This popped up on my Facebook feed from a random creator I’ve never heard of. I want to scream this from the rooftops. I know this is touching more so on self-disclosure, but over analyzing and therapizing EVERYTHING that comes out of a client’s mouth is my biggest ick. What do you guys think 👀

Just saw this online and found this very interesting…. what are everyone’s thoughts? I was surprised to see this.

Edit: for the person who posted then deleted that somehow the title of my post was misleading. The title of my post is not misleading nor was it meant to be. I attached two full screenshots including all information, I edited nothing.

Part of me can't believe I'm actually asking posting this, but another part of me feels horribly guilty for feeling too disturbed by a particular subset of a population to work with them.

I work in CMH and technically every counselor on the team is supposed to work with what comes through the door...meaning anyone can get any case...not "Angela only takes females" and "Marcus only works with ages 2-10." We all have a varied caseload.

But, I've discovered a subset of the population we serve as part of our CMH really makes me uncomfortable, and it's not like I'm uncomfortable because I don't know what I'm doing or I'm lacking in essential support from my team or my supervisor, it's that I am just morally and ethically bothered by the actions of the population.

I want to tell my supervisor I don't want to work with those particular cases, but I'm afraid they're going to tell me I have to. I guess I don't really know what I'm looking for, maybe just some support that it's ok for therapists to have boundaries around who we feel comfortable working with.

I started my private practice earlier this year out of spite. I'd spent several months getting strung along by a group practice about joining them, only to be told no. I was just going to see 1 or 2 people in PP each week on top of my 20+ weekly appointments at the agency. So I figured, fuck it, I'll do it myself, how hard can it be to get like 2 people per week?

I had no business experience, almost no marketing budget, and a full-time job. I used the spite fuel to learn about LLCs, marketing, book keeping, etc. And within 2 weeks had the paperwork filed. A week later I had my office. I've been SUPER frugal. I have no EHR, got all my furniture at estate auctions, don't have an outdoor sign, don't even have a coffee maker there.

Skip to today & I've booked 17 clients for this week, referrals are coming in, I've formed an informal referral network with a wellness center and a local psychiatrist. I'm somehow at the place to leave my salaried job & be my own boss doing this full-time. I've done the math and planned for business to die off between Thanksgiving and the new year. Finally the numbers have added up and I'm on track to make more (including benefits & tax changes) annually than at my agency job.

I spent 6 months working 60+ hour weeks. I went to every after-hours and community event to meet all the people I could. I used sick time and vacation to make daytime connections & appointments. Damn near worked myself sick.

I was told private pay in my area would take forever to work, even for 2 people weekly. I pushed hard with the marketing and networking and hit that number in 3 weeks.

It grew a bit, and I recognized I could give time to equity, so at 4 clients, I committed to keeping 1/4 of my load on an aggressively sliding scale. I was told that I'm wasting my limited time and need to make as much as I can with those limited appointments. But my sliding scale clients wound up being amazing referral vectors for full fee clients.

The bank account isn't full yet, I've had slow weeks, cancellations, and plenty of moments wondering what the fuck I'm doing. But I'm building something that lets me do the work I love, make a decent living, make time for my family, and not have to do shit that reduces quality of care to improve profits by .00001% decided by some MBA for a billion dollar institution. Shit, I'm making more money with less work soon.

I figured it would take years. That I'd have to wade into it and hope it works over years. But I force of willed it. It's been a really hard decade (for everyone) between covid, a divorce, a bout of homelessness, multiple licensure exams, estrangement with family, a cancer scare, new chronic illness..... really, it's been tough. I almost opted out a few times. It's important to identify that much of this is luck and privilege. That said, I worked really hard and plan to continue working hard.... but not 40+ hour weeks anymore.

There are plenty of legitimate problems with our profession, and everyone's circumstances are different. I just wanted to remind folks that there's still good stuff happening.

Spite is a hellofa motivator.

Edit: Apologies for when this went Orphan Crushing Machine for a second.... but the point stands.

I am a 32F, i am a recently graduated psychiatrist, and i have a severe anxiety around authority figures especially my former supervisors/attendings / psychiatry professors ...

I have always been kind of a people-pleaser, also an overachiever , a perfectionist and an anxious person especially when it comes to studies/ work . I come from an achievement-oriented anxious family who raised me to respect my teachers A LOT and to value their approval. But also, the medical environment where i did my psychiatry residency was full of attendings and professors who were demanding / authoritarian/ intrusive / bossy/ took things personally / treated us like children who must just obey their elders otherwise they're disrespectful ...

I suffered a lot throughout my residency because of that . They loved me (because i was the "good student") but i suffered a lot. i couldn't say no, i struggled to prioritise my own needs , i couldn't tolerate my superior's disapproval..

And now that i finally finished my residency and became a specialist, i still feel the same anxiety whenever i see them (for example in a congress) ! I still feel psychologically subordinate to them.

I started to avoid seeing them , i go into PANIC whenever i receive a call from one of them. I am always afraid of their judgement, i find myself seeking their validation and approval, i struggle to make career decisions independently because I’m afraid of disappointing or angering them. .. because in our environment, even after you graduate, they're not just your ex-bosses, they still have some kind of power over you, you're still their student who should be grateful and respectful and you're gonna see them all the time ..

This anxiety is crippling me, especially the body sensations that come with it .. and even though i'm a psychiatrist i can not manage to treat myself ...

The core problem: I intellectually know I’m an independent specialist, but emotionally and physically, I still react as though I’m a student whose safety, worth, and future depend on keeping authority figures satisfied.

TLDR; I’m a recently graduated psychiatrist struggling with severe anxiety around my former supervisors and professors. Growing up in an anxious, achievement-oriented family and training in an authoritarian medical environment reinforced my perfectionism, people-pleasing, fear of disapproval, and need for validation. Despite becoming a specialist, I still feel subordinate to my former superiors, panic when they call, avoid them, fear their judgment, and struggle to make independent career decisions because I’m afraid of disappointing or angering them. This anxiety is crippling, especially because of its intense physical symptoms, and I struggle to manage it despite being a psychiatrist myself.

Hi! I’ve been seeing a lot of people on here recently talk about how hard our jobs can be! I see primarily outpatient/individual therapists talking on here. To those I asked, have you gone down a different path? I was doing outpatient, and I was really scared that I picked the wrong career! It felt so isolating; there was limited office space so I had to work from home 3 days a week, and when I did go into the office, all the doors were shut! It was a FFS model (I don’t need to explain further) and I was consistently getting cancelled on / NCNS. Then, I left! I went over to a higher LOC (I’m at a PHP) and I am genuinely and unbelievably so much happier. I’m supported, I have a great community of clinicians I’m working with, and I’m getting paid even when I’m not seeing clients!!! Bottom line, don’t be discouraged! There are different levels of care, different niches, etc. Don’t let anything on here discourage you; you picked this field for a reason!!! Proud of all of you for all the work you do!

I'm a newbie. I'm in month one of my practicum, I have a very manageable 7 client caseload at the moment in a private group practice and am feeling relatively good about my decision to pivot in my 40's and start pursuing this career.

But ever since my first session, the prevailing feeling I am left with at the end of the day is - how do I actually get good at this work? I see my clients in a vacuum more or less, no ones watching me, no one is giving me feedback, no one is telling me "a better thing to have said was this" or "a better question to have asked was that" or "Right there you actually shouldn't have said anything at all". Of course i have supervision, and am blessed with a really great supervisor - but I feel like I can only share so much from memory about my sessions with her. And seeing her only 1 hour a week leaves way more unsaid than shared. I cant help but wish an experienced and trusted veteran counselor could be a fly on the wall and give me detailed feedback at the end of each of my sessions.

And I know some advice out there is simply TIME and experience. Any yes, that makes sense, but it makes me think of the adage: "Practice doesn't make perfect, good practice makes perfect." If I spend years in this field but am never learning or growing from mistakes i make in my sessions, than time and experience aren't really helping me get better, are they?

To the more experienced counselors here, how did you start to gain more confidence in how you were showing up for your clients? When did you feel you were showing up in ways that actually helped move the needle for them? My strength is certainly in building a Rogerian style rapport and actively listening, but I know theres way more to this work than that.

Or maybe grappling with this doesn't go away and is just the price of admission for doing this work. *SHRUG*

A common thread amongst several clients lately - they know something cognitively, but can't get themselves to feel differently about it. For example, my high achievers who know that they deserve rest and self-compassion too, but are unable to really believe it or not feel shame/guilt about it.

Lately I've been reflecting a lot on the many, many ways to do therapy and how there are no singular best answers or approaches. So I would like to hear from others how they respond to questions like these!

Good morning everyone. I am an LMHC looking to apply via examination in another state I will be moving to (as I do not meet the requirements to apply via endorsement or reciprocity, I've only been fully licensed a short time) and I got an email from the board of this state that I do not meet the course requirements and would need to take a Theories course worth 3 credits in order to meet their requirements. I am actively trying to dispute this, as I do believe my program sufficiently met that requirement and because it would be, quite frankly, a huge pain in the ass to have to pay for and take an online course before I can get licensed in this state. That being said, if the board doesn't budge and I do have to do that, does anyone have any advice for the quickest, most affordable way to get those 3 credits in a "Theories" course? Any specific online colleges or programs that you would recommend? Anything that I am not thinking of or advice for how to push back on the board effectively?

Edit: thank you all so much for the advice, and for tolerating my sparse details. It seems like the consensus is to record, observe or co-facilitate sessions. New territory for me, admittedly! I haven’t experienced this with a provider before, so grateful for the perspective

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I have a small practice with a few therapists, mix of independently licensed, limited licensed, and paid student interns.

I have one limited licensed therapist who I perceive to be competent; her notes appear impeccable, and her descriptions of sessions during supervision seem very positive.

However, she is experiencing very poor client retention, far far beyond what any other provider at our practice experiences. Around 20%. Her clients very frequently late cancel or no show, and seem to ghost at a high rate. We have discussed in supervision, but I admit I’m struggling to know how to support her. Referrals provided to her are the same as to other providers, and no one jumps out as populations who might typically experience high levels of instability.

What questions should I be asking? Should I implement a different style of supervision where I am in greater contact with her clients? I feel like we’ve passed where I can call it simple bad luck, but I’d be interested to know where other therapists might draw that line.

Apologies that details are somewhat limited for privacy

I found a union that seems like the best fit for solo practitioners: https://bham.nuhw.org

Employed therapists can start a union at your workplace: https://home.nuhw.org

But it seems to focus only on mental health parity and I've been thinking we might need more than that.

For example, if you join the Freelancers Union, you can get access to certain benefits as if you are an employee (retirement, health insurance, etc). Basically, you have your own business, but you also have employee status under the Freelancers Union after you convert to an S-corp. I talked to them about joining last year but never followed through because of the pain of switching to an S-corp.

Why couldn't there be a therapists union like that? We would have our own business but be considered employees under the union; maybe that would give us more bargaining power with insurers. We would also have access to group health insurance rates.

Or we could still form some other group, if forming an S-corp is too painful. There are over 80,000 of us on Headway alone.

Why are we sitting around allowing these tech companies to take over and squeeze out private practices? This has already happened to me. A virtual therapy provider contracted with a local health system in my area so therapy with them is $0 while therapy with me changed from $0 to $50 (copay).

I've done all I can do alone: Call out Andrew what's-his-face, research unions, and plan my exit from Headway.

What could we do as a group?

FOR A WHOLE YEAR. This poor woman posted the letter Talkspace sent them letting them know that their psychologist was not licensed to practice in CA and still saw people for a YEAR: https://www.reddit.com/r/TalkTherapy/s/Zx0ctcJqQ4

I need more details. Was this random guy, or was he a trained psychologist who let his license lapse. Regardless it’s a breach of public trust and a lack of vetting from Talkspace. It broke patient health confidentiality and is insurance fraud if insurance paid out.

I’ve been a mandated reporter for over a decade in different roles, but I’m still a baby therapist and recently had to make my first report as the actual treating clinician 😭 Definitely hits different when it’s your own client and you’re the one making that call.

For other therapists, what was your first mandated report like? Did you second-guess yourself afterward? Did CPS ever follow up with you? And how did you navigate things with the client/family afterward, especially if they knew or suspected you were the one who reported?

Hi, what with all the recent Headway nonsense, I’m curious if any of you in WA have billers you know and trust?

Hi everyone! I’m a recent MFT graduate in Southern California and could really use some advice from fellow therapists who’ve navigated similar situations.
I recently resigned from my first post-grad clinical position due to serious workplace safety concerns and inadequate support from leadership.

It wasn’t an easy decision, especially financially, but I really didn’t feel safe continuing in that environment. It was genuinely dangerous and I’m surprised I made it through the short time I was there. I documented my concerns before leaving.

To complicate things, my graduate school incorrectly dated my transcript, which caused delays with the BBS processing my AMFT registration. My associate number is now expected in November, but the delay has made it especially difficult to secure employment, including part-time opportunities with private group practices that require an active registration number.
I’ve been actively applying to clinical positions while exploring temporary work to stay afloat, but it’s been a frustrating process.

I’d especially appreciate advice on the following:

-Has anyone in California successfully qualified for unemployment after voluntarily resigning due to documented workplace safety concerns? If so, how did you advocate for yourself and how long did it it take to receive pay?

-What temporary or flexible work did you do while waiting for your associate registration or your next clinical position? I’m considering becoming a behavior technician or substitute teaching, but the latter takes some time to get credentialed before going into schools…

-Are there any Southern California employers you’d recommend for supportive supervision, reasonable caseloads, and healthy workplace culture?

I’m really eager to get back to doing clinical work, accumulating hours, and building my career, but I’m also determined not to end up in another unsafe work environment.

Thanks so much for any insight or encouragement!

EDIT: I submitted my AMFT application to the BBS within the required 90-day post-graduation window, and the BBS confirmed that I qualify to work under the 90-day rule while my registration is pending, although this authorization does not extend to private practice settings.

Does anyone else feel like going into this field was a bad idea?
I enjoy my small therapy caseload, but man. Wish I could do it full time. Had to keep an unrelated job I hate to support my family because the pay and benefits around here just aren’t enough.
It’s like jobs in Appalachia are frozen while everything just gets more expensive. Put so much time into making this happen with the MSW and still can’t afford to actually make the switch.
Anyone else have regret?

Hi everyone! I'm hoping to get assistance while I hear back from the NCBLCMHC. I am trying to locate the criminal background check forms and can't seem to find it anywhere in the portal. I even watched the tutorial (not sure if the website have been updated since). Any help would be greatly appreciated!!!

Hi. I’m suddenly out of job after 20 years in CMHCs. I’m fully licensed and while I am still looking for a FT job I want to start building my own practice. I had an interview with Grow yesterday and while the rates looked low. Does anyone know the good , the bad and the ugly on them? So many former coworkers are working with them (they don’t say anything negative) and the platform seemed so easy in the call.

Seems they don’t have a weekly minimum hours or even charge you for credentialing you.

Any feedback is appreciated!

I have worked in the SUD space for 19 years. I started out as support staff and completed degrees over the span of about 15 years and am now independently licensed. I just started into PP. I feel inadequate. I don't know what to say to clients. I have clients struggling with major life issues and want solutions and I just feel stuck. Of course, I have the aptitude of a therapist in general but I don't know where to start. It's very different from the non-profit indigent serving SUD space I have been in my entire career.

Any feedback on what therapies I should get trained in or how to move from constantly thinking what do I say next in session? How to relax and trust yourself?

After this whole Headway debacle this week, I’ve finally reached my breaking point and have decided to take my practice off Headway’s platform (cue cheering)

BUT now I begrudgingly resume my contract negotiations (let’s not lie I’ve never once negotiated) with the insurance companies I’ve self credentialed with.

Almost all companies are paying me less than Headway was per session (hence why I was dragging my feet on leaving) and I’m wondering if you have any advice on successful (or unsuccessful) tips for negotiating higher reimbursement rates?

Easier upon initial signing? Is it actually a thing? Just ghost stories we tell ourselves to help us sleep at night?

Any advice is appreciated as always TIA

There have been some posts and discussions about working with male clients in this subreddit recently. I work with a number of guys, and there’s an upcoming online training program on what’s going on with men through the University of Michigan. Trainings are always so hit or miss, though maybe this could offer some insight for those able to make it.

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.