Warning: Treat this article like an imaginal exposure exercise to a very real fear. Mindset acquired? Proceed with caution…

Let me paint a picture: You partied with your classmates, convinced yourself you’re qualified, and reached the culmination of the didactic portion of your training. You battled automatic thoughts like, “I’ll be the only person in my cohort who doesn’t match; I’ll be embarrassed; Everyone will think I’m not ready for internship; They’ll be talking about me and I won’t even know it.” You convinced yourself that you won’t be one of those people who don’t match.

You feel ready. It’s 5 AM on a beautiful morning, and you’ve been awake since 4:30, anxiously awaiting the email that will seemingly determine your career. Finally, the APPIC email arrives. You reread it to ensure an accurate understanding. Turns out, you read it right the first, second, and third times.

You did not match. It sinks in. Sitting on your bed a flood rushes in and you feel incompetent, alone, and for a moment, terrified and hopeless. How did this happen? You re-evaluate everything. Every decision.

STOP. JUST STOP.  Bookmark this article for when it’s needed. Yes, I said when. Start accepting the worst-case scenario possibility now, because here’s a sobering fact: It could happen to you. You probably won’t need this article since most people match, but a classmate might.

Not matching is real, and it stinks. I write this as someone who did not match in round one, someone who is now a proudly licensed psychologist with his own private practice (shameless plug for Sobin Psychology – www.sobinpsychology.com/nerd-therapy/ and The Nerd Therapist – follow me on Facebook at https://www.facebook.com/NerdPsychology/).

Like Princess Leia, never give up hope. You’ve got more coping skills than you think you do, and I guarantee you’re not alone. Yes, it sucks and will drain every ounce of energy for a few days. You’ll be expected to rally, as if it never happened, and apply to what seems like fifty new sites.

I was fortunate to have a cohort who were supportive of the five individuals in my year who failed to match in Phase I. Here’s what I learned.

The Value of a “Match Buddy”

Before match day even arrives, have a classmate to call regardless of the outcome. Pick someone you trust, someone who will listen and be with you, rather than sympathize with you. It’s probably best to avoid someone who will say, “I know what you’re going through. I was also really disappointed when XYZ happened to me.” This moment is about you.

Share the news with classmates if you can, even if you are ashamed or embarrassed. Scream it from the rooftops if you have to. No one likes to feel ashamed or incompetent, yet the route through shame is sharing that experience with someone else. I guarantee with 99% certainty (since we can’t even prove we aren’t computer simulations) that nearly all of your classmates have pondered how it would feel not to match, and most have had this worry or fear in their minds at some point throughout the process.

You Are Not Alone

Here’s something we all tell our patients numerous times (and something I’ve already mentioned). It’s so important it bears repeating — You are not alone. Here are statistics about match rates and just how many people don’t match.

In 2017, a total of 458 (13%) of the 3,655 individuals (including couples) who applied did not match in Phase I. [1] In Phase II, 92 (20%) of the 455 individuals who submitted rankings did not match. [2]  Roughly 144 students did not receive an internship through the Match in 2017. [3] The following year, 432 (12%) of the 3,595 individuals (including couples) who applied did not match in Phase I. [4] In Phase II, 82 (19%) of the 437 who submitted rankings did not match. [5] .

Cope Your Way through the Experience

Use your coping skills to get through this miserable experience. Do you need breathing skills to regulate your physiological arousal? Interpersonal effectiveness to ask for help? Whatever the skills, use them.

Acknowledge your emotions and give them a place to exist. Use the DBT skill of Wise Mind ACCEPTS, which means distract yourself from the intense emotions with other enjoyable Activities, doing something to Contribute, making Comparisons to other situations, making more pleasant Emotions, Pushing away for the time being, generating other Thoughts (counting to 10, for example), and experiencing other intense Sensations (like holding ice cubes). Ask, “What would I say to a friend?” and then, say that thing. It sounds silly, and it works. Validate, reflect, explore and empathize.

Treat and Distract Yourself for a Bit

Why reward yourself when things seem dire? For making it far enough to have the opportunity to match! Something should be said for making it through four-plus years of (occasional) hell.

Make a list of things to occupy an hour or two, and throw yourself fully into those activities. Exercise, see a movie, treat yourself to lunch, play basketball or an Xbox game, watch an episode of a favorite TV show. I treated myself to ice cream, time with friends, and watching Duck Tales, which is my happy place. I start humming and boom, kid in a candy store. I bet half of you can hear it now! I digress… Remind yourself even in times of distress, you deserve something for your hard work. You earned it.

Work for Radical Acceptance

Fighting reality is worse than accepting it. You did not match. Repeat that sentence aloud. “I did not match, and I cannot change this fact.” Breathe as you speak. “I did not match.” Practice the DBT skills of observe and describe – observe the situation/experience with your senses and describe it in objective terms. For example, “coffee ice cream makes the metal spoon cool, and it melts a little bit but not too much when it sits on my tongue. I experience happiness when I eat it.”

Pay attention to the emotions you feel, and where you feel them in your body. Allow the experience of feeling unpleasant emotion, knowing relief exists on the other side of the wave. Listen to signals your body sends; cry if you need to and. Pain is the body’s way of saying, “Pay attention to me and give me what I need right now.” Pain turns into suffering when ignored. Naming emotions reduces their power.

Fight Back

Having used coping skills, breathed your way through the day, distracted yourself (successfully or not), and reached out for support, you are tasked with the challenge of doing it all again for Phase II. Remind yourself you are stronger than you suspect. If you truly couldn’t do it, you would not have made it this far!

Your training director and APPIC should have a list of sites with internship spots still available, much like the list that led you to your initial sites of interest. At this point, your goal may be simply to match somewhere. Your ideal internships are likely no longer viable options, so start looking to the future.

If your match buddy is free, which they of course should be since you guys are match buddies and the best of friends, meet up and ask for their help looking through the site list. Be prepared for the uncomfortable emotions that will be triggered by starting this process again. Ask a friend for help with your cover letters, and remember that aiming for perfection will hold you back. The goal is to get those applications out there, and then be prepared to do a round of interviews all over again for Phase II.

Alternatively, and In Sum

You might decide going through the process a second time and submitting rankings for Phase II is too much of a hassle and not worth the effort. An alternate option is to seek out an internship experience on your own. Some sites have internship programs outside of the match process entirely. Your training director should have access to these lists or should, at the very least, be able to direct you where to look to learn more. I cannot speak to this, but I hope one of you humans out there reading this will have taken this route and write a follow up piece!

No matter what happens, you will figure this situation out with the help of friends, family, classmates, and school faculty. Your program does not want their numbers to drop, and they will likely do whatever they can to help you match. Remember, everyone is on your side, even when it feels like they are not.

References

2017 Statistics:

[1] Keilin, G. (2017, February 17). 2017 APPIC Match Statistics – Phase I. Retrieved from https://www.appic.org/Internships/Match/Match-Statistics/Match-Statistics-2017-Phase-I[2] Keilin, G. (2017, March 20). 2017 APPIC Match Statistics – Phase II. Retrieved from https://www.appic.org/Internships/Match/Match-Statistics/Match-Statistics-2017-Phase-II[3] Keilin, G. (2017, March 20). 2017 APPIC Match Statistics – Combined Results. Retrieved from https://www.appic.org/Internships/Match/Match-Statistics/Match-Statistics-2017-Combined

2018 Statistics:

[4] Keilin, G. (2018, February 23). 2018 APPIC Match Statistics – Phase I. Retrieved from https://www.appic.org/Internships/Match/Match-Statistics/Match-Statistics-2018-Phase-I[5] Keilin, G. (2018, March 26). 2018 APPIC Match Statistics – Phase II. Retrieved from https://www.appic.org/Internships/Match/Match-Statistics/Match-Statistics-2018-Phase-II

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Yoni Sobin, PsyD

Yoni Sobin, the “Nerd Therapist,” is a clinical psychologist who practices cognitive behavioral therapy (CBT), or science-talk for “let’s look at your unhelpful thoughts, emotions, and behaviors, and get you some more helpful ones.” Nerd Therapy integrates movies and comics into treatment. He runs support groups, provides consultation and supervision, and speaks about integration of mental health and media. He has worked in private practice and on inpatient and outpatient psychiatric units. He graduated from the Ferkauf Graduate School of Psychology in 2016, and currently runs an independent practice, Sobin Psychology (sobinpsychology.com).

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