Congratulations on moving a step closer to licensure! Internships are an important aspect of your training and growing into an awesome therapist. What is the best Internship for you: Agency, Private Practice, or Private Practice-Model Agency? What are the things you need to know for any placement you are considering?
This article is for post-masters-level, pre-licensed therapists in California: Marriage & Family Therapist Interns, Associate Social Workers and Professional Clinical Counselor Interns. (Grad student Trainees can only work in agencies in Practicum.) If you live in another state, the laws will likely be different, so please check with your state licensing board or your state professional association. All labor laws and BBS regulations included below are current as of 2016.
The most common type of Internship in CA, these are usually at a non-profit and charitable organization such as a community clinic, school, hospital or other mental health agency.
- Many of these Internships are unpaid, or offer only a small stipend to reimburse you for travel expenses.
- If unpaid, the agency should provide both supervision and training. Not all do, or provide only one unit of supervision (which is enough to cover up to 10 of your client-contact hours).
- If paid, you need to be a W-2 employee. If you work as a 1099 employee (independent contractor), you cannot count the hours towards licensure. (The BBS asks for copies of your W-2 pay stubs when you apply for licensure if you were employed by an agency.)
- Established agencies often can fill your caseload quickly. (Note: a lot of schools are starting to integrate counseling into their program; if they haven’t been doing it for a while, you may need to be proactive to get more clients. See if you can sit in on classes, do trainings for staff, or start a Parent Support Group.)
- Paperwork: the amount and type required varies by agency. If the agency takes Medicaid, or if it’s funded by grants, you can be sure there will be plenty of documentation required.
- If your licensure requires 500 hours working with children, family and couples, agencies may be your best bet to earn these hours in a timely fashion.
*** TIPS: In any agency, you will be dealing with policies, procedures, personalities and, often, intra-agency politics. Some agencies have wonderful, supportive cultures; some do not. Some agencies have adequate funding; others may not, and there’s a sense of never enough. Do your research, ask colleagues what they’ve heard, and, if possible, spend time at the agency beyond your interview to experience what it’s like.
PRIVATE PRACTICE INTERNSHIPS
For many pre-licensed folks, this is the ideal: Working in a licensed clinician’s private practice to build their own practice. The BBS has a lot of regulations for this situation, and both California and the federal government have labor laws that must be followed.
- Your supervisor must hire you as a W-2 employee. You cannot be an independent contractor or volunteer in a private practice and earn hours.
- As an employee, you are not allowed to contribute money to your employer’s business. This means your supervisor cannot charge you for or expect reimbursement from you for anything that contributes to the supervisor’s business. Your supervisor in private practice cannot charge you for rent, supervision, training office supplies, business cards or other promotional material, or anything else. An employer is allowed to make a profit from the work that you do.
- As an employee, you must be paid for all hours worked. That includes client sessions, client calls, paperwork, supervision, training, and marketing (although most supervisors will put a cap on how many hours they will pay for marketing).
- As a non-exempt employee in CA, you must be paid twice a month or bi-weekly (weekly is ok, too), and you must be paid for at least one hour of work each week.
- As an employee in CA, you have a right to paid time off (PTO). For part-time employees, this is accrued at the rate of one hour of PTO for every 30 hours worked, or accrued on a regular basis so that you have no less than three days or 24 hours of accrued sick leave or PTO by the 120th calendar day of employment or each calendar year or in each 12-month period.
- You must be paid at least minimum wage for each hour that you work. Many supervisors will pay you a percentage of the revenue that your work generates.
- You cannot receive payment from clients; clients must make payments to your employer, who will then pay you.
- An important note regarding the 6-Year Rule: You BBS registration number is valid for 6 years. If you have not earned all the hours you need by the end of 6 years, you need to apply for a new number. You cannot see clients in private practice after your first registration number expires, so plan your internships accordingly! (This is especially important if you are working towards your LMFT and have not gotten your 500 required hours of children, couples and family hours.)
- It has surprised me that some supervisors do not know their responsibilities as employers, so it’s important for you, as a potential employee, to know the laws and regulations. You can ask your potential employer about these when you make contact or interview with them.
*** TIPS: Do your homework: Find out all you can about the therapist. How long have they been practicing? Do they have a solid reputation? Is their practice full/will they be able to refer clients to you, or do you need to drum up business mostly on your own? What’s their web presence like? Do they have a large network of other therapists who can send clients your way? And, of course, are they a good fit for you, both as a supervisor and as an employer?
PRIVATE PRACTICE-MODEL NON-PROFIT CLINICS
While there are not a lot of these around, when they’re done well, they can work beautifully. Because they are set up as non-profit, charitable organizations, these agencies do not have to follow the same regulations as an employer in private practice.
- The general model for these clinics is that they hire registered, pre-licensed clinicians as W-2 employees, charge a set fee for for rent and services, and pay the you the rest of the revenues you generate. Some will pay you minimum wage for hours worked until you build up a reserve (that is paid when you leave), and then switch to paying you whatever revenue is above your rent and fees. There are also some that expect you to pay their fee for a set period of time (e.g., 3-6 months), and then start getting paid.
- Some provide supervision; others pay an “off-site” supervisor that you find and choose; some want you to pay the supervisor directly. There may be a cap on how much the organization is willing to pay for supervision. An off-site supervisor must sign an agreement among you, the agency, and the supervisor, and the supervisor must have some kind of access to your client notes. (This has become increasingly easy with the use of Electronic Health Records.)
- Some have an office building or suite that you use will use to provide therapy services. Larger organizations may have several office buildings. Some agencies will sublet an office of your choosing (within certain price ranges) for you.
- Some private practice-model clinics have leaders and support staff actively involved in working with the clinicians and in running the business; others may be more hands-off and leave the business end largely to the clinicians. In the latter case, you may be learning procedures form more senior pre-licensed clinicians, and/or have tasks rotated. This can include marketing, tech, office organization/paperwork, scheduling, intake phones, etc.
*** TIPS: Check out the agency’s online presence: Does each clinician have their own page on the agency’s website? Is the website user-friendly? Do they have a blog? Are they on social media? How do they get clients? Again, do your research about their history and reputation, and find out the details of how the agency runs. Are they looking for a particular type of therapist or modality to round out their staff? It can be especially important to get a feel for your place in the agency, and the expectations of the culture of the agency, if the clinicians run the office together.
THINGS YOU NEED TO KNOW FOR ANY PLACEMENT
- What is the mission of the placement? Does the placement walk the walk, or are they just talking the talk?
- What is the culture of the placement? Is it one that you think you can thrive and learn in?
- What kind of time commitment will you need to make? Days/hours? Over what time period? What about vacations/holidays?
- How many client contact hours can you expect?
- Is there pay or a stipend? How much? If you’ll receive pay, make sure you are hired as a W-2 employee and not as a 1099 independent contractor if you want to count those hours!
- How many hours will you be in meetings? What kind of meetings are they? How many of them can count towards your BBS requirements?
- Will you receive training in the policies and procedures of your placement? Who will provide this training? Who do you go to if you need extra support?
- What kind of clinical training does the placement provide? If applicable, what kind of marketing training and support do they provide?
- If you are interested in providing online counseling, will you be able to accommodate clients through this medium? Will supervision be online or in person? Is your supervisor trained in telemental health? Does the agency or supervisor offer trainings in this?
- What other requirements are there? Are you expected to do things that fall outside of the description of you clinical responsibilities?
- What kind of support does the placement provide for you as a counselor besides supervision?
- How much and what kind of supervision will you receive? If you only receive one unit (one hour of individual or two hours of group supervision), will your placement provide extra supervision to cover all of your client contact hours as needed, or will you be responsible for finding extra supervision?
*** TIPS: Be sure to ask questions of the supervisor during the interview process to see if it’s a good match. Does your supervisor have the same conceptual framework about what happens in therapy as you do? Modalities, although useful, may not matter as much as internal orientation about therapy and supervision. Do they have enough time and space for you? Will they be available in emergencies? Are they adept at working with countertransference? This person is going to be an important part of your life and and your professional development for the next year or more, so make sure it feels right!
Renee Beck has been practicing Dreamwork and Transpersonal Therapy for 30+ years, and has had the honor of supervising over 130 pre-licensed clinicians.
She offers clinical consultation, supervision and training.
Online in CA and at her Oakland office.
Call her for a free 15-minute interview to see how she can help: