r/therapists

I don't particularly like these questions because they are shallow and cliche and often follow a prescribed social script that both client and therapist are overly comfortable with. It also doesn't help that it's a bit of a waste of time because other than as a really mild Icebreaker it does not tend to typically provide much useful information. At the very least it can be a pain to overly rely on this single question every session.

I occasionally mix it up with questions like what has been on your mind? Or, what is it like to be here today? Or even, when you came in today for our session, what did you bring with you?

Posting this because I need to vent! I got fired last week from a private residential substance use treatment facility due to consistent failure to catch up on documentation. I was beyond burnt out, my co-workers are burnt out and no one in management seemed to care! Me and my co-worker even discussed this assertively and professionally with our supervisor a month and a half ago. Nothing changed! Our supervisor when on a two week Alaskan cruise.

I worked there for 2 years and honestly I should have left a long time ago but the pay was good. It was a “startup” and time and time again I heard people in leadership talk about “building the plane while we are flying” to address issues with understaffing and deprioritizing clinical work. This was all while business development continued grow and get pay raises. This might have been the last straw for me for working in the mental health field. I feel utterly taken advantage of and used. And i do have to take accountability, I should have left earlier like other co-workers who left due to similar feelings of burnout and being taken advantage of.

I also feel ashamed, it’s hard not to feel that being fired is some kind of failure, that I just couldn’t hack it or that I was being stubborn and lazy. In all honestly I felt that I was setting boundaries and trying to prioritize myself and my well being. I applied for unemployment and will hopefully have a little time to try to recover from my burnout while looking into a potential career change. I’m not in the greatest financial position currently but I know I can make it work. I’m smart and resourceful! I hope everyone is taking care of themselves out there, this work seems more and more difficult to sustain under the current state of the field/industry!

My wife and I are expecting a baby in a few months and we’re trying to figure out what work could look like afterward.

I’m a social worker at a government agency with solid pay/benefits/insurance, so she doesn’t need insurance through her job. My wife is also a therpist specializing in eating disorders at various levels of care, but she’s considering not going back full-time after the baby.

Ideally, she’d like something more flexible, possibly remote, where she could make her own hours and avoid relying heavily on childcare.

For those who have made a similar switch after having a baby:

What worked for you?

Did you go private practice, group practice, telehealth, therapy apps, part-time agency work, or something else?

Are any of those telehealth apps actually worth looking into?

Any advice, warnings, or personal experiences would be appreciated. We’re just trying to get a realistic idea of what options make sense with a newborn.

I'm an LSW working at a group practice right now as a therapist, but have always wanted to explore hospital settings— not necessarily psych units though, more therapy w/people recovering from physical health challenges. I'd love, for instance, to do therapy w/patients in an oncology or neurology setting. I fear the typical "hospital social work" gig isn't for me/that I'd be terrible at it (I'd bad with details/planning/scheduling/logistics). I'd much rather do actual therapy in hospitals vs case-management/discharge planning (extremely important, just not really my strong-suit). Is this a thing that LCSWs can do? Does anyone here do this?

I love community mental health. But I hate CCBHC’s.

I’m independently licensed and I love working with interns and other supervisees so I willingly give over my therapy hours to support, teach, and supervise.

But 8 hours of my 40 is overseeing treatment planning. Only an independent therapist can sign off and have to be in the room. I’m in rooms with the client and their therapist and most of the time- I’m just there to sign the paper.

I know I’m going to do this for two more years, I want to get my current supervisees to their independent and intern to graduation. After that, I don’t know. But PP is almost impossible because of the insurance aspect, I cover my family. If after two years I hate it, I’ll probably leave the field. I love watching the lights come on for a client- it’s why I do this, not to sit in a room so a box can be checked.

Had an interesting moment with a client recently where they were expressing an interest in CBT, but shared they don’t have an internal monologue. Instead, they think in abstracts. How would you guys approach this when there is no “thought” to reframe? This client stated that there aren’t any identifiable automatic thoughts that run through their mind, rather just the immediate negative emotions. This definitely made me stop and think as I have an internal monologue and never really considered how modalities are received completely differently (or maybe even just don’t work at all) for like ~50% of the population. In this case, would you abandon CBT altogether for this client, or is there a creative way you would use the principle but modify it in a way that is helpful for those that can’t just simply challenge their own thoughts? I realized in retrospect that I could possibly try to explore what is coming up in those moments — if it’s imagery for example, what does it look like — that kind of thing. However, from there how would I alter what that imagery looks like? I actually feel quite stupid now reflecting on this that it hasn’t come up for me yet in any previous client or wasn’t discussed in school.

running sessions is the easy part for me lately its everything around it that eats up the day. notes scheduling telehealth intake forms secure messaging it all works but switching between different screens starts adding up by the end of the week. for those in private practice or even group practice what part of your ehr makes your workflow smoother and what still feels like a chore every single day

What are some of your favorite resources to help educate clients about trauma? For example, shorter YouTube videos, books written for a general audience, podcasts, etc.? I have a lot for myself, but am looking to build more of a library of things for clients.

TL;DR: A list of "targets you might not think of, but that might make a big difference" would be good for making desensitization with somatics more accessible to the public.

I have been doing EMDR since 1992 and am now fascinated by the extension of reprocessing (or whatever you'd like to call desensitization that heavily uses somatic methods) into new areas. Our increasing sophistication with putting these things together is opening up new horizons.

It seems that some of the greatest targets are things that we totally take for granted or are somehow just "embedded" into our experience of life, who we are, etc. Experimenting with my own issues and doing presentations on self-care using techniques drawn from these areas really got me thinking about this.

So… Could you share some examples of targets where you've gone outside of the usual anxiety, trauma, phobia areas? I'm especially curious about stuck places we get into in life. Habits, food noise and such (whether professionally or as self-care).

Example: I was badly procrastinating on bringing my website live, even though it was close to ready. I had done a ton of work to make it suit me. I did a session (self-care style) and found that the overblown/misplaced concerns that had "behavior modded" me away from my website definitely had the makings of good targets. (Fear and loathing of neglecting other pressing issues, mainly.) As soon as I was done, the path to finishing this was much clearer and it took me less than two hours to touch it up enough to go live. I thought, "Jeez, why didn't I do this a year ago?"

So I think creating a list of "targets you might not think of, but that might make a big difference" would be good for making reprocessing (or whatever you like to call it) more accessible to the public, whether for getting therapy or learning a practical self-help variation.

By the way, I also made good progress with long-haul Covid symptoms of my own to help me get my life back to 100%. I learned the EMDR depression protocol, which produced a dramatic improvement in a client with lifelong depression. We need to keep exploring the boundaries of what can be done with these techniques.

P.S. "Targets" are what people focus awareness on in desensitization. A target originally was a traumatic memory, but that definition had expanded.

P.P.S. I'll stick my neck out and guess that we all know the ethics of how to avoid over-promising, and that there are limits to what psychological techniques can accomplish for medical symptoms. So I don't think there's a need for any lectures about that here. Same for warnings about not doing it wrong. But, you be the judge.

Love ERP and working with people with OCD. It is a passion of mine and I love seeing how fast it helps clients. But, the COMS, and upper management are making life miserable. I've been there for over a year and I have been put on meds, have horrible anxiety constantly, feel myself becoming more and more irritable to my family. Yes, I could quit, and I am trying... Believe me, I have even thought about getting fired for unemployment or going on some type of leave. I KNOW they are aware of how their workers feel but they don't care, which is so sad to me. When I first started they acted like they were this therapist first type of company where they really cared about us. Now, they only care about money. They're making millions every single month but they require 32 hours of face to face from all of us where most people require 20-25. They say this is because of cancelations but with a 100 dollar cancellation fee, this barely happens. Then if we're one hour down we get reminded over and over. I love how their emails say these generic "you're amazing" things and then BAM the rest is what you're doing wrong, what you could be doing better, and how much you suck. They also turned off the chat during meetings because they're afraid of what we will say in it. They never used to do this because they never used to be about money only. They can see how many people are leaving, instead of telling us WHY they do what they do that we don't like... they should try to fix what they're doing to work for all of us. We complain about metrix and their response is "we do it because..." Yes, I know the reason, I'm saying we HATE IT! The micromanaging, the COMS, the extra hours, the meetings, they KNOW they contribute to their own therapist's horrific mental health. They don't care. I would caution ANYONE who is considering working here, DON'T DO IT! From one person now struggling with mental health issues I didn't before working here... please don't do this to yourself. You're too important! Sending everyone out there love, kindness, and a career they're passionate about!

Last week I spent over two hours (133 minutes) with a ct for a diagnostic reeval. Are there any alternate or add-on codes I can (properly) use to get paid as much as possible for my time and work (vs the temporally open-ended 90791)?

I made the choice with the expectation that I wouldn't get paid beyond a 90791. But if I can... that'd sure be nice.

Anyone know how this works? Would love some advice

I am interested in it as it seems like a good mix of cognitive, emotional, somatic/sensory elements and I'm not a huge fan of the hype of EMDR, IFS, and similar partly because they seem so consumerist and culty and less focused on complex developmental trauma which is my typical focus. However SP training looks OBSCENELY expensive. The evidence base also seems to be growing, and in a more objective and less bias form than other therapies - less total but seems higher quality and representative research.

Any readings, small trainings, or recommendations for exploring SP that i can use to explore and dip my toes before the intense investment of the full trainings? That looks like for the full 3 levels dozens of thousands of dollars.. while it looks like huge training, it would have to wait much into the future to afford.

I know PESI has been getting some hate lately.

But as someone from a "third world country", PESI has been my most affordable option in taking trainings from real experts in their fields.

Here are some I can recommend:

2-Day Clinical Hypnosis Training with Dr. Eric Willmarth - I just finished this and this is THE Greatest Training I've taken so far. Why? Because it actually allowed me to do hypnosis! Dr. Willmarth demonstrated how to induce trance and how to deepen it, then told his live audience to split into groups and practice. I watched the groups practice, and seeing people who are also total beginners be able to do hypnosis gave me the sense that I could just copy what they were doing. So I practiced with a friend and it worked! He also gave many, many ways and options of how and what to do with hypnosis. I got so much out of this even as it is an on demand course. Dr. Willmarth is very entertaining and fun to learn from.

C-DBT training course with Dr. Lane Pederson (edit: this is the one that comes with the free manual) - this is also a very good course as I felt guided every step of the way on how to conduct a DBT session, heck, how to set up a DBT team! Dr. Pederson is the most engaging and humorous of all the PESI trainers I have watched so far. Personally not a fan of DBT other than DBT skills, but still I highly recommend learning DBT from Dr. Pederson because you get to see how DBT can be integrated to other therapy modalities.

ACT Online Intensive with Dr. Richard Sears - Dr. Sears was able to finally make me grasp ACT, which I thought (from graduate school) to be such an abstract therapy. His course is filled with experiential exercises which gave me the confidence to do the same with clients (with variations). I got a feel firsthand of what can work and what can't, and on how to approach a client's problem through the ACT processes. Not as engaging as the first two since here, Dr. Sears speaks to the camera, but it was still a course where you would be able to learn in an "easy way", minus the complex but clinically unusable jargon. You would feel confident to conduct a session, ACT style, after this course.

SFBT course by Elliott Connie - the man exudes solution focus! This is the first PESI training I took, and it got me hooked to PESI trainings ever since. I felt confident to conduct an SFBT session as a beginning therapist after this.

Courses I DID NOT like:

DSM 5-TR Differential Diagnosis with Dr. Margaret Bloom - it was difficult to follow Dr. Bloom in her discussion.

DBT course with Dr. Charles Jacob - somehow, it felt like Dr. Jacob knows DBT on paper, but did not really practice it. That was the sense I got (maybe I'm wrong). In talking about DBT skills, he explained the skills, but he didn't really give concrete examples of how he taught or used it with patients.

Courses that are 50-50:

Certificate in Neuroscience for Mental Health Professionals - it is made up of six speakers. Some were speaking to people over Zoom, some were recorded, some were with a live audience. I liked all the speakers except one. Since the talks are separate and stand alone by themselves, there was a lot of repetition over the materials covered by one speaker.

I would like to get people's opinion on the following:

IFS trainings (especially by Dr. Schwartz)

CBT-I training

CPT training

And others that you found good!

Hi! I’m a Registered Play Therapist and LPC in the state of Oklahoma. I’m interested in opening my own private practice. What are recommended ways to market a practice? I just posted a few drafts into TikTok and I like the interface!

I imagine it would be smart to contact local school counselors as well as referral sources.

My intention would be to set my rate to $150 an hour starting out.

I have not built a website yet. Although I do have a psychology today profile.

Any other questions others may have for me would be great, I’m hoping to gain some clarity and momentum on how to make actionable steps towards marketing and setting up a private practice in play therapy.

The state of New Jersey is going to start going after employers who are not paying a living wage to people and are on state benefits.

I think this is fantastic because we can see that the community and the state and the country are already paying for these things and it’s corporate welfare when they’re not mandated to pay living wages, but they’re raking in billions every year in profits

The fees are pretty low right now, but I can see where they will eventually be raised

I received a text from someone who wanted to pay cash for sessions -- not that unusual, but I noticed they got a little cagey when I said I needed more information and requested them to send me an email to my secure email address.

I received the following response :

>"Yes, I will do that shortly. Also, I am seeking support to improve my emotional growth. And to ensure consistent support and allow adequate time for meaningful progress and development, I am considering a 15 weeks session.

Could you please let me know the cost for 15 weeks of sessions?"

Odd language for a client to be using and an odd request overall. I responded reiterating my hourly fee and stated I wouldn't know what their needs were until we completed a mental health assessment.

To which they responded:

>"Yes we can schedule a consultation call but I'll be doing prepay. Because I'll be mailing a check for the payment".

Anyone else been a target of a scam like this or heard of anything similar?

Hi,

Therapist in training.

I’m wondering what you wish you knew just before getting you license / when you were just starting professionally?

Thank you!

I’ve been thinking a lot about what it actually means to be an affirming clinician. This applies across everything we do - neurodivergence, culture, race, gender identity, sexuality. If you say you’re affirming, you have to be able to hear valid criticism from the people you’re claiming to affirm. If you shut it down because it feels uncomfortable, that’s not affirming. That’s protecting your identity.

Edit for clarity: When I say “affirming,” I’m referring to identity‑affirming clinical practice. Which is care that doesn’t pathologize someone’s identity and centers the lived experience of the communities we serve. I realized some people were reading “affirming” as “emotionally validating,” which isn’t what I mean here.

And this includes me. Being part of a community doesn’t make anyone automatically right. We all have blind spots shaped by the environments we grew up in. We all internalize things without realizing it. I want people in my own communities to tell me when I’m missing something or getting something wrong. That’s part of the work.

And when I’m not part of a community, I’m responsible for listening to the people who are. I don’t get to override their lived experience with my interpretation. If you’re trying to be affirming, the people living that identity get the final say on what feels harmful or helpful.

Affirming care requires reflection. It requires being willing to hear “this hurt me” or “this approach misses the mark” without collapsing into defensiveness. If you can’t tolerate being told you might be wrong, or that your framework has blind spots (like prioritizing behavioral compliance over internal nervous system regulation), you’re not practicing affirming care. You’re just using the label.

Oh boy. Sorry in advance, gonna just be a stream of consciousness rant.

I have 2 masters degrees and 2 bachelors degrees. I have published research in Neuroscience. I have tons of work experience and volunteer experience. Yet I am being taken advantage of in the workplace STILL after all these years. Every single person in my life just tells me “i need to pay my dues, itll get better.” I have been listening to that bullshit for 10+ years. I have grinded and not complained and did all the things they told you to do to be successful.

I make like 27 dollars an hour. I cannot even afford rent for a small apartment in new jersey after my student loan payments of around 500 a month. Even if that was less, after all the other bills, id still be spending over half my paycheck just to have a place to live. I get 0 autonomy in my clientele. Open slot? Here babysit this 6 year old kid with environmental issues I can do nothing about. Nevermind the fact you have 40 clients this week already filled with other similarly incompatible with specialty cases. Oh dont be ungrateful! Atleast you have a w2 position and are getting paid consistently! It could be fee for service and you could not have benefits and get paid 500 dollars a pay period! Yippee!

This industry is horrible. People dedicating their lives to a good thing - helping and supporting people going through horrific mental pain. And they are just taken advantage of in every way imaginable. And expect you to just go along with it with a smile on your face. And then anyone not in the field is just like “get a new job, that place sounds abusive.” What if i told you that this job is actually the best that can be done? What ifi actually left an even worse prior position for this one? What if you actually took a look at the job market and how awful it is in general?

But just gotta pay my dues! Another year and a half of hours until my paycheck can get bumped by 20k or so when the cost of living and inflation is still exponentially increasing.

This world is a joke.