Clinical Psychologists! How did you know?

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How did you know you wanted to be a clinician? I recently spoke with a professor of mine (I'm an senior about to get my undergrad) and asked this same question. He related to me his story about how when he began his practice, he was somewhat disillusioned with the way therapy would transpire. Patients weren't thanking him for his guidance, but rather angry with him for not solving all their problems. He said a lot of students go into clinical programs with the wrong idea, so I want to make sure I've got my head on straight.

So! Clinical psychologists or masters-level practitioners--do you enjoy therapy? Do you find it satisfying? Do you have any precautions to students that might be naive to the process? And finally--how did you know you wanted to be a clinician?

I don't enjoy therapy as much as I thought I would, so I'm going to try to have a research/teaching career with little to no clinical work. I have a lot of reasons for disliking therapy: frequent no shows, clients who won't comply with treatment, clients who won't do homework, having to balance between building the relationship and using techniques, etc.

Er, I went into a clinical program, but I never had any intention or desire to become a clinician when I grow up.

I'm sort of, kind of, maybe rethinking that stance for various reasons--but I still don't think that I could be a clinician full-time. Just not my cup of tea.

Otherwise, I've never thought my clients would be especially grateful (sometimes they are; sometimes they are not). The primary population I've worked with over the past few years: they almost all come in generally resistant, defensive, withdrawn, and angry as hell. To be expected if you're forced to do something that you don't want to do or that you don't feel you deserve. Work with it and move forward or you're going to burn yourself out quick (and lots of people have revolved through the doors here in the past 1-1.5 years alone). But, I actually still enjoy working with *this* population more than I do the "other" folks for the most part. I think working with my preferred population actually provided me the opportunity to learn more patience with my "regular" clients when they're ambivalent, non-compliant, etc.

I enjoy therarpy, although I enjoy assessment more, in part because I feel that it plays to my natural strengths a bit more consistently (i.e., I'm better at it than therapy). I do find it satisfying, though, even with all the setbacks (some of which cara listed). Not something I want to shape my career around, but a useful tool and interesting experience if nothing else.

Originally Posted by AcronymAllergy

I enjoy therarpy, although I enjoy assessment more, in part because I feel that it plays to my natural strengths a bit more consistently (i.e., I'm better at it than therapy). I do find it satisfying, though, even with all the setbacks (some of which cara listed). Not something I want to shape my career around, but a useful tool and interesting experience if nothing else.

I'd agree with this, but I'm still uncertain regarding whether I'd want to do it on a long-term basis . . . as I have minimal experience in the assessment realm to date (unless we count those cursed intakes! ). However, what minimal experience I do have, I much prefer my handful of assessments than my intervention hours, but we'll have to wait & see if it's something I can stick with for more than a year or two before I'm ready to keel over.

I never wanted to be primarily a clinician, and I have to say that this view was shared by the majority (all?) of my cohort-mates in my clinical Ph.D. program. I was interested in the systems level, program consultation, and administrative side of the clinical field,- more specifically related to programs for individuals with significant behavioral problems. I chose a Clinical Ph.D. because of a) match with the interests and endeavors of the mentor; b) combination of research (systematic outcome analysis) and practical training; c) personal conviction that if you are going to be making systems level decisions, running clinical agencies, and supervising clinicians, you should be a well-trained clinician yourself; and d) the flexibility the Clinical Psych. Ph.D. (and resultant licensure) offers as far as ability to do a lot of different things (e.g. teach, consult, supervise practica students and interns, see clients on the side), both in addition to and in conjunction with any primary job.

I do enjoy doing the little direct clinical work I still get to do (usually in the form of behavior analysis and only occasionally CBT), but not enough that I would feel able to do so for any substantial portion of my work week.

I prefer assessment to therapy, too. I think I like the structured format.

I was never really interested in therapy. The closest I got to liking therapy was strict behaviorist stuff, mostly with children. I am generally not one to enjoy sitting around listening to people's problems. It is draining and depressing. I got into psychology because of my interest in brain and behavior. I selected clinical psych because I thought it would be very flexible. There is more risk to pursuing a research only degree. People with clinical psych phds work in a wide range of settings and research foci. I liked the idea of neuropsychology (assessment and rehab participation). Also, clinical science I think is best practiced by those with clinical degrees.

It seems like you attracted all of the assessment/other folks to your thread....

I came in wanting to do some therapy, teach, and research....but that changed after a few years of practica. I realized I very much enjoyed the assessment and conceptualization aspects of clinical work....but not the actual treatment. I thankfully trained under a behaviorist (in addition to a CBT'er and DBT'er), though some of the psychodynamic stuff was interesting to learn...but always taken with a grain fo salt. I don't do traditional psychotherapy in my job (thank god), but the training is still quite applicable because you still deal with maladaptive behavior, distorted cognitions, etc.

I will speak up on behalf of therapy. I went into clinical psych wanting to work in both research and clinical work. Now that I'm almost done with my program, I still enjoy research and want to incorporate it into my practice, but I want to do clinical work full time. I really enjoy it. I found an orientation that makes intuitive sense to me and is well supported (ACT/ 3rd wave behaviorism), and a population I really want to work with. It's true that some clients can be frustrating, and some don't improve. Some will quit coming and some will be suicidal or otherwise in crisis. However, I think that seeing improvement over time (for some clients) makes the stress worthwhile. I won't say therapy is the only thing I would ever be happy doing, but it does hit a lot of the things on my list.

Originally Posted by cara susanna

frequent no shows, clients who won't comply..., clients who won't do homework, having to balance between building the relationship and using techniques, etc.

This sounds eerily like my experience with teaching so far...

I started my PhD program with a strong goal to pursue research and have little direct patient/client contact. I continue to love the intellectual satisfaction I derive from research, but I have learned that the addition of clinical work provides me with a greater sense of meaningfulness. I actually prefer challenging clients and find the most satisfaction from figuring out how to employ my evidence-based techniques and form/maintain rapport with people who are ambivalent/difficult/hostile/whatever. The satisfaction I take has to come from small victories though most of the time. That's enough for me (as long as I get to do my research too!).

I agree that a good mix of therapy can be satisfying--it really is great to interact with people and build a relationship. You can do this in research, but the therapy helps to give you more perspective about what it's really like "out there." I've just learned not to expect much from my clients, and I'm continually suprised!! Little changes are actually huge and just talking to people can help them to feel a lot better.

For me, the things that suck about therapy are the agency politics and bad supervision. When you get involved in an agency where everyone is miserable, and they are so sick that they are thriving on their client's psychopathology to give them meaning, that is when it becomes unbearable to me!! There are some really miserable therapists out there, and it can easily rub off on you. This is where doing therapy sucks, IMO.

Originally Posted by Psychadelic2012

I agree that a good mix of therapy can be satisfying--it really is great to interact with people and build a relationship. You can do this in research, but the therapy helps to give you more perspective about what it's really like "out there." I've just learned not to expect much from my clients, and I'm continually suprised!! Little changes are actually huge and just talking to people can help them to feel a lot better.

For me, the things that suck about therapy are the agency politics and bad supervision. When you get involved in an agency where everyone is miserable, and they are so sick that they are thriving on their client's psychopathology to give them meaning, that is when it becomes unbearable to me!! There are some really miserable therapists out there, and it can easily rub off on you. This is where doing therapy sucks, IMO.

Yes. I wish I could quadruple bold that statement.

I went into grad school not entirely sure of what I wanted to do (but pursued a research-focused PhD program to keep my options open), and the majority of my classmates are headed into clinical careers. I actually found myself enjoying all aspects of the program, from research to teaching and assessment to therapy. For me, academia is a nice place to be because I get to do all of that. In this program, I can take clients through the in-house clinic or see them through a private practice. All the core faculty here do supervision, and some remain active clinicians in addition to running a research program, so it's really the best of all worlds for me.

Internship taught me that I don't want to do clinical work full time, but I would miss it if I weren't able to do a bit of therapy. Therapy grounds me, reminds me why I do research, gives me experience to rely on when teaching, and the struggle to do good therapy gives me empathy for students I supervise. Not to mention that therapy gives me perspective on my own life, which certainly isn't a reason to do it, but for me is a nice perk.

Originally Posted by EmotRegulation

I went into grad school not entirely sure of what I wanted to do (but pursued a research-focused PhD program to keep my options open), and the majority of my classmates are headed into clinical careers. I actually found myself enjoying all aspects of the program, from research to teaching and assessment to therapy. For me, academia is a nice place to be because I get to do all of that. In this program, I can take clients through the in-house clinic or see them through a private practice. All the core faculty here do supervision, and some remain active clinicians in addition to running a research program, so it's really the best of all worlds for me.

Internship taught me that I don't want to do clinical work full time, but I would miss it if I weren't able to do a bit of therapy. Therapy grounds me, reminds me why I do research, gives me experience to rely on when teaching, and the struggle to do good therapy gives me empathy for students I supervise. Not to mention that therapy gives me perspective on my own life, which certainly isn't a reason to do it, but for me is a nice perk.

Thanks for posting this. Weird as it may sound, I kind of feel like this is my future. I hope I enjoy most aspects of my program, too, even though I'm going in not entirely sure of what I want to do, but with SOME idea nonetheless.

Originally Posted by Psychadelic2012

For me, the things that suck about therapy are the agency politics and bad supervision. When you get involved in an agency where everyone is miserable, and they are so sick that they are thriving on their client's psychopathology to give them meaning, that is when it becomes unbearable to me!! There are some really miserable therapists out there, and it can easily rub off on you. This is where doing therapy sucks, IMO.

This is so disheartening! It makes me sad that it can sometimes go this way and hope that I don't end up in a similar situation.

It sounds like the majority of people (posting here, at least) prefer teaching or assessment to therapy. I have thought a lot about teaching, but I hear it can be difficult to get a job in that arena. I love research though.

I'm just scared because I love social psych literature maybe even more than I like the clinical studies? So the determining factor in my mind was whether or not I would enjoy therapy. Does that make sense? I would love to conduct research in the social psych field, and I would love to conduct research in the clinical psych field. I just am afraid of making the wrong decision I think.

A lot of folks consider a clinical psych degree as a Research+ option...meaning you can do research, but you also have other opportunities for work. If you only have some interest in therapy, you can get a baseline competency and then do as much or as little of it as you want.

I'm excited to post on this topic!

I went into Psych undergrad wanting to provide therapy interventions, and that continues to be the anchor to all my other interests! I enjoy working with complicated presentations (even with the No Show rates), I also love doing clinical research, from outcomes research to identifying areas of needed interventions in various populations. I also love teaching and plan on teaching therapeutic theory and intervention courses because of my passion for developing competent clinicians who are well versed in ESTs.

My own story is that I've known and had a clear vision about this for a long time, and each experience I've had in this process (course work, practica, research, employment in the field) has only increased and refined my passion. I'd gladly share more if you'd like to talk further. Just PM me.

Originally Posted by DJW1025

This is so disheartening! It makes me sad that it can sometimes go this way and hope that I don't end up in a similar situation.

It sounds like the majority of people (posting here, at least) prefer teaching or assessment to therapy. I have thought a lot about teaching, but I hear it can be difficult to get a job in that arena. I love research though.

I'm just scared because I love social psych literature maybe even more than I like the clinical studies? So the determining factor in my mind was whether or not I would enjoy therapy. Does that make sense? I would love to conduct research in the social psych field, and I would love to conduct research in the clinical psych field. I just am afraid of making the wrong decision I think.

You can certainly integrate social psych concepts into clinical research! Also, many clinical psychologists do social psych kinds of research.

Originally Posted by DJW1025

This is so disheartening! It makes me sad that it can sometimes go this way and hope that I don't end up in a similar situation.

It sounds like the majority of people (posting here, at least) prefer teaching or assessment to therapy. I have thought a lot about teaching, but I hear it can be difficult to get a job in that arena. I love research though.

I'm just scared because I love social psych literature maybe even more than I like the clinical studies? So the determining factor in my mind was whether or not I would enjoy therapy. Does that make sense? I would love to conduct research in the social psych field, and I would love to conduct research in the clinical psych field. I just am afraid of making the wrong decision I think.

AS mentioned above, you can definitely integrate social psychological concepts into clinical research/practice. I do. My area of cultural psychiatry/clinical psychiatry is essentially a hybrid of abnormal, social and cultural psychology with sociology and anthropology. You can definetely be a clinician and do social/cultural stuff. Go for it! The one thing is that supervisors for a PhD are harder to come by, but there are several across Canada and the US. Feel free to PM if you want/need more information. I was in the same place as you a few years ago. Wanted to clinical work, but really liked social/cultural psychology. So, I did an honours thesis in social psychology, and applied (and go in to) a clinical PhD program.

I was in a PsyD program (finished last year) because I found therapeutic work fascinating and intriguing. I knew that I always wanted to provide help, and through the process of grad school, found assessment just as interesting as well. After five years of practicum experience (primarily therapy, intervention and community outreach), I found that the first two-three years of practica were really hard. I think this is because you're just figuring things out. It's a steep learning curve in regards to incorporating technique, rapport building and maintaining a therapeutic alliance.

Plus, it's just hard on your ego! When someone says they disagree (whether it's clients and/or supervisors or BOTH), or think your support is bulls***, after all the hard work you put into your program and the therapeutic work, that's pretty hard stuff to hear!

However, I think, especially after internship and now though postdoc, therapy has been so rewarding. It also helps to be in a system where people are actual paying clients who want help. Part of therapy is setting up expectations for your clients, so that they don't think you're going to solve all their problems.

that's just my 2 cents.

Originally Posted by Psychadelic2012

For me, the things that suck about therapy are the agency politics and bad supervision. When you get involved in an agency where everyone is miserable, and they are so sick that they are thriving on their client's psychopathology to give them meaning, that is when it becomes unbearable to me!!

Can you please elaborate on this? I don't think I understand.

Originally Posted by Iwillheal

Can you please elaborate on this? I don't think I understand.

I'm not sure what you mean by elaborate, but I'll try. Many mental health workers are underpaid and overworked, often seeing back-to-back clients and facing enormous amounts of paper work in utterly uninspiring environments. The only focus is: How many more clients can you see? It can be all about the numbers. The supervision can suck, where there is no focus on treatment and the only thing that matters is keeping them coming so the agency gets their money (or else face losing your job). Clinicians get jaded by all of this and lose their drive to really help clients move along in their lives, because they themselves are not moving forward. The excitement of their clients' dramas keep them going--if the client needs them, they have something to get up for in the morning. That is what is sick. They then learn to thrive on client problems and don't seem to want them to get better.

When you have several people in an agency with this type of attitude (i.e., Job = See lots of clients = Low Pay = Uninspired = No effort to treat = Just existing to keep the job = Get their kicks from client's problems), it is really contagious and sick.

Thank you, got it now.

Originally Posted by DJW1025

So! Clinical psychologists or masters-level practitioners--do you enjoy therapy? Do you find it satisfying? Do you have any precautions to students that might be naive to the process? And finally--how did you know you wanted to be a clinician?

I am a MA/EdS level practitioner and I enjoy the experience of providing therapy. I do some consultation, spend time in supervision every week, have some paperwork (progress notes, treatment plans), spend my downtime between clients reading a wide range of articles and books on different types of tx, neuroscience, expressive arts, Jungian/Archetypal/Depth approaches, make my own art (process oriented), and spend most of my work time sitting 50 minute after 50 minute session day in and day out. I find it incredibly satisfying, challenging, inspiring, and enlivening. AND I only work part time - I usually have no more than 15 clinical hours per week (all private pay, no insurance).

Things that helped me be successful:
***I am a career switcher who came to this profession in midlife. Having had success in the workplace, achieved, financial security, raised children watched them become successful adults, been in a long and satisfying marriage, and feeling supported by a community of kind and supportive friends helps me put the experience of being a therapist into a larger context.

***Through the years, I have received therapy from a variety of people with many different theoretical orientations. Most of those experience were short term tx in response to a life stressor.

***In midlife, I entered into a long term depth expereince with a Jungian trained therapist - and somewhere in that process, I realized I wanted to become a therapist/clinician/counselor. I immediately ruled out the PhD/PsyD after having worked in academia off and on for a few decades. I began to look at places like Pacifica (home of Joseph Campbell's library), Naropa (integrating eastern philosophies, wilderness experiences, somatic experiences into western psychology), CIIS (because of some friends who had good experiences there) and other places that were "alternative" to some degree. At the time, I thought I could learn to provide tx similar to my therapist by getting training in the treatment I was experiencing.

***Ultimately, I took the cost effective, direct route to being able to practice in my state, I stayed home (instead of relocating to one of the western schools) and went to my local accredited university. The training was adequate. I was definitely the only one in my cohort who had an interest in depth work. I learned a lot of "techniques" and "theories" in the coursework part of my program - some fascinating and some stultifying. AND I continued my own experiential training in depth work.

***I had excellent supervision during my first practicum. My supervisor was a seasoned clinician (LPC - one of the few in a group of mostly PsyD/PhD clinical psychologists). He nurtured me, gave me mostly easy cases at first and shared with me his love for group process. We were required to complete a 100 hour practicum - 60 indirect/40 direct. I loved the work of providing therapy so much, I completed two in the same setting and a third in a different setting. The fit between me and my supervisor was a good one. That is important. The same situation without a good supervisor, I would have never done an additional practicum for my elective credits.

***I was super picky for my internship. I chose a small agency that worked with the same population I thought I wanted to specialize in. They had a model of group supervision, consultation, and individual supervision (LCSW) that matched my training interests. It was a huge leap to go from the protection of practicum where all my clients were pre-screened to internship where I saw everything and everyone. It gave me a few more gray hairs - AND I am so glad I had all those experiences in an agency! I also did a concurrent internship in a college counseling center and had supervision from a clinical psychologist.

***I graduated with many more clinical hours and experiences than the requirement in several different settings with three different types of supervisors.

***During grad school (and even before) I learned and studied from any clinician I thought had something to teach me. From MI (Motivational Interviewing) - my nugget was "If there is resistance in the room, you created it." The Rogerians and Humanists taught me loving our clients is not enough (even though I think some of them thought it was!) The Freudians taught me how much we are influenced by Freud's ideas of the unconscious. The CBTers and DBTers taught me what to do to prepare people to be able to do "life." I was naive that so many people suffer because they lack basic skills on how to have satisfying relationships with themselves and others. I do a lot of basic skills work with clients. And I weave in the depth work, art, poetry, metaphor, imagery, hypnosis, movement, creativity, and spirituality into many of my sessions.

***Becoming a therapist is a process. It can't be rushed. It takes time and tempering. Excellent supervision is essential. A curiosity about yourself and others is imperative. Self care is a necessity for sustainability. The ability to collaborate and communicate with other MH professionals will expand your effectiveness.

Advice? Get a job after UG before grad school working in a setting where you can see (from a distance and up close) what clinicians do on a day to day basis.

Advice? Be a client.

Advice? Network, volunteer, explore the field.

Great questions - and fascinating replies.