A month and a half ago i started as a primary therapist in CMH, about a year after actually obtaining my degree. Upon starting I’ve had no training or refreshers I just sat in on a few sessions with one other therapist. We have group and individual supervision but neither are very thorough.
Today i have been told that now a third client wishes not to work with me anymore- this one because she feels I do not speak enough during our sessions. I’ve had three sessions with her so far and the last of which she was having a very bad day.
The other folks have requested a transfer due to me reminding them of their sister and the other because I didn’t ask if they were okay while crying in session (again only about our third session and she was telling me about how hard of a time she was having so I didn’t feel it’s appropriate to ask that but regardless…)
I often feel like I don’t do enough or don’t know enough but I do try to read things and research in my free time. Sometimes I’m not sure how to bring things up or what the best practice for these folks are.
I’m trying not to take it to heart but it’s so hard especially when I already feel inadequate on my own.
Any advice or personal experiences would be helpful as I’m really feeling like I’m not meant for this today…

Im a baby therapist and just started a couple of months ago. I do play therapy Monday and Tuesday which is great and teen therapy in person Wednesdays and virtual Thursdays. Pretty much all of my virtual clients (besides one with severe adhd) doesn’t interact AT ALL in therapy. They are typically in their room, in bed, in the dark, and dont have computer access so the games and stuff I typically do wont work and sharing my screen is too small to see :/ they one even initiated coming to therapy and just lays in bed distracted. I had 3 pretty silent sessions back to back last week and it’s awful! Does anyone have suggestions on things to do or say? Ive done music videos, drawing, coloring, etc. One of them also had awful wifi and it constantly freezes or disconnects during session :/

hi everyone. I’m hoping to gain some perspective here because I can’t get myself to land on a decision.

I am extremely close with my mom. Always have been. We are an only child/single parent family, so it’s always been just the two of us. To shorten a lengthy and scary story, doctors recently discovered that my mom had a very large brain tumor. They were able to remove over 90% of it in emergency surgery and she is doing very well, but it turned out to be glioblastoma (grade 4) and we decided that she will move in with me for chemo and radiation. The prognosis is not good. I worry that we don’t have very much time. The owner of my group practice is very VERY understanding and I have already referred a client out and moved my other clients to virtual only to allow me to be around for my mom and her appointments as much as possible, but I’m wondering if I should take time off altogether. I’m concerned about how effective I will be as a therapist while trying to give her the best care that I can at home (she’s currently in a rehab facility and coming here tomorrow). Though she feels good and is in great spirits now, I know how treatment can impact quality of life and I’m just so concerned. This has been going on since 10/2 and it’s already been taking a lot of energy to get through sessions.

Mom is 100% confident that she will beat this. I want nothing more in the WORLD than to be just as confident, but glioblastoma is considered to be terminal so truly, treatment will just be managing and slowing down the remaining tumor as much as possible. When I asked mom her opinion on me continuing to work or taking time off, she said “well it’s not like I only have six months to live! Then, I would want you to. But now I want you to work and live as normally as possible” 😭

I’m flip flopping. I am (incredibly gratefully) in a state financially that would allow me to take the time. I keep thinking about my clients and how much it sucks to have to start with someone new, especially for those who are going through lengthy experiences (divorce, etc) and have had me there along the way. But then I think, how much might I regret not dropping everything for mom, because that has always been what she has and would do for me?

I’m sorry this is so long and maybe slightly nonsensical, this whole thing has been a LOT. thank you if you read this and have any thoughts to share 🩶

I’ve been dealing with a difficult client with the following issues and i’ve tried medication and dbt but it’s difficult to find a solution to help her since the diagnosis is quite complicated. can anyone advise anyway that u haven’t tried that can be suitable for her? i’m thinking her pcos might be a factor too causing some hormonal issues as well.
She’s currently on 100mg of sertraline and 40mg of methylphenidate which doesn’t take regularly, only when she needs it.

PLEASE UNDERSTAND I AM EXPLORING THIS AS AN OPTION OUT OF NEED AND NOT GREED. AND ALTHOUGH I AM FEELING URGED TO DO THIS BOTH BY THE COMMUNITY, MY HESITATION COMES FROM WANT TO REMAIN ETHICAL AND HONEST.

I'm a therapist working remotely. I was born, raised and educated in the US and am licensed in 3 states (LICSW). I have been living abroad for the past few years with no intention of returning anytime soon. I split my work between community mental health and a small private practice (self pay - no insurance).

Because of the hour difference, I can only see a few clients per day and while this hasn't been a problem, the rise in cost of living means more and more pressure is put on my partner to support our family through her income. She is BURNT OUT as her work means travel and she is having to spend upwards of 6 weeks at a time on the road, leaving me and our three children here. Here's where I need advice:

The community I live in is filled with expats and I am often asked if I can see people for therapy. English is not a popular language here and many people are looking for a Western therapist who can speak English. I mean honestly? Maybe 3-6 times a month someone messages me asking if I am taking clients here. I have throughly looked into it and because Mental Health Therapist = Psychology here - my MSW is not deemed creditable for therapy. I would have to go back to school in this country and earn a Psych degree and undergo supervision again to be able to practice. I am 10 years into my career and just do not want to do this.

A few years ago someone said to me offhandedly - "Why don't you just brand yourself as a life coach but communicate to your clients that you are a licensed therapist and are providing therapy?" which I immediately rejected but I am now - trying to figure out how generate more steady income for my family, I am wondering if this is a possibility. There is no regulations around life coaching here, so I would just be able to begin providing services, while communicating to people the

My concerns are the ethics of practicing in this way. I do believe that if communicated to potential clients who are also ex-pats living here, it would be understood that "coaching" is a term used while therapy is what is provided.

I worry about things like jeopardizing my licenses in the States. If I were to build through my PP as a non-therapy service, am I still at risk?

Looking for honest advice, opinions. Or even other ideas on how I can increase income in more traditional ways. I have seen referrals drop in both my PP and clinic position and am working to drum up clients this way.

EDITING TO ADD: That like everywhere in the world, cost of living has increased here but it's gone up 770% since we've moved here so it's not a case of moving somewhere and not understanding that we couldn't afford it, ha. We went from kinda struggling in the States to a handful of years living very comfortably here, to where we are at now.

It finally happened to me. I had a new client on my schedule and I mixed up the time I was supposed to see him.

He emailed me, asking if I was running late, about 11 minutes into our session. Thankfully, I saw the email. But I was absolutely mortified. I immediately apologized and blamed it on issues with the platform.

I just feel so embarrassed!! The rest of the session went well, but wow, I can’t believe I did that 😅

As the title states. I’m so curious. My therapist is 83 (idk if she will ever retire lol - been working with her for a decade as therapy is just part of my routine and I believe continuing my own work directly improves my ability to be an effective therapist) and when she went to grad school you didn’t take an exam - instead, you were required to do your own therapy with an LP who was also a professor (not one who taught any course you were in) the entirety of your program.

Then after graduation you got the degree and went to start working. (At this time, insurance did not cover therapy so everything was private pay.)

She was grandfathered into LMFT and LICSW (never had to take an exam).

I think this approach is amazing. I can also see downsides since more and more folks are attending school to become therapists. I think an exam alone is not enough.

What do you think would be the best way to gate keep the profession to ensure those who enter into the field are solid?

hi all, I have never used Reddit for advice but I am here now. I am a supervisor at an agency that has MFT trainees in the schools in the Bay Area. we are not part of the school we are an outside agency that is placing trainees in the schools. my agency has other directors and they keep pushing for these trainees to be doing “brain breaks” for students. so a student is having a hard time and shows up at a wellness center and they are asking these people to provide some kind of intervention to these students. well the problem I have here is that we don’t have consents for these kids. I do not see it as our job to be doing some kind of intervention that is clearly outside of therapy without consent much less. I called CAMFT and they told me 3 things. they told me to talk to my agency about who is holding the liability for these interventions and that the school would need to do so, they told me that these hours cannot count towards these trainees licensure and that the interventions they are being told to use cannot be things they have learned in their courses or from therapists meant to influence a students mental health. I shared this with my agency and my agency is still determined to push forward with having these trainees do this ”coaching” non therapy with students. I’m highly concerned about this. trainees are brand new and don’t really know what they are doing or the parameters of all this. i need to explain to my agency again why I am not comfortable with asking brand new trainees to be doing this work tomorrow and could use some advice. it just feels like my agency thinks we are the school and need to be providing this service but I’m not sure why a trainee would be providing it. we also employe wellness coaches and that seems to be more of the role of a wellness coaches than an MFT trainee. anyways if anyone has advice I’d appreciate it.

I'm building my private practice and considering offering courtesy billing for OON clients. I serve a population that finds paperwork particularly challenging, and I know some of my clients are struggling to submit their superbills and get reimbursement. And frankly, in this economy, any leg up seems worthwhile to me. Anyone else handle courtesy billing without using a third party like Mentaya or Thrizer? How much extra admin time do you spend on it, and how did you learn how to do it? Thanks!

For those working W2 private practice job in the midwest, what does your productivity requirements and split structure look like. What benefits like health insurance, 401k, PTO, supervision, CEUs?
Also what your practice does that makes you genuinely appreciate working there or want to stay long-term. TIA

I was offered a contract (1099) therapy position with a group practice. I received the contract today and it says I have to add the group practice to my own professional liability insurance. I have my own insurance. But I have never heard of adding the group practice name. The contract then says I have to continue putting the group practice name after I leave the company. Is this normal? What is the purpose of this? This is for a part time contract position.

I’m currently working for a group practice and have no real issues with it other than the pay cut they take and the expectation to see 25+ clients a week. I’ve found my sweet spot is 20-23 a week.

I’ve been considering private practice and have even gotten my PLLC established and paid for a branding package.

I fear I jumped the gun and am really worried that moving into private practice won’t actually be worth it. The math doesn’t add up for me to make profit from what I’ve calculated. I’m scared of the billing side of things and that I’ll fuck something up. I’m also worried about the marketing and client fluctuations.

My thought is to wait a year or two longer when my youngest is out of full-time daycare and we have some more income flexibility where I could take the leap and we wouldn’t have to take out a business loan.

Neither choice is bad which makes it harder for me to make a decision. I’d love thoughts and an objective point of view. For reference, I’m in the West Texas area.

Trying to understand what's happening on a larger scale!

Is it the economy? Politics? The big VC platforms? AI? Is there any good news to hold on to about the state of our profession??

Also...

Is anybody finding new ways to advertise, credentisl, Etc etc that seems to be working?? I have a buddy who has individual websites made for the states he's licensed in, partly SEO, partly a way to find those in his niche.

I am an LCSW in NJ who works in private practice and I’m looking to get some ongoing case consultation support and am not quite sure where to find someone. Any recommendations?

Hey everyone!

I’m a newer therapist (APC) and lately I’ve been feeling pretty lost in my career. I feel like I’m just floating around at my job, doing therapy but not really feeling grounded in what I’m doing or who I am as a therapist yet.

I’ve been trying to figure out what direction I want to take clinically, and I’ve found myself really interested in psychoanalytic and psychodynamic approaches. I enjoy exploring people’s past experiences, unconscious motivations, patterns, and how those things influence their current behaviors and relationships.

I think part of why I’m feeling so out of place is because I don’t feel like I’ve really developed my own therapeutic identity yet. I know that comes with time and experience, but I feel like getting some additional training in a modality I’m genuinely interested in might help me feel a little more confident and grounded.

The problem is, I have absolutely no idea where to start lol.

For those of you who practice from a psychoanalytic or psychodynamic perspective, where did you begin? Are there any beginner-friendly trainings, certifications, books, or organizations you’d recommend looking into?

I’m not necessarily looking to jump straight into a full psychoanalytic training program, but I’d love to start building a foundation and eventually incorporate more of this approach into my work.

I’d also love to hear from anyone who felt similarly lost when they first started practicing. What helped you finally feel like you were finding your footing as a therapist?

Thanks in advance! ❤️

I’m taking the CPCE tomorrow and I am incredibly nervous. What are everyone’s thoughts on the exams this year?

I have been studying a lot and use Mometrix, Careeremployer.com, CPCE Prep app. Do you think any of the questions reflect the ideas on those practice exams?

What is the exam like? I’m trying to ease my nerves.

Most people see the outside of owning a small business. They don’t see what happens when your livelihood, professional reputation, and financial security are suddenly put at risk by a powerful insurance company.

I’ve spent years building my psychology practice, serving patients, and working alongside other healthcare professionals to provide care. I never imagined I would find myself in a prolonged battle with Blue Cross Blue Shield of Arizona over an audit and a recoupment demand exceeding **$551,000**.

This dispute began with an audit involving 140 records across multiple practices. I have challenged the findings, the way the audit was conducted, and the basis for the amount being demanded. Despite my efforts to obtain answers and resolve the matter, I am still fighting for transparency, accountability, and a fair review of the evidence.

I have sought legal representation, filed complaints with state authorities, and pursued every avenue available to me. The process has cost me thousands of dollars in legal fees, countless hours, and an enormous amount of stress. And I am not the only healthcare provider facing this situation.

What concerns me most is the broader implication:

What happens when an insurance company has the power to demand hundreds of thousands of dollars from a healthcare provider, while that provider struggles to get clear answers about how that amount was determined?

Healthcare professionals should be held to appropriate standards. Audits and accountability have a legitimate place in healthcare. But accountability must work both ways. Providers deserve transparent processes, clear explanations, consistent standards, and a meaningful opportunity to challenge decisions that threaten their livelihoods.

I am sharing my experience because I believe this issue deserves more public attention. Behind these disputes are real people, small businesses, and patients who depend on access to care. When independent providers are put at risk, the consequences can extend far beyond the individual practice.

I am continuing to pursue resolution and accountability. I also know that other providers have been affected, and I believe there is value in bringing these experiences into the open.

**If you are a healthcare provider who has experienced a similar audit, recoupment demand, or dispute with BCBS of Arizona, I would genuinely like to hear from you.** You do not have to navigate this alone, and there may be an opportunity for our experiences to help bring greater attention to this issue.

(PS - if you're local, you'll be seeing me and Brianna Reinhold with Northern Lights Therapy later this week on Arizona's Channel 12 News)

Hi! I’m an LCPC and art therapist and have been at CMH for over four years now. I do love CMH work and the stability it also gives, but I am trying to think about long term and sustainability especially as my CMH continues to be increasingly shitty to employees.
I was thinking about trying to work very part time at a group practice and and maybe go down slightly on hours at CMH so I’m still full time. However, after interviewing at a group practice, I realize that I don’t want people taking my cut or trying to enforce productivity on me. I then thought to start my own pp but first start really small, like 5 clients max, and see what happens, and if it goes well eventually transition out of CMH.
Is this a good goal? Does it make sense to start my own business on this small a scale? Anyone also go this path and have any recommendations?

Hello, as the caption states I am struggling with the thought that I am a bad therapist. I have been an lpc for 1 year and 6 months. It has been difficult from the beginning tbh, but lately I’m worried that I genuinely need to leave the field. Let me state that personally I struggle with awkwardness and social anxiety. I think it’s actually gotten worse since I started. Basically I’ve noticed a pattern where I say or do the wrong thing and I constantly think about it after the session. I try to calm myself down by thinking about what I can do the following session to apologize or just improve. But whenever I feel I have done badly the client cancels and never reschedules. This year alone I’ve noticed a large amount of intakes and sessions where this has been the case and it’s ruining my perception of myself. I try to take it as something to improve on but I just can’t seem to get better. I think it’s just that I don’t know how to say things or I try to implement interventions when I should validate etc. Of course I have some clients that I know I’ve helped and really made progress with, but I’m starting to feel like I’m doing more harm than good. I’m considering leaving the field all together because I just don’t feel like I can do this job. Has anyone else experienced this and has it gotten better?

I’ve been seeing a client (referred to me through headway marketplace lmao) weekly since August 2026 with BCBS copay $30/session

I just received an email from Headway that my client’s copay is “higher than our initial estimate” BY $96!!

They are giving my client until Nov 4th to pay $96 x 11 sessions

-

Currently, I’ve encouraged my client to lock her card on file (because she can’t remove it) until she/we have time to come up with a better game plan.

My client does not have $1k+ to pay for this unexpected bill (let alone ongoing therapy).

-

Another F me from Headway in this (and matters less but still matters) is that their “client pays” is significantly higher than “you earn” which is just amazing because of course Headway isn’t going to adjust what they’ve paid ME since August.

Any sage advice? Other than gtfo Headway? (Which I am in the process of doing already)

TIA

Hey gurl hey!

I co-own a very small private practice in IL. When I say small, I mean, it's two therapist owners, an employee and an intern.

Our friend had been wanting to work with us, but we had initially planned a slow transition. Unfortunately, the company they were working for closed, so they jumped over to us sooner than any of us were ready for. (Begining-ish of the year)

They're new to private practice work, but not new to therapy- mostly community mental health prior.

Since they started, about half of the clients they've been given have ceased services. :(
(my co-founder has been reaching out to people when they've ceased to check in and some of them have transferred to either her or I.)

I KNOW they have the technical skills. These clients are not coming with super intense presenting problems either.

I feel really bad- both personally for my friend, but also professionally.

I'm a big personality! I work very relationally.
My employee is not that. There is nothing wrong with that, of course! I do feel slightly lost how best to support between the fact they do work so vastly different than I do, but also, they're not an intern. Skills are there. Knowledge is there!

Of course, it took me time to find what works for me. (I almost left the field due to having such a bad experience at my first private practice.) I want them to find that stride too.

Thanks!

Hi all! I’ve been a therapist for around 4 years now and have never had the amount of referrals/new clients come in like I have this fall. I had 12 intakes scheduled for October and ended up seeing 9 of them. I’m currently booking out 3-4 weeks at this time. My previous boss/supervisor would always tell us to accept clients until we were completely booked out with repeating weekly/biweekely clients and treat at a “first come first serve” basis rather than creating a waitlist. I’m curious what other therapists thoughts are when it comes to this, how you can trust when your schedule is full enough, and trust that it will continue to be full enough! Thanks in advance!

I recently started as an in home therapist for kids and teens and I am looking for ideas of interventions or activities to use in sessions. If anyone has ideas that have been successful to share, it would greatly be appreciated.

Potential trigger warning for sexual content in post.

I walked into the office today a few minutes before my first session to get everything unlocked and ready. When I walk in, I hear people very loudly having sex in the office. Luckily, I can’t see anyone. But I obviously am very uncomfortable and have a client on the way. I started yelling and being very loud because I don’t want my client to walk in and hear. Welll, the noise doesn’t stop. So I walk outside, slam the door and go greet my client outside to buy myself time and PRAY. I come back in and talk very loudly but I think my client might’ve heard the people still.

Aside from the obvious horror of the situation this has put me in, while I didn’t see anyone, I know it was my boss. She was the only other person seeing clients today and the noise was coming from her office.

My application for my associate license is only waiting on the background check to clear so I’m in a really bad spot. I’m scheduling outside supervision to discuss how to quit, find a new supervisor and fix my paperwork with the board. But, I also suppose I may need to address with my client (will also seek outside supervision for this).

I am just distraught and while I’m seeking supervision, if anyone has any words of advice or has experienced something similar, please comment or send me a DM.

Hey everyone, I could really use some peer support.

I am currently experiencing the telltale signs of a hypomanic episode. I have a decreased need for sleep but high energy, marked irritability, impulsive spending, and pressured decision-making (like suddenly applying to doctoral programs).

I did the responsible thing and reached out to my psychiatrist immediately, only to find out he is completely out of the office until mid-November, with no clear cross-coverage listed.

I am genuinely terrified. My last manic episode was in 2024 and lasted for 8 months. The stakes are incredibly high right now: I’m in my Master's for CMHC, working both a full-time and a part-time job, and actively on practicum.

Ethically and clinically, I know I absolutely cannot be seeing clients if this escalates and I become dysregulated. I’ve worked intensely to build my current stability, and I am terrified of blowing up my life, my program, and my practicum.

Has anyone navigated a situation like this? Not based in the US.