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N A S W S P SNational Association of Social WorkersSpecialty Practice Sections©2004 National Association of Social Workers.All Rights Reserved.

IN THIS ISSUE

Musings on the Timing of Entryinto Private Practice ............. 1

From the Chair ......................... 2

From the Editor ........................ 3

NASW Training Opportunities .... 5

Book Review ............................ 7

News Brief ............................... 7

Appreciative Inquiry: A Tool forImpacting Change ............... 8

Social Workers’ Rights to PromptPayment ........................... 11

Did You Know? ....................... 12

MUSINGS ON THE TIMING OF ENTRY INTO PRIVATE PRACTICEJan Wolff Bensdorf, CSW, LCSW

SPRING 2004

See Musings, 0

Private PracticeSectionConnection …

I teach in a clinical social work programthat attracts many students whose careergoal is to be in private practice. While Ibelieve that we prepare them well aca-demically, academic knowledge is not theonly type of wisdom necessary to be agood clinician. We must also learn togather, nurture and respect practicewisdom to inform the work we do. Inaddition, we need to learn about ourselvesas therapists from an internal perspective,and then combine that knowledge with thepublic world of therapy, the articles injournals, workshop presentations, con-tinuing education programs, and ethicaland policy statements set forth by ourprofessional organizations.

Often, during class discussions where casematerial is presented, students talk aboutthe timing for starting a practice. It isalways difficult for me to answer thatquestion. Most states require licenses inorder to practice independently. Thisusually delays the opening of an indepen-dent practice by a minimum of two years.In addition, third party payers requirepractitioners to have clinical licenses inorder for them to be paid for services.During those two years of apprenticeship,the novice is required to obtain regularsupervision. While this helps to codify thetiming of beginning a private practice, itdoes not totally address the question askedby my students.

It is an almost universal concept that webecome better therapists by doing therapy.That, in and of itself, encourages people toquickly become therapists with the goal ofgetting better sooner. But what experienceand knowledge is necessary before settingout on one’s own? Is there a way toidentify certain characteristics, knowledgebases, and self-understanding? Certainlythere are specific areas of practice, whichwe need to examine. We need to under-stand and deal with our fears of beinginadequate and the potential for failure.

While this is a career-long issue, it is mostprevalent in new therapists. We evolve inour understanding of inadequacy andfailure, as well. There is a realization thatgrows over time, for instance, that when aclient does not return to treatment it doesnot mean we have performed at a sub-parlevel. One area of knowledge is recogniz-ing those intuitive understandings whichlead us to trust what we know aboutourselves as practitioners, and whichindicate successful work. This should bebased on practice experience, for it is inthis way that we really gain a sense ofcomfort in our role in the therapeuticprocess. Charles Kramer, in his book,Therapeutic Mastery, says, “Becoming agood therapist demands a long period oflearning, examining and appreciatingmistakes, finding correctives, making newones, and evolving our own style” ( p. 30).

2 Spring 2004 • Private Practice SectionConnection

SECTION COMMITTEECHAIR

Pat Herrera-Thomas, LSCSW,LCSW

Topeka, [email protected]

EDITORDonna M. Ulteig, ACSW, LCSW,

DCSWMadison, WI

[email protected]

Veronica Coleman, LCSWChicago, Il

[email protected]

Steven D. McArthur, ACSWMissoula, MT

[email protected]

Meg Kallman O’Connor, ACSW,DCSW

Morristown, [email protected]

NASW SPS MANAGERNancy Bateman, [email protected]

SPS SENIOR POLICY ASSOCIATELa Voyce Brice Reid, MSW, LCSW

[email protected]

SPS SENIOR MARKETINGASSOCIATE

Yvette [email protected]

SPS SENIOR ADMINISTRATIVEASSISTANT

Antoniese [email protected]

THE NEWSLETTER OF THE NASW SECTIONON PRIVATE PRACTICE

PrivatePractice

SectionConnection

Fromthe ChairWhen NASW decided to increase the number of sectionsfrom four to eight, I worried and wondered about theimpact it would have on recruiting and retaining ourmembers. A year after the new sections were added, thePrivate Practice Section’s membership has not onlyincreased, but remains the largest one.

Many changes have taken place, which have contributedto our growth. For example, the NASW Section Webpages have been updated, and are more user-friendly.You can now visit the Private Practice section Web siteand gather pertinent updates about issues that directlyaffect your practice. The updates are informative, re-searched based, to-the-point, and address a variety ofsubjects. The Web site also features an online forum/bulletin board for section members to communicate witheach other. You can also use the online forum to commu-nicate directly with our committee members. We encour-age you to share your ideas and suggestions. In addition,we also have developed a new brochure answering thequestions most frequently asked by social workers inter-ested in opening a private practice. And, thanks to thehard work and dedication of previous committee mem-bers, the Private Practice Guidelines have been revised.The brochure and guidelines can both be purchasedthrough the NASW Press at www.naswpress.org

We continue to be dedicated to providing you withinformation that would make your practice successfuland rewarding.

Pat Herrera-Thomas, LSCSW, LCSWChair, Private Practice Specialty Practice Section Committee

Private Practice SectionConnection • Spring 2004 3

See Editor, Page 4

Fromthe EditorIn this, the first Private Practice Sectionnewsletter of 2004, we are featuring authorsand articles that we hope will grab yourattention and interest. The articles represent arange of perspectives and topic areas, whilethe authors reside in geographically diverseplaces, like Connecticut, Illinios, and Mon-tana.

You will find something written by MireanColeman, LICSW, ACSW, in all of the PrivatePractice Specialty Practice Section newsletters.Mirean is the National NASW senior policyassociate for clinical practice, and is ex-tremely knowledgeable about policies thataffect our practice. Based in Washington,D.C., Mirean produces the Practice Updateswe receive periodically.

Two other authors, Steve McArthur and MegKallman O’Connor, have both contributed toprevious newsletters. Both are Sectionmembers and serve on the Section LeadershipCommittee. Steve writes from Missoula,Mont., where he works as a managementconsultant, having transitioned from privatepractice. His subject is “Appreciative In-quiry,” a way to approach systems—fromorganizations to families—using a focus onwhat works, rather than on the problem.Meg, on the other hand, shares her experi-ences as an NASW trainer, a workshoppresenter on bereavement guidelines for socialworkers in hospital emergency departments.Meg has a clinical practice in Morristown,N.J.

This newsletter also has a new author, JanWolff Bensdorf, LCSW, who is adjunctprofessor and coordinator of continuingeducation at Loyola University School ofSocial Work, in Chicago. She has maintaineda private practice for 23 years and is alsosecretary of the Illinois Chapter of NASW. Inher article, Jan addresses the dilemma ofreadiness for entry into private practice, fromher experience as an educator. All of these

authors, by the way, invite your e-mailedcomments.

You may be curious about how articles andauthors are selected for participation in thenewsletter. The newsletter is planned by thePrivate Practice Specialty Practice SectionLeadership Committee at a face-to-faceannual meeting in the fall and subsequentconference calls. Each section committeemember is asked to contribute an article,either personally or by soliciting one from acolleague.

We have also invited articles from you, theSection membership. Articles are to besubmitted to the Section Committee Editor inMicrosoft Word or rich text format, arelimited to 1500 words, and must be accompa-nied by information about the author,including an e-mail address. They are chosenfor publication based on their relevance toprivate practice social work, at the discretionof the Private Practice Committee andSpecialty Practice Sections staff. Of course,the lifeblood of the Private Practice Section isthe interest and contribution of members, soyour investment in the Section—in the formof a submitted article—brings cheers!

SOMETHING NEW …In response to feedback from Section mem-bers, we are looking for ways to fosternetworking via the newsletter. In Committeebrainstorming we came up with three ideas,two of which are implemented in this news-letter. First, we have a “Did You Know”column, a series of facts that may influenceour practice.

Secondly, we would like to introduce a“What is Happening in Other States” columnthat includes news blurbs from the member-ship. An example, since I am from Wisconsin,is our problem with licensure rules. The


Editor, from Page 3

development of rules defining alcohol anddrug abuse treatment by licensed clinicalsocial workers is being blocked by thealcohol and drug abuse certification folks.The Wisconsin Certification Board wants allclinical social workers (currently licensed topractice clinical social work) to undergoseparate expensive certification if we are totreat anyone, even briefly, who has analcohol/drug abuse diagnosis, even if thatdiagnosis is secondary. NASW-WI is stronglyopposed to this, and is working to preventwhat could be a nightmare for all of us.News from your state that may be of interestto Section members should also be forwardedto the editor.

MEMBER HIGHLIGHTSFinally, we want to regularly highlightmember accomplishments, to recognize theheroes in our Section, those who go aboveand beyond to contribute to the profession.In this issue, we acknowledge memberStephen Knezek, RN, LCSW, CGP, whopractices in New Haven, Conn., working at afull time private practice, as well as full timeclinical supervision and private practiceconsulting. Stephen writes a column onPrivate Practice Questions and Answers forNASW-CT newsletters.

Stephen has also conducted a three-hourseminar on “Building and Maintaining aThriving Private Practice” for the annualNASW-CT statewide conference. LastOctober the NASW-CT Chapter wasawarded a $1,000 grant by the NASWSpecialty Practice Sections to sponsor thisseminar, attended by more than 45 socialworkers.

Stephen frequently answers questions onprivate practice issues all over Connecticutvia phone, mail, and e-mail. He works closelywith Steve Karp, executive director ofNASW-CT for all issues that affect clinicalsocial workers in, and out of, private prac-tice. Stephen’s biggest victory in workingwith the chapter executive director was, “Tohave Anthem change its policy requiringLCSWs to work with psychiatrists beforethey would allow us to be full networkproviders for their HMO Medicaid product(Blue Care Family Plan) in May 2003.” Hecontinues, “Many LCSWs in Connecticuthave taken advantage of the rule change thatMr. Karp and I instituted, and are fullnetwork providers for one of the neediestsections of our state. People on HMOMedicaid can go to private practice clini-cians, as well as clinics that often have longwaiting lists.”

Stephen Knezek, LCSW, is one of our heroesand deserves the recognition of the collectiveprivate practice community. On behalf of thePrivate Practice Specialty Practice Section, Icongratulate Stephen.

The Private Practice Section Committeehopes that you find this newsletter relevant toyour practice. We can grow and improve, butonly with your input. Please e-mail me withyour feedback, articles, book reviews, newsfrom your state, and information about socialwork heroes at [email protected]

Donna M. Ulteig, ACSW, LCSW, DCSWserves as the Private Practice Section Com-mittee Editor

Ms. Ultieg is a clinical social worker in private practiceat Psychiatric Services, SC, in Madison, Wisc.


See Training, Page 6

NASW TRAINING OPPORTUNITIESMeg Kallman O’Connor, MSW, LCSW, CTSOn November 14, 2003, I returned fromNashville, Tenn., where enthusiastic socialworkers attended the workshop entitled“Bereavement Practice Guidelines for SocialWorkers in Emergency Departments.” Thiswas the fourth and final occasion for me topresent this program, developed by NASWand made possible with funding from Emer-gency Medical Services for Children, adivision of the Maternal and Child HealthBureau under the Department of Health andHuman Services.

In October, the 19 inches of snow that felldid not prevent about a dozen hearty folksfrom showing up in Casper, Wyo., for thesame program. The “jackalope,” true to itsnature, did not make an appearance. How-ever, a friendly shuttle driver took the time tosearch a bit for me—a city slicker—and thelocal antelope herd presented quite a photoop for me along the way.

In Rhode Island, a month later, the gale forcewinds that caused such a stir and cancelledplane flights up and down the East Coast,only served to whip up my enthusiasm.Additionally, I was forced to enjoy yetanother culinary experience in Providence—they have great restaurants there. Sadly,Pawtucket, R.I., was the site of a raging fireon the second day of those winds. Mythoughts were with those first responderswho, just one year ago, were also involvedworking the tragic Station fire. The trainingprogram did include a critical incident stressmanagement piece, which was timelier thanwe could have known.

I am an unabashed devotee of social work,and the social workers I have had the privi-lege to meet throughout these travels are anhonor to know. The New Jersey Chapter ofNASW, of which I am proud to be a member,invited the presentation of this program inSpring 2002, without hesitation. Social workis not a job. It is a career that provides the

opportunity to combine matters of the heartwith public as well as personal service.

The Bereavement ProjectWhen seriously injured or critically illchildren arrive in most emergency depart-ments, they are whisked into a treatmentroom where medical professionals of varieddisciplines descend upon them. Parents andfamily members are generally asked toremain in the waiting room, where they dojust that: wait.

The bereavement project is focused on thistime in a family’s life. From the moment ofthe patient’s and/or the family’s arrival at theemergency room, the program’s goals, asstated in the training, include the following:

• To enhance the social worker’s knowledgeof the grief process of the family

• To develop and enhance the social worker’sskills and ability to help the bereavedfamily

Family-centered care, advance preparation,reactions inclusive of sibling reactions,follow-up, and health care provider issues areamong the topics addressed in this program.An additional goal of the training includes abrief piece “to develop and enhance the socialworker’s skills in disaster situations.”

No Harm in AskingI have been asked how it was that I became a“trained trainer” for NASW. In November1998, an article appeared in the NASWNews, entitled “Project Seeks to BenefitBereaved Families.” The topic is one that isclose to my heart, and working with familiesin the wake of sudden or traumatic death hasbeen the focus of my work since 1988. I tooka chance, a first step: I sent a letter of interest


Training, from Page 5

to Mirean Coleman (NASW’s senior policyassociate for clinical practice), who wasnoted in the article. I included my curriculumvitae, along with a pamphlet entitled “WhatNow?” I had published the pamphlet—whichis written for family members and friends ofthose whose loved one has died suddenly—inMarch of that year. “What Now?” hasbecome a useful guide that first responders,emergency room workers, and funeraldirectors can provide to relatives in those firstcrucial minutes, hours, and days followingthe notification of the death.

I cannot tell you how excited I was to becontacted by Mirean Coleman, and to beinvited to be a panel participant. This work isa passion of mine, and this was a treasuredopportunity.

I encourage all social workers to “take a firststep,” in whatever direction your interestsand circumstances point you. Beyond therichness of the countless professional friend-ships my speaking programs have opened tome, each program gives me greater insightand understanding of the universal, commonproblems that confront all of us who workand seek to ease the pain of grieving. Sharedexperiences flow from shared conversations,and many valuable lessons learned can bediscovered over a cup of coffee, away fromthe speaker’s podium or the quiet response ofthe listening audience.

I strongly urge you to share your unique andexclusive ideas for tackling what may seem tobe nearly insuperable situations and intrac-table problems. You may not only help one ofyour colleagues find that path to a desireddestination, but you might just come awaywith a new appreciation, new understandingsof your own professionalism, or unlock ahidden kernel of wisdom for use in your dailypractice.

The pamphlet, “What Now?” grew out ofnotes I prepared for an acquaintance whoseclose friend’s child had just died in a motor

vehicle crash. Over time, it has become aresource for acute care medical settings,outpatient treatment programs, prosecutor’soffices, and funeral homes. Although notintentionally a marketing tool, “WhatNow?” has become a source of referrals tomy practice, and has also provided me withopportunities to give presentations to profes-sional and community groups.

An Expression of GratitudeSurely, social work has, as its foundation, anappreciation of collaboration, an appeal formutual respect, and recognition of ourfundamental connectedness. This was nomore apparent than on the occasions whenthe trained trainers nationwide, along withNASW staff, met to review and revise theprogram. I end this expression of gratitudewith the names of those with whom I havebeen fortunate to collaborate over the yearsthat this project has taken place.

If my loved ones and I find ourselves in anemergency department involving a life-threatening situation, I only hope that thestaff has in place the practices advocatedthrough this bereavement project. Althoughthe manner in which we will each die isuncertain, what is certain is that the time willcome. Thank you, NASW, for your attentionto this vulnerable time in people’s lives anddeaths.

Thank YouLiz Adkins (New Mexico), Kimberly Barker(North Carolina), Kimberly Bridgman(Pennsylvania), Mirean Coleman (NASW-National), Lori Groenewold (Arizona), MariaLauria (NASW-National), Doris Mitnick(Virginia), Orlando Manaois (Washington),Amy O’Brien (Michigan), Karyn Walsh(NASW-National), Tracy Whitaker (NASW-National), and Rochelle Wilder (NASW-National).

With hopes for peace in 2004, Meg KallmanO’Connor, MSW


BOOK REVIEWPsychosocial Treatment for Medical Conditions: Principles and TechniquesEdited by Leon A. Schein, Harold Bernard, Henry Spitzz, and Philip MuskinReviewed by Mirean Coleman, MSW, LICSW, CT

Meg Kallman O’Connor, MSW, LCSW, CTS, has been inprivate practice for 15 years, while also working perdiem at the regional trauma center as a Mental HealthProfessional with the Crisis Intervention Service atMorristown Memorial Hospital in Morristown, N.J.

She is the clinical director of a Critical Incident StressManagement Team, coordinator of the Morris CountyTraumatic Loss Coalition, and is a mental healthspecialist with a Disaster Medical Assistance Team(NJ1-DMAT). Ms. O’Connor can be reached [email protected].

Psychosocial Treatment for Medical Condi-tions: Principles and Techniques, edited byLeon A. Schein, Harold Bernard, HenrySpitzz, and Philip Muskin, is an outstandingbook for private practitioners seekingcomprehensive information on psychosocialinterventions for chronic and life-threateningmedical conditions. The book applies indi-vidual, group, and family therapy to a varietyof medical conditions, and provides a de-scription of medical conditions, treatments,side effects, prognoses and psychologicalsequelae that help the private practitioner tounderstand patients’ and families’ concerns.

Some of the diseases discussed, along withappropriate psychosocial interventions,include: the psychosocial aspects of neuro-logical illnesses; endocrine disorders; hyper-tension; coronary heart disease; end-stage

renal disease; and gastrointestinal disorders.The book conveys the historical and contem-porary influences of personality and emo-tional styles on the development of illnessesand diseases. It also stresses the importanceof mental health practitioners and physiciansworking together to provide effective treat-ment outcomes for patients suffering emo-tional problems precipitated by medicalconditions.

Psychosocial Treatment for Medical Condi-tions: Principles and Techniques is mosthelpful to private practitioners working inprimary care settings or specializing in thepsychosocial aspects of medical illnesses

Mirean Coleman, MSW, LICSW, CT is Senior PolicyAssociate for Clinical Social Workers at the nationaloffice of NASW.

NASW has published a new product to assistprivate practitioners in the workplace.Clinical Social Workers in Private Practice: AReference Guide, was developed by a sub-committee of the Private Practice SpecialtyPractice Section Committee. The booklet is ahelpful guide for clinical social workersstarting a private practice or veteran privatepractitioners seeking information on specificissues.

Clinical Social Workers in Private Practiceoutlines the knowledge and skills required foran effective practice in today’s marketplace. It

NEWS BRIEFdiscusses topics like technology, recordkeeping and audits, reimbursement, riskmanagement and malpractice, managed care,and third-party payers. Confidentiality,privileged communication, informed consent,and subpoenas are other major areas covered.In addition, the role of HIPAA in privatepractice is integrated within the content ofrelevant topics.

An asset to any private practitioner’s office,the guide can be purchased for $5.50 throughthe NASW Press at www.socialworkers.org/pub


APPRECIATIVE INQUIRY: A TOOL FOR FACILITATING CHANGESteve McArthur, ACSW

Appreciative Inquiry (AI) is a wonderfulphilosophy for facilitating change. Its pri-mary belief is that change can be managedbest by identifying what works in an organi-zation (system), and discovering how to domore of what works. Sue Annis Hammond,the author of The Thin Book of AppreciativeInquiry, Second Edition (1998), credits DavidCooperrider of Case Western Reserve Univer-sity and his associates as being her teachers indiscovering the power of this approach(Hammond, 1998, p. 3).

The purpose of this article is to introduce thereader to what Appreciative Inquiry is and isnot, and to assist the private practitioner indeciding if this approach might be useful inworking with organizations, family systems,and individuals. There is no way to ad-equately cover all of the pieces which com-prise AI in such a brief article; my hope issimply that this “taste” will inspire the readerto want to learn more. Thus, I have includeda number of published references to assist thereader in the journey to become competent inthe use of this philosophy in their privatepractice.

In order to understand AI, it is important toclarify that it is best conceptualized as agenerative process. There is no cookbook tothis approach, as AI arises from thoughtprocesses. Therefore, understanding themental model that participants in a systemaccept and operate within is one importantstep in this process. It is understood thatpractitioners will add their unique contribu-tion to this field of work.

Traditional approaches ask “What problemsare you having?” while AI asks “What isworking around here?” AI moves from theproblem/diagnosis/solution equation to theartistic approach of discovery and explora-

tion. AI applies the notion that systems(organizations) can be seen as expressions ofbeauty. With an appreciative eye, thoseinvolved in the process end up describing, ina series of statements, where the organizationwants to be.

This organic view of the system implies thatthe whole is truly greater than the sum of itsparts. In order to understand the beauty(what works), it is, thus, necessary to look atthe whole. Accordingly, participants in an AIprocess are asked to think back to a timewhen the system was at its best, its highestpoint. They are then asked to developstatements (based on their real experiencesand history in this system), which describe inpractical ways where they want the organiza-tion to be in the future. The “how we getthere” is less problematic because the state-ments are grounded in the actual successes oftheir past actions, with those involvedknowing how to repeat those successes.

The process of AI usually involves a work-shop format that helps the participants accesstheir own positive, energizing moments ofsuccess. This generative process results ineveryone gaining a deeper sense of commit-ment to the future. There is also greaterconfidence in the capacity for being success-ful in the future, based on an increasedaffirmation that they have been successful inthe past. As a result of this process, partici-pants learn how to create more moments ofsuccess. The resulting new “energy” is ahallmark of the Appreciative Inquiry process.

The idea of approaching systems with anappreciative eye is likely to be initially viewedby all of us as rather simplistic and naïve. Weare challenged by Hammond to “suppress(our) cynicism and experience AppreciativeInquiry.” One way to experiment that I have


found useful is to ask at the end of a meetingor session, “What did we, as a group, do wellin this meeting?” At first there is littlecomprehension of exactly what is beingasked, because we are all taught to focus onthe problem and what potential solutionsmight be found (Hammond, 1998). AI turnsthis approach on its head, asking us toreplace our obsession for fixing an organiza-tion/system by identifying what doesn’t work,with an approach that focuses on what doeswork. In so doing, we are encouraging ourclients to leave little room for mistakes bylearning to multiply their successes to thepoint that they crowd out the unsuccessful.

An example of this philosophy would be acompany focusing on and identifying theirsuccesses when it comes to customer service.By lifting up the success stories that haveoccurred and understanding why they arepowerful examples of how to treat custom-ers, others in the organization are able to“see” ways they, too, could interact withcustomers. In a family system this mightmean focusing on a time when the familysuccessfully overcame a particularly difficultproblem, such as a financial crisis, the suddenloss of a parent or child, or illness. Byfocusing the family on their past successesand helping them identify what it was thatenabled them to be successful, they are ableto see how to create more of these successesand thus refocus their emotional /psychicenergies from problems. By leading the clientto talk about and better understand whatworks, they are much more likely to be awareof and use the skills that have brought themsuccess in the past.

The author, Alex Haley, once offered thispiece of advice: “Find the good and praiseit.” This simple mantra could well assistmany parents raising children, or couplesseeking to strengthen their relationship. It isalso an approach that we as helping profes-sionals could use to assist us in change effortswithin our own organizational and family oforigin systems no matter what the size.

Change is difficult. Being effective changeagents who are able to facilitate systemschanges is often a frustrating and long-termproposition. By using the AI philosophy andencouraging exploration into what is alreadyworking, we may be able to effectively movethe system by appealing to what it alreadydoes so well.

Stephen Glenn, a well-known mental healthprofessional, in his work with at-risk youth(over thirty years ago) said something in aworkshop I attended that I have used inmuch of my work with clients. His principleof logical consequences and the idea that anyattention is better than no attention mayassist us, by underscoring the importance ofre-framing and lifting up what is going well.Often, in my work, I continue to find myselfwrestling with the “presenting problem,” andtrying to identify ways to break the cycle ofnegative action/negative reaction.

AI offers one way out of this dilemma and Iam hopeful it will yield results in my practice.I would encourage the strong of heart to takethe plunge and experiment with this philoso-phy. The best way I know to begin is to readHammond’s book, The Thin Book of Appre-ciative Inquiry, and Lessons From the Field:Applying Appreciative Inquiry (revisededition), edited by Hammond and CathyRoyal, PhD. Both books can be ordered on-line at www.thinbook.com

We need not jettison our many years ofexperience of what works. We do, however,need to learn new ways to help systems growand learn. Appreciative Inquiry may be oneway to help us become better private practi-tioners. If you are interested in sharing whatyou discover with others in private practice,log onto the Private Practice SpecialtyPractice Section Web site and Online Forumat www.socialworkers.org/sections/

See Inquiry, Page 12


It is important to understand our criteria forsuccess, our attitudes and feelings towardscertain difficult clients, how our behaviorsinfluence our effectiveness and to be comfort-able with our motivation for being a therapistbefore engaging in private practice. We hopethere is a way to both learn as we go and tominimize the effects on our first clients.

In addition to learning and making a determi-nation about when to go into private prac-tice, we also face the issue of supervision andconsultation. As social workers, we prideourselves on requiring novices to engage intwo nine-month internships (give or take afew months), or to complete one lengthierinternship that takes place during the twoyears of a master’s degree program. Also, inclinical doctoral programs, regardless of howlong a candidate has been practicing, aninternship is often required. These practicalcomponents of our education are based onthe concepts of self-knowledge gainedthrough supervision. Rather than contem-plate the quality of supervision, it will beassumed that clinicians who supervise arehelpful for their supervisees.

When looking at engaging in private practice,especially initially, continued supervision is anecessary component. It is through supervi-sion that issues like those mentioned abovecan be addressed. Additionally, the supervisoralso helps with the following: “The neophyteis brought into the culture of the professionwhere he or she learns to internalize funda-mental values, beliefs, and behavioral norms”(Phillips, 2000, p. 217). Perhaps it is throughacculturation that we know when to begin topractice independently.

This brings us to recognizing that there is atransition to be made, which is often diffi-cult—that of changing from being an internto being a practitioner. If one moves fromtrainee to a position in an agency, and then toprivate practice, a further transition isnecessary. As an intern, our work is scruti-nized and discussed. We use the material

from our experience often: in classes, ver-bally, or in required papers, where it receivesfurther comments. In our apprenticeshipperiod, prior to obtaining advanced creden-tials, we meet for weekly supervision with asocial worker who is responsible for guidingour professional behaviors on an advancedlevel. At the end of this formal trainingperiod, we are finally fully credentialed andare able to practice independently. Supervi-sion changes to consultation at this point andwe ease into independent practice.

Jeffrey Kottler, in his book, On Becoming aTherapist, speaks of the issue of isolation forthe therapist. He acknowledges the physicalseparation from the outside world that takesplace, and says, “It is as if when we are ‘insession’ we cease to exist in the outsideworld” (p. 104). It can be difficult for a newpractitioner who has depended on supervi-sion, consultation, and frequent informaldiscussions with colleagues, to be in this newspace. Certainly, peer supervision andengaging a consultant is a responsible way tosmooth the transition. But eventually, asKramer notes, many clinicians reach a stagewhere they find the freedom from supervisionwonderful.

Most social workers in private practicerecognize the need for dialogue regardingtheir work; but as they become increasinglyexperienced, they seek it less often. Knowinghow to benefit from a mentoring relation-ship, and when to be more independent, isnot always easy.

I suspect that every therapist in privatepractice will honestly look back on earlyprivate practice experiences with horror.Kramer articulates what many therapiststhink: “Ours is a field in which beginnersexpect to do perfectly the first time…Some ofmy earlier cases should never have beenstarted, let alone struggled with. Oftenpatients had enough sense to quit before Idid” (p. 27). In retrospect, I think it took 10years for me to have real confidence in my

Musings, from Page 1


work, and I, too, shudder at some of theblunders I made. I know that I would havebeen a better therapist for many of myearliest clients if I could have begun seeingthem now, 23 years later.

Is confidence in the ability to make a positivedifference in a client’s life a requirement fordetermining the timing of hanging a shingle?Or is the knowledge that we will get betterwith experience—that we need to startsomeplace, perhaps not at the peak of ourgame—a requisite for beginning?

I contend that all of these issues need to beconsidered, and my answer to my students’queries includes the following: You need tomeet the legal and ethical requirementsbefore you even entertain the idea of startinga practice. Hence, you need to have a clinicallicense, so you alone are responsible for thetreatment that takes place, and no one signsoff for you. You need to avail yourselves ofappropriate supervision and consultation asyou begin this venture. You need to under-stand the culture of therapy and privatepractice, and the isolation that can accom-pany it. Above all, it is important to under-stand your motivation for becoming a

therapist; your own issues, which have thepotential to sabotage your work; the ethics ofthe profession; your particular style; and howto use yourself as the facilitator of change.You need not expect perfection. You shouldanticipate maturity, growth, and increasingcompetence. When you can do all that, thenyou will no doubt be in a position to receivereferrals from colleagues and be on your wayto a successful practice.

ReferencesGliberman, M. (1999). The search for identity: Defining

social work—Past, present, future. Social Work, 44,298 – 310.

Kottler, J. (1993). On becoming a therapist. SanFrancisco: Jossey-Bass.

Kramer, C. (2000). Therapeutic mastery: Becoming amore creative and effective psychotherapist. Phoenix,AZ: Zeig, Tucker and Co., Inc.

Phillips, D. (2000). CSWJ forum: Is clinical social work aprofession? Preliminary considerations. Clinical SocialWork Journal, 28, 13 – 225.

Jan Wolff Bensdorf, CSW, LCSW, is adjunct professorand coordinator of continuing education at LoyolaUniversity School of Social Work, Chicago, Ill. She isalso currently secretary of the Illinois Chapter ofNASW. She can be reached at [email protected]

One of the constant complaints aboutmanaged care by social workers and otherhealthcare professionals is the lengthy delaysin payment of claims. The problems are sopervasive and chronic that they appear to bestandard operating procedure in some sectorsof the managed care and health insuranceindustries. The problem of delayed paymentshas become so widespread that states haveresponded to this bottom-line issue byenacting legislation to compel third-party

SOCIAL WORKERS’ RIGHTS TO PROMPT PAYMENTpayers to make timely reimbursement tohealth care practitioners or suffer financialpenalties for violations.

Social workers, including those in privatepractice, will want to diligently monitorprompt payment legislation in their respectivestates. To learn more about this and otherlegal issues affecting social workers, go tohttp://www.socialworkers.org/ldf/legal_issue/default.asp

Private PracticeSectionConnection …

Non Profit Org.U.S. Postage

PAIDWashington, DCPermit No. 8213

750 First Street, NE, Suite 700Washington, DC 20002-4241

N A S W S P SNational Association of Social WorkersSpecialty Practice Sections

Steve McArthur, ACSW, is an independentmanagement consultant living and working inMissoula, Montana. Over the last 20 years, hehas worked with hundreds of not-for-profit andfor-profit organizations around the world.Steve earned an MSSW from the University ofTennessee, and an MA in Religious Studies fromChicago Theological Seminary. He worked for12 years as a clinician in community mentalhealth, hospital, and private practice settings.He is currently a member of the PrivatePractice Specialty Practice Section Committee,and is active in the NASW Montana Chapter.Steve can be reached via email [email protected]

Inquiry, from Page 9

ResourcesBarrett, F. (1995). Creating Appreciative

Learning Cultures. Organizational Dynamics,24(1), 36-49.

Collins, J. & Porras, J. (1994). Built To Last. NewYork: Harper Business.

Hammond, S. (1998). The Thin Book ofAppreciative Inquiry. Second Edition, Plano,TX: Thin Book Publishing.

Hammond, S. & Royal, C. (1998). Lessons FromThe Field: Applying Appreciative Inquiry.Plano, TX: Thin Book Publishing.

DID YOU KNOW?• In 2004, clinical social workers can

expect to see a 1.6 percent increasein Medicare reimbursement.

• The ICD-9-CM and CPT codes havebecome the standard codes fordiagnosis and procedures whenseeking reimbursement from third-party payers.

• NASW has more than 25 practiceupdates specifically for clinical socialworkers and private practitioners.These updates are available toNASW members atwww.socialworkers.org/practice/

private practice - national association of social workers · private practice social work, at the...

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