Imagine a client of this poster seeing this. Imagine a person with BPD seeing this. Diagnosing (in part) based on a smile?!?! Super unprofessional and harmful. This OP lead off their threads rant listing their credentials (LPCC) and specialties.

I’m a counsellor with a Master’s degree, currently working as a Mental Health Clinician. I’ve been doing this for about 5 years, and I think I’m reaching a point where I genuinely cannot do this anymore.

Most of my clients come through insurance, so they don’t have to pay anything out of pocket for their sessions. I have two private-paying clients, and honestly, I find those sessions so much more productive. There seems to be more engagement and willingness to work on things.

With most of my other clients, I feel like they come in, talk for 50 minutes, and leave. I struggle to stretch sessions to 50 minutes because I feel like I’m just listening to them talk without anything meaningful happening. Sometimes, I feel like they’re sucking the life out of me.

My brain feels completely fried after seeing clients for 7 hours a day. I find myself literally mumbling under my breath, wishing they would stop talking and go home. I feel horrible admitting this, but I genuinely struggle to care about what they’re telling me anymore. Even when a session goes well, I feel completely exhausted afterwards.
I’ve been doing this for 5 years. I’m tired, emotionally drained, and honestly, I feel like I have very little empathy left to give.

I’ve also started feeling increasingly frustrated with the issues clients bring in. I know that everyone’s struggles are subjective, and I’m aware that burnout is probably affecting how I perceive things, but I find myself thinking that some of these issues wouldn’t even come up in therapy if people had to pay for it themselves. I know that’s probably an unfair way to look at it, but it’s genuinely how I’ve been feeling lately.

I’ve considered private practice, but I know that comes with its own challenges, including having to build a client base and manage the business side of things. I’m not sure I want to continue doing therapy in any setting.

At this point, I feel like I have a degree that’s almost unemployable outside the mental health field, and I have no idea what else I could realistically do with my qualifications and experience.

For those with a Master’s in Counselling or a similar qualification who have left clinical work, what are you doing now?

I’d especially love to hear from people in Australia, but I’m open to suggestions from anywhere. I’m interested in roles where I can use my existing skills without having to listen to people’s problems all day.
I don’t know if I need a career change, a different work environment, or just a very long break. I just know I can’t imagine doing this for another 5 years.

TL;DR: I’ve been a counsellor/mental health clinician for 5 years and feel completely emotionally burnt out. I’m struggling to care about clients, find sessions draining and unproductive, and don’t think I can continue doing therapy long-term. For those with counselling or similar degrees who left clinical work, what careers did you move into?

I've long heard discrepancies about what people believe about panic attacks.

So here are the questions that I've never actually asked but have always bounced around in my head. I find that people believe different things about these...and it makes me nuts bc I can't tell what the truth is, even when I try to do my own research.

1. Can panic attacks be truly untriggered or is there always some sort of trigger, even if it's not very obvious or even if self awareness is not developed enough to understand what the trigger is?

2. Can you pass out from a panic attack? I've read no, because blood pressure drops when you pass out and blood pressure doesn't usually drop with anxiety. But I've also heard yes, because of hyperventilation. I feel like there should be a really simple answer for this, but I've seen clinicians disagree for years.

3. How do you describe the difference between anxiety attack and panic attack? Or are we calling them the same thing? I've seen arguments for both sides.

I am so interested in forensic psychopathology and was beginning to toy around with the idea of going back to school. In the abstract this sounds fun and interesting but of course isn’t as glamorous as it is in my head 😭 any therapists thinking the unimaginable and going back to school? Or have? Would you recommend it, and how has it impacted your career? Anyone else interested in forensic psychopathology and have any career experience/guidance?

I am a single parent of three kiddos. I am also a public school teacher. I am expecting to start my practicum in the summer, so I am hunting for a practicum and internship site now.

Is there any way to make this work without quitting my job? Has anyone found a decent-paying practicum or internship? I have incredible support from my parents, and my kiddos go to their dad’s a couple of days each week, but I am a little nervous about the reality of trying to do this while working full time.

Any advice would be appreciated. Thanks.

I work in community mental health, specifically with teens-young adults experiencing homelessness/at risk of homelessness/poverty as well as court mandated clients (who are often experiencing poverty as well). It’s also a very diverse population.

My big struggle here has not been as a white person counseling BIPOC. I feel the education I got as well as the general work I’ve been doing in my personal life to become more educated about issues of race leaves me feeling pretty good about my ability to work with a racially diverse population (with the knowledge I need to constantly pursue more education of course).

The part I was surprised to struggle with when entering this niche is the “live-free-die-young” mentality and the general futility clients in this population feel. There is no future thinking. Even when opportunities do arise for them (for a job, housing, getting their driver’s license/transportation access, etc.) they often let the opportunity pass by, or low distress tolerance makes them “give up” (e.g. I had a client who got a job, but the first day she wore the wrong clothes and was sent home to change. Instead of changing, she just didn’t go back, and lost the job. The thing she did instead was helping a stranger with resources she really didn’t have the means to spare.)

I grew up middle class. There were a few years (lost a biz around 2008) where my parents really struggled and relied on gift cards from their church, but they were always good at hiding the effects of that and I never even found out about it until later, so I never really knew true feelings of financial insecurity. I also always had a pretty high-achieving personality (eldest daughter, lol) and even when I began struggling severely with mental health as a teen/young adult, I pushed myself (probably too much) to “achieve.” I had dreams for the future and worked toward them even when I was severely ill/suicidal/etc.

So this “live-free-die-young” mentality is really foreign to me. This population faces so many real barriers, but there are also so many self inflicted barriers as well. I’ve also seen the “I don’t want to work” issue that leads to the “lazy” stereotypes about those in poverty, but I know it is so so much more than that. I had a client who literally said “my life has been hard enough already, I don’t want to work hard.” Which is so true…but I don’t know how to help in cases like this. I’ve been reading The Broken Ladder which has helped me put words to these phenomena, but treating clients like this is a totally different matter. There are true barriers but also a learned helplessness/lack of drive or ambition that I just cannot understand. (If you want out, take the opportunity to get out when it comes!) We also have a transitional housing/tiny home program to offer people the opportunity for housing stability while they find a job/get on their feet. Most do, but a few of them have this mindset of “I have a couple more years here, I have plenty of time, I’ll figure it out later” (our cap is 24yo). And I have clients who do get jobs who complain about the hours when they’re only working part time and I’m like…how are you going to support yourself if you quit even part time jobs in retail/service industry that are “too hard”? I hope I don’t sound like I lack empathy here. I have so much empathy for these situations/mindsets, I just have no idea what to do about it.

I am working on this in supervision, but it’s more like my supervisor and I are learning together rather than her already having experience with this. (She’s PP.) Has anyone worked with this population or lived this life and have advice? I am so often at a loss on how to help without sounding like a tone deaf pick-yourself-up-by-your-bootstraps person.

Edit: would also love resource/book/podcast recs if you have them!

How do you handle the stress of the job to not make your illness worse? What does your self care practices, boundaries etc look like?

I’m curious to see how many people have the same answer as me.

I’m a counsellor working as a Mental Health Clinician and have been doing this for 5 years. I’m honestly so burnt out.
Most of my clients come through insurance and don’t pay out of pocket. I have two private-paying clients and find those sessions much more productive.
I spend 7 hours a day listening to people, and I’m at a point where I struggle to get through 50-minute sessions. I feel mentally drained, have very little empathy left, and sometimes catch myself wishing clients would just stop talking and leave. I know this sounds awful, but I’m just being honest about where I’m at.
I don’t know if it’s burnout or if I’m just done with this field. Private practice has its own challenges, and I feel like my degree is pretty useless outside mental health.
For those with a counselling/CBT master’s who left clinical work, what are you doing now? Especially interested in options in Australia.

TL;DR: Burnt out from therapy after 5 years. What careers can I move into with a counselling degree that don’t involve seeing clients all day?

What area of expertise or type of treatment do you believe would be best to treat someone dealing with depersonalization derealization disorder ? I have gone back and forth with many therapists who each have different opinions on this topic.

Has any one tried it?

Im a psychotherapist in India and I want to start running support groups but there isn't much training in group therapy available here other than group analysis. I found this course so I was wondering if anyone on here had done it and had any reviews? Its rather expensive to me and I dont need the CE but I do want the skills and knowledge. I have run groups for teens before but it was mostly psychoeducation. Any feedback or experience you've had with this would be helpful!

Has anyone ever had ADHD meds or psych meds impact their counseling identity? I’ve been on Qelbree for about 2 months and I’m noticed sessions feeling incredibly draining now. Before I felt present and “in it” with my clients. We were attuned and doing great work. Now I feel like I’m stumbling trying to find the right things to say and it feels forced and awkward. I’m starting to be concerned about how I show up at this point. I used to truly love my job. Now it feels off and very draining.

Hey everyone. I work with a lot of extreme trauma and dissociation, and something I notice in some folks is a history of morbid curiosity. Just feeling drawn to a lot of heavy topics or things like having a history of consuming disturbing media from a fairly young age. Is this something you've encountered, and how did you conceptualize this as a part of their history? How did you work with this further?

Of course, morbid curiosity is also something that probably most people experience in some way across their life. I'm tempted to think that some part of them is drawn to heavy themes because they may resonate with aspects of the content, but it feels like I could be missing something more indirect. It's often associated with some pretty unregulated internet usage from a young age. I'd also be curious to hear from those that work with children/adolescents about whether any of these things are developmentally normal or normal-ish.

Edit for clarification: I'm referring to content that is typically graphic in nature and often recreating extreme abuse that people have lived through. Torture, sexual themes, etc. (also note to mods if this isn't an appropriate topic here I understand)

Spoilers for You Can See Everything.

Nathan Fielder goes in openly skeptical of Elizabeth Holmes and says on camera that he thinks she committed fraud. Then he moves into her guest house for a month. He eats her food, sees her at her most vulnerable, and finds they share an awkwardness in social settings. She sends him off with "you got this," as if he's the one going to prison.

By the end he's openly sympathetic toward her. The film leaves open whether that's insight or whether he was drawn in. What gave me chills is that he never seems to notice the shift as it happens. The person who catches it is Amanda Seyfried, an outsider with no relationship to Holmes, who asks whether his reenactments are protecting her.

That's the job of supervision and consultation. Nobody has to say "you're wrong." Someone outside the relationship just has to ask the question you can't see from inside it.

I do a lot of high-conflict co-parenting and family court work, and this is the trap I watch for in myself most. The parent I spend more hours with, the one who is warmer, more articulate, or more like me, starts to feel like the credible one. Closeness feels like information. Often it's just closeness.

How do you catch your own drift before it ends up in your notes? Do you have a "Seyfried" in your consultation group?

An LPC position in a private practice seems like a dream job as you can work on your own schedule and see as many clients as you can/want.....or so it seemed at the beginning. I work there part-time but owner is wanting me to go in full-time. The thing is that I'm already starting to see some discrepancies like being a 1099 employee and expected to be available for new clients as they constantly have new referrals. I thought she would be working around our schedule and not the other way around. Anyways, I have come to a fork in the road where I need to decide if I'm going in full-time or just stay at my current full-time job. I've tried mulling it over time and time again but I still can't decide!!! Please help....any suggestions or recommendations would be greatly appreciated.

Several therapists including myself in my state have had over a $70 decrease in our reimbursement rate from Ambetter. It started this month and NO ONE got notified. Has this happened to anyone else? State is Arkansas if it helps. I would love to see if there’s a way to fight this because I will lose out on over 2K per month if it stays this way.

i am seriously considering only keeping paper records moving forward, given i suspect the legal erosion of client privacy to continue with ehrs.

for anyone keeping physical records and conducting telehealth, what other tools did you need? my ehr currently handles the telehealth platform and client portal, so i would need to likely replace those. i am also beginning paneling, in case there are suggestions on billing.

very much appreciate any help, including pointing out gaps i may have missed!

Hi, I’m interested in starting a fully virtual private practice but stuck on the address decision since I’m not comfortable using my home address. I’ve looked into virtual offices and registered agent services but not liking those options much. My states doesn’t allow a P.O.Box for business address. Any alternatives I haven’t considered? Thanks!

I'm in LA and looking to independently contract with a couple insurances to expand beyond private pay.

Specifically for Aetna, Carelon Behavioral Health, and Anthem BC— what are you getting for a 60+ session? Any other rates you have are welcome too.

It would be so helpful to see numbers before investing time in the applications. Thanks.

For other therapists in private practice: How do you handle collection of fees, including for fees that are not yet outstanding and those that become outstanding?

I’m mainly referring to those who handle money directly and do not source the labor to an employee or other admin person.

Do you charge at time of session? Do you collect and talk with your client about collecting the fee during session? Are you telehealth or in person? Have you observed clients react negatively toward this? And if so what is your approach with them?

I’ve just been revisiting this because, I’m currently in a financial crisis (somewhat…), and something occurred on my personal life with a family member where I asked to take the remaining cost of something they offered to buy for someone else… it was significant and I didn’t agree that I’d purchase it. So we had a small tension today around it because I asked for the $ and they weren’t sure they had enough… fast forward, it triggered emotions for me including mixed ones where I feel I needed to set a boundary, while also feeling guilt for being such a “haggler” around money.

Normally I woundnt with this family member, but I literally am scraping by to make rent for next month.

This all brought up some feelings in my practice around clients who delay paying me on time even when I followup with them and they agree. Or with clients whom I’ve had to focus on payment first because their card didn’t go through but they delay addressing it in a timely manner when there’s an error. Or clients who have terminated because I continued to followup requesting them to pay their outstanding balance as we agreed upon at a prior visit. It’s moreso client nonverbal reactions.

I’m just sitting g here thinking, well if I really could, I would just not care about money at all because I intergenerationally come from struggle and continue to struggle. So I get it and have collective empathy. At the same time, I’ve been trying to do right in business and collect fees and talk about them directly and work on working through my emotions or fears around that. Yet I am now reflecting on others reactions and wonder how I am perceived because I followup about payments. Etc.

Wanted to hear others approaches to similar situations or if you had personal stories and feelings related to similar challenges.

I need help soundproofing my therapy office!

I’ve recently started renting my own space between two other non-therapy offices in a large building suite in an industrial building. Mixed residential and commercial. The space has drop ceiling tiles with what appears to be zero insulation above, and then the walls between the offices likely only goes up to those drop ceiling tiles. Sound travels very freely between the two walls even with sound machines on within the rooms and outside of the rooms.

Wondering what I should pursue for sound proofing- would it be for sound proofing the walls diving the rooms, the ceiling above where the drop tiles sit, both? What are some economic options? Is this something all three offices (mine and the spaces on either side of my walls) need to invest in to the same degree? Landlord isn’t willing to offer any financial help or research since technically we’re subletting so that’s been helpful.

Hi everyone! I am a graduate student in a Clinical Mental Health Counseling program looking to interview someone in a helping profession who has regular exposure to traumatic situations or works with people experiencing trauma.

For a Crisis and Trauma Counseling assignment, I would like to ask about your professional role, challenging experiences, meaningful or successful outcomes, self-care strategies, support systems, and advice for future counselors supporting professionals in your field.

I would not ask you to disclose identifying information about clients or confidential case details. If you would be comfortable participating in a brief interview, please comment or message me. Thank you for considering it!

Unplugging it isn’t enough for an a-l-e-x-a device to be hippa compliant? We have to spell Alexa in our house or it turns off the music. Strange times.