Sitting with the realities of clinical practice
There is a moment most of us clinicians remember clearly. The moment when all the training is finished, the role is real, and you find yourself sitting in a room thinking, what do we do now?
I remember mine vividly.
After years of university, gruelling interviews to land my first proper role, and a two-week, in-person induction as a new graduate psychologist, I was suddenly there. Sitting in a musty office, on-site in a regional town in Australia. I was the only psychologist on site. Sure, I had support from colleagues and supervisors, but they were not in the room with me in that moment.
I was alone in the office with my very first client.
She was a young girl struggling with overwhelm, anxiety, and motivation. I remember feeling my body tense as I worked through the intake form. I gathered as much information as I had been taught to gather, trying to do things properly, trying to do them the right way.
Toward the end of the session, she looked at me with a clear and quiet question in her eyes. What do we do now?
I felt much the same.
I remember giving her a task to complete between sessions. I think it involved writing down her anxious thoughts (classing CBT move hey). We exchanged pleasantries, I rebooked her for the following week, and she left.
And I remember sitting there afterwards feeling completely lost.
Had I done it the right way? Was the homework helpful or appropriate? Had I missed something important? The insecurity and lack of clarity were palpable.
What I know now is that this experience was not a failure of training or competence. It was the moment when the work shifted from theoretical to real.
With time, my confidence grew. I learned, adjusted, and got better along the way. I developed judgment that could not have been taught in a lecture or practised in a role play. I learned how to sit with uncertainty rather than trying to escape it.
And even now, years later, there are still moments in the therapy room where I find myself thinking, what now?
I do not think that question ever fully disappears. What changes is our relationship with it.
Clinical competence does not arrive as certainty. It develops as tolerance. Tolerance for ambiguity, for emotion, for not always knowing the next step. It shows up as the ability to stay present rather than perform, to listen rather than fix, and to trust that therapy unfolds over time rather than in neat steps.
If you are early in your career and recognising yourself in this, you are not behind. You are not failing. You are encountering the part of the work that signals you have truly arrived in it.
And if you have been practising for years and still have moments of uncertainty, that does not mean something is wrong. It means you are still engaged, still thinking, and still taking the work seriously.
To Sit With This Week
- Notice one moment this week where you feel unsure in the session and pause before trying to resolve it (remember, it's okay to say “I don’t know, but let’s explore it more together”).
- Ask yourself whether the urge to act is coming from the client’s needs or your own discomfort with not knowing.
- Gently remind yourself that confidence and comfort in this work are built over time through experience, not certainty in the moment.
Thank you for sitting with me in the clinical space this week.
Warmly,
Psychologist and Principal, My Thriving Mind