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20 Things I've Learned in 10 Years as a Therapist

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Recently, I started reflecting on all that had happened in my life in the 2010’s and really, how monumental of a decade it was for me.

I think the major theme of it was building.

Building my little family as it’s the decade where I met and married my husband, had my precious daughter and planted roots in the community that would become our home.

And building, too, because 2010 was the year I started grad school to become a therapist.

Looking back at who I was when I entered grad school, I’m reminded of the so-called Rumsfeld matrix that organizes what is known and unknown to individuals (and organizations) into a four-quadrant matrix.

Effectively, you don’t know what you don’t know, you don’t know what you know, you know what you know, and you know what you don’t know.

I remember arriving at my graduate school’s fall intensive experience admittedly a little bit naive and holding the mindset of, “Put me in coach, I’m ready!”

I was jumping at the bit to be a therapist and thought I was totally ready to do so.

I thought I was ready because I had lived at Esalen for three years by that point and was, I thought, well-steeped and well-practiced in psychology, process, facilitation and personal work.

And part of that was true: Esalen was a sort of “pre-grad school” grad school for me.

But still, it’s safe to say when I started grad school, I was still mostly in the “you don’t know what you don’t know” quadrant of the matrix, despite all that amazing lived-out experience.

Learning the psychological theories, interventions, tools and nuances of my craft was a practically vertical learning curve through grad school, traineeship and my many clinical internships.

But also doing my own personal work to become a more grounded, more compassionate, more present, more empathetic and more effective helper was another learning curve on its own that took the remainder of the decade (and that will last a lifetime still).

These last 10 years have been humbling in terms of all I’ve learned and unlearned, how much I’ve been forced to grow as a person and as a clinician, and humbling, too, because even with over 10,000 hours of clinical work under my belt now, there’s still so much to learn and master in my field.

Still, though, despite how much there is yet to master, I’ve certainly learned a fair bit in 10 years. And today, I want to share with you 20 highlights of key insights I’ve learned in a decade of doing this work.

It’s a love letter to what I understand in the “you know what you know” quadrant, all the while knowing that in this work of becoming a masterful therapist, I still often stand in the you know what you don’t know” quadrant.

I look forward to sharing with you what I know now, and what I may come to know further down the road.

1. No matter where you’re starting from, change is possible.

I consider this the unofficial tagline of my business because I believe in this so strongly. You can come from the most traumatic, chaotic, neglectful and unsupportive background, you can have devastating experiences happen to you and you can accumulate decades of grief and defenses, and it is still possible to face, address, grieve and transform those hurts and wounds to move forward and create a life that feels more stable, more connected and more enlivened. We humans are remarkably resilient, resourceful and graced with neuroplasticity — meaning our literal neural structures can change up until the day we die. Take comfort from this if you’re feeling stuck. There is always the possibility of change.

2. It’s not all our parent’s fault, and our early influences and past experiences can still impact us greatly in the present.

Therapists, and my field in general, sometimes get a bad rap with folks assuming that we’re just going to make them talk about their parents so we can blame it all on them. That’s not entirely true. Everything is not your parent’s fault, and yet it is important for a therapist to know and understand your early childhood experiences because that’s where we all tend to form our attachment patterns and many life and relational introjects. Your parents and early childhood experiences were (and possibly are) a strong influence on you, but the goal here isn’t to blame your early caregivers; it’s to understand how they impacted you so we can help you make better and different choices moving forward if that’s called for.

3. Most parents are truly doing their best. However, “best” is highly subjective and it may still unintentionally harm a child.

Nothing has humbled me more and given me a wider window into my clinical work more so than becoming a parent myself. This parenting stuff can be hard. And my lived-out experiences in conjunction with what I’ve seen clinically over the years really has instilled me with a faith most parents (aside from rare and more extreme circumstances) are truly doing their best and love their kids in their own ways. However, “best” is highly subjective. What may look like the “best” a parent can offer may, in fact, be unintentionally hurtful and still negatively impact a child deeply. Both things can be true. 

4. Trauma is subjective and trauma can be relational in nature.

I didn’t know of the terms developmental trauma, complex trauma or relational trauma before entering grad school. Like most people, I assumed trauma was something that could be more easily pinpointed — the 9/11 attacks, a plane crash, a rape. What I now know is trauma can be a single event or a set of ongoing conditions that overwhelm an individual’s ability to deal with the stress. In this way, trauma is subjective, so what may be traumatic to one person might not be traumatic to another and, importantly, this widened definition means, too, that trauma can happen inside relationships over time. Being raised by a depressive, withdrawn, avoidant and unaffectionate parent may be traumatic to someone. So might being parented by an alcoholic who seemed like Dr. Jekyll one moment and Mr. Hyde the next. It’s common for many people to dismiss their early childhood experiences as not being traumatic if they hold the mindset of only single, tangible events “counting” as traumas. It’s important, I think, for all of us to hold a wider lens on what trauma really is so we can honor our experiences and our potential struggles and receive the right kind of support we need.

5. Trauma can be intergenerational.

Trauma and trauma responses can be passed down the family line(s). One person’s maladaptive trauma responses influencing another (often unconsciously) until one member of the family is willing to face the past, get curious and do the deep healing work required to halt the perpetuation of the trauma cycle. Don’t underestimate how important doing your own personal healing work is. It can change the course of your family lines for generations to come.

6. It’s actually not the trauma itself that becomes the issue.

This is another key thing I learned in my work: It’s not that the traumatic experiences themselves that lead to negative outcomes. It’s the lack of metabolizing and integrating the traumatic experiences that can then lead to problems down the road. An individual — be they an adult or child — who is properly supported in feeling their feelings, making meaning of their experience and processing psychologically and physiologically can move forward despite the trauma in constructive, adaptive ways. When this supportive processing and integration doesn’t happen, however, we are more prone to see the long-lasting negative impact of traumatic experiences.

7. All of our behaviors, no matter how destructive they seem, were (and are) meant to support us.

Please hear me: You come by your behaviors — even and especially the ones you feel ashamed and frustrated by — honestly. Those behaviors were, once upon a time, likely an appropriate response and probably a very clever and strategic way of taking care of yourself when you couldn’t get your needs met in other ways. It’s just that now those same behaviors may not be working so well. And that’s OK. We can now do the work in therapy to help you identify and cultivate more choices and resources to help you manage your experiences differently now.

8. Relationships can wound, and they can also heal.

Dovetailing with point number three, while relationships can be a great source of pain, relationships of the right kind and quality can also heal. What is the kind of relationship that heals? Likely one in which there is safety, positive regard, acceptance, attunement, patience and care for the person. Given the right kind of relational conditions, we will, I truly believe, grow and thrive and intuitively move toward psychological health and resilience.

9. It’s not the quantity of contact that counts; it’s the quality of contact that counts.

One thing I appreciate so much as a working mom is a key point I understand from my trauma studies: the quality of relational contact you bring to someone matters more than the quantity of contact. You can spend all day in the house with a child and objectively “be there” with your body in the same space. But if you’re withdrawn and not engaging with the child, if you’re not demonstrating warmth and affection, if you’re four glasses of wine into the bottle, then the quality of your presence likely isn’t high. However, if when you come home from work after being apart from your child for eight hours, and despite being tired you do your best to attune to your child, to be affectionate, warm and playful, you’re providing a good quality of contact, even if the quantity wasn’t as high as you would have liked that day. Remember — especially all of you working parents prone to guilt out there — it’s the quality of contact, not the quantity that counts.

10. We’re all hard-wired for connection and contact. And also, if relationships were easy, my whole field wouldn’t exist.

“But, Annie,” I often get asked/told, “shouldn’t this be easy for me? Why is getting along with my husband/mom/sister/boss so hard?”

“Because,” I often say, “if relationships were easy, my entire field wouldn’t exist.” It’s a playful answer, I know, but I don’t mean it flippantly. The very tricky thing for all us is, from the time we’re born, we’re driven to connect with others. But also, connecting with others (for a multitude of reasons) can be really challenging! Between our own patterns, preferences, needs, wants and unconscious trauma responses, and those of another person, conflicts can happen, relational misses can occur, feelings can get hurt and our desire to feel connected can go thwarted. It may not happen all of the time, but it likely happens enough of the time to keep most therapists I know booked and busy and keep people asking that question again and again, “Why is this relationship so hard?” Again, relationships are deeply meaningful and fulfilling, but that doesn’t necessarily mean that they’re easy.

11. Long-term romantic relationships take work.

If anyone ever tells you long-term romantic relationships “should” be easy and if it’s hard it means you’re not with the right person, I want you to take this with a giant grain of salt. Everyone I’ve ever met who has been in a long-term relationship (I’m talking over seven to 10 years) has said their relationship can feel challenging at times, that it takes work and patience and forgiveness and a constant kind of re-choosing of one another daily, weekly, etc. See point number 10 and then add into this dual careers, commutes, kids, chronic sleep deprivation from said kids, bills, student loans, urban housing costs, in-laws, aging bodies, waning libidos, etc. Please do not berate yourself if a long-term romantic relationship sometimes (or often) feels hard, lonely, isolating and like a grind. I’m not saying this means you have to stay in your relationship (I think a successful marriage can be one that ends just as much as one that endures!) nor am I saying the challenges of your relationship are fixed and can’t be worked through. However, I do think we need to have a more normalized view of how hard most long-term relationships feel some (or a lot) of the time. I think we would all feel a lot less lonely if we talked about this more.

12. The way we do one thing is often the way we do many things.

I think there are clues contained in how we eat, how we travel, how we spend our money and/or how we approach working out. As seemingly innocuous as these content areas may be, they often contain clues and information about our patterns of moving through the world which likely extend to other areas of our lives. For example: binge eating, binge traveling and playing hard/working hard patterning may reflect back to you a larger pattern of pushing, overdoing and extremism you need and want to pay attention to. If you want to be curious about psychological patterns in your life, start paying attention to your relationship to different content areas of your life. It may be illuminating.

13. The goal is to expand our containers and to increase our capacities.

I know you know this, but it bears repeating: We’re not going to eliminate life’s problems and challenges. That’s baked into our human experience. So, the goal in therapy isn’t to make all the problems in your life go away. The goal in therapy is to help you expand your capacity and proverbial “emotional container” to handle more and more of life’s inherent challenges.

14. One of the keys to a more enlivened life is learning how to feel your feelings and use them for the information they contain.

Some of us have come to believe — thanks to messaging from families of origin, the media, the patriarchy and the communities around us — that feelings like anger, jealousy and despair are “bad” and we should “just have a positive mindset.” I truly believe all feelings are important and they contain good information for us. Moreover, when we help ourselves learn to feel emotions in our bodies, we support ourselves to not only live a more enlivened life, but to take the information our emotions contain to make informed, self-supporting decisions from them. This is a skill and it can be learned.

15. Boundaries are foundational to healing and to living a well-lived life.

Boundaries are the protective, unseen, force fields of our lives. They are physical, emotional, mental, spiritual and even financial in nature. They flex and change moment to moment, situation to situation and person to person. Our personal boundaries are meant to keep us safe, whole and physically and psychologically healthy. Because of this, learning what your individual boundaries are and learning how to assert them is one of the most foundational and self-supporting things you can do for yourself in your personal work.

16. Estrangement and disownment from family of origin is far more common than you might imagine.

And certainly more so than society often talks about. So often, folks going through estrangements and disownments with their family of origin or in-laws feel isolated and alone in their experiences. We live in a world that is very much pro-family and expects you to have close, connected and loyal family relationships no matter what. But what if your family or a family member is dysfunctional, abusive or not safe to be around? Then what? It’s common to feel “other” when and if you choose to estrange yourself from someone or when you yourself have been estranged. But what I will tell you from a decade of doing this work is estrangement, disownment and emotional and physical cut-offs from family of origin and in-laws are far more common than you might realize. So, if you feel alone in your experience right now, I assure you, you’re most definitely not.

17. You can forgive someone and you can still elect not to have them in your life.

I personally don’t believe you ever “have to” forgive someone. But it’s also important to say when and if you do by your own choice arrive at forgiving someone who has hurt you in your past, you still do not have to let them into your life. You can forgive someone and keep them out of your life. It’s not either/or, it’s both/and.

18. We can’t talk about improving our mental health without talking about soul.

This aspect of mental health — nourishing our soul and filling our lives with meaning, purpose and fulfillment — is not something the Diagnostic and Statistical Manual of Mental Disorders (DSM) takes into account when someone shows up in therapy looking for support with anxiety management, depression or bulimia and we have to create a treatment plan for them. But I truly believe we have to talk about the soul and tend to it just as much as we might make a plan to manage symptoms and reduce maladaptive behaviors to support someone’s well-being. We’re living in a time where suicide rates and deaths by chemical use and substance abuse continue to rise and where gun violence and mass shootings are so common it’s become alarmingly normalized. None of this is normal. These deaths of despair are reflective, in part, of the soul-sickness of our country. Our world. At the risk of sounding “fringe,” I think we need to invite the abstract but critical conversation of soul into our dialogue about mental health, one-on-one in the therapy room and in larger, social conversations.

19. Everything can look great on paper, and you can still feel unhappy.

You can have the great tech job, the multi six-figure salary, be married to someone with a similar pedigree, have the two kids you always imagined you’d have, that cabin in Tahoe and those season tickets to The Warriors, and you can still feel hollow, numb and depressed. Just because something looks “right” doesn’t mean it’s right for you and privilege doesn’t preclude suffering. To acknowledge you’re struggling while everything “looks good” doesn’t make you a bad or ungrateful person, it makes you a person who needs support.

20. Doing your own personal work is both a privilege and also an act of social justice and an investment in the world.

So often over this last decade I’ve heard, time and time again, people feel guilty for seeking out or being in therapy when “others have it so much worse.” They hold a mindset of, “Who am I to complain when my life is so comfortable in so many ways?” To the point above, suffering and being privileged are not mutually exclusive. Look, the folks who work with me or with the therapists at my center don’t have bombs falling on their heads, don’t live with the threat of ISIS or the Taliban and can provide food and shelter for their kids. These are privileges and we are privileged, relative to most of the world, to be able to even seek out (or in my case, conduct) therapy in the first place. And just because we are privileged doesn’t diminish our struggles. I actually think because we are privileged we have an obligation to do our own personal work, to heal our traumas and maladaptive beliefs and behaviors so we can use our privileged positions to help and strengthen others, cease any intergenerational trauma that may be traveling down our lines, empower our communities and even improve larger social circumstances. The more we can move through the world in functional, compassionate, kind and psychologically healthy ways, the more chance we have to positively impact others and circumstances. From this perspective, doing your own personal work is a privilege, yes, but it also an act of social justice and an act of investing in our world.

I hope this post felt helpful, comforting, thought-provoking or just plain old normalizing for you to read.

Please know, though, this list is not exhaustive.

It’s not reflective of everything I’ve learned as a therapist (the nearly 100 original blog articles barely scratch the surface of all I’ve learned!) and I’m sure as soon as I click publish, I’ll remember more points I wanted to share.

So, I’ll keep doing this work, reflecting on what I’ve learned and putting it in these posts for you, wherever you are, so we can grow alongside each other. Sound good?

Now, I’d love to hear from you in the comments below: What did this post bring up for you? Which of these 20 points did you most need to hear about today? What speaks to you the most of what I shared? Please leave me a message in the comments below. I’d love to hear from you.



Unsplash image by Artem Beliaikin

Originally published: May 12, 2020
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