I want to be a therapist, not a social worker.
August 31, 2011 10:23 AM   Subscribe

I'm looking into earning an MSW in hopes to become an LCSW/therapist. I do not want to work in direct action social work. What can I do during my time in grad school to make myself a really good candidate for private practice?

I'm currently taking a non-matriculated course in an MSW program. Last night, my professor mentioned that only 8-15% of MSW graduates work in private practice. I don't know if this is by choice or because it's really competitive to work as a therapist in private practice.

The idea of being a therapist for people who seek my help genuinely appeals to me. I am a great listener and able to help people, often even strangers, discuss and reconstruct their problems in ways to make them easier to solve.

The idea of being a social worker to people who are forced to accept my assistance, where I would work inside a broken system, does not appeal to me.

I initially felt that an MSW degree would be the quickest, least expensive way to work in private practice. However, I am worried that I'll somehow wind up pigeon holed into direct action social work. What can I do to make sure that won't happen?
posted by Viola to Work & Money (9 answers total) 7 users marked this as a favorite
This is a fairly complex question actually, and probably differs in part based on the state you live/work in. Licensing requirements vary and are probably different in California (where I live, and my lovely wife is an MSW) and New York, etc. Some states don't require licensure to see people in a private practice, but many do.

I think one of the big reasons that many social workers don't end up in private practice is that more often than not, if 'clients' have insurance that will cover mental health services, they either only cover specific types (e.g., addiction treatment, etc.) or they have very limited allotments for the length/number of treatments (6 or 8 sessions per calendar year is fairly common I think). This frequently means very low sliding scale rates, flaky clients, etc. which along with competition make it hard to make a real living just doing private practice.

I would also throw in that it is possible to find jobs even within direct action situations or in agencies where the clients are motivated, want help, etc. My wife works with families where teens and their families are 'mandated' into accepting service due to potential legal/probation situations, and while there are certainly difficult personalities and people who want no part of it, there are also many clients, especially the kids and teens within families who are very appreciative and make good use of the opportunity.

As someone who also used to work in the social services field, yes, the system is most definitely broken. Pay is usually terrible, hours are often long and it's exceedingly easy to end up in red tape and with difficult coworkers, clients, governing agencies, etc. Having said all that, on those occasions where you can make a connection and you do get to really help others, it's awesome.
posted by BigHeartedGuy at 10:52 AM on August 31, 2011 [1 favorite]

Besides focusing on clinical courses I would suggest the following:
1) Carefully select where you do your field placement(s)--find placements in private not for profit counseling/treatment agencies.
2) Commit yourself to building specific clinical expertise in CBT and other direct clinical approaches. Get really really good at some clinical intervention(s)
3) Join relevant professional groups/associations that have members in private practice. Attend conferences/meetings focusing on clinical and private practice(as a student and then graduating professional).
4) Network Network Network--including psychiatrists.
5) Be prepared to pay your dues for at least 2-5 years before starting/joining a private practice. You need credibility and some demonstrated competence.
6) Get your independent license as soon as possible.
posted by rmhsinc at 11:00 AM on August 31, 2011

(i am not an LCSW, but my wife is)

Depending on the state you start working towards getting licensed in (each state is different) you'll almost have to work under supervision at an agency for a given amount of time. It varies, but every state we've looked to moving to, its usually 2 years of direct supervision. So do your homework on your state's requirements (and any other states you may want to live in the future, because as we're learning, starting over in a new state has the potential to be problematic) and plan on working in an agency for a while...it's just part of the game in most states. People sometimes move on from agency work when they get their license, and start their own private practice...

but to echo what Bigheartedguy said, if you're just doing private practice, you're almost certainly going to be dealing with people who have really high-end health care plans, and typically do not need the same level of care that less fortunate economic brackets need.

It's sort of a bummer that the people who get health plans that cover really good mental health coverage, typically don't need that health coverage. At least not to the same extent that individuals with no insurance in lower income brackets do.

Yeah, my wife works for an agency right now and her clients are really split between people who want help, and people who don't give a shit. There's not a ton of middle ground there, from her experience. The system, even at the agency level is pretty jacked, but it's the best that some of these people get. If you're on the LCSW track, you will be interfacing with your clients assigned social worker, and your duties will overlap, but you will not be their social worker, you will be their therapist. It's a very different dynamic.
posted by furnace.heart at 11:03 AM on August 31, 2011 [1 favorite]

By "private practice" do they mean solo practice vs salaried work? Non-hospital, non-academic, non-government? Everything that isn't casework?

Here are some institutional settings where I have encountered social workers doing ongoing therapy with voluntary patients:

--a rape crisis program (they also trained and wrangled volunteers)
--an ADHD clinic
--a college health center
--an infertility clinic
--the VA
--intensive outpatient treatment for adolescents

I also have social worker friends who do mandatory counseling at a methadone treatment center which would probably be your version of hell. There are a lot of options between that and solo practice.
posted by the young rope-rider at 11:05 AM on August 31, 2011 [1 favorite]

Thanks, all.

A few clarifications: I'm in NYC, and plan on attending a two year MSW program, followed by 3000 hours (another two years) of supervised work at an agency or government institution. Then I take the state board certification exam, which qualifies me to work in private practice. I realize it will take years to actually get into private practice, but I want to pave that path starting from the beginning of this process.

Right now I'm mainly interested in cognitive behavioral therapy, though I'm still very new to my studies.

Ideally, I'd like a job where I work in an office where I engage in talk therapy with voluntary clients. I am trying to avoid a job where I am a casework working for terrible pay inside a broken system. It's an exceedingly noble calling, but it's not my calling.
posted by Viola at 11:22 AM on August 31, 2011

I can't offer any better advice than that already offered - but did want to say that all insurance programs I have been on have covered LCSWs for private practice therapy.

I think you probably have to follow the same path other private practice therapists take and network and market yourself well. So, instead of asking how to follow that path from your MSW program, maybe ask how psychologists typically end up in private practice and make it work? I'm guessing word of mouth and referrals from other doctors is big.

I think specializing in CBT would be very wise, especially if the number of times it is suggested to people on this site is indicative of demand. There really aren't a lot of therapists that practice CBT exclusively - most say they do a range of things, or are eclectic or something confusing that doesn't really help you figure out who might be good.

Probably too early for marketing tips, but as a consumer I would value:

- demonstrated professional knowledge (can you publish? or even write blog posts?)
- a professional looking website with a photo
- you take my insurance or offer a sliding scale if you don't
posted by rainydayfilms at 2:14 PM on August 31, 2011

I notice that you're just starting out on this path. I, too, began my training program focused on private practice. The best advice I can give to you is to be open to every opportunity and let yourself experience it fully, even if you're positive it's not what you want to do. I especially recommend seeking out clinical placement at a site where you'll experience everything, like a behavioral health/substance abuse hospital setting where you might rotate through adolescent, geriatric, low/medium/high-functioning psych units, inpatient and outpatient substance abuse treatment, and a dual diagnosis (psych/substance) unit. You, like me, may find yourself startled by what really makes your heart sing.

If you really, really hate the social work aspect of social work, do a counseling or MFT program. The amount of social work that counselors and MFTs do on a regular basis is still pretty significant, especially for those working in agency settings. Even private practice therapists often end up doing SW types of things, especially if they accept aftercare appointments from people who have recently been hospitalized.
posted by catlet at 3:04 PM on August 31, 2011 [1 favorite]

In California, MSW degree holders can become registered ASWs/LCSWs, and they can be therapists (all they have to do is register and start working to collect hours toward licensure), or can also be caseworkers without being registered/licensed ASWs/LCSWs.

The "either be in private practice or be a caseworker" binary you're thinking of isn't really accurate; community mental health (county-funded nonprofits, or Department of Mental Health [etc., whatever it may be called where you are] specific settings) can be an option that pays quite well and allows you to do direct therapy with those in dire need of it. Private practice jobs right out of school aren't easy to come by, and actually don't pay that well for most interns/new therapists anyway because you are 110% at the mercy of the economy, whereas Medi-Cal in CA pays for kids' services as long as it can be demonstrated that they're necessary services, so your paycheck is steady every month. There are pros and cons to all worlds within the therapy profession, and you have a lot of time to figure it all out.

I also want to encourage you to be open to all information and opportunities, as has been said above. I know you said you're mainly interested in CBT (and I know a lot of people outside of the profession seem to think CBT is the end-all, be-all), but it is not possible to be a successful and helpful therapist if you can only "do" one brand of therapy, so you will learn many in your program! Right now, it's most important to concentrate on the learning part, not the marketing or the what-comes-next (yet!). I know it is nerve-wracking, but you will get a traineeship site and you'll learn a lot, and then you'll get an internship or two and learn a lot at those too. The time when you'll need to know what to put on your professional website is still a loooooong way off.
posted by so_gracefully at 7:07 PM on August 31, 2011 [1 favorite]

If it's your first day in an intro to social work class, consider that your professor--who has made a career out of social work--thinks that NYC has enough solo practitioners for relatively functional clients with good insurance already.

Your professor might also think that social work programs should be heavily geared towards turning out people who do social work.

This might lead to hostility or negativity towards the idea of going from their MSW program to private practice. This might lead to a subtle (or not so subtle) effort to weed people like you out of their MSW program so that they don't "waste" resources on you.

If you know people who have spent time in this program, consider speaking to them about whether or not my impression is correct, and if so, think about attending another school that might provide better support for your career goals and a better general atmosphere.
posted by the young rope-rider at 12:09 AM on September 1, 2011

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