Pre-practicum student reflections were studied using an Objective Standard Clinical Examination adapted for social work. One hundred and nine students conducted simulated interviews and immediately wrote answers to reflective questions. Reflections were studied using descriptive qualitative methodology. Three patterns emerged: students rely primarily on their personal and/or professional experience rather than theoretical knowledge; they are easily emotionally dysregulated by intense client emotions; and they benefit from active learning to prepare for practicum. Implications for social work education include greater emphasis on simulated interview practice, explicit attention to assisting students in regulating their affective responses, and actively gauging student readiness for practicum.