When it’s time to quit your internship

May 1, 2014 by Ann

Fed up, yet?

Have you had it about up to here? *insert wild, overhead hand gesture here*

I’m talking about your clinical internship.

Specifically, those 3000+ hours (depending on your state) of applied work that you do while under supervision, before you can practice independently as a counselor, licensed marriage and family therapist, clinical social worker, psychologist, etc etc.

Every licensed psychotherapist has got some sort of internship to do.

It’s a part of the process. An important part of the process.

But, man. Counseling internships can be challenging.

In many cases, you’ve had rather limited exposure to clinical work so far.

Maybe a couple hundred of hours of direct client contact in most cases.

(Which, in the grand scheme of your career and the tens of thousands of therapy hours you will someday provide, is not very much.)

And you’ve gone through 2-3 years of graduate training, if not 5-7 in a Ph.D program, to get to this point.

You want to do therapy. You’re ready to begin, dammit.

This is what you’ve been waiting for… right?

Except in some cases, it isn’t. At all.

I’m getting a tall soapbox today, you guys. I hope you’re ready.

All the things you didn’t expect

You graduated, and you found an internship.

Let’s assume that part, though I know many of you struggle to find internships because they are scarce, or they do not pay enough, or the competition is so fierce.

(If you want to consult about the particulars of your situation, send me an email and we can book an appointment.)

But for those of you already in an internship.

Maybe you’re working as a mental health case manager in a rural mental health clinic.

Or you’re running groups in a partial hospitalization program.

You might be working as direct care staff in a residential treatment facility.

Or doing phone intakes for Child Protective Services.

Most likely you’re doing some combination of a couple of these, unless you’ve managed to find a full-time, paid position somewhere.

And every.time.you.turn.around, you find—

Restrictions.

Organization-wide disorganization.

Red tape.

And rules that sometimes don’t make sense.

And you have clients you don’t know how to help.

Absent supervisors.

Mountains of paperwork.

And low pay.

Or no pay.

What’s a counseling intern to do?

Is it any wonder that you might be thinking about quitting your internship?

Some reality testing

It’s often said that some of the most severely ill clients are often treated by the most inexperienced therapists.

Of course, this isn’t always true.

And as for your limited experience, it’s nothing against you and where you are in the process. You can only be exactly where you are in your own training and development.

And there are even some advantages that come with the territory of being a beginner.

But. But.

When you’re working with clients who have histories of complex trauma,

clients with chronic mental illness,

when you’re probably way more focused on maintenance than recovery,

and you don’t have loads of client success stories to bolster your confidence in your growing skills, that felt-sense-I-know-I’m-helping thing that builds with time,

where progress is measured on a very. different. scale. than among those YAVIS-y clients you read about in school, you know, the one who is having some trouble adjusting to her new job and wants to talk about meaning-making…

…it can be hard. It’s hard!

This is the first part of your reality testing.

And then there’s also the secret fee.  The secret fee you’re probably not getting.

The secret fee

We got into this work to help people. To make a difference.

And the work is about more than the money we’re paid.  

Yes, it’s a livelihood.

But we had a choice of profession, and we chose counseling.

It’s certainly not the world’s easiest job, nor the most lucrative.  But it’s rewarding and amazing, if you’re into that sort of thing.

 

And if you’re reading this, you’re into that sort of thing.

Even if you adhere firmly to a stance of therapeutic neutrality and can tolerate a huge range of feelings and presenting concerns and moral dilemmas, at the end of the day, you still want to see things improve for your client.

Whatever improvement means to them, of course. Doesn’t necessarily mean being happy. In fact, it may mean a lot of crying, a lot of holding painful pieces.

Improvement.  This is a form of payment we don’t often talk about.

Because we don’t want to set expectations, maybe.

We don’t want to pressure our clients, or paint them with goals and progress they aren’t ready for or don’t want or need.

And that’s responsible practice, to notice and be aware of those feelings.

To notice our expectations, our ideas, our baggage, to shield our clients from our stuff, to claim responsibility when it gets out there anyways, to keep a watchful eye on our egos and agendas.

But even so.

We talk about fee-setting, whether or not to accept insurance in our practice, but this is another way in which our work “pays” us.

And we may carefully state that we don’t have expectations, that the client’s job is to show up on time, pay us, and participate, and that’s all we expect.

But we’re human, you know. And seeing improvement is gratifying.  Even if it didn’t have much to do with us, in the end.

And sometimes an hour offers this special sort of payment. And sometimes the hour is grueling—for us, and for the client. And that’s just how it goes. It is what we signed up for.

Bearing witness to these victories is a wonderful thing. A wonderful bonus to the work we do.

This is normal.

This makes sense.

But in clinical internships with recently graduated counseling interns and associates, you often you find these things together:

-clients with complex, chronic symptoms

-low paying jobs

-large caseloads

-poor clinical support

-high staff turnover

Depending on where you work, Aha!! moments may be few and far between for your clients.  You aren’t seeing much of these secret, “hidden” fees.

Maybe you just got no-showed for the third week in a row because your client had to choose between paying the electric bill or covering the bus fare to your office.

And now you have to close their case because they’ve missed too many times.

Or you have to keep their case open because it’s the rules, even though you aren’t meeting frequently enough to feel you’re of much help.

It’s quite possible that many of your clients may not even want to see you. They are forced there, by the courts, by their parents, by someone other than them.

These are hard situations.

If you’re in a situation like this, consider this blog post a bit of reality testing for you:

You are in a hard situation. 

What can you do about it?

Should I stay or should I go?

I cannot give you a clear answer on whether or not to stay or go at your internship.

I don’t know the particulars of your situation, and it’s a decision that you need to make yourself.

But if you’re reading this post and nodding your head, ask yourself a couple of questions:

1.) Are you being asked or pressured to do things at your job that are unethical and/or fraudulent regarding client care, billing, or documentation?

2.) Is your workload, company infrastructure or culture so overwhelming or toxic such that you are essentially “set up to fail” because you cannot reasonably meet deadlines, requirements, or standards for ethical patient care?

For this one, ask yourself if other people in your department are having a hard time meeting deadlines, or if it’s just you. People handle caseloads and paperwork quite differently. If it seems like something that most people would blanch at, pay particular attention. If not, you may want to consider what supports or changes you might need to put in place to meet your duties—or if another job would be a better fit.

3.) Do you feel you are practicing outside the scope of your ability to practice, without adequate support? (And there’s no way for you to get that adequate support, either within your department or privately?)

4.) Are you struggling with compassion fatigue, feelings of burn out, or vicarious traumatization? Is it getting harder and harder to care about your clients? Are you feeling resentful of your clients?  Is your own mental health suffering?

These are just a couple of red flags, and I could come up with others.

No matter what, if something doesn’t feel right, it probably needs some attention!

You should consult with several trusted colleagues—folks outside of the system where you work, if possible.

Maybe you fought really hard to get this job.

Maybe you feel like you’ve got no other choice but to stay.

But remember: if you lose your license, you lose your livelihood. An organization can be sanctioned, fined, and sued. And so can you.  But you can also lose your ability to ever practice again.  A hard choice now can save you a lot of trouble later.

You have options

The main thing to consider is this: even if you feel stuck, you still have options.

Even if you’re at a job in a toxic work environment, but finances, life circumstances, or a tough job market prevent you from leaving, you still have options.

Even if you’re unable to find a paid internship in the town you live in and you absolutely need a paid internship yesterday, you still have options.

They may not be options you love, but you still have them.

Let’s say you’ve spent six months actively searching for an internship, but you haven’t found anything.

You haven’t gotten interviews, or the ones you have gotten haven’t panned out and you absolutely must get a paid position stat.

You may choose to take a job that isn’t clinical in nature to supplement your income.

You may consider a commute to a neighboring town and widen your job search that way.

You may put your internship on hold completely, while you get on better financial footing.

You may choose to relocate to another city or state to complete your internship, where job prospects are more promising.

And what about if you’re in a toxic internship?  What then?

Is it demanding but doable work, with more support?  Or is it truly toxic, something you should walk away from?

Is the workload too much?  Would a part-time position be better?  Can you reduce your hours and take more time to finish your internship?

Maybe the problem is a warm-body supervisor.  Can you partner with someone else to oversee your work, or participate in peer supervision?

Perhaps you need to quit the internship.

I can’t answer this for you. But the fact is, no matter how stuck or trapped you feel, you do have options.

They may not be options you love.  In fact, I’m pretty sure they won’t be, if you’ve put off looking at them seriously up to this point.

So you may have to make some hard choices.  I’m sorry.  That’s frustrating, it really is.

But there’s too much at stake to not look this thing in the eyes and make that judgment call.

Do you have a tough situation you’d like to consult about?

Consider booking a consultation with me.