"The Best Advice I Ever Received as a Therapist"

Approach every session as if it’s your last.

Over my 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 see it as my “North Star.”

In 1980, when I was a young intern at the Family Institute of Berkeley, director Bob Shaw was a savvy psychiatrist who challenged us to stretch ourselves and strive toward being, in his words, “masterful” therapists.

Discussing our cases in weekly meetings, Bob would invariably point out underlying dynamics or small nuances we had missed—and each time, these previously unseen details would turn out to be the cornerstone for treating the client. It was like watching an alchemist transforming life wounds into organic growth.

One morning, a fellow intern asked how to succeed with a client: “I want to make a difference, but he keeps repeating the same stories.” Bob considered the case, 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 the person, as if it’s the only chance you’ll have to make a difference for them.”

The room went silent. You see, most of our training had centered on being somewhat careful with clients. I was taught to be a comforting presence—gently responsive, slow-paced, safe. That guidance was valuable, and I keep it in mind still.

But Bob’s input expanded my idea of effectiveness; it was a clarion call to work more astutely, more intensively. I can be careful and incisive or bold, when needed. Those two facets can coexist—as long as I’m working from a place of deep presence and connection.

To be clear, Bob wasn’t instructing us to work faster. He was talking about the profound 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. Bob was challenging us to stay awake in our work, to approach every single session as if it were our only chance to make a difference. Forty years later, I hold that advice very close.
—Elizabeth Heaney, LPC, Asheville, NC

Find the space where you can thrive.

One of the most meaningful bits of advice I’ve received over the years came from a colleague who encouraged me to work with the type of clients with whom I felt most comfortable. That may seem like a no-brainer! But, in fact, I had previously felt internal pressure to “do it all.” When I gave myself permission to work in a client space where I naturally thrived—in my case, as a women’s psychiatrist—I was able to bring my best self to serve the wonderful clients who grant me the privilege of walking alongside them.
—Ann Woo-Ming Park, M.D., Los Angeles metro area, CA

Remember that you matter.

I had a mentor who told me never to underestimate the impact I have on people by just being there. That’s it—just being a caring presence in the room and giving people the space to tell their story.

I wasn’t sure about this piece of advice until I started noticing what clients often said to me after their first session: Thank you for listening. Initially I’d thought, Isn’t that what I’m here to do? But for some people, it isn’t a given that someone will listen to them. Simply showing up for someone, I learned, can give them the courage to show up for themselves.
—Lauren Dennelly, Ph.D., LCSW, Allentown, PA

Offer exploration, not information.

Lately, I’ve found myself reminding my team that patients have Google. We feel pressured to have a lot of information at our fingertips—we’re scrambling during sessions to remember diagnostic criteria, acronyms, and treatment guidelines.

But our patients rarely come to therapy primarily seeking information. Most have already read extensively about their problems. They know, for example, that excessive weed, alcohol, and social media make them feel bad, while exercise and spending time with friends make them feel good. What they need is a human being to help them explore what’s keeping them stuck in cycles of negative behavior—and process the associated shame and ambivalence—so that they can take steps toward change.

Research and expertise are helpful, but if our job were simply to offer facts, Google would have replaced therapists a long time ago.
—Emily Kline, Ph.D., Boston, MA

Interrupting your client is compassionate, not rude.

Although we should not interrupt clients without rationale, I’ve learned that there are many situations where interruption is not rude, but therapeutic.

Think about it this way: Speech is a window into your client’s inner processing. Because distressed clients tend to have racing thoughts, their speech often races as well. Therefore, rambling or venting may reflect a client’s loss of control over inner experience. When this occurs, interruption helps them regulate.

Often, your interjection will have to be firm because the client may perseverate at first. However, firm interruptions are not by definition callous and unsupportive. They can be the very thing your client needs to leave the session feeling better. You’ll be surprised how readily clients thank you for redirecting them.
—Levi Riven, Ph.D., C. Psych., Ottawa, Ontario

Trust the process.

This works on two levels. First, many therapists, particularly young ones, feel pressure to constantly “do something”—whether out of a desire to help the client or to prove their own worth. But progress in therapy cannot be willed. It needs to be invited and allowed. Sometimes, you must sit with the client’s pain for a while before a helpful path forward presents itself.

Second, process elements in therapy are often more informative than content. That is, paying attention to how the client says something may provide more useful information than tending solely to what they are saying. Truth, rapport, and insight often emerge when we tune into the feelings behind the words.
—Noam Shpancer, Ph.D., Columbus, OH

Ideas alone aren’t enough.

I’ve gotten a lot of mileage from these words, sometimes (inconclusively) attributed to German psychiatrist Frieda Fromm-Reichmann: “The patient needs an experience, not an explanation.” What helps people change are usually not the ideas they hear from us but the experiences they live with us—whether that’s being seen, heard, and loved; being a deeper witness to their experience instead of skimming the surface; or intentionally stretching past the edges of habit and comfort and being different in a way they didn’t know was possible.
—Russell Siler Jones, Th.D., LCMHCS, Asheville, NC

Just say “Wow.”

As a student, petrified that I was sure to harm instead of help, one teacher offered a stunningly simple, all-occasion solution: “Wow.” Said in amazement, empathy, agreement, disdain, or any other tone, wow can serve any purpose. And better yet, it offers a weighty pause, leaving space in the room for the client to offer more content and for the therapist to gather their next best step. Wow!
—Diane Solomon, Ph.D., PMHNP-BC, CNM, Portland, OR

Guide, don’t lead.

The transformative insight of “Don’t work harder than your client” has significantly influenced my therapeutic approach, serving as a reminder that the role of a helper should be mindful and non-leading. The instinct to fix and save arises from a compassionate place, yet it can inadvertently disempower a client—or lead a therapist to burn out.

When therapists avoid the imposition of solutions, they give clients the space to navigate distress, which fosters resilience and self-efficacy and allows them to realize their capacity to overcome challenges and emerge stronger. The therapist’s role is to illuminate the path, not take control.
—Carolyn Karoll, LCSW-C, CEDS-S, Baltimore, MD

Sit with silence.

I used to be uncomfortable with silence in sessions, so I would constantly fill it with words or questions. Logically, I knew the importance of silence, but I still struggled.

One day, my mentor asked me to imagine that the client and I were fishing, each in our own boat. Any fisherman knows that the water needs to remain calm—otherwise, the fish get spooked and swim away. Each time I interrupt silence, she explained, I am making a big “splash” and not allowing the client’s thoughts and emotions to rise to the surface.

She had no idea that I’d grown up fishing with my father, so this advice really stuck with me. It helped me understand that rather than fearing silence, I needed to allow it, embrace it, and trust that it has value and purpose.
—Yvonne Castañeda, LICSW, MSW, Arlington, MA

Leave room for humor.

Humor is certainly not always appropriate, but as one becomes a more skilled therapist, one can sense when a bit of humor will help leaven the moment, provide some perspective on the situation being described, and reduce anxiety. Humor helps create a bond. It’s an empathic connection and a way of acknowledging what a patient is going through. Sharing a laugh or even a sense of irony can help a patient feel less alone.

It takes time to hone this skill. It’s not like telling jokes to a friend. It requires being deeply attuned to your patient and sensing when a humorous or ironic interjection will add just the right note to the therapeutic discourse. But there is deep humanity in sharing humor. It can give a patient the ray of light they need at that moment.
—Samuel Pauker, M.D., New York, NY

Know what therapy can do—and what it can’t.

Despite my being a clinical psychologist and behavioral health specialist, sometimes the single most valuable intervention I can make is to convince a patient to agree to a trial of psychotropic medication. Indeed, in my view, to do otherwise is negligence. During my more than 30 years of practice, I have learned there are some people for whom medication is an imperative part of their treatment. So, while my preferred approach is to have my patients do something about what’s ailing them, it is often necessary for them to take something, too.
—Clifford N. Lazarus, Ph.D., Skillman, NJ

Accept the thanks you receive.

As a novice clinician, I found myself grappling with how to respond to expressions of gratitude from clients. Whether they were acknowledging a particular moment, the safe space I provided, or the progress achieved throughout treatment, my accepting their thanks felt like diverting credit away from their own contributions to their journey. I’d deflect, naturally creating uncomfortable and rather deflating moments.

Yet I came to view these moments as a gift in the medium we use the most: language. Expressions of thanks are a thoughtful reflection, demonstrating that your words about the work clients have asked you to collaborate on have been internalized and are healing. In a profound way, given all that you have offered them—insight, authenticity, care—you are actively receiving from them as well. When a client thanks you, say, “You’re welcome.”
—Afshan Mohamedali, Ph.D., Oyster Bay, NY

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