Welcome to our third post in this monthly feature! The most exciting part of this series is that it allows us to discover the many sides to professions, and even people, we think we know. This month’s "A Day in the Life of..." is from: Dr. Michael Henderey, an associate professor and clinical psychologist in New Hampshire.
1. What is your job title or the title of your hobby/volunteer work?
2. How long have you been doing this work?
Ten years in private practice.
3. Why did you choose this work?
I saw a psychotherapist as a kid after my parents had divorced. I was exhibiting all kinds of anxiety symptoms, and she helped me connect to those feelings that were concealed beneath the anxiety. I did not know a job like this existed back then, and the experience clearly stuck with me.
4. What, if any, skills or training are required or sought out?
There are many roads that can lead someone to become some kind of psychotherapist. There are degree programs in clinical social work, mental health counseling, marriage and family therapy, pastoral counseling, clinical psychology, and others. Many of these are masters-level training, but to become a licensed clinical psychologist, a doctoral degree is (almost always) required. In addition to graduate coursework, all of these programs would require extensive, supervised training on-site, in placements such as hospitals, community mental health centers, and university counseling centers.
5. What does a typical day (shift, etc.) entail?
Hardly any day feels typical, but on the days that I am at my private practice, I will see patients starting at 9a up through 6p (including an hour for lunch). Each session is fifty minutes, with some time in between for notes, snacks, stretching, or anything else you might need to do to try and stay present with the next patient coming in. I work with adolescents and adults, often those who have trauma histories, so the work can be rather intense and emotionally draining. Psychologists (but not other types of psychotherapists) can also work in the field of psych testing. I have colleagues mix up their days by administering psychological evaluations, tests of cognitive functioning, personality measures, and the like. I teach full-time at a university and thus can keep my practice small, limited to two days per week, which creates the best balance for me.
6. What do you feel are the pros of this work?
As a psychologist, I am put in this privileged role of listening to people share intimate details about their lives, hopes and fears, fantasies and regrets. We work together to identify goals and the process that will unfold to try and reach them. There are patients who have transformed their lives, and being part of that process is deeply meaningful.
7. What do you feel are the cons of this work?
Not everyone gets better. Sometimes the most realistic goals are modest gains in functioning, or helping someone not slip deeper into their suffering. The job requires lots of self-care and reasonable expectations regarding the role you can play in another person’s life. This can be quite difficult to manage.
8. Would you recommend this work to others? Why or why not?
I would recommend this work to others, with a few caveats. As mentioned above, you need to be able to care for yourself before you can provide care to others. This does not mean you have to be the picture of mental health, far from it, but you must recognize the boundaries between what you can truly offer someone else and what you wish you could. Also, if you work in private practice, you have to manage insurance company payments, patient records, marketing, tax liability, and so on. It is running a small business, and that is not for everyone.
9. If someone was interested in this work, what are the first steps they should take?
Seek out graduate programs in counseling or clinical psychology. You do not need to have an undergraduate degree in psychology, either. There were plenty of students in my program that had backgrounds in music, anthropology, medicine, so many different pursuits. Grad programs may require a certain amount of pre-enrollment requirements in psychology, but it is entirely doable. And, I would not recommend just any graduate program. Find out what kind of training they offer (e.g. do they specialize in psychodynamic, cognitive, family systems approaches), and have a conversation with both the director and current/former students from that program. If you are not ready to dive into graduate school, try reading books from clinicians such as Irvin Yalom, Christopher Bollas, or Deborah Luepnitz. Go to therapy yourself, too. It is a front-row seat to the profession.
10. Finally, which experience from this work stands out the most to you? (A learning opportunity? Specific training? A crazy event?)
The first real session I ever had was with a twenty-year-old college student who had just found out she was pregnant. This was unplanned, the guy she had slept with did not know, no one else knew at that point. She was terrified. I was an intern, only twenty-three myself, and I remember feeling so ill-equipped to help her. There was no textbook example of what to do in this situation, where to even start. I felt a panic swell inside me that led me to consider running out the door, leaving her and the entire profession behind. I sat with these feelings as she continued to talk about her situation. I realized I was hardly listening to her, more consumed with my own self-doubt. But then I saw the tears in her eyes. She was not just some character cast in my life’s story. She was mired in her own narrative, her own self-doubt plaguing her. She was not asking for me to be some kind of authority who would tell her exactly what she should do, so I could let go of that anxiety-inducing, omnipotent fantasy. She needed empathy, she needed to be challenged to confront her conflicted feelings, and she ultimately had to feel empowered to make her own choices. From that very first session, I started to better understand the relational nature of psychotherapy, and how important it is to be authentic in this kind of work.
There is also a story about a man I once saw who came to therapy complaining that his dominatrix-mistress was not controlling enough, but due to confidentially restrictions, I will have to leave it at that.
11. Is there anything else you’d like to add that wasn’t addressed above?
I have found that psychotherapists struggle to talk about the financial component of the work. The therapy relationship, for all its genuine care and compassion, is also something we get paid to develop. There is a range of how much a psychotherapist charges, often depending on factors such as training level and geographic region. In the smallish city where I live, I set a rate of $130 per session, however insurance companies may only reimburse a percentage of this fee (and each insurance company pays out at different rates). Some clinicians do not take insurance, collecting their full fee at the time of service and then helping their patients try to get reimbursed on the back end. This approach may limit one’s caseload, as many individuals are not in a position to pay session fees up front.
Working in a group practice can provide billing services, referrals, office space, and credentialing reviews, however they will take a cut of somewhere between 40-50% of the gross income generated by your services.
Read more by Dr. Henderey, including an enlightening piece about empathy, here