Clinical: Reflection on Clinical Practice Skills

Self Doubt in Your Clinical Practice Skills
Erreger, S. (2014). Social Work Helper.Retrieved from: http://www.socialworkhelper.com/2014/09/22/self-doubt-clinical-practice-skills/

Self Awareness is critical to the therapeutic process. By being aware of your self-doubt, you are already heading into the right direction. In graduate school, we talked about  the importance  of “use of self” and “self disclosure”.  It is certainly important to talk about how your words and actions will have an impact on the service user, but it’s also important to evaluate how the service user’s responses will affect you.

This is certainly not a new concept in which Freud coined as counter-transference. Not only will the client have feelings towards their therapist, but the therapist will feel both their strengths and inadequacies through the client. A new practitioner starting out in her practice was feeling overwhelm with self-doubt, and she asked the following question:

Hi, I was wondering if you could make a post for me to help my practice? I’m wanting advice on how to portray as a confident practitioner when you may have self doubts, but letting these doubts show may result in the service user ‘walking all over you’. I’m not sure how to word it!

On the surface level, the easy answer would be as Socrates said “I am the wisest man alive, for I know one thing, and that is that I know nothing”. Simply stating, “I am not sure about that, but I might know someone who is” certainly is better than making something up on the fly which will most likely come back to haunt you.  As we peel the layers of the onion, what this interaction really reveals is more about your desire to have the answer.

You are probably responding to the fact that you are their therapist and you are supposed to have “the answer”. We have to remind ourselves and the client that social workers are human beings too. We don’t always have the answer. In our clinical work we make mistakes, we feel things, and don’t know everything. This is why supervision and having a good team behind you is vital, and it is imperative for you check with the team, check with your supervisor, or do more research to expand your knowledge.

Thinking back to working on a psychiatric inpatient unit for adults, I really struggled with the complete lack of insight that comes with psychosis and delusions. I remember meeting with a client who was begging for a discharge due to having an active delusion, and  it was the first time I felt terrible, powerless and even guilty. At the same time, I remembered thinking, you really have no idea why we are keeping you here, and also I remember the feeling of the client was “walking all over me”.

It froze me like a deer in headlights because I had no answer. Then, the client stormed out the room. What I learned to say is that I can’t make these decisions on my own, it is a team decision.  I also discussed my feelings about psychosis and delusions with my supervisor, and I actually utilized a couple of supervision sessions to wrap my head around it.

However, in private practice situation where you are “on your own’, you may need to develop a different strategy. First, I would recommend finding some sort of supervision whether it be with paid professional or a peer.  There is no real computer that you can enter a scenario like this and get a neat answer. The therapeutic process is about assisting people who are in pain or distress in order to help them improve their outcomes. The level of pain and distress can vary greatly and so can your response.

Tackling self-doubt and self-awareness should be an ongoing process for any practitioner. My take home message is that it is normal to feel self-doubt in your practice just as it is to feel confident about a practice method you have may have perfected. Continue to self-reflect and be self-aware of your strengthens and weakness in order to develop a plan to address them. Most importantly, you owe it to yourself to develop and maintain a professional support system that will help you build and grow your practice. I hope this helps, and please feel free to comment below.