The Best Advice I Ever Got About Being a Therapist

Elizabeth Heaney MA, LPC

“Hey, what’s the best advice you ever got about being a therapist?”

I get that question from younger therapists when I teach grad counseling students, supervise interns, and facilitate case consultation groups.

Over the course of 40 years in clinical practice, I’ve had some outstanding mentors, and my skills have developed with their wise input. But one bit of guidance stands out—I think of it as my “North Star” for working with clients.

The “North Star” lesson was offered by my supervisor back in 1980 when I was a young intern at the Family Institute of Berkeley. Bob Shaw, director of the Institute, was a wonderfully perceptive and savvy psychiatrist who challenged us to stretch ourselves, to make a difference in every session, and to strive toward being (in his words) “masterful” therapists. Heady input for a beginning clinician…

In weekly group supervision meetings, Bob would ask us to talk about our cases. Invariably, he’d point to the underlying dynamics we’d missed, and then he’d hand the clinical conceptualization back to us with a whole new orientation. It wasn’t unusual to present a case, only to find him asking about a particular detail or a nuance I’d hardly paid attention to: Was the young boy resigned to his father’s absence … or stoic with heartbreak? Did the couple ever talk about the failed adoption that happened before their baby’s birth?

Every time, the precise, previously-unseen detail Bob focused on would be the cornerstone for treating the client. Week after week, I felt like I was watching a brilliant alchemist, or a therapeutic ninja master, transforming life wounds into organic growth.

The morning Bob offered his “North Star” comment, a fellow intern had asked how to be more successful with their client: “I want to make a difference, but my client keeps repeating the same old stories.”

Rather than offering a “template” suggestion or a specific intervention, Bob considered the case for a moment, then said, “If you truly want to have an impact, if you want to do work that’s transformative for clients, you need to work every session as if it’s the last time you’ll ever see that person, as if it’s the only chance you’ll have to make a difference for them.”

The room went silent, each of us struggling to grasp what he was pointing to.

You see, most of the clinical guidance I received in my graduate training centered on being somewhat “careful” with clients. I was encouraged to be a comforting presence, gently responsive, slow-paced, and “safe.” All of that guidance was valuable, and I keep it in mind to this day.

But Bob’s input helped me expand my concept of being effective; it was like a clarion call to work more astutely, more intensively. I can be “careful” and be more incisive or bold when that’s appropriate. Those two facets will go together well, as long as I’m working from a place of deep presence and connection (not out of an egotistical need). In fact, Bob’s comments gave me permission to work in a way that gave my client the best chance at facing themselves in new ways and opening themselves up to who they might become.

To be clear, Bob wasn’t talking about the speed of our work with clients: “Work faster! It’s the only chance you have!” He was talking about the profound, authentic, and abiding engagement we should bring to every session—a depth of presence that is the bedrock for transformative work. He was encouraging us to “have an impact”—right now, every moment, with every exchange and every reflection. Not sitting back and hoping we’d achieve some insight in five sessions or twelve sessions; not waiting for a light bulb to go on in the client’s mind; not assuming “something” would somehow shift to make things look different.

Looking back, I understand Bob was challenging us to stay awake in our work, approaching every single session as if it was the one and only time I was going to get the chance to make a difference. Forty years later, I still hold that advice very close as I work. Even with clients I’ve seen for many weeks or months, I approach each session “fresh”—as if this one session will make all the difference in the world for the client. I notice that this approach also models presence and deep engagement for clients; they learn it “in their cells,” as I learned it from Bob. (For many clients who’ve typically had disinterested, distracted, or less-attuned interactions, the simple commitment to being keenly attentive in this way can transformative.)

I now understand Bob was asking us to require that presence of ourselves.

Every session.

The dedication to being masterfully present and engaged has been a good fit for me over four decades, and I’m eternally grateful that Bob opened this possibility for me back at the very beginning of my career—as my career developed, his perspective thoroughly shaped my work.

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