Private Practice Internships:
Reflections on Getting Set Up for Success
This article highlights important considerations for both supervisors and interns. My intention is to empower both parties, so that they may create their most successful private practice internship. Fundamentally, a private practice internship is a collaborative business partnership between two individuals. I believe it is wise to clarify the expectations that you each bring to this venture. In this way, you will have consciously built the most favorable working rapport possible.
I have had extensive personal experience in both of the roles of intern and supervisor. As an intern I consciously prepared myself for a successful transition into a private practice. As a licensed MFT, I have supervised private practice interns since 2002.
The knowledge I found I needed, while navigating the transition into private practice, did not come from any aspect of my schooling. Graduate programs generally do not directly prepare interns for the pragmatic realities of building a private practice business. As an intern, my most valuable insights came by paying close attention to friends and colleagues who were two years ahead of me in creating their own private practices.
My first internship was at College of San Mateo. My long-term goal was to develop a private practice in San Francisco. It was clear that I needed to build a local client base and referral network within San Francisco. I decided to invest my time, efforts, and money at a counseling center because I knew marketing had not been one of my strong suits. This strategy served me well, as I was able to leave the counseling center with a number of clients. This assured that my client fees would be more than adequate to cover the costs of the internship, and that is what made it possible for me to find a willing supervisor.
Interns: Financial Realities
As a supervisor I often get phone calls from prospective interns. During these conversations, I have found it necessary to educate the callers about what a private practice internship fully entails. I frequently hear surprise as I mention the comprehensive list of the estimated start-up costs. Here is a rough breakdown:
Supervisor's profit (based on rent & supervision)
Worker's compensation insurance
Initial Start-Up Expenses
A fire-safe lockbox (for client & business records)
Printing business checks
Printing business cards
Then my next step is to help the intern compute the cost of the running the private practice and compare it with the current revenues generated by the intern's monthly client fees. One can quickly assess whether a practice would be financially viable. There is, however, a bit of potential flexibility here, because private practice interns are allowed to pay for supervision out-of-pocket. Ideally, I prefer for an intern's practice to be fully self-sustaining. But during times of unexpected financial fluctuations (such as client attrition), it may be beneficial for interns to exercise the out-of-pocket option as an investment in their business.
It is essential for potential interns to understand that they are beginning a new business when they initiate their private practice internship. Most people are aware that there are numerous expenses associated with building a new business, and that it may take years for their venture to provide a reliable primary source of personal income. I like to encourage interns to hold realistic financial expectations, and plan ahead for a smooth transition. Therefore, I prefer interns to have an additional source of income that enables them to cover all basic living expenses. This may be another job, a financially supportive partner, or some other source of funds.
I encourage interns to set themselves up for long-term success. Therefore, I ask:
- In addition to being an effective therapist, do you feel you have the entrepreneurial self-confidence and the perseverance needed to initiate your own business?
- Have you planned how you will acquire your 500 hours of child/couple/family therapy?
- Do you have enough of a referral network already in place?
- Does your life have adequate personal support in place to deal with the potential isolation of private practice?
- Do you have at least three strong professional references?
- Are you comfortable talking about how you work?
- Do you have an area of specialization?
- Do you understand the work entailed in marketing and networking?
If you answered "no" to any of these questions, you may want to consider working within a counseling center where you can grow your professional capacities and your practice without the pressure to immediately produce new clients.
I stress when speaking with interns that it essential to choose a supervisor wisely. This is a critical juncture in one's career path. A supervisor may be with you from 2-4 years, so this is a relationship that will greatly impact your professional trajectory. When you are interviewing with a potential supervisor, come prepared with your own well-considered questions. It is your job to confirm that your supervisor is a suitable match for you in all ways. Do you get the sense that with this supervisor you can create the safety necessary to truly share your vulnerabilities? Don't make the mistake of latching on to a situation based solely on logistical convenience. Remember, the best fit will always be one in which you like and respect your supervisor.
It is best to plan out the business aspects of an internship, and clarify your philosophical approach in advance. I ask supervisors:
- Do you already know that you enjoy supervising?
- Do you feel an intuitive comfort with your prospective intern's demeanor?
- Do their professional references indicate any areas of concern?
- Will you feel confident in making referrals to them?
- Are you comfortable with the level of responsibility it takes to have others working under your license?
- Do you have the skills and knowledge to generate your intern's payroll, or will you hire a professional bookkeeper?
- Are you prepared for the weekly banking, monthly bookkeeping and additional paperwork at tax time?
- Have you already developed the business forms your intern will use?
- Will you have flat fees for your supervisor's profit, or will you charge a straight percentage of the intern's income that might build as the profit margins grow?
- Would you prefer an intern who shares your same theoretical orientation, or are you willing to be exposed to other methods?
- Will your supervision focus mostly on client material or are you holding that the intern's personal development is an integral part of this process?
- Overall, are you committed to traveling with your intern into whatever territories become necessary?
Philosophy of Supervision
My experience has taught me that the supervisor's role in a private practice internship is inherently multi-faceted: one is the employer, clinical supervisor, business coach and a mentor. Correspondingly the intern holds multiple roles: an employee, a clinician, and most importantly a human being who will grow and change during the time in supervision together. These complexities can, at times, create some tension. In business settings, many of us have learned to conceal any areas of "inferior functioning," being concerned that employers may not tolerate our limitations. However in the supervision setting it is vital that both people be willing to take the risk to be vulnerable and genuine. Thus, holding an integral perspective is essential.
The archetype of the healer governs both the role of therapist and supervisor. Holding the idea - healer, heal thyself, brings us to the holy task of continually making room inside for the full technicolor range of emotions that is this wondrous human experience. As one moves into wholeness, ultimately there is nothing that can be left out. So rather than striving for some concept of perfection, it is important to realize that everyone is on the quest for the deepest authentic expression of truth that can be embodied. From this viewpoint, in therapy and in supervision, there is nothing that needs to be disowned. Rather, everything needs to be brought fully into the light of consciousness.
Ultimately a supervisor's wish is for each intern to understand that the entire richness of his or her life experience is welcomed. With this intention of creating a vessel of sacred trust, in time, interns will feel safe enough to reveal their entire self, including doubts, fears, growing edges and most importantly the areas where they feel most personally challenged. To conclude, this professional relationship, if consciously created, is one that can offer remarkable benefits to both supervisors and interns.
Lori E. Opal, MFT has her private practice in San Francisco, which currently includes supervising two private practice interns. She is available for in-person or phone consultations about private practice internships. Whether you are a potential supervisor, or a hopeful intern, she can help you examine your individual needs to set yourself up for optimal success. Lori also welcomes the opportunity to make this information available via trainings or public presentations; she can be reached at 415-503-0522 or www.loriopal.com.
Lori E. Opal, Licensed Marriage and Family Therapist (MFC 35754)