Abstract
“So what do you think? Do you want to work with Mr. L?” asked my supervisor.
It was the fall of my third year of graduate school, my second year of providing psychotherapy, and my fourth month working at an NCI-designated cancer center. Mr. L was an immigrant to the United States who was in his mid-60s and diagnosed with prostate cancer. He had received his diagnosis eight months ago and was referred to our psychology services due to anxiety that was interfering with initiating cancer treatment. Mr. L had previously been scheduled to receive high-dose-rate (HDR) brachytherapy, but he cancelled the night before the procedure because of severe anxiety.
As I was reviewing his medical chart, my own anxiety started to appear. I had also been running late with a previous patient, so I did not have much time to prepare for our intake session. I started to worry about how I could possibly help this patient, whether I would have room for him on my schedule, and how open he would be to working on his anxiety in therapy. As I was a relatively new clinician and had only been at the cancer center for a few months, I felt anxious about my supervisor watching me conduct the intake and wondered whether she would think this case would be too complex for me. I certainly did.
During the telehealth intake, I learned that Mr. L had four treatment options to choose from, each of which had their benefits and drawbacks. Mr. L shared that he had been experiencing intense anxiety over this decision and felt that he was pressured by his medical team to decide on the HDR brachytherapy procedure he had scheduled. He had requested to learn techniques to manage his anxiety so that he could weigh his treatment options and tolerate his procedure, which he had rescheduled in six weeks.
My anxiety only increased the more I talked to Mr. L during the intake. I began to feel tightness in my chest and an increase in my heart rate. I also felt tension through my body, which manifested by clenching my hands into fists and digging my finger nails into my palms. When I thought about how I could help Mr. L work toward his therapy goals, my mind went blank. I felt an overwhelming sense that I was not prepared for this case and that I would fail if I was the one who was responsible for helping him make such a critical medical decision.
My self-doubt and anxiety instinctively told me to respond “no” to my supervisor. But instead, I said, “Yes…but I'm not confident that I can provide him with the help he needs in the next 6 weeks. I think it would be more beneficial for him to work with you.” Throughout the intake, numerous worries had clouded my mind that led me to this belief:
How would I possibly be able to help him with something as important as choosing which cancer treatment to undergo, which could change the course of his life? Six weeks isn't very long. Will I be able to help him make any noticeable progress in that time, much less get him to a place where he can actually undergo the treatment? Will I even be able to build rapport with him, given our significant differences in age and cultural backgrounds? Even though I've worked with patients with anxiety before, this situation has higher stakes. I have nothing to offer him. If he's my patient, it is my responsibility to help him get to a place where he can make a treatment decision regarding his cancer. If I can't do that within the next 6 weeks, I'll be failing him and failing as a clinician.
My supervisor listened to my concerns, then reassured me that I was ready for this case and that she would be there to help me. Given that I had mainly worked with female patients and patients who were transitioning into the survivorship phase of their cancer, she felt that I would benefit from working with a male patient who was about to undergo active treatment. With all of the worries still overwhelming my mind, my supervisor's support did little to calm my own anxiety. In that moment, it would have been easy for me to give in to my self-doubt and say that I didn't want to work with Mr. L. Instead, I decided to trust my supervisor—and looking back, myself—and agreed to take him on as a new patient.
Throughout our sessions, I found Mr. L to be very affable, grateful, and motivated to improve his anxiety so he could get the care he needed for his cancer. Although my anxiety continued to mirror his, we both slowly began to make progress. He ended up delaying his treatment an additional month, but after only six sessions with me he settled on HDR brachytherapy and completed the procedure.
My time with Mr. L was incredibly meaningful, in part due to how much it highlighted my own anxiety and lack of confidence as a therapist in-training. In reflecting on our work together, one of the most important lessons I learned is that my constant self-criticism and self-doubt did not serve me or my patient. Instead, my anxiety prevented me from being able to stay completely present during our sessions. Rather than worrying about saying the “right” thing all the time, I realized that providing my full attention and offering empathy during those 50 minutes each week were the best way for me to help Mr. L.
I also learned that my worries were not based on facts, and even though I had less than two years of experience with psychotherapy, I was still able to help Mr. L reach his goals and follow through with his cancer treatment.
It is crucial for us to continually engage in self-reflection and work to improve as clinicians so that we can be better for the next session and the next patient. Through this experience, I have learned to place more trust in myself, the therapeutic process as a whole, and my patients to show up and put in the work necessary to achieve the changes they are seeking in their lives. I also learned that anxiety is a natural part of being a human and a clinician who cares about her patients. Even though patients look to us as the experts, we do not always have the answers and can feel immense pressure as a result. Rather than viewing that anxiety as a sign of our incompetence, I believe we should view it as evidence of our commitment to our patients and to being empathetic clinicians.