Students are welcome to post any questions they have for therapists in this thread. Got a question about a theoretical orientation and how it applies in practice? Ask it here! Got a question about a particular specialty? Cool put it in a comment!
Wondering which route to take into the field of therapy? See if this document from the sidebar could help: Careers In Mental Health
Welcome to the Sunday Scaries! Feeling burn out,, struggling with compassion fatigue, work environment really sucking right now? Share your feelings here to get support.
All other posts about burnout will get redirected here.
This is the place for you to vent and complain WITHOUT JUDGEMENT about any stressful work situations going on at work and/or how much you are feeling burnt out doing this work.
Burn out making you want to change career? Check out this infographic by one of our community members (also found in sidebar) to consider your options.
I love that there’s more awareness for these things with the internet, but I’ve had five new clients or consultations this week and all of them have walked into my office and told me they’re neurodivergent. Of course this label has been useful in some way to them, but it means something totally different to each person and just feels like another way to say “I feel different than I think I should feel.” But humans are a spectrum and it feels rooted in conformism and not a genuine issue in daily functioning. If 80% of people think they are neurodivergent, we’re gonna need some new labels because neurotypical ain’t typical.
Three of them also told me they think they have DID, which is not unusual because I focus on trauma treatment and specifically mention dissociation on my website. Obviously too soon to know for sure, but they have had little or no previous therapy and can tell me all about their alters. I think it’s useful because we have a head start in parts work with the things they have noticed, but they get so attached to the label and feel attacked if they ask directly and I can’t or won’t confirm. Talking about structural dissociation as a spectrum sometimes works, but I’m finding younger clients to feel so invalidated if I can’t just outright say they have this severe case. There’s just so much irony in the fact that most people with DID are so so ashamed, all they want is to hide it or make it go away, they don’t want these different parts to exist.
Anyway, I’m tired and sometimes I hate the internet. I’m on vacation this week and I really really need it.
I’m wondering if there are other therapists out there who actively choose not to work with clients presenting with high acuity or high levels of crisis/suicidal ideations. I should also preface this by saying I’m extremely burnt out. I’m finally going on vacation in two days and just got an email requesting for an emergency session. I don’t have availability this week and I just can’t do crisis sessions outside of my hours.
I’m so exhausted and specific clients just drain me. I feel terrible for even typing this out but I hate hate hate how ingrained it is in us (especially social workers) that we cannot refer clients out if the only reason is it’s too much for us personally.
I finally referred out a client to IOP because they needed way more services than I could provide and I felt so much relief. I only have one other client who I dread meeting with. Sessions always go over time, I can’t get a word in, and it’s just constant crisis. I can’t do it anymore. I feel extremely ineffective and downright frustrated with clients presenting this way. And it makes me feel like shit. I hate that I’m 100% the therapist that prefers and enjoys working with the “worried well”. I prefer the clients who don’t have SI and who don’t self harm. Otherwise, I physically become so anxious and worn out that I can’t show up for the rest of my clients. I desperately want to refer this particular client out but can’t even think of a reason to.
I would just like to know if anyone is similar to me. If this makes me a shitty therapist then so be it, I know in my heart that I do really good work with clients who are motivated and aren’t in constant crisis.
I do have my own therapist who is incredibly supportive and I’m a part of really helpful consultation groups. So I think I’m really trying and I also have limits.
I'm looking for a therapist... for myself. Yeap, I'm a therapist -- I evaluate suicidal and homicidal people for work and have been independently licensed for approx 10 years.
I have a ton of trauma, loss, and an endless supply of snark and sass. I struggle finding a therapist because of all this and I'm kinda jaded. I've experienced a good amount of adversity in my life and struggle with things like "how does that make you feel" instead of "holy smokes that sucks" -- ya know. I prefer a fully licensed clinician that is queer. I'm tired of teaching my clinicians what it is like navigating the world as a non-binary, masculine of center human with a vagina using gendered bathrooms and being screamed at to leave.
Life is hard and navigating this complex world without adequate supports is a pain in the arse. Experiences like this are one of the reasons I regret becoming a therapist - help shouldn't be this hard to find. I've outreached to over 40 therapists and it's a bucket of silence.
I have a client who is super disconnected and shut down from their emotion-body connection because of trauma/grief. We’re working on the grief with EMDR but they say that they have trouble really feeling the work they’re doing because they can think about it easily but they can’t feel it. What are your favorite somatic exercises for folks who are just starting out the process of reconnecting with their body and emotions?
Would love to hear other therapist’s ways of managing this!
I am completing my practicum and struggling SO much with feeling like I don’t know anything. I feel like my clients are getting ripped off paying for my service (it’s low cost counselling but still). I am obsessively researching strategies to use for various topics and keep coming up short. I’ve got nothing. I don’t know if this is the career for me anymore. Does it get better? What are some of your tried and true tools that I should know.
I live in Ohio. Of these examples, what does and doesn’t need to be reported?
Things I know that have to be reported: -Suicidal ideation with a plan. -Homicidal ideation with a plan. -Child abuse and neglect. -Elderly abuse and neglect.
Things I know that don’t have to be reported: -Suicidal ideation with no plan. -Homicidal ideation with no plan.
Specific situations that I’m uncertain about: 1. Secondhand information. Example: My adult client says “My friend, John Doe, drives around with his 3y/o daughter in the car while he’s drunk and has open containers. He also uses drugs in front of his kids and has heroin needles laying out in the living room while his daughters are playing.” In this scenario, do I call CPS and the police to report my client’s friend? 2. Child abuse and neglect from the past. Example: My 15y/o client says that they were raped by their uncle when they were a 3y/o, their uncle is still alive, and it was never reported. Do I call CPS to report the issue even though it happened twelve years ago? 3. Adult abuse, rape, and domestic violence. Example: My adult client tells me that they are being sexually abused and physically abused by their boyfriend. Do I call the police and make a report? 4. Adolescent substance use. Example: My 13y/o client tells me that they smoke weed and their parents don’t know about it. Am I obligated to tell the parents? Or is my client protected by 42 CFR Part 2? 5. Felony crimes committed in the past. Example: My client tells me “I murdered John Doe last night and put his body in a river.” Am I obligated to call the police to report the crime?
I am interested to see if anyone here has worked with a client long term, and then had the client start on ozempic or another GLP-1 after having a period of knowing the client.
I am interested to learn if therapists believe that Ozempic has any mental health benefits or harms. Secondly, if so, does it appear to be more “biological” or more psychological? I know it’s very hard to separate out those two.
What emotional and mental effects do you believe the medications had on your clients?
Has anyone else experienced this? I didn't even respond to the text, and it was WEEKS between terminating and this friend reaching out to me, which was extra weird. I feel like I now need to put some kind of "don't give my number to your MLM friends" in my consent or something.
How does everybody deal with parents who ask if you can 'fix' their child? I usually just look straight at the kid and say "Well, I don't think they're broken." What are your strategies? I mean, TBH, we all know it's really the parents that need a bit of work....
Hi there, this question is aimed towards therapists who have been in the field long enough to have worked with children and young people (12-21yrs) of both generations. What characteristics and commonalities of Generation Alpha can you compare to children and young people from the previous Gen Z? What notable changes have you observed over the years, and what do you think has driven these changes? I'm interested in your long-term perspective on how societal shifts, technological advancements, and global events (i.e. influencers, drill music, tiktok/reel-formatted short-video consumption, covid, cancel culture, etc.) have shaped young people today and how different they were to the youth of Gen Z. I look forward to hearing your thoughts, thank you!
Hello all! I have been in this very stuck place regarding my career and I just don’t honestly know what to do. I almost feel like I’m ’that client’ that’s like ‘yeah but…’ all the time with the constant questions I have about where to go or if I should stay. So I was curious if there are any good therapist career coaches out there? Is that even a thing? Or would I just be getting into a very expensive program that’s going to change my life? (Sorry so many of those ads out there rn) or any suggestions on career advice. Thanks!
I specialize in DBT and CPT therapy. My clientele is lots of folx with emotion regulation challenges, including adolescents needing emotion reg support, adults with dx of, or shared symptomology with, BPD, folks with trauma, and folx with eating disorders and trauma, especially binge-eating. As the PP clinic I work at has a lot of teens, but I don't want to take on more than 25% of my caseload as teens, I was wondering about doing training as a family therapist. I enjoy individual work a lot, building rapport, and seeing growth and wonder how family therapy differs.
Family therapists, what should I be aware of before moving in this direction?
Please drop any book recommendations that you have. Either clinical, memoirs, or anything else that has really helped you as a therapist or a human. TIA.
I work for a small practice with six mostly full-time therapists (including me) and a couple of therapists who see just a handful of people each week. It's a very low-key environment, which is very much what I needed and wanted upon leaving my last position at an FQHC, where I was expected to schedule a minimum of 35 clients per week. Here, I am able to manage my own schedule, and my goal is a minimum of 15 per week. (I work three to three and a half days a week.)
I have years of experience, am credentialed with pretty much all insurance companies, am very low maintenance. I know the practice owner is very happy to have me there. I am considered an employee, not contracted, so she does all the employer stuff, like taxes and social security. Staff take care of taking referrals, checking insurance, and doing scheduling, so that's worth a lot to me. I have ZERO interest in going into private practice. She is paying me $50 per client seen (including assessments). The thing is, two of my colleagues are provisionally licensed, and they are also paid per client, and they also get paid $50 per client. (Others are salaried.) I'm pretty sure the reimbursement is quite different for me versus them, so this rankles a bit.
I have been there for just over a year, and I'm wondering if it would be reasonable to approach the practice owner to discuss an increase in compensation. I feel like it is, but I'm reluctant to rock the boat. I'm pretty content there in most ways, and although I know I could go elsewhere, I don't really want to make another move and disrupt my clients again.
Any advice?? 🤷♀️
Maybe this is common knowledge but I wanted to share regardless in case it prevents someone from being audited/dealing with the repercussions. If I’m being honest I didn’t even think about this until today….
It’s important that we try to be on time for our sessions. However, things happen at times and especially if you are doing mostly virtual sessions it can sometimes be more difficult to wrap up a session prior to 60 minutes. With that said, I always tell my clients from the beginning that I begin wrapping up the session at the 50 min mark and I make it a point to end at 53 min if possible so that I give myself time to complete the note for the session and so I’m not late to the next session.
I digress…I meant to jump on this forum earlier and accidentally went to the therapy one. Unfortunately I saw a lotttttttt of complaints about therapists and a common one is virtual therapists especially being late. A common theme I see is people mentioning the code they see their insurance was billed for and what the minimum time requirement is (looks like a lot of clients know 60 min sessions = 53 minute minimum). And then I see people saying they call their insurance to report a short session and/or recommending calling insurance to let them know the therapist is doing less than 53 min. I also saw where parents of teens have reported therapists for not doing a 53+ min session.
I say all this bc I imagine the insurance company will audit you if someone reports it and if you can’t prove you saw the client for a certain amount of time, it won’t be an ideal situation. Pretty sure they consider it insurance fraud. Although I’m really good about doing at least 53 minutes, this has reminded me of the importance of following through on that every time regardless what insurance they have.
Anyone else feel misunderstood or unheard by their supervisors/bosses? I’m at an outpatient D&A/behavioral health clinic now where we are incredibly busy. The groups I’m responsible are teetering on noncompliance because of how full they are. It’s burdening, I’m tired, and feeling worn out. Last week at one of our staff meetings, a challenging case was brought up and I made audible noises (“ugh”) which, to me, were moreso about my frustrations overall with how things are, however, my boss - instead of checking in on me to discuss, just followed me after the meeting and told me how inappropriate my noise making is. I feel invalidated, unheard, and burnt out as it is, but now we can add low morale. Being reprimanded for something that was taken out of context and not what they assumed it was about.
Can anyone relate?
I recently finished my work as an intern at a non-profit organization for my graduate program in mental health counseling. I have since graduated and my last day with the non-profit was on Friday.
One client I worked with asked if it would be possible to continue working with me even after I left the site. I was clear with him about the fact that the non-profit does not allow therapists-in-training to walk away with clients and that I couldn't promise that the private practice site I would be working for would allow for me to work with former clients. He seemed understanding of this and I transferred him to another counselor at the site.
I woke up this morning with an email notification that he sent me a request to connect on LinkedIn and was surprised. Thankfully, I did not update my profile to include the name of the private practice I will be working for. However, it is my understanding that while my limited permit is pending approval, I am not allowed to be in contact or communication with former clients. I also understand it's one thing if a former client googles me and finds my Psychology Today profile to reach out and reinitiate the therapeutic relationship, but to send out a LinkedIn request seems, to me, like a violation of boundaries.
I think it's also worth mentioning that my supervisor at the site, knowing about the client's interest in continuing to work with me, suggested that I provide his new therapist with my new site's information in the event that he becomes adamant about continuing to work with me. The new therapist was told he can use a cover story that he Googled my name and found the name of the practice I work for.
I am not sure what to do. Do I delete my LinkedIn profile? Block him? Ignore the request?
Hi! I am looking to start my journey to a counseling degree. Can anyone offer some recommendations on good online counseling programs?
Hey all, The imposter syndrome is hitting me hard, and my anxiety in really high currently because I consistently feel like I am screwing things up, particularly the documentation side of things. I think I work well with kids, and their families, although the transition from structured trauma work to PP focusing on more everyday stressors for kids has felt like a learning curve. How do you all manage the documentation part of your caseload? I'm on top of my notes, but I know I'm wordy, which impacts my CCAs and TX plans, and the notes too. I take both insurance and self pay, and insurance companies scare me with always thinking I'm doing aomwthing wrong. Any help or advice would be appreciated. Thank you!
I’m trying to figure out a way to reduce my hours at my current telehealth company and start doing my own private practice (telehealth). I’m nervous that I will not be able to obtain enough private pay clients to justify doing this.
What are marketing practices that work for you? Is psychology today and a website enough?
What platform do you use? (Therapy notes, simple practice, sessions health)
Any advice would be helpful. Thanks! 😊
I am utterly shocked at how loving boys are. I’ve grown up primarily around females so it’s quite the shock. In school for my BA in psych, they would have a very "boys don't really talk much" type of bias which just set up this ”men are naturally stoic” vibes but my experience says the complete opposite. They are VERY affectionate and just as communicative and loving as women. Its so palpable that it hurts my soul because our societal structures are so FKCED.
Compared to my high school boys, its heartbreaking. I don't know what happens in the time between middle school and high school but the difference is clear. Their natural tendency to be openly loving is dimished, at least in my sessions. Their communication is so much more limited. They don't co-regulate with their boys. They don't talk about their shame, fears, sadness. Me as a woman, I have sisters and female cousins and aunts and my mom that I could call at a moment's notice and just vent and cry and bounce back from. I've come to learn from both my kids in session and (and as a result asking my male friends) they don't have that. And how fucking sad is that man. Its just so anti-human to me.
With all this men suck rhetoric on social media, it just harms them. I used to be that way after my nasty divorce where my ex husband but this experience has changed my world view. God, what humanity has become due to the emotional suppression of men. The disconnect between a human being and their emotions harms a species that's basis on survival is social harmony.
I don't know what caused this "emotions make you unintelligent/weak/stupid" philosphy but man where would this world be if it didn't exist. Idk just wanted to vent this existential sadness. I just wanna cry lol. Like this is so bad for the human race.
I'm a 1099 working for large group practice. I'm setting up my LCC and need to settle on a name for the business. I might go out on my own in the future but am happy where I am for now.
Does anyone have an opinion on the pro's and con's of using your own name vs coming up with completely separate name for the practice? (e.g. Joe Smith, LCSW vs. Acme Counseling Services)
I had this thought occur to me so I thought I’d pose it as a question on here. I see a lot of posts in other therapy subs where clients talk about experiences they had with their therapist and some of them are pretty detailed. So I was wondering, have any of you read one of these and realized that you were the therapist they were talking about? How did you feel and what, if anything, did you do in response? (If you can disclose that). And did it seem fair and justified? This hasn’t happened to me, but I was just wondering 🤔
