Submitted my License (Associate) Application

This week's progress:

• Associate Licensing Application submitted (need that to practice under a supervisor and move towards full licensure)
• Met with one potential supervisor. Grade: 7/10; meeting with another one in a few days
• Beefed up the content of my website and worked out some kinks
• Maybe found an office to rent!

Getting Licensed
I spent a lot of time yesterday and today completing my application for my associate licence (in case you haven't been reading, in Washington, you are an "associate" until you've gotten all the hours of experience and supervision needed to get a full licence.) It shouldn't have been a surprise, but it turned out to be more work than I expected. And it cost a bit more, too.

There were two main reasons for this:

1. I didn't realize that I needed to request my M.S.W. school transcript. I had to request that... then it turned out that I never completed "Financial Aid training" prior to leaving, so a hold was placed on my account. So, even though I paid all my loans of a few years ago (Thanks, wife's savings!), I had take a bunch of on line quizzes about why defaulting isn't a very good idea. Well, I passed the training and I am now prepared to be a responsible lendee. I submitted evidence of that, and hopefully that will get the transcript processed.
   Cost: $9
2. I didn't realize I needed to get official certification from other states where I've had licenses. I have a LMSW license in New York State. It doesn't help me at all in Washington, but just to be safe I'm having the New York State Dept. of Education certify that I have that license. I had to send the form in by mail, so who knows when it will get processed... (You can just look it all up online, anyway, so I'm not sure why the official certification is necessary).
   Cost: $20

After dealing with all that, I submitted the main application (Cost: $50). The only thing I am missing is the form that verifies that I am receiving supervision, and is signed off by an LMHC. I still don't have a supervisor, but I hope to have one by Monday (I'm still shopping around a bit). Once I decide I'll get the form signed and drop it in the mail. Then I will pray that all the pieces of the application come together into the same folder and get processed swiftly. (The WA DOH says they are processing applications who's checks cleared on 2/2/12, so it looks like there is a 2 week timelag for start of processing. That means I can probably only expect a license number by March 15 if I'll lucky.

Supervisor

I'll have more to write about this topic once I've chosen one for sure.

Website

For now I am using a Wordpress theme that I've converted to look like a website. I can't afford to hire a web designer and I want to be able to change content and design easily. I am pretty happy about the look of my page. Still working on the content - how to describe your practice in the way you want? AND in a way that will attract clients? And what about the all-important photo portrait? Here's a post by Tamara Suttle on using professional photos for our websites, blogs, avatars, etc. I agree with her about the worst offenders of style or business common-sense, but It's still hard to figure out that sweet spot between formal and relaxed/natural.

 

Office

I may have found a weekend office space that I like. The location is quite good; I like the style of the building a lot. Seems quiet. I'm not thrilled by the office furniture - I like chairs that are chairs, not mini sofas - but I can live with it. The one question I have is how to find a child-friendly space that doesn't look like a daycare - that is, where adults would feel good about going to - not full of toys, doll houses, etc.. I'm even thinking of just doing adults and adolescents in this office and, on another day, renting space in the evening for a couples of kids+family sessions. We'll see... And I'll let you know if I put down the money for the office: That will be a big step! I have to rent it for March, so hopefully my licensure application won't eat up that time. I will keep you updated!

Summary: I'm feeling pretty good about this plan. I get waves of, "who the hell do I think I am, a therapist?" and "What the hell will I do once I have clients?" and, "Will I have clients?" But overall, I'm excited.

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.

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.

The To-Do List

As I've written, the process is daunting, at least for someone like me. I'm making use of two high-tech tools to move forward:

1. The to-do list
2. "Next steps" list

"Next steps" are simple things you can do - "Call potential supervisor," "Check licensing rules" e.g. And they are useful because they are simple and specific. It is easy to get overwhelmed by a task like, "Set up business" or "Make website". So you break it down into specific steps. If you do a step every day, you will eventually complete the broader task.

That said, master to-do lists are useful too. So, just to give a sense of what's potentially involved just in getting off the ground, I thought I'd post my current to-do list (not necessarily in chronological order, or in order of priority). Am I missing anything?:

Groundwork

• Find qualified supervisor
• Get paperwork completed for license application
• Decide on target customers:
• Kids, families, couples, adults, men, all?
• Decide on name of practice / business
• Based on my name; location; theme?
• Decide on location:
• Chose neighborhood options
• Find office available at appropriate times
• Choose when I want to work
• Rent it

Misc. expenses and purchases needed

• Toys, materials for kids, families
• New professional clothes
• Small business software
• Business cell phone
• Smart Phone for traffic checks and emailing?
• Transport: Bike, car
• New computer (I need it but this can wait)

Business side of things

• Decide what type of business (leaning towards LLC)
• Get business license
• Get business credit union account (checking, credit)
• Credit card system?
• Malpractice insurance
• Health insurance
• Set up record keeping system
• Excel? 
• Business software?
• Comprehend insurance system (for future)
• Learn more about general business expense rules

Marketing

• Website and email address
• Choose URL
• Hire someone?
• Wordpress?
• Other services?
• Local therapy listings
• Use my current contacts
• Make new contacts
• Business cards
• Logo?
• Design
• Get printed
• Leave in good spots
• Cafes
• Other?
• Beef up LinkedIn Profile
• Spread the word elsewhere
• Local listings (various)
• Facebook?
• LinkedIn?
• Friends?
• Family?

Licensing

• Find Supervisor
• Register as Associate
• Continuing Education hours
• HIV AIDS Training
• Complete hours
• Transfer hours from my old job
• Complete Paperwork, get approved for exam
• Take Clinical Exam
• Get my license

Paperwork issues

• Prepare disclosure form, and policy statement
• Develop a good system for records 
• Prepare list of referrals (Psychiatrist, other therapists)

There, that's not so hard.

Barriers and resistances

Having just written a bit about anxieties, I thought I'd get a little more specific. True, there is a general fear of the unknown that makes it difficult to move forward with changes. But when I think about it, I can break the fears down into more specific categories. I think it is good to be aware of what barriers we face before we begin.

Here are five that I've recognized - some are practical concerns, some cut to the core of how I view myself:

• Confidence in myself as a clinician ("Am I really ready to do this?" / "Who do I think I am?")
• Confidence in myself as a businessperson ("Where do I start?" / "What if I fail?")
• Finances ("Can I afford to invest in a business at this time?" Of course, on the flip-side, we have: "Can I afford to continue to have no job and no income?")
• Indecision about making key choices (such as: fees; locations; focus; etc.)
• Licensure issues (It's complicated; I'll expand on this later)

I'll probably go into these in more detail as I move forward.

Why starting a business is like having a baby

It occurred to me, today, that starting a private practice couldn't  be any harder than having a baby. Granted, I am a father so I didn't have to carry a child inside me, or squeeze it out, or nurse him once he was born. But I've done a lot - from buying strollers to choosing diapers, to changing diapers to waking up at all hours of the night, and so on. Prior to the birth, my wife and I went through a period of planning; decision-making; and preparation. We were a bit nervous about our preparation and readiness, and it was hard to imagine what it would really be like. At that point a baby was all theoretical. Once our son was born, the theory faded and we just did what we needed to do, day by day, and everything went great. Anxiety usually comes from the unknown.

I tell myself that my new business endeavor is similar: a lot of preparation; a lot of unknowns; some anxiety or uncertainty; no instruction manual. But, once the groundwork had been laid and once I start seeing clients, the fear of the unknown should fade (or maybe be replaced by new fears) as the reality takes on its own momentum.

Where I am starting from, more or less

Hello!

Everybody is in different circumstances when they decide to take on a big project. I figure it my be helpful, as I start out, to lay out my own particular situation, and how it has let met to start a private practice. There are a few big reasons I came to this decision at this point in my life:

1. I recently moved to a new state, leaving a stable clinical social work job, after two years, to find that I can't find a job at an agency in my new town (trust me, I have tried for the last four months). But I still need to accumulate hours to get my clinical license here! 
2. Even if I were to find a job, I don't really want one! The idea of working at an agency again (except maybe an imaginary perfect agency) - working for a boss; going to staff meetings; huge caseload; low pay - does not sound very appealing (this is, of course, why so many social workers, and psychologists go into private practice)
3. Meanwhile, I need money!

One event finally pushed me over the brink and led me to decide that 2012 would be my first year of practicing privately. Having spend a few months applying to many jobs and interviewing at fewer, in November, I applied for a position that I really wanted; I interviewed for it twice, it seemed hopeful, and I waited patiently through the Thanksgiving lull to get news. Weeks passed. I remained optimistic. Then, after a month of hoping, the job fell through: They cancelled the whole damn position due to funding (which was, somehow, more frustrating than outright rejection).

It was at that point that I decided to take matters into my own hands.

It is true that pride is involved. I didn't go into social work to get rich, or even to start a private practice. I just wanted to work for an agency that I like, doing work that I felt was valuable to others and earning a decent living. Being rejected for positions that I feel I am qualified for is disheartening. Worse is when you don't get a job for a position you don't really even want: that's just demoralizing - no, I'm just going to call it soul-killing.

I feel some guilt for what feels like cashing in and abandoning the essence of social work by starting a private practice (throughout the field of social work, in school and beyond, there is a very weird attitude towards private practice and money in general. Social work has a foundation in social justice and service, and, if we are being honest, private practice is to a large extent about money and comfort of the therapist; yet tons of social worker go into the field with private practice as their goal - even if they don't admit it).

Despite the pride, after a while I just felt like saying to the whole world of mental health agencies, the following:

"Well, if you don't want me, then fuck off!"

It felt like the whole job hunt was demeaning, like I was begging agencies to give me a job I didn't really want, and I was being rejected (I think a lot of people feel this way about "going into the office" - it just doesn't seem like the right thing to do, it's not natural, but we are conditioned from early on that that's what we do when we grow up).

So (setting the guilt and the pride aside for another day), I am also kind of glad to be pushed to this next step, because, in a lot of ways, agencies are not nice places to work in. More generally, work is not a nice place to work in. I want a life I feel good about - where I can have a flexible schedule, take my own initiative, make my own decisions about my life. I want to be free, but also to survive. That's not too much to ask, is it?