Adventures in Private Practice: Psychotherapist Diane Spear, LCSW

Get to know New York City licensed clinical social worker and psychotherapist Diane Spear, LCSW-R.Tell us a little about your practice...I’m a licensed clinical social worker in private practice over sixteen years. I treat people from older adolescents to senior citizens, in individual and couples sessions.  My practice approach can be described as psychodynamic, interactive, and reality-based, so I’m dealing with how a patient’s formative years affect his/her current conscious and unconscious attitudes about love, work, and play, so that they can build on what works and rethink what doesn’t in order to have a more satisfying life going forward.Why did you decide to open a private practice? I decided to open a private practice because I like the flexibility and autonomy of working when I want, setting my own fees, working with a theoretical orientation I find helpful, and choosing a supervisor whose way of working is compatible with mine.What have you learned from your toughest clients?What I’ve learned from my toughest patients—and my wonderful supervisor, Dr. Ed Campbell—is that they get to be crazy till they’re ready to listen, and that my responsibility is to “put it out there” consistently and to work hard at doing that, but that I’m not responsible for whether or not they are willing to take it in and use it consistently or at all.  That was enormously freeing!  And a great way to avoid burnout.Some of my toughest patients are what my supervisor calls “help-rejecting complainers.”  Realizing that they have every right to reject my help, and learning to not take that personally—“You’re not listening to the great Diane Spear????!!!!”—has been really important!What's your biggest pet peeve about private practice?My biggest pet peeve (and it’s not very big at all, frankly) about private practice is that I don’t get paid sick days and vacation days.  But it’s a small trade-off for the autonomy I value.  Actually the worst deal is having to pay for my own health insurance.How did you discover or develop your practice "niche"?In terms of a niche, I originally worked with a lot of actors, artists, and writers, probably because I had an arts background.  Now I have patients from all walks of life, and I enjoy that variety.  My practice is a general one, and I enjoy that.What resource (book, website, person) helped you the most when setting up your private practice?The resources that have helped me the most in setting up my private practice have been my wonderful therapist, Nancy Becker, LCSW-R, and my tough-love supervisor, Ed Campbell, Ph.D., because they told me and modeled for me that if you want to have a successful practice, you have to treat it like a business and market it, and set it up in a way that’s fair to me.  This was a very different approach than what I learned in social work school, where it was politically incorrect to mention aspirations for a private practice.What has surprised you most about being in private practice?What has surprised me most about being in private practice was that my therapist and supervisor were right:  with hard work, a business attitude, and a commitment to learning theory and technique I could have a successful business, as they do.  In other words, their success wasn’t based on luck; if I wanted their results, I needed to put in the hard work they did and I could have a great business that I enjoy.Has your private practice helped you grow professionally? How so?My private practice has helped me grow professionally because there can be room for laziness at some agencies, without too many repercussions.   But if I’m lazy about learning theory and/or technique, or marketing, I will see the results in a failing practice, so having to be responsible to myself has forced me to have a better work ethic.Has it helped you grow personally, too? How so?Private practice has helped me grow personally, too, because I’m forced to confront my own narcissism on a daily basis with my patients, to know the limits of what I can do—I can’t change anyone except myself, though I can work with someone and help them change if they want to change.  And let’s face it:  anything that makes us confront our narcissism on a daily basis is going to help in every aspect of our lives!Being a therapist can be emotionally exhausting. What do you do to care for your own emotional and psychological health?I avoid burnout by getting lots of treatment from my long-time therapist, and participating in a weekly supervision/study group.  What also helps is, once again, knowing that I can’t change anyone—all I can do is put it out there, and the patient is responsible for using it or not.How do you cope with the inevitable stressors involved with being your own boss?I cope with the stresses of being my own boss by setting up my business in a way that is fair to me, so that I don’t resent my patients.  When I started out, I paid $12 an hour for office space and my first patient paid me $20 per session.  I built from there, but had not learned to set it up yet in a way that was fair to me.  So when a patient cancelled on me, I rescheduled sessions, which meant that I had to pay $24 for office rent ($12 for the cancelled session and $12 for the make-up session), but just get paid $20 for the session.  No small surprise that I wound up resenting my patients!  My supervisor helped me set it up to be fair to myself with time and money.What personal strengths have helped you succeed in private practice?Creativity and a good sense of humor have worked well for me in private practice.  I enjoy coming up with analogies that will fit a particular patient’s situation or to explain a complex concept.  I’ve also found that humor can be a great way past a patient’s defenses.

To learn more about Diane Spear, LCSW-R visit her website