The field of mental health is not kind to professionals.
You would think that a field built on the foundation of empathy and support would grant the same benefits to those working within it. This might be one of the farthest things from the truth. Over my years in the social work and therapy field I’ve learned first-hand and through others that the field is ripe ground for all types of abuse. The field of mental health has expanded quickly, and ethics codes have been unable to successfully regulate the work that professionals engage in.
We are trained to be present during folks’ most vulnerable moments, we witness moments of resilience, transformation, and healing. Personally, these moments are what attracted me to this work. The immense honor of being witness to humanity’s true forms was not lost on me. Even today, these moments anchor me to each moment spent with folks.
If you are starting your journey as a student, intern, or newly licensed clinician, I’d like to pull back the curtain for a moment. I’ve thought long and hard about this blog post and don’t want the information within it to scare you, but to equip you. You deserve to have an experience within your job where you are valued and not treated like a cog in an insensitive client churn. You can be yourself, be valued, and be assertive at the same time. As you begin your work in the field, you will find that our profession can be uniquely exploitative, and many agencies and systems will try to profit from your passion- placing money and profits ahead of our mission. Some places are so deeply embedded in their greed and ego that they have created a new norm of values that directly harm clients.
The work in our field is often invisible. We carry a quiet dignity in the intimate moments with our clients. As we carry on our quiet work in the corners of society, the dark underbelly of the profession continues to go unchecked. Repeat after me - our silence has a cost. The quiet grind has cost many before us their sanity, and will claim many after us. The pressure on our emotional state and professional growth has caused many of us to lose sight of what matters or why we joined the field in the first place.
Behind the scenes, many of us are overworked, underpaid, and completely overwhelmed by the twisted labyrinth of licensing requirements and regulatory tasks. We are asked to show up repeatedly in spaces where we are not paid, shelling out thousands of dollars for tests, supervisions, trainings, and CEU’s. All within agencies that sometimes feel more like factories than places of healing. Ask yourself; who benefits from this system?
In private practice, the field begins to look more and more like a pyramid scheme. Private practice is often seen as the ultimate goal- the gold standard of independence and financial success. The more you look into it, the more predatory it seems. You pay for a training, then pay for supervision, then to be listed in directories, or to use X platform… this system is designed to be overwhelming. The overwhelming nature of the system is a perfect ground for practices to entice you to join them by telling you “you don’t have to worry about that stuff, we’ll handle all of the billing, credentialing, etc., you just show up” all while taking 60% of your earnings in exchange for their niceties. I’m encouraging you to look beyond the smoke. YOU can do this. Some of this stuff is tedious to learn but easy to do. Most private practices are unregulated in their day-to-day treatment of employees, contractors, and interns. There is likely no HR to reach out to when you experience something weird or shady. In these times, return to your code of ethics and trust your gut. YOU are the checks and balances. You are the closest you will most likely be to the textbook foundation of ethics. We rely on your judgement as new observers of the field to help preserve dignity within the field.
Similarly, large mental health agencies continue to churn through interns and new grads, cycling them in and out with minimum investment in their betterment. They might provide a “foot in the door” but fail to nurture clinicians in any meaningful way. Above them all, insurance companies haver above all like true giants in our field, dictating reimbursement rates, paperwork, and shaping what our care should look like.
I’m writing this critique to encourage a moment of reflection. What have your past experiences shown you? How will you maintain your integrity and the mission of our work through the professional hurdles? This is an obvious systemic issue that requires systemic solutions, but while we wait for that mammoth of an initiative to truly help us, we must help ourselves. I have a few practical tips for you and a separate blog post (coming soon) on my experience through my education and practice hours.
Know your worth- even as a student. Congratulations on your work so far! Internships are some of the most exciting parts of completing your program. I remember thinking “This is it! This is the real deal.” I was so excited to start seeing clients and doing field work that I shut up and worked to be the most agreeable person possible. I was very aware of the heirarchy of the agency I was at. I will tell you this if no one else will: You are not lucky to be there. You are working. Ask questions of how your work will be used and how you will also benefit from this time. Being “there” to experience their day to day work is not enough. You need training, mentoring, flexibility, and the opportunity to be creative and heard.
Vet supervision carefully. When you are looking to PAY someone to supervise you, you are hiring them. Interview them. Their experience and credentials should not intimidate you; they should excite you. Ask them how they run supervision and have a written plan agreed on by the both of you.
Learn business skills early. Even if you end up in a group practice or an agency, microdose your understanding of billing, contracts, and how insurance works. This will give you power. Exploitation thrives in the face of ignorance. Don’t be ignorant and ask questions, pay attention to the systems around you.
Avoid agencies that feel like revolving doors. An agency or practice that has a high turnover is a red flag. Vague contracts, unclear policies, and promises of “clinical experience” with little to no structure are huge red flags. Ask your friends, read the google reviews, dig around. Is the agency constantly positing about open positions? Why could that be? A quality placement, practice, or agency will prioritize YOU, not just your productivity. Don’t get me wrong, the money is important to keep these places afloat, but it cannot come at your expense.
Go through those contracts with a fine-tooth comb. As you’re reading through a contract, I want you to ask yourself (regardless of the impression that you have of the agency or person now) “If this person made my work miserable, how can I advocate for future me through the agreements of this contract?” Maybe this means asking for a shorter term or something else. Read everything. If you were to want to end your contract for whatever reason, do you have to pay back trainings they “paid for?” Can you take clients with you, or do they have a non-compete?
Watch out for burnout culture. If you end up at a place that praises your overwork or guilt-trips your around seeing boundaries, RUN. Prep your exit plan and get out. There is an inherent guilt that good clinicians feel when we are looking for ways out of a tricky situation, “what about the clients?” Hear me when I say this, the agency has built an unsustainable system for clients to get adequate care. They have successfully made you the front person, the face of care, for your client. It is not you letting the client down, it was the agency/practice. They have built a system too large that they can’t naturally sustain. They are stepping on you to make money for them. They are getting paid in dollars, and you are getting paid in pennies. Set limits through the uncomfortable emotions and be authentic with your clients about your choices. They will understand. For example, when I worked at Child Protective Services - I was often asked to work “Child Watch” over night for kiddos with no placement. When I was child-less, this was a great way for me to make extra money and I was totally ok with pulling all-nighters. Once I had kids, this boundary changed for me.
TALK TO EACH OTHER. The best protection you have is each other. Compare experiences, hell- pay even. Share your resources. Challenge those unethical systems together. Exploitation thrives on ignorance, don’t be ignorant of what those around you are going through. Exiting a shady situation is hard and it is a rollercoaster of emotions. You deserve community during this process.
I’ll leave you with this: we deserve better and so do our clients. The work we do is powerful and profoundly necessary but we need to stop romanticizing the treatment of professionals in the field. Make the report. Call people on their behavior. Hold people/agencies in power accountable. We must call out the greed, ego, and exploitation to make a better field for us and those after us.