Boundaries in Clinical Social Work

We hear it throughout our schooling: we have to set and maintain firm boundaries. We all get why they’re important, right?

Yet, the boundary creep starts immediately, when professors change plans or the department changes a requirement and suddenly “no classwork on this day” has at least one exception. 

We get to our first practicum site, and the competition is fierce enough that saying “no” to any opportunities feels like a risk.

We get to our clinical internship, and most of us are immediately asked to take on too much too fast, as soon as credentialing is complete. Before we get a chance to set our boundaries and keep them, we hear the way others talk about the employees who do keep firm boundaries.

If you haven’t encountered that, I’ll let you know it’s generally not great. I admire these folks for managing something that feels impossible.

There’s so much coming from our teachers and supervisors that contradicts the edict to keep firm boundaries, and yet, we’re expected to have firm boundaries with our clients from the start. The two practices conflict, I’ve found, especially when a supervisor asks you to compromise boundaries for a client by changing your hours, your availability, or your willingness to work with a certain diagnosis or population.

Some boundaries are pretty easy for me:

• I need to feel physically safe.

• I will not go against the code of ethics, especially as it relates to dual relationships.

• I will not give my personal number or home address to a client.

Others?

I definitely let my client load get too big too quickly, and most with high acuity at that. It’s hard to say no when asked to take someone who urgently needs therapy, especially if they’re in a marginalized group I specialize in. I got better at setting firm limits, but there were days I didn’t get lunch because I had too many clients on my schedule.

Part of the struggle, too, is how many therapeutic boundaries have exceptions. For example, we should wrap up sessions at the correct time, but that’s flexible if someone is in crisis, or out the door if they’re actively experiencing SI/HI. We shouldn’t give clients ways to contact us outside of session without going through the office, but some modalities all but require it. 

Some boundaries I set very loose but do follow, such as with no-shows: as long as the client is trying and communicating, I don’t hold any missed appointments against them, but two in a row with no communication, and I’ve verified they aren’t in crisis? I’m done until they communicate properly (and I’m not picky on mode of communication, either!).

Are boundaries like that still boundaries, or are they ultimately case-by-case evaluations?

I suppose my own conclusion is that I have few rigid boundaries, some porous ones that can be bent in exceptional circumstances, and some that are more like general guidelines.

If you’ve stuck with me this far, I’d like to hear how you keep yourself and your clients safe and avoid burnout while doing a job that’s chronically understaffed and over pressured. If you’re a more experienced provider: since boundaries are easiest if they’re present from the start, what advice would you give a brand new CSW-I about to start their first internship?

Website How-To

I put together a quick walkthrough of our website as it exists today. We have more features planned, and we're always open to suggestions, but this should let you see how things work on the site.

-Nik

Growth While the World Struggles

Note: Some posts may be fact-based, and others may be more based in opinion or support. This is one of the latter. Opinions in this post reflect those of the writer.

 

Social Work Clinical Internship 101 - Getting Started

 The process of becoming a clinical social work intern can be daunting. Here, we try to break it down into simple, digestible steps. This link contains all of the official information and resources on becoming a clinical social work intern and completing an internship in the state of Nevada. 

Getting your LMSW

You may begin this process once you are in the final semester of your Masters of Social Work (MSW) degree. You are not required to begin this process until you are ready to start pursuing your clinical internship en route to becoming an LCSW.

• If beginning this process in your final semester of your MSW, the first step is to ask your school to inform the board of your projected graduation date. This process will vary by school, but for most, it can be initiated via email to your department's main point of contact after you have applied for graduation. If beginning this process after graduation, you may skip this step. 
• Cost to apply for graduation varies by institution.
  
  
• Gather a few electronic copies of documents before you get started. You'll need this for your passport or birth certificate, a current government-issued photo ID, name change documents (if applicable), proof of military association (if applicable and seeking discount), and court-certified records of arrests (if applicable).
  
  
• Apply for your LMSW here. Steps in the application will vary based on what route you have taken to get to this point (were you licensed in another state? are you an LSW?) but are generally easy to follow. Upload documents as requested. Make sure you get confirmation at the end, which will include the ability to download a copy of your application.
• Cost:
• Application Fee: $50
• Initial License Fee: $125
• 50% discount for military and spouse
  
  
• Get fingerprints done. Take this form with you. Choose a facility with Live Scan if possible; this method is simple and quick. Make sure the form is complete before you leave, after providing your fingerprints. Send a copy of the completed form to the board. At time of writing, this means emailing it to slowery@besw.nv.gov.
• Cost of fingerprinting at time of writing approximately $65
  
  
• Use your MSW institution's associated service for having official copies of your transcripts sent directly to the board. If you have not yet graduated, do no do this step until after graduation and degree conferral. If you have not yet graduated, you do not need to worry about this step yet and may continue. Electronic copies are, at this time, sent to slowery@besw.nv.gov.
  
  
• You will receive an email informing you that you are eligible to take the LMSW exam through the ASWB. Within 72 hours of that email, you will be able to register at this link.
• Cost: $230
  
  
• You will receive an email, likely within the next day, citing successful registration. This will include a link for where to register. Follow instructions and schedule a time to take the exam.
  
  
• Take and pass the exam. Study guides and test-taking tips will be the focus of additional guides and will be linked here once added.
  
  
• The ASWB will send electronic confirmation that you passed, and they will also inform the board. Within a few business days, you should have additional acknowledgement from the board.
  
  
• If you began this process before graduation, send official transcripts as described above as soon as your unofficial transcripts show your MSW has been conferred, after graduation.
  
  
• Check on your application status here if you reach this point and have not yet been granted your LMSW, or if you just like checking in on things along the way. If anything looks wrong, contact Sandra Lowery at slowery@besw.nv.gov. 
  
  
• You will receive both electronic and paper confirmation once your LMSW has been issued. Congratulations! You're a masters-level social worker.

Getting your CSW-I

Next up is getting your CSW-I. The first two steps can be done in any order, as your application for CSW-I is not considered finished--meaning the timer doesn't start--until all steps are complete.

• Find an approved internship site. The board has information here, and we are collecting data and organizing it here. Apply for a job and get hired. Make sure they know where you are in this process so they can set your start date accordingly. If you can't find a compatible site, there are ways to request a site become approved.
  
  
• Find an approved clinical internship supervisor. The board has information here, and we are collecting data and organizing it here. Make sure you talk about supervision times and cost, as this information will be required for application.
  
  
• Apply here. If you are within six months of your LMSW application, some duplicate steps, like getting fingerprinted, can be skipped. You may need the same electronic proofs of ID as during the LMSW process. Once the application is complete, you will get an application number that your supervisor will need in order to submit their portion. You may also need to request an access letter from your site if you have an offsite supervisor chosen.
• Cost:
• Application Fee: $50
• Initial License Fee: $125
• 50% discount for military and spouse
  
  
• Have your supervisor fill out and submit this form using the application number you got upon submitting your part of the internship application. 
  
  
• You've done everything you need to except wait. This process usually takes around thirty days. Rarely, it can be faster, and sometimes it takes six weeks, or more if your projected start date is further into the future.
  
  
• Once the board gets a chance to review everything, you will get electronic and paper confirmation that you are approved as a Clinical Social Work Intern or CSW-I. Congratulations!

If you have any questions, check out our other guides or ask the group. You can also send any requests for additional guides to nikprose@gmail.com.