I recently graduated as a Physical Therapist Assistant (PTA). The entire time I was in school I always felt that I didn’t deserve the grades I got, that I wasn’t trying hard enough, and didn’t know enough. But I kept passing with some As but mostly Bs (a failing grade in this program is anything less than a 75). I had 3 clinicals in 3 different settings for a total of 17 weeks and got high marks in all of them.
I got my first job in a nursing home, which was my favorite setting out of all my clinics. I apparently made such a good impression on the rehab director that she cancelled her other interviews and offered me the position 45 minutes after my interview. On my first day I trained with a seasoned PTA. This PTA’s caseload had some of the most difficult patients I’d ever seen; people that couldn’t follow directions and resisted me during the treatment. By lunchtime I was in tears because I felt like I didn’t know what I was doing and that I was doing a bad job. I tried to quit but the rehab director encouraged me to go home and think about it. I came back the next day and asked to not go around with that PTA, to be given a small caseload of simple patients and to go out on my own. I had a good day and was told I did well. That was a Friday. By Sunday night I was having a panic attack (I have a long history of anxiety/depression which had been well controlled with medication for many years). I woke up Monday, had a panic attack and quit.
Now I have zero confidence in myself and I don’t know how I can take another job if this is how I handled my first one. The entire time I felt like I didn’t know what I was doing and I was bad at the job. Choosing another career is not an option. I don’t know how to become more confident or at least fake it until I make it. The only advice I’ve gotten is “go see a therapist”, but I have no job or income. How can I be successful in this career when I don’t believe in myself?
On your No Good Very Bad Day, you showed up. You may not have been the world’s greatest & most experienced Physical Therapist Assistant (PTA) because it was your first day on a difficult job, but you were the PTA those patients had and you did the job as best you could. And then, the next day, you asked for what you needed to learn and you got it, and you did better than fine because you were working at a pace that you could handle. Your employer and their patients were happy and lucky to have you and they recognized that you needed an adjusted case load to help with the learning curve. You absolutely deserved that consideration and those adjustments. You are a beginner, not a failure.
You are a beginner, not a failure. Could you be kind and gentle to yourself? Could you give yourself a break for needing an adjustment period between a school setting and a clinical setting? Could you give yourself a break for being a person with some anxiety and depression who had those things exacerbated when you took on something difficult and new? Could you give yourself a break for having a panic attack and for doing the best you could to protect yourself in the aftermath of it?
The people who are recommending that you talk to a therapist are doing so because your antagonist here is You/Your Brain. Not grades (you’re fine), not the profession itself (you’re fine), not the patients or coworkers (you did fine, especially when you asked for what you needed), not the Platonic ideal of what a perfect person or PTA would do (once again, you’re just fine). Where you are not fine is in the uncomfortable and scary feelings you are having, and in the black and white thinking you’re falling prey to (“I must be perfect or else I HAVE FAILED.”) So the logic of a therapy recommendation is, can you treat the anxiety and have a safe place to siphon off some of the panicky feelings you’re having so that you can function in your day-to-day work? And can you revisit some of the strategies that worked for you when you treated your issues in the past (maybe medication adjustment, maybe some strategies of recognizing cognitive distortions and calming your thoughts when you get overwhelmed)? Maybe there is a larger question to be talked over, like what attracts you to this career, what to expect in the beginning, and what specific kind of employment situation would be best for you. A therapist (aka a fellow traveler in the Helping Professions) might be a really good person to talk that all over with.
It can be very hard to access mental health care when you’re stretched thin, but there are some resources out there. See these posts on locating low-cost and no-cost mental health care, and on green flags for a good therapist. Since we published those posts, a whole bunch of online therapy resources have sprung up, like, 7 Cups of Tea. The National Alliance on Mental Illness (NAMI) has a free helpline and a ton of programming. They are experimenting with an app that offers instant peer-to-peer support. Here’s a massive list of online support groups. Maybe one is right for you.
One of the awesome Twitter people I follow made this useful worksheet for organizing yourself to find a therapist. I thought that BuzzFeed had some excellent writing about mental health last year – see this piece on how to get some of the benefits of therapy even when you don’t have a therapist, ways to make yourself feel better when you feel alone, and this piece on mental health care and race. Ijeoma Oluo is writing some beautiful stuff at The Establishment. I think this NYT op ed about how therapists need to acknowledge political realities is right on. The mental health system has many holes in it and it is not the safety net that it should be for everyone, but you absolutely deserve care, so I hope you won’t talk yourself out of receiving it.
If finding mental health services is totally out of the question right now, could you re-connect with a mentor or teacher from school, the career office there, and some of your classmates? Maybe that network can help you find the right job fit for you, and help you readjust what you can expect at the beginning. Maybe your story of panicking can help someone else know what to expect on their first day.
Whatever you decide to do, you are not alone.
You are not the only one to have a surprising and terrible adjustment period to a new job.
You are not the only one to say “Wait a minute, this doesn’t match what I know from school! How can I tell what is normal?”
You are not the only one to quit something that didn’t feel right for them!
You are not the only one who second-guesses themselves or feel like they are faking it in front of others.
You are not the only one to have a false start (or several!) who has to bounce back.
You may have burned your bridge with that employer, but if you called them and said “I am so sorry, I overreacted. Can I come back with (this adjusted schedule/workload)?” they might take you on. If they don’t (or you don’t want to) that’s okay – don’t even put that job on your resume. The interview skills and resume that made them want to hire you immediately will make you attractive to other employers, maybe ones that are better staffed and have better training/on-boarding procedures for new hires.
In the end, it’s going to be you and the patients in front of you and the work you were trained to do, one patient at a time, one appointment at a time, one day at a time. I hope you can find a way to give yourself permission to be there for them and for that work. Let yourself be a beginner. Give yourself permission to learn as you go. Give yourself permission to have bad days and to not know what you’re doing. Give yourself permission to lean on mental health care when you need to. Give yourself every kindness that you would give to a patient or a friend. Remind yourself that you are a beginner, not a failure, and it’s okay not to know everything yet.