Friday, May 20, 2016

Professional Identity

Chapter One
Professional Identity
   The more than century-old discipline of social work offers a specific identity embodied in the National Association of Social Workers Code of Ethics which includes the values of service, human dignity, and integrity.  Social work training articulates skills including reflective listening, open-ended questions, and non-verbal communication.  Psychotherapy theorists define interventions like identifying specific behaviors, solutions, and relationship styles.  Laws and court decisions require steps like risk assessment, mandated reporting, and documentation.  Insurance means diagnosis, informed consent, and billing.  These are among the questions to be answered in developing a professional identity.  When you decide to “hang out your own shingle”, how does all that fit on the sign?  Of course, the business sign these days is not a sign at all.  And, business is generally not generated by drop-in or drive-by customers.  In ten years, despite investing in print advertising, memberships in therapy directories, and direct mail and e-mail marketing, most of my referrals still come by word of mouth from clients themselves.
    There are a variety of platforms that serve as the modern day business sign, among them websites, Facebook, Linkedin, and Plaxo, and I use them all.  But the one that has been most useful, flexible, and personal is my website:  However, it is not having the website that defines my professional identity but the process of developing it.  It requires answering and continuing to reflect on the big questions: Who are you?  What do you believe?  What do you have to offer?  How do you think about people and their challenges? How do you work?  On what education, knowledge, and experience is your work based?  With whom will you work?  What will you do or not do?  Who are your colleagues and connections?  Because this business sign exists in the ether and not at a specific physical address or even on paper it can represent me where ever I work and whatever I do.  It holds a space for my professional identity and ideas whether I am in private practice or working for another organization or not at all.  It can be changed and updated and refreshed whenever I am.
   The process started by reviewing a lot of websites, both those of other therapists and those of other businesses.  Then I had to determine the necessary content, like contact information, and nice content, like intake forms and other resources.  Most importantly it may be a client’s first introduction to me and my services.  In that way it provides a first impression and first informed consent, the legal and ethical information required to be provided to clients.  This is included in a professional biography, philosophy, and frequently asked questions also contained in the forms clients sign to provide informed consent for treatment and notice of privacy practices.  The latter leads to thinking and planning how client information and files, both paper and electronic, will be stored and secured for retrieval until they can legally be destroyed.  In my case, it is a locked filing cabinet inside a locked office and password protected software and computer.  The first intake forms I used I borrowed directly from the more experienced therapists with whom I worked, changing and updating them to meet my needs as my own experience and training progressed.  The forms are therapeutic tools after all, including important background information, symptom checklists, and risk assessments that contribute to treatment. Providing them online was a practical way to save printing costs but also to allow clients to begin to consider the kinds of topics that might be covered in session.  Developing a list of resources required me to make connections and to consider what referrals my clients might need from emergency to supportive services.  A bibliography suggests options for biblio-therapy.
   These days websites are simple to create and maintain by registering a domain name and hiring a hosting company, even designing the site yourself as one of my colleagues did with a Microsoft program.  I paid a web designer to pull my ideas together into a cohesive presentation.  First, I had to figure out what to call my website.  My television handle, Mike Jones, fit nicely on the screen but a quick Google search showed it was already taken by hundreds of others and my business would be difficult to find on the internet.  Having my face in the public eye made it easy to put it on my website and business cards.  Most of my colleagues do not do this either because they see it as undignified, as if we are selling real estate, or they are simply not as vain as I.  But there is a clinical reason I plaster my picture all over my media.  Going to therapy, like the doctor and the dentist, it not always easy or comfortable.  Many clients are in crisis or distress.  In line with trauma-informed care, showing a client who they will meet, where they will meet, and what they can expect reduces anticipatory anxiety.  It is really the beginning of the therapeutic process, contemplating change.  An explanation of services explains your practice model and socializes a client to the therapeutic process.  Answering frequently-asked-questions helps to define professional boundaries.  The same rationale applies to including maps, directions, and pictures of the office and building along with parking information and amenities.  Including links to blog, Facebook, and Twitter, if not LinkedIn and Plaxo, too, are other ways to extend the reach of a professional identity.  These are the mission and vision of a private practice.

Thursday, May 19, 2016


Private Practice.  That was the pinnacle of success I saw when I decided to change careers and become a social worker.  Private, because it was something that would belong to me, my own creation I would pursue without interference after years of working for media companies and at the whim of whatever news director was in charge at the time.  This kind of independence runs in the family.  My family was farmers used to planting their own crops, butchering their own animals, building their own homes.  Only after farming failed and World War II ended did my grandfathers go to work for the railroad and an ordinance plant to bring home union paychecks.  My father tried all that but chafed under the supervision of corporate bosses and union chiefs.  So, he went from pool hall owner to repo man to delivering propane to heating and air conditioning with independent efforts at running a hardware store and real estate scattered in between.  He liked making his own decisions and making his own hours.  It’s not a surprise then that all five of his children are either in business for ourselves or have carved out unique and independent roles in service to others just like our mother, a registered nurse.
Private also means, to some extent, solitary.  Certainly, private practice can include working in a group, with other therapists and disciplines, or for a company providing mental health services.  But for me private practice meant owning my own business as a sole proprietor or limited liability corporation.  Which means that decisions from advertising to office space, client referrals to specialized training, to risk assessment, mandated reporting, treatment planning, and intervention strategies are mine to make.  With this privilege comes power, and with this power comes liability, and with this liability comes a certain amount of stress, separate from the stress of managing finances, which is often an inside joke among social workers, but rather serious business when your living depends on the literal ebb and flow of income and expenses.  Which is why a saying sticks with me from business books to military training to a law and ethics training by Gerry Grossman: “Never worry alone.”
Maya Angelou describes standing on the shoulders of those who have gone before and of feeling backed by those who have supported us on our way.  I have been lucky to have had many of those mentors starting with my own parents and teachers.  In television as in other industries the moto is “fake it ‘til you make it.”  So, when I started reporting the news I would “channel” Barbara Walters asking serious questions of those in authority or my journalism professor at the University of Missouri, Columbia, Dan Dugan, in writing and Walter Cronkite in pacing my delivery.  During my master of social work studies at Our Lady of the Lake University in San Antonio, Texas, I had the excellent examples of my field instructors.  Ed Cardenas at J.T. Brackenridge Elementary School could calm a group of hyperactive boys just by walking in the room.  At Catholic Charities of San Antonio Arlis Schmidt took me for a Coke after a particularly triggering run-in with a nun.  At Child Welfare Services in San Diego my LCSW supervisor Becki DeBont would simply say, “And the mirror appears”, emphasizing the need for self-reflection.  Supervisor Laurie Adam would back me to the hilt when I disagreed with management about adoption recommendations.  Also at Child Welfare Services, first Renee Smylie then Karen Martin turned me loose to create an internship program that taught me more than anything I had to offer students.  When I did put my foot in the water of private practice after earning my license Nancy North, LCSW was there to hold my hand.  Then I landed in an office with exceptional therapists who had already made the leap from Children’s Hospital.  Chris Diani, LCSW, Laurie Hall, LCSW, and Deborah Holmes, LCSW shared everything from a practice philosophy to the forms and paperwork to get started on my own.  To this day there is a safety net of colleagues with whom to consult and complain.
The practice part puts you at the party with doctors, lawyers, and other professionals who have degrees, licenses, offices, billing, and malpractice insurance.  “My practice,” sounds like you have arrived.  It sounds trite to say that practice is not an end but a beginning and just as trite to say that practice makes perfect.  There can be no end to learning about the nature of humans, our strengths and challenges and what works to apply one to the other.  And there can be no perfection in the joining of unique individuals except in the joy of doing so.  Practice, then, is not a noun but a verb that indicates the act of applying knowledge and experience from our education and training with consultation and supervision to the life experiences and personal wisdom of clients with the intention to help as much as necessary while hurting as little as possible.   It is also cliché to say that these human services, from customer care to nursing, from sales to psychotherapy, are as much art as science.  But despite the efforts of industrial science to quantify human interaction and research into human behavior to develop evidenced-based practice, there is qualitative research to indicate it takes some time to achieve mastery.  Popular media quote 10-thousand hours to achieve mastery in one’s field, approximately five years at 40-hours a week with two weeks off for vacation.  If that is true, I achieved mastery in 2011.  But I and most of my colleagues would say we have achieved some level of competence but nowhere near perfection.
Why, you may ask, did you switch from a lucrative career in television reporting to a completely different career in the profitable field of social work?  (Tongue planted firmly in cheek.)  My answer is that they are essentially the same job.  As a reporter I was expected to respond to crisis situations; fires, floods, tornadoes, murders, political disputes both major and mundane.  I had to find the source; the victim, the perpetrator, the authority.  And, with nothing but a pad and pen, and oh yes, a camera and a microphone, convince them to tell me their story.  I had to ask very personal questions of complete strangers in a way that would reveal the truth of their circumstances.  Then, under deadline pressure, turn this raw data into an assessment of sorts, a compelling narrative with a beginning, middle, and end in the space of a minute and thirty seconds.  Those stories aired on the evening 6:00 p.m. or late night 11 p.m. newscast could entertain, educate, and sometimes challenge people and organizations to change.  Not all of them in 15 years were Emmy-winning, in fact none were, but they did get some attention, some a lot.   For some reason, after a time, I was either assigned or volunteered to find and interview the victims and family members of the disaster of the day.  In April 1992, it was the family of one of four young people lined up inside a walk-in cooler and shot in the back of the head execution style at a Lee’s Famous Recipe Chicken restaurant in Tulsa, Oklahoma.  The mother of the 15-year-old boy let me in the front door.  The very top of the living room walls was lined with pen and ink and watercolor drawings.  It was the work of her son.  It was his story I told that night on the news.  I sat with her and the other family members as the suspects were put on trial and convicted, then I went on to cover the election of President Bill Clinton, lots of 4th of July parades, and the bombing of the Alfred P. Murrah Federal Building in Oklahoma City.
In 1998, as I was starting my graduate education in social work I was sitting at the assignment desk one Saturday morning at KSAT-TV, the ABC affiliate in San Antonio, Texas where I was working part time.  In the morning mail, there was an envelope addressed to me personally.  I opened the envelope and out fell two letters, each written two years apart, and a picture of a woman with long brown hair standing in front of a bright orange Corvette.  I had no clue who the woman was or how she found me.  This was before Google searches and Facebook.  The woman was writing to thank me for my work in showing compassion and telling the story of her son who was one of the victims of the chicken shop shooting.  And then I remembered.  She had shown me the shell of a vehicle in the garage that day that was to be her son’s first car.  But he did not live to be 16 and get his driver’s license, and so she and her husband completed the project and toured car shows with the restored Corvette in his honor.  My lesson: people can survive tragedy and grow and you play a part.  On April 19, 1995, the newsroom secretary interrupted the morning meeting with a report of an explosion in Oklahoma City.  A photographer and I immediately jumped in a car and headed west on the interstate.  We thought we would be back by lunch.  But the state troopers speeding past us signaled something serious was happening.  The city looked like it had been hit by a more familiar tornado and we carefully drove down side streets avoiding broken glass and moving debris.   We made it to a parking lot and saw the federal building two blocks away, its façade sheared off and a pile of rubble where the entrance use to be as the 13 floors “pancaked” during the explosion caused by the fuel bomb in the Ryder truck driven by Timothy McVeigh.  For 10 days, wearing the same blue suit, I broadcast live morning, noon, and night as survivors were pulled from the pile and the body count ticked up to 168 dead including 19 children in the day care.  At one point rescue workers found a tattooed severed leg.  It was gruesome and sad.  However, it was also inspiring.  The workers needed more gloves, more masks, more batteries.  The line of reporters bathed in floodlights would turn to our cameras and tell viewers and trucks of gloves and masks and batteries and more would arrive.  It was my first experience in direct social work practice. 
Then we went into the Red Cross tents and the hospital wards and began telling the survivors’ stories, administrators, clerks, and secretaries in wheelchairs and bandages.  As the search went on first for a “middle eastern” suspect then the quick capture of McVeigh, parents and grandparents, husbands and wives put flowers and pictures on a makeshift memorial fence and waited for their love ones to be identified.  The question remained, why would someone do something like this?  And the broader question for me, why do people think what they think, feel what they feel, and do what they do?  It was the beginning of my social work education and my journey to private practice.  It would take another four years to leave my first dream job and earn my graduate degree.  I would return to the Oklahoma City site a year later where the federal building had been levelled and a memorial park planned.  But my heart and mind were in a different place with hopes of preventing such tragedies or helping those who survived them.
So my intention here is to explain my thought process and the steps I took in establishing my “practice”.  After deciding that social work with its broad person-in-environment view was the best fit for me, I had to put on the mantle of social worker, develop a professional identity, and carve out a niche for myself.  First, there was the role of social worker in “public” practice as a child welfare worker, and then came trainer, supervisor, therapist, and teacher, the jobs that would pay the bills.  In the meantime, in order to run a business, I had to define my product, how to sell it, and what to charge for it.  Marketing a service as nebulous as human interaction is like selling space on the internet.  Others, like Murray Bowen, Virginia Satir, and Aaron Beck, and more recently Insoo Kim Berg, Daniel Hughes, and Susan Johnson have quantified their interventions.  Yet in setting your bicycle apart from bicycles sold by other manufactures, it’s necessary to go beyond the fact that yours has two wheels, handle bars, and a seat to distinguishing what sets it apart from other models and why someone should buy and take a ride on yours.  To take the metaphor further, are you going to teach them to ride or repair the thing if it breaks down?  Most importantly, how will it feel to ride the bike you make?   These are all questions that go into developing your unique brand, the professional identity that is you.