It’s Okay to Not Have it All Figured Out

Graduating from the UW School of Social Work in ’92, I was fairly certain that my career path would take me in to the mental health arena.  In hindsight, I have to laugh at myself since I vividly recall thinking that I wanted to work with “the worried well” (your garden variety anxiety and depression).  I thought to myself that I did not want to work with the chronically and persistently mentally ill.  If I’m going to be really honest, that population scared me at the time.  And yet, that’s exactly the population I landed in, and love working with now!

But I had no actual therapy experience, and in total candor, I felt like a bit of a fraud who was going to have to “fake” being a therapist.  Sure, I completed an internship in a home-based family preservation program located in Federal Way.  But it would have been a bit of a stretch to call that a “clinical role” in light of the scope and depth of what a Clinical Social Worker really does.  Don’t get me wrong!  We absolutely engaged in elements of clinical practice in that internship!  What I’m speaking to is the breadth and depth of knowledge one needs to practice as an autonomous psychotherapist.

It wasn’t long after graduation (just under one year, to be exact) before I landed my first Psychiatric Social Worker job in Southern California.  And as it would turn out, it become my home for the next twenty years.

As time passed and I developed clinical skills and judgement, it slowly became clear to me that I enjoyed this (chronically and persistently mentally ill) population.  While the child was “my client/consumer/patient”, the reality was that the entire family was.  The classic Social Work operating principle is that behavior is a function of the person in their environment.  Therefore, if kids were to be the focus of my clinical attention, so too did their parents and siblings need to be.  And not only that, but where they lived; their access to community resources; their socio-economic status; their level of social connectedness; their culture; and a host of other social principles to take in to account in working with them.

As the years passed, I began to feel competent.  I passed my State licensing exams (back then, it was a written exam, followed by a grueling oral examination by a panel known to pass only 17-28% of applicants), I came to diagnose and treat virtually every condition in the Diagnostic and Statistical Manual of Mental Disorders(DSM), and I was also rotating 24 hours shifts with my peers, roving about the desert at all hours of the day and night, going in and out of hospital emergency rooms, police stations, and jails to conduct involuntary psychiatric holds on individuals.

This work kept me professionally engaged and enriched for the first 7-10 years.  But then boredom started to set in.  I needed something new.  So I moved in to management of one of the County’s mental health clinics.  For two years, I managed a joint substance use treatment and mental health clinic in a very rural community on the California-Arizona border.  That was followed by another two-year assignment supervising the county’s Parents United and Daughters/Sons United program (this is a treatment program for parents who sexually abuse their children, and treatment for the victims) in Riverside.  Aside from working full time at the County, I also decided that I needed to spice my professional life up further by operating a private practice on two evenings per week.  While I loved private practice work, it became evident that the reimbursement rate was just not worth the time and effort, so after four years, I decided to give up private practice and have not returned to that work since (sadly, reimbursement rates have really not changed either in over twenty years!).

While still working full time with the County, I was presented with a unique opportunity to work in an after-hours joint collaborative between the County Sheriff Department, and private therapists doing ride-alongs with Deputies in 8-12-hour shifts.  The idea was to be a first responder to children who are witnessing domestic violence and/or trauma (children who witness trauma whether visually or auditorily experience neuropathway changes that do not favor their future cognitive development).  This program lasted four years before funding ran out.

I found my passion though in the following four years.  I was asked by my full-time employer (still County Mental Health) to implement my region’s first Wraparound program.  We were up and running in a matter of months, and my staff were receiving accolades from the State of California.  This program took the most serious juvenile offenders we could locate in our system, brought them out of incarceration and back in to the home, and provided an intensive, home-based Wraparound service.  Those staff had miraculous outcomes with those kids and their families!  We worked long, hard hours.  And we had fun doing it the whole time!  It was such a rewarding experience.

And during my Wraparound days, I was also teaching part time at Chapman University in a variety of Psychology curriculum courses.  I enjoyed my teaching experience and went on to be a contracted instructor with the University of California, Riverside Extension.

Yet, by this point in time, I was 20 years in to my career.  And virtually all of it in Mental Health.  I needed a growth opportunity…something very different!  I was fortunate to be selected to become the Medical Social Work Manager for Kaiser in Northern California.  I managed a crew of 26 Medical Social Workers across three medical facilities in the North Bay of the San Francisco Bay Area.  This was a real stretch role for me.  I had to quickly learn about the medical community and the interplay of Social Work within it.  I also had to learn how to navigate within a highly contentious union environment.  I would stay in this position for two years, move over to the San Francisco V.A. to be the Education and Training Coordinator for their section of Northern California.  Followed by another year of coming back to Kaiser, this time to manage Palliative Medicine, Life Care Planning, and the Spiritual Care Departments of two large hospitals in and surrounding Oakland, California.

Despite my need for change and having drifted in to the Medical Social Work arena, I found Mental Health still calling me back.  In 2018, I left my decade’s long manager roles behind, and went back in to mental health where I am today.

My current role is somewhat of a homecoming in that I find myself engaging in several professional roles that I did at the outset of my career.  These include triaging individuals seeking mental health services, assessing for safety, managing suicidal and homicidal callers as well as those individuals who present to our Emergency Department, engaging in interviewing and documenting the involuntary detention and placement of individuals where needed, and a host of other semi-related activities.  What is new in all of this, of course, is navigating in a COVID environment in the midst of this pandemic.

In the approximately 9 years that remain until retirement, barring my lottery fantasy, I feel confident that I will remain in the mental health arena.  It’s where I feel most “at home”.  It’s where I’ve had my greatest professional successes.  And it’s where I feel that I have the most to offer in my capacity as a Clinical Social Worker.  But who knows if it will continue to be in the provision of direct practice work?  Or if I’ll drift over to Administrative work?  This is why I love my M.S.W. degree and the versatility it affords!  The options are almost endless!

By Christopher DeLima
Christopher DeLima