Tuesday, July 26, 2016



Ainsworth, Mary D. Salter, Blehar, Mary C., Waters, Everett, Wall, Sally N.  (1978) Patterns of Attachment: A Psychological Study of the Strange Situation, Psychology Press, New York, New York.

American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Publishing, Washington, D.C.

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Curran, Linda A., BCPC, LPC, CCDP, CAC-D. (2013) 101 Trauma-Informed Interventions: Activities, Exercises and Assignments to Move the Client and Therapy Forward, PESI Publishing and Media, Eau Claire, Wisconsin.

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Danziger, Paula. (2004) Barfburger Baby, I Was Here First, G. P. Putnam’s Sons, New York, New York.

Dickson, Donald T. (1998) Confidentiality and Privacy in Social Work A Guide to the Law for Practitioners and Students, The Free Press, New York, New York.

Erikson, Erik H. and Erikson, Joan M. (1997)  The Life Cycle Completed, Rikan Enterprises Ltd., New York, New York.

Forbes, Heather T., LCSW. (2012) Help for Billy: A Beyond Consequences Approach to Helping Challenging Children in the Classroom, Beyond Consequences Institute, LLC, Orlando, Florida.

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Grosso, Federico C. (2009) Advanced Applications of Law and Ethics for California Clinical Social Workers.

Grosso, Federico C. (2008) Managing High-Risk Clients: Protecting the Mental Health Clinician.

Hughes, Daniel A. Ph.D. (2007) Attachment-Focused Family Therapy, W.W. Norton & Company, New York, New York.

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Viorst, Judith. (1972) Alexander and the Terrible, Horrible, No Good, Very Bad Day, Atheneum Books for Young Readers, New York, New York.

Yalom, Irvin D. (2008) Staring at the Sun: Overcoming the Terror of Death, Jossey-Bass, San Francisco, California.


Lessons Learned
I have learned a few things about running a business and providing counseling, supervision, and training over ten years, and I expect to learn a lot more in the years ahead.  I expect never to achieve expert status, only competence.  That is why they do not call it private “perfect”.
·         In an attempt to build my private practice I joined several therapy directories, purchased advertising in various media, attended many professional forums to distribute business cards and brochures, and sent out e-mail appeals to referral sources.  Most of these investments had no returns.  I still receive most of my referrals from existing clients, attendants at my trainings, and directly from insurance companies.
·         As a social worker and therapist it is sometimes difficult to ask for and talk about money and payments.  However, in terms of professional practice it is unethical not to.  I have learned to make sure up front that I will be paid for each and every session.  I cannot stay in business providing services for free and allowing a client balance to grow interferes with therapy and results in lost income that cannot always be written off.
·         My practice model for working with parents and children includes an assessment of the parents’ trauma history and attachment styles.  Sometimes, when parents are in a hurry to see results, when they seem “too nice and normal” to ask, or when the child is in crisis, I have moved forward with family therapy.  Every time I have gone against my better judgment, it has come back to haunt me and to stall progress.  It becomes a sticking point I cannot ignore and must address, which I could have known up front.
·         While I would like to be on the cutting edge of new media with the use of texting, e-mail, and online counseling, it just does not work for me.  I have no desire to be constantly available to clients by texting.  I started with openness to e-mailing with clients but I quickly learned the hard way that I can misinterpret what a client is asking and clients have misinterpreted my comments in response.  So, while clients may feel the need to explain themselves in detail in an e-mail, I have learned to respond only in person so that I can clarify the client’s concerns and check and correct any misunderstandings.  Now, I tell clients I can make, change, and cancel appointments by e-mail and that I will read client e-mail, but that I will not respond by e-mail but only in person during our next session.
·         Sometimes, you just have to apologize for making mistakes or for not being able to help.  Therapists are human, too.  Despite consultation and supervision, sometimes personal issues interfere and cause a break or disconnection with a client.  It is therapeutic to own it and apologize.  It can even propel the process forward.  Other times, in an effort to be helpful I have accepted clients I could not help and needed to send them on to another therapist.  The quicker I can figure that out and make the appropriate referral, the better.
·         To that end, while, at first, I was anxious to have clients and schedule appointments, I have learned that it saves a lot of time and frustration to conduct a more comprehensive intake interview over the telephone or even an initial consultation before scheduling a first session.  Some of the questions I need to answer during the intake: who is the client and is that person willing to participate.  Sometimes a spouse or parent will try to make an appointment for an adult who is not seeking therapy on their own.  If the client is a child, who has physical and legal custody, who will participate with the child in therapy, who has the legal right to consent to treatment with the child.  I have had step parents and grandparents seek therapy for children for whom they do not have custody or legal rights.  Finally, is the issue or concern something for which I have training and experience.
·         When I started I was intent on being as open and helpful to clients as possible.  And, so I would tolerate clients for therapy and supervision not keeping appointments, cancelling at the last minute, and showing up late.  I rescheduled them time and again, even calling and reminding clients to make and keep appointments.  Then, I decided I needed to keep better boundaries in this regard.  And, so now I do not call clients to remind them or follow up after no shows, do not reschedule clients after two no shows, and collect no show fees before scheduling any more appointments.