“What kind of therapist are you?” Many psychology graduate students receive questions of this nature. Additionally, many of us have also observed supervisors and professors share “I’m an ACT person” or “I work from a family systems perspective,” reflecting a sort of certainty around their professional identity. Being a student is often akin to being a sponge—we soak up information and learn to critically evaluate what is important to retain. As trainees, it can be daunting to figure out exactly what kind of therapist we are and at times, we may not have a say in the treatments we learn or the theoretical orientations we are exposed to. Our clinical judgment is an important tool as we explore who we are as a trauma therapist. Developing and trusting our clinical judgment is no simple task and is deserving of discussion and reflection.
Numerous factors may influence how we navigate training and provide certain types of treatment. The types of therapy we provide may be influenced by what is taught to us in our programs, our degree of experience, the approach of our individual supervisors, or the needs of our clients. Additionally, the context in which we provide therapy influences treatment options. Treatment settings often vary in the length of care offered (short-term versus long-term care models), or the degree of specialization of treatments (a PTSD clinic specializing in providing only cognitive processing therapy or prolonged exposure therapy, for example). Individual differences and personal experiences may also influence the types of therapy we provide. These influences may include our confidence in specific modalities, our past experiences with certain types of treatments, or even our own experiences receiving mental health care.
Despite these differences, one common denominator throughout our training is the emphasis on evidenced-based treatments (EBTs). Manualized EBTs provide novice therapists structure to effectively engage in trauma treatment. In a way, they can also encourage our growth as a therapist by increasing our competence and self-efficacy. Yet, our exposure to a number of EBTs and varied clinical experiences often reminds us that no therapy is universally effective, and flexibility is a key clinical tool. This is not to say that we should negate empirically supported treatment; rather, we believe this is a place for integration of science and the importance of clinical judgment (Zeldow, 2009). Thus, although we will likely continue to face the question, it’s possible that we do not need to be one specific “type” of therapist. Ongoing development of our clinical judgment is a helpful solution to resist the pressure to adopt one exclusive theoretical orientation, and to foster a sense of security in our professional identity and capabilities. Below, we offer some recommendations from our experience as graduate students in a trauma-focused doctoral program for developing clinical judgment:
- Consult. Taking the time to consult with supervisors, professors and other students (within appropriate boundaries of confidentiality, of course) provides an opportunity to hear different perspectives. Even though multiple perspectives can feed a trainee's confusion on the “right” decision, the knowledge that different qualified individuals have different approaches to treatment reinforces for students that there may not be one “right” way.
- Open-mindedness and flexibility. Trying new things (and more than once, especially if the first round felt like a major failure!) is a great way to continue to figure out what works for you and your clients.
- Try one thing at a time. Doing a little bit of everything seems to, at times, fuel feelings of insecurity and uncertainty about one’s strengths and preferences. Making an effort to go “all in” on a specific treatment modality or technique to first grasp the basics of that technique can be helpful in establishing familiarity with a treatment modality; then, the next step may be incorporating skills from other modalities based on clinical judgment.
- Take time to reflect. Guidelines, such as The New Haven Competencies for Trauma Psychology (American Psychological Association, 2015; Cooke et al., 2014), provide an objective framework to gauge milestones and development as a student in training. It is also important to subjectively reflect on your progress and areas for growth. Try to allocate time throughout the semester to actively reflect on where you are and where you’d like to be.
- Self-compassion and praise. Try to engage in self-compassion as you navigate the thrilling, yet daunting, world of being a therapist. As trainees, we often tend to be self-critical, particularly with tasks where we perform less than perfect. Allow yourself some grace if you make a mistake and some space to learn from that mistake. Similarly, take time to recognize your successes and growth!
- Get creative. Don’t be afraid to try new and creative ways to bolster your awareness and trust in your clinical judgment. For example, both writers were encouraged by a supervisor to write down one emotion word after each therapy session. The purpose of this exercise was to increase emotional awareness for ourselves and for our clients. Journaling or other creative mediums can also serve as an outlet to process experiences throughout your training.
In summary, students may be exposed to a variety of treatments and orientations throughout their clinical training. Fostering clinical judgment may help students navigate these experiences. Furthermore, trusting in our clinical judgment may help us focus more on the process of developing our identity rather than being consumed with the outcome. We have found the most benefit in understanding that our foundation as a therapist is multifaceted. Because of this, we find value in continuing to ask ourselves, what kind of therapist do I want to be?
About the Authors
Sophie Brickman, BA, is a current doctoral student in clinical psychology with an emphasis in trauma at the University of Colorado Colorado Springs. She earned her bachelor's degree from Brandeis University and completed her undergraduate thesis on profiles of trauma adaptation following the Boston Marathon bombings. Her research and clinical interests include posttraumatic growth, trauma memory, and the role of creative writing in trauma healing.
Julie Hurd, MS, is pursuing her doctorate in clinical psychology with an emphasis in trauma at the University of Colorado Colorado Springs. She earned her master’s degree from Arizona State University and completed her master’s thesis on interpersonal trauma and intimate relationships. Her research and clinical interests include the application of nonlinear dynamics to post-trauma recovery and resilience, particularly in the context of sexual trauma.
References
American Psychological Association. (2015). Guidelines on Trauma Competencies for Education and Training. Retrieved from:http://www.apa.org/ed/resources/trauma-competencies-training.pdf
Cook, J. M., Newman, E., & The New Haven Trauma Competency Group. (2014). A consensus statement on trauma mental health: The New Haven Competency Conference process and major findings. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 300–307. https://doi.org/10.1037/a0036747
Zeldow, P. B. (2009). In defense of clinical judgment, credentialed clinicians, and reflective practice. Psychotherapy: Theory, Research, Practice, Training, 46(1), 1-10. https://doi.org/10.1037/a0015132