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| I'm afraid that I don't remember either the face or name of my first client. But I clearly remember getting ready to go into the therapy room to meet her, and feeling terrified. I remember sitting down with the client and being wholly preoccupied with my own fears. Despite the best efforts of the teaching faculty, I felt that I didn't know anything when I actually met her--a live client. I had no idea how to guide the client through the psychotherapy session. I didn't know how to assess the client's problems or prioritize them. And I was utterly unprepared to deal with crises.
That first therapy session scares me even today, but for a different reason. I now know much of what I was ignorant of that fateful day in 1986. If the client had a mental illness that is difficult to diagnose, like bipolar disorder or ADHD, I undoubtedly missed it. I didn't know anything about psychotropics, so if she could have benefited from a referral, she didn't get one. If the client came in feeling suicidal, I would have had no idea what to do. I didn't know anything about charting, and who knows what errors I made about what to include and what not include in the chart. I doubt that anyone, myself included, told the client anything about confidentiality or informed consent. These are the reasons why that session scares me now.
Uncertainty, fear, and lack of knowledge, still exist among beginning psychotherapists today. Friends who supervise beginning therapists tell of students coming into their offices and asking, "But what do I do?" These students know a lot about theoretical orientations. They have been taught reflective listening skills. They know about legal and ethical issues in psychotherapy. But how to start seeing a real live client still eludes them, because there has been no one source for all the most basic information you need to know before you start seeing a client.
Often, beginning therapists have no idea how to greet a client in the waiting room or what appropriate professional boundaries are. They don't know how to deal with clients on the phone. They may have to screen new clients, but not know much about how to make a diagnosis, and what disorders are commonly missed. Beginning therapists (like all therapists) have a lot of emotions about doing therapy, but beginners tend to feel bad about having these feelings (Brody & Farber, 1996), and they don't know what about them.
Extreme differences in theoretical approaches can leave the beginning therapist confused. However, it is my belief and my hope that we are moving towards theoretical integration and balance. My focus in choosing my references for each chapter was not theoretical orientation--instead, it was clinical utility--and different theoretical approaches have different clinical strengths. I have tried to draw on the strengths of different traditions to integrate them into a whole that will be useful to you.
I'm sure that it is impossible to take away all the fears of beginning therapists. However, I believe that it should be possible for you, the beginning therapist, to feel less confused and uncertain about what to do with your clients. That belief inspired me to write this book.
This is not really a book about how to do psychotherapy. Instead, it is a book about how to start psychotherapy. My goal in this volume has been to provide a well-rounded review of important topics that any beginning therapist should know before seeing a new client. In addition, I have included some material about the emotional complexities of doing psychotherapy for the psychotherapist. Research (Leiter & Harvie, 1996; Pearlman & Mac Ian, 1995; VanDeusen & Way, 2006) has shown that beginning psychotherapists are more often overwhelmed by their emotional reactions, and this is a topic that is not typically addressed in most books about doing psychotherapy.
I sincerely hope that my efforts will help you cope with the anxieties and uncertainties that are inherent in becoming a psychotherapist--and move forward to appreciate the wonderful opportunity you have to make a positive impact on the personal life of another human being.
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