Navigating Practicum as an MFT Trainee

Practicum is a busy time for any therapist trainee. You’re nearing the end of your program, finishing course work, and starting to see clients. Some people choose to finish all or most of their coursework before they go ahead with practicum, but I would say most of the people in my program, myself included, juggle both at once.

Dealing with School and Practicum at the Same Time

It can feel like a lot to balance both seeing clients and finishing coursework. A part of you might want to just throw out everything you’ve learned and start fresh, and a part of you might want to cling to every structure and textbook you’ve read to feel like you have some clue about what you’re doing. You’ll probably fall somewhere in between. You’ll lean on what you’ve learned, but also learn to trust your intuition.

I think there are pros and cons to doing school and practicum at the same time. The pro is that you might start building up your case load of regular clients very slowly, so having a course or two to focus on during that time might be a productive use of time. Otherwise, you might spend a lot of time just waiting around. I didn’t start seeing clients regularly until about 6 weeks in. During that time, there was a period of training, a period of waiting to be assigned my first client, and a couple of “false starts.” Now that I’m finished my first semester, I have about 5-6 regular clients that I see on a weekly basis. I‘m hoping to have a couple more clients assigned to me, and many practicum sites will recommend you hover around 7-10 weekly clients if possible.

The con for doing school and practicum at the same time is that sometimes you might feel overwhelmed. Once your caseload starts getting more full you might start feeling more stress when it comes to your schedule. You might feel a bit more “checked out” of your classes, since they are so theoretical in comparison to the “real” work you are doing with clients. You’re also going to have more than just clients added to your schedule - you’ll have supervision, trainings, meetings, therapy of your own, and most likely some type of “phone shift” (mine is 3 hours a week) where you help intake new clients and return phone calls to potential new clients. Actually seeing clients, spending time getting prepared for clients before appointments, and spending time writing notes after appointments will add up.

What you’re able to handle will depend on your schedule. I will have the option to return to in-person sessions soon, but currently work virtually with all my clients, which is great for my schedule (and I’m sure that’s what my dog prefers). I never work evenings and weekends, but many trainees do choose to offer those times, and many clients prefer those times. You are the only one that knows what will burn you out, so pay attention to when it starts to feel like “too much” for you and don’t be afraid to advocate for your own needs.

Learning from a Supervisor in Practicum

During practicum, you are under supervision. You don’t have your own license yet, so you are working under your supervisor’s license. Your supervisor will approve your notes and sign off on your hours (which I will cover in future blog posts).

The way at works at my school is that you start your first semester of practicum doing group supervision with other students from your program, and during your second and third semesters of practicum you find your own individual supervisor and see them instead. At my practicum site, we also do group supervision with our clinical director once a week.

For me, being in my second semester, this means I have group supervision once a week (for two hours) with my colleagues at my practicum site (along with some additional meetings and trainings), then individual supervision with my individual supervisor (one full hour a week, not a 50-minute “clinical hour”). I also see a personal therapist (for one 50-minute “clinical hour”) once a week, which my school requires of all trainees during practicum.

Group supervision and individual supervision are basically self-explanatory, and both are really great sources of learning and inspiration. I get a lot out of the group supervision at my practicum site, just from listening to my colleagues talk about their cases and hearing the feedback from our clinical director. I also learn a lot from my individual supervisor and get more of a chance to talk about each of my cases in-depth. In either form of supervision you can ask questions about your clients, ask for opinions/suggestions/resources from the group/supervisor and have a chance to think about your cases in a new way.

Getting Hands-on Experience with Real Clients

Practicum is really exciting because although you might be “just” a trainee, you become a “real” therapist! You are someone’s actual therapist, and they might even go around telling people about their therapist so-and-so (aka you!).

I’m lucky that I was able to come to my traineeship with a lot of experience in handling administrative tasks and working in private practice already. As a dental assistant and receptionist, I learned a lot about the “behind-the-scenes” work involved in scheduling, treating, billing, and communicating with clients and became extremely comfortable talking with total strangers over the phone. If you don’t come with a lot of work experience under your belt, don’t fret, because it usually is pretty straightforward. Learning the ins and outs of whatever software your practicum site uses and getting used to talking to clients just takes practice, and if you’re on a team with other trainees, you’re most likely going to be helping each other through the process. Learning the business side of things will be really helpful when and if you decide to go into private practice, and writing up progress notes for every single appointment is a legal and ethical requirement for all therapists.

You’re going to be learning all kinds of new things during practicum! How to intake a new client, how to bill them, how to handle no-shows or late cancellations, how to handle termination, and most importantly, how to be a therapist.

One of my favourite therapists sent me a great video that really helped me stay grounded while I waited for my first ever therapy appointment to begin. I remember being very nervous while the minutes ticked down until the time the appointment was to start (which is totally normal!), but things went surprisingly well! Even though that first client “ghosted me” with no explanation, I had a couple other first appointments that week that went well, so I didn’t take it personally.

You’ll learn for yourself what ends up working for you and what doesn’t. Personally, I’ve decided to start offering a 20-minute complimentary phone consultation to new clients. I find a client-centered, humanistic approach feels best for me. I’m a big reader, so I’ll often offer book recommendations. Maybe a different approach will work for you. My individual supervisor comes from a community mental health background, while my clinical director gives a more psychodynamic perspective. You will find you own style, too.

Practicum is a big commitment. You need to gather a certain number of hours and gain the approval of your supervisors to “pass” practicum. Depending on where you do your practicum, and how quickly you are able to gather client hours, you might be working there for 2-4 semesters. You’re becoming a real therapist and will have clients that rely on you. You have to bring your true, authentic self to sessions which may take more energy than just sitting back during a Zoom lecture. Adjusting to practicum can be a challenge, but it is a very rewarding and exciting time. Remember to be patient and compassionate with yourself and try to remember to prioritize self-care during this busy time. Set a good example for your clients by following your own advice, setting boundaries, and doing things that make you happy.