u/SuspiciousThoughts14

I’ve come to the conclusion that starting a solo practice may be the most beneficial route for me as an LCSW. However, I’m at a loss about where to begin and would love to hear from others who have successfully built their own practices.
I would like to start with virtual sessions only and eventually offer some in person sessions. A few questions I have:
How did you choose your practice management software and telehealth platform?
Did you start with self pay clients while working on insurance credentialing, or get credentialed before opening?
What was the credentialing process like for commercial insurance, Medicare, and Medicaid?
What were your first steps, and what do you wish you had known before starting?
Any practical advice, resources, things to avoid, or lessons from your own experience would be greatly appreciated. I’m hoping to build something sustainable and would love to better understand what getting started actually looks like.

Most of my social work experience has been in case management, supporting people with a wide range of mental health diagnoses, intellectual disabilities, and complex medical needs. After obtaining my LCSW, I accepted my first full time therapist position.
I’m neurodivergent and have chronic health conditions that worsen with stress. I went into the role expecting reasonable work and life balance, some control over my schedule, and the opportunity to use my clinical judgment. Instead, I’ve experienced micromanagement, rigid productivity expectations, and little room for the individualized, trauma informed, person centered care I value.
I’m required to provide 32 hours of availability and see a minimum of 25 clients each week. Some days I see eight or nine clients, often with four consecutive hour long sessions and no break. I can control scheduling for my standing clients, but intakes can be placed anywhere within those 32 available hours, without my input. That makes it difficult to pace my day around my energy and health needs.
I enjoy aspects of being a therapist. What I’m struggling with is the volume, limited scheduling control, and feeling restricted in how I can meet clients where they are. I’m also being evaluated against expectations that don’t always reflect the complexity of their needs or the progress they’re making.
This has taken a significant toll on my mental and physical health. The thought of returning to this job now triggers panic attacks. As a new therapist, I’m struggling to separate this particular work environment from my ability to do the work. I’m starting to question whether providing therapy can be sustainable for me.
I’d really appreciate hearing from other LCSWs who are neurodivergent, chronically ill, or both:
What helped you find a sustainable pace when you were new to providing therapy?
What strategies, accommodations, or boundaries have helped you prevent burnout, especially when you have limited control over scheduling?
Did changing employers or settings make therapy more sustainable?
What interview questions helped you get an honest picture of productivity expectations, scheduling autonomy, flexibility, and clinical support?
Have you found sustainable roles beyond full time direct therapy, or positions that combine therapy with other responsibilities?
How do you recognize early warning signs of burnout, and what do you do when you notice them?
I’d especially welcome experiences with case management, clinical oversight, training, quality improvement, or program development. I’d also appreciate employer recommendations from people who have felt supported in workplaces that understand neurodivergence and chronic illness.
I want to do meaningful work, but I don’t want to sacrifice my own mental and physical health to help other people with theirs.

Most of my social work experience has been in case management, working with people with a wide range of mental health diagnoses, intellectual disabilities, and complex medical needs. After obtaining my LCSW, I accepted my first full time therapist position, which is remote.
I went into it expecting reasonable work and life balance, some control over my schedule, and the opportunity to use my clinical judgment. Instead, I’ve experienced micromanagement, rigid productivity expectations, and a steady stream of sessions with little room for the individualized, trauma informed, person centered care I value.
It has taken a significant toll on me. I also have chronic health conditions that worsen with stress, so this is affecting both my mental and physical health. At this point, the thought of returning to this job and providing therapy is triggering panic attacks. I’m starting to question whether I can be a therapist at all, and I’m struggling to separate my experience with this particular job from my ability to do the work.
I’d really appreciate hearing from other LCSWs who have been through something similar. Did changing employers or settings help you feel differently about therapy? What questions would you ask during interviews to get an honest picture of productivity expectations, scheduling autonomy, and clinical support?
I’m also interested in roles beyond full time direct therapy where I could use my license, experience, and clinical judgment. If you’ve found a sustainable role or an employer that actually supports its clinicians, I’d love to hear about it.
I want to do meaningful work, but I don’t want to sacrifice my own mental and physical health to help other people with theirs.

I am wanting to get some feedback from therapist who currently work for NOCD or who have worked for NOCD. I would like to know about your experience, work life balance, scheduling , etc.

Today I had one of the most frustrating customer service experiences I’ve had in a long time at the Washington Walmart.

The experience actually started back in electronics. I spent probably 10 minutes standing in the printer aisle researching and comparing printers on my own because no employee ever came over to ask if I needed help. Which honestly was fine. I was perfectly capable of figuring it out myself.

I finally picked the printer I wanted, but it was not out on the shelf even though Walmart’s app said it was in stock. So I found an employee and asked if he could check the back for me. His response was basically that if it was not already out there, I would probably have to wait until Wednesday because they were doing inventory.

I asked if he could at least check the one place he thought it might be and, surprise, he found it. He at least ended the interaction politely and told me to have a good rest of my day.

I continued shopping and eventually headed up to self checkout near the pharmacy side where an employee named Cheryl was overseeing the registers.

And to be clear, I actually like self checkout. I like bagging my own things. I like organizing my cart myself. I like taking my time. I like being independent and not having to interact with employees unless I absolutely need to.

I did not have a huge order either. I had some groceries, makeup, three large bags of potting soil, and the printer.

Everything scanned fine until I got to the printer.

Every barcode I scanned gave some kind of loud warning sound. One said the item could not be found. Another asked for a serial number. I tried multiple barcodes because I genuinely thought maybe I was missing something. I even tried entering what I thought was the serial number myself. Same warning. Same loud error sound.

At that point I tried getting Cheryl’s attention, but she was busy standing there having a conversation with another employee. So I waited. I tried again. Finally she started walking back toward her register and from across the area asked me what the problem was.

I explained that I was having trouble scanning the printer and that every barcode was giving me warning messages.

Without even coming over, Cheryl immediately responded with, “The barcode is right in front of you. I can see it from here. You just need to scan it.”

I told her I already had and that it was giving me warning messages.

Then she said, “Well did you get the serial number?”

I explained that yes, I tried that too and it still gave me the same warning.

At this point Cheryl came over looking visibly annoyed and said, “Well this usually only happens with fruit.”

And I said, “Well apparently today it’s happening with a printer.”

She again insisted it was the barcode I needed to scan. I told her I already scanned that barcode multiple times. Finally I said, “Why don’t you go ahead and scan it then?”

She looked at me like I had asked the most ridiculous thing in the world and scanned it herself.

And shockingly, the register did the exact same thing it had been doing for me the entire time.

Then Cheryl suddenly goes, “Oh, you have to enter the serial number.”

And I said, “I know. That’s exactly what I was trying to tell you.”

She pointed to the number on the box and said, “It’s this number right here.”

I said, “That’s great. Do you want to enter that in?”

And she responded, “No, you need to know this for next time.”

That was the moment I was done.

I said, “No. I’m not a Walmart employee. I do not need to know this for next time.”

And Cheryl snapped back with, “Ma’am, I am trying to help you.”

No ma’am. You were trying to get me to do your job while acting irritated that I even needed assistance in the first place.

Then after all of that, I walked toward the exit and heard Cheryl standing near customer service openly talking badly about me to another employee about how “rude” and “disrespectful” I was.

Really Cheryl? Really?

I did call and speak to a manager named Michele who seemed genuinely apologetic and said the situation would be addressed. I appreciate that she listened, but honestly I am not confident Cheryl even realizes there was anything inappropriate about the way she behaved.

Technical problems happen. Inventory issues happen. What should not happen is customers being treated like an inconvenience for needing basic assistance after already trying repeatedly to solve the issue themselves.

Walmart takes enough of people’s money. The least they could do is employ people who know how to treat customers with basic professionalism and respect.