r/therapists

I'm hoping to get some perspective and advice from others who have experienced a difficult transition into the profession.

I'm in Alberta, Canada, and recently completed a masters in counselling psychology degree and an eight-month clinical practicum that was a very positive experience. This is my second career after many years working in an unrelated professional field, and I came into counselling with high hopes and a genuine enthusiasm for this next chapter.

My academic credentials have been approved by our provincial psychology regulator, but I still need to secure a suitable practice setting and supervisor to begin working toward full registration.

I've spent the past several months applying for positions, reaching out to private practices, and contacting potential supervisors. Many practices have recently hired, aren't accepting new provisional psychologists, or simply don't have the capacity. I've been willing to arrange and pay for external supervision, start part-time, and offer flexible availability, but so far, none of these efforts has led to an opportunity.

It's taken years of sacrifice, hard work, and commitment to reach this point, and I'm feeling increasingly discouraged. I genuinely enjoyed the clinical work during my practicum and felt confident that I had chosen the right direction for my second career. I hadn't anticipated that finding somewhere to begin supervised practice would be such an impossible challenge.

For those who struggled to find their first supervised position, what eventually worked for you? Were there opportunities or approaches you hadn't initially considered? Did things become easier once you were provisionally registered?

I'd especially appreciate hearing from anyone who entered the profession as a second career later in life. I'm trying to remain hopeful, but right now I'm feeling rather lost.

Not sure what I'm looking for, maybe to hear from others who have been through it. We worked together for around 18 months. It was a difficult case and someone who felt so stuck and trapped. They didn't say anything about it ahead of time but I feel so strongly that I should have known and done something. It's been four months and I'm not back to myself yet and it's worrying me. I'm having a hard time relaxing and working can feel really terrible. I'm about to get my independent license and have plenty of clients to have a successful practice and I think about quitting all the time. This is supposed to be the great moment that I've worked towards for 5 years but I feel worse than when I started.

The practice I work at thankfully has me as W2 with benefits but that also means they dictate my schedule. We work with high acuity individuals with high needs. No individual therapist can be away from the office for more than 3 consecutive days, including holidays. But we also aren’t open on Fridays, so we are all away for 3 consecutive days already. I’ve asked about taking a Tuesday-Thursday block off and been denied due to this rule.

My family is spread out throughout the world and I always use 2 weeks at Christmas to see everybody with every other job I’ve had. This has been denied already at my current job.

I am about to lose a pet to cancer and would like to take time in order to put her down and have a day or so to grieve, but I can’t extend my 3 day weekend. I’ve asked my boss before what would happen if I were to be incredibly ill, and I was told that’s what telehealth is for. A coworker of mine lost her mom and had to be back at work after the weekend.

I personally cannot function like that. I cannot see clients for 10 hours right before euthanizing my pet and then have just the weekend to grieve that. 3 days also doesn’t give me the necessary travel time to see family so I’ve literally not seen my family all year. I have arguably the highest paying job a therapist can get for where I’m at in my career and in my city, but I’m wondering if it’s simply not worth it. I would love to even be able to take just 1 day. Have 4 days off… ever.

Hi therapists. I’m 28 years old and have had my LCSW for about two years now. I opened my private practice at 26, just a few weeks after obtaining my LCSW. I initially ran it on the side while working full-time elsewhere, but eventually transitioned into the practice full-time. Since then, I’ve grown it to include three clinicians, and we accept insurance.
The first year and a half was manageable, but the past six months have been absolutely terrible for me. I’ve developed a significant amount of stress and anxiety from both sides of the job; seeing clients clinically, but also directing and managing the practice, dealing with employees, billing, insurance companies, and everything else that comes with being a practice owner.
I’m at a crossroads now and genuinely don’t know what to do. The practice is covering my bills, but that’s about it, so financially, the amount I’m making doesn’t feel worth the level of stress and anxiety I’ve been experiencing.
I keep wondering whether this is just a difficult phase that I need to push through until I’m in a position to hire someone to handle the administrative and management side, allowing me to focus primarily on clients, or whether I’ve reached the point where I need to seriously consider closing the practice.
Everyone around me seems to tell me not to close it and to keep going. I also feel like some people think I’m exaggerating how much this has affected me, but I genuinely feel awful about 90% of the time lately, and it feels directly connected to both running the practice and being a therapist.
What makes the decision even harder is that I don’t know exactly what I would do if I closed it. At the same time, I’ve reached the point where I’m reconsidering whether I even want to be a therapist anymore not just whether I want to own a practice.
I’m feeling really stuck and unsure of what the right move is. I would genuinely appreciate hearing perspectives from other therapists and practice owners, especially anyone who has experienced burnout like this or reached a similar crossroads. Did you push through and eventually find a way to make it sustainable, step away from practice ownership, leave the field altogether, or do something else?

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By now, most of you have probably seen the Headway updates of taking $9.99 per client who books through Headway, as well as the mandatory annual note review.

Like many, this is my final straw for staying on Headway. I’ve already being toying with the idea of leaving, so this felt like the final push. However, I’m torn between self-credentialing with insurances or going fully private but offering sliding scales.

I have between 10-15 active clients on my caseload who are insurance clients. Some could afford my full rate ($135), while others definitely can’t or wouldn’t. I would like to get credentialed with the main insurance carrier that these clients fall under (BC/BS), but I have such an intense fear of audits and clawbacks and other horror stories that have been shared on this subreddit before.

I’m curious to hear other people’s thoughts who have been in this situation. What did you end up choosing? If you did go fully private pay, how did you broach that with clients?

Thanks in advance!

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.

Read an interesting suggestion today to gather "best practices" from your field (from the James Clear newsletter). Made me wonder what best practices we would all list. As an example:

1. Discuss scheduling and billing at the beginning of a session rather than at the end--one never knows where a session will go, and taking the last 5min to update a credit card number or try to find a time to reschedule next week's session, is often undesirable.

2. Don't sleep with your client.

*Note: best practices listed here not necessarily listed in order of importance