On the Importance of Not Knowing for a Young Clinician

by Ryan Smedberg, LSW

     For the counseling and psychotherapy neophyte, the start of practice is a complicated experience. No doubt, an excitement animates the desire to put to use all of the theory and practice you’ve immersed yourself in during your time of study. There is a palpable longing for freedom: to break free of the onerous titles of “trainee” and “intern.” To finally be able to take oneself seriously—it is a liberating feeling indeed. What complicates this transformative, breakout moment is an ever-so-creeping sense of fear and uncertainty. Chief among these concerns might be the question: Do I know enough?

     Psychotherapy, much like my former undergraduate discipline in anthropology, suffers a split and often aggressive relationship to itself. There are warring tribes within that tout both new and old modalities, each espousing a slightly different philosophical outlook that spans from a qualitative, perhaps even murky psychoanalytic/relational-focus, to a highly quantitative and procedural set of practices. Newly minted practitioners have the dizzying task of finding out where they fit in the conflicted dynamics of this profession.

     Stepping out into a world where skeptical minds think of therapy as “merely talking,” one might be tempted with vehemence to swing swiftly to the camp of hard facts and data. Generally speaking, this is the world of managed care and the varieties of cognitive behavioral oriented modalities that often speak of “evidence-based practices.” Not to say that statistical data is without value, but in a world of “p-hacking” where therapies compete for the questionable blessings of insurance companies, it’s difficult to invest comfortably in the oft touted evidence-based tagline. This camp cozies up well with the hard science dimensions of therapeutic work—such as psychiatry, psychopharmacology, and neuroscience. And with an association with these hard science dimensions, it might also accompany a particular idea of expertise: the therapist as master of human behaviors, anatomy, experience, and its cures.  

     Although at first attractive for one’s sense of legitimacy, this can be a particularly crippling idea within a clinician’s self-understanding. Just as clients sometimes harbor saboteur inner self-concepts, clinicians can also harbor professional self-concepts that impair their ability to flourish in their work. For the perspective of the hard-facts expert, every new client is a new confrontation with insecurity. You may feel an overwhelming urge to arrive at answers (whether in the form of a diagnosis or an intervention)—a panic to consume whatever content you feel you’re lacking in the moment. From this view, the clinician is a container for the right ideas and insights at the right time.

     But the clinician, more realistically, is not a container of the right ideas for the right time. The clinician is a container, as well as a reflector, for the client’s inner-world and outer-world experiences. If as therapists we can harness what the wise English poet John Keats called a “negative capacity,” or what I call here the position of not-knowing, we can better facilitate therapy as a process for our clients and ourselves. Accepting the humbling limitations of what we know protects us from the desperations of expert knowing, and opens up room to understanding and seeing the complicated flux of client experience.    

     Through not-knowing, I do not mean to entail giving up on practice itself, or that clinicians cannot be professionals who know things professionally. To the contrary, I want to emphasize a continuous and lively curiosity that reads and practices widely and actively. I am thinking of a stance that doesn’t take the facts of a human life for granted, and that is open to the unpredictability of authenticity. For those just beginning their craft, I want to suggest that a desire for absolute sources of knowledge is a tempting defense for our own self-esteem and the validity of our profession. Again, similar to anthropologists, we seem to constantly teeter in public debates between being scientific and being an art. However, utilizing a little radical acceptance of our limitations, a little embrace of our inevitable unknowing, is a fertile place from which we can cultivate not only effective practice for our clients, but a good and honest life for ourselves as practitioners, too. 

Ryan Smedberg, LSW, received his MSW from Rutgers University in 2021 and currently practices as a school social worker and group counselor in Hunterdon County, New Jersey.