Speech-Language Pathologist – Internship Year with an Anxiety Disorder

The Situation

Going in, I knew my Internship year was going to be hard- like graduate school, but with more real-world consequences. Having an anxiety disorder, my brain raced through thousands of worst-case scenarios. What it did not imagine was a 60+ caseload across two campuses, 30-60 minute commutes, all while being in an unfamiliar school district and state. It was not long before I felt myself unraveling. Therapy and diagnostic services took up my 40-hour work week, and I inevitably worked evenings and through weekends. I always felt I was on the back foot and couldn’t regain my balance. I began having panic attacks frequently, which would sometimes last for days. Panic attacks included sobbing, inability to fall asleep, my body being in “flight mode” constantly, intense stomach pains, and headaches.

The Flashback

I received an official anxiety diagnosis smack in the middle of graduate school, although I have had it for as long as I can remember. During my second year, I “disclosed” it to my supervisors and professors. For the most part, instead of acknowledgement, advice, or strategies, I received warnings. If I took mental health days, it would be a slippery slope and then one day I would stop showing up to work. I was warned that if I could not take care of myself, I would not be able to take care of others. Most feedback was negative, indicating I would have to succeed in spite of my mental illness, and that failure was not an option. I took this to heart and carried it into my internship year.

The Fast Forward

You can imagine my surprise when my supervisor, Phuong Palafox, asked me what supports were helpful, when I told her I had an anxiety disorder. I knew what I needed, but before I would never ask, as I internalized that action as a sign of weakness or incompetence. I also found support in another SLP coworker, and the administration at one of my campuses, which actually reached out to offer any resources I might need. I sensed I was in a different place from graduate school.

The Challenges

Working as a school-based SLP is already stressful, and an anxiety disorder can compound that. The SLP Internship year comes with its own special flavor of anxiety-inducing circumstances. I am brand new. I have the knowledge but not the experience, which affects confidence. (Imposter Syndrome, anyone?) Scheduling services in a school is incredibly difficult, and I am always worrying about meeting service hours as efficiently as possible. Remaining organized with so much work in a new system is overwhelming and I always feel I am forgetting something.

Maintaining energy to bring to sessions with my students is challenging on a few hours of sleep. As any millennial would, I turned to the internet. I tried to find pieces with specifics about tackling the first year as an SLP with an anxiety disorder. Google returned many “CF year is stressful and overwhelming for everyone” results, and some “don’t forget to do self care” tips, but nothing that targeted anxiety specifically. So what is an intern with anxiety to do? The following has helped me during my internship year so far, and might help you, too.

Know Yourself

Know your strengths. My anxiety keeps my nose to the grindstone when scheduling sessions and writing reports. I can target goals in therapy with little planning, if necessary. Know where you need support. During a panic attack, it is difficult to carry out multi-step tasks so I make checklists and flowcharts to support myself. As soon as A happens, I know that B and C must happen within the next 2 days. I have a daily, pre-loaded to-do list to make sure I do not overlook the routine tasks when feeling overwhelmed. I plan everything into my calendar as soon as it crosses my eyeballs. This keeps me from double booking and helps me plan ahead, making everything less overwhelming. If you know your triggers and you plan ahead, you can both avoid the triggers, and have a working system in place to get you through the panic attacks when they happen.

Know Your Resources

Who can tell you about processes, resources, and strategies? A special education teacher? A fellow SLP? A principal? Write down your questions for them and the answers you receive. Reach out to for feedback on your problem solving and show that you are actively working on addressing a problem or learning a necessary skill. If you feel comfortable, talk with your supervisor. Communicate openly the supports that you need. Can you get more indirect time to review procedures or intervention techniques? Are there acceptable hours outside the workday to contact them with anxiety-related questions? What are their biggest pet peeves? Is asking for extensions acceptable? What do soft and hard deadlines look like? Know these ahead of time can help reduce anxious reactions when things come up unexpectedly.

Normalize It

My anxiety is not an excuse, but it is a reality that I, and many others, live with. The more I acknowledge it, the more normalized it becomes. I show up every day and do my job, while having an anxiety disorder. It does not change my outcomes – it just changes how I go about tackling them.

Celebrate Your Successes

Just like with our students, we need to celebrate each success within ourselves. Whether that means reaching out for help, not making the same mistake twice, or taking 10 minutes to yourself for lunch, each step in the right direction shows you, YOU are doing it.

Written by: phuonglienpalafox

9 Comments on “Speech-Language Pathologist – Internship Year with an Anxiety Disorder”

  1. May 3, 2019 at 7:49 am #

    Thank you for writing this. I am entering grad school this fall and have been wondering what it will be like with my anxiety disorder and pain disorder that is linked to anxiety. I agree with all your tips. I would add that talk therapy and anxiety medication can be life-saving. I wish I had known this as a teenager. There is a stigma around medication because it can be over-prescribed, but if the disorder is real and affecting your daily ability to function or ability to be your best self, then it’s something to consider.

    • May 3, 2019 at 3:18 pm #

      Mairin, thank you for sharing your experiences. You are right–the more we talk about this, the better our SLPs will be.

  2. May 3, 2019 at 10:02 am #

    Wonderful article- I shared with graduate students!

  3. May 3, 2019 at 10:05 am #

    Great article- I shared with my graduate students!

    • May 3, 2019 at 3:17 pm #

      We are so glad Alison’s story will support the endeavors of SLPs-to-be.

  4. May 10, 2019 at 8:06 am #

    Thanks for this. I also found that a big help for me was discovered by beginning to meditate 2x per day for 20 minutes (Transcendental Meditation).

    • May 15, 2019 at 10:57 am #

      Thank you for sharing this strategy, Jordan.

  5. May 14, 2019 at 11:41 am #

    Thank you so much for writing this article. It could not have come at a better time for me as I will start my intern year in August. It was a great reminder that I can get through this just like I did with Graduate School. I would also point out that medication can be helpful as well as having a counselor/therapist to talk to if needed. We can do this guys!

    • May 15, 2019 at 10:59 am #

      Thank you, Emily. I appreciate you sharing your journey and the strategies that supported you. Yes, we can do this!

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