How I Got Here: A Social Worker's Road to Practice

Lex Enrico Santi, LCSW, MFA

I didn’t always know I’d be a therapist. In fact, my path here started with words—stories, poems, voices that needed to be heard. I began my professional life as a writer, earning an MFA in creative writing and devoting myself to stories that revolved around justice, identity, and the quiet struggles of ordinary people. Long before I had clinical tools or therapy techniques, I was practicing the art of listening—deeply, intentionally—through the lens of story.

But something kept pulling me toward people—not just their narratives, but their healing. I was the guy at the party who skipped the small talk and ended up having hour-long conversations about someone’s life. I didn’t always know what to say, but I knew how to hold space. Over time, that pull became a purpose. After 30 years of walking the earth, I realized helping people was the only thing that made sense.

So I went back to school. I trained at the Brown School at Washington University in St. Louis, one of the top social work programs in the country. It was a big move from central New York, but I went on a scholarship and committed to learning how systems work—and how they break. My field placements reflected my passion for justice and community: supporting diversity administration, working with international students, and providing therapy in a bipolar clinic. I focused on serving marginalized and underrepresented populations from the start.

Social work has a proud legacy. It’s the field that brought us the five-day workweek, after all. At its best, social work means stepping into messy systems, advocating for people who are overlooked, and offering support both big and small. Calling myself a social worker means I do everything from helping someone write a resume, to talking through a divorce, to calling thirty landlords to find safe housing. It means helping a 17-year-old plan for college while holding space for someone navigating loss, change, or uncertainty.

After graduate school, I took a role at Cornell University supporting international travel safety—a high-pressure job that required crisis management around the clock. Over time, though, I realized what lit me up wasn’t the logistics of international work. It was being present for people. I joined Cornell’s crisis team and began supporting students in distress. That’s when it really clicked: this was the work I wanted to do. When I was told I could no longer do the direct student support, I knew it was time to move on.

In 2017, I joined Family & Children’s Services of Ithaca. Within weeks, I felt at home. I built a full caseload, seeing 25 to 30 clients a week, and I loved it. I had studied the frameworks—CBT, IFS, MI—but it was in the room, person to person, that I found my voice. I drew from my writing background, blending narrative and mindfulness to help clients make sense of their lives. My practice spans ages 17 to 70, and I work with a broad range of issues.

By 2020, I launched my private practice and consulting/coaching company. I still contract with colleges, but my passion lies in one-on-one and small group work. I use a range of modalities—Cognitive Behavioral Therapy, Internal Family Systems, Narrative Therapy, Motivational Interviewing, strength-based approaches, and Mindfulness. If there’s a common thread, it’s presence: being deeply, mindfully with someone. I explore the roots of these methods more in other posts.

Philosophically, I’m grounded in existentialism, spirituality, and compassion. I don’t reduce people to diagnoses. I believe we are all here to learn. Life gives us challenges, and when we avoid those lessons, we get stuck. That stuckness—that’s often the entry point into therapy.

Alongside my clinical work, I remain committed to writing. Between 2005 and 2015, I founded and ran Our Stories Literary Journal, a publication committed to giving thoughtful feedback to every writer who submitted. Whether accepted or not, writers received real responses—sometimes a few lines, sometimes page-by-page critique. It was radical in its simplicity: everyone deserves to be heard.

Since then, I’ve published books of poetry and prose. My creative work continues to echo the themes I explore in therapy—healing, identity, struggle, transformation. My life as a therapist and my life as a writer inform one another. Both require honesty, vulnerability, and a deep respect for story.

That’s how I got here. And the road keeps unfolding. Thanks for walking it with me.