Dear Inadequate Gradate,
I work at a clinic where there is a high no-show rate, and it is extremely frustrating. Some days I’ll race from school or another commitment to the clinic, only to be stood up for several hours. Not only do I feel discouraged that none of my patients like me, but I’m starting to get resentful to the point that I don’t always feel clear-headed or empathic in session when someone does come in. I know it sounds selfish, but I am mad that I don’t get to practice the techniques I learn. Besides that, I’m worried that I’m not getting enough hours for the internship application and that I will fall behind. I don’t want to waste my time waiting around for patients, but this feels like an endless stream of rejection and it’s really bringing me down.
I’ve been there – both as a trainee and a professional – and I know others have, too. Some professions have tangible projects outside of themselves to show and measure success, but as mental health providers, we are the instrument. We use our skills, emotions, and knowledge in an intuitive and personal way to effect change, and our work can be extremely disheartening if we don’t feel like we see ‘progress’ in some form. Every career has potential for frustration, resentment, or angst, but when people do not show up to receive your help it hurts. I hear that you are not only discouraged and frustrated, but you are also worried about what the ‘continuous stream of rejection’ means for your future.
This is totally legitimate and normal.
Sure, we enter a helping profession with the intention to serve others, but this altruism also serves our needs. It feels good to educate or offer tools from which someone can learn and grow. We take pride in crafting a skill that is useful and appreciated, and sometimes patients validate our need to know that we are important. While we must be careful that we do not rely on those we serve to fulfill us, you do need the opportunity to practice what you are learning.
A bit of wisdom I received in graduate school is, “If nothing changes, nothing changes.” This means you need to take action instead of continuing to sit and wait for your patients. Call them to follow up on why they haven’t returned or check in with them the day before to remind them of the appointment. There are a variety of reasons people do not show up when they need to – find out theirs and work with that. Is it a transportation issue? Was the last session too intense or are they afraid what they will say next? Is the person just not interested? You can explore these issues if you connect with them, but if they still resist you know you at least made the effort.
The other (or perhaps simultaneous) route is to explore what addition opportunities there are for you at the clinic. How can you use your skills elsewhere? Can you start a group or try an alternative way to engage people? Can you do outreach? Do you need to change sites?
One last suggestion is to examine (as you mentioned) how you’re feeling might be interfering with the therapeutic alliance. If the frustration or lack empathy you feel is salient, it might be a reason patients do not return and it would be important to find someone to talk with yourself. It’s totally fine to feel what you feel and important that you are in touch with the anger and frustration, but dwelling in that will not help you or anyone else. I know internship application is competitive, and can bring out less attractive parts of ourselves, but use that knowledge, take action, and reach out if need be.
It’s easy to let rejection discourage us, but remember at the end of the day, no matter what,
You. Are. Enough.
The Inadequate Graduate