36 Things I Wish Someone Had Told Me Before I Became a Psychotherapist

“Il n’y a pas 36 solutions.” ~ French proverb

“Everyone has a plan until they get punched in the mouth.” ~ Mike Tyson

The aspiration of becoming a great or even just competent psychotherapist is, at its root, somewhat paradoxical. Over the past 15 years of daily practice I have learned that psychotherapy is not about mastery, not about “fixing” people, and certainly not about discovering truth. If anything, it’s about constantly evolving, unlearning mastery, tolerating uncertainty, and embracing the often irrational and patently absurd complexity of human beings. The path to greatness in this metier is littered with counterintuitive situations and if you are in search of clarity this may not be the ideal profession for you.

Here are 36 things I wish someone had told me before I became a psychotherapist:

1. Once you start working you will quickly realize that much of what you learned in school is inapplicable, useless, misguided or wrong. Most graduate programs in psychotherapy are like sweatshops without the sweat. The supervisors in your associateship or internship teach you everything worth knowing.

2. 130 years ago Freud called psychoanalysis “the talking cure.” Today, psychotherapy is better understood as “the listening cure.”

3. Therapy is less about teaching people how to live and more about helping them unlearn what keeps them from living fully.

4. In session, you are modeling authenticity. This includes what you wear, how you sit, how you smell, how clean or dirty your office is, how you speak, what words you choose, the way you blink your eyes, if you fall into a food coma after lunch, how you stifle a yawn, if you swear or do not swear — everything. If you do not understand the paradox, irony and even comedy of the concept of “performing authenticity,” then you may want to reconsider your previous entertaining profession.

5. Psychotherapists are emotional prostitutes: we lease our hearts in 55 minute intervals. Deal with it. And know how to use those 5 minutes to clear your emotional field.

6. Trust is subconsciously established through mirroring and matching. If you do not know how to mirror your patient’s affect and match their body language then you will not be an effective therapist. If you were taught at an elite private school or country club to persistently smile, you will need to unlearn that shit pronto. Meet the patients where they’re at. Their comportment and disposition is your comportment and disposition, every hour on the hour. This is how you subconsciously validate your patient’s emotional experience.

7. In session you will ask yourself, “What is the corrective emotional experience that this patient is subconsciously yearning for?” Eventually you will learn that you will probably never answer that question but your genuine curiosity will land as the care, love, appreciation, affection and acceptance that your patients need to make healthier decisions about their lives.

8. Happiness isn’t a goal of therapy; it’s being able to help ameliorate unhappiness.

9. Be resistant to diagnoses and provide them only when required by insurance companies. Be even more resistant to diagnoses when announced by your patient during their first session. Ponder, rather, if this person spent the last ten years picking coconuts and playing soccer with their extended family members on a desert island, would they be suffering from this affliction and/or wearing this diagnosis (often proudly or as an excuse for misbehavior) like a scarlet letter?

10. When you experience countertransference, use it in session; when your countertransference keeps you awake at night, seek supervision.

11. The times you kick yourself for uttering the wrong thing may save a patient’s life; the times you hurt your arm patting yourself on the back for stating the perfect thing may lead a patient to despair.

12. You will realize that the word “client” is a monstrosity of capitalism and that you serve “patients.” Yoga teachers, Reiki Healers and other phonies have clients. You are a licensed healthcare provider and you serve patients.

13. There is no such thing as a Reiki Healer. There are only Reiki Practitioners, people who have received attunements to act as conduits for healing energy. Anyone who calls themself a “Healer” is a fraud. This is a great analogy for psychotherapists: we are not healers, we are merely highly skilled conversationalists.

14. To get noticed in the capitalist circus, you will have to “brand” yourself. This is a Faustian pact you will regret when patients suffering from BPD scour your online presence for contradictions and hypocrisies (and find them).

15. Your “branding” must be a razor’s edge between confidence and humility that you carefully navigate.

16. For marketing purposes you need to espouse a therapeutic modality or “style” but these days we’re all really eclectic. You can say that you are Rogerian or practice CBT, narrative therapy or attachment theory, but you are probably lying. Just be able to bluff your way through whatever ChatGBT tells you are the most effective psychotherapy modalities of that day, then cut your own path.

17. Want to be a truly gifted therapist? Study literature. Every emotion ever felt was written in some scene by Shakespeare or another playwright or novelist.

18. Text messaging is your worst enemy. Never send anything to anyone that you wouldn’t mind hearing read or misread aloud in court.

19. Learn the French exit when patients appear unexpectedly in public settings.

20. Most of you will disagree with this, but the only way to become filthy rich as a psychotherapist is to be lazy. Since Covid the majority of psychotherapists have been cheap and lazy. Psychotherapy can only be done in person; it cannot be done virtually. Ever hear of pheromones? Ever been assaulted by a patient? Ever say, “This session is over. Please leave.” Wrap your head around this: Nobody ever did not violate someone on Zoom. The highly unlikely possibility of violence is essential to what is happening subconsciously. Zoom therapy is analogous to animals in adjacent cages while in-person therapy is like two boxers in a ring. And with couples and families in the same room you will probably end up playing the role of referee. If you are not in the same room then you cannot see the nervous leg twitching or fingernail picking or seat squirming or get a complete picture of the person in their multitudes. Yes, you will save $25,000 a year renting an office but just know that you are not really doing psychotherapy.

21. Here is one neat trick that is like pulling a quarter from a kid’s ear at a birthday party: for every “Yes, but…” your patient receives in the real world that invalidates their emotional experience and/or makes them feel “not good-enough,” complement them with “Yes, and…” The word “but” negates everything that precedes it. Learn it. Live it.

22. Pavlov was right: positive reinforcement of any small victories your patient had that week encourages them to continuing those behaviors.

23. You know that cognitive-behavioral tools and exercises such as gratitude lists help patients gain new appreciation so suggest them liberally.

24. Our minds were built to create “woulda-coulda-shoulda-didn’ts” about our pasts so know how to gently guide your patient into the present. It’s as easy as commenting on the weather or the bird outside your window.

25. The most important thing you will ever say to a patient might be a light smile.

26. All suggestions can land as criticism — so learn how to not be the smartest person in the room.

27. A patient’s resistance isn’t a wall; a patient’s resistance is the therapist’s failure to enroll them in new possibilities.

28. You need to write a book. Preferably one with a catchy but not too smart title. Not one entitled “How To Survive Your Childhood Now That You’re An Adult: A Path to Authenticity and Awakening” — that wouldn’t be at all helpful. You cannot afford the time wasted not writing. Fret not, some patients may listen to it on Audible but 95% will not actually read it.

29. Like a chess master, you need to think five moves ahead of your patient. And never let them see that you are strategizing.

30. Future-tripping: know that our minds say inane things such as “When I become xxxxx, then I’ll be happy!” so teach patients how to be grateful for the present moment. Sometime in the future even the present moment will not exist.

31. Colleagues you admire and respect will end up throwing you under the bus; patients you love will end up suing you and trying to get you delicensed. This is if you are doing a good job.

32. Do not use inane words to try to appear smarter than you are, words such as “neuroscience.” Unless you are also a Medical Doctor (not a chiropractor) who spent years with human brains sloshing around your gloved hands, you know nothing about neuroscience and are a fraud if “neuro-anything” appears anywhere near your website. As Nassim Taleb said, “Studying neuroscience to understand behavior is like studying ink to understand literature.”

33. Everything that irritates you about your patients reveals something about you. Keep your side of the street clean.

34. For many patients you are the calm in the eye of their storm; for others you may be the storm in the eye of their complacency.

35. It will turn out that your richest, most refined patient murdered their spouse’s pet with cyanide while your gangsta thug patient donated a kidney to their 2nd cousin. Expect the unexpected. And you will still be surprised.

36. If capitalism did not exist neither would your job.

Lastly and summarily, find a professional North Star by a theorist who you respect, maybe one such as James Hollis who said:

Were therapists required by “truth in advertising” legislation to tell their reality, then virtually no one would enter therapy. The therapist would be obliged to say at least three things in return to the suffering supplicant: First, you will have to deal with this core issue the rest of your life, and at best you will manage to win a few skirmishes in your long uncivil war with yourself. Decades from now you will be fighting on these familiar fronts, though the terrain may have shifted so much that you may have difficulty recognizing the same old, same old. Second, you will be obliged to disassemble the many forces you have gathered to defend against your wound. At this late date it is your defenses, not your wound, that cause the problem and arrest your journey. But removing those defenses will oblige you to feel all the pain of that wound again. And third, you will not be spared pain, vouchsafed wisdom or granted exemption from future suffering. In fact, genuine disclosure would require a therapist to reveal the shabby sham of managed care as a fraud, and make a much more modest claim for long-term depth therapy or analysis. Yet, however modest that claim, it is I believe, true. Therapy will not heal you, make your problems go away or make your life work out. It will, quite simply, make your life more interesting.

And, yes, when teaching at Esalen I have been called “The Fortune Cookie Guy.”