“Should I even be a therapist?”  A Qualitative Exploration of the Sources of Self-Doubt Experienced by Therapists-in-Training

“Should I even be a therapist?” A Qualitative Exploration of the Sources of Self-Doubt Experienced by Therapists-in-Training | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “Should I even be a therapist?” A Qualitative Exploration of the Sources of Self-Doubt Experienced by Therapists-in-Training Tessa Natale, Nicola Gazzola This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6830639/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract One of the key elements of effective psychotherapy is the mental health of the practitioner. Research has shown that psychotherapy efficacy is diminished if therapists project anxiety in their role or lack confidence in their mastery of skills (Lambert, 1989; Royse-Roskowski, 2010; Tsai, 2015). Therapist factors contribute to approximately 9% of the outcome variance (cf. Wampold & Imel, 2015), which is higher than the variance attributed to the actual treatment used. Therapist feelings of incompetence (FOI) or self-doubt may potentially impact the therapeutic outcome (Theriault & Gazzola, 2009, 2010). However, the experience of self-doubtfrom the therapist-in-training perspective requires further investigation. This stage of development is characterized as one that presents many challenges through its exposure to novel experiences and changes in professional identity (Morrissette, 1996; Rønnestad & Skovholt, 2003). The research question that guided the current study was: “What are the sources of self-doubt in therapists-in-training?” Using inductive qualitative research methodology, 8 therapists-in-training in Ontario, Canada participated in semi-structured interviews to discuss their experiences of self-doubt. Data were analyzed using Braun and Clark’s (2012, 2014) six-step thematic analysis to uncover themes shared by participants. A total of 5 main themes and 16 sub-themes emerged from the data analysis, describing the sources of self-doubt for therapists-in-training. Findings are discussed in the context of psychotherapist training, supervision and practice. qualitative research thematic analysis self-doubt psychotherapy therapist-in-training Introduction The role of a psychotherapist is nearly impossible to master. Therapists are tasked with understanding their clients’ experiences while recognizing they will likely never fully do so (Brown, 2023). They are taught to become comfortable with questioning, both internally and externally, and to embrace “not knowing” (Brown, 2023, p. 1). Needing to gain comfort with the unknown contributes to the complexity of psychotherapy. It is a profession that places unique demands on its practitioners, including the necessity for acute self-awareness to practice ethically and effectively. Psychotherapy graduate programs emphasize inner reflection, heightening both positive and negative internal processes. This heightened awareness may lead to rumination and self-doubt, as therapists question their professional abilities. Self-doubt has been linked to poor well-being, often through repetitive, self-critical thinking and perfectionism (James et al., 2015). Though self-doubt is normative and even considered growth-promoting (Nissen-Lie et al., 2017), it also poses risks to the therapeutic process and may potentially become detrimental to therapists' mental well-being (Thériault & Gazzola, 2005, 2010). Therapists experiencing self-doubt may be at higher risk for burnout, low self-esteem, and early career abandonment (Altaf, 2022; Thériault & Gazzola, 2005, 2010). Psychotherapists are ethically required to engage in continual inner reflection, specifically monitoring when their personal lives and/or insecurities begin to interfere with their professional work. When difficulties arise, they must seek supervision or support to prevent potential harm (CCPA, 2021). Therapist well-being has been identified as key to therapeutic outcomes (Nissen-Lie et al., 2017). Practitioners must exercise self-monitoring before, during, and after sessions to mitigate signs of potential burnout and to protect themselves and their clients (CCPA, 2021). The profession also requires therapists to integrate their personal traits with professional competencies seamlessly (Nissen-Lie et al., 2017). They are expected to be authentic and responsive while applying their clinical knowledge and resisting countertransference. High expectations for self-awareness and skill application, along with ongoing professional development, can amplify self-doubt, especially among student therapists completing practicum placements. The Individual Therapists’ Impact on the Therapeutic Process Therapist factors, referring to the traits, behaviours, and beliefs of the individual, can influence client outcomes. Research shows that therapists themselves account for about 9% of outcome variance, a greater contribution than the treatment modality (Imel & Wampold, 2015; Barkham et al., 2021). Howard et al. (1969) were among the first to recognize that the person of the therapist, not just treatment protocols, plays a role in client outcomes, identifying self-doubt and self-recrimination as common struggles. Lambert (1989) later emphasized that therapists’ personal difficulties could negatively affect clients. Variance in client outcomes is influenced by several factors, including by technique used, client expectation for positive change, the therapeutic alliance, as well as by therapeutic variables that are independent of the therapy (such as client strengths and supports) (Duncan et al., 2010; Lambert, 1986). Thus, a high percentage of outcome variance can be attributed to factors not related to the therapeutic modality or psychotherapeutic techniques employed, suggesting that the person of the therapist is an important consideration in therapy outcomes. Skovholt (2012) and Brown (2023) suggest that some aspects of therapeutic change are mysterious and unmeasurable, such as the timing of sessions or the therapist-client connection. Newcomers to the field may feel destabilized by uncertainty, leading them to experience self-doubt in an effort to make sense of outcomes. Even experienced therapists continue to question their effectiveness (Kottler, 2022). Therapist Self-Doubt Self-doubt or feelings of incompetence (FOI), refer to the internal challenges to therapists’ belief in their abilities (Thériault & Gazzola, 2005). One study showed that even experienced therapists (10+ years) experience FOI, ranging from mild doubts to severe questions about their career suitability. In a grounded theory study of experienced therapists, findings showed that self-doubt intensified when psychotherapists’ personal struggles interfered with their clinical work (Thériault & Gazzola, 2005). In a follow-up study, experienced therapists described levels of FOI ranging from “Am I saying this right?” to “What if something fundamental is missing in my personality?” (Thériault & Gazzola, 2010, p. 238). Coping strategies such as supervision and self-awareness helped them manage distressing experiences. Another study examined novice therapists (1–5 years of experience) and found both positive and negative impacts of FOI (Thériault et al., 2009). Self-doubt prompted some to engage more deliberately with their work and seek out supervision and training. Others, however, reported being debilitated in sessions and ruminating afterward. Many feared being discovered as impostors. Coping strategies included adhering to theory, practicing self-care, and trusting in their professional development. Thus, three trends were emerging regarding feelings of incompetence: they seem to be present in varying degrees regardless of clinician experience levels, clinicians employ a variety of corrective measures to cope, and some FOI can be motivating to clinicians (Theriault & Gazzola, 2010). Therapists-in-Training and Self-Doubt Although there have been several qualitative studies on clinician FOI, little work has focused specifically on therapists-in-training, who engage in psychotherapy for the first time during their practicum. The current study aims to address this gap and explore how trainees experience and manage their self-doubts. In Canada, counselling psychology programs are competitive, and the pressure to succeed may create a highly emotional training environment (Morrissette, 1996). In Ontario, trainees must complete supervised practica (CCPA, 2021; CRPO, 2019), and supervision is a critical tool for both clinical development and managing self-doubt (Nyiri, 2010). Supervisors, typically experienced psychotherapists, support interns through individual and group formats. When supervision is validating and supportive, interns benefit greatly. However, supervisory conflicts and power struggles may exacerbate FOI and create distress in the intern (Morrissette, 1996; Gazzola & Thériault, 2007). Therapists-in-training are often evaluated by their supervisors, which can intensify fear around disclosing self-doubt (Daly, 2018). Many trainees suffer in silence, fearing their doubts signal incompetence (Thériault et al., 2009; Nissen-Lie et al., 2017). It’s essential to distinguish between self-perceived and actual incompetence; one reflects internal self-criticism, the other a real skill gap (Thériault & Gazzola, 2005, 2006). Constructive supervision enhances the therapist’ skills, protect clients, and helps to increase therapist self-efficacy (Gazzola & Theriault, 2007). Bandura (1977) described self-efficacy as a belief in one’s ability to perform a task. In counselling, this refers to confidence in clinical skills and client work (Larson & Daniels, 1998). Supervisory feedback and praise can support self-efficacy development (Bernard & Goodyear, 2014). However, anxiety and self-doubt can undermine it (Larson, 1998; Tsai, 2015). Tsai (2015) distinguishes personal anxiety (e.g., fear of being unskilled or judged) from professional anxiety (e.g., concerns about rapport or clinical skill). Self-doubt may compromise both forms of confidence and interfere with clinical development. Counsellor Development Counsellor development theories highlight how self-doubt is a normative, yet challenging, part of early professional growth (Bernard & Goodyear, 2014). Benefits to self-doubt include supporting critical reflection and boundary setting (Altaf, 2022), although it may also lead to unrealistic expectations around change-making, contributing to burnout (Finan et al., 2022). If overwhelmed, therapists may question their fitness for the role. Development theories (e.g., Rønnestad & Skovholt, 2003) identify six stages of counsellor growth, from student to experienced clinician. The second and third stages, described as the beginning and advanced student phases, are especially relevant to the current study. During these stages, trainees develop clinical skills, navigate new identities, and form professional relationships. These transitions may feel destabilizing. Anxiety could impair focus in session, and criticism can threaten fragile emerging identities. As graduation nears, expectations rise and conflicts with supervisors may increase (Gazzola & Thériault, 2007). Self-evaluation may spiral into self-doubt. Without guidance or a structured framework, student therapists may feel lost. Perfectionism, program pressures, and personal anxiety can impact performance and client care (Morrissette, 1996). To protect clients and support student development, further research is needed to explore the experience of self-doubt. This study was guided by the research question: What are the sources of self-doubt in therapists-in-training? Methodology Participants Criteria for Involvement in the Study and Sampling Criterion-based sampling was used to select participants who would best be suited to inform this study. To be considered for the study, the participants had to meet the following inclusion criteria: 1) speak fluently in English, 2) are currently enrolled in a counselling/psychotherapy Master’s-level program in Ontario, Canada, 3) are completing their practicum where they are meeting with clients for the first time in their careers, and 4) are willing to discuss their self-doubt. Emphasis was largely placed on recruiting participants who disclose having experienced self-doubt and are willing to share about their experiences. Participant Demographic Data The participants (n=8) included seven individuals who identified as women and one participant who identified as gender-fluid. Ages ranged from 23 to 35 years (M =29.35). Four of the participants were in the 20–29 age range, and the remaining four were in the 30-39 age range. The participants held varying undergraduate degrees, primarily in social science-related fields. Participants reported to be operating from eclectic/ integrative theoretical approaches as they discovered their professional identities. See Table 1 for participant demographic data. [Insert Table 1 about here] Procedure Data Collection Once the study, along with its recruitment materials, received approval from the Research and Ethics Board (REB), a recruitment poster was distributed by the Canadian Counselling and Psychotherapy Association (CCPA), National Capital Region (NCR) Facebook page. Those who expressed interest in participating contacted the primary researcher via email correspondence to ensure confidentiality. They were then provided with the recruitment text with further details on the study and were asked to confirm that they met the eligibility criteria. Once confirmed, they were sent a formal invitation to participate. Along with the formal invitation, the participants were sent a consent form, which they were asked to electronically read and sign. Once completed, they returned it to the researcher via email. All those who expressed interest to participate met the inclusion criteria and were sent formal invitations. Pseudonyms were assigned to participants to protect their confidentiality. Interviews A semi-structured interview protocol was created and piloted with the researcher’s research team. The protocol was intended to invite naturally flowing conversations that explore participants’ experiences of self-doubt in a non-judgmental and safe space. Informed consent was obtained from all individuals who participated in this study. The participants were offered the choice to meet in person for their interviews at a secure location or to meet virtually. All 8 participants chose to meet virtually for their interview with the first author, using the video conferencing platform Microsoft Teams. The interviews ranged from 60-75 minutes in duration. The variation in length was dependent upon the detail provided in the participant’s responses. The interviews were conducted using a semi-structured interview protocol containing open-ended pre-determined questions, leaving an opportunity for pertinent prompting and improvised questions. The interview questions were piloted with the second author as well as with other research colleagues and research team members before their use with participants to aid in increasing their clarity and ability to investigate the topic. Before beginning the interview, the interviewer checked in with the participants to ensure they had understood, read and signed the consent form and were clear on the goals of the study, including their rights within it. The interviewer offered the participants the opportunity to ask any questions they might have, prioritizing their comfort. Once any questions were answered, the researcher asked for the participant’s verbal consent to proceed with the interview. The interviewer then collected their demographic information (e.g., gender, location, theoretical orientation, etc.). The interview protocol explored their sources of self-doubt. The researcher asked the participants questions such as “Are you able to name any specific pressures that may have contributed to your self-doubt?” Once the interviews concluded, the participants were provided with a debriefing form thanking them for their participation in the study, as well as information on individualized available resources should they require additional support after the interview due to psychological discomfort recalling their self-doubt. Each interview was audio recorded using the iPhone audio-recording function and was automatically transcribed using Microsoft Teams. All original data was virtually stored in a password-encrypted Word document, saved on an external hard drive, as well as a backup USB key owned by the first author, which were both kept in a secure location in the researcher’s home office. The data files, including the audio recordings and their transcriptions from each interview, were also stored on this external hard drive and USB key when not in use. Data Analysis Once data was collected from the participant interviews, it was analyzed and sorted using the Braun and Clarke (2012, 2014) six-step thematic analysis. This method of analyzing data allowed the researcher to systematically pull out both themes and sub-themes (i.e., shared perspectives and experiences) from participant responses in their interviews. The researcher is then tasked with organizing the themes and offering insights into their meanings. The six-step process emphasizes identifying and understanding both shared and unique experiences among participants. The results contributed to the creation of a conceptual structure detailing the experience of self-doubt by therapists-in-training to help better understand how self-doubt is experienced and navigated by participants. In the first phase of the six-step process, the first author immersed herself in the data by listening and re-listening to the audio-recorded interviews. This involves taking down notes of initial thoughts and reading/re-reading interview transcripts until they are familiar with the data. This is done from a critical and analytic point of view, aiming to find information that is pertinent to the research questions (Braun et al., 2019; Braun & Clarke, 2006, 2012). In the second phase of the data analysis, the researcher began generating initial codes from participant responses in the interview. This serves as a preliminary way of organizing and summarizing the main ideas semantically (i.e., staying close to the participant’s meaning) to work towards identifying data that helps answer the research questions. The codes created by the primary researcher were shared via email correspondence with the second author for feedback. The following data analysis step followed by the primary researcher, was to turn codes into initial themes. Themes refer to patterned responses expressed by participants to display similarities in their experiences or ways of thinking (Braun & Clarke, 2012). This requires the researcher to actively construct themes by revisiting the previously created codes to group them, if appropriate, into a bigger theme. Once completed, the next step taken was to revisit the previously created themes, similarly to “quality checking” (Braun & Clarke, 2012, p. 65). This involves comparing generated themes against the data set. This may entail discarding some codes or reworking themes with the goal of better capturing the data. These preliminary themes were again shared with the second author for auditing. Feedback provided was used to refine and narrow the themes. In the following phase, the themes were reviewed once again, labelled and defined to ensure clarity. This resulted in the creation of sub-themes if an idea or experience is described differently by participants to reflect their unique experiences. By the final stage, the data had been reviewed many times by both authors, had been organized and labelled, and had been separated into specific themes and sub-themes. The researchers then share the findings in the form of a thematic structure, presenting the themes in an ordered, logical and meaningful way that helps build a picture of the data and helps to answer the study’s research questions. The thematic structure includes the researchers’ analysis and interpretation of the results, backed up by evidence, to provide more substance and life to the themes. The final set of themes and sub-themes were reviewed by the second author. Researcher as Instrument It is important to acknowledge the first author’s educational position and experience with self-doubt during the study’s completion. When the interviews took place, the first author was completing her second year of a master’s degree in counselling psychology. At this stage in her learning, she was in her practicum placement, performing the controlled act of psychotherapy for the first time. With this new learning experience, many emotions occur, some of which are self-doubt. Therefore, first author has a personal relationship with the topic of self-doubt in this context. The goal is that this understanding provides participants with a safe space to reflect on their experiences while speaking to someone who can relate to feeling self-doubt at this stage in their professional development. Keeping this in mind, the researcher intentionally attempted to separate her own emotions and experiences from those of the participants during the interviews. The researcher was cognisant that not doing so may impact the participant’s ability to provide true responses to the questions. The researcher put effort into remaining neutral when conducting the interviews, not allowing their ideas and experiences to cloud their interpretation of the participant’s responses. To encourage transparency, the researcher self-disclosed to the participants that she is also in the same stage of professional development as they are. Ensuring Trustworthiness and Insight An important element of qualitative research is ensuring both the credibility and reliability of research findings (Ahmed, 2024). Trustworthiness is earned through a clear demonstration of credibility, transferability, dependability, and confirmability (Lincoln and Guba, 1985; Nowell et al., 2017; Stahl & King, 2020). The current study utilized peer debriefing to ensure credibility, thick and detailed descriptions to support transferability, documentation of each step of the process to ensure dependability, and clear demonstrations of interpretations to allow confirmability. An audit trail and the retention of all transcripts were kept by the researchers. The central aspect of ensuring trustworthiness was the auditing process. The second author audited all open codes, themes, sub-themes, and subsequently the conceptual structure of the data. The data were audited by the second author, an experienced university professor specializing in counselling and psychotherapy. The second author has extensive experience as a psychotherapist (approximately 30 years of experience) and as a supervisor (approximately 20 years of experience). He provides supervision to practicing psychotherapists in private practice as well as to psychotherapist trainees in a master’s program in counselling psychology that leads to licensing as a registered psychotherapist in the province and country where the study was conducted. The current study was inspired by the second author’s collaboration on an ongoing research agenda that focused on therapist experiences in the psychotherapy process, including self-perceived inadequacies and self-doubt. Findings A total of 5 main themes and 16 sub-themes describing the sources of self-doubt for therapists-in-training emerged from the thematic analysis. The five major themes, along with their subthemes, are described in Table 2. Each sub-theme is accompanied by participant verbatims to give voice to their insightful experiences. [Insert Table 2 about here] Theme 1: Professional Individuation This theme aims to capture the self-doubt that participants associated with developing their professional identities as clinicians while completing their internships. It speaks to the challenges they faced when feeling limited in their experimentation with different approaches and how internal tensions developed when their clinical judgment differed from their supervisors. It encompasses the following three subthemes: (A) Discovering a Professional Identity Inherent in being new to the profession of psychotherapy is being given the exciting yet daunting task of discovering who you are as a therapist/clinician. While studying to be therapists, they are exposed to various therapeutic theories and approaches. However, their internships are commonly their first opportunity to begin putting them into practice. Therapists-in-training are quickly swayed from the role of student to practitioner, attempting to integrate what they have learned and begin to identify which therapeutic approaches resonate most for them. In participant Gabby’s words, “It’s [about] trying to figure out what type of therapist you wanna show up as.” The challenge of determining what feels most authentic to the therapists-in-training, compared to their supervisor’s approach and/or training, was identified as a source of self-doubt. Harper described how her self-doubt was most prevalent when she questioned herself in session, “the self-doubt comes up the most is when I am wondering who I should be in the room as the therapist.” While excitement can be found in therapist self-discovery, stress and anxiety were reported when therapists-in-training felt overwhelmed by the task at hand. (B) Limited Experimentation and Control Experimentation with different approaches in sessions is a key factor in the development of a professional identity for therapists-in-training. However, feeling limited by the real-world implications and risks of doing so was reported to be a source of self-doubt for participants. Arya reported prioritizing intent and consideration in session, “I just feel like there's so much that I can't try because it's real life.” She continued to describe her concerns that her professional identity negatively impacts her clients, “my professional identity is a big question, and I sometimes worry it influences the process with the client.” Experimentation was also described as limited by the pressure they experienced to be “blank slate therapists” in session. Being a blank slate therapist refers to the omission of self-disclosure and a softening of personality traits in session. Harper described, “A lot of us actually feel like we kind of all were taught the same thing to start with, we were all like squished to being this blank template of a human.” The process of moving beyond this template towards professional self-discovery led to self-doubt as they worried about the impacts of doing so. They shared feeling as though they needed to exercise high amounts of control, limiting their experimentation. (C) Professional Development Tension Differences in perspective or approach between the therapist-in-training (i.e., supervisee) and their supervisor were described to lead to internal questioning and self-doubt. This occurred when the therapist-in-training began to develop their clinical judgement, gaining the realization that there are multiple pathways to approach the profession. Differences in perspective between the supervisor and supervisee may lead to internal questioning of their newly developed identity. Kai (they/them) described feeling proud of an intervention with a client until their supervisor disagreed with it: I was really proud of that moment, because it was one of those moments where I identified a need that they had, and then you know, kind of went with my gut of what to do. And then I told my supervisor about it, and he basically completely disagreed with what I did. Feeling proud of a moment with a client and disagreeing with the feedback received led to internal tension for the therapist-in-training. Kai shared how developing their clinical judgement was paired with self-doubt: “it's a combination of my self-doubt and also my belief in myself coming [together] at the same time.” Harper described how she is developing the ability to trust her voice in session while also valuing her supervisor’s opinion, sharing: “There's value in what I'm learning from my supervisor, but I also have to go with my gut because I'm the one that's in the room with my client.” Theme 2: Difficulty in the Supervisory Relationship This theme addresses how difficulties in the supervisory relationship contribute to developing self-doubt. Not receiving enough guidance and structure from their supervisor, observing differences in perspectives/approaches, and a perceived lack of emotional safety were noted by the participants. The three following sub-themes emerged from the data: (A) Lack of Structure and Guidance Not receiving enough structure and feedback from clinical supervisors was reported to heighten self-doubt. The participants shared their need for guidance and reassurance to build confidence in their skills and clinical decisions. Without feedback from their supervisors, participants were left doubting their abilities. Samira recalled asking herself, “What if I'm not doing this right?” while experiencing a lack of oversight while completing her internship. A desire for feedback was also reported, as a lack of feedback contributed to participants feeling unsure about their progress and worried about making mistakes. Samira felt that her supervisor’s hands-off approach contributed to her doubt. She stated, “I don't really have anyone watching me,” leading her to question her work with her clients. (B) Differences in Perspectives/Approach Operating from a different theoretical orientation as their supervisor was a source of self-doubt for many participants. When the participants’ theoretical perspectives differed from their supervisors’ theoretical orientation, participants tended to question their methods, especially when a disagreement occurred within the supervisory relationship. For example, they do not see eye-to-eye regarding the case conceptualization or treatment plan. Self-doubt was exacerbated when the therapist began to compare their limited experience to their supervisors. Kai shared, “When I disagree [with my supervisor], my self-doubt goes up because I'm, like, do I disagree because I have something to stand on? Like they have so much more experience?” In these situations, they wonder whether they have done something wrong or whether it is simply operating from a different perspective. (C) Fear of Judgment and Emotional Safety A perceived lack of emotional safety in the supervisory relationship contributed to therapists-in-training withholding from sharing their self-doubts with their supervisor out of fear of judgment and/or negative perception. The evaluative component of supervision was viewed as an obstacle to expressing self-doubt, Kai shared, “There's an evaluative component to the relationship. You are judging me, and you are the reason that I pass or not . . . I don't want my self-doubt to make you doubt me.” Violet described how she was disappointed by her supervisory experience, noting how her self-doubt was highest after supervision sessions due to not feeling validated or supported. She shared: For me, the worst is definitely after my supervision [sessions]. Where it's almost like I'm entering the supervision with the hope that I'm going to [feel] validated and that we can take care of my doubts and the pressure that I put on myself, but it's sort of like brushed off almost, and so afterwards the feelings of discomfort are pretty intense. A safe supervisory environment fosters emotional vulnerability for therapists-in-training. Without it, they are missing out on an opportunity to process their experience and the challenges that occur. When supervisors shared their own experiences and doubts, interns expressed feeling less comparison and were more reassured in their experiences. Samira shared: “My supervisor has shared a moment that was really, really, difficult for her - and [hearing] it did help me feel more comfortable with myself and my own learning, but also to feel more comfortable with just like sharing more generally.” Theme 3: Personal Sources The current theme describes the weight that personal expectations and struggles contribute to the experience of self-doubt. When the participants were asked to reflect on whether they felt as though their self-doubts originated from more internal or external sources, the majority agreed that they stemmed from an internal place. For example, Samira shared, “I honestly can attribute most of it to like my own, like, personal stuff.” Personal sources refer to doubts surrounding competence and preparedness, mental health capacity, struggles with perfectionism and comparison to peers. The four following sub-themes were created to reflect the experiences of the participants: (A) Doubting Competence/Preparedness/Training Doubting competence, preparedness, and training were often reported as a source of self-doubt, emphasizing the high expectations participants set for themselves. Sage described doubting her skills learned before beginning her internship, “I had a sense of, ‘I really don't know what I'm doing’ besides kind of those basic skills.” Violet shared how her doubts nearly motivated her to pass off her client to another, more experienced therapist, describing: “If they were with somebody more experienced, maybe they could help them more effectively than I can.” Not feeling prepared to begin seeing clients was reported by all of the participants, as they did not feel confident in their abilities at the onset. (B) Doubting Personal Mental Capacity Doubting their mental health capacity was raised as a source of doubt by the participants. They reported feeling anxious before and throughout their internships when worrying about their capacity to hold space for others, concerned about how their personal issues may impact them, and feeling a responsibility to look internally. Amelia shared a doubt early in her internship, “it's doubting that I even can just go and sit with a client.” She shared about the fears that surfaced for her when required to show up authentically in session, noting how requesting vulnerability from her clients meant she needed to reciprocate. She described, “So, the fear was of vulnerability, of opening myself up to be curious, to lean in, to be open to that other person's vulnerability.” Her gruelling process of leaning into her discomfort and expressing vulnerability led her to consider whether she was cut out for the role, wondering to herself, “Maybe I'm not cut out for this.” With the help of her supervisor, Amelia shared having gained more comfort in showing up authentically with her clients. This highlights the toll that also “doing the work” has on therapists-in-training. (C) Sense of Responsibility to Help Clients A common thread between participants was their sense of responsibility to support and help their clients. A desire that is often deep routed in their personal experiences. Gabby expressed, “I figure, especially like this profession, most people go in [to it] because they've had life experiences, not just because they're interested [in psychotherapy]. A lot of people go into this wanting to help others.” The pressure they place on themselves to have a positive impact on their clients leads to self-doubt. Harper expressed the pressure she felt to “fix” others: “If someone is showing up, if they're sitting in front of me, then there's something that they really, really need, I need to be the one to change that or fix that for them.” While this genuine desire to help is rooted in an altruistic place, it led to self-doubt for the participants. A few participants shared how their role as a therapist is tied to being a caretaker in their personal lives. Noting how their identities as caretakers are put into question if they do not perceive their clients to be benefitted from their sessions. Sage shared: “It's almost as if my self-worth is attached to that role and if I'm not potentially fulfilling that role, then some kind ‘of uh’ definitely strikes, that kind of self-doubt in that worry.” This worsened if the therapist-in-training struggled with perfectionistic tendencies. Harper noted how her perfectionistic habits, paired with her cultural/religious background, led her to experience excess pressure to help and support others in need. She described the stigma which individuals in her culture face when seeking mental health support and how this placed extra responsibility on her to make it worth their while. She shared: “If someone's showing up to therapy, it's because they need help. So I feel like I have to be the helper.” She continued, “So it's me being a perfectionist, it's me coming from a culture where if you're gonna go to therapy, you're gonna get help from it.” Placing pressure to be the agent of change was reported as a source of self-doubt. (D) Comparison to Peers Interestingly, peer support was described as adaptive by participants unless it developed into a negative comparison. This occurred when they compared their progress, knowledge and confidence to their peers in supervision or seminar courses. Sage shared, “I kind of think to myself, wow, like, they seem so confident, [when speaking about their experience] then thinking like ‘I'm not that confident.’” Gabby shared a similar sentiment: “I mean, it's interesting because, umm, I've noticed sometimes hearing like peers experience can spring up self-doubt, there are some people that just seem to really like know what it is they're doing and have such confidence.” This resulted in the individual feeling doubtful of their knowledge, approach and skills. Further emphasizes the need for normalizing discussions surrounding internship struggles and sources of self-doubt. Theme 4: External Pressures This theme emerged through the participants describing how external pressures, such as societal expectations, client feedback, and looming ethical and legal implications, have contributed to fostering self-doubt for therapists-in-training. The three following sub-themes were created to reflect the experiences of the participants: (A) Societal Expectations The participants shared how societal expectations and misconceptions of therapists contributed to their self-doubts. Some of these were described as the view that therapists are “healed people” and can “fix others.” They shared how societal illusions that therapists can control or significantly change client behaviours led them to feel inadequate when such results were not produced. Sage stated, “I don't have control over other people's behaviour, and that's something that I think society kind of tells us a lot. It almost gives us the illusion that as therapists, we're able to kind of like make people do things, which is completely erroneous.” Others described how the societal expectation that therapists should not suffer personally led to self-doubt when internal struggles occurred. Samira shared a moment when someone near to her disclosed their hesitation to receive treatment from a therapist managing their challenges: “She's like, ‘oh, I don't know if I would see a therapist that was struggling like that kind of thing.’” Hearing such a comment may lead to internal questioning of their fitness to support others. (B) Client Feedback Client interactions, especially unexpected or challenging feedback from clients, were described as important contributors to self-doubt and anxiety among the participants. Harper reflected on a moment when a client expressed concern and requested a change in session, “we did the regular like check-in chit chat and then they were like, ‘I do have a concern,’ and immediately my heart dropped.” She shared how this led to feelings of anxiety and self-doubt surrounding the support she has been offering. Sage also reflected on an experience when her client did not show up to their last session together. She described how it led her to wonder about her potential role in the client’s decision not to attend. Amelia also reflected on a moment when she was met with resistance from a client and how she attributed their reaction to a misstep on her part: “I must have done something wrong because the client responded with resistance.” Displaying the responsibility that therapists-in-training may take for the behaviours or actions of their clients. (C) Legal/Ethical Concerns The participants shared their worries about unknowingly violating a legal or ethical guideline and its implications on their client and career progression. Amelia described, “In this line of work, we have legal and ethical obligations we need to consider, and to a degree that puts a sense of pressure that what if I miss it and don't recognize it?” Therapists-in-training are held accountable to both their graduate programs and professional regulatory bodies. They described struggling with the pressure to respond ethically when put on the spot with clients. Sage reported an experience where she was put on the spot by a client and shared the panic that occurred, “and that I'm like, oh, my God, I've never this has never happened to me before, and I'm just gonna kind of wing it.” The fear of a misstep contributed to increasing their self-doubt. Theme 5: Isolation Despite Commonality This theme explores the paradox of self-doubt being commonly experienced yet isolating in nature. Suffering in silence and fear of negative perception is explored in the current theme. The three following sub-themes were created to reflect the experiences of the participants. (1) Suffering in Silence While self-doubt was considered by the participants as a universally experienced phenomenon, it was also described as an isolating experience, and participants questioned whether or not they were the only ones suffering. Amelia described how withholding sharing her self-doubts with others before beginning her internship led her to feel alone, “it's an isolating factor because you then think you're the only one,” creating further opportunity for self-criticism and doubts. Amelia shared some of her thoughts, such as, “Am I the only one?” “Is there something wrong with me?” Fears of judgment were reported to prevent therapists from sharing their experiences of self-doubt. (B) Fear of Being Perceived Unprofessionally Not wanting to be perceived as unprofessional for having doubts contributed to feelings of isolation. Facing judgment, stigma, and shame are some of the unfortunate risks when sharing about self-doubt. Participants expressed that they were uncertain regarding how others would react if they shared their self-doubts and wondered whether they would be met with compassion and validation or be made to feel ashamed and isolated. Gabby shared feeling worried about this and stated, “A big source of self-doubt is just how you think people will perceive you . . . are they gonna think I'm like a bad therapist?” Samira described how she feels the need to filter her experience when sharing in an attempt to avoid negative judgment: “It's almost like impression management. As much as we don't want that to matter, in mental health professional settings, it does still matter.” Especially at this early stage in their career development when they are attempting to establish themselves and a positive reputation. Violet described feeling as though she was walking on eggshells when she spoke about her self-doubt within her program, where the conversations on the topic felt important and yet, at the same time, highly limited and lacked depth. This experience was perceived as contributing to apprehension regarding sharing self-doubts due to a risk to psychological safety. (C) Not Enough Program Support The participants reported a broader lack of support surrounding the initiation of conversations that normalize the experience of self-doubt within their training programs. Many described that the topic was usually brought up by students as opposed to course professors. Gabby shared her belief that she would have benefited from a regular open dialogue about self-doubt initiated by professors and supervisors. Violet noted how the experience of self-doubt was normalized during her training program, although it was not actively discussed. She pointed out that class discussions within her internship/practicum class (completed at the same time as the internship) centred mostly on their work with clients as opposed to their own experiences and challenges. She explained, “It's not like we're invited to share or talk about how it showed up or how it made us feel.” She reported that there were no direct invitations to share, contributing to a sense of isolation. Amelia similarly shared not having had the opportunity to debrief in her internship/practicum class: “We did not have very much opportunity to debrief in a practicum class.” She shared how she would have appreciated having received more curiosity from her professors and the opportunity for open dialogue within her program. Amelia described how receiving questions such as “How are you arriving with the thought of taking your first client?” from course professors would have felt normalizing and supportive. A desire for more structured conversations surrounding self-doubt was reported by participants. Discussion The role of a psychotherapist is multifaceted, requiring self-awareness, integration of personal and professional traits, and the capacity to manage self-doubt (Nissen-Lie et al., 2017; Theriault & Gazzola, 2006, 2010; Theriault et al., 2009). This study aimed to explore sources of self-doubt among therapists-in-training, with the intent of informing supervision and training practices and safeguarding client care. Findings revealed that self-doubt contributed to considerable anxiety and disrupted professional development, with five main themes emerging: challenges related to professional individuation, difficulties in supervision, personal sources, external pressures, and isolation despite shared experience. Fortunately for therapists and clients alike, our knowledge of the individual therapist’s impact on the therapeutic process/outcome has grown (Barkham et al., 2021; Lambert, 1989; Howard et al., 1969; Imel & Wampold, 2015). However, further attention is needed on how self-doubt manifests. Research has shown that even seasoned therapists are not protected from self-doubt (Thériault & Gazzola, 2005, 2006, 2008, 2010). Previous studies have identified the risks of severe self-doubt, including burnout, diminished self-esteem, mental health issues and early career abandonment (Altaf, 2022; Thériault & Gazzola, 2005, 2010). Despite existing research on feelings of incompetence, the therapist-in-training perspective had not received sufficient attention (Daly, 2018; Gazzola & Theriault, 2007; Morrissette, 1996; Nyiri, 2010; Thériault et al., 2009; Thériault & Gazzola, 2005, 2008). This group refers to those who have less than a year’s worth of experience and are currently completing their clinical practicum placements. Counsellor development theories suggest that self-doubt is a normal part of the early stages of therapist development, although it requires cautious management to prevent it from hindering learning and professional growth (Bernard & Goodyear, 2014). Therapists-in-training are undergoing a novel experience while completing their internships. For the first time in their training, they are attempting to integrate the complex approaches they have been taught in class into their work with clients and learning about the intricacies and expectations of the field (Brown, 2023; Morrissette, 1996; Ronnestad & Skovholt, 2003). The demands placed on practitioners in the field are no small feat. They are expected to seamlessly integrate their personal and professional traits/skills, practice self-awareness to avoid negative spillover and stay up to date on training and therapeutic skills (Brown, 2023; Nissen-Lie et al., 2017). Meanwhile, those newer to the profession are also attempting to discover their professional identities and preferred ways of being/approaches to use in session. This experience is only made more challenging by both internal and external pressures they face, heightening their vulnerability to self-doubt. Being tasked with developing their sense of self as therapists was reported as a main theme and source of self-doubt for therapists-in-training. This refers to the process of discovering their professional identities and learning their preferred ways of approaching sessions. When they felt limited to experiment and explore, or when their supervisor operated from an approach that did not resonate, their doubts were amplified. Difficulty in the supervisory relationship was also described as a main source of self-doubt for therapists-in-training and can contribute to issues for student counsellors (Gazzola & Theriault, 2007). The literature suggests that supervision has been consistently viewed as an effective tool for helping interns manage their self-doubt (Nyiri, 2010). It was designed as an opportunity for therapy interns (i.e., students) to discuss a variety of topics to promote their professional development and protect client welfare (Curtis et al., 2016). This was deemed as helpful when the supervisory relationship was viewed as safe and welcoming by the participants. While supervision may help manage self-doubts, there is a risk of worsening symptoms if the supervisory relationship is not deemed supportive. Not all participants reported supportive supervisory relationships and named a lack of emotional safety with their supervisor, highlighting its detrimental impact on their internship experiences. Some participants described having kept their struggles internal and “suffering in silence” out of fear of judgment or being considered inadequate for their roles. Personal anxieties, intensified by a profound sense of responsibility for client welfare, were common. According to Morrissette (1996), the most prevalent concern for student counsellors is the experience of personal anxiety. The current study found the impact of personal doubts to be prominent, as the participants described feeling an immense sense of responsibility for the well-being of their clients and how it led to internal questioning. Previous studies have discussed how personal doubts surrounding competence and skill have contributed to early career abandonment (Altaf, 2022; Thériault & Gazzola, 2005, 2010). While none considered leaving the profession, many questioned their adequacy, echoing earlier findings. They reported asking themselves, “Should I even be a therapist?”. For many of the participants, personal sources of self-doubt were paired with facing the pressures of external expectations. These include societal myths about therapists' roles and mental health, client feedback, and legal responsibilities. They noted how widely held societal beliefs surrounding their role, personal mental health, and ability to “fix” others led to the creation of doubts surrounding their clinical abilities. Societal misconceptions, along with receiving client feedback and the fear of missing an ethical and legal obligation, led to increasing self-doubt for the participants. Participants in our study reported that they frequently felt isolated and uncertain about sharing their self-doubts with supervisors. This is consistent with findings reported in the literature that indicate that therapists-in-training often hesitate to express their self-doubts due to the fear of being perceived as incompetent or unprofessional, particularly by their supervisors (Daly, 2018). For student therapists, discussing these doubts is rarely made comfortable. Unfortunately, many 'suffer in silence,' internalizing their experience, concerned that they are alone in their insecurities or will be judged if they open up (Nissen-Lie et al., 2017; Thériault et al., 2009, p. 116). The current study’s findings similarly found that the participants often hesitated to share their doubts out of fear of being perceived as unprofessional. They often chose to keep their doubts internal, asking themselves, “Am I the only one?” “Is there something wrong with me?” When training programs failed to acknowledge self-doubt, students were more likely to internalize their distress. Many noted how their programs did not often initiate conversations about self-doubt, causing them to further believe that they were alone in their struggles. The current study highlights the impact of self-doubt on therapists-in-training. Self-doubt was reported to trigger anxiety, rumination, and disconnection. Through identifying sources of self-doubt for therapists-in-training early on, therapists-in-training are better equipped to cope when/if their symptoms recur. This supports trainee development and prioritizes effective client care by aiming to limit the impacts of self-doubt on their clinical work. Based on the findings, the study provides recommendations for training programs, supervisors, and therapists-in-training. De-Limitations and Limitations The current study’s transferability of findings is de-limited by our targeted population of practicum students in counselling and psychotherapy in the province of Ontario in Canada. While we hoped to get a wide range of participants from different university programs in the province, the final sample included participants from only two masters-level counselling programs, both in the same city. This could be due to the advertising for the study by the National Capital Region Chapter of the Canadian Counselling and Psychotherapy Association via its Facebook page. Trainee self-doubt may be experienced differently in different geographic or individual program contexts, which have their own respective professional cultures and pressures. In Canada, mental health is regulated at the provincial level (Gazzola & Gignac, 2025). Canada is a large country that includes 10 provinces and three territories. Our sample of therapists-in-training does not capture students studying in all provinces and thus any transferability of findings must be mindful of the limited diversity of our sample relative to Canada’s multicultural and linguistically plural population (Gazzola, 2016). While the researchers made an effort to ensure the participants selected represent a diverse group of individuals, not all genders were represented in the current study. This was due to the lack of representation in those who expressed interest in participating in the study. The study consisted of 7 women-identifying individuals and one gender-fluid person. However, the profession has been reported to be primarily occupied by women in Ontario. According to the College of Registered Psychotherapists of Ontario (CRPO), there are four times as many women-identifying registrants than there are male-identifying, and less than one percent have gender identities other than male or female (CRPO, n.d.) Naturally, this may result in the study receiving more interest from women-identifying individuals than from other genders. The participant sample also comprised White-identifying individuals, displaying an underrepresentation of diverse ethnic backgrounds, which is also a representative of the lack of diversity in the mental health field (Beaton et al., 2009; Bedi et al., 2020; Lee, 2010). This may lead to a limitation in the study’s transferability and provide less data that can reflect the sociocultural aspects of self-doubt. Implications and Contributions While self-doubt originated from personal, external and professional identity-related sources, a common thread was the sense of isolation in their experience of self-doubt. Suffering in silence resulted from a fear of being perceived as unprofessional and was worsened by a lack of support in the experience of self-doubt. These findings offer recommendations for counsellor education programs, clinical supervisors, therapists-in-training, and future research. Implications for Counsellor Education Programs The participants emphasized that responsibility for initiating dialogue surrounding self-doubt should rest with those in authority (program professors, supervisors, etc.). Being under evaluation was described as a barrier to disclose self-doubt, unless prompted. This further emphasizes the need for counsellor training programs to create safe, open, and intentional conversations surrounding the experience of self-doubt. Participant Amelia shared how she would have appreciated being asked questions such as “How are you arriving at the thought of seeing a client?” by her professors before beginning her internship. Through course professors’ initiation conversations, ideally at various points in their training, the experience of self-doubt is normalized as being an expected part of the professional development process. Professors who shared personal experiences helped demystify the process and reduce stigma. Participants suggested the implementation of peer support systems or dedicated courses that normalize self-doubt in training programs. For example, a mentorship system that groups first- and second-year students to facilitate conversations on the topic, or the creation of a course specifically designed to address the challenges that arise at their stage of professional development (e.g., discussing their evolving professional identities, overwhelm when integrating approaches, etc.). Emphasis was placed on such a course being held in a welcoming environment and in a small group format. Implications for Supervisors Supervisors also play a critical role in fostering emotional safety. Supportive, nonjudgmental supervision encouraged disclosure, while its absence worsened doubt and risked client impact. Experiencing a lack of safety in the supervisory dynamic emerged as a source of self-doubt for the participants. This refers to supervisees/trainees not feeling safe or welcome to disclose their self-doubts with their supervisor for a variety of reasons related to fear of negative judgment. Emphasis is thus placed on the supervisor’s responsibility to create a warm environment for trainees to encourage the sharing of their experiences. Self-disclosure of self-doubt by supervisors also contributed to normalizing the experience, reducing the risk of isolation in their doubts. Implications for Therapists-in-Training For therapists-in-training, connection with peers and safe individuals helped reduce self-doubt. These were often described as peers, those who could relate to the experiences. Opening up to individuals deemed as ‘safe’ also reduced the risk of comparison, further isolation, and shame. Recognizing that discomfort is normal, especially when applying new skills, and cultivating self-compassion were also emphasized. Practicing self-compassion is highly encouraged for those experiencing high internal and external expectations. Implications for Future Research While previous studies have explored how self-doubt presents itself for experienced therapists, this study contributes to understanding how self-doubt manifests in early clinical training. The current study displayed how severe self-doubt caused by both external and internal sources can lead to high self-questioning, seen through anxiety and rumination. 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Family Relations , 29 (1), 133. https://doi.org/10.2307/583738 Tables Table 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1and2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6830639","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":467358760,"identity":"5dcee384-4df8-48ff-8a62-0d10492bc7f4","order_by":0,"name":"Tessa Natale","email":"","orcid":"","institution":"University of British Columbia","correspondingAuthor":false,"prefix":"","firstName":"Tessa","middleName":"","lastName":"Natale","suffix":""},{"id":467358761,"identity":"15006a3b-4529-40c1-88fd-c2ce9cfa6773","order_by":1,"name":"Nicola Gazzola","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYNCCAgY5UrUYMBgzMDAzNpCkJbGBaC3y7scff/hgYJe+4Xj/8Qc/2+wY+NsP4NdieCYhwXCGQXLuhjOHGRt725IZJM4kENDSkHAgmceAOXfDjWTGBt5tzEBHEtLS/7DhMI9BfboBUEvj3231DAb8Dwj4RSKZsZnH4HACSEsz77bDDAYSBGwxkHjGzDjD4LjhzDOHDWfL/jvOI3GDkC396cAQq6iW5zve+ODjmzPVcvz9hGw5gCbAg189yJYGgkpGwSgYBaNgxAMAbClEsJGz7usAAAAASUVORK5CYII=","orcid":"","institution":"University of Ottawa","correspondingAuthor":true,"prefix":"","firstName":"Nicola","middleName":"","lastName":"Gazzola","suffix":""}],"badges":[],"createdAt":"2025-06-05 15:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6830639/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6830639/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84354923,"identity":"c44b8476-18fe-4bc6-9f91-b44411b0edea","added_by":"auto","created_at":"2025-06-11 02:31:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":945524,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6830639/v1/7b265c62-4ca7-4080-a0c5-0e020e1054cf.pdf"},{"id":84276299,"identity":"63ff0ca4-1207-4302-bf83-9d325eaaf309","added_by":"auto","created_at":"2025-06-10 05:40:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22179,"visible":true,"origin":"","legend":"","description":"","filename":"Table1and2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6830639/v1/f1123a261adc07e54cd59633.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"“Should I even be a therapist?” A Qualitative Exploration of the Sources of Self-Doubt Experienced by Therapists-in-Training","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe role of a psychotherapist is nearly impossible to master. Therapists are tasked with understanding their clients\u0026rsquo; experiences while recognizing they will likely never fully do so (Brown, 2023). They are taught to become comfortable with questioning, both internally and externally, and to embrace \u0026ldquo;not knowing\u0026rdquo; (Brown, 2023, p. 1). Needing to gain comfort with the unknown contributes to the complexity of psychotherapy. It is a profession that places unique demands on its practitioners, including the necessity for acute self-awareness to practice ethically and effectively.\u003c/p\u003e\n\u003cp\u003ePsychotherapy graduate programs emphasize inner reflection, heightening both positive and negative internal processes. This heightened awareness may lead to rumination and self-doubt, as therapists question their professional abilities. Self-doubt has been linked to poor well-being, often through repetitive, self-critical thinking and perfectionism (James et al., 2015). Though self-doubt is normative and even considered growth-promoting (Nissen-Lie et al., 2017), it also poses risks to the therapeutic process and may potentially become detrimental to therapists\u0026apos; mental well-being (Th\u0026eacute;riault \u0026amp; Gazzola, 2005, 2010). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherapists experiencing self-doubt may be at higher risk for burnout, low self-esteem, and early career abandonment (Altaf, 2022; Th\u0026eacute;riault \u0026amp; Gazzola, 2005, 2010). Psychotherapists are ethically required to engage in continual inner reflection, specifically monitoring when their personal lives and/or insecurities begin to interfere with their professional work. When difficulties arise, they must seek supervision or support to prevent potential harm (CCPA, 2021). Therapist well-being has been identified as key to therapeutic outcomes (Nissen-Lie et al., 2017). Practitioners must exercise self-monitoring before, during, and after sessions to mitigate signs of potential burnout and to protect themselves and their clients (CCPA, 2021). \u0026nbsp;The profession also requires therapists to integrate their personal traits with professional competencies seamlessly (Nissen-Lie et al., 2017). They are expected to be authentic and responsive while applying their clinical knowledge and resisting countertransference. High expectations for self-awareness and skill application, along with ongoing professional development, can amplify self-doubt, especially among student therapists completing practicum placements.\u003c/p\u003e\n\u003cp id=\"_Toc185248904\"\u003e\u003cstrong\u003eThe Individual Therapists\u0026rsquo; Impact on\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe\u0026nbsp;Therapeutic Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTherapist factors, referring to the traits, behaviours, and beliefs of the individual, can influence client outcomes. Research shows that therapists themselves account for about 9% of outcome variance, a greater contribution than the treatment modality (Imel \u0026amp; Wampold, 2015; Barkham et al., 2021). Howard et al. (1969) were among the first to recognize that the person of the therapist, not just treatment protocols, plays a role in client outcomes, identifying self-doubt and self-recrimination as common struggles. Lambert (1989) later emphasized that therapists\u0026rsquo; personal difficulties could negatively affect clients.\u003c/p\u003e\n\u003cp\u003eVariance in client outcomes is influenced by several factors, including by technique used, client expectation for positive change, the therapeutic alliance, as well as by therapeutic variables that are independent of the therapy (such as client strengths and supports) (Duncan et al., 2010; Lambert, 1986). Thus, a high percentage of outcome variance can be attributed to factors not related to the therapeutic modality or psychotherapeutic techniques employed, suggesting that the person of the therapist is an important consideration in therapy outcomes. Skovholt (2012) and Brown (2023) suggest that some aspects of therapeutic change are mysterious and unmeasurable, such as the timing of sessions or the therapist-client connection. Newcomers to the field may feel destabilized by uncertainty, leading them to experience self-doubt in an effort to make sense of outcomes. Even experienced therapists continue to question their effectiveness (Kottler, 2022).\u003c/p\u003e\n\u003cp id=\"_Toc185248905\"\u003e\u003cstrong\u003eTherapist Self-Doubt\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSelf-doubt or feelings of incompetence (FOI), refer to the internal challenges to therapists\u0026rsquo; belief in their abilities (Th\u0026eacute;riault \u0026amp; Gazzola, 2005). One study showed that even experienced therapists (10+ years) experience FOI, ranging from mild doubts to severe questions about their career suitability. In a grounded theory study of experienced therapists, findings showed that self-doubt intensified when psychotherapists\u0026rsquo; personal struggles interfered with their clinical work (Th\u0026eacute;riault \u0026amp; Gazzola, 2005). In a follow-up study, experienced therapists described levels of FOI ranging from \u0026ldquo;Am I saying this right?\u0026rdquo; to \u0026ldquo;What if something fundamental is missing in my personality?\u0026rdquo; (Th\u0026eacute;riault \u0026amp; Gazzola, 2010, p. 238). Coping strategies such as supervision and self-awareness helped them manage distressing experiences.\u003c/p\u003e\n\u003cp\u003eAnother study examined novice therapists (1\u0026ndash;5 years of experience) and found both positive and negative impacts of FOI (Th\u0026eacute;riault et al., 2009). Self-doubt prompted some to engage more deliberately with their work and seek out supervision and training. Others, however, reported being debilitated in sessions and ruminating afterward. Many feared being discovered as impostors. Coping strategies included adhering to theory, practicing self-care, and trusting in their professional development. Thus, three trends were emerging regarding feelings of incompetence: they seem to be present in varying degrees regardless of clinician experience levels, clinicians employ a variety of corrective measures to cope, and some FOI can be motivating to clinicians (Theriault \u0026amp; Gazzola, 2010).\u003c/p\u003e\n\u003cp id=\"_Toc185248906\"\u003e\u003cstrong\u003eTherapists-in-Training\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and Self-Doubt\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough there have been several qualitative studies on clinician FOI, little work has focused specifically on therapists-in-training, who engage in psychotherapy for the first time during their practicum. The current study aims to address this gap and explore how trainees experience and manage their self-doubts.\u003c/p\u003e\n\u003cp\u003eIn Canada, counselling psychology programs are competitive, and the pressure to succeed may create a highly emotional training environment (Morrissette, 1996). In Ontario, trainees must complete supervised practica (CCPA, 2021; CRPO, 2019), and supervision is a critical tool for both clinical development and managing self-doubt (Nyiri, 2010). Supervisors, typically experienced psychotherapists, support interns through individual and group formats. When supervision is validating and supportive, interns benefit greatly. However, supervisory conflicts and power struggles may exacerbate FOI and create distress in the intern (Morrissette, 1996; Gazzola \u0026amp; Th\u0026eacute;riault, 2007).\u003c/p\u003e\n\u003cp\u003eTherapists-in-training are often evaluated by their supervisors, which can intensify fear around disclosing self-doubt (Daly, 2018). Many trainees suffer in silence, fearing their doubts signal incompetence (Th\u0026eacute;riault et al., 2009; Nissen-Lie et al., 2017). It\u0026rsquo;s essential to distinguish between self-perceived and actual incompetence; one reflects internal self-criticism, the other a real skill gap (Th\u0026eacute;riault \u0026amp; Gazzola, 2005, 2006).\u003c/p\u003e\n\u003cp\u003eConstructive supervision enhances the therapist\u0026rsquo; skills, protect clients, and helps to increase therapist self-efficacy (Gazzola \u0026amp; Theriault, 2007). Bandura (1977) described self-efficacy as a belief in one\u0026rsquo;s ability to perform a task. In counselling, this refers to confidence in clinical skills and client work (Larson \u0026amp; Daniels, 1998). Supervisory feedback and praise can support self-efficacy development (Bernard \u0026amp; Goodyear, 2014). However, anxiety and self-doubt can undermine it (Larson, 1998; Tsai, 2015). Tsai (2015) distinguishes personal anxiety (e.g., fear of being unskilled or judged) from professional anxiety (e.g., concerns about rapport or clinical skill). Self-doubt may compromise both forms of confidence and interfere with clinical development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCounsellor Development\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCounsellor development theories highlight how self-doubt is a normative, yet challenging, part of early professional growth (Bernard \u0026amp; Goodyear, 2014). Benefits to self-doubt include supporting critical reflection and boundary setting (Altaf, 2022), although it may also lead to unrealistic expectations around change-making, contributing to burnout (Finan et al., 2022). If overwhelmed, therapists may question their fitness for the role.\u003c/p\u003e\n\u003cp\u003eDevelopment theories (e.g., R\u0026oslash;nnestad \u0026amp; Skovholt, 2003) identify six stages of counsellor growth, from student to experienced clinician. The second and third stages, described as the beginning and advanced student phases, are especially relevant to the current study. During these stages, trainees develop clinical skills, navigate new identities, and form professional relationships. These transitions may feel destabilizing. Anxiety could impair focus in session, and criticism can threaten fragile emerging identities. As graduation nears, expectations rise and conflicts with supervisors may increase (Gazzola \u0026amp; Th\u0026eacute;riault, 2007). Self-evaluation may spiral into self-doubt.\u003c/p\u003e\n\u003cp\u003eWithout guidance or a structured framework, student therapists may feel lost. Perfectionism, program pressures, and personal anxiety can impact performance and client care (Morrissette, 1996). To protect clients and support student development, further research is needed to explore the experience of self-doubt. This study was guided by the research question: What are the sources of self-doubt in therapists-in-training?\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc185245160\"\u003e\u003cstrong\u003e\u003cem\u003eCriteria for Involvement in the Study and Sampling\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCriterion-based sampling was used to select participants who would best be suited to inform this study. To be considered for the study, the participants had to meet the following inclusion criteria: 1) speak fluently in English, 2) are currently enrolled in a counselling/psychotherapy Master\u0026rsquo;s-level program in Ontario, Canada, 3) are completing their practicum where they are meeting with clients for the first time in their careers, and 4) are willing to discuss their self-doubt. Emphasis was largely placed on recruiting participants who disclose having experienced self-doubt and are willing to share about their experiences.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185245161\"\u003e\u003cstrong\u003e\u003cem\u003eParticipant Demographic Data\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants (n=8) included seven individuals who identified as women and one participant who identified as gender-fluid. Ages ranged from 23 to 35 years (M =29.35). Four of the participants were in the 20\u0026ndash;29 age range, and the remaining four were in the 30-39 age range. The participants held varying undergraduate degrees, primarily in social science-related fields. Participants reported to be operating from eclectic/ integrative theoretical approaches as they discovered their professional identities. See Table 1 for participant demographic data.\u003c/p\u003e\n\u003cp\u003e[Insert Table 1 about here]\u003c/p\u003e\n\u003cp id=\"_Toc185248910\"\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc185245163\"\u003e\u003cstrong\u003e\u003cem\u003eData Collection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnce the study, along with its recruitment materials, received approval from the Research and Ethics Board (REB), a recruitment poster was distributed by the Canadian Counselling and Psychotherapy Association (CCPA), National Capital Region (NCR) Facebook page. Those who expressed interest in participating contacted the primary researcher via email correspondence to ensure confidentiality. They were then provided with the recruitment text with further details on the study and were asked to confirm that they met the eligibility criteria. Once confirmed, they were sent a formal invitation to participate. Along with the formal invitation, the participants were sent a consent form, which they were asked to electronically read and sign. Once completed, they returned it to the researcher via email. All those who expressed interest to participate met the inclusion criteria and were sent formal invitations. Pseudonyms were assigned to participants to protect their confidentiality.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185245164\"\u003e\u003cstrong\u003e\u003cem\u003eInterviews\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA semi-structured interview protocol was created and piloted with the researcher\u0026rsquo;s research team. The protocol was intended to invite naturally flowing conversations that explore participants\u0026rsquo; experiences of self-doubt in a non-judgmental and safe space. Informed consent was obtained from all individuals who participated in this study. The participants were offered the choice to meet in person for their interviews at a secure location or to meet virtually. All 8 participants chose to meet virtually for their interview with the first author, using the video conferencing platform Microsoft Teams. The interviews ranged from 60-75 minutes in duration. The variation in length was dependent upon the detail provided in the participant\u0026rsquo;s responses. The interviews were conducted using a semi-structured interview protocol containing open-ended pre-determined questions, leaving an opportunity for pertinent prompting and improvised questions. The interview questions were piloted with the second author as well as with other research colleagues and research team members before their use with participants to aid in increasing their clarity and ability to investigate the topic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBefore beginning the interview, the interviewer checked in with the participants to ensure they had understood, read and signed the consent form and were clear on the goals of the study, including their rights within it. The interviewer offered the participants the opportunity to ask any questions they might have, prioritizing their comfort. Once any questions were answered, the researcher asked for the participant\u0026rsquo;s verbal consent to proceed with the interview. The interviewer then collected their demographic information (e.g., gender, location, theoretical orientation, etc.). The interview protocol explored their sources of self-doubt. The researcher asked the participants questions such as \u0026ldquo;Are you able to name any specific pressures that may have contributed to your self-doubt?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eOnce the interviews concluded, the participants were provided with a debriefing form thanking them for their participation in the study, as well as information on individualized available resources should they require additional support after the interview due to psychological discomfort recalling their self-doubt.\u003c/p\u003e\n\u003cp\u003eEach interview was audio recorded using the iPhone audio-recording function and was automatically transcribed using Microsoft Teams. All original data was virtually stored in a password-encrypted Word document, saved on an external hard drive, as well as a backup USB key owned by the first author, which were both kept in a secure location in the researcher\u0026rsquo;s home office. The data files, including the audio recordings and their transcriptions from each interview, were also stored on this external hard drive and USB key when not in use.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185245165\"\u003e\u003cstrong\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnce data was collected from the participant interviews, it was analyzed and sorted using the Braun and Clarke (2012, 2014) six-step thematic analysis. This method of analyzing data allowed the researcher to systematically pull out both themes and sub-themes (i.e., shared perspectives and experiences) from participant responses in their interviews. The researcher is then tasked with organizing the themes and offering insights into their meanings. The six-step process emphasizes identifying and understanding both shared and unique experiences among participants.\u0026nbsp;The results contributed to the creation of a conceptual structure detailing the experience of self-doubt by therapists-in-training to help better understand how self-doubt is experienced and navigated by participants.\u003c/p\u003e\n\u003cp\u003eIn the first phase of the six-step process, the first author immersed herself in the data by listening and re-listening to the audio-recorded interviews. This involves taking down notes of initial thoughts and reading/re-reading interview transcripts until they are familiar with the data. This is done from a critical and analytic point of view, aiming to find information that is pertinent to the research questions (Braun et al., 2019; Braun \u0026amp; Clarke, 2006, 2012). In the second phase of the data analysis, the researcher began generating initial codes from participant responses in the interview. This serves as a preliminary way of organizing and summarizing the main ideas semantically (i.e., staying close to the participant\u0026rsquo;s meaning) to work towards identifying data that helps answer the research questions. The codes created by the primary researcher were shared via email correspondence with the second author for feedback. The following data analysis step followed by the primary researcher, was to turn codes into initial themes. Themes refer to patterned responses expressed by participants to display similarities in their experiences or ways of thinking (Braun \u0026amp; Clarke, 2012). This requires the researcher to actively construct themes by revisiting the previously created codes to group them, if appropriate, into a bigger theme. Once completed, the next step taken was to revisit the previously created themes, similarly to \u0026ldquo;quality checking\u0026rdquo; (Braun \u0026amp; Clarke, 2012, p. 65). This involves comparing generated themes against the data set. This may entail discarding some codes or reworking themes with the goal of better capturing the data. These preliminary themes were again shared with the second author for auditing. Feedback provided was used to refine and narrow the themes. In the following phase, the themes were reviewed once again, labelled and defined to ensure clarity. This resulted in the creation of sub-themes if an idea or experience is described differently by participants to reflect their unique experiences. By the final stage, the data had been reviewed many times by both authors, had been organized and labelled, and had been separated into specific themes and sub-themes. The researchers then share the findings in the form of a thematic structure, presenting the themes in an ordered, logical and meaningful way that helps build a picture of the data and helps to answer the study\u0026rsquo;s research questions. The thematic structure includes the researchers\u0026rsquo; analysis and interpretation of the results, backed up by evidence, to provide more substance and life to the themes. The final set of themes and sub-themes were reviewed by the second author.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248911\"\u003e\u003cem\u003eResearcher as Instrument\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIt is important to acknowledge the first author\u0026rsquo;s educational position and experience with self-doubt during the study\u0026rsquo;s completion. When the interviews took place, the first author was completing her second year of a master\u0026rsquo;s degree in counselling psychology. At this stage in her learning, she was in her practicum placement, performing the controlled act of psychotherapy for the first time. With this new learning experience, many emotions occur, some of which are self-doubt. Therefore, first author has a personal relationship with the topic of self-doubt in this context. The goal is that this understanding provides participants with a safe space to reflect on their experiences while speaking to someone who can relate to feeling self-doubt at this stage in their professional development. Keeping this in mind, the researcher intentionally attempted to separate her own emotions and experiences from those of the participants during the interviews. The researcher was cognisant that not doing so may impact the participant\u0026rsquo;s ability to provide true responses to the questions. The researcher put effort into remaining neutral when conducting the interviews, not allowing their ideas and experiences to cloud their interpretation of the participant\u0026rsquo;s responses. To encourage transparency, the researcher self-disclosed to the participants that she is also in the same stage of professional development as they are.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248912\"\u003e\u003cem\u003eEnsuring Trustworthiness and Insight\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAn important element of qualitative research is ensuring both the credibility and reliability of research findings (Ahmed, 2024). Trustworthiness is earned through a clear demonstration of credibility, transferability, dependability, and confirmability (Lincoln and Guba, 1985; Nowell et al., 2017; Stahl \u0026amp; King, 2020). The current study utilized peer debriefing to ensure credibility, thick and detailed descriptions to support transferability, documentation of each step of the process to ensure dependability, and clear demonstrations of interpretations to allow confirmability. An audit trail and the retention of all transcripts were kept by the researchers. The central aspect of ensuring trustworthiness was the auditing process. The second author audited all open codes, themes, sub-themes, and subsequently the conceptual structure of the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data were audited by the second author, an experienced university professor specializing in counselling and psychotherapy. The second author has extensive experience as a psychotherapist (approximately 30 years of experience) and as a supervisor (approximately 20 years of experience). He provides supervision to practicing psychotherapists in private practice as well as to psychotherapist trainees in a master\u0026rsquo;s program in counselling psychology that leads to licensing as a registered psychotherapist in the province and country where the study was conducted. The current study was inspired by the second author\u0026rsquo;s collaboration on an ongoing research agenda that focused on therapist experiences in the psychotherapy process, including self-perceived inadequacies and self-doubt.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eA total of 5 main themes and 16 sub-themes describing the sources of self-doubt for therapists-in-training emerged from the thematic analysis. The five major themes, along with their subthemes, are described in Table 2. Each sub-theme is accompanied by participant verbatims to give voice to their insightful experiences.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Table 2 about here]\u003c/p\u003e\n\u003cp id=\"_Toc185248914\"\u003e\u003cstrong\u003eTheme 1: Professional Individuation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme aims to capture the self-doubt that participants associated with developing their professional identities as clinicians while completing their internships. It speaks to the challenges they faced when feeling limited in their experimentation with different approaches and how internal tensions developed when their clinical judgment differed from their supervisors. It encompasses the following three subthemes:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(A) Discovering a Professional Identity\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInherent in being new to the profession of psychotherapy is being given the exciting yet daunting task of discovering who you are as a therapist/clinician. While studying to be therapists, they are exposed to various therapeutic theories and approaches. However, their internships are commonly their first opportunity to begin putting them into practice. Therapists-in-training are quickly swayed from the role of student to practitioner, attempting to integrate what they have learned and begin to identify which therapeutic approaches resonate most for them. In participant Gabby\u0026rsquo;s words, \u0026ldquo;It\u0026rsquo;s [about] trying to figure out what type of therapist you wanna show up as.\u0026rdquo; The challenge of determining what feels most authentic to the therapists-in-training, compared to their supervisor\u0026rsquo;s approach and/or training, was identified as a source of self-doubt. Harper described how her self-doubt was most prevalent when she questioned herself in session, \u0026ldquo;the self-doubt comes up the most is when I am wondering who I should be in the room as the therapist.\u0026rdquo; While excitement can be found in therapist self-discovery, stress and anxiety were reported when therapists-in-training felt overwhelmed by the task at hand. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(B) Limited Experimentation and Control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExperimentation with different approaches in sessions is a key factor in the development of a professional identity for therapists-in-training. However, feeling limited by the real-world implications and risks of doing so was reported to be a source of self-doubt for participants. Arya reported prioritizing intent and consideration in session, \u0026ldquo;I just feel like there\u0026apos;s so much that I can\u0026apos;t try because it\u0026apos;s real life.\u0026rdquo; She continued to describe her concerns that her professional identity negatively impacts her clients, \u0026ldquo;my professional identity is a big question, and I sometimes worry it influences the process with the client.\u0026rdquo; Experimentation was also described as limited by the pressure they experienced to be \u0026ldquo;blank slate therapists\u0026rdquo; in session. Being a blank slate therapist refers to the omission of self-disclosure and a softening of personality traits in session. Harper described, \u0026ldquo;A lot of us actually feel like we kind of all were taught the same thing to start with, we were all like squished to being this blank template of a human.\u0026rdquo; The process of moving beyond this template towards professional self-discovery led to self-doubt as they worried about the impacts of doing so. They shared feeling as though they needed to exercise high amounts of control, limiting their experimentation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(C) Professional Development Tension\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDifferences in perspective or approach between the therapist-in-training (i.e., supervisee) and their supervisor were described to lead to internal questioning and self-doubt. This occurred when the therapist-in-training began to develop their clinical judgement, gaining the realization that there are multiple pathways to approach the profession. Differences in perspective between the supervisor and supervisee may lead to internal questioning of their newly developed identity. Kai (they/them) described feeling proud of an intervention with a client until their supervisor disagreed with it:\u003c/p\u003e\n\u003cp\u003eI was really proud of that moment, because it was one of those moments where I identified a need that they had, and then you know, kind of went with my gut of what to do. And then I told my supervisor about it, and he basically completely disagreed with what I did.\u003c/p\u003e\n\u003cp\u003eFeeling proud of a moment with a client and disagreeing with the feedback received led to internal tension for the therapist-in-training. Kai shared how developing their clinical judgement was paired with self-doubt: \u0026ldquo;it\u0026apos;s a combination of my self-doubt and also my belief in myself coming [together] at the same time.\u0026rdquo; Harper described how she is developing the ability to trust her voice in session while also valuing her supervisor\u0026rsquo;s opinion, sharing: \u0026ldquo;There\u0026apos;s value in what I\u0026apos;m learning from my supervisor, but I also have to go with my gut because I\u0026apos;m the one that\u0026apos;s in the room with my client.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248915\"\u003e\u003cstrong\u003eTheme 2: Difficulty in the Supervisory Relationship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme addresses how difficulties in the supervisory relationship contribute to developing self-doubt. Not receiving enough guidance and structure from their supervisor, observing differences in perspectives/approaches, and a perceived lack of emotional safety were noted by the participants. The three following sub-themes emerged from the data:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(A) Lack of Structure and Guidance\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot receiving enough structure and feedback from clinical supervisors was reported to heighten self-doubt. The participants shared their need for guidance and reassurance to build confidence in their skills and clinical decisions. Without feedback from their supervisors, participants were left doubting their abilities. Samira recalled asking herself, \u0026ldquo;What if I\u0026apos;m not doing this right?\u0026rdquo; while experiencing a lack of oversight while completing her internship. A desire for feedback was also reported, as a lack of feedback contributed to participants feeling unsure about their progress and worried about making mistakes. Samira felt that her supervisor\u0026rsquo;s hands-off approach contributed to her doubt. She stated, \u0026ldquo;I don\u0026apos;t really have anyone watching me,\u0026rdquo; leading her to question her work with her clients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(B) Differences in Perspectives/Approach\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOperating from a different theoretical orientation as their supervisor was a source of self-doubt for many participants. When the participants\u0026rsquo; theoretical perspectives differed from their supervisors\u0026rsquo; theoretical orientation, participants tended to question their methods, especially when a disagreement occurred within the supervisory relationship. For example, they do not see eye-to-eye regarding the case conceptualization or treatment plan. Self-doubt was exacerbated when the therapist began to compare their limited experience to their supervisors. Kai shared, \u0026ldquo;When I disagree [with my supervisor], my self-doubt goes up because I\u0026apos;m, like, do I disagree because I have something to stand on? Like they have so much more experience?\u0026rdquo; In these situations, they wonder whether they have done something wrong or whether it is simply operating from a different perspective.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(C) Fear of Judgment and Emotional Safety\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA perceived lack of emotional safety in the supervisory relationship contributed to therapists-in-training withholding from sharing their self-doubts with their supervisor out of fear of judgment and/or negative perception. The evaluative component of supervision was viewed as an obstacle to expressing self-doubt, Kai shared, \u0026ldquo;There\u0026apos;s an evaluative component to the relationship. You are judging me, and you are the reason that I pass or not . . . I don\u0026apos;t want my self-doubt to make you doubt me.\u0026rdquo; Violet described how she was disappointed by her supervisory experience, noting how her self-doubt was highest after supervision sessions due to not feeling validated or supported. She shared:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor me, the worst is definitely after my supervision [sessions]. Where it\u0026apos;s almost like I\u0026apos;m entering the supervision with the hope that I\u0026apos;m going to [feel] validated and that we can take care of my doubts and the pressure that I put on myself, but it\u0026apos;s sort of like brushed off almost, and so afterwards the feelings of discomfort are pretty intense.\u003c/p\u003e\n\u003cp\u003eA safe supervisory environment fosters emotional vulnerability for therapists-in-training. Without it, they are missing out on an opportunity to process their experience and the challenges that occur. When supervisors shared their own experiences and doubts, interns expressed feeling less comparison and were more reassured in their experiences. Samira shared: \u0026ldquo;My supervisor has shared a moment that was really, really, difficult for her - and [hearing] it did help me feel more comfortable with myself and my own learning, but also to feel more comfortable with just like sharing more generally.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248916\"\u003e\u003cstrong\u003eTheme 3: Personal Sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current theme describes the weight that personal expectations and struggles contribute to the experience of self-doubt. When the participants were asked to reflect on whether they felt as though their self-doubts originated from more internal or external sources, the majority agreed that they stemmed from an internal place. For example, Samira shared, \u0026ldquo;I honestly can attribute most of it to like my own, like, personal stuff.\u0026rdquo; Personal sources refer to doubts surrounding competence and preparedness, mental health capacity, struggles with perfectionism and comparison to peers. The four following sub-themes were created to reflect the experiences of the participants:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(A) Doubting Competence/Preparedness/Training\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDoubting competence, preparedness, and training were often reported as a source of self-doubt, emphasizing the high expectations participants set for themselves. Sage described doubting her skills learned before beginning her internship, \u0026ldquo;I had a sense of, \u0026lsquo;I really don\u0026apos;t know what I\u0026apos;m doing\u0026rsquo; besides kind of those basic skills.\u0026rdquo; Violet shared how her doubts nearly motivated her to pass off her client to another, more experienced therapist, describing: \u0026ldquo;If they were with somebody more experienced, maybe they could help them more effectively than I can.\u0026rdquo; Not feeling prepared to begin seeing clients was reported by all of the participants, as they did not feel confident in their abilities at the onset.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(B) Doubting Personal Mental Capacity\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDoubting their mental health capacity was raised as a source of doubt by the participants. They reported feeling anxious before and throughout their internships when worrying about their capacity to hold space for others, concerned about how their personal issues may impact them, and feeling a responsibility to look internally. Amelia shared a doubt early in her internship, \u0026ldquo;it\u0026apos;s doubting that I even can just go and sit with a client.\u0026rdquo; She shared about the fears that surfaced for her when required to show up authentically in session, noting how requesting vulnerability from her clients meant she needed to reciprocate. She described, \u0026ldquo;So, the fear was of vulnerability, of opening myself up to be curious, to lean in, to be open to that other person\u0026apos;s vulnerability.\u0026rdquo; Her gruelling process of leaning into her discomfort and expressing vulnerability led her to consider whether she was cut out for the role, wondering to herself, \u0026ldquo;Maybe I\u0026apos;m not cut out for this.\u0026rdquo; With the help of her supervisor, Amelia shared having gained more comfort in showing up authentically with her clients. This highlights the toll that also \u0026ldquo;doing the work\u0026rdquo; has on therapists-in-training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(C) Sense of Responsibility to Help Clients\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA common thread between participants was their sense of responsibility to support and help their clients. A desire that is often deep routed in their personal experiences. Gabby expressed, \u0026ldquo;I figure, especially like this profession, most people go in [to it] because they\u0026apos;ve had life experiences, not just because they\u0026apos;re interested [in psychotherapy]. A lot of people go into this wanting to help others.\u0026rdquo; The pressure they place on themselves to have a positive impact on their clients leads to self-doubt. Harper expressed the pressure she felt to \u0026ldquo;fix\u0026rdquo; others: \u0026ldquo;If someone is showing up, if they\u0026apos;re sitting in front of me, then there\u0026apos;s something that they really, really need, I \u003cu\u003eneed\u003c/u\u003e to be the one to change that or fix that for them.\u0026rdquo; While this genuine desire to help is rooted in an altruistic place, it led to self-doubt for the participants.\u003c/p\u003e\n\u003cp\u003eA few participants shared how their role as a therapist is tied to being a caretaker in their personal lives. Noting how their identities as caretakers are put into question if they do not perceive their clients to be benefitted from their sessions. Sage shared: \u0026ldquo;It\u0026apos;s almost as if my self-worth is attached to that role and if I\u0026apos;m not potentially fulfilling that role, then some kind \u0026lsquo;of uh\u0026rsquo; definitely strikes, that kind of self-doubt in that worry.\u0026rdquo; This worsened if the therapist-in-training struggled with perfectionistic tendencies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHarper noted how her perfectionistic habits, paired with her cultural/religious background, led her to experience excess pressure to help and support others in need. She described the stigma which individuals in her culture face when seeking mental health support and how this placed extra responsibility on her to make it worth their while. \u0026nbsp;She shared: \u0026ldquo;If someone\u0026apos;s showing up to therapy, it\u0026apos;s because they need help. So I feel like I have to be the helper.\u0026rdquo; She continued, \u0026ldquo;So it\u0026apos;s me being a perfectionist, it\u0026apos;s me coming from a culture where if you\u0026apos;re gonna go to therapy, you\u0026apos;re gonna get help from it.\u0026rdquo; Placing pressure to be the agent of change was reported as a source of self-doubt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(D) Comparison to Peers\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInterestingly, peer support was described as adaptive by participants unless it developed into a negative comparison. This occurred when they compared their progress, knowledge and confidence to their peers in supervision or seminar courses. Sage shared, \u0026ldquo;I kind of think to myself, wow, like, they seem so confident, [when speaking about their experience] then thinking like \u0026lsquo;I\u0026apos;m not that confident.\u0026rsquo;\u0026rdquo; Gabby shared a similar sentiment: \u0026ldquo;I mean, it\u0026apos;s interesting because, umm, I\u0026apos;ve noticed sometimes hearing like peers experience can spring up self-doubt, there are some people that just seem to really like know what it is they\u0026apos;re doing and have such confidence.\u0026rdquo; This resulted in the individual feeling doubtful of their knowledge, approach and skills. \u0026nbsp;Further emphasizes the need for normalizing discussions surrounding internship struggles and sources of self-doubt.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248917\"\u003e\u003cstrong\u003eTheme 4: External Pressures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme emerged through the participants describing how external pressures, such as societal expectations, client feedback, and looming ethical and legal implications, have contributed to fostering self-doubt for therapists-in-training. The three following sub-themes were created to reflect the experiences of the participants:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(A) Societal Expectations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants shared how societal expectations and misconceptions of therapists contributed to their self-doubts. Some of these were described as the view that therapists are \u0026ldquo;healed people\u0026rdquo; and can \u0026ldquo;fix others.\u0026rdquo; They shared how societal illusions that therapists can control or significantly change client behaviours led them to feel inadequate when such results were not produced. Sage stated, \u0026ldquo;I don\u0026apos;t have control over other people\u0026apos;s behaviour, and that\u0026apos;s something that I think society kind of tells us a lot. It almost gives us the illusion that as therapists, we\u0026apos;re able to kind of like make people do things, which is completely erroneous.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOthers described how the societal expectation that therapists should not suffer personally led to self-doubt when internal struggles occurred. Samira shared a moment when someone near to her disclosed their hesitation to receive treatment from a therapist managing their challenges:\u0026nbsp;\u0026ldquo;She\u0026apos;s like, \u0026lsquo;oh, I don\u0026apos;t know if I would see a therapist that was struggling like that kind of thing.\u0026rsquo;\u0026rdquo; Hearing such a comment may\u0026nbsp;lead to internal questioning of their fitness to support others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(B) Client Feedback\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClient interactions, especially unexpected or challenging feedback from clients, were described as important contributors to self-doubt and anxiety among the participants. Harper reflected on a moment when a client expressed concern and requested a change in session, \u0026ldquo;we did the regular like check-in chit chat and then they were like, \u0026lsquo;I do have a concern,\u0026rsquo; and immediately my heart dropped.\u0026rdquo; She shared how this led to feelings of anxiety and self-doubt surrounding the support she has been offering. Sage also reflected on an experience when her client did not show up to their last session together. She described how it led her to wonder about her potential role in the client\u0026rsquo;s decision not to attend. Amelia also reflected on a moment when she was met with resistance from a client and how she attributed their reaction to a misstep on her part: \u0026ldquo;I must have done something wrong because the client responded with resistance.\u0026rdquo; Displaying the responsibility that therapists-in-training may take for the behaviours or actions of their clients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(C) Legal/Ethical Concerns\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants shared their worries about unknowingly violating a legal or ethical guideline and its implications on their client and career progression. Amelia described, \u0026ldquo;In this line of work, we have legal and ethical obligations we need to consider, and to a degree that puts a sense of pressure that what if I miss it and don\u0026apos;t recognize it?\u0026rdquo; Therapists-in-training are held accountable to both their graduate programs and professional regulatory bodies. They described struggling with the pressure to respond ethically when put on the spot with clients. Sage reported an experience where she was put on the spot by a client and shared the panic that occurred, \u0026ldquo;and that I\u0026apos;m like, oh, my God, I\u0026apos;ve never this has never happened to me before, and I\u0026apos;m just gonna kind of wing it.\u0026rdquo; The fear of a misstep contributed to increasing their self-doubt.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248918\"\u003e\u003cstrong\u003eTheme 5: Isolation Despite Commonality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme explores the paradox of self-doubt being commonly experienced yet isolating in nature. Suffering in silence and fear of negative perception is explored in the current theme. The three following sub-themes were created to reflect the experiences of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(1) Suffering in Silence\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile self-doubt was considered by the participants as a universally experienced phenomenon, it was also described as an isolating experience, and participants questioned whether or not they were the only ones suffering. Amelia described how withholding sharing her self-doubts with others before beginning her internship led her to feel alone, \u0026ldquo;it\u0026apos;s an isolating factor because you then think you\u0026apos;re the only one,\u0026rdquo; creating further opportunity for self-criticism and doubts. Amelia shared some of her thoughts, such as, \u0026ldquo;Am I the only one?\u0026rdquo; \u0026ldquo;Is there something wrong with me?\u0026rdquo; Fears of judgment were reported to prevent therapists from sharing their experiences of self-doubt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(B) Fear of Being Perceived Unprofessionally\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot wanting to be perceived as unprofessional for having doubts contributed to feelings of isolation. Facing judgment, stigma, and shame are some of the unfortunate risks when sharing about self-doubt. Participants expressed that they were uncertain regarding how others would react if they shared their self-doubts and wondered whether they would be met with compassion and validation or be made to feel ashamed and isolated. Gabby shared feeling worried about this and stated, \u0026ldquo;A big source of self-doubt is just how you think people will perceive you . . . are they gonna think I\u0026apos;m like a bad therapist?\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSamira described how she feels the need to filter her experience when sharing in an attempt to avoid negative judgment: \u0026ldquo;It\u0026apos;s almost like impression management. As much as we don\u0026apos;t want that to matter, in mental health professional settings, it does still matter.\u0026rdquo; Especially at this early stage in their career development when they are attempting to establish themselves and a positive reputation. Violet described feeling as though she was walking on eggshells when she spoke about her self-doubt within her program, where the conversations on the topic felt important and yet, at the same time, highly limited and lacked depth. \u0026nbsp;This experience was perceived as contributing to apprehension regarding sharing self-doubts due to a risk to psychological safety.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e(C) Not Enough Program Support\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants reported a broader lack of support surrounding the initiation of conversations that normalize the experience of self-doubt within their training programs. Many described that the topic was usually brought up by students as opposed to course professors. Gabby shared her belief that she would have benefited from a regular open dialogue about self-doubt initiated by professors and supervisors. Violet noted how the experience of self-doubt was normalized during her training program, although it was not actively discussed. She pointed out that class discussions within her internship/practicum class (completed at the same time as the internship) centred mostly on their work with clients as opposed to their own experiences and challenges. She explained, \u0026ldquo;It\u0026apos;s not like we\u0026apos;re invited to share or talk about how it showed up or how it made us feel.\u0026rdquo; She reported that there were no direct invitations to share, contributing to a sense of isolation. Amelia similarly shared not having had the opportunity to debrief in her internship/practicum class: \u0026ldquo;We did not have very much opportunity to debrief in a practicum class.\u0026rdquo; She shared how she would have appreciated having received more curiosity from her professors and the opportunity for open dialogue within her program. Amelia described how receiving questions such as \u0026ldquo;How are you arriving with the thought of taking your first client?\u0026rdquo; from course professors would have felt normalizing and supportive. A desire for more structured conversations surrounding self-doubt was reported by participants.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe role of a psychotherapist is multifaceted, requiring self-awareness, integration of personal and professional traits, and the capacity to manage self-doubt (Nissen-Lie et al., 2017; Theriault \u0026amp; Gazzola, 2006, 2010; Theriault et al., 2009). This study aimed to explore sources of self-doubt among therapists-in-training, with the intent of informing supervision and training practices and safeguarding client care. Findings revealed that self-doubt contributed to considerable anxiety and disrupted professional development, with five main themes emerging: challenges related to professional individuation, difficulties in supervision, personal sources, external pressures, and isolation despite shared experience. Fortunately for therapists and clients alike, our knowledge of the individual therapist\u0026rsquo;s impact on the therapeutic process/outcome has grown (Barkham et al., 2021; Lambert, 1989; Howard et al., 1969; Imel \u0026amp; Wampold, 2015). However, further attention is needed on how self-doubt manifests.\u003c/p\u003e\n\u003cp\u003eResearch has shown that even seasoned therapists are not protected from self-doubt (Th\u0026eacute;riault \u0026amp; Gazzola, 2005, 2006, 2008, 2010). Previous studies have identified the risks of severe self-doubt, including burnout, diminished self-esteem, mental health issues and early career abandonment (Altaf, 2022; Th\u0026eacute;riault \u0026amp; Gazzola, 2005, 2010). Despite existing research on feelings of incompetence, the therapist-in-training perspective had not received sufficient attention (Daly, 2018; Gazzola \u0026amp; Theriault, 2007; Morrissette, 1996; Nyiri, 2010; Th\u0026eacute;riault et al., 2009; Th\u0026eacute;riault \u0026amp; Gazzola, 2005, 2008). This group refers to those who have less than a year\u0026rsquo;s worth of experience and are currently completing their clinical practicum placements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCounsellor development theories suggest that self-doubt is a normal part of the early stages of therapist development, although it requires cautious management to prevent it from hindering learning and professional growth (Bernard \u0026amp; Goodyear, 2014). Therapists-in-training are undergoing a novel experience while completing their internships. For the first time in their training, they are attempting to integrate the complex approaches they have been taught in class into their work with clients and learning about the intricacies and expectations of the field\u0026nbsp;(Brown, 2023; Morrissette, 1996; Ronnestad \u0026amp; Skovholt, 2003).\u0026nbsp;The demands placed on practitioners in the field are no small feat. They are expected to seamlessly integrate their personal and professional traits/skills, practice self-awareness to avoid negative spillover and stay up to date on training and therapeutic skills\u0026nbsp;(Brown, 2023; Nissen-Lie et al., 2017). Meanwhile, those newer to the profession are also attempting to discover their professional identities and preferred ways of being/approaches to use in session. This experience is only made more challenging by both internal and external pressures they face, heightening their vulnerability to self-doubt.\u003c/p\u003e\n\u003cp\u003eBeing tasked with developing their sense of self as therapists was reported as a main theme and source of self-doubt for therapists-in-training. This refers to the process of discovering their professional identities and learning their preferred ways of approaching sessions. When they felt limited to experiment and explore, or when their supervisor operated from an approach that did not resonate, their doubts were amplified.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDifficulty in the supervisory relationship was also described as a main source of self-doubt for therapists-in-training and can contribute to issues for student counsellors (Gazzola \u0026amp; Theriault, 2007). The\u0026nbsp;literature suggests that supervision has been consistently viewed as an effective tool for helping interns manage their self-doubt (Nyiri, 2010). It was designed as an opportunity for therapy interns (i.e., students) to discuss a variety of topics to promote their professional development and protect client welfare (Curtis et al., 2016). This was deemed as helpful when the supervisory relationship was viewed as safe and welcoming by the participants. While supervision may help manage self-doubts, there is a risk of worsening symptoms if the supervisory relationship is not deemed supportive. Not all participants reported supportive supervisory relationships and named a lack of emotional safety with their supervisor, highlighting its detrimental impact on their internship experiences. Some participants described having kept their struggles internal and \u0026ldquo;suffering in silence\u0026rdquo; out of fear of judgment or being considered inadequate for their roles.\u003c/p\u003e\n\u003cp\u003ePersonal anxieties, intensified by a profound sense of responsibility for client welfare, were common. According to Morrissette (1996), the most prevalent concern for student counsellors is the experience of personal anxiety. The current study found the impact of personal doubts to be prominent, as the participants described feeling an immense sense of responsibility for the well-being of their clients and how it led to internal questioning. Previous studies have discussed how personal doubts surrounding competence and skill have contributed to early career abandonment (Altaf, 2022; Th\u0026eacute;riault \u0026amp; Gazzola, 2005, 2010). While none considered leaving the profession, many questioned their adequacy, echoing earlier findings.\u0026nbsp;They reported asking themselves,\u0026nbsp;\u0026ldquo;Should I even be a therapist?\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eFor many of the participants, personal sources of self-doubt were paired with facing the pressures of external expectations. These include societal myths about therapists\u0026apos; roles and mental health, client feedback, and legal responsibilities. They noted how widely held societal beliefs surrounding their role, personal mental health, and ability to \u0026ldquo;fix\u0026rdquo; others led to the creation of doubts surrounding their clinical abilities. Societal misconceptions, along with receiving client feedback and the fear of missing an ethical and legal obligation, led to increasing self-doubt for the participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants in our study reported that they frequently felt isolated and uncertain about sharing their self-doubts with supervisors. This is consistent with findings reported in the literature that indicate that therapists-in-training often hesitate to express their self-doubts due to the fear of being perceived as incompetent or unprofessional, particularly by their supervisors (Daly, 2018). For student therapists, discussing these doubts is rarely made comfortable. Unfortunately, many \u0026apos;suffer in silence,\u0026apos; internalizing their experience, concerned that they are alone in their insecurities or will be judged if they open up (Nissen-Lie et al., 2017; Th\u0026eacute;riault et al., 2009, p. 116). The current study\u0026rsquo;s findings similarly found that the participants often hesitated to share their doubts out of fear of being perceived as unprofessional. They often chose to keep their doubts internal, asking themselves, \u0026ldquo;Am I the only one?\u0026rdquo; \u0026ldquo;Is there something wrong with me?\u0026rdquo; When training programs failed to acknowledge self-doubt, students were more likely to internalize their distress. Many noted how their programs did not often initiate conversations about self-doubt, causing them to further believe that they were alone in their struggles.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe current study highlights the impact of self-doubt on therapists-in-training. Self-doubt was reported to trigger anxiety, rumination, and disconnection.\u0026nbsp;Through identifying sources of self-doubt for therapists-in-training early on, therapists-in-training are better equipped to cope when/if their symptoms recur. This supports trainee development and prioritizes effective client care by aiming to limit the impacts of self-doubt on their clinical work. Based on the findings, the study provides recommendations for training programs, supervisors, and therapists-in-training.\u003c/p\u003e\n\u003cp id=\"_Toc185248920\"\u003e\u003cstrong\u003eDe-Limitations and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study\u0026rsquo;s transferability of findings is de-limited by our targeted population of practicum students in counselling and psychotherapy in the province of Ontario in Canada. While we hoped to get a wide range of participants from different university programs in the province, the final sample included participants from only two masters-level counselling programs, both in the same city. This could be due to the advertising for the study by the National Capital Region Chapter of the Canadian Counselling and Psychotherapy Association via its Facebook page. Trainee self-doubt may be experienced differently in different geographic or individual program contexts, which have their own respective professional cultures and pressures. In Canada, mental health is regulated at the provincial level (Gazzola \u0026amp; Gignac, 2025). Canada is a large country that includes 10 provinces and three territories. \u0026nbsp;Our sample of therapists-in-training does not capture students studying in all provinces and thus any transferability of findings must be mindful of the limited diversity of our sample relative to Canada\u0026rsquo;s multicultural and linguistically plural population (Gazzola, 2016). While the researchers made an effort to ensure the participants selected represent a diverse group of individuals, not all genders were represented in the current study. This was due to the lack of representation in those who expressed interest in participating in the study. The study consisted of 7 women-identifying individuals and one gender-fluid person. However, the profession has been reported to be primarily occupied by women in Ontario. According to the College of Registered Psychotherapists of Ontario (CRPO), there are four times as many women-identifying registrants than there are male-identifying, and less than one percent have gender identities other than male or female \u003cu\u003e(CRPO, n.d.)\u003c/u\u003e\u0026nbsp; Naturally, this may result in the study receiving more interest from women-identifying individuals than from other genders. The participant sample also comprised White-identifying individuals, displaying an underrepresentation of diverse ethnic backgrounds, which is also a representative of the lack of diversity in the mental health field (Beaton et al., 2009; Bedi et al., 2020; Lee, 2010). This may lead to a limitation in the study\u0026rsquo;s transferability and provide less data that can reflect the sociocultural aspects of self-doubt.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248921\"\u003e\u003cstrong\u003eImplications and Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile self-doubt originated from personal, external and professional identity-related sources, a common thread was the sense of isolation in their experience of self-doubt. Suffering in silence resulted from a fear of being perceived as unprofessional and was worsened by a lack of support in the experience of self-doubt. These findings offer recommendations for counsellor education programs, clinical supervisors, therapists-in-training, and future research. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Counsellor Education Programs\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants emphasized that responsibility for initiating dialogue surrounding self-doubt should rest with those in authority (program professors, supervisors, etc.). Being under evaluation was described as a barrier to disclose self-doubt, unless prompted. This further emphasizes the need for counsellor training programs to create safe, open, and intentional conversations surrounding the experience of self-doubt. Participant Amelia shared how she would have appreciated being asked questions such as \u0026ldquo;How are you arriving at the thought of seeing a client?\u0026rdquo; by her professors before beginning her internship. Through course professors\u0026rsquo; initiation conversations, ideally at various points in their training, the experience of self-doubt is normalized as being an expected part of the professional development process. Professors who shared personal experiences helped demystify the process and reduce stigma.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants suggested the implementation of peer support systems or dedicated courses that normalize self-doubt in training programs. For example, a mentorship system that groups first- and second-year students to facilitate conversations on the topic, or the creation of a course specifically designed to address the challenges that arise at their stage of professional development (e.g., discussing their evolving professional identities, overwhelm when integrating approaches, etc.). Emphasis was placed on such a course being held in a welcoming environment and in a small group format.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248923\"\u003e\u003cstrong\u003eImplications for Supervisors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupervisors also play a critical role in fostering emotional safety. Supportive, nonjudgmental supervision encouraged disclosure, while its absence worsened doubt and risked client impact. Experiencing a lack of safety in the supervisory dynamic emerged as a source of self-doubt for the participants. This refers to supervisees/trainees not feeling safe or welcome to disclose their self-doubts with their supervisor for a variety of reasons related to fear of negative judgment. Emphasis is thus placed on the supervisor\u0026rsquo;s responsibility to create a warm environment for trainees to encourage the sharing of their experiences. Self-disclosure of self-doubt by supervisors also contributed to normalizing the experience, reducing the risk of isolation in their doubts.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248924\"\u003e\u003cstrong\u003eImplications for Therapists-in-Training\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor therapists-in-training, connection with peers and safe individuals helped reduce self-doubt. These were often described as peers, those who could relate to the experiences. Opening up to individuals deemed as \u0026lsquo;safe\u0026rsquo; also reduced the risk of comparison, further isolation, and shame. Recognizing that discomfort is normal, especially when applying new skills, and cultivating self-compassion were also emphasized. Practicing self-compassion is highly encouraged for those experiencing high internal and external expectations.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc185248925\"\u003e\u003cstrong\u003eImplications for Future Research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile previous studies have explored how self-doubt presents itself for experienced therapists, this study contributes to understanding how self-doubt manifests in early clinical training. The current study displayed how severe self-doubt caused by both external and internal sources can lead to high self-questioning, seen through anxiety and rumination. Further research is needed to explore its impact on clinical work and to inform interventions that support trainee development and well-being.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAhmed, S. K. (2024). 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Feelings of inadequacy, insecurity, and incompetence among experienced therapists. \u003cem\u003eCounselling \u0026amp; Psychotherapy Research\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(1), 11\u0026ndash;18. https://doi.org/10.1080/14733140512331343840\u003c/li\u003e\n \u003cli\u003eTh\u0026eacute;riault, A., \u0026amp; Gazzola, N. (2006). What are the sources of feelings of incompetence in experienced therapists? \u003cem\u003eCounselling Psychology Quarterly\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(4), 313\u0026ndash;330. https://doi.org/10.1080/09515070601090113\u003c/li\u003e\n \u003cli\u003eTh\u0026eacute;riault, A., \u0026amp; Gazzola, N. (2008). Feelings of Incompetence among Experienced Clinicians: A Substantive Theory. \u003cem\u003eEuropean Journal for Qualitative Research in Psychotherapy\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e, 19\u0026ndash;29.\u003c/li\u003e\n \u003cli\u003eTh\u0026eacute;riault, A., \u0026amp; Gazzola, N. (2010). Therapist Feelings of Incompetence and Suboptimal Processes in Psychotherapy. \u003cem\u003eJournal of Contemporary Psychotherapy\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e, 233\u0026ndash;243. https://doi.org/10.1007/s10879-010-9147-z\u003c/li\u003e\n \u003cli\u003eTh\u0026eacute;riault, A., Gazzola, N., \u0026amp; Richardson, B. (2009). Feelings of Incompetence in Novice Therapists: Consequences, Coping, and Correctives. \u003cem\u003eCanadian Journal of Counselling\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(2), 105\u0026ndash;119.\u003c/li\u003e\n \u003cli\u003eTsai, P.-C. (2015). \u003cem\u003eTrainee\u0026rsquo;s anxiety and counseling self-efficacy in counseling sessions.\u003c/em\u003e [Doctor of Philosophy, Iowa State University, Digital Repository]. https://doi.org/10.31274/etd-180810-4254\u003c/li\u003e\n \u003cli\u003eWalters, L. H., \u0026amp; Corey, G. (1980). Theory and Practice of Counseling and Psychotherapy. \u003cem\u003eFamily Relations\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e(1), 133. https://doi.org/10.2307/583738\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"qualitative research, thematic analysis, self-doubt, psychotherapy, therapist-in-training","lastPublishedDoi":"10.21203/rs.3.rs-6830639/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6830639/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOne of the key elements of effective psychotherapy is the mental health of the practitioner. Research has shown that psychotherapy efficacy is diminished if therapists project anxiety in their role or lack confidence in their mastery of skills (Lambert, 1989; Royse-Roskowski, 2010; Tsai, 2015). Therapist factors contribute to approximately 9% of the outcome variance (cf. Wampold \u0026amp; Imel, 2015), which is higher than the variance attributed to the actual treatment used. Therapist feelings of incompetence (FOI) or self-doubt may potentially impact the therapeutic outcome (Theriault \u0026amp; Gazzola, 2009, 2010). However, the experience of self-doubtfrom the therapist-in-training perspective requires further investigation. This stage of development is characterized as one that presents many challenges through its exposure to novel experiences and changes in professional identity (Morrissette, 1996; Rønnestad \u0026amp; Skovholt, 2003). The research question that guided the current study was: “What are the sources of self-doubt in therapists-in-training?” Using inductive qualitative research methodology, 8 therapists-in-training in Ontario, Canada participated in semi-structured interviews to discuss their experiences of self-doubt. Data were analyzed using Braun and Clark’s (2012, 2014) six-step thematic analysis to uncover themes shared by participants. A total of 5 main themes and 16 sub-themes emerged from the data analysis, describing the sources of self-doubt for therapists-in-training. Findings are discussed in the context of psychotherapist training, supervision and practice.\u003c/p\u003e","manuscriptTitle":"“Should I even be a therapist?” A Qualitative Exploration of the Sources of Self-Doubt Experienced by Therapists-in-Training","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-10 05:40:18","doi":"10.21203/rs.3.rs-6830639/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2013907e-ae1f-4e62-8c91-bb6852c9254b","owner":[],"postedDate":"June 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-11T02:23:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-10 05:40:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6830639","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6830639","identity":"rs-6830639","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}