Episode 164 | Bringing on Interns and Practicum Students with Tara Sanderson

Maureen Werrbach  

Hey, everyone, welcome to another episode of the Group Practice Exchange Podcast. Today I have someone on that I’m going to be trying not to drill on behalf of all of you guys. Her name is Tara Sanderson, and she knows a thing or two about bringing on interns and practicum students. And so I have her on today to chat a little bit about that, cuz I know that’s a topic that is really popular right now. Hi, how are you?

Tara Sanderson  

I’m doing well, thank you so much for having me on. This is such an honor to be here.

Maureen Werrbach  

So tell us a little bit about you and why this topic is one that’s relevant to you and one that you have some information on.

Tara Sanderson  

Absolutely. So I’m a licensed psychologist in Oregon. And I have a small group practice that I’ve been building for the last five years. Before that I worked in community mental health and a little private nonprofit. And we had interns all the way through that process, as well as of course, I had to be a student intern and a practicum student. And all of those pieces. 

One of the things that I got really passionate about with supervision was I had a couple of really good supervisors and a couple of really terrible one. And I kept thinking to myself, like, there’s got to be a way that everybody can get a really good experience if they are willing to go through that process. So when I started my private practice five years ago, I brought two interns on board with me at the time that I was starting it. So I was jumping full in to the endeavor of how to make this thing work and how to make sure that my students got good or really great experience learning a lot of things in private practice. So one of the things that I get super passionate about is systems and how you set things up to make sure that everything works the way it’s supposed to, and the students get their best experience.

Maureen Werrbach  

I love that you jumped right into it while bringing people on. So my friend Mike did this similar thing, not with interns, but with starting his private practice going straight to group and not starting solo. And it is definitely a different experience than someone like me who gets their bearings in business, starting solo and then bringing people on. So I feel like that’s a brave first step. 

Tara Sanderson  

Yes, yes! I felt so like they were they were my people. And I had to make sure they had everything that they needed. So they got to see the experience from the first step of how to start a private practice what they would need to be a business owner, and all of those pieces, which was probably an education of a lifetime for them, because that’s really not stuff you learn in school.

Maureen Werrbach  

Right? So what was and I’m literally just going to fire with a ton of questions. I feel like I’ve seen being asked, my first question to you is for someone who’s contemplating bringing on, whether they’re a newer established group practice owner contemplating bringing on an intern or practicum student, I guess, one, maybe a simple difference between the two? I don’t know, I get like statewise people use different terms. But I know there’s a difference between the two. And for those that don’t know, what would you say is the difference?

Tara Sanderson  

Yeah, I think that there are just interesting layers in the process of naming these different components, like different programs have different names for them, different states have different names for them. I have kind of gone into a couple of categories, like there are student interns, so pre degree, basically interns. So any level in there is technically an intern in that category, although some places call them interns or externs, or all sorts of different names in that process. And then there’s post degree interns that some states call them associates or CMHMC folks or all the different right types of titles, but basically, post degree pre licensed under supervision. And so I kind of keep those in those two different categories, because I think that helps all of us just like know where they fit, no matter what the actual title is. Does that make sense?

Maureen Werrbach  

Yeah. And I feel like there’s also different expectations on you as a business owner, if it’s someone who’s still in school, because then you have to follow expectations that the school has for that intern versus post grad?

Tara Sanderson  

Absolutely. Absolutely. In my in my other course, how to start a private practice I talked about we have to have three different hats as a clinician who’s running a business, you have your boss hat, your clinician hat and you have your employee hat, and they when you’re making a decision, you have to kind of figure out which hat you need to be wearing at that time to do the best thing for you and your business. Right. And in having interns in your practice, you have some additional hats that you have to wear. You have your boss hat still but it has a new arrangement because it’s now connected to school right? You’re now in contract with them, you have your supervisor hat, which is very specific to following all of the guidelines to making sure that this clinician gets what they need, and that you’re following your boss hat rules, right. And then you have your trainer hat, where you’re really trying to help this person truly understand what it means to be a clinician. And that’s different than signing off on their notes. When we’re a trainer, we’re really teaching them those pieces of what to do next, when we’re a supervisor, we’re signing off on notes, we’re signing off on hours, we’re making sure we’re doing all the right things. When you’re a boss, you’re really trying to figure out how do we make money? How do we move things forward? How do we make sure we’re hitting all the benchmarks of what we’re doing? So it’s a whole different experience adding that on to running a business.

Maureen Werrbach  

What would you say is the major differences between a business owner who decides to or is trying to choose between bringing on someone who’s still a student intern, versus someone who’s like a provisionally licensed person or someone who’s post grad, but isn’t yet independently licensed? What are some of the consideration differences, because I know they’re pretty big. But I feel like people, again, like you’ve said, use them interchangeably. But there’s a big difference in terms of as the business owner, the value that the community gets between those two, but also the role and time commitment and expectations on you, as well.

Tara Sanderson  

Yeah, you just named the big three, right, the role you take with them, the time constraints that you do, and the expectation you have of them. When I think about student interns, anybody that’s still in a school program, I think about you’re meeting somebody at the base level of where they’re learning, no matter if they’re a fourth year doctoral student, or a first year Masters student, you are meeting them at the base level, you are setting a lot of groundwork, which takes a lot of time and a lot of energy, you’re really pouring into them. So if you don’t have time to do that, then they’re not your bucket to use in your practice. With post masters or post doctoral people that are in their pre license category, you still are in a place where you’re helping them grow and learn because they’re still new to this industry. But you do have the advantage of them having already met a bunch of benchmarks, and now you’re just honing. And that can, that takes a little less time, although for some people, they still need a lot of support. But that can take a little less time. But it does take a lot more boss direction. So I think it’s that difference of those hats of like, with the with the student interns, you’re really trying to use a lot of that trainer hat. And with the other one, you’re using a lot more of that boss,

Maureen Werrbach  

I really liked that distinction. I never actually thought of that, that difference. But it makes total sense in how you navigate issues that happen with an intern versus issues, or problem areas that might occur with someone who’s provisionally licensed or fully licensed. And then at that end, there is definitely a different way to go about it. I love the idea of trainer hat /boss hat really like distinguishes the two.

Tara Sanderson  

Yeah, it keeps everything really clear when when my intern comes, when my student intern comes to me, and wants to know about some interventions to use, I throw on my trainer hat and I start looking up resources and I start sharing and digging into that with them right? When my post masters person or my pre licensed person comes in and asks for those same interventions, I start looking at it differently of like, I’m paying you for your time here. Do I need to be paying me plus you for this activity? Or do I need to give you a quick direction where you go look at it on your own, and do those pieces because they should have a foundation of where to go for some of those tools, or other colleagues and their supports that they can do in that way too. Exactly.

Maureen Werrbach  

For the practices that are thinking about bringing on, let’s say, intern, right, someone who’s a student still, and obviously is likely to be short term in some sense–obviously, there’s a lot of practice owners who choose to post graduation, maybe keep them. What are some things that a group practice owner should be considering before starting that process?

Tara Sanderson  

Yeah, so the first one is, of course, time, make sure you have plenty of time in your schedule to do that. I also think about the resources in the rest of your practice, like who else can they go to? What needs will be met by other people in there? And what services do you want them to perform? 

So I have several layers of student interns from master’s level folks to doctoral level folks. And I have my doctoral level folks who are usually in their fourth year of the program, do a lot of assessments, will do a lot of individual therapy and other pieces too. But directly I want them doing that assessment piece versus my my master’s level students who don’t have that experience, I have them do a lot more of the group therapy work or individual therapy work. So I’ve kind of created these little, not silos necessarily, but like real specific categories of what I want them to do in my practice. 

The other thing that I really encourage people to think about is what is your purpose of having them is. If your purpose is I want to break things up in my world, and I want to teach and I want to train awesome, these are great opportunities to do so. If your purpose is I just want to make money, then really take a good hard look at how much they would have to work to do that, and make sure that you’re actually going to be doing that, or else you’re gonna get really frustrated the whole time. I mean, I do make money off of my interns, and I absolutely adore them. Until I start putting in things like how much supervision time it really did take to read all of those notes. And those pieces, if I just roll it out there of like, Well, yeah, it got done, the budget wise, sure. I purposely did not set my budget in to include any of my interns money. I can pay for everything myself, I don’t actually need them. My purpose and having them was to be able to provide low and no cost services to the community. Which means the donation I’m giving of my time and my room, and paying for them being a part of all of my EHR system and stuff, is really just what I’m giving to be able to provide services to the community.

Maureen Werrbach  

And that I think is a reason why a lot of people do choose that route is either that they want to be a part of training that next generation of therapists or being able to give lower cost services to the members of their community. You mentioned right at the beginning of this systems. Tell me or those of us listening, what are some of the systems that might be different, or that we need to consider when having an intern or practicum student that might not be there for a practice that has fully licensed therapists?

Tara Sanderson  

Yeah, I think the biggest thing is that it’s an extension of all of your other parts and services. So in addition to your–we have what’s called for our masters folks, here, a PDS or a professional disclosure statement about who you are as a clinician and how they can report if there’s anything wrong. In my doctoral world, we have that in our informed consent. In addition to what you normally give to clients, you now have to have this additional layer of like, who is the student? And why are they here? And who’s protecting the client from the student if they mess things up, right? So it’s this, these extra layers that you’re adding into the paperwork that you give the client to make sure that they know what’s going on. Specifically things like a videotaping, recording or video recording consent form, who’s going to have access to that all the HIPAA or policies around how we’re keeping their information secure, because your student is likely going back and forth from place to place. So some of those layers in that system. But then also, I think, the layers of your internal documentation. So one of the first things that I figured out with having insurance was when they call Child Protective Services, how are we documenting that, because how I would document that just for me in private practice is different than having somebody who’s documenting it to give it to you so that you know what’s going on, because technically, they’re your client, even though the intern is seeing them. So in some of those other ways, it’s this extra layer of them reporting on what they’re doing to you that you need to build into your practice policies and documents.

Maureen Werrbach  

That’s a really good point to make. On that note, what expectations do you typically see from schools that are on top of the ones that you might be doing within your own practice? I, you know, assume we’ve had insurance, obviously, I know, from our perspective, what that’s like. But talk a little bit about those added expectations, and I totally get each school is a little different.

Tara Sanderson  

For sure, for sure. One of the things that I didn’t realize, because it wasn’t my experience from my from my own personal program, was that some schools will require you to be on site, anytime that the clinician is on site, which was super limiting for me. I had to really take a good hard look at my own schedule and what I was doing and figuring out how to be there when when the intern was there. Some schools don’t have that requirement. So definitely you have to check those contracts when you’re signing them to see like, what is the school actually expecting of you specifically, that was a big one.

Maureen Werrbach  

For telehealth, or during a COVID did that shift it?

Tara Sanderson  

It did. It then required that–so all of the schools that did require that now require you to have a three part system for navigating any issues that come up. So they have my number, they have their school number, then I had to have one other qualified mental health professional available to them anytime that they were doing therapy so that if they couldn’t get ahold of me, and they couldn’t get a hold of the school support person, they could get hold of a third person to give them any clinical support, which as a single clinician, in my private practice, all of my people are either pre licensed or students. That meant I had to call a colleague to see if they would be willing to supervise my person if they ever couldn’t get ahold of me, because I was in session, which was super limiting. I had a lot of conversations with our school about it trying to figure out like, is there any other way? Yeah, because that’s a that’s a big ask for solo kind of clinician in a practice?

Maureen Werrbach  

Yeah, that’s, I think these are all the types of things that when practice owners are thinking about bringing in an intern, or not even thinking about, right. We also have, I mean, there’s on top of that, we’ve had schools that require their supervisors at school to come on site and like, visit at the beginning and the middle. And towards the end, there might be some expectations around you having to do you know, communicate with, as the supervisor with their school, obviously added an extra time on that as well. Are there any other things that a practice owner might not be thinking about that needs to be thought about when?

Tara Sanderson  

Yeah, some schools even require you to take specific trainings through them. I’ve had one school that said, we would like for you to take this 30 hour course in supervision. And they said, like, I clearly have already done that. Because my license requires that all of these pieces, and I gave them all the information, they were like, no, we want you to take ours. And you can choose to do so obviously, I didn’t, I just said, you know, that’s way more of a commitment that I’m really able to offer to take students from your school. But you know, you do have to really be thoughtful of what those pieces are. I think the other thing that people don’t think about is the amount of space everything takes, right. So not just clients in your office or interns in your office space, but digital space. So how are we recording all of those sessions? Where are they going and living? How do you make sure that the the intern is doing that with HIPAA compliance, but also, I mean, I had an intern a couple of years ago, who’s putting everything on an external hard drive, and then the external hard drive died. And so now all of those records are gone, or supposedly gone? And how do we destroy that so that it’s safe. And those are some of the logistics that you do have to build into how you’re thinking about things for your practice. When I said systems, I was definitely also talking about manualising things, every time something changes with my insurance, with the COVID changes, or when that hard disk drive died, I immediately went into my manual and made an update of like, okay, when something like this happens, this is how my practice deals with this thing, and updated it so people could see it and knew like exactly what to do next. 

Maureen Werrbach  

That’s really smart. I want to actually–jumping out a little bit into different direction as we get close to the end here. But I know one concern that I had years ago when I was bringing my first person on. And I can anticipate this as a question, at least the people who are first starting out with interns might be thinking about is the required amount of time that they need to be doing direct face to face work versus indirect. Obviously, the indirect stuff is really a lot easier to ensure that they can get. But especially for those practices where this is their first intern they might not have in the community, this awareness that they’re offering free or low cost sessions. And so they might be getting, you know, all full fee or insurance based clients who want to see someone fully licensed. What are your thoughts? What do you say to that person who’s just thinking about that and maybe nervous about not being able to help that intern actually complete their hours in the appropriate time?

Tara Sanderson  

I would say think outside of the box number one. Like co therapy is a beautiful gift to student interns. Being able to have them see you how you do therapy, being able to interact in a way with your client who they know they’re not going to screw up because you’re in the room doing it is an awesome gift to give to students. I love doing it with my practice. I love having them sit in on my virtual appointments or in person if possible. Because it does give the students so much more real life about what we’re doing, which is awesome. And by doing co therapy, by them not watching but being a part of the experience they also can count those hours, which is really nice. 

Yeah, the other part that I love to do, I’m a I’m a fully insurance practice. So I mean, that’s all the phone calls I get or insurance ones every day. The other part that I do is I have my interns answer the phone calls. I don’t have because I’m a small practice, they don’t have a lot of other supports and I don’t have a virtual assistant or anything. They answer all of the phone calls for my practice. And so when they do, they’re starting from moment one, building rapport with this client, finding out what they need, and seeing if they’re able to offer it, and letting them know like, hey, you absolutely can use your insurance, I’d be happy to get you some referrals to whichever insurance panel you’re on. But I can also provide that for probably less than your copay if you want to come in and see me. And by that point, they’re really like, already engaged with the client, they’ve got an opening in their schedule. When a client says yes, most of the time, I think when I was checking my stats, before I came on, I’ve got an 87% success rate of my of my pre licensed student interns getting clients because they answer the phone call. And because they talk to the client at first.

Maureen Werrbach  

That’s great. For anyone who’s listening, that’s a huge, a significant statistic.

Tara Sanderson  

And we do a whole training at the beginning of them starting the internship with me of like, this is how you run a phone call, this is the script that you kind of follow. Let’s practice it a lot. I’m a big on doing a lot of roleplay and having us call each other as if we’re clients and doing a lot of time where everybody kind of plays the role of the client and trying to build that rapport so that they get experienced before they end up actually answering the phone. But that’s another part of the interviewing process, too. Like when I pick my interns, I pick my interns who have a lot of those skills already built in, who have either been entrepreneurs before. I love people who are doing their second career, because they’ve got a lot of those skills that already are built in. Yeah, it just makes a huge difference in us being able to like start right out of the gate.

Maureen Werrbach  

My last question for you is, have you ever had to deal with–or, and, either one–what happens when there are problems with a placement? An intern and suggestions around like what it’s like to deal with that? And I feel like that is also where time and energy and stress and resentment can come up if you are not doing it for the right reasons, is when things go wrong, right?

Tara Sanderson  

Mm hmm. Yeah, my two situations that I’ve had with that, were really just a bad pick on my part, like, I think I got convinced by somebody else, or I just chose too quickly and didn’t really think through my stuff. And they were just not a good fit for me as a supervisor. One of them I had to do a performance improvement plan and dig all into that. And whenever you have to do an improve performance improvement plan, I always think of it being like grounding your kid, you were also grounding you. Like it’s not just about that, like you have to do a whole bunch of extra work, right? The other one, I really had to do more of my own personal work of like, how can I change what I’m doing to support what she actually needs. Because my goal isn’t just to have someone to do my bidding. My goal was to help people grow and change. But that may mean I have to change how I do it in order to get there. And both of those took a ton of time and a ton of emotional energy. I would come home, super drained from those services. And I had to really learn like, what was it that I missed in those things to get there? I’ve never had to send someone away and be like, no, we’re not finishing your year. And I think part of that’s my own, like bullheadedness of wanting to be like no, I can finish this and do the thing. And probably part of my, you know, compassionate side that just like I don’t want to, I don’t want you to fail, how can I help you just get there. But on those times, I think that the biggest thing I can offer is really have good support systems, with other supervisors be in really good contact with their school because their school doesn’t want them to fail either. And just make sure that you’re doing your own self care and that because man, it’s emotionally hard. It’s not worth not doing. Yes, I absolutely love it. And I think that all of the new clinicians need really good, awesome supervisors and a ton of different niches and backgrounds. But it can be hard if you choose the wrong one.

Maureen Werrbach  

Yeah, sure. I guess the silver lining in that is that with interns, at least there’s a beginning and an end, you know, in some ways, not that that means that you need to keep every person on, you know, if it’s detrimental to the business or they’re doing it in a way that’s you know, just is not congruent with a healthy private practice setting. You know, obviously you got to do what you have to do, but there is also this, like light at the end of the tunnel so to speak, which I think a lot of business owners in general have an issue with when they hire like an actual employee is like there’s no end in sight unless they choose or you choose that and so you know, there’s a little bit of silver lining with as you learn because as with all things, hiring and bringing new people on as you learn how to interview better with time, the more you do it. And so I guess it can be one good thing about interns, when you make a bad hire in that sense is that it is semi shortened in some ways. Yeah. I totally appreciate you coming on. I know you do some support around this kind of stuff as well. How can people reach out to you if they’re wanting to get support on this?

Tara Sanderson  

Absolutely. So  my website is set up with a page just about interns. So it’s Dr. Tara Sanderson dot com. And then if you do the slash, and then interns, you’ll find that page really quickly or it’s on the menu, of course, and you can contact me through through that link for all of any questions. I love answering questions about this stuff. And it does make my heart sing that people want to help the next generation of interns become really great therapists.

Maureen Werrbach  

Yeah, I see you giving so much feedback in my facebook group too. So people are very lucky to have you in giving, giving some feedback. So I appreciate you coming on. Thank you so much, and I hope you have a good rest your day. 

Tara Sanderson  

Thanks, you too.