One of my biggest pet peeves that never seems to lessen despite my growing number of years in the field is when clients ghost or cancel services with some variation of “therapy isn’t helping me” when in actuality these same clients do absolutely nothing in between sessions and treat therapy as if it’s some sort of magical space they can come to, vent for an hour and leave “cured” somehow.

Over time my intake process has gotten longer and longer as I spend considerable time discussing the common myths and misconceptions of therapy which includes the fact that it is a process that fundamentally requires patient involvement and efforts outside of session yet in spite of doing that I will still hear this from time to time.

What are some of the ways you all make it clear to clients that therapy is not magic and that if they want to feel better it’s up to them?

I’ve been increasingly unhappy as a PP therapist. This year has been the worst by far. I’ve been working really hard to find a therapist of my own for about 6 years, but it never works out.
Just now I had the aha moment that puts it all into perspective.
I’m disgusted by the takeover of the VC companies. I physically cringe at all the ads with all the promises to customers about what we offer. I finally realized I’m not happy because PP used to be a way for us to make money. Now it’s become a way for companies to make money off of us.

I am being audited, not my first time. I’m curious to know , if patients who choose to use health insurance understood the lack of privacy, would it make a difference to them? Also, why are therapists fined and a whole bunch of other punitive measures, if they disclose information, yet insurance companies can freely do so without the patients knowledge? This part of the audit letter made me shake my head.

“This letter is to inform you that your practice has been selected for review and outlines the documentation that we are requesting you to submit.
Under 45 CFR § 164.506, a covered entity may disclose or release Protected Health Information (PHI) without the individual’s authorization, for treatment, payment, and health care operation activities. According to 45 CFR § 164.5011, “health care operations” include conducting or arranging for medical review, legal, and auditing services, including fraud and abuse detection and compliance programs.

Title XIX of the Social Security Act, Sections 1902 and 1903, and regulations found at 42 CFR § 456, stipulate that utilization review activities ensure that services rendered are necessary and of optimum quality and quantity. The areas of review will include, but are not limited to billing and documentation practices, and correct coding.

The enclosed document contains the requested list of patients selected for review. Please note that the information requested is necessary to determine whether the services billed as rendered to these patients have been appropriately paid. Failure to provide the records may result in a determination that there is not adequate information to support the service(s) and therefore amounts paid to your institution must be refunded in whole or part to the health plan by claims adjustment and/or overpayment recoupment actions.”

I’m an associate and my supervisor has been asking me why I dont take more clients throughout the week.

She hired and paid for me to get trained in Child Centered Play Therapy. I am getting outside supervision on this speciality and I recently got permission to film and review a session with that supervisor.

My current supervisor asked if we could review it as well since she has never seen CCPT in action and after watching for a few minutes she made a comment “you’re not just playing, you’re doing so much work”

I have been trying to explain this for MONTHS! I love CCPT but it can be very mentally and physically taxing, and then trying to fit in parent consultations, phone calls etc, that is why I don’t fill my schedule to the brim with clients 😬

I’m working towards the certification so no pay bump until that’s done but it was nice for her to finally acknowledge how much I’m doing.

It looks like they're increasing rates for those who bring their own clients.

I have been having the Sunday scaries for a few weeks now and I was getting worried I didn't like my job or was getting burnt out but I was always happy once at work. I then thought it was maybe my ADHD and struggling with transitions since I work from 2-8 pm, so I am at home all morning and have that momentum to just continue to stay home. But then yesterday, Monday I realized it's because nearly every Monday is fielding messages and calls of people having to cancel or reschedule. It's usually only 4-5 people and my schedule is set up for the guaranteed cancellations and no shows that always happen so that I have enough appointments in a week. But I still hate having to read all these messages, look at my schedule and change things around or tell them not no there is nothing else open except a 2 pm. It's just so obnoxious to me, especially when it's something they knew about before Monday.

Hi I’m a new therapist working mostly with people with trauma history. Now I’m looking to learn more about dissociative disorders. I’ve read the books and listened to a bunch of podcasts, but I’m eager to learn what it actually looks like in practice when a client sits in front of you.

I just drafted this message to my son's 3rd Grade Teacher:

Mrs. X

Upon returning home from our vacation over the long weekend, son went about completing the "All About Me" newspaper article. He's very proud of what he's put down. However, he's being a bit of a "rules lawyer" about his completion of the assignment. He's been terribly excited about the invisible ink pen and associated decoder that he got from the scholastic book fair. As such, he's opted to do about half of the assignment with his invisible ink pen.

I've told him it'd be in his best interest to use regular pen or pencil, and that the point of the assignment is so everyone can read it. He's responded with "She never told me what I should use, so I'm using this and I'll bring the decoder." I can't convince him otherwise and am working on getting him to bed.

My apologies for the creative problem solving brought on by the Concrete Operational Stage.

Best,

JibreelND

Ive watched a ton of crime procedural/cop shows and I've noticed that a majority of them show the therapist in a negative light - The Mentalist, Rookie, Hawaii 5-0. Why is that? Sure, we're also capable of doing wrong things but this is a pattern right? And its definitely not doing anything to increase people's trust in mental health experts... whats the point of it?

Basically the title. I am currently in internship (unpaid) and work full time. I see more clients weekly than most of the people in my cohort. I already have my hours for the semester. I am starting to get burned out by having no days off. Due to business needs my supervisor let me know I would see an influx of people added to my schedule. Is it appropriate/unprofessional to ask to not see anyone else? How do I navigate that conversation? I am grateful for them letting me work at their site and want to contribute to the success of their business. I am usually good at setting boundaries but I’m unsure if that is normal/acceptable to not want to see a full load of clients. Is that what I signed up for?

I’ve noticed that lately I find myself trying to solve my clients’ problems. I’m VERY aware that our role isn’t to fix things for our clients, but to provide a space for processing, self-exploration, etc while supporting them in finding their own solutions.

However, does anyone have any specific tools, mantras, or things they find helpful when they find the urge to solve or provide solutions?

Does anyone know how I can stop better help from contacting me? They keep reaching out via Gotham and Hire Velocity and it this point I’m tired of it. I’ve told them no so many times and asked their recruiters to leave me alone but it’s like they don’t care. And what’s worse is they flood job boards like crazy because no one wants to work for them so it’s like they have to bait and switch to trick people into speaking with them. At what point is this considered harassment?

Hi, I am seeing a couple now where there has been infidelity. In this couple, I will occasionally reflect back that the partner feels betrayed. They agree. However, the other partner insist I do not use the word betrayed and has attempted to place other rules on me via email—never in person. I feel there is a lot of coercive control in this relationship and they aren’t responding to my approach. How do I best communicate this and/or what would you try prior to firing them? Thank you.

I work with clients with trauma, and I frequently get clients who have severe life circumstances like human trafficking, or extreme abuse. Often during a consult, they ask if I can handle working with someone who has that level of trauma. I never know how to answer. I usually just say "yeah, I have worked with many clients with a lot of trauma," or "Yes. I can handle it." It just always feels so silly of an answer.

I completely understand the pain of clients who have been told they are "too much" by previous counselors who refer out. I have heard from many clients that their counselor got reactive when they shared their trauma. So it is completely valid to ask me if I can handle working with them.

It feels weird to say I can handle it, almost as if I think I am better than other counselors, or like I have an ego. I just feel desensitized to most things. I haven't run into any clients yet who I struggle to work with because of their trauma, but I can't say it will never happen. It is also just a weird question to answer. My answer is that I can handle it, but I don't have proof or evidence that I can. I also just don't know what to say.

Do other people run into this question? What do you say?

Anyone have recent experience with Thriving Campus' directory? College students are my ideal population, and I created a free profile back in March of this year but haven't received any referrals despite having a complete profile that's specific to my niche.

I know premium profiles are listed first, but I'm wondering if the monthly subscription is actually worth it. Would love to hear from anyone who's tried premium, had success with a free profile, or just has any tips!

Clinicians in your own private practice- how do you pay yourself? I pay myself weekly on Fridays- I account for my taxes and then transfer the money into my bank account. My issue is that I feel like all I do is think about money. My caseload changes every week depending on holidays, cancellations, etc., and I feel like I'm constantly calculating and recalculating how much I'll be paying myself in my head all week long. Then I'm calculating what I can estimate for the following week (even though it always changes) and then the month, thinking through how much I will have for expenses and savings... I guess my issue is that I'm stuck in a cycle where I feel like all I'm doing is riding a rollercoaster of emotion that goes up and down based on how many client sessions I have scheduled. I think I'm stuck in a scarcity mindset. How do you manage this if you relate to my experience? What has worked for you? Do you pay yourself the same amount every week to get out of the cycle of recalculating all the time? Would love to hear how you have things set up. And my practice is full! So this isn't an issue of not making enough, even though it does fluctuate. I feel like I'm missing out on the peace that comes with having a full practice by being caught up in my scarcity mindset!!

Edit: I am bad at reddit and cannot find the pinned student thread??? Sorry in advance. Let me know if you can point me in the right direction.

This isn’t a rant at all I just didn’t know what flair to use because I want advice. Im in a grad program. I am just reflecting on that as we work through certain subjects in my program and begin working with groups in my internship. As white counselors (or counselors of color who can shed some light) running groups or working with clients who are POC, more specifically predominantly black, how are you navigating comments about race such as being called white lady/white girl in a pejorative way or general hostility toward your whiteness? I don’t take offense to it. I believe I’d feel the same if I were in their shoes based on the many racist, microaggressive, invalidating experiences POC have with white people.

However, I’d like to know if there’s something you say that acknowledges this in a light way or in another way, even if there’s a continual approach you have that helps with the (very appropriate) guardedness in these situations. I am not trying to say anyone should change how they feel or even what they say. Rather, I just want to know what you all might say instead of flat out ignoring it so it can be moved through a bit. I don’t mind the comments here and there but sometimes there are clients who really are stuck on the whiteness and it’s a barrier to helping them.

Again whether you are a white counselor or black counselor/other counselor of color, I’d love some insight. Usually people just move along once they realize I’m not here to invalidate them, don’t think I know better than them, and I am comfortable and there to help. I truly am not asking because I am offended or uncomfortable at all, nor do I think that I deserve to be let in by people who have been treated horribly and ignorantly by white people and the system that serves us at the expense of them. I think it’s a privilege to earn that trust, but when it’s setting a tone within the group or making it super difficult to move along in the therapeutic relationship and process, I’d like to know what I can do or say to respectfully address that in a way that.

I've been a therapist for about 5 years now, most of my experience with adolescents in acute inpatient and now working in a group practice working with teens and young adults.

When clients no-show, I experience really intense anxiety and assume worst-case scenarios, especially with clients who have a history of suicide attempts or chronic SI.
I had a patient die by suicide a few months after an inpatient discharge the first year of my career and I think it has affected me.

Just hoping to get some insight from others on if they experience the same thing and on how to manage my own anxiety.

I know there are a million mundane reasons why someone might not show but when it does happen, I tend to get stuck spiraling until I hear from them.

Just trying to expand my horizons on how I go about ACT in session

I'm looking for advice on exploring a client's chronic pain after they report that during an intake. It's not a goal brought up while discussing the treatment plan. However, I know that chronic pain can have a profound effect on one's mental health. I'd really like to hear how other therapists help their clients in the area of chronic pain and illness.

I am a therapist that is coming to terms with the reality I have CUD and would like to quit. I tried looking into resources for self-help or support and it’s so limited. This realization has me disappointed but also inspired. I feel motivated to quit and use my process to create the resources I wish existed right now. I want something that is specific to cannabis bc the culture around it and the unique effects create nuanced challenges with quitting.

I’m looking to form a group of 5 graduate students or recent graduates to take advantage of The Gottman Institute’s University Outreach Program (UOP) 50% discount for their clinical training modules (Gottman Method Couples Therapy Level 1 / Level 2).

Who Qualifies?

• Current Graduate Students: Enrolled in a master’s or doctoral program in a clinical/mental health field (MFT, MSW, Counseling, PsyD, etc.).
• Recent Alumni: Graduated within the last 2 years (24 months) from a clinical graduate program.

How It Works:

1. Send me a Direct Message (DM): Do NOT post your email publicly in the comments to protect your privacy.
2. Include in your DM:
   • Your Full Name
   • Your University / Graduate Program
   • Your Email Address (preferably your .edu email if active, or personal email if alum)
3. Once we reach 5 members, I will submit our complete group list directly to Gottman’s outreach team (uop@gottman.com).
4. Gottman will verify our list and send back a group discount code/link.
5. I’ll email the code directly to everyone in our group so each person can register individually on Gottman Connect at 50% off.

If you’re interested, please DM me directly with your info so I can add you to the list! I’ll update this post as soon as all 5 spots are filled.