Making the Most of your Graduate-level Clinical Internship

Atlas Concepts LLCSo you’ve landed the long awaited internship opportunity.  No more showing up at potential sites with yet another fine linen resume, ink barely dry, hoping that the clinician you seek isn’t behind with their case notes for that particular day nor finds your beard particularly disturbing.  You discovered that diamond in the rough, a chance to begin the final chapter of likely your largest financial investment to date.  What now?

Here are a few points to guide you toward the successful completion of your clinical internship, the culminating experience of your mental health degree.

Establishing a plan.  While you will be told this, probably understand its necessity and are likely doing so as a requirement, you should really take the time to thoughtfully plan.  Ideally your plan for your clinical experience is done through conversation with your supervisor.  Items such as schedule availability for client contact as well as individual and group supervision is a must, but also include how supervision will transpire (e.g. video recording, in-person, verbatim, etc.).  One plausible sticking point may be satisfying the CACREP criteria for “some” experience in leading groups.  Discuss this note specifically with your supervisor.

Do the math.  How many hours do you need per week to complete your program in your desired (or required) timeline?  Don’t forget to plan for academic breaks, vacations and other schedule conflicts.

Consider the caseload of the site.  Ask your supervisor if it is feasible to maintain a steady caseload throughout the year.  Many practices see a decrease in clientele during particular times of year.  Don’t believe the minimum is enough, plan for being sick, fluctuating caseloads, no shows and cancellations.  Contemplate the impact of time requirements for endeavors such as school or home visits and coordinating care.

And remember, while you can likely continue to accumulate hours during breaks within the semester, you will most likely not be able to accumulate hours between semesters.  These weeks add up.  In the end, it’s more advantageous to have too many hours than not enough.  The more hours the more experience you have moving forward.  Not enough hours likely results in another academic semester!

Setting goals.  Goals related to competence not simply having the goal of completing the requisite hours.  Having goals related directly to completing your degree and to becoming a better counselor are necessary to get the most out of this phase of your journey.  For example, if you plan to get licensed, you will have to pass a state exam.  Have a resource such as the Encyclopedia of Counseling handy.  Have access to resources related to your theory of choice and research interventions which may relate to your current caseload.

At this stage, you may benefit from reviewing case notes or assessments and relating themes, symptoms, and processes with the material you have learned and are learning in school.  Put your goals on paper, ask for feedback and if your school doesn’t provide a form, find a way to track your progress.  Through discussion, compare your self-evaluation with your supervisor’s observations.

Calculating hours.  Understand how your hours should be counted.  This should meet your academic requirements and also the educational requirements for the state you wish to eventually seek licensure.  This includes distinguishing what, if any, of your academic class time counts as supervision.  Additionally, understand that your administrative proficiency will likely increase over the course of your clinical training experience.  Items such as post-session notes and case management will take up a great deal of your time early on, this may mean less time for client-contact.  However, be abreast of lulls that may occur as your administrative proficiency increases and work with your supervisor to adjust your caseload accordingly.

Understand co-therapy is not merely sitting in observing your supervisor conduct a session.  Get clarity from both your state board and your academic institution regarding distinguishing time being observed, doing observation and engaging in co-therapy.  Calculating your hours is dependent upon your role in the session, not necessarily how you refer to the experience.  I’m sure you know the importance of keeping record of your time, but I’d be remiss not to mention it.  Minding confidentiality, make your records inclusive.  This is not only a requirement, if done particularly can provide you with valuable qualitative and quantitative information for job seeking purposes later on.

Remembering the hierarchy.  Yes, you’re thinking about Maslow which is great, but here I am reminding you the client always comes first.  Early on you may find yourself sitting in during sessions.  Clients’ permission must be obtained prior to sitting in during a counseling session whether or not co-therapy is being performed.  If a client declines to permit you into a session, don’t take it personally.  There are too many possible reasons for such a decision by a client and the overwhelming majority of those possible reasons likely have little to do with you personally.  The client’s needs are above both site and school requirements.

This can be a complex concept or a non-issue, but should remain central to the therapeutic process.  A common reason clients prefer not to introduce you into the session, especially early in the internship, is because they have established rapport with their counselor and are simply comfortable working with that person in the established manner.  As new clients arrive at the site, it becomes easier to integrate you into the process.

Minding your own mental health.  Don’t forget your own mental health.  Counselors in training may be on the extremes concerning time.  Some interns may not have much else going on other than their internship while others are working several jobs and have others who are dependent on them.  In either case, beware of countertransference.  If your emotions are high and/or out of control you may run a risk of losing track of the therapeutic process.  While in itself countertransference is not necessarily a fault, ignorance of its presence can be harmful to the client as well as result in ethical dilemma.  If at any time you feel concerned about your feelings toward or relating to a client a discussion with your supervisor should be in order.  Establishing good routines which include eating appropriately, drinking water, sleeping, and exercising are important.  Also, schedule some “me time” in between your school work, clinical work, and other obligations.

Assuring confidentiality and ethical standards. Client’s names are never presented to individuals at your academic institution; initials are acceptable.  Concerning client information, a good rule of thumb is maintaining a double lock standard.  This relates to traveling to and from the site, storage at home, laptops, audio/video recording devices, etc.  Client paperwork and digital information should be protected and stored until the statute of limitations on malpractice expires or you graduate, whichever occurs last.  In general, when there are competing guidelines always defer to the higher standard.  Remember, guidelines are set by your academic institution, the internship site, state law, associations Codes of Ethics, etc.  You won’t be the first to find it confusing at times.

Furthermore, understand ethics codes generally act as guidelines.  They may lack clarity, conflict with laws, be reactive versus proactive, etc.  Being ethically responsible as a counselor is not necessarily complicated but it takes being educated and appropriately mentored to hone in on best practice.  Some points to remember include the importance of informed consent.  Specifically state your status as a graduate intern, your requirement to be supervised and note how your work with them may be integrated into your scholastic endeavor.  Of course, always get permission (often by way of a Release Form either from your site or academic institution) from clients prior to any type of recording of session content.  For individuals under 18, it is best practice to have both the client and their legal guardian grant written permission.

You may have heard it before, but don’t forget it:

Don’t be on time, be early.

Maintain liability insurance.  You may have to renew this during the course of your training.

Dress appropriately and maintain acceptable grooming standards.

Expect to be introduced as an intern.  Prepare for this.  It may prove more difficult to deal with than you think.

Caring confrontation.  Yes, with your clients but also with your supervisor.  For example, find ways to improve the environment or administrative processes and make suggestions.  As well, it has likely been some time since your supervisor completed her degree.  Offer discussions based on things you are learning in your academic setting.  Be an asset!  You’ll likely be looking for a job and/or supervision after graduation to suffice your state requirements.  Your current site could offer to keep you on if you’re valuable or at the least offer you a solid reference letter.

Concentrate on what you do well, as well as things you don’t.  Use this supervised experience to face what you feel is most challenging and leverage your current skill set to overcome your fears.  Work with silence, work with children, work with the opposite gender, etc.  Do it while you have help readily available.

Additional Resources:

Issues and Ethics in the Helping Professions, Updated with 2014 ACA Codes (Book Only)

Encyclopedia of Counseling: Master Review and Tutorial for the National Counselor Examination, State Counseling Exams, and the Counselor Preparation Comprehensive Examination (Volume 1)


Jordache Williams

Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC.  Additionally, he is a Licensed Professional Counselor Intern and Certified Life Coach.

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Locating an Internship Site

Fields of Knowledge_Locating an Internship Site

For graduate students who are required to display competency through a clinical experience, you will inevitably undergo an integration process at a site which will facilitate this chapter of your educational journey. If your academic institution has partnered or is contracted with a site (or multiple sites) guaranteed to facilitate your clinical experience, then consider yourself fortunate.

For many graduate students it is not that simple. In some cases, those institutions which do provide sites for students actually require that the student work with the site(s) provisioned. Not one scenario is necessarily better than the other, as all offer advantages as well as disadvantages.

So, if you are a student who has been provided a list of potential sites, been left to figure things out on your own, or are seeking a secondary site to supplement the experience of a site predestined by your school, here are a few thoughts from my experiences.

Review potential sites. If your advisor or other faculty present you with a list of potential sites, it’s probably a great place to start. At some point in time you’ll probably try an internet search engine or attempt to “show up” at a place you’ve heard about.

In this age, technology tends to seemingly ease the burden of learning about potential places to intern; however, the information provided by a computer or smart device is not always inclusive. So after you have tried 50-60 keywords in Google, a few hundred pages of opportunities on websites such as Monster.com, signed up for newsletters, participated in forums, reached out to groups on social media such as LinkedIn and prayed to the internet god for mercy…understand that you will at some point have to remove yourself physically from the comfort of your favorite chair and the soulful sounds of Kenny G.

My academic institution estimates that it takes 66% of its students 3-4 months to locate a suitable site and a willing supervisor, with the remainder having to search for over 6 months. With this said, understand that the effort may take time, so plan to be thorough and deliberate in your search.

Keep a sharp lookout for supervisor candidates. A great choice for a supervisor is a supervisor candidate. These individuals include those who are pursuing the Approved Supervisor designation with an organization such as the AAMFT. They are licensed professionals who are seeking opportunities to train, educate and, in essence, supervise individuals working towards a graduate degree or licensure.

The AAMFT provides a list of Approved Supervisors on its website; however, it is not as easy to locate candidates working towards fulfilling the requirements necessary for approval. Oftentimes by contacting Approved Supervisors you can accomplish a great deal.

You can inquire about opportunities to work with that individual in particular (who is “on paper” the quintessential supervisor), ask about opportunities they are aware of in surrounding communities and also ask them specifically if they are working with any supervisor candidates or are aware of any such candidates who may be of assistance.

Organize your effort. Make a list of potential sites, keep track of the “who, how and when” concerning your contact with each potential site. Keep records of individuals you have networked with including their contact information, how they may be able to assist you, where they work and/or volunteer and any leads they may have referred you to.

Additionally, look for ways to ensure that you stay relevant to individuals in key positions. This may be done by attending programs in which the individual is involved, joining them in volunteer experiences or stopping by to ask if there is anything you can do for them.

Prepare yourself. Yes, you are a student and you are locating a site to assist you with an educational experience, but I can almost guarantee that during the course of your search for a site and supervisor you will be asked questions pertaining to your personal interests and objectives, the models and theories which you plan to utilize with clients, any professional association affiliation and your level of participation with each, as well as inquisition pertaining to your level of experience. Yes, the last one got me too.

The first time I was faced with explaining my experience, I thought…“I’m a student, what experience do you think I have?” Preparing for such questions is critical to your ability to garner the support you need, and at the least can leave a good impression. You can always mention the experiences you have had during your academic coursework with classmates in mock sessions. Additionally, having experience in a counseling setting (even administratively), having personally attended counseling or having held a position (at a job, within an organization, etc.) which included coaching, teaching or mentoring are all great ways to build your credentials.

Liability insurance. From the moment an individual is identified as your supervisor, and throughout the course of that relationship, that individual is ethically and legally responsible for you. Though it is likely required by your academic institution, plan to, at a minimum, obtain liability insurance and keep it current throughout your internship.

One way to accomplish this is to join an association such as the American Association of Marriage and Family Therapy (AAMFT). The AAMFT offers malpractice insurance as a part of the benefits of student membership. Already being insured during the pursuit of your site and supervisor speaks to your level of commitment and proficiency, as well as your knowledge of the field.

Bring something to the table. Understand what you offer in addition to being able to articulate what you need. The sites you visit may not have opportunities posted for an internship or currently have a program specifically for interns. If this is the case, attempt to locate job postings at the organization to understand the type of information (e.g. curriculum vitae versus resume, background checks, etc.) that is required of potential employees. Think about it like this…if you qualify for a job (say minus the graduate degree) then you are in pretty good shape to be a candidate for an internship. Nearly any and everything you would do for a job…do for an internship. That includes over- versus under-dressing, updating your resume, brushing up on your interview skills and mustering up that necessary confidence needed to talk about yourself.

In the pursuit of an internship, oftentimes it’s those who can give that get. As I stated earlier, some potential sites may not have a program in place for interns, and may even find that entertaining such would be more burdensome than beneficial. Through careful consideration of the site, you may be able to present yourself as an individual who can provide a relevant impact to the site. This impact may be through providing support for programs that the site currently sponsors.

You can present ideas for programs that you could organize and maintain, or volunteer to help out administratively. You may even offer to dedicate yourself to establishing an internship program at the site, by charting your experience and through research and evaluation of other programs. You first have to understand your own potential, personal/professional interests, desires and qualifications.

Next, find ways you can be of benefit to the potential site and/or supervisor and articulate these ideas concisely. You must understand that when you approach a clinical internship your presence is not associated with benefits such as free or cheap labor. You are a legal and ethical liability, an administrative burden and ultimately take time away from an individual who is likely otherwise paid for it. Yet and still, they have been in your shoes, so stick your chest out, hold your chin up, shake with a firm grip and present your essence.

Staying afloat. Lastly, have a plan that includes a sustainable income during both your pursuit of a site and your tenure at the site. The reality is that paid internships are not always available, couple that with the fact that your academic clinical experience likely lasts for a year (or more) and the understanding that locating a site may take a significant amount of time as well.

If you are already living on a strict budget, then the worst-case scenario includes having to pay for supervision. In some areas, this may be your only option. In any case, you must evaluate your living situation, means of income and your costs of living and plan ahead. The commitment you are about to embark on will likely change a great deal of your daily routine, absorb a significant amount of your energy and time. Prepare yourself, employers and loved ones and ensure you rally the necessary support from each.

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As mentioned earlier, each journey towards graduation in a helping profession is unique to the individual student, however each academic institution approaches facilitating education and evaluating competency in a specific manner. In this light, my particular experience with locating an internship site has been highly influenced by two facts: I attend an online academic institution which is located approximately 400 miles away and I am a relatively new resident of the area which I am seeking support. Notice that I refer to these two circumstances as “facts,” not disadvantages or excuses.

It is my personal belief that I learn through each of my experiences every day. The experiences I have had during my efforts to locate a site are no different. I have been granted an opportunity to question the very core of my pursuit, asking questions such as, “Why did I choose to pursue a career as a therapist?” and “Is this still really what I want to do?” These questions are warranted, as I actually began pursuit of my M.A. in MFT in the spring of 2007.

So here I am 7 years later, now with a wife, now with a daughter, now out of the Army, now a business owner, now a certified Life Coach, now having been awarded a Human Services graduate degree, still working towards the same goal. Perhaps I made compromises that have elongated this process; there is hardly a time when a person “could have done no more.” Yet and still, the desire exists and a certain priority remains incumbent to the same. In closing, I would like to encourage you to continue your effort at a steadfast and deliberate pace, while continuing to grow through the experience and achieve in other endeavors as well. No matter your course, be holistically prepared for the journey and understand that not all “helping professionals” are interested nor capable of helping you! Moreoverly, none can help you more than you can help yourself!!!

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.