My post-graduate social work career began in 2002 at the community mental health center as a crisis intervention specialist that provided follow-up therapy for those I had assessed in the field. As with most similar gigs, the pay was low and the atmosphere chaotic, but it was not without its benefits. I had plenty of seasoned therapists with whom I could staff cases and I received free supervision for my LCSW, a perk that would, in and of itself, have made the job worth it. I view the four years I spent at that particular agency (two in the crisis intervention position and another two as a Child and Adolescent Outpatient Therapist) as a kind of social work boot camp, a wholesale education in clinical work, community resources, networking, and the incorporation of theory into practice. I could not have asked for a better foundation upon which to build my career. It is somewhat ironic that I did not receive my LCSW until shortly after leaving the agency in 2006 to go into Hospital Social Work, a field where a clinical license is not mandatory.
I found a portion of my new job in the hospital to be dull in comparison to my clinical work. Social workers in the hospital setting are primarily responsible for “tasky” things such as arranging safe discharges for patients and making sure that patients are discharged before they cost the hospital any money. While being a therapist consisted of building rapport and relationships within a somewhat stable structure, working with patients and families in the hospital involved forming rapid alliances in order to present an acceptable outcome following a relatively short stay. The rest of the job did provide opportunities to deliver more clinical services in that many families had difficult dynamics that were being strained by the stressful event of having a sick loved one. For example, I found myself working with several families that were struggling with the heartbreaking decision to put their family member on hospice. These situations required a skilled practitioner and my clinical training was very applicable. This was what ultimately led me to choose a career in Hospice Social Work.
I find that working in hospice is the perfect combination of clinical skills and medical social work knowledge. I have the luxury of building relationships with some patients and families while addressing complex grief issues and seemingly irreconcilable family differences. I am a unique piece of the puzzle, as important to the agency as the nurses, aides, and supervisors. I bring insight regarding patients with mental illnesses and emotional difficulties and get to work with such people that would not otherwise reach out to or have ready access to a counselor. I also have the freedom to choose how often and for how long I see each patient. In addition, I often find myself entering intense crisis-like situations where families are making split-second decisions about hospice and require clear, concise education as to how we can help their loved one. Lastly, the job demands a seasoned veteran as hospice social workers are very autonomous and have to be extremely organized in order to balance patient acuity, rapid response, triaging on the fly, and completion of documentation. These are all skills that I first developed in a clinical mental health setting and that are transferrable to all areas of social work.
While many medical social workers do not hold clinical licenses, I feel better-equipped to handle certain complicated circumstances than my peers that have not had prior clinical experience. The wonderful thing about medical social work, and primarily hospice social work, is that the job can be as clinical as you want it to be. I have developed the ability to perform patient and family counseling while maintaining the boundaries that I learned to set with my therapy clients. I would not be half as good at my job without my mental health background.
In short, the skills accrued in a clinical setting while earning your LCSW will be transferrable to any future social work setting in which you find yourself. In fact, they can only serve to make you better in all your interactions with people in both your personal and professional life. Until next time.