In our respective positions with the Counselor, Social Worker and Marriage and Family Therapist Board for the state of Ohio, we have the unique opportunity to encounter many clinicians as they are starting their careers. (We use the term “clinician” to refer to the counselors, social workers and marriage and family therapists regulated by the Ohio Board who also provide direct services to clients.) This includes discussing the challenges and questions these new clinicians have as they embark on their career paths.

Clinician Jeffrey Kottler’s book, titled The Therapist in the Real World: What You Never Learn in Graduate School (But Really Need to Know), prompted some thinking from our perspective as a licensing board staff. What follows are some additional lessons that we believe fall under the category of “were never taught in graduate school but still need to know.”

One area in which newer clinicians often encounter difficulties is documentation. In our experience, issues with progress notes and other record-keeping concerns result in more complaints and employment issues for new licensees than most other possible violations. Proper documentation is critical for billing, quality control and transitioning clients to other providers, and when there are questions or concerns about a licensee. Case notes can form an integral part of a licensee’s defense if a concern or complaint is filed against the licensee.

In many settings, from community mental health to school-based settings, productivity demands can compound issues with record-keeping. Agencies must produce billable hours, and these demands fall upon clinicians. New clinicians are particularly susceptible to the pressures of productivity requirements. Our conversations with licensees suggest that productivity demands are occasionally a focus of training and education but that some of these associated skills, such as how to engage clients to show up for appointments, are generally learned on the job.

Understanding how important it is to meet client needs and agency goals and yet still remain ethical in record-keeping practices is critical for beginning licensees. Newly licensed clinicians may find themselves unable to keep up with these demands. This is where seeking proper supervision and practicing effective communication are key to the success of new clinicians.

Another important area concerns appropriate termination. We are now in an era when employees start and leave jobs more frequently than in the past. The world of mental health counseling is no different. For instance, better opportunities may emerge that licensees would like to pursue. New clinicians may wish to leave a job when they find the position is not satisfying or isn’t a good fit for them.

Unfortunately, licensees cannot simply walk out. No matter the reason, leaving a job must be done according to jurisdiction rules and agency/practice policies. New licensees should prepare to leave by reviewing termination requirements, offering written notice, ensuring that client documentation is complete and up to date, and helping to refer and transition clients.

The impact of mentors and supervisors on new licensees should not be understated. However, although these relationships are important for professional development, too often newer clinicians rely on others for answers without first doing their own research. New licensees need to develop their skills in reading and interpreting the laws, regulations and codes of conduct governing their profession. Although we coach licensees to rely on supervision, we realize that not every professional keeps up with developments in the field. Use good judgment when relying upon others to guide your career.

New licensees often confuse work supervision, or clinical supervision, with training supervision. Recognizing the difference between these two types of supervision is key to the success of new professionals. Having a supervisor to whom you report, and who is responsible for signing off on diagnoses and treatment records, is not the same as training supervision, which is supervision that is intentionally provided to develop the professional’s skills for possible independent licensure. Unfortunately, we encounter situations in which new clinicians mistake the work meetings they attend with training supervision that would qualify their hours toward independent licensure.

Many newer clinicians are savvy in their use of social media and technology. Their facility with these tools has both upsides and downsides. Make sure that you limit any personal accounts with privacy settings to protect yourself, and of course do not perpetuate multiple relationships by adding clients to your online accounts such as Facebook. Other tools such as texting can also be an issue. Be sure to limit texting and email to confirming appointments and similar administrative tasks, unless those tools are a planned part of therapy, for which proper notice is provided.

The last observation applies to everyone: A little humility goes a long way. The passion and excitement of starting a career can overwhelm good judgement or give one more confidence than is warranted. Use that passion and energy to serve clients well, while at the same time investing in growing your knowledge and understanding of the field.




Brian Carnahan is executive director of the Ohio Counselor, Social Worker and Marriage and Family Therapist Board. Contact him at


Tracey Hosom is an Investigator with the Ohio Counselor, Social Worker and Marriage and Family Therapist Board. Contact Tracey at




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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