What Brings You Here?- Advice for the couch

This week is about stepping out of your reference books and diving deep into the real world of what therapy might look like for you. Shivika Mishra MBPsS , clinical psychologist and in-house expert on all things therapy, breaks down some skills she’s learnt in her journey of being a therapist straight from the therapy room.?

If you’ve been doing this for a while, and by while, I mean even if this is your first year of practicing as a therapist, there are few things you’ll realize pretty soon into your practice. Which is– the real world of therapy is a little bit different from what the textbooks say. This can be exciting– there is always something new to discover in the work. But let’s be real, sometimes, it’s daunting to realize that maybe the textbooks didn’t tell us all (bold of us to say this after releasing a newsletter last week on books you should be reading as a therapist :P).?

In the real world of therapy, you have awkward silences, questions that shatter the illusion of the “blank slate therapist”, strong feelings of relatedness to clients or sometimes, the complete opposite. You have self-doubt, feelings of stuckness or even exhaustion with the therapy process. In those times, it can feel like those skills of empathy, paraphrasing, summarizing or reframing just don’t seem to cut it. In those times, we might actually find ourselves branching out into entirely new parts of therapy and of ourselves, looking for answers to these feelings.?

In my own journey of addressing places I feel stuck in, I have come to realize the importance of a few skills that I’ve picked up over the years, outside of the textbooks (even the ones I dearly love).?

Curiosity. I’ve learnt (or atleast, I’m trying to learn) to approach not knowing what to do next in a session with a sense of curiosity rather than panic. This has meant gradually becoming curious not only about what the client means or feels, but also asking myself–?what about not knowing bothers me? Rather than trying to adopt an approach where I know exactly what the client might need from the session, I am open to asking the client what they would like to hear or do. For me, it’s allowed a sense of authenticity and depth in our relationship that’s been meaningful for both the client and my growth.?

Flexibility. As much as I love those sessions where everything goes exactly like I had planned (yes, they mostly exist in my imagination), every now and then, I am reminded just how human this process is. There will be shifts in the process that I cannot possibly predict, and that means I need to be flexible with them as well. Flexibility not only helps me adapt, adjust and break out of my own rigidities, but reminds me I’m here to effectively help the client, even if that means adding new skills to my toolkit.?

Creativity.? Those moments of stuckness or self-doubt are also the moments when I find myself becoming the most creative. I might find myself reaching out for metaphors, reflective activities, art or simply asking more creative questions as a way to engage with the client and the process further. For instance, sometimes I would find myself sensing that a client is having difficulty expressing their feelings through just language and so I would have to pivot and maybe explore other modalities say art, movement, writing. Sometimes I sensed it was just about bringing this up with the client and asking- hey I felt you might be having trouble here I wonder what it might be about??

While these skills are something I’ve found helping me whenever I’ve felt stuck, the one that has been my north star is building my own emotional capacity. The capacity to reflect on my own feelings, unlearn and relearn my biases, draw my boundaries, nourish myself have all been a big part of being able to practice these skills, engage with the process and use my own feelings in therapy to work with the client.?

If you’re someone who is feeling particularly stuck with a part of the process right now, this is your gentle reminder that you’re on the right track. Not all parts of you being on this journey will be found in books, some will be discovered through doing and falling, making mistakes and reflecting. So get back to that session and try again. You never know what new skill you’ll discover this time. ;)