Day in the life of
LMSW – Janine Ilsley
I am currently an LMSW or otherwise “pre-licensed” psychotherapist of a larger mental health group practice in NYC. I personally consider myself to be an empowered and embodied integrative healer – that is, a psychotherapist (mind), psycho-physicalist (body), and psycho-spiritualist (spirit).
My typical day
This will look very different across LMSWs depending on their contexts, for it speaks to the ways in which a therapist nurtures and nourishes herself in order to provide the therapeutic services of her background and specialty. While every day is truly different by nature of the content we work with, a typical day for me is as follows:
Beginning at 8am, I meet with about 4-5 clients a day for about 45 minutes, with 10- or 15-minute breaks in between. I use these breaks to restore myself – use the bathroom, grab a snack, move my body, or take clearing breaths so that I can remain present and engaged for my next session. Following clients, I complete documentation for insurance purposes in addition to any process notes for myself regarding pertinent content that comes up.
But my work doesn’t end after my sessions are done and administrative tasks completed; rather, there is a processing, integration, cleansing, and personal reflection phase that must proceed. For me, that looks like taking a 90-minute mind-body practice of choice (Iyengar Yoga), and in the evenings I take time for reflective writing.
Just like much of what takes place in therapy is “behind closed doors,” much of the power of our work is hidden from the naked eye – that is, the recycling of feeling, listening, reflecting, and responding that takes place inside of ourselves during the unfolding of the therapeutic process in real time. When I first started as a pre-licensed therapist, I experienced a good deal of emotional contagion that was exacerbated at the start of the COVID-19 pandemic – including heaviness, dullness, headaches, exhaustion, and physical pains. I literally was taking my clients’ pains and sufferings into my body. As an avid mind-body practitioner, I understood that I was experiencing psychosomatic symptoms of my clients and therefore carried this insight into my Iyengar Yoga practice (or any mind-body practice of choice). In doing so, I subjectively come to learn what the pains of my clients are and better understand the circumstances without becoming otherwise paralyzed by it, as though taking the seat of an “observing witness” while also emotionally cleansing all that was accumulated over sessions. As therapists, it is our goal to see our clients without the overlays of their identities generated by past narratives. Having a personal mind-body practice is just one of the many steps that allow us to maintain this ability to observe and witness, thereby assisting our clients to see themselves the same way.
It is how I CHOOSE to structure my day in which I can remain a resilient young therapist, and I am privileged that being in a private practice setting allows me to do so.
Pros and cons
While it sounds that I have described much of the arduous, never-ending inner work required by a therapist, there is so much more joy than pain. Being a therapist is a privilege that cannot be put into words; it’s ineffable and can only be experienced.
Pros
Being in private practice has allowed me to creatively flourish in my therapeutic approach, where I find myself constantly evolving and growing. The journey inward never stops; the minute we say “I know” – whether it be to our clients or ourselves – we stop learning.
It is not that therapy changes the way we see things per se; rather, it transforms the person who sees. It is both humbling and awakening.
Cons
I work in an incredibly intimate setting – individuals are sharing their deepest, darkest stuff with both their voices and their bodies. This is not a disadvantage; however, LMSWs early on in their career are at more risk for compassion fatigue or burnout because they have not yet built the internal resilience that can sustain the journey to merge deeper with clients. In addition, there can be a lack of role clarity and perceived inadequacy of resources with early-career LMSWs as opposed to older therapists who have more clearly defined roles.
LMSWs in private practice don’t make as much as mental health professionals with higher licensure; expect to be paid like medical residents compared to doctors – essentially compensated at a modest salary that may increase with training and experience.
Most companies don’t offer benefits like paid time off, health insurance, and 401K for LMSWs. Personally, my practice has recently transitioned staff from per-diem to salaried positions with benefits but it’s not industry standard. Just know that although the opportunities for LMSWs have drastically improved, working in the mental health space is, at its core, about helping people – it’s a whole-hearted choice and not a get rich quick degree.
If LMSWs don’t have their supports put in place, it can become isolating, especially with telehealth on the rise. At Cobb, we’re working on putting programs into place that help our team to connect and maintain an ease in collaborative care, for example, I have frequent Zoom meetings with other providers and email groups where we can easily reach one another to cross refer, confer on best practices and find the best solutions for our patients. For lower-licensure professionals, we have supervision standards in place not only to ensure they get the best training but that these developing professionals are supported – if you’re working somewhere this isn’t the standard, advocate for it!
Advice to LMSWs
If there is any advice I could give to LMSWs it’s this: You can only give what you yourself have experienced – if you wish to help others through the healing power of therapy, you have to put yourself at the service of the therapeutic process and through experience gain true therapeutic wisdom.
