Carlton L. Quarells, PhD
The transition from clinical training to private practice small business entrepreneur is fraught with challenges, setbacks, and opportunities. The skills acquired in graduate and post-doctoral education generally do not prepare most psychologists for the world of private practice (El-Ghoroury, 2011). This journey is particularly challenging for black male psychologists, as African-American role models are few and far between. In this article I will address some of the unique challenges facing African-American males in the world of professional psychology, as well as the benefits provided by working with the mentors who have assisted me in my career. Most fortunately, while enrolled at Wright State University School of Professional Psychology, I was blessed to have two prominent African-American psychologists as mentors. Dr. James E. Dobbins was my advisor and dissertation chairman. In addition, Assistant Dean Dr. W. Rodney Hammond and several other administrators and professional support staff represented a wide-range of professional African-American men in various roles within the university community. These men served as role models and many are now colleagues.
As I reflect on my career thus far, I would be remiss if I did not provide some context to my early educational opportunities and my family background. As the youngest of seven children I, like many of my childhood friends and current colleagues, did not know my biological father. While growing up between Lincoln, Nebraska and Houston, Texas, I was a Head Start participant in my early education, which speaks to the level of income and lack of resources available to my family. Fortunately, over the course of my high school and college experience, educators imbued in me a love of learning. This provided me with a rare advantage. African-American students whose backgrounds include a family constellation and economic situation similar to mine face lamentable odds in being able to earn a doctoral degree in psychology (Belgrave & Allison, 2010). Unfortunately, current social and economic trends in the United States do not suggest we are improving these odds for most students of color.
After completing my undergraduate degree in psychology at Fisk University, I was accepted to Wright State University School of Professional Psychology. As with most Doctor of Psychology (PsyD) programs, Wright State accepted approximately twenty-five students per year into the program. In my cohort, the class of 1991, there were four African-American students in the class. Of the four African-American students, I was the sole male. This pattern was similar in the two cohorts preceding mine, each of which had two African-American males. I was very fortunate that Wright State promoted and made a commitment to diversity throughout the School of Professional Psychology. In addition, the program established an informal Big Brother/Big Sister program in order to assist first year students in their adjustment to graduate school. My big brother, Joseph Green, was instrumental in providing support throughout my graduate school years. Joseph was able to provide critical advice on developing effective study habits, what to expect from professors in upcoming classes, and the books to purchase for various courses.
In addition, as most students new to graduate school can attest, being able to secure decent and affordable housing is challenging. At the time I was looking for housing, two African-American male students from Wright State University School of Medicine were looking for a third roommate to share a house. After a brief conversation with my still good friend, Marcus Griffin, I was able to secure affordable and quality housing with these two African-American graduate students for two of my three years in the Dayton, Ohio area. Upon reflection of this experience, my housemates were an extended family and provided the mentorship to navigate both personal and academic challenges throughout my graduate school years.
The academic and professional support offered at Wright State University was interwoven into the course offerings and the practicum experiences. Perhaps one of the most professionally rewarding experiences occurred while working as a practicum student with the Positive Adolescent Choices Training (PACT) program designed by Dr. W. Rodney Hammond. The PACT program was designed to address the high incidents of violence and aggression in African-American middle and high school student populations. This pilot program took place in a middle school in Dayton, Ohio, and was coordinated with the Dayton public school system. Our role was to identify and work with students in a social skills training program. Students were selected based on teacher ratings and recommendations, identified as evidencing limited social and interpersonal skills, or coming from families whose members were victims of violence (e.g. a family member wounded, seriously injured, or murdered). Findings from this program were eventually presented in various publications and formed the basis of a training program for violence prevention published by Research Press (Hammond & Yung, 1991, 1993). In developing the PACT program during my graduate training, we considered risk factors as well as protective factors. The Office of the Surgeon General’s Report on Youth Violence (2001) provided a framework for classifying domains or spheres of influence in the adolescent populations. Individual, family, school, peer, and community group are common domains of adolescent support. Some identified individual risk factors for violence are low socio-economic status/poverty, exposure to television violence, anti-social beliefs and attitudes, and poor parent-child relations (Office of the Surgeon General, 2001). Additionally, Hammond and Yung’s (1993) findings suggested African-American male adolescents are frequently at increased risk for death or significant injury from assaultive violence. In developing the social skills in this population of students in the Dayton area, we sought to develop some protective factors. For example, having a positive social orientation, such as negotiating conflicts, providing peer support, as well as parental monitoring, commitment to school, and warm and supportive relationships with parents and significant adults in the lives of students are commonly some of the protective factors in the lives of African-American male adolescents (Office of the Surgeon General, 2001) that we incorporated into our program.
The program afforded me an opportunity to learn the process of community-based research from an experienced and dedicated leader in the field of youth violence in Dr. Hammond. This mentorship with Dr. Hammond started prior to my enrollment at Wright State University. Before his tenure at Wright State, Dr. Hammond was a professor at Meharry Medical College in Nashville and a colleague of my undergraduate advisor, Dr. Carrell Horton, at Fisk University. Dr. Hammond was in contact with Fisk University in his previous role at Meharry and happened to be in the Nashville area recruiting potential graduate students. These fortunate coincidences ultimately led to my application and eventual enrollment at the School of Professional Psychology. The theme of mentorship has been a consistent part of my career as a graduate student and psychologist.
Another opportune moment in mentorship developed at Wright State University where I led a support group for African-American male undergraduate students on campus, named “Black Men on the Move.” During my years at Wright State, of the 20,000-plus undergraduate student body, less than 5% were African-American, and less than 3% of those were male. At the time, fewer than fifty percent of the African-American male students graduated within five years of their initial enrollment (Quarells, 1989). Prior to commencing my role as the group leader, I received training and guidance from Duke Ellis, another African-American student and former group leader. My advisor, Dr. James E. Dobbins, provided the necessary academic and clinical supervision to lead these bi-weekly support groups. My experiences were consistent with research (Bridges, 2011; Utsey & Elligan, 1999; Utsey & Payne, 2000) that provides compelling validation for the observation that robust and consistent social support networks and mentorships are vital for African-American male students to successfully steer through majority white colleges and universities.
Network Development and Getting Started
The transition from graduate student to full-time practitioner is challenging. Financially, in addition to the burden of graduate loans, there are significant costs associated with applying for licensure and establishing a practice. Dittman (2004) reported graduate students who sit for the Examination for Professional Practice in Psychology (EPPP) soon after completing their graduate education tend to achieve a higher test score than those who wait a few years after completing graduate school. In my personal experience, I initially applied and was licensed in the State of Maryland. At the time I took the examination in the mid 1990’s, Maryland’s cut off score on the EPPP was higher than most states in the country. The expense of applying for state examinations and purchasing optional study material typically can range from $500-$3,000 (Dittman, 2004), which may pose an additional burden on minority students.
In spite of the investment of years of education, passing licensure requirements, and other accomplishments, there is little to inform the aspiring practitioner about how to begin a business. It is especially difficult for African-American males simply because of the extremely small number in practice, thus a natural lack of mentorship exists. These numbers, in spite of attention paid to diversity within the profession, have remained stubbornly low over the past several decades. In 1995, a survey of approximately 5,000 practicing psychologists indicated that 1.5% identified as African-American. In 2003, this figure was a mere 0.7%. It increased slightly to 2.5% in 2009 (no breakdown by sex was provided; Greenberg, Caro, & Smith, 2010). Other recent licensure data also point to the very small number of ethnic minority males in practice. In 2007, the American Psychological Association conducted a survey of early career psychologists. The total number of ethnic minority males (ethnicity not disclosed) who responded was 8%. Among those ethnic minority males only approximately half were licensed (American Psychological Association, 2008). A 2009 survey from the American Psychological Association revealed that less than one percent of the respondents nationally of African-American descent (the data do not specify the gender of the respondent; Michalski, 2011) were employed in full-time private practice settings. These data are not inclusive of psychologists working part-time or in multiple settings.
Most of my African-American male colleagues in private practice methodically developed practices through collaboration with former supervisors, professors, and colleagues. My initial foray into private practice occurred while working full-time in public psycho-educational program for the District of Columbia government. I met my former colleagues at an annual meeting of the Association of Black Psychologists in Philadelphia (I met my eventual wife at this conference as well). This practice was located in Northwest, Washington, D.C. near the former location of the Walter Reed Army Medical Center. At this practice, there were three African-American male psychologists (myself included) and four African-American females. Referrals were typically generated from within the practice as well as from community contacts, insurance panels, and often by recommendations from former patients in the greater Washington, D.C. community. I received and continue to receive referrals from the families of church members as well as from pastoral staff of my local church, both in Washington and in the city of Atlanta. A reciprocal and collegial relationship with faith-based counselors as well as pastors and ministers has been useful in understanding the needs of communities I have served in my career as a psychologist. Novotney (2009) profiled the career of Baltimore, Maryland psychologist Dr. Grady Dale. Dr. Dale makes a compelling case for psychologists partnering with the local community in order to develop meaningful interactions and ways to assist in uplifting the communities in which they live. Additionally, working in a group psychological practice as an early career psychologist will allow both formal and informal professional supervision, case collaboration, and the initial referrals needed to build your private practice.
One obvious advantage in joining an existing practice is that it is likely to have established a market presence and a referral network. However, if the objective is to start on your own, marketing creativity is essential. Some clients have informed me at the onset of treatment they specifically asked their respective insurance plans if they had African-American male psychologists in their provider networks. However, some plans are not allowed to disseminate or categorize this information in marketing materials. Having a picture of yourself as well as a description of the scope of your practice will allow for consumers to better find your services in the marketplace.
As an African-American psychologist specializing in providing services to children and adolescents, an increasing number of African-American parents and parents of bi-racial children are seeking my services with issues related to bi-cultural and bi-racial identity and racial discrimination. Testing services are also a distinguishing niche and talent that can be provided to consumers seeking our services. Developing an expertise in providing quality assessment services will often lead to consistent referrals from health service providers such as physicians and social workers and non-health service providers such as clergy, as well as educational institutions. Typically, we used well-normed tests of psychological measurement (e.g., Stanford-Binet scales, Wechsler scales) when working with our predominately African-American practice clientele. However, many parents are often understandably concerned that their child would be negatively labeled by the educational system if the child was determined to have an emotional or educational limitation. Due the disproportionate numbers of African-American boys receiving special education services, African-American parents are often reluctant to consider testing which may result in the placement of their children in this type of educational environment (Fine, 2002). Additionally, once children are placed in special education, they often remain there for the remainder of their educational careers (Daniel, 2008). Parental anxieties regarding misclassification of a child can be allayed by appropriate use of testing by a culturally competent provider.
One of the more cost-effective strategies I use to emphasize my gender and ethnic identity is social media (e.g., Twitter and Facebook). Of course, appropriate caution in the use of client testimonials and reviews of services is needed, and it is essential to remain in compliance with both HIPAA and ethical requirements. Another cost-effective marketing strategy is the use of online referral websites which allows for links to your practice website and list your practice via zip code search. Having a picture of yourself on a website will identify you as an African-American male psychologist. In light of data that generally support more positive therapeutic outcomes for racial and ethnically matched clients and therapists (e.g., Cabral & Smith, 2011; Walling, Suvak, Howard, Taft & Murphy, 2012; Ibaraki & Hall, 2014), therapists’ photographs may be an important client selection tool.
Maintenance and Growth in Private Practice
African-American males may need to utilize different strategies than other professional colleagues in order to grow and sustain a practice. For example, Cheng, Kwan, and Sevig (2013) found that minority college students experienced higher levels of perceived and self-stigma in seeking psychological services, but that high levels of ethnic identity among African-Americans lowered perceptions of stigma. African-American therapists, therefore, may be uniquely positioned to offer services to African-American youth who might otherwise avoid seeking help.
As new African-American psychologists develop their practices, it is incumbent upon them to find ways to develop the necessary skills to expand such practices, particularly if they intend to work with predominantly African-American clientele. Such resources are not always easy to access. Many states now require continuing education in the area of diversity, including ethnic and racial diversity and it is, of course, important for psychologists of all ethnicities to stay abreast of current research addressing work with ethnic minority clients. But in addition to scarce ethnic-specific practice guidance, it is equally important to stay abreast of changes in reimbursement rates for various health plans, particularly in client groups not traditionally well-insured, and updates to psychological tests administered within ethnic norms.
Analysis of specific revenue streams is also important. Most psychologists have multiple roles and revenue streams that typically maintain their practice (El-Ghoroury, 2011). For African-American psychologists, veteran services is an area of potential growth and opportunity. With a large percentage of African-American military personnel (roughly 21% of enlisted Army personnel are African-American; Defense Manpower Research, 2013) the services that culturally competent psychologists offering African-American perspectives provide are in high demand in areas where large military populations exist. Working with this population may be particularly important in light of research suggesting that Post-Traumatic Stress Disorder is underdiagnosed and undertreated in African-American populations (Graves, et al., 2011).
In closing, there are ample opportunities and a considerable need for culturally competent African-American male psychologists to expand our role in various private practice settings. Hopefully, we will see this historically underrepresented portion of the mental health workforce grow, and with it enhanced treatment options for clients of all ethnicities.
Dr. Quarells is a graduate of Fisk University and the Wright State University School of Professional Psychology. He is a licensed Psychologist in the state of Georgia, and the principal and owner of Quarells Consulting, P.C. He has been in private practice in the Atlanta area since 2002. Dr. Quarells has clinical expertise in psychological testing, individual, and family psychotherapy. He also has experience and expertise in coaching services with amateur and professional golfers in the areas of mental game coaching and performance enhancement.
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