I’ve learned that sharing uncertainty and vulnerability is not a sign of weakness or inexperience but a way of modeling to our clients. I’ve experienced the power of making eye contact with an incest survivor and felt the unraveling vigor of Schizophrenia. And throughout I’ve recognized that the most valuable gift we can give to ourselves is trusting that our mere presence and willingness to listen in a session, alone, is good enough. Simply sitting with a client provides a natural avenue for diagnostic interpretation. Our body’s reaction to the energy that flows between the client and ourselves often provides an understating of what is happening emotionally within the session. I’ve learned that it is important to trust those reactions and use them as a therapeutic tool to deepen our work.

I recall one particular session in which relying on body reactions was helpful. I had been working with a middle aged woman who was suffering from depression and severe physical pain in her joints. During most sessions she would discuss how debilitating her physical pain had become since giving birth to her first child. Interestingly, I became aware that when she talked about her pain, I had an immediate reaction. I felt my own chest tighten as if I was being held back. I felt tired and unable to stay focused.

Initially, I chose not to share my reactions with her. After discussing my experience in supervision I decided that there was a connection between how I was feeling and the emotional state of my client. I had an inclination that her emotional stress was somehow contributing to her physical pain. Much to my surprise, my thoughts were confirmed during our next session. This client became more aware that her pain intensified when she was feeling overwhelmed or depressed. She also recognized that she was negligent in addressing her physical symptoms, which ultimately made her feel vulnerable. She felt tired most of the time and had little energy to devote to her family, hobbies and a career. This work allowed her to build better skills in nurturing herself, which in turn improved her emotional and physical health.

Last, I’ve realized that supervision is not a weekly reminder of how much I do not know but a time to honor the wisdom of a seasoned clinician. A time when there are no right or wrong answers, just an opportunity for growth. The exchange of knowledge between supervisor and student reminds me of a rite of passage in which an adolescent is initiated into adulthood. This is where a maternal or paternal figure passes down life lessons that could only be taught through years of experience, rather than explained in the pages of a monotonous textbook.

As my thoughts decrescendo to a silent echo, I finish packing my internship office. I am aware of the sadness that engulfs me, knowing that I will not be seeing clients individually again until the fall semester begins. At this moment I embrace the most valuable lesson that I have learned these past seven months… quite simply, I truly love this work. I say a silent, inner “Thank you!” to my clients who have courageously allowed this young therapist the privilege of walking with them on their personal journeys. I’ve been deeply touched and inspired by you all.

Through the Eyes of a Young Therapist: A Psychotherapy Internship

by Claudia Pina, MSW Student