When I decided to pursue a career in psychotherapy, I did my homework to research graduate schools and programs that I thought would be a good fit for me in terms of program model, course offerings, faculty reputation, and research and internship opportunities. A naïve mid twenty-something, I chose to study at the NYU School of Social Work. I loved every second of it. I had great internships with supervisors who gave me great individual clinical supervision, treated both staff and patients with kindness are true concern, gave me supplemental academic materials, mentored me about my career after graduate school, and who were just stand-up people who would give the shirt off their back if it was possible to do that without being half naked. I graduated and my internships ended, and I was in a positive headspace. I passed my licensing exam and was ready to pursue my 3000+ clinical hours that I would need to for the next level of licensing that I would need to eventually start a private practice.My first job post grad school (actually post grad school the second time; I already had a master’s degree and was making a career change) wasn’t exactly what I was looking for in terms of the kind of clinical work that I ultimately wanted to do (nor in terms of commute- it’s a long trip to the Bronx!) but I learned some valuable tools. I felt that the supervisors there had the best interests of the community in their hearts and were always kind to staff. We always had consistent individual supervision and had team supervision every Friday. Both of these were crucial to high quality work. The supervisors always had a snack or breakfast for team meetings, had a lovely holiday party each year, and always made sure to ask how we were doing in terms our own stress and wellness. We often would do deep breathing or meditation at the start of our team supervision. Whenever someone would celebrate a milestone, we always had cake (usually from Artuso’s which made some incredibly delicious cakes!) We hosted group sessions for our adult patients and had cupcake decorating parties for the children we worked with. After about a year of working in such a caring environment, I decided that I wanted to pursue working with the population I wanted to work with, which, at the time was serious mental illness.
When I started my next job, I was in for a rude awakening. Three weeks into working there, I would start to look for new jobs. I barely lasted 10 months of working there. The administration there was terrible to both patients and staff. I had to be in the presence of so-called “professionals” who would yell at patients to the top of their lungs saying degrading things, which would often lead to at least one psychiatric hospitalization, and then turn around and do the same thing to clinicians. My colleagues and I all lost a substantial amount of weight from not being able to eat and would drive to work daily being anxious and on edge with knots in our stomachs. Additionally, I would witness other things that I found to be ethically questionable. And this wouldn’t be the first place I would work where I would see such behavior. To make things worse, clinical supervision often went by the wayside, which is so important to the development of newer clinicians, but to ensure the best possible care of all patients. In order to be licensed in New York State, all clinicians had to have a minimum of a master’s degree yet were grossly underpaid and overworked. Many institutions where I’ve seen newer clinicians work were non-profit agencies which had barely enough funding to provide care and pay staff, let alone hire new staff when caseloads became overwhelmingly large. In the rare event of group supervision sessions, the time was used to shout and blame one another, never taking responsibility for one’s own errors, and did nothing whatsoever to contribute to improved patient care. Clinicians schedules usually ran very late, keeping people sitting in the weighting room sometimes for hours, because they did not have enough time to take phone calls and facilitate referrals. The facilities were often dirty and uninviting, putting patients off from wanting to receive their care at many of these organizations.
When I no longer could tolerate many of the things I had been witnessing, I decided to go into private practice on my own and was operating at full-time capacity in 6 months. But working alone is challenging. And I found it very difficult to meet up with other clinicians in private practice for peer supervision. I worked very long days to do my best to accommodate patients, as many wanted to be seen in the early morning prior to the start of their work day, or after work, often requesting appointment times as late as 9pm. But I got to do things my way and make sure that people were taken care of.
I’ve done a great deal of thinking about the progression of my career and what was helpful and what was traumatic. I had a supervisor who was a good person and did all that he could to shield us from the administration above him that looked at patients as numbers and not as people. He taught us all a great deal about how to make running a clinic successful and how to pacify incompetent idiots. I had another supervisor who ensured that we had weekly individual clinical supervision. But sadly, the good experiences I’ve had have not outnumbered nor outweighed the bad.
My dream has been to build a group practice where clinicians would consistently receive individual and team supervision to ensure that patients get the best care possible and so that clinicians can mentor and learn from one another. I’ve had high hopes of creating a place where clinicians wouldn’t be burnt out, verbally abused, or made to feel stupid- a place with open communication and positive morale. This practice would be the first of its kind that I’m aware of, which would also make an effort to integrate the community in ending the stigma of mental health treatment. It would be a place where local artists could display their work and where local businesses could collaborate to provide high quality services and goods to the patients and the community. It would be a place that would create a comfortable atmosphere and a feeling of home. Appointments would run on time because there would be someone to help with referrals and other items needed for patients. Scheduling would be at ease, as patients would be able to schedule and receive appointment reminders through a HIPAA compliant app, where they could also track their progress to their goals, add an overview of their sessions as well as what they would be working on in between sessions, as well as communicate with the treatment team and paying their bill. It would be a place that young adults could work with clinicians who can relate to them. It would be a place where people could come to receive their care without judgment. It would be a place where staff would be able to model the self-care skills that are needed to maintain good mental health and balance in life.
My vision of starting Refresh has been a quite a journey. But I’m glad to say that I can finally work on my dream of creating a psychotherapy practice unparalleled to any other and hoping that this will give staff and patients the knowledge and passion needed to begin to make changes to our country’s mental health system.