This is the 1st part of a 3 -part series. 
Dorlee M, in New York blogs on Social Work Career Development. Earlier this year, she wrote in asking why I have have repeatedly stated that working in a community agency (nonprofit, hospital, or organization) is the smartest thing a new graduate can do.
Here’s 8 reasons why I believe new mental health professionals should spend at least 3-5 years gaining their clinical sea legs before stepping out into private practice.
- The clinical experience will be rich.
- Professional development is usually free in a community agency.
- Peer consultation is right down the hall.
- Shared liability in an agency reduces your risks.
- Administrative supervision is free and abundant in a community agency.
- Clinical supervision at no additional cost will position you for greater success with your clients.
- Community resources abound in agency settings.
- Opportunity to foster community relationships will pay dividends down the road.
Not sure what I’m talking about? Check in on Wednesday for Part 2 of this post as I explain. And, if I’ve left off other benefits to working in a community agency, feel free to add them below!
The second part of this 3-part series can be found here.
I agree that working in a community agency is a great start, though some agencies cannot or do not provide free clinical supervision as required for licensure. Again, depending on size and budget, they may or may not give what you need for professional development hours. One thing which you did not spell out, though it falls under “rich clinical experience,” is that you will work with a truly amazing variety of clients with an astounding variety of problems and circumstances. This is particularly true if your agency has you work with both children and adults, but, I believe would be true in any case. Just when you’re thinking, “I’ve seen it all,” you discover that you have not! It’s like being in one setting, but getting experience with dozens of different areas of mental health. This can only make you more competent (than you were already) to handle most of what might come to you in private practice and also train you to look for things which possibly might be otherwise unexpected and unspoken.
Susan! It’s so good to hear from you again! Thank you for taking time to drop in here to share your insights. It sounds like you just may have done a stint in non-profits yourself. “I’ve seen it all” really is a great way to describe how you feel after a year or two in an agency!
I hope you’ll drop back in to chat again soon.
I’ve have completed practica and paid work experience in clinical positions in a community mental health center. The experience was rich indeed, and the opportunity to see a variety of clients with a plethora of different presenting issues was great learning. I say that I got my “sitting in” experience from this work, as it involved working with individuals with severe and persistent mental illness. I was able to witness what a psychotic episode looks like, what it feels like to sit with someone who is actively hallucinating, what tardive dyskinesia actually looks like, etc. I was also able to witness the clinical “gaps” at the agency where I worked, and if given the opportunity to work there again, I would take that opportunity and try to fill some of the clinical need that I saw there. I highly advise others to get this kind of experience.
Samantha! WElcome back and thanks for dropping in to share your experiences. It makes our community so much richer to have your voice here! What a fabulous experience you have had seeing the extreme end of mental illness! And, your point about the gaps . . . the many, many gaps in community mental health are heartbreaking, too.
So glad I’m not the only one singing the praises of the rich experiences you get when working with community mental health. It was where I gained my most important clinical skills and where I was able to build a strong network to support me in private practice.
Samantha, do drop back by soon to chat!
I will say that my experience in community mental health, non-profit and for profit agencies have been rich and educational. I have worked with some tough and interesting cases, and making the change to private practice I believe I will always use my experience, because you never know who will walk in the door! Also it gives you more of a chance to figure out your niche, and experiment working with different folks, and learn what to do and (not do!).
Hi, Jill! Thanks for showing up to chat! One of the things that I didn’t address in this post is that some of that education comes in learning what not to do. I’m thinking that you and a lot of others can probably speak to that piece of learning, too!
Congrats on that move to private practice! I’ll be interested in hearing how your experience in community mental health continues to inform your decisions in private practice. Drop back in soon!
YES, I completely agree on all points. I spent four years doing agency work with my BSW and then went back for more agency experience after my MSW. I’ve had many levels of engagement with agency work. I would add that:
-In addition to a rich clinical experience, you get a rich introduction to working with multidisciplinary teams, learning the lingo and the approach from many types of professionals. Social workers, medical personnel, law enforcement, courts, psychiatrists, political folks, etc. It helps broaden your skills and learn how to collaborate (to nourish those networks).
-Along those lines, you may have an opportunity to do more than just clinical work if your agency is small and underfunded (which ones aren’t?) I have had the chance to coordinate volunteers, do marketing, write grants, and get my feet wet with many other things that will come in handy later. This also helps you multitask brilliantly!
-This benefit is kind of sad to think about, but it really helps to learn from others’ mistakes. You do see more on a day to day basis and you get a chance to see mistakes being made or approaches that wouldn’t work for you. While you always hope that no one is harmed through a mistake being made, you get to hear about the file audit that went horribly wrong because this person did not take confidentiality seriously, or the person who’s files worked against them in some other way. You can share clinical missteps with one another and come up with a better approach. While you can share that kind of stuff some with consultation groups, the richness of the demands and level of transparency in an agency give you a lot of opportunity to learn. I believe this has given me a greater level of adherence to “best practices” in many areas simply out of the fear of ever being in some of the situations I’ve seen!
I think that the idea of private practice is alluring to many who romanticize the perks while neglecting forming a solid foundation of clinical, administrative, and other skills. I used to cringe when new graduates in supervision announced that they were going in to private practice straight away, sort of as a proclamation that they were bypassing something needless by not working with an organization. I wish them the best, but I know they missed out.
Thank you!
Kat
This is so true. I am right now considering my options before graduating I had it set in my mind community but I’m not sure.
I didnt enter grad school for clinical counseling until I was 48! Once I received my Masters degree, I spent my first five years working for a community agency before opening my own practice. You are absolutley right…it would have been even more of a struggle to get my practice established had I not gone through the learning experience of working for a community agency. Both now and then, I am a provider for most insurance plans. In learning the ins and outs of working with insuranace plans and their requirements / procedures saved me countless hours and dollars. Great subject. I’d be interested in hearing more about what other services practitioners offer to expnad their revenue sources. Keep up the great work,
Jim Baer, LPC, NCC, NBCCH,
owner, Changing Habits, LLC
Hi, Jim! Thanks for dropping in here to chat. OK, so you really were a late bloomer! How cool is that?!
And, yes! I completely forgot how much I learned about working directly with insurance from my time spent working in community mental health and psychiatric hospitals, too! That’s where I learned how to get approval (or lose approval) for additional sessions with my clients, too. Sometimes when I look back on those days, I really think I should have been paying them for the education! At the time I worked in some of those settings, I remember feeling frustrated that the pay was so minimal and the work was never-ending. But, it was also exciting and mentally challenging and even then I knew that I was learning much more than ever before.
Jim, I appreciate you taking time to mention what you would like to see future posts focused on. That’s extremely helpful to me. “Other services” to expand revenue sources . . . . Got it! It’s in the tickler and . . . of course, for any of you that are reading this, I’m always happy to have you pitch your ideas for guest posts here at Private Practice from the Inside Out. You can check out Guest Posting Guidelines for further information.
I agree! Working at a non-profit taught me who my ideal client was which will help me in defining my private practice. I was very lucky to find a full-time psychotherapy position where I get weekly supervision. Plus I get to learn the business end of things (billing insurances, processing private pay, marketing, etc.) from watching the administrative side of things.
Hi, Liza! Thanks for including your voice in the mix here! I’m not much of a believer in “luck” but other than that I’m right there with you! Learning about billing, insurance, private pay, and marketing put you at a HUGE advantage over your peers . . . and with an eye toward the future . . . a few years of not-so-great-pay will come back to you in spades once you are in private practice! Good for you!!
I love this topic and preach it to others all the time! I can always spot the difference between those therapists in private practice who served in the trenches and those who did not. I spent almost 4 years working in a government community mental health setting prior to private practice. I learned many lessons from what to do when an actively psychotic client becomes suicidal to giving presentations on mental health topics to the general public. Also, you forgot another advantage with these types of positions, you get paid even if the client doesn’t show up:)
Oh, Aaron! You are so right . . . about getting paid whether the client shows up or not AND being able to spot those who took the shortcuts! I have a colleague that chose social work as her second profession. I can’t tell you how many times she has claimed that her years in her first profession provided “more than enough” experience to replace time in community mental health. Although she states it with pride; it falls on others’ ears as a statement that, in my opinion, amplifies a deficit in her professional experience.
Thanks for taking time to drop in today, share your thoughts, and remind me of one more advantage to add to the list! I’m so proud of our online community here. Every one of your voices makes this a rich and vibrant resource for mental health professionals around the world.
Funny, this topic reminded me of Grad School. I saw 20-23 year olds doing Masters Programs, planning to be “Administrators.” It sounded rude at the time, but I told one I wouldn’t hire her for such a position, because she didn’t have any experience in the work and wouldn’t have enough credibility for me! I also notice those who’ve never worked in community MH/SA, government, etc. It makes me so grateful for my experiences as I would not be the Therapist I am now. As others noted, nothing surprises me, and I meet the most Interesting people in my community!
I love my chosen work!
Hi, Stacey! It’s so nice to see you back here! It’s been a too long! I’m laughing at your reference to those administrators-to-be! What a picture. I’m sure that it’s hard to hear that “you don’t have the experience I’m looking for” but what we sometimes forget is that the people in charge have a responsibility to their clients and their boards of directors. It only makes sense to hire those with a depth of experience. Thanks for the excellent example of why every mental health professional can benefit from a stint in community mental health!
I hope to hear from you again soon!
In theory I would say I agree but it has not been my experience. My first two experiences as a therapist have been a disaster. I have not received any in-house supervision toward my licenses. In fact, my first supervisor only had an associates degree. My next supervisors had no licenses of any kind and one was a newer graduate than I was. These supervisors typically relied on me an other co-workers for clinical advice and guidance. I have had my license and career threatened by superiors in multiple locations when I pointed out unethical activities. Additionally cuts to funding, limited supervision, and unmanageable caseloads (my last job any active caseload under 70 plus two groups was considered small–these are for hour-long appointments) are contributing factors to some of the brightest minds that I graduated with already being out of, or considering leaving, the field. The community mental health center attributes listed above simply, in my opinion, are not true. I believe they were true, once upon a time. But they are not today. Five years in the community mental health agencies I worked is neither realistic nor healthy.
There is no denying that the clinical experience is awesome. It provides a chance to try almost anything on for size. It certainly contributed to my career in a big way. But, truth be told, community mental health has crippled or aborted the careers of some of the most caring, driven therapists I have met. It would have taken me if I had not made a serious, cost-ineffective change.
-Lem
Hi, Lem! I’m so glad that you have dropped in and spoken up! You have pointed out how important it is to actually interview and check out potential working environments. There absolutely ARE lousy places to work and incompetent people to work for and under! Community mental health is certainly hard work and the work is never done. (I, too, remember caseloads of 70+, hour-long appointments, and running multiple groups.) However, patterns of unethical practices are never OK and, Lem, congrats to you for apparently choosing to leave those settings rather than indulging them!
It occurs to me, Lem, that you probably learned way more about the dark and difficult sides of the business of mental health as well as the clinical end. I didn’t mean to say that you would just learn about the light and goodness of the work we do. It was for me . . . and, apparently for you, too . . . a reality check . . . about money and marketing . . . about severe mental illness and broken down systems . . . about needs greater than any one institution can meet . . . about ethics and legal limitations . . . and, mostly about me . . . and self-care . . . and where I was and wasn’t willing to draw the lines.
Working in community mental health – in a hospital, agency, or other organization – can be a really big adventure . . . and it can at the same time be a really difficult journey. And, Lem, you are right on target . . . there are many folks who get their Master’s or Doctorate degrees and think, naively that they can hang their shingles out and make a six-figure income seeing the worried well. However, I contend that until you have some experience with a broad spectrum of mental health experiences, you just aren’t ready for private practice.
You mentioned that you made some changes. Anything you can share with us that might help others to make some positive changes,too?
And, thanks so much, Lem, for adding a different perspective to our conversation here. I hope you will come back often and speak up again!
Yes, Lem is right in many aspects. I’ve seen similar things and have had quite unreasonable expectations placed on me at times. I think attrition is a fact of the field, and situations like this may hasten the departure of some. But those of us who stick around and get creative, figuring out the tough questions, are rewarded with battle scars and wisdom to do things differently. That’s why I’m a new addict of Tamara’s blog because without mentoring and community, no one would know that things could be different, and that there are supervisors who care and you can go find them. And we can all be supportive to those in whatever battle they find themselves in.
Kat, you’re talking about tenacity and persistence . . . about problem solving in a complex world. That is the world that we live in and it does require us to be ferrets of sorts . . . ferreting out the the good from the bad, the useful from the useless.
I’m not much of a fan of war analogies . . . mostly because I don’t really care to fight about much. But, the truth is that we can look for the easy path or we can look for our own right path . . . sometimes those are one and the same . . . and sometimes they are not. Shopping analogies work better for me than the war analogies. And, I advocate serious shopping . . . for internship and practicum sites, mentoring and supervision, and most other things related to the mental health professions. Not all Master’s degrees are equal and neither are all therapists. Before we can teach our clients how to get out of the maze, we have to be willing to learn how to get out of the maze ourselves.
I’m on the same page as Lem. My clinical experience fresh out of graduate school was not a positive experience. I had to chase down my supervisor for our weekly meetings, most of the clinical and administrative staff had been at this facility for years and the apathy was rampant. The clients we served were a very difficult population to work with but I enjoyed that challenge. I learned more from the clients than I did from my colleagues. Fortunately I was only working at this facility part time and was also employed in a private practice setting where my supervisor went above and beyond my expectations. Without her encouragement I wouldn’t have lasted as long as I did at the other facility.
Hi, Pam! Oh, yes, I think you and I have chatted about that hard start you had before . . . . It sounded grueling. Obviously you had the fortitude and the will to get what you needed and to move on. It’s not an uncommon story and, I think, as disillusioning as it is for some to hear, it’s also invaluable, I think to new professionals who feel isolated and confused by the hours and expectations that can exist in many mental health settings.
I have a colleague, Marguerite McCormack, MA, LPC who speaks eloquently about the way mental health professionals – especially entry-level mental health professionals – are often mistreated and abused in sick mental health systems. It’s true. We have some very dysfunctional systems out there. My point is only that therapists are by and large better trained and better equipped clinically and business-wise if they have spent some time working in an institution – public and private – before jumping off into private practice.
Thanks, Pam, for underscoring the good and the bad and having the determination to make your way to survive in this field. We need more mental health professionals willing to ferret for the good stuff! It’s there!
Hi Tamara,
I have seen you blogging for years now. I am excited to finally share some of my comments. I so agree with you Tamara. New therapists do need wide a variety of experiences, and agencies or community mental health centers are the place to get these rich experiences.
Now, I have just finished my graduate school in July and have been searching for a position at an agency since then. So far, I have not been lucky with my job search. Because of that, I have been thinking more about opening up my private practice. Completing a post-graduate certificate at Denver Family Institute, having an awesome quality supervision, and developing my niche, one would think that I should be ready to open my practice. That; however, is not the case. I think that all of the 8 reasons to work in an agency before going into practice are extremely valid, and in a way, they all come down to confidence….specifically, therapist’s confidence in his/her own capability to perform.
Working in an agency can be rough; however, the amount of self-efficacy the therapist gains after working in a environment like that is invaluable, not only for the therapist himself/herself, but also for the client, who will pick up on therapist’s confidence.
Hence, as frustrating and discouraging as it is for me to look for a job at agencies that are unable to take care of their employees, I want to believe that, by doing so, I am just that much closer towards opening up my own practice.
Hey, Marta! It’s so good to finally get have your voice here! Thanks for dropping in and thank you so much for your support of Private Practice from the Inside Out! Community mental health work does help build your confidence for sure! I know it really is difficult to do the job search thing day after day! (My fix-it brain kicks in here and I want to start saying “Have you tried X?” and “Have you thought about Y?” Trying not to go there, though, because, of course, that is not why you are dropping in here today.)
Marta, I know you are going to ROCK in private practice but I also know that you don’t know that YET. So, I’m grateful to get you into an agency for a little while longer. And, to get you there . . . I won’t try to fix it for you but I will remind you and others who are in the job market to ask yourselves these questions . . . .
What’s your plan? You need a plan to market yourself and get that ideal job.
Are you networking effectively? And, how do you know?
Are you networking online?
Are you networking face to face?
Does everyone you know (and everyone they know) know that you are looking for a job in mental health?
Having your resume on the computer at home alone is not going to get you a job. People have to know about you in order to interview / hire you. If you need support, get it . . . from friends, family, faculty, or hire me. Don’t just fade into the walls. You’ve trained, you’ve experimented, and hopefully now you’re a good deal waiting to happen for the right community mental health agency.
If I or anyone else in our online community looks like we might be of use, please don’t hesitate to call. Marta, you will find lots of support for you and other new graduates here among our online community. However, we can’t support you if we’ve never heard your voice or met you. Don’t be shy! Drop in to chat often – and don’t be surprised if you new boss and colleagues-to-be are hanging out right here looking for their next employee!
Tamara,
Thank you for the great response Tamara. I appreciate the questions that I need to ask myself. These are all valid questions, and I am sure that my answers would be extremely helpful in my job search.
How would I know that I network effectively?
Ooooh, Marta! You ask a really good question! I’m sitting here asking myself if I should answer that here or in another post . . . . I think that is what I am going to do – answer it in a blog post so that the information is more easily accessed. Stay tuned . . . a new blog post coming soon!
I am so glad to find this site. I’ve been fortunate to have a wide variety of adventures in both public and private settings. I’m currently working with a Psychiatric NP, developing our business, and mostly I focus on not doing the things I didn’t like others doing! So, whether its ethical clinical practices, or business practices, or even attitude about clients, we’re working to be “A new Option in Behavioral Health” for our community.
I had worked as a UM Clinician for a BH Company, which has been useful in numerous ways- language of insurance, Brief Solution Focused therapies, getting on panels, claim submissions, etc. Very few providers here take insurance, and I choose to take all. Crazy? Maybe..Maybe not…
Anyway, I’ll look forward to participating in this community.
Stacey, I’m just now scanning old comments and discussions from 2011 and ran across yours here. Not sure how I missed it for over 2 months but just wanted to say that I appreciate your presence here in this community and your contributions to your discussions, too.
I have been working for a community mental health organization (non-profit) for two years and I really do not like it. I feel as though I have spent the last two years on fire, running around constantly. The volume of paperwork and documentation that is expected of me in a very short period of time is unmanageable. While my caseload has provides me with solid clinical experience, I have not truly been able to process or learn from this experience in a satisfying way due to the constant stress and demand that I feel comes with the territory of working in community mental health.
Hi, Amie! Welcome to Private Practice from the Inside Out! And, thank you for doing a stint in community mental health.
I can so relate to your situation. In the beginning of what is often our first job(s) in mental health, we often begin in agencies that are under-funded, under-prioritized, and often mandated to provide clinical care to clients while providing clinical training to new mental health professionals. That was certainly my experience in public mental health. If your workload is like mine was, you are likely never to find yourself completely “caught up” on your paperwork and constantly putting out fires, looking for resources, etc. It’s important for you to realize that this IS the nature of our dysfunctional mental health agencies. It sounds as if you have gotten a that clinical base that you needed and it may be time to consider moving on to a new setting.
When I left Tarrant County (Texas) Mental Health in the 1980’s, at my exit interview I explained that I was leaving because I could earn 30% more money elsewhere and that I did not see a career path of upward mobility. I was also tired of not ever being caught up on my work and felt that my contributions of staying late and coming in early were increasingly taken for granted. The human resources professional I spoke with said “We don’t expect you to stay here over 5 years. We think of ourselves as a training ground and know that you can make more money elsewhere.” I appreciated her telling the truth but would also have liked to have known that going into the job.
Community mental health is so important . . . to new professionals as well as assuaging some of the clinical needs in our communities. However, it’s rare to find an agency setting that does not use up and burn out the creativity and optimism of new professionals. As harsh as it sounds, my advice to any new professional is to do your stint in community mental health and then move on unless you have the stamina to work long term on initiating change from within the organization.
I just graduated a month ago with my MSW and am looking for my first job in the mental health field. I am in my 40s. My previous career was in a technology field, but rapid advances in technology have now automated most of what I used to do, and my skills in that field were so specialized that they were useless for other applications. So I am now starting out all over again, in a new career mode. I chose social work because I have long been facinated with human behavior and relationships, and because I enjoy helping people—particularly helping them to find resources that they need. I did a couple of years of volunteer work at a community agency prior to going back to university for the MSW. As part of the MSW program I did two internships, one at a substance abuse recovery clinic and the other at a community mental health agency. In my role as a therapist at the community mental health agency, I often felt ill-prepared and rather incompetent in conducting individual therapy with clients who had schizophrenia, schizoaffective disorder, bipolar disorder, and borderline personality disorder. I rarely got a sense that the therapy was “progressing”, and it felt distressing to have to complete post-session progress reports that specifed me to rate progress gained during that session for EACH of the client’s therapy “goals.” It puzzles me why students and new grads—-budding professionals with the least amount of experience—-are paired with clients suffering from the most complex and difficult mental disorders. I currently feel sheepish (and somewhat ashamed) to admit that I feel a waivering sense of confidence in my capabilities to effectively treat people suffering with mental health issues, even though I know I am an excellent listener and am empathetic. Through my internships I have also observed that the “clients” who are most effectively served by these agencies are the funding sources, not the people suffering from illness. In our fee-for-service system, agencies are incentivized to do strange maneuvers (such as taking in new referrals even though existing caseloads are so large that clients cannot be effectively served) in order to take in more funding. Frankly, I now wonder if I made the right decision to go into social work as a new career move, and I feel hesitant to apply for a job in community mental health.
Hi, Dave! Welcome to Private Practice from the Inside Out! I’m so glad you took time to introduce us to your journey tonight. What I know is that the mental health professionals that I worry about are not the new ones who are second guessing themselves or even the ones who feel completely clueless when working with clients who have serious mental illnesses. What you may not realize is that individuals with the symptoms that you are describing are at the extreme end of the spectrum when working with mental health. It’s crazy, isn’t it, that our profession takes the least experienced and least informed in our field and give them their first experiences with those individuals that we all have the most difficult times working with and have the least success in helping?! Some might call that insane!
On the other hand, I wonder what you (and others) might have learned through your experiences in agencies and clinics . . . . I suspect you’ve learned a lot. We all question our abilities to effectively help clients when we are faced with new situations / problems that we are not familiar with. While your waivering confidence is normal, I would encourage you to put it in context and also remember why you chose social work – rather than counseling or psychology.
You said . . . “I chose social work because I have long been fascinated with human behavior and relationships and because I enjoy helping people – particularly helping them to find resources that they need. Those are perfect reasons to pursue the profession. You just need to be clear that you aren’t looking to provide therapy; you’re looking to work with clients to help them find resources in your community. There is a huge need, Dave, for those interests and those skills.
You might consider researching potential employers at first by volunteering with them. That would enable you to see first hand where those with your interests best fit in the agencies. I hope you’ll stay connected with us here at Private Practice from the Inside Out. I’ll be looking for your voice!
Hey, Dave – here’s a link to a post that will tell you how to set up your own little gravatar (that tiny picture of you that shows up next to your comments).
I wish I could say the same about my recent years in a community based not-for-profit mental health center. I am no longer there but clinical supervision is not free. If you leave with a year you will be charged for it. Another downfall of “the agency” is that supervision cannot be truly open and robust due to the hierarchy of positions in said agency. Finally frequent turnover and significant role confusion “educate” you in a way that eventually must be corrected. I had some amazing colleagues but they leave if they are good because agency work takes too heavy a toll on one’s own mental health and burnout is blamed on the individual rather than proactively addressed by the system itself.
Hi, JB! Thank you so much for dropping in to share your experience!
That is so valuable to less experienced therapists that are just entering the field.
I’m so sorry to hear that this was your experience.
What do you mean when you say “If you leave with a year you will be charged for it?”
I don’t understand.