Okay, back on track

The last two weeks have been tumultuous. I accepted a job in a field that is not directly related to mental health: I hadn't had any luck with social service agencies in the area, and it was time to start getting some paychecks. The job is a research position in the field of education; I'm still kind of bummed about this step, as it feels like I'm moving away from what I want, not towards it. This is more symbolic than real - I know I can always leave after six, twelve, or 15 months when something more relevant comes along - but can symbols still have a strong hold on our ideas about ourselves.

But I've come to some acceptance about this step. Now I need to make some progress on my practice: The whole point of taking this job (besides not becoming homeless) is to have the financial stability to move ahead with my licensure and with my private practice.

My current goal is this: By the end of the year I will have saved a decent amount of money; I will have 4-6 regular clients (I'd be happy with 4) on one day a week (and maybe an added evening); I will have made a number of mistakes and corrected for them, thus learning what I need to learn about what works and what doesn't, and honing my business into a well-functioning practice. Then I'll only be 4 months or so away from getting my license. I'm hoping that, around 2013, a promising part-time agency position will open up somewhere. I like the idea of working at a mental health center for 2-3 days a week and doing my private practice 2-3 days a week.

My plan of 'opening shop' by February 1 is looking like it needs scaling back. I still need a supervisor signed on, then I need to file the forms with the Dept. of Health. I need to write my blurbs, website, etc.

But as long as I take it one 'action step' at a time I think I can move forward. Stay tuned!

Running out of steam...

Last week I made a lot of progress... this week I've been running out of steam. This is in part because of my potential job. I mentioned in the last post on 'progress' that I'd gotten a job. It's not a job I particularly want, but it would give me financial stability as I start up my practice. I originally wanted to work 3 days/week, but they pushed for four. This would only leave one weekday (probably a Monday) for my practice, and maybe a weekend day.

I'm still in negotiations over salary, but I've found that my spirit is already somewhat broken, at least temporarily. I'm afraid I won't have the time or energy to really focus on my practice the way I'd like, and there's something about being forced to sell your time for money that just squashes the soul. In that mindset, it's hard to put a lot of energy towards something that feels like it's going to get pushed aside.

This job would entail some travel, and while they agreed that I could request to not travel on the day I have free for my practice, there's always a chance when they will "make" me go if it's an emergency; or, I might have to be in Nebraska on a Tuesday morning, and need to travel Monday night. This would seriously mess with my practice schedule if I have sessions on a Monday evening.

What to do? I think I still have to take the job, but I'm nervous. Maybe I should consider just doing my practice on a Saturday. I wish I knew if there was much demand for therapy on a day like that. Does anyone know? Where would I find out?

Also, my supervisor - the one I was really happy about finding - fell through. I have some more options, but I haven't had the energy to contact them - I need to find out what my work situation will be first.

So, that is all. Oh, and my business license came in the mail. I taped it to my office wall, and I also went to the thrift store and bought an in-out box. So that's progress, right?


At times like this, I wish I were independently wealthy. I recently saw, randomly, on Facebook, that the mom of an old class-mate had gone into private practice late in her life (all the kids in their 20s and 30s). She can rely on her husband's work and just take it up as 'lightly' as it were.

Not that I'm suffering - I'm very lucky overall. But I have to make sure my family has insurance and enough money first, and in this country that involves working in a salaried position. (remind me to make a tangential rant about insurance in this country, even though it's been made a million times; in brief: This country's healthcare system is fucked up!) My point is that it would just make things a lot easier if I could focus on my new business 100%.

I'm hoping once the job is worked out, or not, I'll feel more able to really focus on the business again - hopefully in couple of days.

Two online resources for private practitioners

So, as I said in my last post, a pretty good week overall. One more positive: I found a couple of good on-line resources that I'm surprised I didn't uncover before.

• First: Private Practice Blogs, which is basically an aggregator of other blogs on private practice. I haven't had time to check out the blogs they link to, but request that this blog be listed there!
• Second: Private Practice from the Inside Out. Wow: A treasure trove of articles about the nuts and bolts of a private practice. I haven't had the time or energy to read much there, but I can tell that I'll be making a lot of use of Tamara Suttle's know-how.
• Third: Mental Health Pros Lots of tips for private practice.

I will note, though, that as far as I can tell these blogs and sites don't focus specifically on the challenges of starting from scratch (I've found this to be the case with many of the books I've check out.) I'm sure if perused the archives I would find some good info on that. For instance, Tamara Suttle has a number of posts on insurance, preferred providers, etc., but I still wonder if as a LICSW-Associate (i.e. pre-full licensure) there is any way to accept insurance. My gut feeling is that the answer is 'no', but I'd like to know for sure. Maybe I'll ask her when I get the chance...

Progress and Procrastinations

I'm happy to report that I've made some important progress in the last week. I've also had a few steps I've been procrastinating on.

Progress:

• Made some progress with my website design (using WordPress templates for now - pretty easy, but I don't love any of the designs), and had a couple of friends look it over
• Registered new business (sole proprietership - why? I'll try to write about that a bit later), and received UBI (but not the license, yet), which is the business ID I need to set up a business account at my credit union
• Almost opened my business account - I went in and got all the info, but, since I want my wife to be a partner in the sole proprietorship, and since she's on the license, it turned out I couldn't open the account without her present. But that should take 5 minutes - hoping to do that before Friday.
• (Side note: The main reason I want a separate business account is so I can put all my expenses on one card, which will make bookkeeping a lot easier I hope.)
• I confirmed (per my most recent post) from the WA DOH that I CAN have a supervisor who is NOT an LICSW - more on that later.
• Which brings me to: I think I found a great supervisor! It was based on a professional recommendation. We're not officially signed on yet - she's still checking on availability and details, but her background, focus, theoretical orientation, are great matches. Once we meet and make sure we're a good fit, I'll be really relieved because I was not looking forward to shopping around
• (Side note 2: I already emailed several people, but they are on hold for in case my current favorite falls through; for the record, this seems to be a good place to find supervisors in Washington State).
• I emailed several people about office space; one person required a 2-day/wk commitment, including a Saturday; another one caters to new practices, lets you rent by the hour, has family and play facilities, and is in a decent, although not great, location. I'm hoping to visit their site next week.
•   (Side note 3: I used the Counseling Seattle Office Space Page)
• Oh, yeah, and I got a part-time job! I'll discuss that later, but I'm generally very happy about this development. It will put me and my family on a solid financial base, and I can start up my practice as slowly as I want, without feel pressure to make it grow faster than I feel comfortable.
• I also went to the store and bought a bunch of office supplies

Okay, on to what I haven't done. Looking over my to-do list and action-step list, I see a few things that I am clearly resisting... 

Procrastinations:

• Everything to do with writing content for my website and 'listing blurb' (is that what you call it?)
• Why do I resist this? Despite being a therapist, I have a deep aversion to therapist language on websites - it just sounds fluffy, self-promotiony, and so on. How do I write something that is 'me' but also will attract strangers - basically, customers? It's much easier to do other things.
• Also, I'm not quite out of the closet about my 'theripality' as it were. I have relatives who look down on therapy, or think it's crap; others maybe think, "What, Justin's a therapist?" This boils down to self-confidence, of course, but it's projected on others. How will I feel when my uncle or father-in-law or high school friends read my website? Can I take myself seriously and ignore what others think? Does part of me secretly think therapy is a load of crap?
  Here's a question for readers: What are the best private practice therapist sites you have seen?
• Fill out LICSW Associate application form
• There is a simple reason for this: I didn't have any printer paper; now I do, so I might as well get it filled out - especially the form I need my new supervisor to complete.
• Come to think of it, maybe now's the time to have my OLD supervisor fill out my hours - that way I won't have to worry about him dropping off the face of the earth.

Next priorities on my agenda are:

• Finish opening business account
• Start writing content for my website and blurb
• Make sure I have a supervisor and meet with her
• Check out offices

Licensure: Seems like it should be simple enough...

One of the issues that feels like a road block for me is obtaining licensure. Typically, in this day and age, we obtain our license over three years (at least in my former state, and my current one) at an agency. New York State now actually requires this - i.e., you can't hire a supervisor to supervise you outside of an agency setting, so there is no way to open a private practice until you work for three years in "psychotherapy setting"; then you take the test and get an LCSW (Licenced Clinical Social Worker), which allows you to practice privately, or not. This is a controversial issue - at least it was when I got my MSW - but I won't go into it now. Currently I am living in Washington State, and I want to get my LICSW (Licensed Independent Clinical Social Worker). I have two years of experience in New York that I want to transfer, then I have to get the rest of the hours completed, take the test, and I'm done! In the mean time, I have to be a "licensed social work associate-advanced clinical" (which is just a terrible string of words) in order to practice. The "Associate" essentially means "Under supervision".

My original plan was to go the standard route - get a job in an agency and work for another year or so to complete my 3 years. However, I haven't gotten a job in the last few months, and I can't just wait around going broke, so I'm starting a private practice without my LICSW (hence this blog). This is perfectly legal in Washington, as long as I am under the supervision of an LMHP (Licenced Mental Health Professional) who is an approved supervisor. (Note: Washington has two types of SW licensure: LICSW, and LASW, but for the life of me I don't know why LASW credential exists; maybe a reader can illuminate me in the comments... Meanwhile, everything I write applies to LICSW, which is what you need to practice privately.)

Okay, that should be simple enough, and maybe it will be, but I'm having a hell of a time parsing the law to figure out what, exactly I need to do. First, let's take a look at the relevant legislation (with my highlighting):

(2) The following are the supervised postgraduate experience requirements for the social worker applicant's practice area:

     (b) Licensed independent clinical social worker. Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of four thousand hours of experience, of which one thousand hours must be direct client contact, over a three-year period supervised by a licensed independent clinical social worker, with supervision of at least one hundred thirty hours by a licensed mental health practitioner. Of the total supervision, seventy hours must be with an independent clinical social worker; the other sixty hours may be with an equally qualified licensed mental health practitioner. Sixty hours must be in one-to-one supervision and seventy hours may be in one-to-one supervision or group supervision. Distance supervision is limited to sixty supervision hours.

[Pause; let's discuss]

I've color-coded the relevant requirements, and will parse each one below:

• Green: Minimum of 4,000 hours of experience - This should be fairly simple: If I work at an office, 40 hours per week, I will accumulate 4,000 hours of work experience in 100 weeks, or about two years (counting staff meetings; chatting at the water cooler; and surfing the net in my office). What, though, does 'experience' mean for some one working as a private practitioner under supervision? What do I count for hours? If I count just client contact, I need to have a very full load of clients. Can I also count planning? Scheduling? Administration? Paperwork? Who knows? And, maybe more importantly, who decides? 
• Blue: 1,000 hours of direct client contact - This is pretty clear too. I essentially need to sit down, face-to-face, with clients, for 1,000 hours - more or less, have 1,000 sessions with clients. Okay.
• Yellow: Over a three year period - I THINK this means that I can't cram all 4000 experience hours and all 1000 client contacts into a whirlwind 18 months and get my license, the presumable, and understandable, rationale being that I would be so overworked that I would not learn much or do much, and that it takes three years of growth to get to the point where you can do things on your own. But I could be wrong in my interpretation. "Over a three year period" could mean I have to get all my hours done within a three year period. Hmmm...   
• Orange: Supervised by a LICSW - This seems to suggest pretty clearly that during all 4,000 hours of experience, all 1,000 hours of client contact, and all three years, I must have an LICSW as a supervisor. Right? Well, look at the next section...
• Purple: With supervision of at least 130 hours by a Licenced Mental Health Practitioner; of the total supervision, seventy hours must be with an independent clinical social worker; the other sixty hours may be with an equally qualified licensed mental health practitioner. ["Licensed mental health practitioner" (LMHP) is a more general term that includes licensed psychologists, psychiatric nurses, psychiatrists, marriage and family therapists, etc.] Wait a minute... I thought they just said all of my 3 years and 4,000 hours needed to be supervised by an LICSW? So what the point of saying that some of my supervised hours can NOT be under a LICSW?

This last point isn't just a technicality: I have received some good recommendations for supervisors, but they have MAs, not MSWs. I don't want to find out, after applying, that, ooops, no, those hours do not count! So how can I be sure? (my concern may be prompted by my experiences in New York, where some SWs I knew worked three years at agencies, only to find out that the work they were doing did not count as "psychotherapy" (it was school psychology, or case management) and they had to start from scratch. (Just to make clear, I don't think licensure requirements should be loosened; I only wish it were more clear what was required).

All this is to say that I've been pretty confused, but I haven't found any info online that would help me. Even the otherwise very helpful Counseling Seattle website just cuts and pastes the laws; as does the Washington State chapter of the NASW (seriously, WA NASW, you could really enhance your website - these laws you list are "drafts" from 10/04 - that's seven years ago - and you list "new sections" and "amendatory sections" in a way that doesn't make sense. This isn't convincing me to get a membership anytime soon. How about a few useful FAQs?)   

Anyway, the point of all this is that I couldn't find the info so I contacted the DOH directly. When I get answers to my questions, I will post them here, on this blog, so that future social workers don't have to wonder the same questions I'm wondering.