Unlike many members of the GLI family who go abroad, I chose to complete an internship locally (Polson, MT). For my internship, I shadowed Erika Weber, a licensed clinical social worker (LCSW). Erika works with her clients using various forms of therapy, but one form that especially caught my interest was art therapy. Before I reached out to Erika, I already had a small interest in art therapy and little knowledge on how it worked and what benefits came with it. However, being that I major in psychology and minor in art, art therapy has been on my radar for potential career options. Before knowing what I wanted to do for my internship I knew I wanted to complete it locally and shadow someone who specializes in therapy for mental health. This is where I came across Erika and Boule Sophia LLC. Through Psychology Today, I found a description of Erika’s work and that she practices independent from an agency. While working privately, Erika created Boule Sophia LLC, which translates to ‘Counsel Wisdom.’
During my internship, I sat in on a few therapy sessions with Erika’s clients. Because of how private therapy is in nature, Erika had clients who felt comfortable with an intern sitting in sign a consent form and additionally give Erika verbal consent. If a client ever felt uncomfortable with me present, I would leave. In addition to the consent form, I was forbidden to discuss any specific details about clients, such as age, name, or place of work, etc. Basically any identifying factors that could potentially out a client. This is all protected under HIPAA. This is also why I won’t be posting any photos. While sitting in on therapy sessions, I was permitted to take notes. Erika taught me how she, as a LCSW, takes notes. When taking notes, I would write about body language (crossed arms, shaking, touching or messing with nearby objects, etc.), mood and affect (affect being that a client’s mood matches their expression. For example, a client expressing they’re sad and crying. Affect and mood don’t always match. A client can say they’re sad but be smiling, affect does not match mood), memory (if they can retain past events), and orientation (this includes awareness of where they are, awareness of the situation they are in or why they’re in therapy, and diagnosis). Other than taking notes, Erika and I worked on creating a therapy group which focused on self-care and the betterment of women while using art therapy and exercise. Each week had a different exercise along with an art therapy activity that fit with the exercise and theme of the week. For example, one week would be focusing on mindfulness. The exercise for that week would be yoga and the art therapy activity would be a soul collage. Another week would be self-care, which would be creating an inside me outside me mask (how we perceive ourselves inside the mask vs how others perceive us on the outside) and cardio. In some sessions, Erika utilized art therapy. For example, a client was in distress. Erika introduced them to sandtray therapy, which is a form of art therapy. The client would run their finger through the sand, or mold it into shapes while continuing on with the session. This was proven to work for the client as it began to calm them down. Another client created a collage using images and text that resonated with how they felt towards their spouse. The client would then create another collage of their spouse at a later time. The two collages were starkly different, one even containing bitter words such as control.
As previously noted, Erika practices privately. I learned that there are many steps to begin practicing privately. Firstly, it is important to have your degree as well as a business license. After that, signing up for multiple health insurances is important. Not every client has Medicare or BlueCross. Some health insurances are easy to sign up for; however, some require additional information and specifics of what therapy you’ll be providing for your client. After sessions, health insurance is important because this is how you’ll bill the client and receive payment unless the client pays themselves. It’s also important to have plenty of money saved up once you begin to practice privately. Some health insurances take months to mail or fax you your payment. Additionally, they may even take a few dollars off your payment depending on what type of payment they give you (typically when given cards). Lastly, getting your name and services out there. This could be placing an online ad or making cards and handing them to hospitals and other therapists. Additionally, developing relationships with hospitals and other therapists helps you gain clientele as they can refer clients to you. Practicing independent from an agency comes with its pros and cons. Firstly, the pros. Pros include creating your own schedule, taking on clients when it best works for the client and you, having flexible hours in case a client has an emergency session, and deciding whether you want to rent a space or work from home. While there are pros, there are also cons. Cons include no internet connection. Erika provides therapy in person and also online through Zoom, BetterHelp, and Telehealth. If Erika or a client cannot connect to the internet, then the session cannot be held. More cons include privacy. Erika works from home and often has clients that visit her house for sessions. Occasionally her family is home as well which raises concerns for privacy. Practicing from home raises questions about safety. If a client is known to be harmful to themselves or others, meeting with them in-person can be dangerous. Recently, there has been a report where a therapist was tortured and beaten by their client during a session which took place in their own home. Clients who know where Erika lives could potentially visit her at any time, even during her off hours present problems and conflicting with the safety of her family. Unlike working for an agency, Erika does not have resources or materials for specific problems. For example, a client was struggling with alcohol addiction; however, Erika does not have the authority or resources to help out that client other than make a referral to an addiction specialist or place the client on a waitlist for rehab. Agencies on the other hand have those resources.
During my internship, I was presented with some challenges. The biggest challenge was actually the therapy sessions themselves. Clients who felt uncomfortable having an intern sit in on their session would have me leave, clients would often no call no show, and occasionally clients cancelled minutes before their session began. Some clients would run late, making their therapy session run slim if another client was booked afterwards. Erika has described having days where all but one or two clientele cancel, resulting in a major loss of income. Another challenge is how small of a town Polson is. The population is relatively small and you’re bound to run into a client outside of work. One thing I noticed was how there was a lack of mental health providers in Montana. Some of Erika’s in-person clients traveled hours just to meet with her once a week. Another issue I noticed were mental health stigmas. A client had been prescribed with Seroquel, which is often used as a mood stabilizer in low dosages. The client’s spouse had done some research and learned that Seroquel is also used as medication for individuals displaying psychopathy. The client’s spouse then came to the conclusion that the client was a psycho hence why she was taking Seroquel, not to stabilize their mood. This lack of knowledge or misconception spreads misinformation about mental health and further enlarges stigmas around mental health. Another stigma I noticed was that Erika’s clients were white and native women with a few exceptions. Generally, women report experiencing more mental distress than men; however, men do not always seek help for mental disorders. This could be deeply rooted in the old belief that men should not display emotions or seek help. Unrealistic gender norms create stigmas towards mental health.
Despite the challenges I faced, I learned a lot more about therapy. I learned how to deal with a client who has suicidal intentions, especially when in a rural area and / or when practicing privately. I also learned how to file and fill out a medical request relief form for a client who needs time off of work for mental reasons, so long as the client continues therapy. This is the first internship where I was able to sit in on sessions, as I had not done that prior. It was a lot more different than I expected. Some clients were difficult to get a response out of whereas some belittled or ridiculed Erika during a heated conversation. Towards the end of my internship I used some art therapy activities on my younger siblings. I utilized an art therapy card deck, which is used when dealing with clients who shut down, refuse to speak, or are overall difficult. The cards contain four subcategories, 1. control 2. responsibility 3. safety and 4. relationships and connectedness. Each card has a different art activity centered around topics such as mindfulness or how to better control anger / rage. Overall, my internship went well and I had connected with Erika and her clients. This internship was an opportunity for me to get an early look into what a potential career would look like for my interests and major. I would recommend my experience to anyone else interested in art therapy or learning the basics of practicing therapy privately.