When Gila Frank, a clinical psychology grad student at Pepperdine University, began her first year of practicum working with sexually exploited youth, she used to wonder, "Is the world really this bleak?" Her work involved listening to stories of sexual abuse, sex trafficking and drug use.
She also worried that sharing such a thought with a supervisor might be considered a weakness. "Maybe I'd be perceived as incompetent to work with different populations," she says. "I asked myself, ‘Am I good enough?'"
Feeling out of your depth can be uncomfortable, but no one should expect to know how to handle every situation during a practicum or internship, says Nabil El-Ghoroury, PhD, associate executive director of APAGS. "It's normal and natural to be out of your depth on some things while you're training, rather than being that way later on the job. It's better if something happens when you still have supervision."
That was the case for Frank, whose supervisor suggested that she affirm her own as well as her clients' positive life experiences and accept her reactions as the natural process of career growth.
She's also learned to raise her concerns with supervisors in a well-thought-out way instead of "just falling apart in a panic," she says. "I am very clear about what I need, so my supervisors can be more responsive to my needs."
Here's how you, too, can handle an overwhelming situation with grace.
1. Cultivate a strong relationship with a supervisor
So much of your success as an intern depends on the relationship you have with your supervisor, says Jennifer Stinson, a psychology intern at Michael E. DeBakey VA Medical Center in Houston and a doctoral student at the University of Houston.
"Then, when crises come up or you're caught off guard, you can ask, ‘What am I supposed to do now?'" she says.
Regular collaboration and a strong working alliance with your supervisor also builds a solid foundation for those anxious moments when a client discloses something big or the exchange devolves into an emergency, says Catherine Grus, PhD, deputy executive director of APA's Education Directorate.
To cultivate that alliance, be proactive. Instead of wondering whether you took the best approach to a situation, for example, ask for feedback, including how you can better handle it next time. It's also helpful to video or audio record your sessions so that you can discuss specific challenges with your supervisor afterward, Grus says.
Still feeling disconnected? Stinson recommends finding another clinician with whom you feel comfortable asking questions and learning from.
2. Lean on peers
Most accredited internships must have at least two students for a reason: Your peers can provide perspective and support when a case feels dramatic or just plain overwhelming, El-Ghoroury says. He recommends asking one to lunch or coffee when you want to talk about a situation. "Your peers can give you a real boost when you say, ‘I don't know what to do with this case,'" he says.
3. Recognize that you don't know everything
To grow in your career, you have to realize that you may not have done everything right the first time. "That requires that a trainee is OK with saying, ‘I don't know everything,' be reflective about their skills and be able to identify areas for further growth," Grus says.
Some programs make this easier by creating models that assume trainees don't know everything they need to know. At the University of Southern California's Center for Excellence in Developmental Disabilities, for example, trainees observe supervisors — and then are observed by supervisors — before seeing clients independently. The program also has three supervisors for every intern. "We have a very open-door policy so trainees can approach anyone — and they do," says Sara Sherer, PhD, the program's psychology training director.
Sherer also suggests reminding yourself that internships are learning experiences. "Everyone comes here with different levels of skills or experience," she says. "We believe that if you do know everything, then there's nothing left to do here."
4. Monitor your emotions
Like Frank, the Pepperdine student, trainees can be reluctant to share their emotional reactions to therapy because they fear a negative evaluation could impact their future, says Carol Falender, PhD, an adjunct professor at Pepperdine and co-author of the 2004 book, "Clinical Supervision: A Competency-based Approach."
"The trainee might say, ‘It's just me,' or ‘It's nothing.' Sometimes they just discount it and don't bring it to supervision," she says.
But valuing your own emotional response — and then addressing it with your supervisor — is important in order to inform the therapy, Falender says. "It begins with trusting the supervisor enough to let them know that ‘these are the issues I'm facing.' It can be challenging, scary, but this is how you learn and grow as a professional."
That's a lesson Regina Corpuz, PsyD, learned when she was a mentee of Falender's in 2006. Just hours after completing a client home therapy visit, she learned that the client had attempted suicide.
"I was the last to see him, and I thought I'd missed something, or I should have asked more questions," says Corpuz, who now lives in Japan. "I always wanted to be ‘omniscient.'"
She eventually shared her distress about the client with her solution-focused supervisor and was glad she did. Her supervisor reassured her that the client would enter an inpatient program and that Corpuz's treatment team would support her then and in the future.
5. Know when to disclose
Most interns don't admit their therapeutic flubs to their supervisors: One study found that 97 percent of supervisees didn't disclose everything (Journal of Counseling Psychologyopens in new window, 1996).
This may be due to concerns about evaluation and negative feelings from the supervisor, power dynamics, demographic or cultural variables, or the supervisor's theoretical orientation, according to another study by Marquette University researchers (Psychotherapy Researchopens in new window, 2008).
But disclosing an error is important because learning from mistakes is a key part of supervision, Falender says.
"Supervisees should understand that making errors and discussing them is an essential part of the process, as is working to be open to all kinds of feedback," she says.
The time to talk about a challenging situation isn't when it happens but before, adds Nancy Elman, PhD, an emeritus faculty member at the University of Pittsburgh School of Education.
For example, you can bring up potentially difficult situations with peers and supervisors by discussing overall program values during training sessions. "It's fine to say, ‘Help me make a plan.' That way you can communicate that you expect to grow from your experiences, rather than being worried when they happen," she says.
When those situations happen now, Frank views them as a gift rather than a burden and seeks to be even more "present" with her clients. "I don't want to just become a witness. I'm on a journey with them, and grateful for the opportunities to be part of that journey," she says.