An acquaintance of mine has seen several AI image generated ads with copy on them I consider to be sexist and promoting some forms of toxic masculinity. Do you agree or is it just me?
Don`t mind my vent. I accept insurance for 99 percent of sessions. I can`t tell you how many times I have told people calling to inquire that my private pay cost is 120 per session and they have acted like I said 1000000 dollars. I don`t think 120 is unreasonable but tell me if I am wrong. I can`t tell you how many times I had patients call and once they hear that price they are not interested, even if I offer sliding scale or superbills. One person even called asking if I provide FREE THERAPY for people who have been through abuse. Of course this is an area I am passionate about but people this is how I pay my bills!! If the cost is more than 30 or 40 dollars per session people are not interested but no one blinks an eye about paying 80/90 dollars for a massage. No one asks if their massage therapist provides superbills or sliding scale. They treat the body, we treat the mind. Yet are we the problem for even putting the options out there that there are all these ways around for them to lower the cost rather than other wellness fields the cost is what the cost is and thats that.
I say this because I am tired of us getting tramped on. Insurance barely reimburses and even then its like "you have to prove yourself" to get reimbursed for claims. I read Alma just lowered their rates for 90837 sessions. Highmark added in the contract therapists must be available 24/7 for emergency calls and cannot just have a voicemail directing them where to go. We do amazing work yet because we are a mental health field the expectation is we are there for everyone and expect nothing in return. WTF?!!
⚖️ Nurses just got two major wins in one day.
A bipartisan bill — the Nursing is a Professional Degree Act — was introduced to officially classify nursing as a professional degree, restoring $50K/yr in federal loan access for MSN, DNP, and PhD students.
The same day, 24 states and D.C. filed a federal lawsuit to block the RISE rule that slashed those loans in the first place.
The rule was based on a list of "professional degrees" that hasn't been updated since the 1950s — before modern graduate nursing education even existed.
The bill already has 250+ organizations backing it, including the ANA and AACN 💜
Do you think the bill or the lawsuit has a better chance of fixing this?
I’d love to hear if our organizations are doing anything?
I cried in session with a client today.
I’ve been a psychologist for six years.
I have previously welled up when hearing significant trauma, usually from a place of care and empathy. Unfortunately, today felt different.
It is very important to me that my client remains the focus of the session, and that any self-disclosure is carefully considered in terms of whether it supports their therapeutic goals. Because of this, I naturally keep my personal and professional identities quite separate.
I also value having clear boundaries while still being authentic with clients, and I am always holding ethical considerations in mind.
For context, last year I experienced a significant health scare. I thought I had processed it.
Today, something a client shared unexpectedly resonated with that experience.
I felt myself getting upset. I am usually quite confident in my ability to regulate and cope, but in that moment everything flooded in too quickly. I began to tear up.
This is the part I am struggling with.
I was not tearing up purely from empathy. I was not regulated, and honestly, I was triggered. I was re-experiencing the fear I felt back then, which has never happened to me in relation to this illness. I have spoken about it before and have never been triggered like that. I genuinely thought I was not carrying any leftover pain from that time.
I started to cry the kind of crying where I was trying very hard not to properly cry and took maybe 20 seconds to gather myself. From there, I was able to redirect the focus back to them.
Afterwards, I was mortified. I went into my room and cried more. It really shocked me, because I have never had this experience before.
I am seeing my supervisor and I am also thinking of seeking counselling to process any pain that may still be left over from that time.
In the meantime, I am not entirely sure what I am looking for from this post. I feel guilty and, strangely, as though I have done something very unethical because there was such significant countertransference.
I checked in with the client about the impact, and they did not report feeling uncomfortable.
Thoughts?
I am conflicted about whether or not to report a colleague to the board. There have been instances in the recent months that have raised a lot of clinical concerns for me, however there are some concerns about retaliation from this colleague. They are considered the “senior therapist” at the pp I work at. Since receiving my supervision designation on my license the vibes between she and I have felt off. A couple months ago there was something that happened and there was a complaint filed on her. Just some background.
Yesterday I was talking to a client, spouse sees this colleague of mine. My client told me that their entire family sees this colleague of mine as family and that they spend time together outside of sessions (going over to each others homes, her hiring the kids to do work for her on her property, etc). I already had concerns about this dual relationship but now that I know it actually is happening I feel like I need to report it. I am terrified of retaliation as a couple months ago she and I had a big argument after her accusing me of outlandish things via a Teams message and when confronted about it she got very intimidating n kind of aggressive towards me. My clinical judgment is telling me I need to report but I am so scared she is going to find out it is me and she is going to work harder to push me out. Any advice or feedback would be so helpful
I work in an agency with some other therapists and we get a fair amount of trans/nonbinary clients. I’ve noticed a trend where some therapists will refer to all trans clients with they/them pronouns. I’ve brought it up before and they say they use they/them just to “be inclusive”. It drives me crazy!
These people are telling us their pronouns! If someone AFAB came in with no trans identity, you wouldn’t refer to her as “they/them” to her face. Same should go for someone AMAB with she/her pronouns. It’s still misgendering someone, just not with their gender assigned at birth. Am I nuts?
Fellow therapists and mental health workers, I come seeking insight and advice. I lost a teen client to suicide last week and will be meeting with their parents for a processing session. Many things cross my mind: Will they blame me? what does this session look like? how do I hold space for them while also managing my own grief? what is appropriate or not?
After consulting with my supervisor, I am trying my best to go into this session with no expectations and recognize my own insecurities (self-blame) are not necessarily going to show up from the parents. I also acknowledge that i did not fail my client and did my best to check in regarding SI/NSSI and had no reason to be concerned at our last appointment. I’m trained in CAMS and understand how to look for and communicate about suicidality. I guess I’m still trying to wrap my head around this, just as I’m sure their parents are. I'm wondering if anyone else has had a similar experience and can share what this session dynamic might look like.
After doing some reading on therapy with suicide survivors, my priority is to ensure the parents have adequate support, resources, and examine any barriers to the aforementioned. I know this session is not about me, and if the parents are trusting me with their processing, they likely do not blame me for what happened. This is bound to be the most challenging session of my career thus far, but I am willing and know I can hold space for them, just as I have for their child.
Thank you for reading and thank you for any insight and advice.
We’ve had a large volume of posts today regarding the recent reimbursement changes announced by Alma involving Aetna and CPT codes 90837/90834, so we’re consolidating discussion here to keep the subreddit usable for everyone.
Please keep all discussion, reactions, questions, concerns, and updates related to this issue within this thread moving forward.
From Alma’s announcement:
>What's changing
>Extended sessions will no longer be reimbursed at a higher rate. Starting July 15, 2026, CPT code 90837 (53+-minute sessions) will be reimbursed at the same rate as code 90834 (37-52 minute sessions).
>You can review the new rates in your Alma portal.
>Our position and what comes next
>We disagree with these changes. We recognize the disruption this change may cause to your practice, particularly when you determine that extended time is clinically appropriate for a client.
>We have put together an anonymous survey to collect your feedback. The survey will be open until 11:59pm ET on May 29, 2026. We plan to share aggregated, de-identified results with Aetna as a part of our advocacy efforts and commitment to you as Alma members. Your feedback will help us better understand provider and client-access impacts:
>Whether you anticipate changing your Aetna caseload as a result of these rate changes.
>Your experiences with 90837 billing.
>Reminder: Please do not include client names, dates of birth, contact information, clinical details, psychotherapy notes, or other client-identifying information in your responses.
A few reminders before posting:
Thank you!
So i've been in private practice for about 3 years now (solo, outpatient, mostly anxiety/depression/trauma) and honestly the admin side of things was starting to eat me alive. Like I'd finish my last session at 6 and then sit there for another hour and a half doing notes because I'd let them pile up. Some weeks I was doing notes on Sunday morning which... no. Just no.
I tried a bunch of different things over the past year or so. Started with SimplePractice which a lot of therapists seem to use and it's fine, it does a lot, but I felt like I was paying for a ton of features I didn't need (I don't do insurance billing, don't need telehealth through them) and the interface felt cluttered to me. Tried just using Google docs with templates for a while which was honestly chaotic lol.
Anyway a few months ago I stumbled on PsyPlanner and it's been... really solid actually? The thing that got me was the SOAP/DAP templates with auto-filled variables - like client name, session number, date, that kind of stuff just populates. Sounds small but when you're writing 25+ notes a week it adds up. I also started using their PHQ-9 tracking and being able to pull up a chart showing a client their score trajectory over time has been genuinely useful clinically. Had a client last week who was feeling like "nothing is changing" and showing them the actual trend was a really powerful moment.
The booking page + intake form combo also cut out so much back and forth with new clients. They book, fill out paperwork, sign consent forms before we ever meet. I used to spend like 15 min of the first session on logistics and now we can actually get into it.
I'm not saying it's perfect - it doesn't have insurance/billing stuff if you need that, and it's newer so it doesn't have the massive feature set of some of the bigger platforms. But for what I need it's been great and it's way cheaper ($28/mo, there's a free tier too).
But honestly I'm curious what other therapists are doing to manage the documentation burden. I feel like we all went through school learning how to be clinicians and then got thrown into running a small business with zero training lol. Have you found systems or tools that actually help? Or is everyone still doing notes at 10pm on a Tuesday like I was 😅
I’ve been having a few cancellations and drop outs after just a few sessions and i am finding it hard to cope. This is something ive always struggled with and have taken to supervision as well but i dont seem to be coming to terms with it. Everytime it happens it takes me right back to thinking I shouldnt be a therapist or I’m really bad.
I dont know how other therapists deal with it. (I have adhd and wonder if RSD is stronger for me)
But it just seems like ive failed to be a good therapist. Logically im aware there are things probably in their life and things they are not ready to face. I’m not sure if I’m rushing them or i cant seem to understand whats going wrong?
Any recommendations for any psychology or psychology adjacent podcasts? I find many that I’ve tried listening kind of boring. I’d ideally like to learn from the podcast but it doesn’t have to feel like a CEU. I’ve been listening to a lot of True Crime and need to snap out of it a bit 🤣
I saw this from a group I am in. What is going on with this?!
How closely do you feel you have to align with your therapist’s treatment style/modality/philosophy to feel the treatment/relationship is effective or a good fit?
Those who are working through Alma, I’m sure you received the email starting July 15th in the U.S. extended sessions (53 mins plus) will be reimbursed same rate as a 90834(37-52 mins) I hate this so fucking much. I’m just sad. Watching the mental healthcare industry and how it’s burning at all times. This country is in crisis. Clients suffer. You commodify every way you can insurance companies. Come after us - low paid, struggling as it is. I don’t see why people even strive for this career path anymore. I will make more as a bartender without student loans. Please fill out your surveys. Please be honest. Idk what it will do. I feel powerless. Struggling so much financially. I may just depanel.
I’m a new therapist looking for advice on how to handle this reoccurring situation. I’ve loved the job so far and feel confident in my abilities, until it comes to setting uncomfortable boundaries. I’m fine upholding boundaries around things like the cancellation policy and rules for contact outside of sessions, but I’m struggling with setting boundaries with certain clients, specifically, older white men. They refer to me as “sweetheart” or “young lady” and idk how to shut that down, especially since I let go the first few sessions, which I know was a mistake.
Second time I received this type of scam message, and almost fell for it. Client reaches out, schedules a consult with me, proceeds to send me “links to articles they wrote” asking what I think about them.
How This Specific Scam Usually Works:
The Bait: The "client" reaches out to schedule a consultation, making the therapist feel secure
that a normal business interaction is occurring.
The Switch: Right before or right after booking, they send links or "attachments" claiming they are relevant to their care (e.g., "Here is a summary of my mental health history," "Here are articles I wrote about my struggle," or "Here are my medical records").
The Trap: Clicking the link takes you to a fake login page (often spoofing Google, Microsoft, or LinkedIn) designed to harvest your professional email and password. Once they have your credentials, they can compromise your business accounts, attempt to access HIPAA-protected data, or impersonate you to scam your actual clients or colleagues.
Keep yourself safe out there!
I’ll start by saying I am grateful to have a job where I am awarded a generous amount of 22 vacation days per year, as well as paid holidays/holiday breaks (University Counseling Center).
I usually try to take majority of them in the summer which is client “off season” at a UCC where my case load decreases significantly, however I want to get in the habit of taking some time throughout the rest of the year as well to mitigate burnout.
The trouble is we are fairly busy through the year. Taking vacation during the year would mean I would need to fit in any client sessions I would usually have while on vacation, into my work week when I return. So I end up avoiding taking vacation during the year and then scramble to use days up in the summer.
Ex: If I take a week off, as soon as I return I then need to have a full week of 7-8 session days. Which to me is absolutely exhausting.
Considerations:
- I am not paid per session, I am paid salary regardless of number of sessions.
- I don’t have a certain amount of quota clinical hours to hit, other than generally I should have space for about 4 clients per day blocked in my schedule. I am not penalized if any of my clients cancel, ask to skip their session, etc. nor do I need to “fill” their spot with another session or new client if they do cancel.
- Most of my clients are biweekly so a missed session would then mean 1 month without being seen, so I would feel bad to not offer to “makeup” that missed session, and most if not all would take the offer of a “makeup” appointment.
I don’t think there is any miracle answer here. Just looking for general feedback, discussion, or anyone who can relate.
How many times in your life have you typed “utilzied”? I just did it for the one millionth time and feel like I deserve a prize.
This question is for anyone, but particularly for veteran therapists who’ve gotten to branch out organically into the corners of the field, adjacent fields, or into things that new therapists wouldn’t consider to be possible.
I’m a therapist who likes to live a weird, variegated, experience-filled life, and I would love to know where this can take me other than the basic article-writing, talk-giving options. Paid or unpaid, career trajectory changes or one-off crazy stories, whatever. What unique opportunities have you gotten that you might not have known to look out for beforehand?