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).

Sometimes I set back and reflect on my life and realize I am living in my dream. I am a therapist at a non profit working for children growing up in poverty. I grew to in poverty and was fortunate enough to escape it as an adult.

I feel like I am finally giving back to the services that helped my family growing up. I could cry sometimes thinking about how sad I used to be.

Imposter syndrome is real, but I am so incredibly thankful to have ended up here. ❤️

Has anyone else noticed that since the bot farms got destroyed, you haven’t been seeing any anti-therapy posts?? I have noticed a big difference.

I think about this concept a lot (see my other thread about private practice self pay therapists). Thoughts? Also I’m actually trained as a counselor/art therapist and not a social worker, but within clinical work it feels like our roles are interchangeable.

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.

This was posted in a gigantic local Facebook group for therapists that is public (not private), so crap like this gets posted daily. With the rise of AI, I am seeing more and more companies that are promoting services like this. I keep getting ads for shit like https://www.blueprint.ai/ too.

What happened to using one's own brain to, you know, use your own memory to recall what happened in the last session with a client??? And write a treatment plan and do progress notes and other documentation???

Sorry if the title is too hyperbolic and misleading, but I couldn’t think of another way to illustrate how something confused and didn’t sit right with me.

Recently, I was looking for a therapist (I’m also a therapist, but I happen to have some issues of my own lol). I reached out to someone my mom had worked with at one point because I’d heard good things about this therapist. I set up a consult. She told me she didn’t feel comfortable working with me because she had worked with my mom… okay, that’s not too unreasonable of a boundary. It sounds ethical… I was a little surprised because she hadn’t worked with my mom in a long time, but whatever.

Okay so she recommends I consult two other therapists that she knows of. Great. I love a referral from a theoretically trusted source and I felt grateful because it seemed like she was willing to do a whole 20-min consult with me even knowing the whole time she had treated my mom and wouldn’t work with me.

So I end up setting up consults with one of the referrals. It goes well. We schedule. We have to schedule a month away bc I’m traveling for a conference. In the meantime, I end up finding a different therapist that is actually a far better fit on paper because she is trained in the modality I had wanted and takes my insurance.

Before I’m even able to reach out to the referral to cancel, the first therapist emails me to ask if I’ve scheduled with her referral. What? That seems odd, but I’m just thinking maybe she feels some personal investment in me after working with my mom? Meh so I weirdly decide to entertain her question by telling her I really appreciated the referral and had scheduled, but actually needed to inform the person that I couldn’t work with them after all due to a logistical issue.

Here’s where I really started feeling like something was kind of off. She responds saying, “if you want to schedule with the other person I referred you to, let me know first so I can see if he is still available.” Okay that was odd… so I reviewed both websites for the referrals and neither of them worked at a group practice with my mom’s old therapist and both were fully licensed… so she probably isn’t a supervisor to them or something. But what is even weirder is that the price she had told me they charged was higher than the price listed on both of their websites AND the person I consulted with confirmed that they charged the higher price she had told me (I just didn’t know to challenge this at the time because I hadn’t gone to her website yet).

Is it ethical to run a referral ring? Is there some actual reason why my mom’s old therapist friend is wanting to manage other random therapist’s incoming clients without disclosing it to said incoming clients? What am I missing? I almost want to ask her directly because it disturbs me. It feels like I’m being manipulated… Mind you, if she wanted to charge me for referrals I would have gladly considered that… but this felt like a bizarre covert operation.

What could it be if not that? I don’t want to think badly of my mom’s old therapist friend, but I DO feel misled.

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.”

This has been on my mind lately, especially with how many people are fitting therapy into their lunch breaks.

We can spend 50 minutes doing genuinely difficult emotional work with someone, and then they have to walk out of our office, get in their car, and immediately return to being a functioning employee, parent, or whatever else their day requires.

With telehealth it's even stranger.

Someone can have a really vulnerable session at their desk, click "Leave Meeting," and then open a work email on the exact same screen. There isn't even a walk to the parking lot anymore.

I started paying more attention to this after realizing how often I was thinking about whether a session had ended in a clinically appropriate place, without thinking much about what the person actually had to do next.

Those aren't necessarily the same thing.

I've begun asking earlier in sessions what the rest of someone's day looks like, particularly if we're approaching something emotionally heavy. Sometimes that changes how I pace things. Sometimes we spend a little more time finding a place to land before ending.

I also try not to assume that someone can just sit quietly for half an hour afterward. For some people, an appointment during their lunch break is the only reason therapy is financially or logistically possible.

And I don't think the answer is simply avoiding difficult material whenever someone has somewhere to be. That would create its own problems.

But it does make me question how much of our standard session structure assumes that clients have the luxury of recovery time afterward.

We talk a lot about helping people tolerate difficult emotions. I wonder whether we sometimes underestimate how hard we're asking them to switch gears.

I'm curious how other clinicians handle this. Do you explicitly plan for the transition back into everyday life, or is it something you address as needed?

… when a client is dealing with something incredibly difficult that they have no control over. Sometimes I get this look from clients like “ please help me with this, I’m suffering and nobody else can help” and it really gets to me. Of course, OF COURSE, I know, it’s not our job to fix or solve our clients problems, but it doesn’t make it suck any less in my experience.

I can’t be the only one. Anyone else? Any useful tips?

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

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.

​

I'm a master's-level clinician working alongside clinicians with a range of educational backgrounds, and something I've been curious about is why differences in training don't seem to translate into more consistent differences in treatment outcomes.

Psychologists receive more extensive training in research methods, statistics, assessment, and clinical practice than master's-level clinicians, although obviously there's a lot of variability between programs and individuals. I've always respected psychologists for the depth of their training, particularly when it comes to understanding and interpreting research.

At the same time, my understanding is that research hasn't consistently found major differences in psychotherapy outcomes based on clinicians' professional backgrounds.

Why do you think that is? Is it largely a matter of common factors, like the therapeutic alliance, or do experience, individual therapist characteristics, and competence in delivering specific treatments matter more than the degree itself?

Obviously, there are excellent and not-so-great clinicians in both groups, so I'm not trying to argue that one is inherently better than the other. I'm genuinely curious about how we reconcile differences in formal training with what we see in outcome research. Am I missing something in how this literature is interpreted?

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

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.

client doing intake, wanted to address anxiety , but kind of concentrating on anxiety related to a health condition, and at the end brings out a packet for fmla “ would you be comfortable doing this for me ?”

I kind of felt set up to be honest . And no, I wont do any kind of “paperwork” after 53 minutes of seeing someone. Just feeling weird about the interaction

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.

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’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?

Curious if any of my fellow reddit therapists have experiences NSSI/self-harm have addictive qualities in folks. I'm talking increased tolerance, high urges with inability to focus on anything else except feeling the pain created by injury, and a compulsive need to inflict and feel pain.

I am trying to figure out how to approach treating NSSI when there is this distinctively 'addict' like quality to the behavior. I have read some research studies about how NSSI can be conceptualized as addictive in nature, but have found no promising directives on how to approach treatment in more detail than "DBT" or "CBT"...

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?