Internship as Hazing/Indentured Servitude

I'm an MFT Intern in California--graduated Pacifica 2004, MA Counseling Psych. I love the work I do with clients and consider it an honor to share the journey with other human beings. But it has been a struggle for survival as a single parent--managing nearly 20 hours a week in an unpaid internship on top of 32+ weekly hours at my "day job". Typical work days are 12-14 hours for me with little time for myself, and the financial pressure has been intense. And I know there are many of us engaged in this struggle.

I have been thinking a lot about the irony inherent in the intern/licensure experience. We are tasked with animating soul in the world and in our clients, and yet the process often leaves us little with which to animate our own souls. Reflecting on the archetypes of wounded healer, victim, martyr, savior, prostitute, etc. that are evoked by this kind of system, I am interested in what changes might be set in motion to create a healthier system and healthier therapists who can experience and model good self-care and high self-worth.

There is a clear relationship between the nature of the intern experience and our health care system, mental health parity laws, and insurance systems. A system that does not value mental health on par with physical health will not compensate mental health providers with parity. Because poor, uninsured, and disenfranchised people often cannot afford the fees of licensed therapists, there is a need for agencies which provide low-fee therapy. And how do these agencies provide low-fee services? Through unpaid interns! Then interns, who require 3000 hours supervised experience to become licensed, have no choice but to complete their supervised hours without pay. Only those who are financially independent or supported by someone else can commit to several years of work without compensation. The end result is overworked, underpaid, often highly stressed interns--like moi.

Maybe changes in health care and insurance systems will naturally result in changes to the internship process; this remains to be seen. As for me, I am considering my beliefs and mythology about what it means to be a healer, a keeper of the flame of soul in the world. And asking myself, "How I can approach this experience in loving support of myself, my clients, interns to come, and the future of our profession?"

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Comment by Barbara Pannoni on May 27, 2010 at 2:03pm
Ed: Yes, in theory, you actually could see every client for only one hour. It could not be 3000 single hours alone, as the requirement includes weekly supervision for the face to face hours to count. But, yes, an interesting point/observation. And the fact is, licensing rules vary substantially by state. Some states do not require any license to practice and call yourself a therapist. They usually have some kind of optional licensing and related requirements, should the individual choose to become licensed by that state. I understand NY and CA have the toughest requirements. There are 2 comprehensive exams to pass after completing the 3000 hours, but these can really only test knowledge (technique) as opposed to the art/effectiveness, all those qualitative issues.

Gary: Are you practicing in BC? What are the requirements in Canada? I had a Canadian classmate who was also a nurse. She went directly from school into a full time private practice in hospice.

Thanks for the support, everyone!
Comment by Ed Koffenberger on May 27, 2010 at 1:48pm
I think this also brings up the question of therapy as art &/or technique. I'll bet there is no qualifying, in those 3000 hours, how many clients actually left in a better state than they started. (?) Could you spend one hour with 3000 people and still get the license???
Comment by Gary S Bobroff on May 26, 2010 at 11:55am
Hi Barbara: As a fellow Pacifica grad I always saw this 3000 hours requirement as a classic example of a system that confuses quantity with quality soul-wise. 3000 hours is an illusory quantitative (Masculine) standard for a society that doesn't understand or value the quality of soul (Feminine) in which the standard of who should be practicing is based on inner values only. There are many, many personality disordered and otherwise unqualified (quality-wise) individuals who will end up as a professionals in California after completing their 3000 hours and many highly-qualified (inner-wise) individuals who will never attempt to participate in such a system because of its ridiculous draconian quantitative requirements. :O)
Comment by Ed Koffenberger on May 23, 2010 at 8:58pm
Eat, sleep, laugh, cry, exercise and know that your work is a precious gift.
(Who knows, one day all this spun straw may turn to gold.)
Comment by Barbara Pannoni on May 23, 2010 at 8:52pm
Ed: just wrote you a reply, then lost it. In short, yes, I am getting lots of experience with the populations mentioned above. Also interesting that many formerly middle class folks are not unemployed and seeking therapy to address related stresses.

Support groups do exist and I have attended some when I have had time. Time is a big issue for those of us who have to also support ourselves financially in addition to accruing hours toward licensure. At my agency we meet for weekly group supervision, so that helps some. And you are correct that many aspects of therapy as business are not addressed in the intern experience. Friends and colleagues have shared some of the pitfalls they faced upon entering private practice--marketing, self-employment tax, managing the financial implications of cancellations and slow periods like summer, to name a few. At this point I imagine I will always have a "day job" for stability.
Comment by Ed Koffenberger on May 23, 2010 at 8:22pm
After reading this I am also aware that interns will, most likely, be well experienced in the concerns of the poor, uninsured, and disenfranchised but not in the concerns that may be unique to any other socio-economic group, much less get any experience with the business end of providing therapy. Do the interns ever get together as a "support group" if you will, or is time a major factor here as well for most interns?

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