Beginning Counselor, Therapist Journal

The Journey Of Becoming A Clinician

What does it take to be a mental health clinician? Generally, whether a physician, or mental health professional “a clinician is a health care professional that works as a primary care giver of a patient in a hospital, skilled nursing facility, clinic, or patient’s home. A clinician diagnoses and treats patients.” Once you enter the mental health field you are always striving to be the best mental health clinician that you can be; fostering your own internal clinician.

However, where does that fit in the context of the workplace? Are there some positions that make you more of a clinician than others? In the mental health field there are a variety of jobs (and each one having it’s own level of clinical thinking) but after a review one finds that the following progression occurs in a mental health career:

  1. Intern – Shadowing, assisting, and developing clinical knowledge and skills within the context of a secondary education institution. Goal of this type of position to be a sponge for information, interventions, and theory to be implemented as able.
  2. Counselor – A term used more and more (within the mental health field) to describe entry level positions at residential facilities, group homes, Medicaid based agencies, etc. that do not require a state license to practice. More often than not this requires direct care such as supervising clients, following individual service plans, and assisting with daily living activities. Starting to develop and utilize your own clinical mind more so than your supervisor’s.
  3. Resident in Counseling (Optional) – After completion of the educational requirements and gaining initial experience a residency is entered into in order to gain licensure. Utilizing counselor positions to continue developing, refining, and practicing clinical thinking and intervention.
  4. Clinician – A term and position that describes an individual who utilizes clinical knowledge, and skill to design, implement, and evaluate therapeutic interventions. Typically, this includes assessment, diagnosis, conducting therapy sessions, and supervising entry-level workers. Preference is for these individuals to hold a state license but can be held by individuals who are in their residency.
  5. Therapist – A term used most often for individuals who provide therapy in the context of outpatient clinics, private practice, individual/group/family sessions in a high level of care (residential/inpatient) that require a state license in order to practice; occasional exceptions made for residents.

Life is full of challenges, surprises, and in some cases things that feel like miracles. Looking back on how my career in the mental health field has started I can only feel amazed and generally positive. My journey started with a small rural university in Upstate New York called Alfred University. While at Alfred University (AU) I completed my Bachelors in Clinical/Counseling Psychology with minors in Music and Theatre. There is never a dull moment in Alfred – all you need to do is wander around a bit to find a social justice campaign, students having a blast with Nerf guns or medieval gear, participating in a 5k run around campus, and more.

While at AU I conducted a research study focusing on whether there are trigger words that cause communication struggles in cross gendered friendships. The results of that study showed that when giving others criticism the shorter the statement the more profound of an affect it has on the other person. While it was a general study to set up the structure for a future study focusing more on the question of “Do trigger words exist?” it helped me establish my understanding and familiarity with human behavior and my desire to provide direct clinical care for them.

That desire led me to my graduate program for a Masters in Science in Education with a Certificate in Advanced Study in Mental Health Counseling at AU. The university still held it’s undergraduate charm but at the same time took on the stress and challenges that come with graduate level coursework. I was challenged in what I believed my way of interacting with others meant, what I thought about myself, and most importantly how I would be able to help clients in the future. Through a lot of self-reflection and memorizing the most recent research on developmental psychology, abnormal psychology, counseling theory, counseling techniques, and psychological assessments I was able to gain enough knowledge and experience to graduate and even earn certification as a National Certified Counselor (NCC).

A majority of my clinical experience leading up until this point had been in a halfway house, intensive outpatient substance abuse clinic, a campus outpatient clinic, and a community based program called Multi-Systemic Therapy. Utilizing my skills developed over summers working at a summer camp near Syracuse, NY I developed my counseling style integrating various theories, practices, and interventions as I started my first post graduate employment at Blackwater Outdoor Experiences. Blackwater Outdoor Experiences provided me with a look at what it means to provide direct clinical care for a client 24/7 for 22 days in the wilderness while also learning what it means to work as part of a multi-disciplinary treatment team to ensure the clients are receiving the best clinical and medical care possible. It was in this position that I also took on the task of becoming a resident in counseling in an effort to become a Licensed Professional Counselor (LPC).

Through the Blackwater Outdoor Experiences treatment team, the clinical director Margie Crow, LCSW, and my licensure supervisor Anthony Lea, LPC I was able to start recognizing even more concretely how theories and academics of counseling were implemented into direct clinical work. Most importantly I gained the knowledge of what it means to assess an individual’s capability to participate in activities of daily living, communicate with others, effectively manage their medication, and the different levels of support that exist for individuals struggling with mental health disorders.

Following my departure from Blackwater Outdoor Experiences I started to learn about the Medicaid based programs which include therapeutic day treatment (TDT), intensive in home (IIH), and mental health skill building (MHSB). These Medicaid funded programs allow for intensive mental health counseling programming to assist children under the age of 21 (for TDT, and IIH) and supportive skill development for those over the age of 18(for MHSB). I learned that such programming is extensive, and provided by Bachelors (entry level) providers who are being supervised by an individual with a Masters in a Social Science field. I grew in my knowledge and experience with clients who are experiencing mental health disorders that have more devastating symptoms that the more common generalized anxiety disorder, major depressive disorder, etc. After some time of providing this level of care as a counselor I was lucky enough to get my newest job.

I now serve as a Clinician at Brothers Keeper, Inc. (BK) in Chester, VA. In this position I am responsible for conducting psychological assessments and typing up clinical reports to send to Medicaid insurance companies, clinically supervising two counties of the BK Therapeutic Day Treatment program, review clinical notes and services plans, conduct a staffing/training once a month with each county, and provide counseling for an IIH client. At this new level of responsibility there are challenges of incorporating clinical knowledge into learning experiences for entry level staff but also utilizing your clinical knowledge to produce countless clinical arguments to the Medicaid insurance companies.

Throughout all of these experiences I have found myself critiquing my interventions, being challenged to revisit diagnoses, treatment strategies, and the basic questions used to assess an individual’s clinical situation. What I’ve found, is that at each level and position your internal clinician grows and becomes more confident so that you are able to provide the best care and make the best decisions for your clients. Through this continual growth you develop the following skills and more:

  • Develop a safe and empathic relationship/environment
  • Reflect thoughts, feelings, and meanings
  • Question and assess what is typical versus atypical
  • Provide multiple perspectives to a single situation
  • Consider the drivers of a client’s behaviors based on their history, behavioral presentation, and observation
  • Determine a client’s struggles and validate their experiences
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Reflections & Updates, Therapist Journal

An End Of An Adventure At Blackwater Outdoor Experiences

Dear Blackwater Outdoor Experiences Family,

I am writing this letter to officially inform you that as of November 30, 2017, I will no longer be working for Blackwater Outdoor Experiences.

Taking such a huge step has without a doubt been one of the toughest decisions Dr. Bright, the other BOE staff, and myself had to make this year. Over the past two years I have worked hard to help Blackwater Outdoor Experiences (BOE) develop, grow, and provide extraordinary care to our clients. Throughout those two years I spent over 135 days in the wilderness, accrued over 2400 contact hours towards licensure as an LPC, and helped implement social media and the transitions program to name a few things. I have truly enjoyed the experience of being able to provide wilderness therapy (Outdoor Behavioral Healthcare) right away after graduating with my masters’ degree. I have poured a lot of time and energy into BOE challenging myself and the organization to consider new programs, new accreditations, and more.

I hope that you continue to reach out to Dr. George Bright and the rest of the Blackwater Outdoor Experiences staff as resources as you navigate through life.  Regarding your future relationship with Blackwater Outdoor Experiences, the company’s other employees will undoubtedly carry on offering you the same services until further notice.

As of November 30, 2017, Sarah Cazares will be your main contact regarding therapeutic curriculum and counseling services. She can be reached by phone at 804-378-9006 ext. 4 or by email at sarah@blackwateroutdoor.com

Thank you for providing me with the opportunity of assisting you, as well as expanding our company. I truly am appreciative and grateful for all the relationships I have made throughout working at BOE and hope to maintain these relationships moving forward to the best of my ability.

I will be available via e-mail at ugaldecounseling@gmail.com

Yours faithfully,
Jonathan Ugalde, M.S.Ed./CAS, NCC

Field Therapist, Blackwater Outdoor Experiences

Resident in Counseling in Virginia