For those who have a calling to help others, mental health might be an alluring career. Working in mental health can be extremely rewarding but it is also an emotionally taxing field that can lead to burnout. The profession is trying to appeal to a greater number of potential workers while maintaining retention rates and combating attrition.
Sarah Spurlock, a Marriage and Family Therapist owns Denver Counseling Solutions, a group practice with several locations in the Denver Metropolitan area. According to Ms. Spurlock, her practice “helps individuals who want to go from living to thriving.”
In addition to helping people address mental health issues, Ms. Spurlock has devoted her career to paving the way for rookie therapists who are starting on their own professional paths. Ms. Spurlock wants to ensure that nascent professionals are equipped with the experience, grit, and the tools they need to flourish. Ms. Spurlock understands the challenges those entering into the mental health field are up against all too well; she recollects when she was fresh out of graduate school, working long hours at a community health clinic with a mounting caseload and low pay.
Ms. Spurlock has made it her mission to create positive training opportunities for students and new professionals. “I wanted to help [other professionals] get the leadership skills they need to be successful. Working in private practice can be somewhat like being on an island. It felt important to create opportunities [for professionals] to have a good experience where they felt supported in an ethical way.”
A natural-born “helper,” Ms. Spurlock was drawn to working in mental health from a young age. She described taking on a helping role within her own family while growing up. That desire led her to eventually earn a Master’s Degree in Marriage and Family Therapy. As a way to “give back” to the profession that she is passionate about, Ms. Spurlock created a prolific internship program within her practice. Throughout the pandemic, mental health issues have risen at unprecedented rates and practitioners are feeling the effects of immense client needs. “Anxiety is pervasive,” explains Ms. Spurlock. “Edges are frayed. Patience and kindness can be short.”
In a sit down with Mental Health Missions, Ms. Spurlock discusses her professional journey to becoming a therapist, guiding those entering into the field, and delivering quality treatment in the ever-changing landscape of mental health care.
Mental Health Missions: Oftentimes, mental health treatment is associated with crisis. Can you describe some of the different treatment options, including private practice, the environment in which you work?
Sarah Spurlock: There are different components of mental health treatment. The place where individuals usually get help in crisis is at a hospital, behavioral health emergency room, or a community clinic. Crisis treatment consists of stabilization. Kids might get some help at school and, colleges and universities generally offer counseling services on campus. Those who have higher needs might go to a residential treatment program, which could be 30, 60, or 90 days.
When an individual is in a more stable place, they may get counseling at a mental health clinic or private practice. These settings usually offer a variety of counseling types; there’s individual, couples, and family counseling. Some practices also offer group therapy.
Private practice varies a lot when it comes to clients and issues they’re coming in for. Some people might be lacking certain daily functioning skills. People are often working on interpersonal relationships, and communication. For individuals who have more insight, it might be working toward congruency with actions and behaviors as well as thoughts and feelings. Sometimes therapy is about people who want to go from living to thriving, stepping it up and acquiring skills to get to the next level in their lives.
MHM: Why are mental health prevention efforts important?
SS: Prevention is about awareness and maintenance to mitigate a crisis from occurring. Crisis response and handling acute mental health issues call for specific protocols and unique treatment. Awareness and education are essential to sustaining proper mental health hygiene and for an individual knowing when to seek help.
MHM: Can you talk about the different roles within mental health and the path to a professional becoming independently licensed?
SS: There are different disciplines within mental health that offer counseling. These include Licensed Professional Counselors, Marriage and Family Therapists, Clinical Social Workers, and Psychologists. Individuals either have a Master’s or Doctoral degree in their respective fields. Most disciplines require students who are working toward their degrees in the education system to complete an internship or practicum. During this time student interns would be seeing clients anywhere from 10-20 hours a week, which would likely be their first direct contact with clients. Simultaneously, they would be getting extensive on-site supervision as well as supervision within their academic programs.
Following graduation there is a usually substantial waiting period before an individual can become independently licensed in their field. This varies by discipline and each state has different requirements and regulations for licensure candidates. Before becoming independently licensed, individuals generally have a provisional license and are supervised by a licensed provider. Once individuals complete a required number of supervised hours [which varies by state and license type], most candidates need to be approved to take an exam from their regulatory board as a step toward independent licensure. Once a person becomes fully licensed by their respective regulatory board he or she no longer requires supervision.
Psychiatrists and psychiatric nurse practitioners are also mental health providers, but they go through a medical curriculum. Similarly, licensure is dependent on the profession’s board requirements.
MHM: What are attributes of an effective supervisor and how can a new mental health professional get maximum benefit from a supervision experience?
SS: Well supervisors only know what supervisees tell them so I would say that students, interns, licensure candidates etc. need to advocate for themselves. I always tell my supervisees, ‘I’m remarkably accessible and I’m a resource for you to utilize but I don’t read minds.’
Sometimes people who are entering into the field don’t want to appear inexperienced. Being under supervision is a rich opportunity and you don’t want to hide behind your mistakes. You want to discuss areas where there is room for growth with someone who can give you direction and perspective. I recommend those under supervision get clear about the questions they have and draw upon their supervisor(s) as a resource, that’s how to maximize the benefit of supervision. Supervisors can provide the basics but only when they are informed can they offer more effective guidance. That is what enriches the experience [of having a supervisor].
It’s also possible supervision might not be a good fit, if a supervisor and supervisee aren’t well matched. If that’s the case, drawing upon alternative resources such as other professionals or academic instructors who can offer advice and varying perspectives could be helpful.
MHM: You have developed a robust training program within your practice. Can you talk about the significance of training opportunities and why it is important for new professionals to be exposed to different areas of mental health?
SS: Personally, I had very good and versatile experiences getting trained during school, but not all people coming into this field have those positive training experiences, for whatever the reason. Being in a position where I could offer training opportunities to individuals starting their careers, I wanted to give that back. I also have varied perspectives having been a student, an intern, a candidate for licensure, and a fully licensed clinician. With all of these different vantage points, I observed there to be gaps, particularly when it comes to placements in private practice. Most graduate schools and training programs are lacking when it comes to exposing students to private practice. I wanted to make sure I could offer this experience to those who are seeking it out.
MHM: What are some of the benefits of a client working with a trainee?
SS: Trainees are typically getting a great deal of supervision from a licensed provider and they have various supervisory resources. Trainees also tend to have smaller caseloads allowing them to focus more time and attention on their cases. Other benefits are that trainees are eager, excited, engaged; they want to learn, and be effective.
Another advantage is cost. Typically interns or licensure candidates will see individuals for a fraction of the cost of a licensed provider. I would say to not be closed off to meeting with a trainee, there are a lot of benefits that might be overlooked simply because of a title. And, if someone has doubts or questions, you can always ask the trainee and/or the supervisor.
MHM: If an individual is receiving counseling services from a licensure candidate or intern, are there certain questions to consider asking?
SS: I think if you are seeking therapy there are some general considerations to think about no matter what type of professional you plan to see and if the person is under supervision or fully licensed. Sometimes it’s just a matter of if it’s a good fit or not. Studies show the efficacy of therapy is greatest based on the connection between the therapist and client, not necessarily the amount of experience someone has or how long they’ve been practicing.
Clients may want to learn about different therapy styles or modalities ahead of time. If there is a particular style that resonates, maybe seek out a provider who uses that modality. You also may want to think about specialization. If you’re seeking therapy for a specific issue, it can be helpful to look into therapists who have expertise in that area. For example, as a Marriage and Family Therapist, I work from a place of using a families and systems orientation. This would likely be good fit for family therapy but not all therapists come from this orientation. It’s important to keep in mind that clients are going to get different experiences from therapists with different areas of expertise who use different treatment modalities.
MHM: What is case consultation and why is consulting with other professionals about clinical cases important?
SS: Case consultation helps clinicians get perspectives from other professionals and allows colleagues to learn from one another’s areas of expertise. It’s very easy to discuss cases on a higher, broader level without sharing any identifying information [which ensures compliance with HIPAA and patient privacy]. Clinicians and trainees are able to discuss cases on a theoretical level and be objective to point out factors that the treating clinician might be missing. Consultation is very common in the field as standard practice. Clients should be encouraged by case consultation as it helps therapists to stay accountable and not be isolated in their treatment approaches.
MHM: What advice would you give individuals who are considering pursuing a career in mental health?
SS: Do whatever you need to outside of work to have joy and stability to ground you when working with your clients. Having a focus outside of yourself is necessary for character development and healing of oneself. Throughout the pandemic, people have become destabilized, and acuity has risen. Self-care is primary and the need for community awareness is very high. The stigma of mental health problems and diagnoses is waning. This means more people are seeking help and increased demands are causing an influx on many mental health systems and providers. Clinicians and trainees attending to their needs while maintaining awareness of their limits is necessary for helping others.
This interview is the result of several conversations and has been edited for clarity.
Sarah Spurlock, MA, LMFT is the Executive Director of Denver Counseling Solutions, serving clients with several office locations throughout the Denver area.