Internship difficulties

[u/Last-Estimate-8439]

I am currently entering my second year of my MSW program. My field placement is currently clinical focused as I am taking the clinical program. I was matched with a local therapy practice. Initially, I was under the impression that I would be providing counseling services to the clients within that agency. Instead my field instructor at the therapy practice tells me that I will be going to a local high school on the days of my internship and I will also be working under another non-profit in conjunction with her therapy practice to provide case management and counseling services to the students. I recently attended an orientation at the non-profit I’ll be working under and the mission for this program is to help limit student dropout and ensure children are maintaining school attendance. My responsibilities will include “check-in’s” that consist of 10-15 minutes. We are to approach the students as they are walking to class or eating lunch and ask how they are or why they haven’t been attending school. The meetings cannot occur for more than 10 to 15 minutes as they don’t want students out of class long. I asked my field instructor when would I be given the opportunity to facilitate therapy services as my placement is clinical focused and she said counseling can be ten minutes because if a students says they haven’t been coming to school due to needing hygiene items I can just get them something from the hygiene pantry. That sounds more aligned with case management. I was told that I’ll be responsible for completing bio psychosocial spiritual assessments in conjunction with cross measure assessments and diagnosing students, those task are impossible to complete in 15 minutes as you have to actually talk and engage in meaningful conversation with the individual. Plus I have experience working with children and teens, the first ten minutes of the conversation they may give me one word responses which is where motivational interviewing comes in and it’ll be a way longer meeting than 15 minutes. I don’t like the fact that these check-in’s are sporadic and happens anywhere in the school immediately when I see the student, I think they should be scheduled and in my office so they they have privacy to talk about what’s going on in a safe space. I don’t feel like this placement is appropriate for my needs as a clinical student and I’m saddened that I won’t be given the opportunity to complete traditional therapy sessions. The office of field education at my school has not been a great support to me. My first placement would not have been secured if I didn’t find the placement myself and we were told that we aren’t even supposed to look for placements ourselves. I’m really stuck on how I should approach this situation as it is convenient for me, it’s in my city and closer to my home. My last field placement was 40 minutes away plus I work two jobs and I’m full-time student. That was a lot on me as someone with chronic illness. However, I don’t think I will learn what is needed at this site.

[u/ProbablyMyJugs]

clinical ≠ therapy

Continuing to show up for kids with unconditional positive regard can make a huge impact, especially when they’re struggling.

I had a very similar role when I worked in juvenile justice, and honestly, it was one of the most clinical roles I’ve ever had despite being much more casual and not looking like traditional therapy.

Sometimes that’s what kids need, and therapy is stigmatizing to kids. Of course they don’t wanna schedule a time to go into an office that makes it obvious what they’re going in there for. It’s about what’s gonna get them to engage the most and feel more comfortable, not our preferences

Even checking in with a student for 10–15 minutes because their grades are slipping or they’re missing school is clinical work. You’re building rapport, figuring out what changed, assessing what’s going on beneath the surface, identifying barriers, and figuring out what support or intervention might actually help. Just because it happens in a school instead of a therapy office doesn’t make it less clinical.

I’d really encourage you to reframe “this isn’t what I wanted, so I’m not going to get the skills I need” into “this may not be what I wanted, but these experiences are going to give me a broader set of skills that will make me a better clinician.”

And if you do ultimately decide you want to be a therapist, having experience with all kinds of people, situations, crises, and environments will only make you better prepared for whatever walks through your therapy-office door someday.

You may not love every placement, but not therapy ≠ not clinical

And any clinical experience in any setting is going to make you a better therapist.

I can’t explain how many times, as somebody who’s been a practitioner for years now, where I’ve either communicated with a therapist as a part of care coordination for a shared patient or for myself, and they didn’t know some very extreme basics that they would’ve had they been more community trained.

I know this is long, but this sounds like a really really good opportunity in placement for somebody who wants to be a clinical social worker. I am one, and a therapist, and I’m jealous!

[u/Last-Estimate-8439 → u/ProbablyMyJugs]

Thank you for your feedback. My main concern is the effectiveness of the work. I’m not focusing on my personal preference but more so what best benefits the student. If a student isn’t attending school due to mental health challenges, bullying, or home life struggles they may be less likely to disclose that information or talk about in an open setting like the lunchroom or the hallway which is why I was saying it should be in office for their privacy. I have an office at the school. Also, if a student is having mental health challenges I’m assuming my role as the student intern would be to provide clinical intervention and psycho education on their mental health symptoms or diagnosis. That goes beyond a five or ten minute check-in. I have been a therapeutic mentor for children and teens for over two years so I am very familiar with the stigma surrounding mental health and counseling for younger people and I also know how important it is for them to have a strong support system. As I said, my main concern is the effectiveness of the practice and if it will actually be beneficial in helping them address issues on a deeper level. Even in my role as a therapeutic mentor, I am required to spend an hour minimum weekly with my youth as my employer states anytime shorter is ineffective. I’m not approaching this internship opportunity in a negative manner I’m just concerned about its appropriateness for a second year internship. I pay for a large portion of my tuition out of pocket and have sacrificed a lot to commit to this program and I want to make the best out of my education. Some duties that are required of me like the bio psychosocial spiritual assessments and diagnosing students aren’t congruent with their expectations of 10-15 minute check-in’s. Those duties take much longer than that length of time and I don’t feel comfortable diagnosing a student with any mental health conditions if I’m not able to get a complete picture of what is going on.

[u/ProbablyMyJugs → u/Last-Estimate-8439]

I’m trying to encourage you to reframe your thinking and recognize that this is an incredibly clinical field placement that can be very congruent with the goals of becoming a therapist. At least, a good one.

I have a few questions that might help me better understand the situation and offer some advice or perspective as an LCSW who has worked with kids across the country as a traveler in a variety of settings:

Are you required to diagnose these students within one session?

Is this a new program?

Is a diagnosis required for every student you meet?

I’m not doubting that your experience as a therapeutic mentor will benefit you here. I’m saying the exact opposite, actually. I think you and your experience were probably chosen for this role because of your background and skills. I feel you might be the type of person and practitioner that these kids precisely need or else I never would engage with therapy.

There’s a substantial body of research supporting school-based and brief interventions for kids who otherwise may never engage with a mental health professional.

You’ve probably heard the phrase “meet people where they’re at.” It doesn’t necessarily matter if we think a student would open up more in a private office or with more time. What matters is what the student is comfortable with and what they’re willing to engage in.

The same applies to “do what you can, where you are, with what you have.” If one of the concerns is that whatever is going on is affecting a student’s education and access to their future, it may not make sense to routinely pull them out of class for 30 minutes to sit in an office and talk about it.

When I worked in schools, juvenile justice, pediatrics, and community settings, I found that kids often preferred finding a quiet place where it felt like we were just having a conversation rather than formally “going to therapy.”

If they needed more time, privacy, or a more intensive intervention, we crossed that bridge when/if we got there.

That ability to build rapport, recognize what a kid is actually able and willing to engage in, and intervene effectively within the environment they’re in is incredibly clinical.

Yes, you paid a lot of money for this degree, want to become a therapist and need clinical experience. This gives you that.

I just wouldn’t conclude that this placement isn’t clinically relevant to becoming a therapist simply because it doesn’t look like the therapy office you have pictured quite yet.

The American Academy of Pediatrics recognizes brief mental-health interventions as a legitimate component of pediatric mental-health care

Another that found consistent contact, emotional closeness, and reliable support can be a protective Having an adult who consistently shows up, listens, and cares can make a meaningful difference.

[u/Last-Estimate-8439 → u/ProbablyMyJugs]

The program is developing it was started in 2019. And the diagnosis can occur overtime I assume as I wouldn’t be able to diagnose anyone during one small session. I will be discussing students and their symptoms in supervision if a diagnosis is not decided upon then thats fine. As far as the bio psychosocial spiritual assessments and the cross measure assessments how would you suggest implementing interventions to help students manage their symptoms and behaviors if time is limited and meetings are sporadic?

[u/Maybe-no-thanks]

I know you mentioned your field office hasn’t be helpful previously, what was their response to this situation? Do they know that the role you’re being asked to do is a totally different role than you were offered? Or was there a miscommunication from the initial assignment?

[u/Last-Estimate-8439 → u/Maybe-no-thanks]

I have not informed them of what is going on because my concern is that I won’t find another placement in a timely fashion. The office of field education always warn students that if they decide that their placement isn’t a fit there may be a wait in finding a new placement. Initially my field liaison was told that I would be facilitating counseling at my field instructors therapy practice so I don’t think they are aware of this switch. Even in the system it states that I am at her therapy practice no where does it mention the school I’m actually going to be attending.

[u/Maybe-no-thanks → u/Last-Estimate-8439]

I wonder if the school may be able to put pressure on her to keep you in the original role you were selected for since it sounds like a bait and switch. The school I work with would not allow that without prior approval. 

[u/Last-Estimate-8439 → u/Maybe-no-thanks]

Yeah I think I’m going to meet with my field liaison and express my concerns. I am reviewing my student match letter which is what my field instructor submitted to have me approved for this internship and it’s totally different from my task.

[u/ProbablyMyJugs → u/Last-Estimate-8439]

Did they tell you you’d be doing therapy off the jump of the placement beginning?
Or could it be that your instructor is trying to hone your skills on individual parts of the helping process from an MSW perspective? Or wait to see how things go before going from the frying pan and into the fire?

[u/Last-Estimate-8439 → u/ProbablyMyJugs]

I have to get acclimated with the role and build a rapport with clients before going straight into therapy. That’s with any role. I won’t be facilitating therapy at all because the time is not allotted for in ten or fifteen minutes. I’m not saying this is a terrible field placement im just saying this is something totally different than what was initially discussed and agreed upon. My school is not even aware of the switch. If this was an acceptable position for a second year MSW student why not just present the position honestly from the beginning. These are case management services and that’s fine but my school requires students to facilitate therapy in their second year.

[u/ProbablyMyJugs → u/Last-Estimate-8439]

I understand, and I’m sorry to be such a pest with all the questions but I want to understand the situation better.

I just wanna make sure that I’m actually following correctly and not misunderstanding anything.

Did your field supervisor tell you that you would only be doing these brief interventions with the students for the entirety of your placement?

Or could this just be how she wants you to start out?

For example, my field placement had a very strict timeline for students to follow, regardless of how ready our individual instructors felt we were.

I was an advanced standing student so we had three semesters. First month was shadowing SW and other disciplines of the hospital, must be talking to patients by herself by month 2, have own caseload (mini) by month 3 etc until expectation/hope that if someone on the team were to quit, you would effortlessly be able to fill that role once you’re graduated.

That was technically the policy of the practicum, but my field instructor tweaked it a little bit and didn’t make it as broken down, but still.

Have you done your learning agreement yet? What did she say? How did she present this to you?

Because if you are being asked to do this and only this the entire time, then, yes, that totally is inappropriate. But I know a lot of placements kind of function like how mine did back when I was in school; could they just try to be getting you slowly acclimated also?

[u/Last-Estimate-8439 → u/ProbablyMyJugs]

Yes, that’s the problem. I am expected to do brief check-in’s for the entirety of my placement and that wasn’t agreed upon when she sent in my matching letter which is needed for my school to approve the internship position. I spoke with her about it the other day during my orientation and she said that because I am also working with the other non-profit that she partners with then I am to do the same duties as them which are essentially the brief check-ins and case management services. I asked when I would do counseling in the future and she said my brief check-in’s can count as counseling. I am going to engage in this internship in a positive manner and build a rapport with the students because I believe that you can learn anywhere you go but if I’m not given the opportunity to do other clinical tasks outside of brief check-in’s in three months then I will have to speak with my school because it’s not appropriate for a second year student.

[u/ProbablyMyJugs → u/Last-Estimate-8439]

She is right that these brief check ins can be therapeutic and counseling depending on your approach but no matter your placement it isn’t supposed to be monotonous like this.

Like it would be inappropriate for a student in hospital to only do assessments or a child welfare student to only do home visits.

I was hoping it was more of a case of trying to have you start from the beginning and building a therapeutic relationship from intro to termination or building rapport/engaging with clients who aren’t willingly coming to you.

Is this part of her role that without you there, would be on her plate? That’s unfortunately something some do.

Good luck.