6 things I wish I’d known before becoming a therapist

The world needs more therapists. Some reports show that around half of Americans live in an area with a mental health provider shortage, with some states needing a whopping 700 additional therapists to have enough to meet local mental health needs. 

There are so many complex factors leading to this shortage, including (but not limited to) therapist burnout. If you’re thinking about becoming a therapist, you’re filling a vital need – but it’s essential to prepare yourself for every part of this multidimensional and rich career.

Here’s what I wish I’d known before becoming a therapist.

1. Invest in the process, not (only) the outcome

As a therapist in public health spaces (community mental health clinics, public school districts, etc.) I was trained to focus on outcomes. I needed to set measurable goals and track how every intervention helped my clients reach these outcomes.

I understand the importance of outcomes and why, especially from the outside looking in, it can seem like therapy is insignificant if you haven’t reached specific goals. Effective, evidence-based practice is important. Positive client outcomes are important.

But the heavy focus on outcomes sometimes leads to a feeling of hopelessness when your clients don’t meet those goals or you feel like you aren’t making the “progress” that their official treatment plans demand. Other times, you never even get to see the outcomes. Your clients may move away or get transferred to another therapist. For a myriad of human reasons, they may no longer be able to come in and see you.

But that doesn’t mean that the entire process you walked together was pointless. There are so many small steps and achievements and breakthroughs that happen on the way to the final outcome that are worth celebrating. I wish I’d known how powerful the process could be, even if the outcome was unclear.

2. You don’t need to change the world to have an impact

I finished graduate school at the ripe age of 24; wide-eyed and passionate, I was ready to get out there and change the world. I think many new therapists, especially those of us who got into the profession as younger adults share the same idealistic sentiments.

I have empathy for that young, hopeful girl, but I wish I could tell her: You aren’t all-powerful. No one is.” Yes, your work is important and makes a difference.  But it’s enough just to be present. You don’t need to carry the whole world on your shoulders.

As therapists, we can feel so helpless in the greater context of our clients’ lives. Our clients deal with things like racism, poverty, and injustice. We fight within systems that are so much bigger than us. As much as we try, we can’t change everything for them. Unfortunately, it’s not so easy to change the world.

I wish I’d known not to view myself as all-powerful or 100% responsible for changing my clients’ lives. It’s not fully our responsibility to “save” anyone from the world. We can, and should, fight alongside our clients to help make the world a safer and more just place – and that fight is worthwhile, even during times when it feels like it doesn’t amount to anything. 

3. Real therapy is messy and unpredictable

You probably remember the training videos we all watched in graduate school of what a therapy session was supposed to look like. Two therapists, one role-playing as the client, work through a seemingly complex problem in mere minutes, demonstrating just how effective certain therapy methods can be.

I’m also a motivational interviewing trainer. I’ll always remember one of my students, after completing our “MI basics” course, told me: “I feel like I’ve just read a textbook about how to play basketball. And now it’s time to go out there and learn how to actually play basketball.”

I wish that I’d been as wise as that student before becoming a therapist. These trainings on what to do during a session are all well and good, but what happens when a teenaged client in a group home slams the door on you when you show up for your first session together? What do you do when you’ve finally managed to build trust with your client’s parent, and now you need to send a child abuse report against them? How do you navigate a client who’s at risk for suicide but begs you not to call crisis services?

Real therapy doesn’t look like it does in role-plays and training videos. It’s human and messy, because the people on both sides (both therapist and client) are human and messy. That’s not something to be discouraged about – it’s part of the beauty of this profession.

You will get to witness so much joy.

Before working with people in therapy, I prepared myself to be able to carry their suffering alongside them. Because that’s what I believed a therapist does – they share the weight and work, through different methods, to try to relieve their clients’ suffering. I think that’s what draws many of us to the profession in the first place.

What I (for some reason) didn’t realize is how much joy we also have the opportunity to bear witness to. People with mental illness still laugh. Children in foster care with PTSD still play and run. Families get reunited after treatment. People get new jobs; have babies; fall in love. There is so much joy, even in the darkest of times.

It was an indescribable honor to be trusted to bear witness to people’s suffering, but it may have been even more of an honor to be able to bear witness to their joy and love. That’s really what has stuck with me when I look back on my time as a therapist.

5. You don’t need to know everything all the time

Fresh out of graduate school, I felt an intense pressure to be the expert that had all of the answers for everyone’s problems, which I believe is a pressure that many new therapists feel. After all, people are expecting results. Many of them are paying to see us week after week. We are the professionals in the room, and are expected to have some knowledge.

While this is partly true – we do have a great responsibility to continue learning and only take on clients within our scope of knowledge and “expertise” – it’s also okay not to know everything all the time. In fact, there’s no way you can have all the answers to someone else’s problems. To have imagined that I even should have all the answers lacked humility on my part. What could I possibly know about what it was like to be them?

I learned that it’s best to lead with curiosity. The client in front of you is not a problem to be solved or fixed. They are a human being with so many layers and nuanced experiences. You can allow them to teach you about what it’s like to be in their shoes. You can help them work things out for themselves. It could backfire on you to pretend like you already know the answers.

6. Take advantage of tools and resources that help you

We spend a lot of time researching different resources to help our clients. A lot of that happens to be helpful to us as well, like looking for training opportunities to be better able to serve our clients’ specific needs. But it’s also so important to look for tools and resources just for yourself; it isn’t selfish to spend work hours doing so.

For example, therapy for therapists is one resource that’s essential, especially for newer therapists. I did have my own therapy while I was a therapist, but I wish I had felt less shame around it. I wish I’d known that it was a necessary resource to help me be successful in my career, not a humiliating sign that I wasn’t “cut out” for this work. 

Another helpful tool that could make the job easier is using AI software to help you save time on progress notes. You don’t need to do it all on your own. By outsourcing the parts of being a therapist that you don’t enjoy, you have more energy for the parts of it that you do. 

Final thoughts

Becoming a therapist is a journey that's nuanced, dynamic, and deeply fulfilling — but it's also one that comes with unique challenges. I wish I’d known these things before becoming a therapist. But at the same time, I know that the unpredictable outcomes and inevitable moments of self-doubt are part of the process for all of us.

Therapists today are fortunate to have technology on their side. Tools like Upheal, which can handle your notes and treatment plans, allow you to focus more on client care and less on paperwork. It’s a reminder that you don’t have to do everything yourself.

Try Upheal for free and save between 6 to 10 hours per week on documentation.