How to Overcome Self-Doubt as a Therapist By Steve Alexander, LMHC on 9/21/22 - 6:13 PM

“Steve, I’ve decided to stop talking to Marc,” said Sheila, starting the session without the usual pleasantries. I could hardly contain my excitement. 

I had been working with Sheila for two years, attempting to help her develop a sense of self-worth. She had been in and out of multiple abusive relationships and thought very poorly of herself. This was despite having two master’s degrees, a rewarding career, and being highly attractive (all societal markers of success). 

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Sheila had permitted Marc to enter her life and erode what little self-confidence she had left in the wake of the abuse she had suffered prior to meeting him. She complained of his manipulation tactics and how he had recently “gotten a prostitute pregnant behind my back.” I was ecstatic that she was finally standing up for herself. 

I decided to follow up with a Rogerian type of approach. I feared that questioning might be too confrontational. Instead, I wanted Sheila to reflect on where she got her courage from to finally cut Marc off. Secretly, I wanted to be praised for being a world-class therapist. I wanted to hear that our work had paid off and that she felt stronger. So insecure and immature of me, right?! 

“Say more about that,” I gently nudged. “Well, my psychic told me not to do it,” she replied flatly. Two years of weekly 45-minute sessions invalidated by a single 15-minute psychic reading. It felt as though I had been punched in the stomach. I could feel my face getting numb. I was at a loss for words. 

“She told me that Marc is bad news and has wicked intentions for me,” Sheila continued quite proudly. While I was pleased that she was no longer tolerating oppression, I felt small and insignificant. I also thought of it as a flight into health. One discussion, and now Sheila was cured. It made me reflect on countless times that my therapeutic efforts were dismissed by a client who just so happened to be influenced by a friend, clergy member, or some insight they received on TikTok. 

This case caused me to reflect deeply on my role as a helper. Why did I feel the need to be the sole agent of change for Sheila? Why wasn’t I more open to all (other) avenues of support that Sheila could receive? Doesn’t it take a village? I also wondered about how often clients come to me for direct advice. Sheila was no exception. 

So many times, I have non-directively responded to “What do you think I should do?” with “What would you like to do?” It is not that I am afraid to answer questions from my clients. I do it often. However, I have found it to be ineffective to give clients direct answers when their presenting problems are highly nuanced—such as relationship dynamics in the case of Sheila. If the advice works, I’m heralded. If it fails, I’m demonized. I find it much more effective, as well as in their interests, to help clients come up with their own solutions. 

Within two weeks, predictably, Sheila was sending Marc a barrage of text messages and outwardly professing all his admirable qualities. There was no longer any mention of the psychic. “What good is that psychic now?” I wanted to cry out but restrained myself. Instead, I maintained a calm, nonjudgmental demeanor and allowed Sheila to tell me all about what led her to reach back out to Marc. 

By the end of that session, Sheila thanked me for “always being there for me.” That was all the validation I needed. She reminded me that while all the men in her life—including her father — were inconsistent, I was the one man who stood by her side. It wasn’t necessarily about giving or not giving her advice. Sheila is smart enough to make her own decisions and deal with the consequences. It was more about the fact that I was the one person who had been there for her. 

I had spent two years of therapeutic effort wondering when I would say something that might resonate with Sheila. However, the true work has revolved around being a consistent and supportive presence in her life. My work with Sheila is far from over, but I do feel that I am on the right track for us to make meaningful progress together. 

Questions for Therapeutic Thought 

  • What about the author’s experience with this client challenged you to think about your own clinical work? 
  • What types of clients trigger your own self-doubt and how do you address that discomfort? 
  • How might you have addressed this particular issue with Sheila? 

File under: A Day in the Life of a Therapist, Musings and Reflections