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Knowing Thyself: the Importance of Self-critique

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‘Knowing yourself is the beginning of all wisdom.’ This quote by renowned philosopher Aristotle highlights the importance of self-critique in evaluating one’s strengths and weaknesses. Not only is this necessary for personal growth as an individual but vital in service delivery as a psychotherapist. This paper seeks to provide a critique of my experience as a novice therapist during my practicum experience. The client referred to in this paper is a 24-year-old male referred to the psychotherapy clinic by the psychiatrist to complement medical therapy. In the counseling room was two other student therapists and me. Since it was an initial session, I decided to conduct a clinical interview to get a better understanding of my client’s clinical picture. One of my strengths during the clinical interview included establishing and maintaining rapport with my client. In the initial phase of the session, I was able to explain informed consent. Here, I outlined the essence of a therapeutic relationship, confidentiality, institutional procedures, and my background and experience. 

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In addition, I demonstrated active attending behavior through active listening and maintaining eye contact. Having noticed that my client was nervous at the beginning of the session, I brought to his attention that these feelings were normal since this was a new experience. Whenever my client would talk about sensitive material, I would respond with accurate empathy. Since this was my first session flying solo without my supervisor, I had a few challenges during the session. I would sometimes find myself asking close-ended questions. I would remind myself of the importance of open-ended questions to get an exhaustive narrative from the client. Due to the limited facilities within the hospital, therapy sessions would take place inside nurses’ offices. Sometimes the nurse would walk in to pick some files or equipment which would be distracting. Once, my client was sharing sensitive information regarding difficulties faced due to his condition and the nurse walked in. The room was silent all through and I felt as though I was at risk of losing my client. I would try to apologize to my client whenever this happened and promised to get a more suitable space for subsequent sessions. Towards the end of the session, I felt stuck when my client asked for either of our numbers. He went on to add that he wanted it for communication purposes in case of booking appointments. I was left speechless since I saw his request as genuine yet the ethical codes which I abide by, advocate maintaining healthy boundaries with clients. I did not want to create dependence in my client but neither did I want to make him feel abandoned after sharing personal information with me. 

My co-therapist stepped in to salvage the situation by explaining the ethical codes that we were bound to. She was congruent through this process whilst emphasizing the importance of maintaining appropriate boundaries. After the session, I consulted the site supervisor for clarification on the issue. She advocated for use of clinical judgment based on the client. If the client was genuine and understood the professional relationship, the sharing of contacts was not discouraged. However, if the client seemed to want to detract from the therapeutic relationship, it would be best not to share my contact. Despite feeling like I had made a mistake by not sharing my number, the clarification from the supervisor served as a lesson for future interactions with clients. I also resolved to acquire another number strictly for professional use. Since therapy involves investing my humanity into my client’s humanity the therapy session left me feeling emotionally drawn to my client. I noticed some countertransference towards my client since I saw him as the younger brother I never had. I seemed to relate to his issues and I sometimes felt as though some issues he talked about were similar to those I dealt with during my personal therapy. His enthusiasm with wanting to get better motivated me into wanting to offer him the best service as his therapist. 

Since he was keen on researching issues to deal with mental health, I was challenged to brush up my knowledge. My overall response to the interview is that I was engaged and willing to do all that was necessary to accompany my client through their journey. I felt connected to my client through most of the interview except in cases when I would ask a question and later think of a better line of probing. I hope to improve these skills within our subsequent sessions. In hindsight, I should have gone further to explain what to expect within the first session where history taking takes center stage. The session ended up going to about 90 minutes since the client was eager to share. In a bid to maintain rapport, I would let him keep talking since I didn’t want him to feel rushed. Moreover, I should have investigated further the conditions behind my client’s sporadic attendance of psychotherapy sessions despite dutifully attending all appointments with the psychiatrist. In my opinion, I found that the quality of our engagement was commendable. As I wound up the session, I checked up on my client to ensure his feelings about therapy. The client expressed gratitude for the session and was relieved with the detailed nature of therapy as compared to consultation with the psychiatrist which were brief and symptom-based. 

To sum up my experience as a therapist, I am glad that I successfully managed to take a detailed history. The initial jitters of doing it for the first time persisted, however when my client expressed his appreciation, I was relieved. Moving forward I hope to keep on practicing introspection to become more aware of any biases I may have that may hinder the stability of the therapeutic alliance. 

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