Importance of Early Clinical Training
An Interview with Jamie Lacy, LCSW
by Akiva Singer
Clinical work occupies a unique place in our current society. Therapists must both learn how the human mind works in an academic sense and understand how that abstract knowledge translates into the lives of real people dealing with the everyday struggles of life. Most importantly though, therapists must do both of these and still be able to build trusting, comfortable relationships with their clients. In order to build the diverse skill set required by clinicians, programs training new therapists typically require them to engage in a certain amount of clinical experiences to complement their academic preparation. A second-year clinical internship is almost always the first of these required experiences, and as such the Training Institute for Mental Health has placed the utmost importance on constructing its internship program.
Jamie Lacy, the director of the Training Institute’s internship program, sees internship programs as an important first step towards being comfortable with the “human to human experience” required in clinical professions. “You can read these textbooks, you can read articles that people have written and that’s not for nothing… however, at the end of the day, therapy is a relationship, and we have to learn how to sit with someone.” While a strong theoretical understanding of the human mind is important for being able to help one’s clients, that knowledge will be ultimately irrelevant if a therapist cannot empathize with them and build comfortable relationships. It takes experiences with real people in clinical settings like those in internship programs for people to really learn those skills. As Mr. Lacy puts it, “What’s it like to sit with someone who’s incredibly depressed is crying for 45 minutes with you? What’s it like to sit with someone who’s on the verge of a panic attack, or just moderate levels of anxiety or depression?” As typically empathetic people, young therapists’ first instinct is often to try and make the client feel better he says, but that isn’t what many moments call for; “Empathy isn’t all about making someone feel better. Sometimes it’s sitting in it with someone and letting them know it’s okay.”
In light of this view of the clinical setting, much of Training Institute’s internship program focuses on giving future clinicians the experiences and therapeutic tools they need to deal with these intense situations in their future practices. Interns are encouraged to discover and understand how they naturally respond to such distressing moments so that they can learn how they can best deal with them when they arise. If an intern’s first response to a distressing situation with a client is to try to fix the problem “who are [they] trying to fix that for?” say Lacy. If the urge to fix the problem comes from a genuine belief that it will help the client, it is likely worth pursuing; however, if the urge is coming from the intern’s desire to dissipate their own distress, it may not be what is actually best for the client. Such feelings are natural for therapists new and practiced, but understanding their source and when it is wise to act on them are powerful skills one can only learn through experience.
Jamie Lacy is the Director of the Internship Program, a faculty
member and a supervisor at TIMH. He is in private practice in Brooklyn, NY.
It is also important that that these learning experiences be reinforced in non-clinical settings. To provide its interns with as best reinforcement as possible, the Training Institute puts great emphasis on its didactics and case seminars. In the former interns are taught and discuss clinical theories, while the case seminar gives interns a supportive environment in which interns can grapple with specific clinical situations. Under the supervision of an experienced therapist, interns can discuss these situations with their peers and be reflective and curious about what is going on for both themselves and a hypothetical client. According to Mr. Lacy, this dual method of teaching interns how to deal with difficult situations helps them develop the skills to find and meet clients where they are.
While he does believe that these seminars are an important component in helping interns acquire these skills, Mr. Lacy stresses that there is no adequate academic replacement for simply being with someone in a clinical setting, particularly if they are going through an immediate crisis. Reflecting on his own experiences training to be a clinician, he believes that having such experiences early on helped him feel confident and comfortable helping people when they are in a really bad place. He fears that as training has become more and more digital—a trend intensified by the current pandemic—the focus of many training programs has shifted strongly toward the academic at the expense of the clinical experiences such as these. One thing the pandemic has made clear in this regard though, is that, while not the same as sitting with someone in person, technology does not have to be a barrier to clinical experience and can actually be the opposite. How we utilize technology in training programs going forward is crucial in how prepared the clinicians that come out of them will be when entering practice.
What Mr. Lacy believes sets the Training Institute’s internship program apart, with or without technology, is the unparalleled focus it puts on giving interns these clinical experiences. The large amount of clinical work given to interns in tandem with the tools given to them through seminars and support of the Training Institute’s staff, gives interns a robust foundation on which to build their practices. “This is field where you really have to jump in the deep end and figure it out… but I also want students to know where the wall is. That’s me, that’s the staff, that’s their supervisors, their cohort. They don’t have to just tread water and hope for the best.”
Akiva Singer is interning at TI this summer, writing articles about mental health issues, and interviewing people from the TI community. Akiva is an undergraduate neurobiology student at the University of Wisconsin Madison. He expects to pursue a graduate education in clinical psychology.