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Laura Groshong, LICSW, CSWA Director, Policy and Practice
We clinical social workers all recognize the possibility that an unexpected life event could interfere with our clinical social work practice. We help our patients deal with unanticipated events every day. Yet many clinical social workers have no plan for notifying patients in such a case, and no arrangement with a colleague who, should it become necessary, would enact this plan.
Of equal concern is the end of a practice: best practice dictates a mindful approach to closing a practice, with a plan developed long before retirement draws near. Yet a comprehensive study (Hovey, 2014) of how social workers address the end of a practice found that only 18% of those surveyed had completed a professional will. The sample (n=83) consisted primarily of White/Caucasians (94 %), female social workers (82 %), ranging in age from 24 to 80 years, most of whom were in private practice (78 %). While 35 % said they had made some informal arrangements with colleagues, 47 % had made no arrangements at all. These results highlight the likelihood that clinical social workers have not given practice interruptions and endings the attention that they should have.
What Makes Planning So Difficult?
As Ragesua, Shatsky, and others have noted, it is often difficult for clinicians, including clinical social workers, to anticipate interruptions in a practice, planned closing of a practice, or instructions for the unplanned closing of a practice. Shatsky states: “As clinicians, we champion our patients’ examination of the difficult, important transitions of their lives. Yet, when it comes to this issue, more often than not we fail to conduct a competency examination on ourselves….Why is it unusual to hear cognitively fit colleagues openly discuss looking forward to retirement? Unlike other health professional arenas, why is planning for and discussing this significant transition (amongst psychotherapists) rarely embarked upon with enthusiasm?” (2016). Ragusea gets to the heart of the matter in his adaptation on ending a practice “On rare occasions, reality breaks through our merciful denial and we all consider our own demise. Yes, the last great adventure beckons to us; even psychologists [and clinical social workers] die. Most of us like to think that we will pass away quietly in old age, peacefully sleeping in our own beds and, perhaps, surrounded by loved ones. But, what if the path goes off in a different, surprising direction? What if we die suddenly, unexpectedly?” (Ragusea, 2002).
The internal process of accepting the fact that there are likely to be interruptions and there will definitely be endings to clinical practice may involve working through feelings of loss, ambivalence, guilt, relief, and much more. Clinical social workers should begin to consider their feelings about the inevitable ending of clinical practice from the beginning of their careers, rather than wait until nearing the likely end of their working lives. Having no plan in place for an unexpected interruption or ending could put patients at risk for a wrenching disruption in treatment and may burden an unprepared spouse, partner, or colleague with the complex task of closing a practice. The responsible clinical social worker will have a plan in place; this is best practice, ethical practice, and even required in some states by the boards of social work.
What The Clinical Social Work Association Can Do To Help
There are four major ways that clinical social work practices may be interrupted or ended:
Hovey, J. K. (2014). “Mortality practices: How clinical social workers interact with their mortality within their clinical and professional practice” (Unpublished master’s thesis). Smith College School for Social Work, Northampton, MA. Available from https://dspace.smith .
Ragusea, S. "A Professional Will for Psychologists", adapted from VandeCreek, L. & Jackson, T., Eds. (2002) Innovations in Clinical Practice: A Source Book, Vol. 20, pp. 301-305. Sarasota, FL: Professional Resource Press.
Shatsky, P. (2016) “Everything Ends: Identity and the Therapist’s Retirement”. Clinical Social Work Journal, Vol. 44, No. 2, pp. 43-149.
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