My Clinical Skills Acquisition Journey: Reflections
My journey into clinical skills acquisition began with having zero experience as a counselor/therapist. I've had experience as the patient seeing a therapist, but never the other way around. Over the past couple of months, I've practiced several important skills needed to be an effective and successful therapist, typically within dyad and triad environments. The process began with practicing listening skills. These were broken down into experimentations by listening with only my head, then only my heart, and finally, listening with my whole body. Building rapport with my patient and focusing on the use of body language were additional skills practiced, as well as acknowledging inner biases and how they might impact the therapist-patient relationship and therapy progress.
Additionally, we briefly worked on recognizing transference and countertransference. I learned about specific theories and the genre of questions inherent in each. These further developed my abilities within the therapeutic process and provided structure. I also practiced Cognitive Behavioral Therapy (CBT) techniques and applied them to irrational beliefs and cognitive distortions with my patients.
Initially, when I began the counseling process, I felt very nervous and struggled with listening skills. That was largely because, in my head, I was frantic to pick up on the right parts to paraphrase and the right questions to ask, which made authentic listening harder. While specifically focusing on developing listening skills, I felt rigid when listening only with my head. I also felt detached. As I contemplated the detachment, I noticed the feeling felt familiar, and I began to realize I often listen to people with only my head. That might be a developed defense mechanism to counter the era when I listened too much with my heart and absorbed the problems of the people around me. In the therapeutic practice setting, when listening from my heart, I felt a dramatic shift in my facial muscles, body language, and mirroring. Listening with my whole body felt similar.
Listening more with my head can be an asset in not absorbing too much and avoiding burnout. However, I must be mindful of not being all in my head and jeopardizing the therapeutic relationship or limiting the growth of rapport. My patient must feel seen and heard within the therapeutic relationship. My heart and whole body need also to be present and hold space to provide a balanced and caring atmosphere for the patient. The key to listening skills development is to strike that balance of caring more from the heart and less from the head, where I not only hold a level of detachment but also tend to want to "fix" everything. I must also be mindful of not absorbing patient problems as my own, as I have a history of doing. Problem-solving or giving advice is a continued struggle that I must work on. It helps to remember that just holding space for the patient to be seen and heard is enough. I also need to be cognizant of the questions I ask and be mindful that my questions aren't too leading. I can expand on that by gathering more information about the patient's problem(s), helping them learn to tolerate uncertainty, and holding the space for whatever feelings or concerns are coming up for them.
As the observer, I noticed the therapist occasionally giving direct patient advice. The inherent danger of problem-solving or advice-giving was evident to me in witnessing these events. Specifically, it was clear that if the patient took the therapist's advice and it turned out badly, it could damage or destroy the therapeutic relationship and rapport. Instead, I think it makes for a healthier relationship to avoid "should-ing" on a patient and instead redirect the discussion back to the patient in a manner that encourages them to find the best answer inside themselves and for themselves. Carl Rogers, in his Humanistic Therapy approach, is an excellent example of a person who has shown great skill with that. Seeing this play out helped me to step away from my instincts and desire to problem-solve or fix patient problems.
I also learned that I have more biases than I realized. I need to be aware of these and how they might impact the therapeutic setting. Additionally, getting a better grasp on the patient's biases is also essential, and this information can be obtained by listening with curiosity and asking appropriate questions. I also struggle with recognizing transference and countertransference. However, I am confident I'll improve as I progress and gain more experience.
Another area for growth is to increase my level of mirroring. For example, if a patient indicates they are feeling anxiety in their chest or tightness in their throat, I can better reflect their feelings by placing my hand on my chest or throat to help them feel seen and heard. I tend to mirror through facial expressions alone, and a more whole-body language approach would be beneficial.
I loved learning about and working within the framework of CBT. Implementing CBT techniques when working with irrational beliefs and cognitive distortions felt natural. Helping the patient shift unhealthy thoughts and replace them with thoughts that more positively serve them was wonderful. I also appreciate the progress measurability inherent in CBT and having such a framework conducive to mapping progress benefits both therapist and patient. Other theories I've felt connected to are Jungian Analytical Therapy, Relational-Cultural Therapy, and Acceptance and Commitment Therapy. As I progress through my journey, I'll dive deeper into each style and determine which I want to focus on more energetically.
Throughout this journey, I've noted self-conscious tendencies, particularly early in the process. Counseling was new to me and well outside my comfort zone. Although it also increases my vulnerability exposure, stepping outside my comfort zone helps me grow. I have an early history of approaching the world around me through a fixed mindset, during which I tended to avoid situations where I might fail or become vulnerable. I've made great strides in shifting to a growth mindset over the years. I now work on failing forward by seeing different situations where I fall short of my inner expectations as learning and growth opportunities rather than failures.
As time progressed, my self-conscious bent significantly faded, especially as I've worked with some of the same individuals multiple times. Listening with curiosity and paraphrasing is becoming easier and more natural for me. Allowing the therapeutic process to flow more naturally has opened the door for more authentic listening, and appropriate questions to ask have begun to develop more naturally. Additionally, applying a theoretical framework to the process is of great benefit. I look forward to the continuous unfolding of this journey into becoming a successful art therapist and counselor.
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