r/therapists

Well…I did it. “Unofficially” passed and excited about my future in my career.

However, I underestimated the lack of “breaks” within the exam. There is a 15 minute break at the end of the 5th narrative, but if you need to use the whole time, be prepared to be uncomfortable.

I took my test virtually/at home. I brought a coffee and some water bottles with me. Sipping on coffee helps me. 90 minutes later I was squirming in my seat trying to stay focused as a had to pee so badly. My entire 5th narrative I must had skimmed and answered based on the questions alone. Luckily, I made it to the break and used the bathroom.

I ended the break and proceeded with the exam. Another 90ish minutes passed and I had 2 narratives left. At this point it was unbearable and I couldn’t hold it. I messaged the test proctor who essentially said “if you get up and leave your seat, the exam will end”. I was in between narratives and explained and they still said no. Well that’s great…I tried to read the next narrative but I couldn’t focus, so I did what I had to do…I just let myself go.

Yes, I peed my pants in the middle of my exam. After accepting the fact that I did what I had to do, I was able to fully commit to the last 2 narratives with a clearer mind and passed!

One bathroom break in a 4ish hour span is kind of ridiculous. Maybe I have medical issues with my bladder…? But instead of one 15 minutes later break, can we do just 2 7 minute breaks?

Hopefully you learn a lesson from this story and don’t make the same mistakes I did. But Now I’m taking recommendations for new office chairs

15 fucking years and three degrees later, the day has come...and yes I did cry 😩

What the title asks. Would you receive therapy form a therapist less experienced than you?

Hello,
This client has in the past been no show without any contact before, so do you think I am justified no longer waiting?
Thanks!

I’m an LLPC, a recent ish grad and I hate this concept of “paying your dues” and “this is what you have to do when you have a limited license.” We spent X amount of time during an unpaid practicum and internship paying our dues. And since when did “paying your dues” mean I have to take on clients I don’t want to see and pay that is absurdly low. It feels very exploitative and maybe this is just my current job and not the field as a whole. But regardless, is bs. Especially for the companies that advertise autonomy regarding choosing clients and saying yes/no to potential clients. Then turns out that’s not really the case. Being an LLPC shouldn’t mean we get paid significantly less and have to do more.

I’m a community based therapist who works with middle/high school students. I’m currently pregnant and feel like a potato, so of course this happened…I was playing a game with a pre-teen boy and I see him averting his gaze. I look down and my blouse came unbuttoned. I said “oops” and buttoned it back up. We continued to play the game, but I just want to crawl in a hole forever now.

Embarrassing things happen to us all, so tell me your stories so I’m not alone.

I have a client who often references a particular Bible verse and will say all of their trauma following their sin is punishment, just like this verse. It's pretty significant trauma, but it seems we're stuck until they can move past the idea that this trauma is God punishing them. I'm not religious myself and unsure of how to challenge this thought without (probably) being rude or ignorant.

I'd love to hear how others navigate situations like this, resources that were helpful, really anything. Thanks!

Hi all! I'm almost 16 weeks pregnant and have been thinking about the logistics of when and how I should tell clients. I have a few clients who have complex feelings around pregnancy and plan to tell everyone in person, but it occurred to me some people may prefer time to process privately first.

Also I plan to make some schedule changes. I'm self employed in private practice and have worked 5 days a week, morning to evening, my entire career. Prior to pregnancy, I considered adjusting my schedule to be more consolidated and possibly fewer days a week, and pregnancy has only strengthened that desire. I believe I've figured out what schedule I would like to have when I return to work from maternity leave, but I would love to implement it in the next few months instead of waiting.

The idea of communicating multiple changes to clients in such close succession has me a bit worried. I understand that some people will not be able to make my new hours work, and some will not want to wait while I am on maternity leave. I'm seeking advice on the best way to communicate these changes. Some of my clients have been paying a reduced fee that we initially agreed would be temporary, but I never initiated a conversation about raising the fee when that time elapsed (completely my fault). So that throws in another potentially difficult conversation I need to have at some point 🙃

Would you recommend addressing some of these things at the same time? Such as schedule changes and pregnancy. Should I wait to address the fee side of things until the new year or when I return from maternity leave? Definitely feel like I'm learning a lesson on being overly accommodating and kicking myself a bit for it. Would appreciate any advice or encouragement.

This has definitely happened to me quite a few times as a telehealth practitioner. Every time it happens, it feels like a slap across the face, but hey, the parents certainly seemed dignified in door slamming and sabotaging without any sort of two-way dialogue or reconciliatory effort. I know I feel injured because I genuinely care about the consequences it may have on the child and also... I hate being misunderstood. It's been a real drain seeing professional therapeutic work reduced to customer service work. Like when an intervention makes a child slightly uncomfortable it is magnified and attributed to the therapist's ineptness or lack of empathy. Sometimes I feel stuck between the professional PC sendoff and kinda sticking up for myself? Explaining my rationale and calling them out on their assumptions? My brain definitely entertains the latter but part of me believes it to be pointless if someone has already written me off as a person. Just curious what your personal approach is with handling blatant disrespect during abrupt closeouts.

Money's been really tight, it felt like a good time to start my practice on the side of my agency job, only wanting 1-2 clients/week for now. I thought that would surely be doable. I got signed up with Headway, Sondermind, and Grow (still in progress). Got the Psychology Today profile. Been networking like crazy on the therapy groups in my area, putting my name out there for every referral needed that is up my alley. It's been about a month that I've been 'open for business', and crickets. I've had one (1) consult call that did not convert. Nothing else. I really didn't expect it to be this challenging to get a single client and I'm feeling a lot of self-doubt right now. Advice appreciated. I did create my website and published that a couple days ago, working on SEO and hoping that will help also. I feel like I'm the only therapist in the world who can't get a client in PP 🫠

guys, every time i find a vacant position, it says medical social worker. Can i apply to it if i am an AMFT? i dont understand why they specify if i can do the job too!!??

I’m curious how cultural background intersects with modality preference. This is not research or anything - I thought it would be fun to see if there are any common threads or patterns.

I’ll go first!
Culture: United States 🇺🇸
Top Modalities: existential, CBT, IFS

Every day i see hundreds of therapists on facebook and in listservs just dogpiling on every referral request, just out of breath spamming their awful chat GPT posters and saying IMMEDIATELY AVAILABLE! Yeah, we get it. We all offer SPECIALIZED COMPASSIONATE THERAPY!What other healthcare profession has tens of thousands of people doing that all day every day everywhere you look on every platform? Its really discouraging and honestly im feeling at a loss because im in that same boat despite spending thousands on advertising, SEO, and building relationships in the community.

Whether it's trauma, ED recovery, etc. I have success with some clients and struggle with others. I'd like to hear how you approach self compassion with clients. Any advice/resources would be helpful. Movement through MI or other modalities as well.

Might sound really crazy as it did to me when I first pondered doing it but I recently found out that i excel with two ten hour back to back days and five days off.

It sounds crazy but I have ADHD and find that when I’m locked in for the day I can stay locked in and keep my stamina up. What’s been burning me out is feeling like I have no days off because when I have just three clients scheduled it feels like it consumes my entire day and I can’t focus on anything else.

I also found that I do the two ten hour days and spend the third day doing all the notes but it feels chill knowing I have four days off after that to rest and focus on other things. I think this works really well because I have adhd and just wanted to throw it out there for other providers who would consider it. I experimented with it slowly.

Several years ago, I started noticing something new when teenage girls or young women came to my office for their first psychiatric sessions. Patients used to dread being told that there was something, as they saw it, wrong with them. Now these young women were announcing their diagnoses — attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, depression — almost before telling me their names.

They had researched their symptoms on Instagram; they’d taken TikTok quizzes about them; they had cross-indexed their conditions with those of their friends. It was everyone — gravel-voiced film majors and earnest high school athletes, class presidents and girls who skipped school, girls who spent weekends in the Hamptons and girls who had to work for their spending money. The patients of this new wave were talking in therapy-speak, and their therapy hadn’t even started.

The physician part of me would instantly start thinking through an alphabet soup of treatments for the conditions these girls were reporting — D.B.T., C.B.T. and E.M.D.R. and medications to go with each.

Another part of me — the parent, the Xennial — would struggle to suppress an inner eye roll. If you’re a parent of an adolescent girl, you might have experienced your own version of these two reactions: either terror for your daughter’s psychological well-being or alienation from all the jargon. You might have even tried to convince your daughter that everything was fine. None of those responses set us up to hear what these girls and young women are trying to say.

I’ve been listening to girls every day for years, and I’ve learned a few things that can help parents, therapists and anyone else who struggles to communicate with young women as they describe some form of distress.

It starts with accepting that diagnosis words may function differently for these young women from the way they do for others. They are not necessarily claims to cold, scientific truths, yoked to specific evidence-based treatments. Instead, research increasingly reveals, these words are often a coping mechanism, an effort to find some accepted narrative in which to situate one’s very personal pain. We should try to hear them that way: We should take the therapy-speak, to borrow an expression, seriously but not literally.

One girl told me she had assigned herself a diagnosis of depression, which she later acknowledged she thought would make me care about her. Another girl was stuck on an A.D.H.D. diagnosis, mostly because it made her feel less alone by connecting her to a vocal and vibrant online community.

Several young women insisted they fit the clinical definition for anxiety, because it was less scary to blame an inherent flaw in their brains than to explore the causes of their very real discomfort — which turned out to be a mix of anger toward their loved ones and guilt for having those feelings. Another girl said she used her various self-diagnoses as a container for whatever felt like “too much” about her, allowing her to fulfill what she thought was the teenage female’s highest calling: to be chill.

In some cases, my patients’ self-diagnoses were spot on. In many others, however, the psychiatric label seemed more like a compromise between uncomfortable feelings and the desire for social acceptance. Are these labels a source of strength or a straitjacket? Are they helping young women find help and acceptance or standing in the way? The answer isn’t so simple.

Adolescent girls and young women aren’t the only ones reaching for therapy-speak, of course. According to some measures, 50 percent of Gen Z-ers have labeled themselves with mental health conditions, and illness identities have taken hold of young people, both online and off. But girls are by far the primary drivers of this trend. They are the main group looking up health information online, talking about their feelings and relationships and seeking labels for what’s wrong.

They are also the demographic with the worst mental health profile. I think the association with young women, a group so often dismissed as frivolous, is a big part of why therapy-speak is regarded as a sign of weakness and self-indulgence.

As for therapists, we think about psychiatric diagnosis a lot less than you might imagine. That’s partly because categories in our field tend to be more flexible than those in other areas of medicine. Classifications often evolve and change over time, especially for young people and most of all for young women. Besides, no two people experience these conditions in exactly the same way. So we always have to try to understand the person first.

‼️Warning ‼️ Random‼️

Client and I cracked up about a fart story from their job. They’re animated in general so it doesn’t take much for them to make me at least have a quick chuckle. It was the most untherapy-like 10 mins I think I’ve ever experienced but I would do it over and over again.

Well, it finally happened. Other clinicians warned me about this, and some even told me they intentionally throw in 45-minute sessions (even when they’re actually doing an hour) to keep insurance from getting on their backs.
I received a letter from UHC stating that I bill 90837s more frequently than the average clinician and that they are essentially monitoring my billing patterns. They said they may reach out in the future regarding “billing efficiency.”
How have you all handled this?
I schedule all of my sessions for 53+ minutes, and honestly, if a client is more than 10 minutes late to their session, I consider it a no-show. I’m not billing 45-minute sessions hardly ever because I’m actually providing the full 53+ minutes.
I also use Headway, so I’m curious if anyone else using Headway has received a similar letter.
Am I at risk of being audited? Has anyone gone through this and had UHC eventually request records or take further action?
Would love to hear how other clinicians have handled it. Thanks!

Does anyone have thoughts, other than discharging for excessive no-shows, for encouraging Medicaid clients to show up for appointments? My practice wants us to discharge after a certain number of no-shows, but then I am in the position of getting a new client and going through the (sometimes multi-week) process of scheduling, and then, sometimes they show up and sometimes they don't. I don't see how discharging folks who are generally good about showing up but miss a few times will help my overall attendance rate. And then, there's also people who call and cancel in advance, so they don't even count as no-shows. I'm really struggling to get sufficient clients.

To be clear, I discharge for excessive no-shows, but if I have someone I've seen for four or five months, and they've had two no-shows over that period, that doesn't seem like a situation where discharging the client would help the client, me, OR the practice.

I'm seriously considering seeking out an after-school program with high Medicaid participation rates where I can set up shop a few afternoons a week. In this imaginary scenario, I'd see whichever 3 kids are in attendance that day of the 7 or 8 whose parents sign them up to see a therapist. "The Doctor is In, 5 cents."

I’ve been a LPC in Wisconsin for 5 years. Experienced community mh, did some time in the schools, and some time in private practice. Guys I can’t do it anymore. No one wants to help themselves. Everyone’s looking for a quick fix. The supervisors always have a huge ego. Idk what to do but I know I need to jump ship with this field as I don’t see anything getting better with the state of the world too.. can anyone relate lol