Discover Top Posts Tagged with #school based counseling

Are you a therapist in a school setting? If so is that any different from something like a private practice? How?

I’ve done therapy in a residential setting, in a school setting and some in private practice. Right now, I’m primarily in a school setting. It’s very different than private practice. Private practice - it’s all on you administratively. You are marketing yourself to get referrals, billing insurance if you take it, finding, renting and maintaining your own space, your own health insurance etc. It also means that most of the time, you set your own schedule, which days you work and the times, how many clients you see. Clients also come to you. You still have to write some notes but from my experience - private practice folks vary *widely* in how extensive they are. Cost can be issue (i.e. if you think a client needs supplemental sessions or more than once a week, that’s coming out of the client’s pocket or you are justifying that to the insurance panel). When a client misses sessions, man it’s a thing you have to deal with. Depending on your policy, you have to charge them because that is time reserved for them. Income can be decent if you are seeing a fair number of clients.

In a school setting, most of the time you aren’t dealing with most of the stuff above. You are an employee for a district or an agency. They do the business taxes, the health insurance, the physical space stuff. When you are seeing clients in school, you get a lot more flexibility - especially if you are at placement all week. Client absent? No worries. Try and catch the client tomorrow. Major dissociation in session? Again no worries. The client just stays through the next period. Something major just happen? Cool, twice a week this week. And your clients have to be at school so it’s easy to find them, even if they are choosing not to come to session. It’s not my therapy and it doesn’t affect my livelihood if they don’t show. I can be way more patient with school based than in private practice because I get paid whether or not they come. It gives slow to warm clients more flexibility - I have no problem holding a slot for them and them not taking it because I do have the flexibility. I can fill that time a lot of ways - including seeing other clients because of the environment. It can also be really fucking frustrating to deal with everything not client related. It’s formal assessments and treatment plans every 6 to 12 months for every client. It’s not being able to control your caseload. I’m not good with psychotic disorders. But I’m expected to take what come down the line. They also control my caseload. I can (and do) push back against this aggressively but unless I can make an ethical argument or my individual supervisor backs me up I don’t have a lot of choice. Medi-Cal or district note writing can die in the fire. Having to get notes in within 24, 48, or 72 hours is a exercise in both futility and aggravation. (My notes? Basically only on time if I’m writing about a no show. If I have to choose between clinical care and paperwork - clients come first and I can’t maintain 10-12 hour days.). I also have to step carefully around teachers and school staff as well as all the office drama. To me, it’s worth it because I do get to do such cool work and get this much flexibility. But most agency therapists eventually get burnt out and leave or just make the choice to leave because the pay isn’t very good, you are expected to work long hours, to meet impossible productivity requirement and you are often dealing with intense trauma. And all of that is happening in addition to the systemic racism and oppression inherent in the systems that you and your client are trying to navigate. And most of the time the district doesn’t want to hear, “Hey this long term teacher is a racist asshat who is using racial slurs in class” especially if they are teaching the difficult to fill classes (like special education). I wish that I could say I have done this. I'm done it multiple times. I mean I do it. Everytime. It’s important that my clients know that I believe them and will fight with them and for them. But I know it will cause me a mountain of shit. I know it and do it anyway. But some people can’t. And that’s okay because hopefully they’ll move onto something that suits them better. For me, this is worth it and I love, love my job.

{Sidebar to the therapists and social workers reading this: We are going to real for a second. if you are a therapist in a school, public health or a community setting and you are feeling like, “Fuck me. I can’t do this work anymore” - get out. Secondary trauma is a serious occupational hazard. Take care of yourself. Try a new job in the same setting if you think it’s the agency. Try a new job is a different type of therapy. You have to make the best choice for you and your family. You won’t be helping anyone if you are burnt out. You’ll miss stuff and beat yourself up. You have to put your oxygen mask on first. Anyone who judges you for knowing your limits is fucking jerk and should be mentally classed as such. Love to all y’all}

Got a little windy there but I hope that explain it.