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Answer and Rationale for FREE Practice Question on Self-Harm

Posted by Heidi Tobe

September 28, 2017 at 11:59 AM

 

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Yesterday we posted the following question on self-harm, and today we have the answer and rationale for you!

Question:

A 25-year-old woman has been working with a social worker for two years around issues of anxiety, depression, and non suicidal self-injury. For the past 18 months, the client has abstained from cutting herself, but came into the most recent session wearing long sleeves on a hot summer day. The social worker inquired about this and the client lifted her sleeves to reveal several shallow cuts on her forearms that appeared to be healing. The client stated that she got into a fight with her best friend a few nights ago and in a moment of intense emotion engaged in cutting. What should the social worker do FIRST?

A. Discuss voluntary hospitalization with the client

B. Teach the client coping skills to utilize in moments of intense emotion

C. Explore the thoughts and feelings that preceded the client’s self-injury

D. Refer the client to an MD to take care of the client’s injuries

Answer:

After reading through the question and possible answers for this question, what answer did you come up with? This is a good example of a question that could show up on either of the ASWB practice exams to determine whether you are able to differentiate between the steps you would take with a client engaging in self-harm versus one who is actively suicidal. Let’s go through each of the answer options one at a time and think about them.

  • Answer A: does the client need to be hospitalized? Not at this time. Nothing in the question stem indicates that the client is having suicidal thoughts or is a risk to herself. The question stem specifies that the client engages in non suicidal self injury, meaning, she is engaging in self harm without the intent of killing herself. Further, the cuts are on her forearm and are described as shallow and healing normally, so there is no medical emergency that would indicate a need for hospitalization. Especially for therapists inexperienced with self-injury, seeing a client’s self-inflicted injuries can be alarming and upsetting. From a place of concern and wanting to make sure our clients are safe, we can jump to too extreme of interventions, such as unnecessary hospitalization.
  • Answer B: does the client need concrete coping skills to help her cope during moments of intense emotion? Definitely. This is something you would want to do, but is not necessarily what you would do.
  • Answer C: should we explore the thoughts and feelings the client had before engaging in self-injury? Yes! This answer option allows us to stay in the moment and respond to what the client has shared. Exploring her thoughts and feelings leading up to her self-injury will help us gain a better understanding of the precipitating factors and triggers for this behavior. From there we could discuss various coping skills for the thoughts and emotions that triggered this behavior (B).
  • Answer D: does the client need a medical evaluation? Probably not. The question indicates that the cuts were shallow and healing normally. Nothing else in the question stem indicates a need to seek medical attention.

Which answer did you choose? Does the rationale fit with your understanding of self-injury, or did you learn something new with this scenario? If you have any further questions, we encourage you to check in with a TDC Coach. We are here to support you! And if you came up with the same answer-great job! You are on the right track to getting licensed.

Still haven’t signed up for an exam preparation program? We look forward to helping you PASS your exam with confidence! Our structured, straightforward approach to exam prep will provide you with exactly what you need to pass your social work exam or MFT exam and nothing you don’t. . Once you pay for the program, we are with you until you pass: extensions are always free, materials are structured and comprehensive, and you have access to a coach for 1:1 support. You can learn more about our social work licensing exam prep HERE and more about our MFT licensing exam prep HERE. If you’d like to connect directly with one of our coaches, you can do that HERE

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Topics: Exam Prep, LCSW Exam Prep, Social Work Exam Prep, Suicide Prevention

LCSW/LMSW FREE Practice Question: Self-Harm

Posted by Heidi Tobe

September 27, 2017 at 1:56 PM

September is Suicide Prevention Month, and here at TDC we’ve been using our blog to begin conversations around this often-taboo topic. On both the social work and MFT licensing exams, this topic is sure to show up in several forms. We have focused our free practice questions this month on suicide and today we explore the topic of self-injury. These topics are highlighted on licensing exams because our licensing organizations want to ensure that we are equipped with the knowledge and skills necessary to recognize the signs and symptoms of risk to self, distinguish between life threatening and non life threatening behaviors, and take the appropriate steps based on the level of risk.

TDC’s study systems help prepare you for this topic in a number of ways: we provide concrete information on danger to self and others, risk factors, signs, behaviors, how to evaluate the level of risk, and a spectrum of interventions that will be reflected on the exam. We also provide numerous practice questions with rationales that help you think about this topic from all angles.

Let’s get into a practice question that explores this topic.

SAMPLE QUESTION:

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A 25-year-old woman has been working with a social worker for two years around issues of anxiety, depression, and non suicidal self-injury. For the past 18 months, the client has abstained from cutting herself, but came into the most recent session wearing long sleeves on a hot summer day. The social worker inquired about this and the client lifted her sleeves to reveal several shallow cuts on her forearms that appeared to be healing. The client stated that she got into a fight with her best friend a few nights ago and in a moment of intense emotion engaged in cutting. What should the social worker do FIRST?

A. Discuss voluntary hospitalization with the client

B. Teach the client coping skills to utilize in moments of intense emotion

C. Explore the thoughts and feelings that preceded the client’s self-injury

D. Refer the client to an MD to take care of the client’s injuries

So, what would we do here? Leave your answer in the comments below and be sure to tune in tomorrow for the answer and a discussion of the rationale!

 

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Topics: Exam Prep, LCSW Exam Prep, Social Work Exam Prep, Suicide Prevention

Pathways to Success: Ryan Lindsay

Posted by Heidi Tobe

September 25, 2017 at 11:23 AM

So often when I see a successful clinical social worker who is a leader in their area of expertise I find myself asking “how did they get where they are today?” and wondering what their first few years out of grad school were like. Each month we are interviewing and sharing the story of a clinical social worker’s “pathway to success” that has brought them to where they are today. It will share insights, hard earned wisdom, and tips that we hope will encourage and inspire you no matter where you are on your own pathway to success.

It’s incredibly fitting that our Pathways to Success interview during Suicide Prevention Month is with the Assistant Dean of Social Work at the Brown School of Social Work and co-founder of St. Louis Center for Family Development (STLCFD), Ryan Lindsay, MSW, LCSW. Ryan Lindsay is known for his leadership in evidence-based treatments, in particular Dialectical Behavior Therapy (DBT), a treatment modality used with clients who experience chronic emotion dysregulation, suicidal ideation, and self-injurious behaviors. We are excited to share his unique pathway to success and hope you will it as encouraging and inspiring as we do.

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TDC: What drew you to the field of social work?

Ryan: I understand now that I have a high compassion predisposition: I feel the pain of others, I see it in others, and I desire to make it less in others. Throughout my life, I’ve been sensitive to the difficulties that others experience. While I was originally focused on psychology in undergrad, I always felt it was too person focused. I was minoring in sociology and anthropology and found the contextual piece very interesting to me. People live in environments and contexts matter. I realized it’s not enough to look solely at the individual person. We must look at that person within the context of their environment. I decided to major in social work because it fit with my values and my understanding of the world, and was also a faster track to doing clinical work.

TDC: During graduate school where did you complete your internships?

Ryan: I went to graduate school at the University of Michigan and completed my internship at the University of Michigan Mental Health Center. I spent half of my time at the Department of Psychiatry in their outpatient clinic and the other half at a community mental health center on a DBT team. When I landed the internship, I didn’t know what DBT was, but it became formative for my career path. After I graduated with my MSW, I applied for and completed a post-master’s fellowship at the University of Michigan.

TDC: What came after your fellowship?

Ryan: After I completed the fellowship, I worked at an organization called Ann Arbor Consultation Services, which was a very, very large group practice. During my fellowship program, I helped get them prepped to start their own adolescent DBT program and when I went to work for them, I got the DBT program up and running. Once I became licensed, I started the Ann Arbor DBT Center with two friends whom I met through my internship. This was the first DBT oriented practice in Ann Arbor. While working at these two practices, I also applied for a half-time position with Washtenaw County in their Youth and Family Services and I started the first community mental health adolescent DBT program in Michigan. It was both a first for the state and something I genuinely loved doing.

TDC: It sounds like you did a LOT during those first few years out of grad school. What gave you the confidence to accomplish so much so early on in your career?

Ryan: Arrogance. And stupidity. [Laughter] And strong supports that encouraged me along the way. I was never doing all of those things in isolation. I had supervision and a strong network of other social workers around me. It was definitely a lot, though. At one point I was working six days a week, in three different practices, at four different locations and had a part-time job with the county doing crisis stabilization.

TDC: Four jobs! Did that burn you out?

Ryan: Oh totally. Around three and a half years out, I was getting really burned out. I had recently lost some mentors that were no longer accessible to me. I had my fingers in a lot of things and I needed to focus, but didn’t really know how to do that. On top of that, there was this expectation of high, high, high performance. I had a lot of people on my caseload and started to burn out big time. I came to a place where I had to decide whether I was going to stay in this profession, go back to school, give up, or approach my work differently.

TDC: So you were considering being done with social work?

Ryan: Oh yeah. Part of what drove that was the realization that in order to make a living in social work, you have to hustle, and I didn’t know if I wanted to hustle for the rest of my life. Additionally, I was getting paid very little and was working with chronic suicidality, self-injury, and extreme trauma. So there was a value piece to that. Ultimately, I decided to go to therapy myself, which was extremely helpful. It helped me put priorities back in place and organize myself in new ways. By that time (about four years out) there was also a level of competency that was under my belt. Fortunately, every single day wasn’t a learning curve like it was those first few years out of graduate school.

TDC: So what brought you from Michigan to St. Louis?

Ryan: I moved to St. Louis in 2008 when my husband got into an MBA program. Since he moved to Ann Arbor for me during my fellowship program, it was time I invested in my relationship.

TDC: What was it like leaving behind everything you’d worked so hard on?

Ryan: It was a really difficult thing to pack up everything I’d built and leave a place where my name was established. No one knew who I was in St. Louis, so nothing I’d done back in Ann Arbor meant anything here. I was also moving to a system here in Missouri where evidence-based treatments and practices weren’t really talked about-people didn’t even have a clue what DBT was. The positive side to this was that there was a tremendous opportunity to fill that gap, which is what led to founding our organization, St. Louis Center for Family Development (STLCFD). We wanted to create a place where quality mental health services existed, ideally for the people who need it the most.

TDC: STLCFD is known for delivering quality mental health services, but it’s also known for the training it provides to its clinicians. What inspired that focus on clinician training?

Ryan: Back in Ann Arbor, I had an experience where I was sitting in the basement of Huron Valley Child Guidance Center playing ping pong with one of my clients after they did some really good work. There was this other therapist down there who was not there to reward his client for hard work, but who was instead engaging in shame based therapy. He was belittling the client and shaming him. I found myself thinking, “this is not just or equitable. Why does my client get a therapist who cares about him and knows what they’re doing, while this other client gets a shaming therapist?” After that, doing one-on-one therapy wasn’t as satisfying for me in terms of the overall impact I wanted to make. I realized I had a privilege; I had opportunities to learn from the best in the country in a very organized and structured way. I wanted to figure out a way to recreate that so other people could have opportunities to receive excellent training. So when we started STLCFD, it was both to create an organization that provides stellar quality services, but also to build and train phenomenal clinicians.

I also started working as an adjunct during that time at the Brown School of Social Work. While I like being able to provide training and consultation and help shape behaviors of providers who have been in the field for years,  it’s a whole lot easier to set a trajectory than change a trajectory.

TDC: You’re at the Brown School full-time now. How did that transition occur?

Ryan: It was really the universe coming together. I was at a place organizationally where I had six people doing what I used to do myself. In the year leading up to the transition I decided to take a year off from providing trainings after a previous very hectic year, so I actually didn’t have a lot to do. When the opportunity came to join the faculty here as the chair of the mental health concentration, it just made sense personally and professionally. Choosing between two very good things was probably the hardest decision I’ve ever had to make, but I had to do what was best for me. My own personal growth had stalled, so I needed to find a community that would foster that growth.

TDC: Shortly after becoming the chair of the mental health concentration, you had another pretty big transition. Tell us about that.

Ryan: After about a month at the Brown school, I was presented with the opportunity to be the Assistant Dean of Social Work. It wasn’t on my radar and I had no idea what it entailed at the time, but I decided I would give it a try. I had spent the previous 10 years building STLCFD and logging a lot of hours. The intensity of that work was worth it for the time, but I also learned that work is not everything. In terms of satisfaction in life, there’s really something to be said for not being tired all the time. Academia here is a well oiled machine and this job allows me to have a greater balance in my life.

TDC: What are you hoping to accomplish during your time at the Brown School?

Ryan: I want to build on the strengths of our program. My immediate goal for the mental health concentration was to ensure we could actually build competencies and create a more organized structure and path towards what people want to do. That wasn’t as clear when I landed here and I’ve done a lot of work on that. I’ve revamped a lot of required courses to make sure people are getting what they need by the time they graduate.

In terms of the assistant dean position, I actually don’t have a vision yet. My first year was spent really learning about the position and my second year will be about our reaccreditation process. After that, the next step will be revamping our entire curriculum and concentration options as a school.

TDC: Final question: What advice do you have, especially for social workers just entering the field or who are in the process of getting licensed?

Ryan: Dream big and take it one step at a time. Understand we are all vulnerable and fallible humans and no one expects you to be perfect. Learning is uncomfortable, but learning is what will get you there. Don’t hide your difficulties-that leads to fatigue. It leads to burnout. It leads to people leaving the profession.

Know that you don’t have to know it all. The people who we help care most that we care about them, and for the most part they aren't concerned that you’re still learning. As long as you have their best interest in mind- and they know that and you feel that- that’s the juice that’s necessary for change. The technique stuff comes over time. There’s a shift that occurs at some point, about six or seven years out. Eventually you’ll feel more competent and steady. You’ll get to a space where you stop worrying about being incompetent and start embracing it. If there’s anything I’ve learned, it’s that it doesn't scare me that there’s an infinite amount of knowledge; it excites me that there’s an infinite amount of knowledge.

We are encouraged and inspired by all that Ryan has done in his career so far and all that he will continue to do. If you know a clinical social worker or MFT who should be highlighted in an upcoming "Pathways to Success" story, email Heidi at [email protected]

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Topics: Professional Development, Suicide Prevention

The Wounded Healer

Posted by Heidi Tobe

September 18, 2017 at 2:55 PM

 

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September is Suicide Prevention Month. Here at TDC we are using our blog as a platform to start conversations around this topic. While suicide is still an oft taboo subject, it is encouraging to see a greater willingness to talk about suicide, self-harm, and mental health in recent years. While there is still a long way to go, we have seen improvements in reducing stigma, evidenced in the prevalence of people speaking out about themselves and loved ones, open discussion around these topics, and the increased presence of mental health issues in mainstream media. A piece of the conversation that I feel is missing for us as therapists, though, is an acknowledgement of the reality that many of us struggle with our own mental health issues, even suicidal ideation.

With 1 in 5 adults diagnosed with some form of mental illness in a given year, 7% of adults suffering from depression, and 34,000 individuals dying by suicide each year (nami.org), it is inevitable that these statistics include people in the helping professions, including therapists. Perhaps even at a higher rate than the general population. Psychoanalyst and psychiatrist Carl Jung introduced the term "Wounded Healer.” A Wounded Healer is someone who is compelled to help others after going through their own experiences of suffering. When an individual survives the wounds of their past, their lived shared experience can help provide deeper understanding and empathy for their clients and can motivate them to help others overcome similar struggles. We hear stories of therapists who have gone into the field because of their experiences with loved ones who have suffered mental illness. There are also countless, often untold stories of therapists who go into the field because of the mental illness they themselves have struggled with or continue to struggle with.

Despite our work to destigmatize mental illness, we as therapists can still fall into traps of believing we must hide our own suffering. I have dear friends in the profession who suffer in silence with their mental illness, hiding it from those around them in ways they wouldn’t if their issues were purely physical. They fear others may judge them, or worse, deem them unfit to continue serving their clients. As I was discussing this topic with a friend and fellow social worker, she shared that she has heard a number of people bring up the idea that if a therapist doesn’t "have their stuff together" how can they help someone else? Some even going so far as to say they wouldn’t see a therapist who sees a therapist. I say to that, I wouldn’t want to see a therapist who has never seen a therapist! Would we not see a doctor because they have gone to a doctor themselves? Certainly not. But these are very real concerns we as therapists can have. And these concerns can unfortunately keep people very isolated in their struggles.

There isn’t an easy fix for this, but we wanted to take the time to write about this topic for several reasons. First: You are not alone in your struggles, fellow therapists. While it may feel like you're on an island, know that there are many excellent therapists out there with past and present mental health issues who are serving their clients well.

Second: Recognize the strength and value your own healed wounds can bring to your work with clients. Your ability to empathize and genuinely understand where your clients are coming from, the compassion you possess, and the awareness you hold based on your experience can be powerful healing tools for your clients-even without any direct self-disclosure. Of course, if you do choose to engage in self-disclosure with your clients about your own mental illness, it is of the utmost importance to carefully consider what you are sharing and why. Consultation with colleagues or supervisors is an essential tool for ensuring that what we choose to disclose is in the best interest of our clients.

Third: who you choose to share your own struggles with is a deeply personal choice that only you can make-but we encourage you to share your struggles with someone. Regardless of when and with whom you choose to share with, be sure to take time to seek out spaces where you can receive support. Engage in self-care on a regular basis, whatever that looks like for you. Seek out your own counseling as needed. Nearly 60% of adults with a mental illness did not receive mental health services in the previous year (nami.org). Sixty Percent! That number is astounding, but not altogether unsurprising. The hour I spend in counseling every other week is one of my most treasured times, and I know that I am a better social worker because of it.

As workers in the mental health field, we have a responsibility to take care of ourselves first before caring for others, and we here at TDC believe our own mental health care is a big piece of that. Even in our coaching, we talk to many individuals preparing for their social work or MFT licensing exams who suffer debilitating anxiety (not just regarding the test, but in other areas of their lives as well), who have never sought out counseling services. We know it is a hard step to take, but it is one that is worthwhile. If you’ve been suffering on your own, consider reaching out for help. Whether that is talking to a friend, family member, classmate, trusted colleague or supervisor, or making a call to schedule a therapy appointment, we encourage you to take the necessary steps to keep yourself from suffering in silence.

And lastly we share because we want to hear your wisdom and experience. What has your experience been like caring for your own mental health while also caring for others? What has helped you open up and seek help when needed? Or what has kept you from doing so? What can we as a community of therapists do to support one another? We encourage you to share in the comments below or join the discussion on our Facebook page.

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Topics: Self Care, Suicide Prevention

Project Semicolon

Posted by Heidi Tobe

September 15, 2017 at 6:02 PM

“A semicolon is used when an author could've chosen to end their sentence, but chose not to. The author is you and the sentence is your life."-Project Semicolon

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As many of you know, September is Suicide Prevention Month. Here at TDC we are using this month to start conversations around this topic and highlight organizations who are working tirelessly to prevent suicide. One such organization is Project Semicolon, a nonprofit whose mission is to help reduce the incidents of suicide around the world through connecting communities and providing greater access to information and resources. Project Semicolon believes suicide is preventable and recognizes that each and every individual on this earth has a role and responsibility in preventing suicide. Project Semicolon works to equip people with the tools necessary to engage in suicide prevention, including educating communities and raising public awareness around the topic of suicide.

Amy Bleuel created Project Semicolon in 2013 in honor of her father who died by suicide. Amy was courageously open about her own struggles with mental illness and suicide, and in doing so inspired others to share that same vulnerability. Since the inception of her organization, the symbol of a semicolon has come to represent hope and inspiration for those who are struggling with thoughts of suicide, self-injury, depression, addiction, and other mental health diagnoses. It is a reminder that this is not the end, but can be a new beginning. Tens of thousands of individuals have since gotten tattoos or temporarily draw this symbol on themselves as a personal reminder, to support loved ones, or to mark themselves as an ally for those who are struggling. A community of semicolons now lives and breathes as an encouragement to keep living and to not end stories prematurely. Founder Amy Bleuel lost her battle with suicide earlier this year, but her passion continues on in the movement she started through Project Semicolon.

To learn more about Project Semicolon, visit https://projectsemicolon.com. Their website has a lot to offer, including interactive sections and resources:

  • You can sign up to share your story here.
  • To read about others who have chosen to continue their stories, click here. 
  • To discover tangible ways to take action, click here.
  • To learn about mental health, click here.
  • If you are concerned about someone, click here.
  • If you are having suicidal thoughts, click here.
  • If you are a suicide attempt survivor, click here
  • If you are interested in purchasing Project Semicolon products, click here.
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Topics: Suicide Prevention

The S Word

Posted by Heidi Tobe

September 12, 2017 at 11:59 AM

Recently the TDC team had the honor of screening a new film, The S Word Documentary: Opening the Conversation About Suicide. And for our team it did just as the title indicated-it opened up a space for us to have conversations about suicide and the ways it has impacted our lives personally and professionally.

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I want to share a bit of information about this groundbreaking movie with you; it’s being released this month and is a must-watch. The S Word director Lisa Klein is a survivor of her brother's and father's suicides. She knows on a deeply personal level the silent suffering that accompanies suicide and just how necessary conversations about suicide are. She uses The S Word to reduce silence and give a voice to the stories millions are stifling on a daily basis. The film invites you to join suicide attempt survivor Dese’Rae Stage’s journey as she seeks out fellow attempt survivors, and documents and shares each of their rich and complex stories. Dese’Rae skillfully captures the courage, pain, humor, and hope of her fellow survivors as she hears and shares their stories.

Throughout The S Word, we are reminded that suicide is not a them issue; it's an all of us issue. Despite the silence that so often surrounds this topic, every one of us is touched by suicide in some way. For some of us, it is in our work with clients. For others, it is within our family or close friend circles. And for some of us, it is an issue we battle ourselves (yes-even mental health professionals can struggle with suicidal ideation!). Suicide doesn’t discriminate: it affects people of all backgrounds, all socioeconomic statuses, all races and ethnicities, all faiths, all ages, and all sexual orientations and gender presentations.

The S Word is an open invitation to engage in honest and brave communication about suicide. It is a reminder that none of us are alone. The S Word has a myriad of goals: raising awareness about suicide prevention and resources, opening up conversations about suicide to include all people, creating spaces to speak about suicide openly and without shame or judgment, thinking about suicide in a different way, and ultimately changing the world. We here at TDC think it’s on its way to doing just that.

A TDC staff members shared, “the overarching theme for me is making space: how do we make space for the dialogue to occur safely? How do we help or support the family members left behind create and keep space for the person they lost (if that’s what they want)? How do we make space for different perspectives and ideas about suicide? How do we support couples and families in making space for a person’s pain and feelings? How do we support them in being vulnerable enough to let go of their own narrative to support the person who is suffering? How can we help support people in creating the groups and spaces that would be most healing for them? And how do we make space for the very rational fear that goes along with suicide without being consumed by it?

While the film and this topic can be difficult to engage in, we believe it is an incredibly important one to watch. This month there are screenings for The S Word in Michigan, Toronto, Washington, Iowa, Utah, Colorado, and Texas with additional screenings scheduled for October in Georgia, Kansas, California, and Massachusetts. To learn more click here.

Don’t see your state on this list? You can host a screening in your community! Learn more about hosting a screening of The S Word here.

We encourage you to check out their extensive list of resources available here. If you or someone you know is struggling with suicide, don’t stay silent. Help is out there.

Join us on our Facebook page to engage in conversation. Let's talk about the fears you have with this work, experiences, thoughts on how to increase awareness, and what you can do to further the conversation.

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Topics: Suicide Prevention

MFT Success Story!

Posted by Heidi Tobe

September 11, 2017 at 8:54 AM

Last month we shared Yves Domond's successful journey using the Therapist Development Center to pass his master's level social work exam after failing the exam four previous times. This month we are excited to share our interview with Caroline Moreno who recently PASSED her marriage and family therapy exam to become a Licensed Marriage and Family Therapist!

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Caroline Moreno graduated in 2014 from California Baptist University. She's had a passion for helping people as far back as she can remember. Caroline shares that her journey to getting licensed "has been a very interesting one to say the least." She is glad that despite some bumps in the road she was able to follow through with this process and make her dream of becoming a LMFT come true!

TDC: How did you find the Therapist Development Center?

Caroline: I heard about Therapist Development Center back when I was in grad school. Then a couple years later, once I was ready to take my exams, my co-workers at the time were using the program and shared how helpful it was.

TDC: Had you taken the exam before? 

Caroline: I had taken the test once before. The first time I took the exam I definitely let anxiety get the best of me. Not only was I anxious about taking the test, working full time did not make it any easier to study. It was difficult to incorporate studying into my personal life.

TDC: What did you like about the Therapist Development Center’s approach?

Caroline: What I liked about Therapist Development Center’s approach was how user friendly it was. Like I had mentioned before, when you work full time it can make it difficult to study. With TDC you can set up your own schedule and figure out how long you need to study. Another thing that I liked about the program was that they do not overwhelm you with a bunch of study material. The material is very specific and the lectures that go along with it make it easier to comprehend the concepts. The best part about TDC is even if you do not pass the exam the first time, they will restart your program at no charge. They truly work with you to ensure that you will pass.

TDC: Did you use any other prep materials?

Caroline: I personally did not use any other prep materials, but I had friends that did. When looking at their material even I became overwhelmed for them. They were sent packets of papers and books with no direction. Most of them complained that they had no idea where to start because they were sent so much material.

TDC: How long did you study with TDC materials and what did your studying look like?

Caroline: It took me about 4 to 5 month to study because I decided to go at my own pace. After contacting TDC and telling them that I would be retaking my clinical exam they recommended that I go over the whole program. I am going to be honest, I did not want to go through all the material, but I am glad that I did. I studied about 3-4 days out of the week. I utilized my city library to study because I found that there were fewer distractions. I really focused on areas that I felt were my weak points. I listened to the lectures more than once until I felt comfortable with the concept. Even though I was focused on studying, I made sure to incorporate self-care into my routine. For me that was hanging out with friends and family, going to concerts, and doing whatever I found fun. This helped because when I felt myself burning out, doing something fun was a refresher and made it easier to go back to studying.

TDC: Did you utilize coaching at all? If so, tell us about that experience and how it impacted your studying.

Caroline: I had a great experience with the coaches at TDC. Whenever I had a question, a coach would contact me in a timely manner and give me a detailed answer. The coaches are encouraging and I truly felt like they were genuinely there to help me pass.

TDC: How did you feel while taking the exam after using TDC materials?

Caroline: Before entering into the testing center, I parked my car and took a couple of minutes to myself. I listened to one of my favorite songs that motivated me (Eminem-Lose Yourself), said a quick prayer, and told myself “You got this.” This helped me get my anxiety out. Once I was inside taking the test I felt confident, because I knew that I knew the material. There were times where I started to second guess myself, but I remembered what TDC said about feeling like you will be failing the test, and being comfortable about being uncertain. This helped because you normalize the feeling before taking the test. The exam is truly a marathon. By the time I reached question 100 my brain was tired, but once I got up and took my break I was refreshed and ready to pass the test!

TDC: What do you think made the difference to help you pass this time?

Caroline: My mindset definitely was the difference between me passing and the previous time I took it. The first time I took the exam I had a lot going on personally. I had just been laid off, my Mom had a major surgery, and I just felt pressured to take the test. I went in telling myself "I am not going to pass" because I did not feel ready. The second time around I made sure that I was mentally and emotionally ready to take the test. I had a job that was supportive of me studying and my friends and family were understanding of the process. I made sure that I was going to take the exam on my own time and kept a positive attitude.

TDC: What were the best and hardest parts of the licensing journey?

Caroline: The best part of the licensing journey is the experience. You learn so much being an intern and working with different environments and people. When you finally get licensed it is like a weight is lifted. It is also a surreal feeling because you start to think back to all of the sacrifices you have made to get to that point and realize that everything was worth it. Even though sometimes being an intern can be a stressful journey, I know that every little step made me a stronger therapist. I am just grateful that I also had some fantastic people that helped me on the way.

TDC: How is your life and career different now that you've passed?

Caroline: Now that I am licensed I feel like the sky is the limit! Being licensed allows me to be a little more independent, which is always exciting. Since I am newly licensed I cannot wait to see what the future has in store for me!

TDC: Do you have any advice for people studying for this exam?

Caroline: My advice for people studying for this test is RELAX! There are going to be times when you feel overwhelmed, but do not forget to live your life. Do not let this exam take over. If you set up a realistic schedule of when you can study and follow through with it you will be fine. Surround yourself with positive people and think positively going in. You can do whatever you set your mind to. Good Luck!

TDC: Anything else you'd like to add?

Caroline: Everyone’s experience is different when studying/taking the exam. Find a routine that works for you and never compare yourself to someone else. You will PASS the test if you study at your own pace and in your own way. TDC is there to help you do so!

We at TDC are so excited for Caroline! Whether you’re studying for the first or the tenth time, we encourage you to sign up for TDC today and join the thousands of social workers and marriage and family therapists who have successfully passed their licensing exams using TDC. To read more about social workers who have successfully used TDC to pass their licensing exams, click here. To read more about marriage and family therapists who have successfully used TDC to pass their licensing exams, click here.

Social Work Exam Prep Programs     MFT Exam  Prep Programs

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Topics: MFT, Exam Prep

Monthly Meditation Blog: Intro to Progressive Muscle Relaxation

Posted by Heidi Tobe

August 30, 2017 at 10:00 AM

Five years ago, I hadn’t yet been introduced to the concept of mindfulness and the idea of creating a daily meditation practice was far from my radar. As I entered into my first practicum experience where mindfulness was central both to the office culture and the mode of therapy used (DBT), I was unaware how foundational this would become to my own clinical and personal practices.

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Mindfulness didn’t come easy to me. Like most people, my mind wandered constantly. Trying to keep my mind still and in the present moment brought up some intense feelings of anxiety, and internally I fought against this practice. Over time my attitude shifted and I now greatly value the practice of mindfulness both personally and professionally. It took me a long time to get there, though. I remember the first time I felt I could maybe get on board with this whole mindfulness thing was when I was led in a progressive muscle relaxation. The physical aspect that came with this allowed me to stay focused and engaged, and it brought to awareness just how tense I was keeping various muscle groups in my body.

To engage in Progressive Muscle Relaxation, you systematically tense various muscle groups throughout your body (for example, your feet, face, neck and shoulders, etc.). After holding that tension in a particular area, you release it and observe how your muscles feel in a state of relaxation. The immediate benefit of Progressive Muscle Relaxation is that it can help reduce tension and stress. Over time it can teach you to recognize what it feels like to have tense vs. relaxed muscles, as many of us are so consistently tense that we don't even recognize when it's happening! As you increase awareness of when and where your body is carrying stress and muscle tension, you can start to intentionally release that tension and bring your body to a state of relaxation and decreased stress. Progressive Muscle Relaxation is now something I engage in regularly to check in on my own physical well-being and to release physical stress. It’s a great practice to teach to those resistant to more traditional mindfulness and meditation and is a favorite practice amongst the high school students I worked with. If you’ve been unsure of or hesitant to try mindfulness or meditation up until this point, this could be an easy, no-pressure way to test the waters! My hope is that you will find it as impactful as I did.

Find a comfortable place to sit or lay down, silence all distractions, and enjoy 15 minutes of relaxation. 

We will be taking next month off from our monthly meditation blog to focus on our September Suicide Awareness Series, but will return in October with another meditation blog and audio recording!

Progressive muscle relaxation script by Dr. Christopher Lloyd Clarke from www.the-guided-meditation-site.com

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Topics: Counseling, Exam Prep, Self Care

Imposter Syndrome: Surviving Feeling Like a Fraud

Posted by Heidi Tobe

August 21, 2017 at 3:38 PM

 

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You recently finished grad school and got hired on at your very first job doing clinical work (or, if you’re like me, you might be on your second or third job feeling this way!). You face your client as they begin to share with you the issues that brought them to therapy. You try to focus on their words and stay present in the moment, but there is a battle going on. Your anxious mind is throwing constant attacks your way: You don’t know what you’re doing. You aren’t competent to help this person. You’ve never worked with this issue before. You don’t have the skills you need to be an effective clinician. No one should be paying you for your services. In a multitude of ways, your anxious mind is yelling at you, “You’re a fraud! And just wait- it’s only a matter of time before your client finds you out.”

Have you been there? I know I have. It's one thing to learn CBT in grad school. It's another to try and take that knowledge and apply it to a real-life situation with an actual person. In school, we often learn a little bit about a lot of things, but come out lacking the knowledge and experience in any one area to feel competent in our practice. I was incredibly lucky in grad school- I had an amazing practicum that provided me both experience and excellent supervision in DBT. Even so, the Imposter Syndrome I had both during and post grad school were overwhelming and downright debilitating at times.

Nearly every social worker and MFT I’ve spoken with has experienced Imposter Syndrome at some point during their careers. While some clinicians are very open about this experience, others bury these anxieties and fears deep beneath the surface, afraid they are the only ones feeling this way. These feelings can shake us to the core. Genuine human interaction is foundational to our experience as clinicians, and feeling like you are performing the role of a therapist instead of actually being one is counter to all that we hope to be in our clinical work. It can make any and every client interaction exhausting and overwhelming. And ultimately, being caught up in our own minds rather than fully present in the room makes us less effective clinicians, thereby reinforcing our Imposter Syndrome.

So how do we get out of this? How can we make it go away?

Unfortunately, there is no quick, easy fix to make it disappear. Overcoming Imposter Syndrome is something that takes time, acceptance, and experience to get through. There’s no fast-forward button. While there’s not a way to entirely bypass these feelings of inadequacy, we have found some helpful strategies to make this uncomfortable experience more tolerable and fruitful:

1. Sit with the anxiety.

So often we try to fight against our feelings of fear. We try to push them away, bury them, or act like they don’t exist. Instead, try accepting these feelings as part of your present, lived experience. The feelings of anxiety that you are experiencing mean that you care about the quality of your work. If you didn’t care about being an excellent clinician, you wouldn’t feel anxiety. Make it a regular practice to validate yourself. Continually remind yourself that you are at the beginning of your career and that’s where everyone starts. No matter how skilled and experienced a clinician is, we have all been at a minimal place of competence. Rest assured, you're improving and growing every day. This is the beginning and it’s okay to be where you are, not having all the answers (and even experienced clinicians will tell you, you’ll never have all the answers!). It’s okay to not know what to do sometimes. That’s exactly why your supervisor is there!

If you have a supervisor that challenges you (which I hope is the case for each of you!), remind yourself that it is helpful to be challenged. A supervisor who is able to highlight what you could have done differently or what you can do differently going forward will help to make you a better clinician. While this may not feel good in the moment, and can certainly heighten that sense of feeling like an imposter, it is a key element in growing into a more confident and competent clinician.

2. Be vulnerable.

The more I talked about my feelings of fraudulence with others, the more I realized I was not alone. I was so ashamed of the fear I felt, but found comfort in knowing so many of my peers were going through the same thing. As I spoke with supervisors and mentors further along in their careers, I realized that the people I looked up to the most had spent years feeling the same way I was feeling. In her book Daring Greatly Brene Brown states, “Shame derives its power from being unspeakable…If we can share our story with someone who responds with empathy and understanding, shame can't survive.” While opening up about my own experience didn’t remove the feelings completely (even now, I still have moments where I feel like the only real fraud out there who just happens to do a really good job of appearing competent), it helped remove some of the power those feelings had over me. It reminded me that this is all a part of the process. It doesn’t have to be shame inducing, it won’t last forever, and none of us are immune from or alone in it.

3. Remind yourself of what you do know.

It’s easy for me to mentally spiral. One stroke of incompetence can lead to a slippery slope that lands me at a place where I convince myself I know nothing. It’s important that we remind ourselves what we do know. In my work with individuals preparing for their social work exams, I encounter a lot of people days (or hours) before their exams who feel like they don’t know anything. I remind them of how far they’ve come from their first pretest to their final mock exam, as well as the intangible ways I’ve personally seen them progress in their reasoning skills. It doesn’t erase their anxiety, but this dose of encouraging reality is often a soothing balm to the sting of unyielding fear.

When I get to a place where I feel like I know nothing, possess zero rapport building skills, and lack the basic personality traits to be an effective clinician, I remind myself that my feelings are not facts and that in reality there is a lot I am very good at. I remind myself of where I started back in 2012 and where I am now. When you find yourself at a really insecure place, it may be helpful to ask others for feedback on your skills and strengths. If you do this, write their responses down and use them in the future when you need a kick starter for self-validation. And don’t wait until you’ve crashed to the bottom of the pit of self-criticism. Start now practicing self-validation on a daily (or multiple times daily) basis. When your anxious mind feeds you lies about your incompetence, combat them with encouragement and truth. While it’s easier in the moment to let your mind run wild with insecurity, each time you choose to fight back with truth you come one step closer on your path from incompetent imposter to confident clinician.

4. Engage in this quick activity:

Think of something you are really good at now, but that was at one point new and difficult. Maybe it’s a sport, musical instrument, second language, or a challenging hobby. What did it take to move you from a place of ineptitude to a place of proficiency? For me, I think about my first time driving a car. I remember feeling as though driving would never feel natural-that it would always be scary and take immense amounts of mental energy. Now, it feels completely natural and takes minimal effort. I remind myself that in many ways, I am still like a new driver as a clinician, but it won’t always be that way. When I want to run far, far away from the clinical world, I think about the fact that if I gave up on driving when I was 16, it wouldn’t have become second nature like it is today. It took a lot of practice and a lot of uncomfortable moments (if my memory serves me correctly, I was at a complete loss as to how to pump gas the first time. Pre cell phone days and in the middle of a Michigan winter, I stood out in the snow red faced and confused for a good ten minutes before finally asking a kind stranger for help), but over time I moved to a place of competence. What would it have been like if you gave up on the very things that were once hard and are now second nature? What would you have missed out on in life?

It’s a long journey, fellow clinicians, but know that you are not alone. Seek out peers going through the same things you are and individuals further along their career paths who can empathize with you and encourage you along the way. I’ll leave you with the wise words Christopher Robin shared with his best friend Winnie-the-Pooh: “There is something you must always remember: You are braver than you believe, stronger than you seem, and smarter than you think.”

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Topics: Professional Development

Veterans Service Scholarship Winners

Posted by Heidi Tobe

August 18, 2017 at 2:07 PM

On Monday we announced our five winners for Therapist Development Center's 2017 Veterans Service Scholarship. Today, we share a bit of each of their stories. We hope you are as inspired by each of them as we are!

Fernando Chavarria

Michigan State University

After receiving his undergraduate degree in communications, Fernando Chavarria had no plans to pursue education in a different field. It wasn't until Mr. Chavarria was offered a career as a Peer Specialist that he began considering the social work profession. On a daily basis, Mr. Chavarria collaborated with clinicians and it was during this time that he discovered that the field of social work was one comprised of complex communication, relationship building, and collaborative efforts-something not so far off from his original field of communication.

During his time in the military, Mr. Chavarria saw what it looked like to push his mind and body to new limits, increased his confidence and determination, and learned that "impossible is just the body operating without the mind." Mr. Chavarria worked on the short-term inpatient medical floor of the VA Hospital for his first-year internship, assisting with discharge planning and high risk screenings. This experience provided him greater insight into the types of support and interventions provided through the field of social work. Mr. Chavarria has an innate desire to help his fellow comrades and wants to do everything he can to help fellow veterans stay alive in both mind and body when they return home. He plans to become a clinical social worker with the VA upon graduation and to move into positions of leadership that will allow him to advocate for organizational changes that will lead to more effective delivery of recovery-oriented care.

Dr. Brady is a psychologist at the agency where Mr. Chavarria is a Peer Support Specialist. Dr. Brady was so impressed by his clinical skills that she has had him assist in sessions with veterans. She describes Mr. Chavarria as "extraordinary in his authentic depth, ability to connect with others, and ability to convey understanding and accurate empathy” and goes on to state that she has “never seen anyone better.” Dr. Brady has seen Mr. Chavarria “able to offer even difficult feedback in a way which meets with acceptance. He has this essential clinical skill honed, yet keeps striving to encompass more of the human experience." Mr. Chavarria is someone Dr. Brady states has a great deal of life experience and wisdom and is able to use these to lead humbly and authentically. She expects that Mr. Chavarria's clinical social work career will "deeply touch many lives, and help bring about advances.

 

Jonathan Gill

The Ohio State University

As a United States Marine Corps service member who decided to 'come out' after witnessing the repeal of Don't Ask, Don't Tell, Jonathan Gill discovered a community of hidden LGBT service members who created their own support networks due to the stigma of reaching out for help. He encountered many individuals who silently struggled with issues of substance use and mental health issues, failing to get the services they needed. It was during that time that he learned about his own identity, what trauma is like, and how one needs to seek healing once they are removed from the trauma.

During his first-year internship, Mr. Gill met veterans and non-veterans experiencing chronic homelessness. He witnessed and heard stories of trauma and chronic homelessness that he was surprised to find were in his own back yard. Mr. Gill is currently pursuing his Masters degree in Social Work at The Ohio State University, with an internship at the Chalmers P. Wylie VA Ambulatory Care Center in Columbus, Ohio. Mr. Gill’s goal is to work with veterans as a clinical social worker for the VA to address the needs of those transitioning into the civilian world, with an emphasis on homeless reduction, vocational rehab, trauma-informed care, and substance use disorders after graduation. Mr. Gill is interested in using his shared identity as a veteran to build strong therapeutic alliances in his clinical work.

Anna Stewart is one of Mr. Gill’s instructors at The Ohio State University and has worked with Mr. Gill over the last year in three very unique settings, which include a student run free health clinic, a field seminar course, and overseeing his field placement experience. Ms. Stewart describes Mr. Gill as "one of the most motivated students I have ever worked with" and someone who is "humble in his approach to his work and education.” She goes on to share that “he asks for help when needed and never assumes he knows it all. His humble nature allows him to quickly build rapport with patients/clients allowing them to feel at ease." She describes his involvement and commitment to the service of others through his time in the Marine Corps and other campus and community volunteer activities as "commendable" and shares that Mr. Gill is someone who is already "an agent of change for vulnerable and oppressed populations” and that she "can't wait to see where his career takes him.

 

Kelli Hatzenbuehler

University of Nebraska Omaha

Kelli Hatzenbuehler has worked for the United States army for 20 years. Through both her and her husband’s military service, Ms. Hatzenbuehler has learned first-hand about the sacrifices service members make, including being away from their children and spouses for extended periods of time. Through her service, Ms. Hatzenbuehler has developed a great deal of empathy that she will take with her into her career as a clinical social worker.

Ms. Hatzenbuehler recognizes that there is often a language barrier between veterans/service members and the civilian population and believes she is able to understand that language and the unique problems that veterans face. Ms. Hatzenbuehler was first deployed in 2003. During her first year of deployment, she lost three members of her unit. In the thirteen years that this unit has been home, 3 additional members were lost to suicide. Ms. Hatzenbuehler wants to assist service members and veterans when they are feeling hopeless and hopes to do so by working at the VA or a similar entity as a clinical social worker. 

William Buettner has worked with Ms. Hatzenbuehler for over 5 years in the Resilience and Suicide Prevention Office of the Nebraska National Guard and has served in the same units with her on occasion for the past 10 years. Mr. Buettner describes her as someone who "uses her empathy to relate to people in crises and or distress...her empathy helps make the persons at risk talk more freely." He describes Ms. Hatzenbuehler as a person of integrity who "takes the ethical road and helps others along that path." He shares that Ms. Hatzenbuehler is "an expert in her field and looked at by her peers as a subject matter expert” and is someone who continually strives to become better at her duties, consistently rising to the top.

 

Kevin Rumley

Western Carolina University

As a United States Marine Corps combat wounded veteran who has undergone 32 surgeries, Kevin Rumley is someone who has witnessed first-hand the devastation and chaos of war. Mr. Rumley received world class psychotherapeutic and physiological rehabilitative care, including services from clinical social workers at the Walter Reed Medical Center. This along with his early maternal introduction to serving others were catalysts for his passion to become a clinical social worker. It was through his military service that Mr. Rumley's belief in the critical importance of building relationships and active-listening were solidified. He learned that “only through listening can we begin to understand.” Mr. Rumley describes himself as “a veteran for peace” and strongly believes that clinical social workers have the capacity to change lives. He is passionate about recovery, resiliency, and fighting for social justice and is someone who strives to be a positive agent of change within his community.

During his first-year internship serving at the Buncombe County Veterans Treatment Court, he found that non-punitive treatment-based programs are effective modalities for reducing recidivism. He discovered the importance of self-care and boundaries in this difficult work. Mr. Rumley learned that it is through open dialogue and ongoing advocacy that change can occur and that to be the most effective clinician possible, he must remain open and receptive to his environment. Mr. Rumley has worked at NC Brookhaven Behavioral Health, a Service Disabled Veteran-Owned Small Business, for the last five years on the ACT Team (assertive community treatment). He plans to become an LCSW, LCAS, and EMDR practitioner, promoting change on an interpersonal level through EMDR and on a policy level with the goal of instituting harm reduction clinics in rural parts of Western North Carolina. Mr. Rumley additionally hopes to pursue his DSW in the future.

Susanne J. Loar served as Mr. Rumley’s supervisor for the North Carolina Substance Abuse Professional Practice Board for the past two years. Ms. Loar shared that Mr. Rumley is dedicated to assisting people-especially veterans-in their recovery from substance use and mental health disorders. She describes him as "an advocate for veterans living in the community." Ms. Loar reports that Mr. Rumley has been unofficially running the team while he pursues his graduate degree and shares that his "innate intelligence, ethical integrity and vast experience have added value to the individuals and to the wider community.” She describes Mr. Rumley as "a great advocate for people on medication assisted programs” and that he “brings empathy and expertise in the field." Further, Mr. Rumley “has been instrumental in setting up and following veteran's through the veteran's court system" and has been a "driving force in the local and state judicial system." Ms. Loar states that Mr. Rumley is "a tremendous addition to the field of social work" and that she "cannot think of a person more deserving" of this scholarship.

 

Shayne Wiggins

Western New Mexico University

Shayne Wiggins was drawn to the field of clinical social work after returning from his deployment with the United States Marines. He had a difficult time finding a military social worker who was also a veteran. It was through this experience that Mr. Wiggins realized 1. there is shortage of master's level social workers who can provide services through a veteran's lens and 2. many veterans who have experienced combat trauma may feel more comfortable opening up to a professional who can relate to their military experiences.

Mr. Wiggin’s military experience taught him how to fight through adversity and serve with honor. During his deployment, he developed integrity, dedication, commitment, and honor to both his country and his shipmates. His first-year internship taught him that he is a culturally competent social worker in training and that becoming a competent social worker takes commitment and dedication-two things that Mr. Wiggins has. Mr. Wiggins plans to practice clinical social work with veterans who have experienced combat trauma, homeless veterans living with substance use disorders, and veterans who are survivors of military sexual trauma and assault. He recognizes that these are underserved populations that deserve well-trained and competent clinicians that understand their trauma and can help them resolve and manage their traumatic experiences through empirical translational science.

According to Kendrick Lockett, who Mr. Wiggins met through his internship at the Atlanta Mission organization, Mr. Wiggins is someone who "has a gift for working with those who have been subjugated and marginalized within our society." Mr. Lockett stated that "our veteran services have improved significantly since his internship began here” and that “he has excelled in his internship above and beyond the agency's expectations." Mr. Lockett describes Mr. Wiggins as someone who "exemplifies strong attributes and abilities in becoming a clinical social worker.

 

We at the Therapist Development Center believe that more can and should be done by every civilian American to support our troops and veterans, so we are now offering our programs FREE for any veteran or active duty military, including each of our scholarship applicants. To learn more about how to obtain this offer, click HERE. To learn more about our social work exam preparation programs, click HERE.

Haven't signed up for an exam prep program yet? Our structured, straightforward approach to exam prep will provide you with exactly what you need to pass your social work exam or MFT exam and nothing you don’t. You can learn more about our social work licensing exam prep HERE and more about our MFT licensing exam prep HERE. If you’d like to connect directly with one of our coaches, you can do that HERE.

We look forward to helping you PASS your exam with confidence!

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Topics: Exam Prep, Social Justice, Social Work Exam Prep, Professional Development