The Unspoken Truths of Being a Therapist: The Inner Critic in the Consulting Room
This is the second installment in our ongoing series examining the human realities of therapeutic practice. Today we explore how therapists' internal self-criticism impacts clinical work and what to do about it.
The Uninvited Guest
There's a voice that follows many of us into the consulting room. It sits quietly during easy sessions but becomes increasingly vocal when the work gets challenging. It has opinions about everything we say, critiques our interventions, and offers a running commentary on our inadequacies.
This voice has a name: the inner critic. And it has a lot to say about how we practice therapy.
Research shows that therapists across all experience levels report episodes of intense self-criticism during sessions, particularly when working with challenging cases or facing therapeutic impasses. Yet this nearly universal experience gets little attention in training programs, despite its significant impact on both therapeutic process and practitioner wellbeing.
When the Voice Gets Loud
Rachel, a supervisee, described her experience with tears in her eyes:
"I was working with a teenager who'd been cutting. She was finally opening up about her family, sharing things she'd never told anyone. Right in this breakthrough moment, my mind started racing: 'Are you asking the right questions? Should you address the cutting more directly? You're not trained enough for this level of self-harm. What if you say something that makes her hurt herself more?' I became so consumed with my own anxiety that I completely lost connection with her. I could see her starting to shut down, and I knew it was because I'd left the room emotionally."
Sound familiar?
The Anatomy of Therapeutic Self-Criticism
The therapeutic inner critic has a particular flavour, distinct from general self-doubt. It's hypervigilant, catastrophic, and often emerges at the most crucial therapeutic moments.
Here's what it typically sounds like:
"You should have caught that sooner."
"A competent therapist would know exactly what to do here."
"You're going to make them worse."
"They're going to realize you're a fraud."
"You should refer them to someone more qualified."
Unlike everyday self-criticism, the therapeutic inner critic carries the weight of professional responsibility. It's not just about our personal adequacy—it's about our fitness to hold others' pain and facilitate their healing.
The Neurobiological Reality
Understanding what happens in our brains when the inner critic activates helps us work with it more skilfully.
When we start internally criticizing ourselves during a session, our threat detection system goes online. This shifts us from the calm, receptive state needed for therapeutic presence into a defensive, hypervigilant mode. Our prefrontal cortex—responsible for empathy, perspective-taking, and complex reasoning—becomes less accessible.
Meanwhile, our clients often sense this shift through mirror neurons and unconscious attunement. They may not know we're criticizing ourselves, but they feel our emotional departure from the relationship.
Where the Critic Comes From
For many therapists, the inner critic has deep roots:
Training experiences: Some of us learned in environments where criticism was harsh and support scarce. Supervisors who focused more on what we did wrong than what we did right.
Personal history: Many came to this field partly because of our own experiences with pain, which often included critical voices from family, teachers, or ourselves.
Professional pressure: In cultures emphasizing achievement and expertise, admitting uncertainty or making mistakes can feel dangerous to our professional identity.
The helping trap: We entered this field to help others, so when that help isn't visibly effective, it can trigger deep questions about our worth and purpose.
The Cost of Internal Warfare
When our inner critic is active during sessions, several things happen that interfere with effective therapy:
We lose presence. Instead of being fully with our client, we're managing our own anxiety about performance.
We become reactive. We might talk too much (to prove competence), offer premature advice (to feel helpful), or withdraw emotionally (to protect ourselves).
We miss attunement opportunities. While we're internally focused on our inadequacies, we're not tracking the subtle shifts in our client's emotional state.
We model self-criticism. Our clients often sense our self-judgment, which can reinforce their own patterns of self-attack.
When Self-Criticism Becomes Clinical Information
Sometimes our inner critic carries important clinical information. I think of David, a client who was incredibly hard on himself. During our sessions, I noticed my own self-criticism becoming unusually loud. I found myself second-guessing every intervention, worrying I wasn't helping him enough.
In supervision, I realized my internal experience was mirroring his. My heightened self-criticism was a form of countertransference—I was unconsciously taking on his internal critical voice. Once I understood this, I could use my experience as information about his internal world.
Learning to Work WITH the Critic
The goal isn't to eliminate the inner critic—that's usually impossible and potentially counterproductive. Instead, we can learn to work with it more skilfully.
Notice Without Judgment
The first step is awareness: "I notice I'm criticizing myself right now." This simple recognition can create space between you and the critical voice.
Get Curious About Its Purpose
Instead of fighting the critic, ask: "What is this voice trying to protect me from?" Often, it's trying to prevent mistakes, maintain standards, or protect us from shame.
Return to the Client
When you notice self-criticism arising, gently redirect attention: "What does my client actually need from me right now? “This shifts focus from internal performance evaluation to external attunement.
Practice Self-Compassion
Research shows that self-compassion is more effective than self-criticism for motivation and performance. Speak to yourself the way you would to a valued colleague facing the same situation.
Use the Critic as Information
Sometimes the critic points toward something important:
Are you working outside your competence area?
Do you need consultation on this case?
Are you taking on too much responsibility for your client's progress?
Practical Strategies for Daily Practice
Before sessions:
Take three conscious breaths and set an intention for presence
Remind yourself: "I am enough for this moment"
Acknowledge any anxiety without judgment
During sessions:
When you notice self-criticism, take a breath and return attention to your client
Trust that confusion and uncertainty are sometimes exactly what's needed
Remember that authentic presence is more valuable than perfect performance
After sessions:
Practice self-compassion instead of self-analysis
Ask "What did I do well?" before "What could I have done better?"
Remember that your clients chose you for reasons beyond your credentials
The Supervision Conversation
Traditional supervision often focuses on case management, but working with the inner critic requires different conversations:
"How was your inner critic showing up during that session?" "What did you notice about your internal state when the client became emotional?" "How did your self-doubt impact your ability to stay present?"
This shifts supervision from performance evaluation to process exploration, creating space for the very human experience of being a therapist.
Training Implications
Training programmes could better prepare therapists by:
Teaching about the ubiquity of therapeutic self-criticism as normal rather than pathological Providing experiential learning through role-plays that activate and work with self-critical responses Requiring or encouraging personal therapy for trainees to explore their own patterns Offering ongoing supervision that addresses both case dynamics and therapist internal experience
Reframing Professional Competence
What if competence isn't about always knowing what to say or never feeling uncertain? What if it includes:
The ability to notice when we're being self-critical
The skill to return to presence when we've become internally focused
The wisdom to use our reactions as clinical information
The courage to stay authentic even when we feel inadequate
The humility to seek consultation when needed
The Paradox of Caring
Here's the cruel irony: the therapists most tormented by their inner critic are often the most caring, ethical, and committed practitioners. The very qualities that make us good therapists—empathy, responsibility, self-reflection—can fuel our self-criticism.
Your self-doubt isn't evidence that you're not cut out for this work. It's evidence that you care deeply about doing it well. The fact that you question yourself, worry about your impact, and want to improve—these are signs of exactly the kind of therapist the world needs.
Moving Forward
Next time your inner critic shows up in session, try this: Thank it for caring about your client's wellbeing, acknowledge its concerns, then gently set it aside and return to the person in front of you.
You don't have to be perfect to be profoundly helpful. Your authentic, imperfect, caring presence is often exactly what healing requires.
The therapists who never question themselves are the ones I'd worry about. Your self-doubt, when held skillfully, can actually enhance your work—keeping you humble, curious, and connected to your own humanity.
And that humanity? It's not a liability in this work. It's often the most therapeutic thing you bring to the room.
Resources for Further Learning
Recommended Reading:
Self-Compassion by Kristin Neff
The Mindful Therapist by Daniel Siegel
The Resilient Practitioner by Thomas Skovholt
Training Opportunities:
Link to training. Page
Link to group supervision info
Link to Membership
About the Author: link
About The Academy: link