Unspoken Truths of Being a Therapist: "I Should Know This By Now"
This continues our series exploring the human realities of therapeutic practice. Today we examine the persistent feeling that haunts many experienced therapists: the belief that we should have figured it all out by now.
The 2 AM Google Search
It's 2 AM and you're in bed with your phone, secretly googling "how to work with borderline personality disorder" even though you've been practicing for eight years. Or maybe you're researching autism spectrum symptoms because you're wondering if you missed something with your teenage client.
Your partner stirs and asks what you're doing. "Nothing," you mumble, quickly closing the browser, feeling like a fraud who doesn't deserve the "Expert Therapist" title on your website.
Sound familiar?
The Myth of Therapeutic Mastery
Jennifer, a therapist with twelve years of experience, shared this in a consultation group:
"I had a moment last week where a client asked me about somatic therapy approaches, and I realized I knew almost nothing about them. I felt this wave of shame—like, shouldn't I know about every therapeutic approach by now? I've been doing this for over a decade. When does the feeling that you're still figuring it out go away?"
Here's the truth that no one tells you in graduate school: it doesn't go away. The feeling that you should know more, be more competent, have more answers—it persists throughout your career, often intensifying as clients bring increasingly complex presentations.
The Competence Paradox
The more we learn about human psychology and therapeutic practice, the more we realize how much we don't know. This creates what I call the "competence paradox":
Novice therapists often feel confident because they don't yet know what they don't know.
Intermediate therapists experience the most anxiety as they become aware of the vast complexity of human experience and therapeutic practice.
Experienced therapists develop wisdom about the limits of knowledge while maintaining curiosity about what they're still learning.
But even experienced therapists can get caught in the "should know this by now" trap, especially when facing:
New diagnostic categories or clinical presentations
Emerging therapeutic modalities
Cultural or demographic groups they haven't worked with extensively
Complex trauma presentations
Challenging family dynamics
Severe mental illness
The Ever-Expanding Field
Part of our anxiety comes from the reality that the field of mental health is constantly evolving:
New research emerges monthly that challenges previous understanding Treatment modalities continue to develop and gain evidence support Diagnostic criteria get revised and refined Cultural awareness expands our understanding of diverse presentations Technology creates new tools and treatment options Neuroscience reveals new insights about brain function and healing
No one can keep up with everything. The expectation that we should is both unrealistic and professionally harmful.
The Impostor's Inner Voice
Late-night doubts often sound like this:
"Everyone else seems to know what they're doing." "My colleagues would be shocked to know how uncertain I feel." "I should have learned this in graduate school." "If my clients knew how much I'm figuring out as I go, they'd find someone else." "Real therapists don't have to look things up this much."
These thoughts reflect what psychologists call "impostor syndrome"—the persistent feeling that we're not as competent as others perceive us to be and that we'll eventually be "found out."
The Neuroscience of Professional Anxiety
Understanding what happens in our brains during these late-night doubt spirals can help us work with them more skillfully:
Threat detection: Our amygdala interprets not-knowing as a threat to our professional identity and livelihood.
Rumination loops: Our prefrontal cortex gets stuck cycling through the same anxious thoughts about competence.
Comparison activation: Social comparison centres light up as we imagine other therapists being more knowledgeable.
Sleep disruption: Cortisol release interferes with our ability to rest, creating a cycle of fatigue and increased anxiety.
The Hidden Costs of "Should Know" Thinking
When we get trapped in believing we should know everything by now, several harmful dynamics can emerge:
Consultation avoidance: We stop seeking help because asking questions feels like admitting incompetence.
Learning paralysis: The shame of not knowing prevents us from engaging in continuing education.
Client disservice: We might avoid working with certain populations or presentations rather than admitting we need to learn.
Isolation: We withdraw from professional community to hide our perceived inadequacies.
Burnout acceleration: The constant pressure to be expert in everything is emotionally exhausting.
What We Actually Need to Know
Here's a reality check about professional competence:
Core Competencies
Strong therapeutic relationship skills
Basic assessment and case conceptualization abilities
Knowledge of common mental health conditions
Understanding of trauma-informed practice
Cultural humility and awareness
Ethical decision-making framework
Crisis intervention skills
When and how to refer
Specialised Knowledge
Deep expertise in specific populations or approaches you choose to focus on
Awareness of emerging trends without needing mastery of everything
Recognition of your scope of practice limitations
Curiosity and willingness to continue learning
What You Don't Need to Know
Every therapeutic modality ever developed
How to treat every possible condition or presentation
The latest research in fields outside your specialty
Every cultural nuance for every population
How to help every person who walks through your door
The Supervision Reality Check
In supervision, I often ask: "What would you tell a supervisee who felt they should know everything by now?"
The response is usually immediate compassion: "I'd tell them that's impossible and unrealistic. Learning is lifelong in this field."
Then I ask: "So why don't you offer yourself that same compassion?"
The silence that follows is telling.
Reframing Professional Development
Instead of "I should know this by now," what if we thought:
"I'm learning something new, which means I'm growing professionally."
"Not knowing this creates an opportunity to expand my skills."
"Curiosity about what I don't know makes me a better therapist."
"My willingness to keep learning serves my clients better than pretending to know everything."
The Wisdom of Strategic Ignorance
David Epstein, in his book "Range," discusses the concept of "strategic ignorance"—the wisdom of knowing what you don't need to know so you can focus on what matters most.
For therapists, this might mean:
Developing deep expertise in specific areas rather than surface knowledge of everything
Focusing on populations or conditions that align with your interests and training
Building a referral network for areas outside your competence
Staying informed about general trends without mastering every new approach
Practical Strategies for Late-Night Doubt Spirals
In the Moment
Notice the spiral: Recognise when you're caught in "should know" thinking Name it: "I'm having that late-night impostor syndrome feeling again" Reality check: Ask yourself what you'd tell a supervisee having the same thoughts Set boundaries: Establish "no professional googling after 9 PM" rules
Ongoing Practices
Curate learning: Choose 2-3 areas for focused professional development each year Normalise not-knowing: Practice saying "I don't know, but I can find out" with colleagues Seek consultation: Make regular consultation a routine part of practice, not crisis intervention Document growth: Keep a learning journal to track your professional development over time
The Consultation Conversation
When late-night doubts arise, supervision questions that help:
"What specifically am I worried I should know?" "Is this knowledge essential for my current clients?" "How could I get this information if I needed it?" "What expertise do I actually possess that I'm taking for granted?" "How does my anxiety about not knowing affect my clinical work?"
Case Example: Working with Professional Anxiety
Mark, a therapist with six years of experience, began experiencing intense anxiety about his competence when he started seeing more clients with eating disorders. He found himself spending hours each night researching treatment approaches, second-guessing his interventions, and considering declining these referrals.
Through supervision, he learned to:
Acknowledge his growing expertise in other areas while recognising this knowledge gap
Seek targeted training in eating disorder treatment rather than trying to learn everything at once
Develop consultation relationships with eating disorder specialists
Practice transparent boundaries with clients about his developing expertise in this area
Reframe learning as professional growth rather than evidence of inadequacy
The Cultural Dimension
The pressure to know everything is often intensified by:
Social media: Seeing colleagues' highlight reels of professional achievements
Professional conferences: Feeling overwhelmed by the vastness of what you're not learning
Managed care: Pressure to be expert in everything to maximize referrals
Professional Body requirements: Continuing education that feels scattered rather than focused
Client expectations: Living in an era where Google makes people expect immediate expert answers
Building Professional Confidence
Real professional confidence comes from:
Knowing what you know: Clearly identifying your areas of expertise and strength Knowing what you don't know: Honest assessment of your limitations and learning needs Knowing how to find out: Developing resources and relationships for ongoing learning Knowing when to refer: Understanding when someone else would better serve a client Knowing you're still growing: Embracing learning as a career-long process
Training Implications
Training programmes could better prepare therapists by:
Setting realistic expectations about the scope of knowledge required at different career stages Teaching information management skills for navigating the overwhelming amount of available knowledge Modelling curiosity over omniscience in faculty relationships with students Addressing impostor syndrome as a normal part of professional development
The Wisdom of Continuous Learning
After twenty years in this field, here's what I've learned: the best therapists aren't those who know everything—they're those who remain curious, seek consultation, and continue growing throughout their careers.
Your late-night doubts aren't evidence of inadequacy. They're evidence of:
Intellectual humility
Commitment to client welfare
Awareness of the field's complexity
Desire for continued growth
Recognition that every client deserves your best effort
Moving Forward with Professional Humility
The next time you find yourself googling clinical questions at 2 AM, try this reframe: instead of "I should know this by now," think "I care enough about my clients to keep learning."
Your willingness to acknowledge what you don't know and seek information makes you a better therapist, not a worse one. The colleagues you imagine as all-knowing are probably googling their own questions on their phones too.
Professional competence isn't about knowing everything—it's about knowing enough, knowing how to learn more when needed, and knowing when to seek help.
The field of mental health is vast and ever-changing. No one masters it completely. The goal is to be competent, curious, and committed to growth.
And those late-night moments of professional uncertainty? They're not bugs in the system—they're features. They keep us humble, motivated, and connected to the lifelong learning that makes us effective healers.
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