A story of my first patient as a therapist
Every job has its first– A baker will have a first cake, an author will have a first book, and a therapist will have a first client. For me, having that very-first client was a startling realization in the middle of my third semester of grad school. I wouldn’t magically be the serious, stoic counselor in a cardigan and square-rimmed glasses that I had always envisioned. I wouldn’t immediately hold the keys of the universe like I imagined my personal therapists did during our sessions. I’d have to start as a beginner, holding distanced meetings due to COVID restrictions. Any number of things could go wrong and the idea of every single one of them loomed over me as I awaited my turn to undergo this rite of passage.
In the semester before my final year of graduate school, the time came to meet my first clients. My professor explained the procedure before my class and I were to meet our respective clients. We’d review their file, set up device recording, give warnings and disclaimers, then jump into a standardized getting-to-know-you document.
Easy, right?
But when my time came, I was sweating. A giant lump in my throat formed while I waited for the people on the other side to join my meeting. Glancing through their intake information was simple enough, as was setting up the recording and invisible third-guest options on the computer for my class to silently watch the session happen live. But what would I say to these clients after they joined? Hi, I know you think I can help you, but I’m just a kid in therapist dress-up?
Thankfully, the couple on the other side greeted me before their faces even appeared on screen. I exhaled a sigh of relief as they jumped into pleasantries.
Ryan introduced himself first. He and Paulie, his husband, were in a rough patch. Paulie’s drinking problem had gotten worse over the past year, which only made it more difficult for Ryan to temper his own anxieties. They agreed that their main goal was to improve communication in the relationship, a vague goal that I knew I would have to poke at after we built some more trust.
I introduced myself with a quick acknowledgement that, as a student, I’d have to record all of our sessions and that there might be a live audience during any given meeting. I mentioned that therapy can be complicated and may feel worse before it would feel better. They politely confirmed and understood after every prompt I gave them, but the more I continued with my housekeeping tasks and intake questions, the more I was sure that they were getting uncomfortable. Sometimes their eyes would dart between one another before answering me; other times, they’d take extended pauses before sputtering out a response.
These behaviors made total sense. It’s possible I was totally projecting my own nerves onto them, but they were justified in having any sort of reaction to me. Therapy itself is a bizarre concept– You pay a total stranger to hear your problems, which they help solve by digging around in your deepest thoughts and fears. It was only natural that the absurdity would be apparent to them in this moment too.
Once we finally got into the less-structured portion of our conversation, I shifted my tone. With more freedom in how we could speak, I took a gentler approach to these big topics. I asked forgiveness for being intrusive and made light jokes where I could. I never wanted my clients to feel like I was above them or judging them in any way. My approach here would be the start of my career-long therapeutic style.
The couple began to relax, laughing at my jokes and gradually answering without looking to the other for reassurance. Before I knew it, I was asking the quintessential therapist question: Same time, next week? After agreeing, our call ended.
It was over. I’d done it. I made it through my first session as a therapist without causing my clients to quit halfway through or making it so awkward that I stressed myself into a panic attack. Still, I couldn’t celebrate yet. It was time to face my classmates.
“Well, how do you think you did?” My supervisor asked, her steely demeanor as resolute as ever. I tripped over a response while my eyes shot around the screen. My classmates had equally good poker faces.
“They loved you. Congratulations.”
Loved me? I thought everyone involved was being courteous and professional, but my professor doubled down.
“You charmed them. I’ve been doing this a long time. They’ll be good clients for you, trust me.”
Yeah, we’ll see next week, I thought.
But she was right. Ryan and Paulie dutifully showed up to every session enthusiastic, responsive, and open to change. At the end of our therapy journey together, Paulie had maintained 90 days of sobriety and Ryan’s relationship-based panic attacks subsided. After we celebrated, I asked them if they had any questions for me since I had certainly asked many of them.
They gave each other the same hesitant look I’d seen during our first chat.This time, there was no rattle of anxiety in my chest.
“Anything you want. Kinda seems like you’d like to say something,” I prompted.
“Well, yeah,” Paulie said. “We want to know how we’ve done in relation to your past clients.”
“Past clients?”
“What Paulie means is,” Ryan’s hand patted Paulie’s lap just out of frame. “We feel pretty good about how much progress we’ve made, but we want to know if your other couples have gotten this far then crashed back to Earth again.”
My heart swelled.
“Guys, I can’t compare you to anyone.” They started to protest, thinking I was flattering them.
“No, no, no. I can’t compare because you were my first clients. Ever.”
An immediate lightness came over my body. I didn’t have to embody the expert or fear that they’d see me as an imposter anymore. Now they knew the truth.
“We couldn’t even tell! Wow. That makes it even more meaningful for us, thank you.”
I gave my appreciation in return, the words failing to capture how truly grateful I was. Over a few short months, my work with them boosted my confidence tremendously. Paulie’s 90 days of sobriety were 90 days of his life back. The men were happier together. The seedlings of my professional identity were taking root, being tested with every subsequent meeting. Even if I never took another client again, my work with them meant something, for them and for me. They made me a therapist, officially, an experience I will always cherish.
Alicia Ortega
Mental Health Counselor
University of Akron Master’s degree, Counseling 2018-2021
Kent State University Bachelor of Arts (BA), Psychology 2013-2017