Cover Story

Nervous at the thought of sitting with your first client? You're not alone.

At her first client session, Lynne Padgett, PhD, was so anxious about making a good impression, her fear knocked her to the ground, literally.

"[The client] sat on the sofa and I sat down in a chair, or perhaps I should say 'near' a chair as I missed it and fell to the floor, flashing the poor woman because I had on an above-the-knee skirt," recalls Padgett, a health psychologist with Kaiser Permanente in Atlanta who earned her doctorate in 2003. Although she says she regained her composure, "I can't say I was surprised when she didn't return the next week."

To help you get off on the right foot, or at least avoid putting your foot in your mouth, gradPSYCH asked a few early-career and veteran psychologists how to get over those first-client jitters.

Here are a few pearls of wisdom they passed on.

Judith S. Beck, PhD

Director, Beck Institute for Cognitive Therapy and Research

Psychologist since 1982

"Your most important goal should be to start to develop a nice therapeutic relationship with the client. This means you need to work on your anxious, automatic thoughts for many days before the first session...writing a coping card can help. To develop the relationship, be a nice human being in the room with the client. Be interested. Smile. Put the client at ease.

"Make sure to ask for feedback at the end of the session. It will go a long way in establishing the relationship. For example, [ask] 'What did you think of today's session? Was there anything you thought I misunderstood? Anything you want to make sure to talk about next time?'"

John Murray, PhD

Sport and clinical psychologist in private practice, Palm Beach, Fla.

Psychologist since 1999

"I see a lot of performance anxiety and one of the ways to get out of that is to focus your mind, your thoughts, your everything, on something external--try to get outside of your own thoughts. It's your own thoughts that create this anticipation, so if you can keep yourself focused on something external, like the sound of the client's voice or the color of their shirt or something interesting about the topic, you'll be much more comfortable with your first client."

Rachel Uffelman, PhD

Staff psychologist and outreach coordinator, University of Missouri Kansas City Counseling Center

Psychologist since 2006

"If you feel unprepared to see clients, talk about this with your supervisors. It's very normal to feel that way, but it is really powerful to process this with the people who have trained you. You'll feel more confident that you've been prepared adequately to venture into new territory in your training."

Richard Kilburg, PhD

Senior director, Office of Human Services, Johns Hopkins University

Psychologist since 1974

"The easiest thing to realize in your first job is that all you have to do is listen. A lot of the anxiety that people carry is that they will be revealed as imposters, or that a challenging client will question their degree or where they graduated from, and that people will discover that they haven't been doing this for very long.

"If you realize going into your first session that you don't have to be absolutely brilliant in what you say to your first client, that you just have to listen intently, directly and empathize with where they're coming from, then you'll cruise through that first hour.

"Socrates said that wisdom begins with knowing what you don't know. If you are aware of what training you've had, you should have a fairly good idea of what you know and what you don't know."

Stanley Sue, PhD

Professor of psychology and Asian-American studies at University of California, Davis

Psychologist since 1971

"When you work with clients, have an agenda. There should be some purpose in mind and ways of trying to get there. But don't let the agenda make you so impersonal that you don't respond to the person as a person. It's a balance, and you have to make sure the agenda doesn't result in you treating the individual in an impersonal manner that hinders the development of rapport and a therapeutic alliance.

"Realize also that sometimes problems can't be resolved right away, but you do want to have some gains even in that first session. Gains are not solving the client's entire problem, but giving the client a gift of some kind so that they will see some relationship between what is done in treatment and the possibility of a favorable outcome."