I am a field instructor for graduate and undergraduate students in social work going for their bachelor’s and master’s degrees. I am also a professor of social work at a university. As a field instructor, I am the point person in the field where social work students at the university level go to their placements or ‘internships’ where they learn social work practice skills from working with real clients.
Due to my position as a supervisor in a mental health clinic, my students, at my site, learn how to practice in a mental health setting. Undergraduate students learn case management while postgraduate students learn how to practice psychotherapy and have their own caseloads with clients with various diagnoses. As their supervisor, I teach my interns how to be effective therapists.
Being a good therapist is sort of a loaded word, isn’t it? What is a good therapist? I think most of us would agree to treat the whole person and seeing people as individuals is a step in the right direction. That is a person-centred approach that situates diagnosis right where it belongs. Balancing a diagnostic clinical approach with empathy, support, and all of those excellent qualities is a step further. My focus, however, isn’t to micromanage their ripening skill set or tell them how to practice. Sure, I will guide, model, and lead, but telling a therapist how to practice is walking down the path to the same narrow focus the medicalisation of mental health did to the system of care.[adthrive-in-post-video-player video-id=”B8wna0VE” upload-date=”2019-12-20T06:00:00.000Z” name=” Maxwell Guttman: Lived Experience of Schizophrenia” description=”Maxwell Guttman, mental health advocate and author, shares about his lived experience of schizophrenia.” player-type=”default” override-embed=”default”]
One of my former students updated me on his present work situation. He said he continues to feel unsupported by the agency higher-ups and feels alone in doing the work he does as a mental health therapist in a clinic. He asked me: ‘Max, what keeps you moving forward?’ Aside from grinning and bearing the entry-level nonsense and plight of the worker who sets out against a learning curve, I told him the truth. Reinforcing the long-term goal ahead, I said that it all keeps things in perspective. Our work matters, and our impact matters. More importantly, how do we keep all this in mind and be successful in putting theory into practice?
Within the mental health profession, this is so hard to do. As a field instructor, my main goal is to support my interns in how to survive the system of care. Setting out as an entry-level social worker and working within the limits of an agency is my primary concern when monitoring the success and ability of my interns to succeed. Every day, we mental health therapists expend our valuable energy to alter, augment, and improve the quality and level of care we can provide our clients with limited resources, time, and support.
Maybe this is my focus because I have a very systems approach at the root of understanding of how care operates in the US. But I also believe the job of the classroom, as a professor, is to supply the theory and knowledge for their students to implement in their placements. As a professor, I stop at nothing to explain clinical approaches to different theories of psychotherapy, differentiate between abstraction and practice, and supply examples through role play and discussion. However, as a field instructor, my job is to take this work in the classroom, and direct its application in the field: Point out weak points in practice, support reflection, and above all, explain how all of this learning and growth plays out in each student’s long-term plan for practising as a future mental health practitioner.
Without the right support, or the right people around us, no skill, no technique and no theory will save our jobs. Even worse, our clients will no longer benefit from our help when we get walked out of the agency because our political clout evaporated over a non-clinical issue or contestation of our judgement because we get a new boss or team member that has a personal issue with our character. Please don’t get me wrong. I am no cynic, but I know and believe too much in my interns’ abilities to allow anything other than their innate skills to shine in the face of systems issues and agency politics in mental health settings.
An earlier version of this article was published on Mental Health Affairs.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.
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