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Navigating the choppy waters of Professional Uncertainty and becoming the Competent Practitioner

Doubting your abilities isn’t necessarily a bad thing. Who would you rather be, the cocky novice who thinks they are always right and rarely is, or the steady early learner who is aware of their need for more experience? 

When Doctors and nurses begin their training, they understand that getting it wrong could cost someone their life. The risks of making mistakes are less severe for teachers, but the pressure to juggle learning your trade and organise your time efficiently can be just as unbearable.

This article is for both the novice and the advanced practitioner. As a qualified Behavioural Psychotherapist, I’ve realised in many years that professional uncertainty never goes away.

Well, that’s depressing!

Uncertainty remains part of the landscape. Yes, it changes. Being a novice is more frightening. But, when you are ambitious, you want to learn new skills and take on new challenges. These ventures take you outside your comfort zone and slap bang in the middle of conscious incompetence.

You don’t have to look far, and you will discover that even the most incredible mind’s in the history of this planet were filled with doubt.

“The more I learn, the more I realise how much I don’t know”.

Albert Einstein

Back in 2003, I started my post-graduate training in Cognitive Behavioural Psychotherapy. At the time, It was a running joke amongst my housemates that each week I came home with a new book. It was a joke because they knew there was no way that I had made time to read everything. Somehow, in my mind, I was alleviating my fears about not knowing enough every time I got hold of another textbook.

The feeling of “I don’t know enough” was anxiety-provoking. I mean, I am putting it mildly. In truth, I often feared getting it wrong, making mistakes or being criticised.

I was sensitive to criticism. And I felt an urgency to receive approval, recognition and confirmation that I was doing it right. You could say that I was hyper-alert to the signs and signals of what my teachers thought about me.

Why is there so much professional uncertainty?

You can’t put value on high-quality training. You can be resoundingly grateful when you’ve got great teachers, supportive mentors and an organised system or environment in which to learn.

Good quality training lays out the theory, allows you to practice and ensures you get the right kind of feedback to help you learn. But even with all these ingredients in place, you still feel like you don’t know what the hell you are doing. So, why is that?

In one of my favourite textbooks, The Resilient Practitioner, Skovholt and Thomas-Matthison, suggest that there are two reasons:

1. Human Complexity
2. Competing Ways of Knowing

Human Complexity

Human beings are not robots; that much is obvious. But surprisingly, they are not as simple as training courses and textbooks describe them. Even when the list of symptoms tells you clearly what the diagnosis should be, you discover that it is not that at all. Even when you clearly instruct the student in your classroom, their application can make you wonder, “were they even here in my lesson?”

Human beings are complex and unpredictable. The body doesn’t always behave as your training taught you; people don’t learn everything you teach them. There is a gap between what you give and what they receive. There is a gap between theory and practice. They are not the same thing.

Competing Ways of Knowing

People are complex, so we are not all the same. People see things differently and have come up with different ways of seeing what we call models.

These models shape how the healthcare professional learns medicine or nursing, how the teacher learns to educate and how the therapist engages and connects with their client.

The trouble with this is that it makes it more complicated for the novice practitioner. You have to apply different models without mucking them up. You have to make sense of varying teachers’ interpretations of the literature and digest the changing science of what we know works. Being a novice practitioner and applying what you learn is choppy waters indeed!

Ways we cope with the landscape of not knowing.

So, how do people deal with these uncertainties? Well, you turn up to your lectures. You do your homework, and you practice as much as you can. It is a practical and logical approach. The inevitable storm is that we are also emotional people who get side-tracked.

When you get side-tracked, you end up focusing on actions that are short-term ways of coping. They are the natural human survival responses that kick in when you feel out of your depth. Here is a handful I’ve come across:

1. Hero Fantasising – In your enthusiasm and drive to save the world one person at a time, you hope and expect that you’ll be successful. And you will be successful, but the truth for many people is that you will also fail far more than you had dared to anticipate.
2. Cynical Disillusionment & Learned Helplessness – this is the dangerous swing away from hero fantasy. Instead of believing you can save everyone, you find yourself caught up in a cycle of thinking that you can help no one or only do the basics.
3. Pretend you know more than you do – overlapping with the idea that you fake it until you make it, pretending your skills are more advanced can be a problem. Instead of being open to learning from mistakes, you miss out on the opportunity because you are too focused on appearing competent instead of becoming competent.
4. Put off Practice – It is tempting to say I am not ready. I don’t know enough yet, and I need to read, read and then read some more. The trouble is that all the reading in the world will not fully prepare you for the discomfort of trying out a new intervention for the first time. You have to get stuck in!
5. Copy your Mentor’s Style – This can be useful. You learn to be a certain way that works, but without knowing what she is doing and why she is doing it, you deny yourself the chance to develop your unique personal style.
6. Criticise your Mentors – sometimes, this is wholly justified. Mentors are not perfect; they can make mistakes or be inappropriate. In these situations, you have a right to express your opinion. But, sometimes, criticism can come from frustration, impatience and shame. So, you push back on that discomfort by throwing it at the person who has not taken it away from you. You blame them for you not knowing enough.

Significant problems arise when you use these coping strategies too often. And that big problem is that you risk burnout. These ways of fixing or eliminating your fears and anxieties are short-term solutions. They only ever delay your discomfort, and they don’t permanently get rid of your uncertainty. My experience has taught me to protect myself against burnout by focusing on something different.

How to make space for uncertainty

Yes, making space for uncertainty is different and what is needed. But it isn’t easy. Your mind has evolved to fix things, so your natural urges are to resolve the uncertainty. But you can’t fix it by plugging your mind into a computer and downloading it. Only time will give you what you need.

When you make space for uncertainty, it is a lot like pulling up at the traffic lights. When it shows red, you stop. In this metaphor, red represents fear, anxiety, frustration and shame. When it shows up, try to stop instead of fixing it.

And then, when you’ve stopped, take some time to acknowledge what you are feeling. Name it and validate it. You validate what you feel when you say, yes, it is ok that I don’t know all this stuff. I am still learning. And it works to say this gently rather than abruptly.

And then green is like when you are ready to get going again. But instead of just ploughing on through, you choose what direction to take and how fast to travel.

Five lines to gently pull on and stay upright.

When you navigate seas of professional uncertainty, you are in choppy waters. It would be best if you sailed your way through. You need to pay attention to the weather, speed and direction. You keep an eye on your dials.

Here are five ways you can navigate through ‘not knowing. When your lights turn green, choose what will work best for the situation:

1. Find your Mentor – a good mentor will be available and supportive. So, do all you can to nurture this relationship. And, when you need their guidance, seek them out.
2. Prepare Adequately – Preparation has always made a difference in my interventions. With experience, the degree to which you need to prepare can reduce. And adequate preparation is a worthwhile goal. Over-preparation can make things worse, and not planning enough can leave you fighting to stay afloat, where you and the person you are helping can suffer.
3. Keep Learning – make time to learn something new to develop your competencies and practice. I can’t even imagine that there would ever come a time when I would need or want to stop learning.
4. Intervene Mindfully – When you administer your procedure, take a class through an exercise, or move a client through an essential psychological process, aim to do it with awareness. Notice what is happening inside you and outside. Track your experience so you can make it more rewarding
5. Make time to reflect – this is when you sit down and ask yourself some questions intentionally. Reflection is different to rumination, which is involuntary mulling-over. Reflective practice occurs when you ask pertinent questions to help you learn, e.g. what response did it get? What was the feedback from the patient or the student? What theory justifies the intervention? Does this outcome support the hypothesis or challenge it?

You develop as a reflective practitioner when you make time for reflective practice. It is the development of your professional self. You start to rely on yourself and others when you can learn through your reflections. You move from a not-knowing position and begin applying your profession’s art.

Most of us don’t want just to become competent. We want to be great. We want to be knowledgeable and proficient. We want to stretch the boundaries and make it better. We want to excel and help people to the best of our abilities. This enthusiasm is present in trainees, and my advice is to hold on to it, channel it and surround yourself with people who want it for themselves.