“What If I’m Doing It Wrong?” Untangling Therapist Performance Anxiety
Dr. Lisa Marie Bobby is a licensed psychologist, licensed marriage and family therapist, board-certified coach, AAMFT clinical supervisor, host of the Love, Happiness, and Success Podcast and founder of Growing Self.
Therapists, have you ever walked out of a session thinking, “Did I help? Was that enough? Did I say something weird?” Or maybe you’ve stared at the ceiling at 2 a.m. unable to stop dissecting a client conversation like it’s a cold case file. Sound familiar? If so, pull up a chair, friend. We need to talk about therapist performance anxiety.
Therapist Performance Anxiety: The Risk of Over-Caring
As therapists, we care deeply. That’s the whole reason we do this work, right? But here’s what they don’t tell you in grad school: sometimes, that intense desire to do a good job can actually backfire.
In a recent episode of the Love, Happiness and Success for Therapists podcast, I dove deep into this sneaky, exhausting, and incredibly common experience. Therapist performance anxiety isn’t just uncomfortable—it’s clinically dangerous. When we start evaluating our worth based on client progress, we unintentionally shift the focus of the session from our client’s needs to our own fear of inadequacy. And the wild thing? It feels so justified at the moment.
You want to be ethical. You want to do no harm. But when anxiety starts scrambling your clinical judgment, you might start doing things for you—not your client. All while burning yourself out in the process.
Meet Sarah: The Everytherapist
Let me introduce you to Sarah. She’s not a real person, but oh—she’s real. I’ve supervised Sarah. I’ve worked alongside Sarah. I have been Sarah.
She’s compassionate, competent, and driven by a deep desire to help. She’s got the credentials, the CEU trainings, the bookshelves full of theory. And yet… she leaves sessions questioning everything. Was that okay? Did I say the wrong thing? What if I missed something huge?
Sarah’s therapist performance anxiety isn’t about not caring—it’s about caring so much that she starts to lose her clinical grounding. She either pushes clients too fast because she needs to see movement to feel like she’s doing a good job, or she hangs back too much, afraid to take a stand or give direction in case she gets it “wrong.”
She swaps interventions weekly, calling it eclectic—when really, it’s reactive. Her clients can sense the undercurrent of uncertainty, and it creates subtle distortions in the work. Some perform wellness to reassure her. Other clients ghost never to return.
But the root problem? Sarah doesn’t trust that she’s enough. And that imposter syndrome and fear—not lack of skill—are what’s undermining her practice.
If you recognize yourself in Sarah, you’re not alone. This isn’t about shame. It’s about awareness—and reclaiming your confidence from the grip of therapist performance anxiety.
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Therapist Performance Anxiety Can Be Ethically Compromising
Let’s also talk about financial pressure. You’re running a business. You’ve got bills, maybe a team, and definitely a calendar to fill. But when financial anxiety mixes with clinical anxiety, it can turn into therapy ethical grey zones: accepting clients outside your scope, avoiding termination when it’s clinically appropriate, or unconsciously clinging to relationships because the alternative feels like failure.
None of this means you’re unethical. It means you’re human—and possibly anxious. Check out my podcast episode on what therapists need to know about financial therapy for guidance on managing any financial anxiety that comes up.
The Coaching Crisis: Where Fear Meets Ethics
For those of us who straddle the worlds of therapy and coaching (hello, private practice clinicians expanding into new territory!), performance anxiety can also show up as massive confusion. Am I coaching? Am I doing therapy? Am I breaking rules? Is this a licensing violation? Is someone from the board hiding under my desk right now?
If you’ve ever abruptly referred out a client mid-process because they cried during “coaching” and you panicked—you are not alone. But that fear-based overcorrection? It’s not protecting your license. It’s doing the opposite.
Check out my podcast episodes on Coaching Ethics for Therapists and The Risks of Therapists Coaching without Certification to clear up these boundaries between coaching and therapy.
How to Break Free From the Cycle
Therapist performance anxiety isn’t something we can “therapist” our way out of alone. It takes reflection, clarity, and often a return to our foundational skills.
Here are a few things I recommend to every clinician I supervise:
- Know your model. Your theoretical orientation should be your anchor in the storm.
- Post-session journaling. What feelings came up for you? What choices did you make from fear vs. strategy?
- Build a professional community. Isolated therapists are vulnerable therapists. We need each other.
- Train where you’re shaky. If you’re moving into new populations or new modalities like coaching psychology, get educated and get credentialed. Confidence is competency, and competency kills anxiety.
Let’s Keep Growing, Together
If performance anxiety is making you second-guess whether you’re “doing it right,” you’re not alone. This is particularly true for therapists who are in or headed into the realm of coaching. The waters between therapy and coaching can get murky which creates ethical dilemmas that most of us aren’t trained to identify.
My free CEU training Think You’re Coaching? 8 Red Flags You’re Actually Doing Therapy is designed to clear that uncertainty. When you’re not sure where the line is between coaching and therapy — or you’re worried you’ve already crossed it — anxiety starts calling the shots. This training will help you get crystal clear on what’s what, so you can show up grounded, ethical, and effective in your work.
Even better? When you complete the training and pass the quick quiz, you’ll earn 1 CEU and a certificate — totally free. Check out the training here.
And while we’re at it—let’s not do this work alone. I’d love to stay connected with you. Come find me on LinkedIn where I share free CEU trainings, nerdy insights, and the occasional spicy debate about ethics and practice. Come say hi!
Xoxo
Dr. Lisa Marie Bobby
P.S. Know someone else who could use this message? Maybe a supervisee, a consultation buddy, or that therapist friend you always debrief with after a tough session? Send this their way. Let’s normalize the conversation and support each other in doing this work with clarity, integrity, and heart.
Resources:
Shamoon, Z. A., Lappan, S., & Blow, A. J. (2017). Managing anxiety: A therapist common factor. Contemporary Family Therapy, 39, 43-53. https://link.springer.com/article/10.1007/s10591-016-9399-1
Menninger, W. W. (1990). Anxiety in the psychotherapist. Bulletin of the Menninger Clinic, 54(2), 232. https://search.proquest.com/openview/64ac8997978c7434616e8e5ea507b713/1?pq-origsite=gscholar&cbl=1818298
Williams, E. N., Polster, D., Grizzard, M. B., Rockenbaugh, J., & Judge, A. B. (2003). What happens when therapists feel bored or anxious? A qualitative study of distracting self-awareness and therapists’ management strategies. Journal of Contemporary Psychotherapy, 33, 5-18. https://link.springer.com/article/10.1023/A:1021499526052
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