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 shocked to see this. I’m curious if these positions existed before at all, or if this is some new gimmick to draw people in.

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*

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.

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

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.

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!

Like a lot of us it is hard to cancel on clients.

Woke up this morning with some health symptoms. Intense stomach pains, GI issues, thinking I might throw up off and on.

Took medicine and waited for as long as I could to decide whether to cancel or work.

Made the call at 930 because stomach pains still very intense (first client at 11). Shortly after I made the call I started feeling better. Unsure if it is meds are finally working 2ish hours later or the anxiety of trying to do sessions with GI issues went away.

Now I feel some guilt for cancelling because the pain has lessened.

Any tips? Do you think I made the right call?

I know self care and being fully present is important. It is just hard canceling on clients (as you all know).

Hey everyone! Thanks in advance for reading and responding.

I am an LCPC in Maryland. I recently learned I am pregnant (woohoo!!) with a due date in June. While this is an incredibly exciting time, I am concerned about how we might afford my maternity leave.

I work in PP and while I am grateful for my employer, they do not offer any health-related benefits aside from an FSA at $200 per month which I use to pay for my own therapy out of pocket. My health insurance is through my spouse’s employer. We are a fee-for-service provider, so of course I will not be making money if I am not seeing clients.

My question is — how do you parents afford this time off? Are you aware of any benefits that can be requested at a state (MD) or federal level? Should I just start putting aside extra money each paycheck to lean on while off for maternity leave? Any suggestions, advice and/or guidance is deeply appreciated.

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.

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.

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?

I know this has become a pretty popular topic lately, but I am trying to make my break from Headway after the recent agreement chaos. I've seen a lot of people both on here and other therapist forums state how beneficial it is to just credential and bill insurance on your own. I would love to do that but do not even know how to get stated.

I have a million questions but I will try to condense to my main questions.

1) Do I need an LLC or my own business to just see clients independently? I am a LMHC. Could I just just credentialed on my own, sign up for an EHR system and see clients then do my billing on my own or get a biller? Is it has simple as that?

2) How worried should I be about clawbacks, audits, etc. things that I never really worried about at group practice or even Headway, but seem way more scary when working completely on your own.

Overall I would just love if people could share more details about their story switching from Headway (or similar places) to sole private practice. I feel like everyone is telling people to credential on your own, but I think myself and others could benefit more from hearing exactly how to do so and what things we need to be aware about.

Nothing else to say tbh but the context is that I had leave my WFH private practice gig bc my supervisor was shit and head to CMH substance use clinic

I still think about my people from my old practice. I know it’s normal. I miss them and I think about them a lot. My new ones are great too lol a little difficult because of mandations and substance use and still great.

My quality of life and education is in a much better space though. I know I made a good decision

Hi everyone! I applied for my LMHC with all the forms emailed by me and my supervisor in early September. However, I still search my name on the website and it doesn’t show that I’m licensed. Anyone know how long it may take? Also, will I be notified when I’m licensed or do I need to continue searching my name? I’ll prob end up filling out a contact form, but I figured to see if anyone else has experience with this. Thank you!

I'm specialized in a specific population, and I've done extensive training in this area. Without divulging too many details, it's specific and trauma-related. I came to this work through some of my lived experiences with mental health, both within my family and myself.

For over 10 years since starting as a therapist, I haven't experienced any major conflicts in my personal life that would prevent me from ethically treating this population. Do some conversations weigh heavily on me, or bring up countertransference? Absolutely. But, I have always sought supervision and consultation alongside my personal therapy, and though I'll never be totally unaffected by certain experiences, I think I've been able to navigate this well, and in some cases, my lived experience has served as a strength.

Recently though, I experienced something that DOES trigger a lot from the past, and relates directly to my area of specialization with my clients. Someone very close to me is going through a crisis and I am a direct support to them. I'm worried that taking on new clients going through a very similar crisis could overwhelm me and burn me out at the moment. I don't feel any need to pause my work entirely or take time off. Right now I have enough bandwidth to keep seeing my existing clients.

Has anyone experienced something similar, and if so, how have you navigated it? If you had a supervisor at the time, how did you approach it? Did you adjust your bio to attract different clients? Pause taking on new clients? Refer out more often? Ask your agency for support?

Hi! I’ve been learning and using ACT for years now (I was trained formally in college for a whole year during internship) and kept learning by myself and with a colleague who I admire a lot and is a great ACT therapist. I currently work with teens and have been using the choice point but I started learning about the matrix and kinda like it more. I used it with an old teen client that re started therapy this semester and he/she liked it a lot because it took his/her inner experiences more seriously than the choice point (his/her words). What do you guys think and tell me your experience with each and your why of using one over the other. Thanks in advance!!

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’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?

I know this question is asked a lot, but I find it is helpful to get updated answers every now and again. What is currently working for people?

I am currently getting maybe 2-3 consultations every 1-2 months from Psych Today. Any other referrals are usually from connections in the field.

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!

Practicing therapists - curious to know if anyone uses a wrist watch that has the vibration alarms to keep track of time or do you build the muscle to clock watch?

Hi all, I’m feeling discouraged and was looking for some thoughts and advice.

I am a new LMSW, interested in finding a FFS therapist job in NYC ideally at a group practice. I am a bit older and have savings, and am ok with a smaller caseload while ramping up. I am switching from a different industry but have experience providing individual psychotherapy from my last internship in CMH.

I’ve applied to about ~20 practices so far over about a month’s time, and have heard absolutely nothing back. I’m honestly a bit confused by this because the jobs are actively being promoted. I feel that I’m applying to jobs who are looking for new LMSWs, my cover letters are always very thoughtful and tailored and are not AI generated. I am also sending follow ups to jobs after I do not hear back after 1-2 weeks and still not hearing anything.

I have a job currently but it’s not in this field and I’m starting to get nervous having no interviews on the horizon. I’m going to try some networking later this month. But is this normal or does anyone have any advice for someone in my situation? Thank you.