1. Many clients will not change. At least not in the ways we think they will. Not because they don’t want to, but because they do not, for a multitude of reasons, know how. This is not a reflection on you or your abilities. This is a reflection on so many extraneous factors: the messages they learned as children, their subconscious defenses, the ways they cope with stress, their fears, the amount of time allocated, the external environment of finances, physical health, and family. Furthermore, many clients do not necessarily come to therapy to change. They come to be heard, acknowledged, and validated. Few people have the space to just express and learn about themselves. Remember that awareness cannot be unlearned. Awareness, which naturally occurs in any therapy, is already facilitating a change.
2. For clients who do change, it is often slow, gradual, and nonlinear. There are setbacks and questions and worries along the way. The road to healing is a funky roller coaster, which is why the ride of life is a worthwhile one. A slow pace is actually ideal, as the steadiness prepares clients with acclimation, rather than the dreaded crash-and-burn we experience when we go too hard too fast. Moreover, contrary to popular belief, change never just entails restructuring one thing. Our worlds are dynamic, connected energies. Existentially, everything influences everything. Change in one area inadvertently affects every area.
3. Graduate school will teach you theories and case conceptualization and sample therapy interventions. It will not teach you the idiosyncrasies and unique threads of humanity. No amount of school or reading can prepare the therapist for the feeling one actually gets when a client starts making sexual innuendos in session or the fear, guilt, and terror a therapist experiences when debating whether an actively suicidal client needs to be hospitalized. There is no training to prepare for the feeling of driving home after a full day of working with abused children or clients with fierce drug addictions. Therapy is an active and organic experience. Though the science can be taught in books and lectures, the art of it must be felt.
4. People cannot work on self-actualization, healing, and wholeness until the basic necessities of food, water, shelter, and safety are met. It is futile to help a client struggling with homelessness and malnutrition to understand his “inner motives” without addressing his dire situation. An individual struggling with drug addiction does not need to work on her self-esteem while she is actively using and engaging in high-risk behavior. That work is important for maintenance and future success in the long run, but survival needs are paramount.
5. 99% of children in therapy do not have the problem. The parents have the problem. 99% of the parents will blame the problem on the child. And so the cycle continues. “Problems” or whatever word we want to use for the difficulties a client experiences are systemic and arise from the passing of cultural and familial interactive patterns. Children are reflections of their immediate environments; their identities shape from their parents’ implicit and explicit reinforcements and acknowledgements. When stress in a family exists, children, with their limited control, react in the best ways they know how. Greater society may interpret such behaviors as dysfunctional, when they see it as necessary for survival. In this regard, youngsters represent keys to unlocking a family’s health.
6. The ideal therapist is the flexible therapist. Therapy cannot always take place on the comfortable couch in the dim-lit office with the accessorized bookshelves and perfect finishings. Therapy occurs in empty classrooms, in a conference room, wherever confidential space is available. Having a playroom with kids is ideal, but the flexible therapist can work in a poverty-stricken school with a single box of crayons on the fly. Flexible therapists are the open-minded therapists. They rely on themselves and their empathy, love, and compassion to connect with the client across from them. They do not rely on the techniques, amount of time, resources, room, or books available.
7. Many clients will want to know about you, and that is not always a negative transference speaking. Sometimes, they just want to know the human sitting across from them. Where you live, did you grow up around here? Do you have kids? Sometimes, they feel nervous and need the reassurance that the expert is also a genuine person behind the trained blank slate. Self-disclosure is a complex and controversial matter, but at the heart of it, stripping away the labels of therapist and client, removing the distance between the arbitrary professionalism, we need to realize that humans simply and innately want to know other humans.
8. Graduate school teaches you about being a therapist. They don’t tell you how to make a business, practice, or actually make money. For therapists going into their own practice, it’s a business. And that territory gets murky when most therapists want to save the world. If a client doesn’t pay or cannot pay, the ethics become confusing. On one hand, nobody wants to be that bitter, jaded professional who worries more about the money than the work. On the other hand, everyone needs to make a living, and hard as that may be, doing so may require some moral sacrificing.
9. All the advanced training and glamorous therapeutic techniques cannot make up for the basic humanistic skills of active listening, empathy, mirroring, validating, and sharing closeness with a client. Without a general undertone of safety and trust, there is no rapport, and when there is no rapport, there is no foundation. It is like trying to bake a cake without thinking you need the pan to keep it all together.
10. There is no right way to do self-care, and yet professionals in this field will continuously make it seem like it is an all-or-nothing skill. Just know what things make you feel good, which people make you feel good, and which places make you feel good, and prioritize your time to engage in those three categories. Prioritize them the same way you would prioritize your work. And if you sometime slip and find yourself forgetting to take care of yourself, that’s okay! You are a human being, and most of us struggle to carve time for ourselves. This is a learning process, and it will get easier with practice. At the core of it, self-kindness is more important than self-care. With self-kindness, you are all but invincible.