When Cheryl Dolinger Brown, CSW, headed off to social work school, she took with her a mental model formed while growing up with her social work administrator father. She imagined that she would follow in his footsteps; it never occurred to her that she had started on a path to become a therapist.
What set her in this direction? „In social work school it was highly recommended that students engage in their own therapy,“ says Brown. She „found it very helpful.“ Clinical social work was „satisfying“ and she decided that it was more suited for her than doing community organization or administration, as she had originally imagined. The work resonated with why she had gone to social work school in the first place, which was „to help people make changes in their lives.“
After she was graduated from social work school in Minnesota, in 1973, she moved to New York and over the next twelve years attended the National Psychological Association for Psychoanalysis. Becoming a psychoanalytic therapist entailed attending classes at night and being analyzed herself. She began a small private practice in 1981. The birth of her daughter intervened, but she began to build her practice in earnest in 1984 and hasn’t stopped since. Several years ago she went back for more training in Imago Relationship Therapy, a therapeutic approach used to work with couples. She speaks enthusiastically and passionately about her West Side Manhattan practice for couples and adults. Clearly, she has not regretted for a moment her decision to pursue a career as a social worker doing private therapy.
Lynn Grodzki, MSW, has had a successful career as a private therapist since 1988, and since 1966 has also been a business coach for therapists. She has written four books about the business of being a therapist and coach. Like Brown, being in therapy was a catalyst to becoming a therapist herself. She was in the midst of a career change from running a family business when she started her own therapy. She was impressed with how helpful therapy was to her, and as she considered a change of careers, she thought that she might like to be a therapist. She enrolled in the University of Maryland’s School of Social Work. Grodzki also has had extensive post graduate training — about eight years, she estimates. Much of her training has been in group therapy and, in addition, she holds a certification in Gestalt therapy and a certification in neurolinguistic therapy.
Ruth Dean, Ph.D, social work professor at Simmons School of Social Work and chairperson of the clinical practice sequence, has been practicing social work since she was graduated from the University of Pittsburgh in 1961. To fulfill the requirements of her graduate fellowship she needed to work in a medical setting. She practiced medical social work at Beth Israel Hospital in Boston, but soon found herself providing therapy to clients through Beth Israel’s Department of Psychiatry Outpatient Clinic. Eventually she was working almost exclusively for the Department of Psychiatry and beginning her own private practice. Like Brown and Grodzki, Dean accumulated many hours of postgraduate training, for the most part through the training opportunities at the teaching hospital where she was working.
Training Social Worker as Therapists
Looking back over their extensive careers as social workers in private practice, each practitioner agrees that postgraduate training is absolutely essential. Each of them also advises acquiring a broad array of training techniques. Brown suggests that getting a „smattering“ of techniques in the beginning helps novices in the field of therapy learn what works for them. „It is not one size fits all.“ In addition, most states now require postgraduate training for social workers who want to be licensed in private therapy practice.
Dean reinforces the importance of postgraduate training. She says, „Most social work schools, including the program at Simmons School of Social Work, are training people for agency practice rather than private practice. They are preparing students for work with vulnerable populations, which is not necessarily the typical private therapy practice client.“ She advises that a social work student who is preparing for a career in private practice should be sure to take the classes offered in social work programs concerning trauma, issues of family violence and addiction. In her view, these courses provide an important foundation for all forms of practice, including a private practice. In addition, there are many practice-focused courses in clinical work that are relevant. Simmons School of Social Work, for example, offers courses in couples therapy, family therapy, group therapy, and brief therapy.
The Role of Supervision
Supervision is a critical element for any successful private therapy practitioner and usually a requirement for licensure. Brown admits that she has „very, very strong views about that. I believe you should not be in any kind of private practice unless you are in supervision and that it is unethical to be in private practice unsupervised.“ She suggests that there are many ways to acquire appropriate supervision. She was in a supervision group for 10 years, she now is in a supervision group with Imago Relationship Therapy therapists and she also does peer supervision. Brown is so adamant about the importance of supervision because she feels that „you must bounce your ideas off of someone else.“ Her experience has been that „common transference issues come up all the time and that you can learn by talking it out with other people. You can never get too smart or too experienced.“
Grozki had ongoing weekly supervision for the first ten years she was in private practice. She believes that this is a key to being a good therapist, and also the best way to build a practice. According to Grodzki, „Building a successful private practice depends on doing the best work that you can.“ Because the work never gets easier, she believes that supervision also helps protect against burnout.
Ruth Dean, Ph.D., advises students who are planning to develop a private therapy practice to join a peer supervision group when they graduate as part of their ongoing education and support network. She herself has been a member of a peer supervision group for 20 years. She suggests that these groups also become referral networks
because „people tend to refer to people whose work they know very well and not to others.“
Building a Private Practice
Brown who has written about how to market a private practice believes that marketing yourself is the best way to build a private practice. She advises new practitioners to „talk to everyone you know about what you love about your work, with specifics about what you do.“ She tells people to put it together „like a mission statement.“ The goal is to get people to know you; once people get to know you, they refer to you.
Grodzki echoes Brown’s advise when she coaches therapists in the development of their practice. She advocates talking about what you are doing „with enthusiasm and passion“ as the most effective way to build your practice. She speaks from experience. When she was in social work school she sought out training in neurolinguistic therapy, in large part to help her own disabled son. Before she knew it, her practice was filled with learning disabled children and families. She sounds a cautionary note, however. You need to have a vision for your practice, she says. „Even if you haven’t intentionally thought about a vision for your practice it will take a certain path-it is better to decide early on where you want to go rather than let circumstance determine it.“ Circumstance determined her initial path, but eventually she shifted her own practice from learning disabled children and their families to adults.
Other strategies that Brown has used to market herself include public speaking and marketing letters. She suggests talking to corporations at lunchtime seminars, speaking at a professional organization and at the local PTA as examples of venues. She has had success with a marketing letter sent out several times a year that included information about what she was doing, some information about herself and an announcement of a workshop or a group that she was giving.
Brown believes that a niche is important and advises that new therapists pick an area where other therapists aren’t comfortable, such as acting out teenagers or alcohol and addictions. She clarifies that this „does not mean that that is what you exclusively do, but it is a way that people get to know you. Once you get to know them, you can share with them that this specialty is not what you exclusively do.“
In the beginning, Brown spent much of her time marketing, but now her practice is for the most part self-sustaining. She believes that it is slow for someone starting out, because it takes time to identify the best people to meet. She observes, „Successful marketing is about building relationships-something social workers know very well. That means that you must devote time every week, whether it is writing letters, sending out emails, or meeting people.“ Grodzki agrees. She also suggests setting aside time every week for building up your practice — what she calls „CEO time.“ She estimates that 50% of the new private practice therapist’s time needs to be devoted to building the new business. In her opinion, you always will need to devote 10% of your time to marketing because, given the nature of business, nobody’s practice is consistently full.
Grodzki also cautions new therapists that building a business for the long term is slow. Her experience is that many therapists, because they are starting small, don’t think about their practice from a business perspective. She suggests that they consider such questions as: Do I have any other cash flow coming in? What needs to be in place to effect a consistent amount of growth? How much of my time is going to be marketing? How much of it is going to be delivering services?
Grodzki advises new therapists to „double the number of people that you know in a year.“ She has found that most therapists and coaches tend to be introverts. She observes that this makes you good at your craft but not at your business. Citing observations from Malcolm Gladwell’s Tipping Point , she says, „Isolation is the new poverty. Most small business people tend to be impoverished in that way specifically-they just don’t know enough people. “ Gladwell found that there is strength in „weak ties.“ You don’t have to know people well. In fact it is better if you don’t, because acquaintances occupy different worlds from your friends. In the end, the research shows that it is not whom you know, or how well you know them, but how many you know.
Introverts should not be discouraged about their potential to develop a successful private practice. Grodzki believes that they can be taught the behaviors of extraverts. She coaches new therapists that they need „an engine that you can repeat over and over again with very little effort, something that is known and comfortable to you.“ Examples of practice building engines may be a certain type of writing, a certain type of networking, presenting, or advertising. This engine needs to generate a flow of referrals to deal with the vicissitudes of practice. New therapists need more in the engine. Through coaching, Grodzki helps therapists to look at what is most comfortable for them. She says, „There is not just one way to market, it is a question of determining what is best for them and what shows them off.“ Patience and persistence are required because it takes a while for something to work. For example, experts say that it takes 6-10 exposures to an advertisement to move a consumer to action, and half a dozen times for a workshop to be offered before it fills up. „You have to build an audience and to do that, you have to build on the long view,“ concludes Grodzki.
Is it Worth It?
The path to becoming a successful social worker in private practice requires hard work, business acumen, training and supervision. It takes time to build a practice and to get the required training and supervision for licensure. But for those who are interested in this career path, there are job opportunities. According to the US Department of Labor, job opportunities for social workers in private practice are expanding, in large part because of the growing popularity of employee assistance programs. These programs are expected to spur demand for private practitioners. Some of these practitioners will provide social work services to corporations on a contractual basis. The challenges for social workers who are pursuing a career in private practice include the fluctuation of the popularity of employee assistance programs as a consequence of business cycles and the managed care organizations who restrict mental health services. But once established, the social worker in private practice has the potential for a stable, lucrative career. As Brown says, „I love this field because you can keep working as long as you have your mind — and you just get wiser.“