I supervise a lot of health professionals who work with eating disorders and complex presentations. Want to guess the number one concern that people bring to supervision?
It is not how to formulate a tricky case.
It is not which evidence-based technique to use.
It is not even how to help someone stuck in chronic eating disorder behaviours.
It is this:
“What if I’ve done something wrong? What if I have made a mistake and I’m going to get into trouble?”
If you find yourself ruminating, worrying, or spending far too long on weekends replaying sessions in your head, you are not alone.
On the surface, this kind of worry might seem like a good thing. After all, being conscientious helps us do no harm and stay ethical.
But what I hear from clinicians is not the helpful kind of concern that encourages reflection and growth. It is the stomach-churning kind of worry that makes you want to quit your job and work in a supermarket. It is a deep sense that you have somehow messed up, and punishment is coming.
Where Does This Fear Come From?
This fear is so common and so intense that I have started to wonder what is driving it.
When I put on my schema therapy hat, I see how common schemas show up in therapists, such as emotional deprivation, unrelenting standards, and self-sacrifice. But I also wonder about schemas like defectiveness, mistrust, and subjugation, with voices that whisper, “You are not good enough,” “You will be punished,” or “Do not speak up because it is not safe.”
Our training often reinforces these fears too. We are taught to rigidly follow manuals but sometimes we are left with the impression that any mistake equals harm, and harm equals catastrophic consequences.
If these fears feel familiar, your own therapy can be invaluable, especially if you notice old schemas getting activated. But in the meantime, here are some reframes and reminders that have helped many of the clinicians I supervise:
Mistake does not equal harm
We all make mistakes. Maybe we word something clumsily. Maybe we miss a cue. Maybe we have an off day. That is not harm, that is being human. Harm involves neglect, boundary violations, or recklessness. Most of the clinicians I supervise are open, diligent and responsible, which is the exact opposite of harmful.
You will trigger or frustrate your Clients AND that is NOT a bad thing
Therapy is not always comfortable. Giving honest feedback or setting limits will sometimes upset clients and that does not mean that you failed them. In fact, avoiding discomfort can sometimes be more harmful than leaning into it with care. Skills like empathic confrontation in schema therapy can help you say hard but important things. Even then, it might still sting for the client, and that is okay.
When a client is stuck is not a sign that you have failed
Being stuck is part of treatment. It is not a reflection of your skill. Instead, see this as an opportunity. Often, it points to a deeper part of the client that feels afraid of change. Curiosity about the stuckness is the most helpful response.
Treatments can be harmful but you can prevent that
Yes, some approaches, when delivered rigidly or without attunement to the client, can be traumatic. But you are listening and being flexible and checking in. That makes a big difference.
You do not have to discuss the eating disorder every session
This one is for the Australian mental health professionals who fear that they will go to APHRA and Medicare hell if they do not discuss the “eating disorder” in every session. Eating disorders do not exist in isolation. They are connected to relationships, identity and trauma. Exploring those things is treating the eating disorder. This is completely different from misusing Medicare sessions to focus on something entirely unrelated.
Complaints Happen (And You Can Survive Them)
It is scary to say it out loud but sometimes clients complain or make formal reports. But keep in mind that unless there has been a serious boundary violation, the punishment we fear does not happen. The systems are there to protect clients but that does not mean they are there to punish us. Support and supervision are crucial during this time. You do not have to face it alone.
A Self-Compassionate Reminder
When these fears arise, try saying to yourself:
“I notice I’m feeling anxious about making a mistake and getting into trouble. This is really hard for me right now, and I’m struggling. But I know that many other health professionals feel this way too. I’m not alone.”
And just for good measure:
“I’m a good clinician, doing my best and that matters”
Want to Unpack This More?
If any of this resonates and you would like to explore it in supervision feel free to reach out at psych@natashahepworth.com.au
