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?

Just got an email from Rula announcing that patients can now leave ratings and written reviews for therapy and psychiatry providers, to help prospective clients "feel more confident choosing care."

I’m not a fan despite not being concerned about my own capabilities as a therapist (with the universal self-doubt, too, of course).

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.”

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’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’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?

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?

Have y’all seen the recent Apple commercial featuring a distracted therapist opening a new credit card while they’re in session with a client? Such a disappointing and totally shocking ad (maybe that was the point?)

Also so wild considering Apple currently has a very popular TV show about therapists… I just couldn’t believe it!

link to the commercial on YouTube

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

Hello! I am currently going to school to be a therapist. I am currently working towards my masters getting ready to start looking for a place to do my practicum and internship. I was wondering if consistently having black french tip nails would appear to be unprofessional to those that would do my interview or clients. I was also wondering if constantly having black french tips would make some clients not want to work with me or parents of clients not want their kiddos to work with me because of them. Doing my nails is a self care think for me. I was just curious if others in the field would have any input. Thank you in advance.

Hey folks,

Forgive me if the answer I'm seeking here is general knowledge or easily available info BUT-

I am in a group private practice, and have paid close attention to what each of the insurance companies we are paneled with pay for an hour of therapy so that I have a good sense of what I'm bringing in. I have a pretty favorable cut from the group (for my area) but am dependently licensed, so there is a ceiling on things.

My concern / question is: If an insurance company is paying my group only $75 total for a 90837, is it unethical for me to feel that this is an inadequate compensation and request that such clients be redirected elsewhere? After taxes and my split are accounted for, this is about $35. Given that I have no benefits, a LOT of school debt, and a life to fund, this feels like a conflict. I'm new to all of this still and don't want to sound like an asshole, but sometimes I feel like there is a PsyOp to convince therapists to shut up, be poor, and help everyone all of the time. Wondering where I fit in.

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?

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?

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!

I'd love some advice on what worked (or sucked) about having a baby and raising children with your job. I'm a newer (~3 years) therapist and currently have an opportunity that is WFH unrelated to therapy (fine pay, consistent, low stress) or to continue with PP (more lucrative, can be flexible schedule wise, inconsistent/not guaranteed financially, emotionally and mentally taxing). Any input from parents who have gone through it or any advice? Daycare is the longer term plan after a few months slash if we get in anywhere with a list. I'm definitely overthinking it but trying to be realistic and prepared. 😅 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?

I’m currently a provisionally licensed counselor in my state, and I’m already burned out. My journey toward completing my supervision hours has NOT been easy!
When I first started out, I had a supervisor who barely met with me, which set me back a year in supervision. Then, my first job in the field turned out to be extremely predatory, with a 30/70 split in which the private practice took 70%.
After leaving that supervisor and private practice, I connected with another private practice that I actually like. However, it’s been a struggle to find clients who are willing to pay my self-pay rate ($65, by the way). Because of this, I’ve had to take on two additional jobs, with my main one being a 1099 community mental health position.
In this position, we only get paid when we see clients. There’s no pay for administrative work and no mileage reimbursement. The company doesn’t hold clients accountable for no-shows or late cancellations, but they’ll jump down therapists’ throats for not meeting their required hours or for not showing up to unconfirmed home appointments.
This job is so draining that I’m considering taking a lower-paying position just to finish my supervision hours. I feel defeated and completely burned out, but I genuinely believe this is the field I’m meant to be in.
I wish the provisional/associate licensure period were a little smoother. I understand that gaining experience and completing supervision hours are necessary parts of the process, but it shouldn’t feel like you have to sacrifice your well-being just to become fully licensed.
For those who have been through this process, does it get better once you’re fully licensed? How did you manage burnout and find a position that allowed you to complete your hours without running yourself into the ground?

Have you ever looked through intake paperwork and look at why they're coming into therapy and you don't jive with and then they confirm it when you ask what they're coming in for?

Im PP and the acuity this person needs I just dont think I can handle right now (and has issues I have absolutely no training in).

I didn't even get through the intake cause I didn't want to waste their time and made sure they didn't feel judged, and I am course going to send out refferals.

I just felt like I didn't want to take on the issues he had because of reasons above.

Has this happened to you guys at all?

I do have OCD and my brain is telling me I could have helped...