Parental Leave and Parenthood in Private Practice: 20 Ways to be Trauma-Informed by Suzanne Rutti, LISW-S
I have had a lot of people reaching out to me lately for some advice and insight on balancing private practice work with parenthood, and more specifically, how to handle parental leave. In the spirit of developing an open dialogue, I have decided to share my experience in the hope that it may be helpful to others. For some background, I am an EMDRIA Approved Consultant and Certified Therapist, focused primarily on trauma therapy. I have been in the field of social work for almost twenty years and started my EMDR therapy journey in 2008. I am a faculty member with The Institute for Creative Mindfulness, and own a small private practice in Columbus, Ohio where I work with clients of all ages who have experienced some form of trauma or adverse life experiences. I live with my husband, dog, and beautiful one-year-old daughter.
There are days I feel like I am really succeeding as both a business owner and a mother. There are other days it seems I am frantically trying to juggle all the pieces of my life, without feeling confident that I am successfully managing any of them. This has just become part of my personal journey. Self-care and balance are hard enough concepts when we are solely dealing with being mental health providers in the field. Add to that a relationship with a partner, and the responsibility of caring for a child, and it’s easy to see how self-care can be pushed to the back burner. As we preach to our clients though: if we are not taking care of ourselves, we will not be able to care for others. So here I am, putting on my oxygen mask first and finding ways to balance my sanity, in order to have time and energy to devote to my family and my work.
I’ll start off with some of the things to think about as you prepare for taking some leave from work. Whether you are giving birth, adopting, or your partner is having a baby, there will be a period that you will need to be home with your family.
Things to consider before your leave:
1. Think about how and when to tell clients about your baby: The timing of this is completely your choice. Some people start telling everyone they know as soon as they get a positive pregnancy test. Others wait until they are as far along as possible to minimize the risk of having to disclose a lost pregnancy. Just be sure to think through all of the options before going to one extreme or the other. If you are pregnant, you cannot assume that your clients won’t notice a growing bump or other symptoms. This is particularly important when working with trauma survivors; many trauma clients pick up on any small changes. Their brains have been programmed to attune to others as a form of protection and defense. So, if you are experiencing extreme fatigue, nausea or other symptoms, you may want to let clients know what is going on so that they don’t form any of their own conclusions.
2. Consider that your situation may be triggering for clients: While you may be bursting at the seams with your exciting news, please keep in mind the impact this could have on your clients. Some of your clients will be overjoyed for you. Some clients will immediately start to panic in anticipation of your absence, or even the possibility that you won’t be returning to work at all. For others, they may have dealt with infertility, had an unplanned pregnancy, had a miscarriage, lost a child, or have a history of terminated pregnancy. Think about each of your clients carefully and consider how you will deliver your news.
3. Decide when to stop taking new clients: You will need to decide on a reasonable date to ethically stop taking new clients on your caseload knowing that you have an upcoming period of leave. This time frame should depend on the nature of your populations and scope of practice. If you have started telling existing clients on your caseload, then you also need to inform potential new clients before they start investing time into coming to see you. You will also need to consider the type of work that you are doing with clients as you approach your baby’s arrival date. Be sure to allow ample time to work with your clients on planning their transition. With some clients, it is not responsible to continue to do trauma processing up until your last day, because of the possibility of destabilization and your inability to be available to support that client. You also need to consider the possibility that your leave will begin sooner than anticipated.
4. Have a plan for coverage while you are on leave: What you do with your cases while you are off is something that you will need to decide with some input from your clients. Some of your clients will be able to manage a period without attending counseling. There are some clients that you may think would be able to manage without counseling but will elect to see someone anyway, and vice versa. Finally, some clients may be required to see a counselor during your leave due to safety reasons. If you work in a group practice or with colleagues, reach out and see who would be willing to cover your cases while you are on leave. If you work alone and don’t have many colleagues, reach out in some networking groups to see if anyone is available, or do some of your own research and find some referral sources for your clients. You can link clients with specific clinicians, or you may provide a list of a few therapists that are available and willing to see them while you are off and leave it up to them to make the contact.
5. Clean up your caseload: I do not recommend leaving any cases open on your caseload while you are on leave. Complete a discharge summary for each client that outlines your recommendations while you are on leave. You can always re-open cases when you return to work. However, this will relieve you of any liability while you are off as well as compensate for any potential delays returning to work or issues that could prevent you from returning to work. I also recommend creating a form letter that lets clients know that you will be going on leave with general recommendations. Provide a copy to your clients and keep one in their file. This can prevent any claims later that you did not provide ample notice or planning.
6. Plan how long you intent to be off: Think about how long you plan to be off and begin financial planning as soon as possible. If you are in private practice, you may be an independent contractor and not have access to paid time off. If you plan far enough in advance, there are some short-term disability insurance plans that may fit your needs. You will need to start paying into the plans before you or your partner are pregnant. Remember that babies are not always on the same timeline as we are, so consider a window of time that allows for the baby to come earlier or a little later than expected, and consider how you will handle any situations that may require extra time off. Consider alternative strategies for income to make up for your time off. If professional development or consultation are within your scope of practice, consider scheduling some trainings before and/or after your leave to bring in some additional income. Think about hiring someone part-time to supplement your time off (and as an added bonus they can start off by covering some of your cases while they build their own caseload). In my experience, trainings allowed me to supplement my maternity leave and enabled me to come back to work seeing clients part-time. I invest about one weekend a month to training, but it allows me to spend more days at home with my daughter overall. Consultation groups for EMDR therapists have also allowed me to make income in a shorter block of time than seeing a full day of clients. Balancing a schedule of trauma therapy with consultation and training also facilitates self-care and secondary trauma prevention.
7. Identify how you will communicate the start of your leave: Figure out a plan for how you will communicate that your leave has started. You may want to pick a date a few days before your baby’s due date as your last day to see clients. You do not want to be thinking about calling to cancel clients while you or your partner are in labor or arranging plans for the immediate arrival of your child. If you need to work until your baby comes, create a new voicemail each day that states whether or not you are in the office. Let your clients know to call the voicemail before heading in for their appointments. When you start your leave, be sure to change your voicemail and email responses to communicate that your leave has begun, as well as the steps clients should take if they have a clinical need.
8. Have a backup plan: As mentioned earlier, babies do not always follow the plans we have set in our heads. Some people also fully intend to come back to work but things change while they are home snuggling their new squishy babies. Be sure you have a strategy for communication of any changes to your schedule to clients that are hoping and planning on coming back to see you when your leave is over.
9. Identify how you will communicate your return: Just like the form letter that you sent to clients to notify them of your upcoming leave, you will want a plan for how to announce that you have returned to the office. If you have a social media account for your business, you could direct clients to check there and make a post when you have a return date. You could also send a general announcement to your former client load.
10. Establish a plan for working during your leave: If you plan to do work while you are on leave, I would encourage you to think about how crucial that is. In my case, I was running a small practice without an office manager, so I didn’t have a choice but to continue to do billing and payroll. Decide whether any of your tasks can be delegated, and if not, identify specific times in your week to allot to doing work. You only get parental leave one time with your baby and you want to make the most of it.
Things to consider with your transition back to work:
11. Don’t plan on continuing to work as effectively at home as you do in the office: I thought I would be able to get a lot more work done from home. As I look back, the time period I probably could have gotten the most work done was the first several weeks of leave when my daughter was mostly sleeping. However, that was the time I soaked up the most and really bonded with my new baby. Once they start becoming interactive and eventually mobile, you will need to be more deliberate in delegating a time and space for working in the home. Fortunately, I have an amazing partner and a lot of family and friends that jump at the chance for some baby time.
12. Ease back into your schedule: Some of you will be itching to get back to work by the time your leave is done, and some of you will be dreading it. Either way, make sure you plan for a transition back to work. Not only will you be making the adjustment back to seeing clients and using your brain in a new way again, you will also be adjusting to a new schedule and being away from your baby. This doesn’t have to mean a very gradual transition, but I don’t recommend planning to see a full day of clients your first day back.
13. Expect to be sleep-deprived: Sleep deprivation is a real thing. I know people joked to me about it all the time, but it is the real deal. I have not slept through the night in almost two years, counting the sleepless nights that started while I was expecting. I don’t have any good advice here, but I wanted to normalize and validate this for all of you. You are going to be tired. There are going to be days you have a full day of intense clients and your child is also teething, has a fever, or just didn’t sleep the night before. Take care of yourself. And coffee. Sweet, sweet coffee.
14. Prepare for a range of emotions: As I mentioned earlier, you are going to experience a lot of emotions as you return to work. Whatever those emotions are, notice and pay attention to them. Take care of yourself and your needs. If you feel you need extra support and you don’t already have a good therapist, find one! EMDR therapy can work wonders for postpartum depression and anxiety. There are also some great groups on social media if you are looking for some camaraderie with other working parents, such as “Moms in Private Practice (Mental Health).”
15. Think about countertransference: As trauma therapists, you may find that you experience some new countertransference now that you are a parent. As a clinician, I validate to my clients that as their own children reach certain developmental stages, they may find themselves newly triggered by their past experiences at those ages. The same can happen as clinicians. Hearing about trauma and adverse life experiences your clients experienced as children may feel different to you now that you have your own child. Just be aware of what you are experiencing, and find someone that you trust and that you can process these feelings with: a coworker, supervisor, consultant or even your own therapist.
16. Establish a self-care plan: Establish a self-care plan, and don’t minimize it. As a new parent, I have to schedule time that is set aside for myself. I make an extra effort to go to bed at a certain time, drink water, and eat healthy meals. I also schedule purposeful social interaction with other adults. Identify self-care strategies that are small and some that take more time, and figure out how these can fit into your routine. If we just assume that it will get done, it won’t. You need to be purposeful about this. I have found bullet journaling to be especially effective for tracking my daily, weekly, and monthly goals.
17. Prepare for pumping needs: If you will be breastfeeding, you will need to think about your pumping needs. Be sure to schedule time for pumping. Because of the nature of our work, most of us already have a private office, but if not, find out how to establish a private space for pumping. Kellymom has some great articles for support with pumping at work.
18. Re-examine your boundaries: The biggest change for me since going back to work as a mother has been my boundaries with my schedule. If you ask any of my colleagues, they will be the first to tell you I used to work a ridiculous schedule. I was known to see nine or ten clients in a day and work sixty hours a week. As a new mom and recovering workaholic, I am now forced to say “no” to appointments that are outside of my scheduled week. Primarily because I would need to arrange additional childcare, but also because it intrudes on my time with my family. I learned the hard way that coming home right at my daughter’s bedtime to put her to bed didn’t go as smoothly as I planned. I also know that I cannot allot exactly enough time to drive to pick up my daughter from my last scheduled session. Sometimes sessions run over, or I need to make a client phone call at the end of the day.
19. Let the guilt go: The first day I went back to work, I definitely cried more than my daughter did. Looking back now, I’m actually not sure how much she noticed me walking out the door. At the time, my guilt was at an all-time high, and I had an unrealistic impression of how much my work would affect her. In reality, she has been able to spend much more time bonding with family members and caregivers and finding ways to develop. I had to let go of the grief around not getting to see every single thing she did, said, and discovered. Instead, I make an effort to be fully present when I am with her. There are going to be things that I don’t get to see, but I try to make up for it by mindfully experiencing the events I am there for.
20. Find a new balance: I have to be more purposeful about when I check work email and when I do work from home. I want to be fully present at work and fully present with my family. I am definitely not always perfect, but I don’t feel good about my role as a mother when I am trying to do work while simultaneously feeding my daughter lunch, nor do I feel like a great clinician when I am responding to an email while trying to sing Old MacDonald.
I hope that this article has been a useful resource for considering your parental leave, and I hope to hear from many of you with more helpful additions to this conversation. I have to make a conscious effort every day to try to practice the kind of self-care and balance that I encourage for my clients. It is my hope that by sharing my experience some of you may be inspired to begin planning for balance in your new journey.
Suzi Rutti, LISW-S
Rutti Counseling & Consultation, LLC
Expressive Arts is a beautiful process of coming home to oneself. We often spend a lifetime detached from our bodies and others-replacing connections with fallacies of social media and text message. It’s easy to scroll for hours, send a quick text, developing a habit of nonchalant routine. But is that really connection? Some say yes. They are able to check in with family all over the world or they need to check out after a long day, but that is not connection with self or with others. We’ve developed a nasty habit of leaving ourselves without coming back to self. It is anything that allows someone express who they are, their experience, giving a voice to the voiceless (i.e. believed to be unheard or experiences stuck in the emotional part of the brain that does not have access to language in the thinking portion of the brain).
Coming home to self and providing a voice to our emotions and experiences that get shoved aside with disconnection, allows the individual to settle into their own skin. They’re able to figure out what it’s like to build a home with self and the meaning of connecting to life around them. For me, Expressive Arts as provided a way for me to communicate what my home, my body, needed to spring clean to feel safe.
For me, the best part of Expressive Art Therapy is the aftermath, when the supplies are strewed about the space and smudges of paint, pastel, and glitter are left behind. There is always a different light that shines brightly in my clients’ eyes. A sense of fresh air that I’m able to sit with. The aftermath is a complete flip from when I start working with clients, because what is this going to accomplish? I can’t tell you how many times I get eye rolls or eyebrow raise when I begin pulling out crafting supplies in session.
The aftermath of Expressive Arts processing is different from the excitement in the middle of the process and the middle of their treatment continuum. Once the world of Expressive Arts is introduced, the craving to express, the desire to be heard, seen, healed, takes a front seat. It’s the lit match blossoming to life, of insight settling in for the ride. It’s the self-permission to express leaking out onto the page.
I promise you when someone is in process, it is mesmerizing. It is awe-inspiring to watch someone learn to trust themselves enough, and you enough, to express themselves. It is awe-inspiring to sit back after a session with paint smudges, charcoals, cut paper littered about, and seeing that person, that client running with ideas (regardless if it’s merely an upturn of one corner of their mouth, staring at their piece, or rushing to share what they noticed in excitement). It is wonderful when you’re able to experience this yourself. Sitting back from my pieces and taking in the message conveyed in writing or imagery. There’s nothing quite like it.
When I’m cleaning up after a client and groups, I can’t help but smile at the charcoal coating a chair or paper debris on the floor. They made a mess. They made a mess, even thought they were previously asking permission to move, worried about staying in the lines, asking to use paint. They made a mess. They let themselves make a mess, to put their hands in paint, fold and tear paper, to express everything they’ve kept inside. They let themselves try something new and permission to sit with self and explore. In a world where we’re told what to do and stay in the lines, to disconnect and move on, the best thing we can do for ourselves and those we work with is to step outside our comfort zones and greet the unfamiliarity of imperfections, emotions, and to provide a space for expression in all its formats.
For as long as I can remember, I have adored flowers. Looking at wildflowers in the fields or noticing several varieties alongside houses in my neighborhood are some of the first pictures that come up in my head when I float my memory back. I remember having to ask my mother’s permission before picking them in my own yard or my grandfather’s yard nearby because I once got in trouble for plucking some of the neighbor’s tulips. I’ve only recently started to appreciate the awesomeness that my mother is named Rosie (which she prefers to Rose)—and that literally makes me a flower child!
I can’t remember when I first received flowers—it was likely when I made my first communion around age seven. I fondly recall getting flowers from my friends and family when I was in my first big stage show at twelve. The confirmation name I chose for myself when I received the sacrament in the Roman Catholic Church is Marie-Therese. I selected the name to honor St. Therese of Lisieux, also called the Little Flower. The first tattoo I got was of a flower (a peace lily on my hip). Even though both of my marriages ended in bitter divorce, I still have several fond memories from both relationships that involve receiving flowers. On a recent pilgrimage to India, one of my drivers—a lovely man named Ratan—climbed a tree to pick me the state flower of Uttrakhand in the foothills of the Himalayas. This gesture had me beaming from ear-to-ear and made me realize just how much I love receiving flowers.
So what better way to honor the sacredness that I am than to practice buying myself flowers? We can put so much weight, especially as women, on what it means to receive flowers as a gesture of love or appreciation. But who is to say that for flowers to have such appreciative value, they have to be gifted by someone else?
Although I’ve picked flowers for myself over the years, I do not consciously recall buying myself a bouquet of flowers until about two years ago. I purchased a beautiful dozen of pink roses to celebrate my separation from marriage number two and all of the pain it represented. After that marriage ended, I entered into a period of deep inquiry to investigate and ultimately heal the remaining layers of relational trauma that kept me in this loop of unserving relationships. And in my sadhana (spiritual practice), my guides led me back to a favorite poem from which I’ve drawn great strength over the years, After A While by Veronica A. Shofstall. After my first divorce, I wrote a song called “Grace of a Woman” (which became the title track to the last album I recorded in 2012) based on a line from this poem. The repeating line in her poem is “after a while you learn”… During that period in my life, this line most resonated for me:
And you begin to accept your defeat with your head up and your eyes ahead
With the grace of a woman, not the grief of a child
Clearly that was the lesson my foolish heart needed at the time. Yet with one of the classical definitions of foolish being “slow to learn,” there was still more healing to be done…
Within a few weeks after my second husband and I parted ways, I remember standing at the entrance to the grocery store near my home where the florist is located and Veronica’s poem came back to me like a lightning bolt. Specifically the wisdom:
After a while you learn that even sunshine burns if you get too much
So you plant your own garden, and decorate your own soul
Instead of waiting for someone to bring your flowers
Thus, as a ceremony representing the new phase of healing that life was bringing me through, I bought myself that bouquet of the most beautiful pink roses. I brought them home, put them in a vase, and all felt right with the world.
“I can do this,” I resolved, “I can be okay by myself, as I am.”
During the period of initial healing I bought myself flowers regularly to keep reminding myself of this lesson. Truthfully, I fell out of the practice after about six months. I started to feel much better. And then, about a year after the separation, I started seeing someone. Although not to the same extent as in earlier seasons of my life, I noticed some of the same patterns about needing to be wanted pop back up and disturb the peace in my life. Even though I’m slow to learn when it comes to my personal healing, I do learn and I’ve been able to nip much of this potential destruction in the bud.
Getting my latest book Process Not Perfection prepared and ready for publication happened alongside me doing some deep therapeutic digging about the remnants of relational trauma. Healing those wounds has proven to be the greatest process of my life. The day that the book officially released, I allowed myself to sit on my couch, breathe, and take it all in. And then the wisdom inherent in Veronica’s poem came back once again—go out and buy yourself flowers. Celebrate you! Celebrate not just all that you’ve accomplished, celebrate the wonder that you are! Indeed, decorate your own soul…
We can decorate our soul in a variety of ways along our healing path in ways that are not entangled with attachments to others. Even if you are in a committed relationship, please consider nourishing yourself in this way. Perhaps planting a garden is more your style than buying flowers. Do it. Do whatever is going to help you celebrate your own wonder while cultivating beauty in your life. I am worth it, you are worth it. And perhaps if we deepen into this practice of gifting ourselves with the beauty we deserve, we will indeed spread that healing like wildflowers through this suffering world desperately in need of that colorful energy.
Institute for creative mindfulness
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