Private Practice: The Role Of Social Work In Social Care

I. Introduction
Across America, social workers can be found in a wide variety of settings, working with a vast population of people. One such setting in which social workers provide service is through private practice. Private practice social workers work outside an agency of government facility to provide services through their own established practice. Many people associate private practice social work with the work of psychologists, counselors or therapists initially. While they each provide similar services, educational requirements often differentiate the fields of practice and ultimately allow them each to make varying contributions to their clients.
"Psychiatrists can prescribe medications, psychologists administer and interpret psychometric

tests to assess mental health problems, and social workers use a systems perspective by incorporating family members in the treatment process and use community resources to improve client functioning" (DiNitto & McNeece, 2008).
In addressing mental health, multidisciplinary teams often work together to provide many resources necessary for a client to seek help.
"While embracing the mission and core values of the social work profession, clinical social work has the following main purposes: (1) diagnosis and treatment of biopsychosocial disability and impairment—including mental and emotional disorders and developmental disabilities; (2) optimal prevention of biopsychosocial dysfunction; and (3) support and enhancement of biopsychosocial strengths and functioning ability" (ABE, 2002).
Clinical social workers in private practice can work with individuals or groups. Private practitioners typically have a Master’s Degree and at least two years of clinical experience. They may also possess a doctoral degree. In order to practice privately, they must also meet state licensing requirements. Some private practice social workers may do work out of the office, serving as expert witnesses in court or consultants on behalf of health plans or school programs. (NASW, 2011).
While some debate exists regarding the privatization of social work, practitioners in this field enjoy the flexibility and accessibility that they have to clients in private practice. Further, studies have noted an increased interest in private practice by students working to obtaining licensing. Considering social workers are the number one provider of mental health services, it is true that private practice is, therefore, a necessary resource for many clients to consider for therapy due to the holistic approach of social work overall.
II. Overview of Private Practice
Generally speaking, numerous writers have suggested that social workers, in fact, do more psychotherapy than psychiatrists and psychologists combined (Cohen, 1966). Furthermore, clinical social work offers many unique services to people in contrast to other fields of social work. Many agencies are struggling to meet the needs of their clients due to a decrease in funding and resources. However, social workers who have a private practice tend to see more clients than those working in agencies. Further, clients in private practice counseling tend to have more significant levels of mental health issues. Practitioners also tend to better cultivate “virtual teams” by linking together different resources and service providers in order to help meet the needs of their clients (Brauner, 2015). Data suggests that practitioners engaging in private practice are more likely than others to be experienced in family service, psychiatric social work, and teaching social work (Cohen, 1966).
The field of private practice originated in the late 1920’s and has continued to grow over the years (Cohen, 1966). Since then, due to an increase in opportunities as well as uniform state licensing standards, the private practice aspect of social work rapidly expanded in the end of the twentieth century (Brauner, 2015). In the 1960’s it was contended that social work had developed a technique suitable for use with the middle-classes and that a demand for this service now existed among those able to afford it. They also maintained that some individuals, including those who otherwise would not seek services due to the stigma associated with approaching an agency, could get the help they needed from a private practitioner (Cohen, 1966). In those days, private practice social workers mainly worked with middle-class individuals.
Private practice social workers nowadays work with a wide array of people including children, adolescents, adults, and the elderly.

They may provide individual, couples, family therapy, group therapy, play therapy, crisis intervention, bereavement counseling, and more services (NASW, 2011). One study with a sample of 1,000 randomly selected social workers in private practice found that the largest population seen was Caucasian (88%). Following Caucasians were African Americans who accounted for 7.5% of the clients seen and Latino and Hispanics who accounted for 2.3%. In regards to age range, those between 21 and 59 encompassed 71% of the clientele, those 60 or older accounted for 12%, adolescents accounted for 11%, followed by children under 13 who accounted for roughly 6% (Lord & Iudice, 2012). Also, a majority of the social workers (86%) stated that they typically saw clients individually; that is in a one to one session. However, 48% reported that they offer family therapy, 20% reported doing group work, and 10% said that they offer clinical case management (Ibid). Roughly two-thirds of social workers in private practice work in a solo setting while 14% work in a group practice, 16% work in a home office, and 6% work in some other setting

(Ibid).
There are many forms of evidence-based practices or interventions that a private practice social worker may utilize. Factors that play into a social worker’s decision includes personal preference as well as taking into consideration which treatment might work best depending on the client, their presenting problems, and what has or has not worked for them in the past. In addition, it is important to note that other factors include whether or not a social worker has received evidence-based-training. Many graduate programs do not always primarily focus on evidence-based practices (Lord & Iudice, 2012).
While a majority of social workers are eclectic in their approaches, cognitive behavioral therapy (CBT) is the most common form of therapy employed by social workers (74%). Following CBT as the most widely used practice is a psychodynamic approach, then a person-centered approach, a solution-focused approach, a systems approach and narrative therapy (Lord & Iudice, 2012). Among all these different approaches, the most common issue spoken about in therapy is family issues. In addition to family issues, other common issues addressed include individual or behavioral problems, issues of grief and loss, employment issues, health issues, drug and alcohol issues, and violence (Ibid).
One unique form of treatment is animal or pet therapy. While it is not an extremely common method of intervention in social work, recent studies suggest that the bond between animals and humans can be beneficial in psychotherapy, and therefore may be used by some social workers in clinical practice including John Davidson, who often brings his dog Katie to sessions. “Studies have confirmed that the presence of a pet lowers blood pressure, raises survival chances after a heart attack, and facilitates social contact. Pets have proved effective in reducing loneliness, anxiety, and depression” (Sable, 2012). There has been increasing acknowledgment that “furry companions give people a wide array of psychological, social, and health-related benefits [which] has important implications for social work, including for policy and prevention” (Ibid). This includes policies that allow elderly to keep pets in apartments or retirement communities, and provide comfort and counseling for those who have lost a pet.
Some additional skills and methods in clinical social work include biopsychosocial assessment and diagnosis, crisis intervention, psychosocial and psychoeducational interventions, client advocacy and therapeutic life management when appropriate, and brief and long-term psychotherapies (ABE, 2002). Social workers can also acquire skills in specified areas, such as human behavior. In this area, a social worker would focus on theories of human behavior and development, psychopathology, symptomatology, racial, ethnic, cultural and socioeconomic differences, social problems, diversity associated with gender, age, sexual orientation and disability, strengths and stressors in the social environment, and social system structure and dynamics (Ibid).
Clinical social workers may also employ a variety of technical tools to work with their clients, such as differential diagnosis of mental or emotional disorders, assessment of mental status, physical, mental or behavioral indicators of physical illnesses and disorders, indicators of chemical dependency, psychopharmacology (e.g., awareness of appropriate use of psychotropic medication, expectable results, side effects and parameters for medical consultation), standardized tests and use of other systematic assessment frameworks, clinical record keeping, statutes, case law and regulations affecting clinical practice and clients’ health and welfare, anatomical, physiological, genetic and medical information, outcome evaluation and research methodologies (ABE, 2002).
While it is important to focus on evidence-based treatments, it is also helpful to focus on rapport. Carol Conklin, a social worker who works in a private practice, explained how “the most important thing one can do in counseling is the relationship and figuring out how to build that relationship. She believes that this is a skill that she has possessed for a long time. Unconditional positive regard is another skill that can be helpful. In regards to techniques, she uses all of them. Cognitive behavioral therapy and also a model she created for sex addiction recovery through harm reduction. She also works with anxiety in an eclectic way. “You use things that will work” (Conklin, 2016).
Throughout the past few decades, there has been a steady rise in social workers engaging in private practice in recent years. Looking back to 1993, over half (57.5%) of the National Associations of Social Workers members were involved in a full-time or part-time private practice (Brauner, 2015). Furthermore, in 1994 all fifty states in the U.S. “had licensed or certified social workers for clinical practice” (Brauner, 2015).
While this field of practice has been increasing, there are specific certifications and educational requirements.

A recent requirement in every state is that a private practice clinical social worker must acquire licensure (Brauner, 2015). Clinical social workers in private practice also move through levels of professional competence. The first level is the postgraduate practice level, or the Masters in Social Work (MSW) level. An MSW will provide students with a wealth of information about clinical social work, but it does not qualify them to immediately work in their own practice. The general consensus is that MSW graduates must work in a supervised environment for at least two years before becoming licensed to work privately. The second level is the autonomous practice level or licensure level. Autonomous practice means unsupervised practice, inside or outside of an agency. Social workers who are at this level have completed at least two postgraduate years of supervised clinical work. They should be competent in diagnosing and treating clients, establishing intervention plans, and working within the parameters of the law. They can apply to be licensed and move on to independent practice. The next level is the advanced practice level or diplomate level. In order to get to this level, the social worker must have at least five years of clinical work post-MSW graduation and have achieved the autonomous practice level. These social workers are advanced and are now typically

considered qualified to supervise or teach new social workers (ABE, 2002).
Private practice works mostly at the micro and mezzo levels. A practitioner's work day will typically consist of individual and group appointments where they speak with clients and provide counseling. However, private practice social workers can also work on the macro level in various ways. One example is by advocating for their clients. At the macro level, social workers are necessary advocates for mental health care and promoting better insurance coverage for clients seeking therapeutic care (DiNitto & McNeece, 2008).