Clinical Psychology in Private Practice (feat. Elisa Lee)
Alumni Aloud Episode 66
Elisa Lee received her PhD in Clinical Psychology from the Graduate Center. She is now a psychologist in private practice.
In this episode of Alumni Aloud, Elisa talks to us about the challenges and benefits of opening up a private practice, the impact of the pandemic on her work, and the importance of networking in order to build a sense of community.
VOICE-OVER: This is Alumni Aloud, a podcast by Graduate Center students for Graduate Center students. In each episode we talk with a GC graduate about their career path, the ins and outs of their current position, and the career advice they have for students. This series is sponsored by the Graduate Center’s Office of Career Planning & Professional Development.
SARAH HILDEBRAND, HOST: I’m Sarah Hildebrand. I’m a PhD candidate in English at the Graduate Center and a Fellow in the Office of Career Planning & Professional Development. In this episode of Alumni Aloud I interviewed Elisa Lee who graduated from our PhD program in Clinical Psychology and is now a psychologist in private practice. She’s going to be talking to us about the challenges and benefits of opening up a private practice, the impact of the pandemic on her work, and the importance of networking in order to build a sense of community.
So Elisa, would you mind giving us an overview of what you currently do for a living and what you view as your mission there?
ELISA LEE, GUEST: Sure. So first of all, thanks for having me on, Sarah. And so, I’m a therapist currently in private practice. I do that fulltime. So I see mostly adults as well as young adults so a lot of college students as well as graduate students in my practice. And I sort of went into private practice largely actually to work with the Asian and Asian American population that has sort of historically been a population that has been underserved by the psychological community. And so that was something that I made a prime focus in my private practice. So not surprisingly, many of the clients I work with identify as Asian and Asian American, so that’s the main mission of my private practice.
HILDEBRAND: Is that also what led you to become interested in your field? You saw a gap that needed to be filled?
LEE: I would actually say that I was less consciously aware of that gap. It wasn’t until I was maybe midway through my time in graduate school that I started noticing it more and more and just reading about it and getting more interested in working with that population in general. I think growing up, because I also am Korean American, I knew that therapy was not often the done thing and that not many Asian Americans that I knew sought out therapy even when that may have been a good option for them. So, I knew that the stigma was within that community. Not that it makes them necessarily unique because I think therapy in general tends to be stigmatized, you know, perhaps a little less so now but still for the most part it’s a difficult option that people go with. So I wouldn’t say I was quite aware of it or consciously aware of it at the time, but I’ve always been interested in psychology and just how the mind works. Even when I was in high school and college I took classes. But I came to my career in psychology later on in life. I did other things before I settled on that and kind of returned back to the initial thing I was interested in, which was psychology.
HILDEBRAND: And once you entered your PhD program, did you always have that career goal set in your mind that you wanted to eventually open up a private practice?
LEE: Yes. So I always had in mind that I would eventually work out of a private practice. I had initially envisioned that I would likely do private practice maybe part time like half the time and also parttime work at a clinic or university counseling center. But then as I actually started to move along and start realizing this career goal, it just started to make a lot more sense that I do private practice fulltime.
HILDEBRAND: And what was your journey like from when you were a graduate student to eventually being able to open that private practice?
LEE: So I did most of my training at the City College’s psychological center. So the graduate program where I got my Clinical Psychology degree was housed at City College even though it was still through the Grad Center. And up at City College there is a training clinic, so that’s where I began getting my clinical skills. For anyone who is earning their PhD in Clinical Psychology, you would do a one-year predoctoral internship that is a requirement of the degree. And so you usually end up doing that internship possibly after you defend your dissertation or at least after you defend your proposal. And so that one year you do it at a site that is accredited by the American Psychological Association. There’re these different sites that they evaluate and deem appropriate to complete internships there. So I did mine at Pace University’s counseling center in New York City.
So I was there for a year. And then after I completed that I was able to actually earn my degree. Afterwards, I did a one-year postdoctoral fellowship. So the one-year postdoc is designed so that you can gain the clinical hours that you need in order to get licensed in whatever state you wish to practice in. So it doesn’t really matter in what state you actually do your postdoctoral fellowship, it’s more about gaining the hours. And so I did mine at the Harvard Medical School, which was affiliated with the Cambridge Health Alliance in Massachusetts. So while I was there, I was focused on continuing on with, you know, learning techniques of psychotherapy as well as psychological assessment.
So after I did my one year there and gained my hours, I was able to finally get licensed to practice in New York. So after that happened, I moved back to New York and I worked for two years fulltime as a staff psychologist at Columbia University’s counseling center. And it was while I was still working there that I opened up my private practice parttime. So I had this idea for awhile that I would be able to continue to work fulltime at Columbia and do my private practice as like a parttime thing in sort of the later hours and on the weekends. But as time went on and the way that my work flow was going, it made more sense to me just in terms of what I wanted to do and the kinds of people I wanted to work with that I should just transition into doing private practice fulltime.
So I eventually left my position at Columbia and I moved into private practice. And you know in the beginning there’s always that worry that you won’t be able to fill up your private practice or that you certainly won’t be able to earn enough to keep it going, and definitely I had that. But it was really a period when I became really dedicated to making that work, so any gaps that I had in my knowledge just in terms of how to run a small business I tried to fill very quickly and am sometimes still filling in as time goes on. Because new things come up, you learn new things as you do it. But I would say that it’s probably been one of the more rewarding experiences of my life.
HILDEBRAND: Yeah, what were some of those unexpected challenges that came up as you were trying to get started?
LEE: So one of the things that I think doesn’t get spoken about much in any sort of Clinical Psychology program is the business side of things—that if you want to run a private practice, what is that going to look like for you practically? I don’t think I’ve ever met a single psychologist or therapist who went into the field because we were all looking to make tons of money in a short amount of time. It’s oriented around helping people, particularly people who are often underserved. So we often don’t really think about the financial piece. So if you work at a counseling center or a clinic, you get a salary. So you don’t really have to think much about how much is this person actually sitting in front of me paying. It’s more about what are we going to work on and focusing on them.
When you’re in private practice, you do have to consider these things. And I think in the beginning it was pretty challenging for me to think about like how much do I actually have to earn and how much do I have to charge per person. Am I going to get on insurance panels in order to fill up my practice, and if so, what panels am I going to get on? Is the rate of reimbursement going to be enough? How am I going to set my fee? Am I going to offer a sliding scale? If so, what is that going to look like? And I think in the beginning, like many people I think who start out private practice not necessarily having thought through these things much much earlier, you end up undercharging; you end up making concessions like oh, it’s okay if this person can’t pay me. And after awhile I think you have to get comfortable asking yourself these questions more around how are you going to sustain your business, and realizing for yourself that you’re not being selfish and withholding when you think about the limits that you have to set in how many people you’re going to see on a sliding scale and how many people you need to see charged your full rate.
HILDEBRAND: Yeah, it sounds like there are definitely a lot of logistics to keep in mind throughout the process.
LEE: There are. And there are some that I think you’re not even aware of that you have to think about until it’s right in front of you. And then you learn by either doing it and making a mistake or doing it and succeeding or hearing about other people’s experiences.
HILDEBRAND: What does a typical day look like for you now? How much time do you devote to those administrative tasks versus how much time are you actually spending with clients?
LEE: So I work 4 days a week. So Monday through Thursday are the days that I do private practice and on average I see about 6 to 7 patients a day. And so the administrative tasks involved at least for me tend to be not as heavy as I think it can be for others. I’m not on that many insurance panels. So to bill and do those kinds of things it doesn’t take me that long. And in terms of doing notes and things like that, it ends of taking maybe half a day or so; usually Fridays are my admin days when I catch up.
The other things that I’m involved in as part of my private practice is that I’m also a part of a peer supervision group. So a lot of Clinical Psychology students will know this, that while you’re in training you have a supervisor who is licensed who supervises you on your cases. And once you’re in private practice, it’s not a requirement that you have a supervisor since you are now licensed to be a free agent. But the other thing that became pretty apparent to me the longer that I did private practice fulltime is that it can be quite lonely. Because it’s just you sitting with your patient and just you thinking about how you’re seeing your patient, how you want to try to help them. And I very much missed having conversations with colleagues around what I was seeing, hearing from them what they were seeing, and having that kind of back and forth.
And so I belong to a peer supervision group, we meet once a week and we take turns presenting cases, you know, in a confidential manner, but talking a little bit about who we’re working with. And that has been great. And that is also something that’s in my weekly schedule.
And I also supervise current doctoral students, so that is also something that I’m doing as part of my practice. Which, in many ways, I feel like I learn from them just about as much as they might be learning from me. Just hearing from them and how they’re conceptualizing cases, because they are in that sort of rich period where you’re devoting so much of your mental energies into thinking about your clients. Like much more so than I think some people do once you have your degree and you’re working because you’re busy with so many things that it’s really really energizing to hear that from a supervisee, so that’s also something that gets folded into my week.
So to sort of finally answer your question, I would say that Monday through Thursday is when all the clinical stuff happens where I see all my clients and I do notes throughout the day. And then Fridays, at least the half portion of it, is sort of devoted to more admin stuff that might be lingering.
HILDEBRAND: I really appreciate that answer because I think your recommendation to be involved with those groups would be useful for a lot of students. Because I think they don’t realize how isolating it can be or I think they do realize how isolated they are in grad school and know that they don’t want to do that anymore, so it’s good to know that there are ways around that even if you do know that this is the career path you definitely want to be on.
LEE: I mean, one of the things that I encourage a lot of graduate students—either graduate students that I meet or graduate students that I’m working with—to do is being able to expand your bubble outside of your program. I mean, my program was great. I really got a lot out of it and the skills that I learned there and the connections I was able to make there have helped me enormously in building my private practice. But what I’ve also found incredibly helpful was actually finding groups who were really targeting the same population I was interested in working with and having those kinds of conversations, as well. Because everyone sort of says this and to a large extent it’s true: you’ll have an easier time in private practice of you have a certain niche or population that you are focused on—that you definitely know you want to work with so that you can concentrate not only on targeting that group, but to do your research and to do your studies and to do your scholarly work in understanding that population.
And so, at City, the psychological center was geared towards serving underserved populations, but I actually didn’t see that many Asian clients when I was there. It was really only when I was doing my internship as well as my externship and working at Columbia that I started to really work with those clients. But when I was in graduate school I was trying to find other associations and other psychological groups that were geared towards working with Asian American clients and to get involved with that a little bit earlier on so that I can have those kinds of conversations in that community as I was going through graduate school.
HILDEBRAND: Yeah, that sounds like a good tip also for those who are building up their private practice. To know who their intended audience is going to be.
LEE: Yeah, I think we all go into it with this mentality that we want to be able to help everybody. And certainly that’s not a bad goal to have, but I think a lot can be gained when you hone in on who are the people that you are most interested in working with and who you feel would best benefit from the skillset you’re cultivating and the skills you are able to utilize. So in that sense, I felt fairly lucky in that early on in my graduate program I kind of knew who I was wanting to work with so I was able to focus in on that.
HILDEBRAND: That’s great. And what do you enjoy the most about your work now?
LEE: I think one of the things I enjoy the most is the fact that I really have full freedom over my schedule. I think when you’re in graduate school you just do what’s asked of you and don’t make too many waves around, oh, that’s in awkward time or, oh, I just gotta shove that in somewhere. I really enjoy the fact that there is really no one else I necessarily have to check in with in terms of scheduling how I’m going to run my practice other than with myself and what my personal goals are and what I want to be able to achieve.
I think it’s also a huge privilege that I can select the people that I would want to work with and who I feel would be the best fit with what I have to offer and what they’re looking for. Often if you’re working at a center or a clinic you work with who is in your schedule, who needs your help, and you sort of have to do that whether or not you feel it’s the best fit for you or not because that’s usually how it tends to work. But in your private practice you get to choose, and you can be very open with anyone who is talking to you about possibly receiving services that you may not be a good fit. And to be able to direct them to other clinicians who may be a better fit, which I think is a huge huge benefit in just helping one manage one’s schedule, managing things like burnout.
HILDEBRAND: Yeah, it’s really nice to have that sense of autonomy both in terms of your scheduling and a little bit in terms of the relationships you build.
LEE: Yeah, and it’s really at least for me a huge breath of fresh air after coming out of graduate school where everything felt so heavily oriented towards getting a degree and devoting your life to that—that I now really had the opportunity to have that work-life balance that everybody talks about but to actually make it happen is a lot more challenging.
HILDEBRAND: Yeah, that is definitely a goal for many of us that is sometimes hard to realize. How has the pandemic affected your work?
LEE: So, on a very practical level, I think the biggest change is that everything had to move to video sessions, to telehealth. For me I think there was a huge loss that came with that because one of the most healing experiences for any client is to physically be with somebody while they’re sharing the most intimate sides of themselves and they’re being vulnerable with another person who is sitting with you as you are going through this. And there was this loss when we switched to video and everything is through screens. And I would say that in terms of the technology piece I was fairly comfortable making that switch, but there was a lot of processing around just the different set up—the kind of awkwardness there was, this desire to want to be close. Which you know within the patient-therapist dyad sort of echoes the larger thing that everyone was going through—like this desire to be close to other people and not being able to because we’re all social distancing and really feeling that loss and distance. So that’s one very large thing that the pandemic had changed.
The other thing was that a lot of people that I was working with left New York or were planning on leaving New York, so there was this question about whether or not we could continue to work together since I’m only licensed to practice in this state. And luckily because we’re in the middle of the pandemic, a lot of states loosened up their rules around who can see who because everyone was in a state of chaos. But it really did bring up to the forefront this question about these specific state laws—whether or not there needs to be something a little more blanket-wise in terms of whether or not one can see patients across state lines and the logistics of that. Because really I think that was one of the biggest upheavals—this idea that if suddenly your client was going to move to, you know, Illinois, like what were you going to do? It doesn’t really make sense to abruptly end treatment because they’re moving. I mean probably during one of the most challenging times of their lives and because of certain rules that might not’ve been allowed. And so it definitely created a conversation that I’m hoping is going to continue on even after things will hopefully return to in-person.
HILDEBRAND: Yeah, that’s interesting because on the one hand I see how the pandemic has created a sense of loss in relation to some of these relationships, but also at the same time kind of brings up issues of access and accessibility. And I think it will be a continued conversation of what have these new platforms done for the field and do we need to keep some vestige of it later, or is it best if we return to some kind of sense of normalcy.
LEE: Yeah, one of the things that I was in a strange way sort of grateful for, but also recognized the morbidity of feeling that gratitude, is that I think I became my busiest when the pandemic really hit and people were really needing services. So I was getting calls almost consistently for awhile because so many people were desperate to find help. And the fact that we were meeting through video I think made it a lot easier for me to see people almost back-to-back. Like in the past there would have to be some consideration around like if they’d be able to travel like how much time would I need in between. But you know, it became really simple to be like, okay, they can make it at that hour and that hour and just squeeze everyone in. So it became some days a little bit more than perhaps I should have taken on, but certainly things got a little more… a lot busier.
The other thing that I wanted to mention that was a big change at least for me personally during the pandemic in my work is I work with a lot of Asian American clients. And I think given that this pandemic reportedly originated from China and just the US reaction to this and the resurgence of violence and racism, like very overt racism, toward Asians Americans here really I think changed a lot of the dynamics of my work with my clients. Certainly I had a lot more clients coming in wanting to process this and to be able to find a space to talk about this. Which as somebody who studied Asian American history and how this impacts the way that we all function, it felt almost more of like something that I read about in books, something historical. And that did resonate with my experience, but sometimes in the room it could be hard for clients to talk about this or vocalize this because historically there just hasn’t been as much of a platform for Asian Americans to talk about the kinds of racisms that they’ve encountered.
With the pandemic and with things becoming much more overt, I think it really in a way opened up the lid for a lot of Asians to start speaking about their experiences in the past with racism, with being targeted with the anger, and the sadness they feel that this is something that they’ve gone through and really haven’t been able to vocalize for a variety of reasons. And so in that sense my work shifted quite a bit or rather it got amplified quite a bit. For my clients it might have felt like a shift, but in some ways it gave voice to something that was always in the room that was kind of hard at times to be able to really pinpoint. But particularly in recent months with the rise in just violence against Asian Americans, it’s really given a lot of context for us to have these kinds of discussions.
HILDEBRAND: Yeah, the pandemic has definitely exacerbated certain types of racisms and it seems like you’ve really been able to adapt your practice to that. And as I’m hearing you talk about your experiences I’m thinking about the skills that you’ve developed throughout your journey from graduate school into your current position, because you have your hard skills that you learned as you got licensed, but you also seem to have a lot of soft skills. You have a certain resiliency; you have a certain amount to be able to adapt to the constantly changing landscape of what therapy becomes or of the general state of the world which affects everything. What do you think it was about your graduate level studies and about your experience at the Graduate Center that helped give you that skillset?
LEE: Well, I think because we were housed up at City College, even though the program was through the Graduate Center, there was a lot of just, on a very practical level, there were a lot of ups and downs on the administrative end of things, regarding where we had to go, who we had to talk to. So being organized was one thing, but being flexible and sort of learning how to go with the information that you had and work with what was available to you was something that I learned early on in my graduate program. And that has served me quite well throughout.
In general, I think the idea of graduate school might be that everything has to be structured and everything has to be followed in these sort of rigid lines, but when you’re going through it you sort of see all the ways in which those lines don’t hold, or if you stick to those lines you actually make your life a lot more difficult because you’re holding onto something that doesn’t perhaps always make sense. And so to kind of balance out knowing the things that you have to do and the things that you want to do in graduate school with all it has to offer, but also being able to keep in mind that there may be some things at your program or the things that you want to accomplish, the program can’t always give you everything that you need in order to make that piece happen. And so to be able to look for those resources elsewhere to be able to make the time and be able to be flexible to go after the things you are also interested in that perhaps you can’t necessarily find at your doorstep.
HILDEBRAND: Yeah, that’s interesting. And you had also mentioned earlier that you’ve done several internships, you did a postdoc, and I know that those can be really competitive applications for those jobs, do you have any advice for students of things they could be doing in grad school that could help boost their resumes?
LEE: So one of the things that I always encourage people to do that are currently in their programs is that, we’re in the field where I think one’s genuineness is very prized. In other fields there are ways in which one can finesse a certain kind of resume, a certain kind of cover letter, in order to get a certain kind of position. But I think in our field we take seriously who you want to work with, how you understand who you are as a clinician, and the kinds of people you would like to work with and why and how you approach your clients. And so I encourage people to really articulate for themselves how they identify as a clinician, cause there’s very different ways in which you can see yourself and how you work. And so to be able to declare for yourself, genuinely, like what sort of draws you to the field and draws you to how you work, and can you articulate that and how do you understand that impacting the people that you work with.
I know that’s a slightly more vague answer than a nuts and bolts make your resume look like this. But in general I have found that your resume will be your resume; you will have the externships you will have the internships and the different clinical experiences. The graduate school programs I think are extremely well-connected and well-run in getting their students to those opportunities and helping them get to those positions. It’s really the things like the essays that you write and the interviews that you are going to do that I think make the big difference in terms of these sites recognizing you as a clinician that not only takes their work seriously, but has a very good understanding of who they are and how they will work that I think really makes them stand out.
HILDEBRAND: I think that’s great advice, because I think that probably the more that applicants can develop that sense of being genuine or what their identity is, that’s what’s going to make their resume strong or their cover letter strong. Because hopefully they’ll be able to articulate that to a hiring committee.
LEE: Yeah, and the externships that they will do are going to be the very people that they’re eventually going to ask for recommendation letters from for things like internships, as well as fellowships. And you want those people to have met the real you as a clinician so that as you move along, they can really speak to the kind of work that you have done.
HILDEBRAND: That’s great. So I’m conscious of your time here and I don’t want to keep you for too long, so as a final question we usually like to ask if you have any advice for current graduate students, whether they’re in the Clinical Psychology department or graduate school at-large, is there anything that you would tell them to do now or that you wish you knew at the time?
LEE: Umm, I would definitely encourage any student to take some time to network. I know in some ways that’s sort of a pat answer, but not necessarily network for the sake of your career, but for the sake of building your support community. Particularly for those who are in Clinical Psychology, like I said before, private practice can be a very lonely business sometimes, and I have always gained a lot—both emotionally as well as intellectually—reconnecting with the clinicians that I had the privilege of working with or meeting in graduate school. Like old supervisors, old training directors, and to be able to continue to have them in my life and to be able to continue to converse with them as a clinician—a fully licensed clinician—it really gives me quite a lot, especially in these times. And so for the sake of not just one’s professional development, but for the sake of feeling centered and to continue on doing work that is quite challenging particularly during times like this. I would say that that’s quite vital.
HILDEBRAND: I think that’s great advice, too. Networking serves a lot of purposes. It is helpful professionally, but it also helps socially and emotionally and psychologically as you move forward in your career.
LEE: Yeah, I mean when I talk about networking I’m not necessarily talking about the business networking like those coffee chats I know some fields often do. That’s very helpful for a different set of reasons, but I think specifically with my field this networking around building a community has been a very prominent thing. And to be a part of that is quite a privilege and it offers up a lot.
HILDEBRAND: Yeah, that does sound really useful. So on that note I just really want to thank you for coming in today. It was really interesting to hear all about your work and I hope that we hear from you again soon.
LEE: Thank you, Sarah.
HILDEBRAND, VOICE-OVER: Thanks again to Elisa for coming in to talk to us about how she’s put her PhD to work. The Office of Career Planning & Professional Development can help you decide what career path is right for you. Find a list of our upcoming events or make an appointment to speak with one of our career advisors at cuny.is/careerplan. You can also follow us on Twitter @careerplanGC. Thanks for listening.