Source: Kelly Sikkema, Unsplash

Authored by Liz Pignatelli, MS, and Amy Vigliotti, Ph.D.

Finding a therapist is a bit like speed dating: interviewing several different people at a time, and even when you do seem to gel, you’re never 100 percent sure they’re going to be a good match.

People who come to therapy have often been let down, given terrible—or at best, irrelevant—advice, and are searching for more stability and wellness. It makes sense, then, that they want to make sure their therapist has what it takes to meet their needs.

In choosing a therapist, new patients sometimes show hesitations about working with a pre-licensed therapist. We sometimes hear: “I would really prefer a licensed clinician,” or “I would prefer someone who has more experience.” These sentiments are understandable concerns—and yet pre-licensed clinicians can generally provide sound, effective treatments.

Research suggests that having a pre-licensed therapist can be beneficial in unexpected ways. According to Harrichand et al. (2021), pre-licensed counselors are benefitting from the current zeitgeist that places a refreshed emphasis on three facets of counselor education: multicultural competence, education about the signs of counselor burnout, and self-care. Those recently joining the field typically come from programs that encourage therapists to remain cognizant of both their client’s well-being and their own. A prospective client should want someone who is able to balance the challenges of the work, while also knowing they can work on themselves at the same time.

Another important piece of the pre-licensure puzzle is supervision by a licensed professional. According to an article by Stephanie Hairston (2021), “This means you’re benefiting from the fresh energy of an intern or trainee at the same time that you’re benefiting from the wisdom and experience of their clinical supervisor.” Additionally, Gray’s (2009) study found that regular observation of clinical skills by a supervisor led to higher self-efficacy in pre-licensed clinicians. Not only is supervision a version of “two heads are better than one,” but it also increases a pre-licensed clinician’s confidence in their ability to be the best clinician they can be.

To shed further light on this topic, we interviewed three of our pre-licensed clinicians to get their perspectives.

Q: How do you handle questions about your competence as a pre-licensed therapist?

TN: One time, I had a consult call. It was the one that everyone kind of dreads; they said something like “You’re too young” and they even asked about my supervisor. So, I told them about my supervisor and gave them some information on new trainees—such as how they tend to have more enthusiasm right off the bat and tend to have better adherence to sticking to certain treatments before trying a new one too soon.

With a different client, we had developed a pretty good working alliance, and they recommended me to a friend who had some concerns about my status. Thankfully, I was able to alleviate their concerns.

Q: What does it mean to be in supervision?

MP: It was a weekly check-in just to see if anything pressing had come up that I wanted to discuss. Once I started seeing clients for an extended period, it was a space to allow me to find common patterns and threads.

TN: I think it’s a good mix of bringing in treatment questions and discussing content from the sessions. When I think about treatments and how to approach different things as they come up, it’s nice to talk about your own reactions and what’s coming up for you personally, and how to navigate that in real-time. There’s information in your own reactions and your transferences that become more apparent as you talk about them out loud in supervision.

Q: How can supervision be helpful?

TN: It can be a lot to work with clients with extensive trauma histories, and it can feel like there is a lot to hold on to in between sessions. It’s nice to talk about that with someone else, to not feel alone in that space, and to be around someone who knows some history about your client, too, so you can help them and better understand some of the unconscious processes at work.

TA: I think supervision should be in every profession. It means you’re getting guidance to be a better therapist. In fact, a study by Ebersole et al. (1969) showed that the therapists who were not in supervision actually got worse over time without that guidance. Therapists who had both education and supervision, however, continued to improve.

Q: In addition to having the right treatment models, what are other aspects of treatment that you find important for healing?

TN: It’s a healthy amount of balancing two modes: both challenging clients while also empathizing with them. There’s a need for validation and reflection of feelings while also not pushing them too far too fast. The therapist can acknowledge moments where things are kind of slow and becoming a bit more static to show where there might be some avoidance. You want to be mindful of that to encourage growth.

TA: At the heart of it, having a trusting relationship with your therapist is the most important thing. If you don’t have that, you don’t really have treatment because you can’t be honest and learn and grow together.

Source: Nik, Unsplash

Q: What advice would you give to someone beginning therapy?

TA: If you’re having questions or doubts, or don’t understand their credentials and you want to know more, it’s not off-limits to ask. Nothing is off-limits!

When we really look at the heart of therapy, this relationship is going to mimic your relationships outside of the therapeutic space; it’s all fair game. I know it’s scary, but the importance of bringing these things up can unlock all different types of conversations you didn’t think were possible.

TN: Give it time. You never know what can happen until you take that first step.