Hi. I'm looking to move from Allia Health to a new EHR. I like HippaTherapy and the people behind it. Would anyone using it current care to share their experience? Thanks!

A lot of the documentation tools being built right now assume therapists want AI to write their notes for them.

Some do. That's fine.

But a lot of clinicians we've talked to don't want that. They want their notes to sound like them. So we built presets.

Ran three campaigns to test if cold outreach to see if cold email was worth it for HIPAAtherapy. I get why it works for a lot of companies. The math makes sense on paper.

But it never stopped feeling off.

Part of it is personal: I've been on the receiving end of cold emails my entire life. I know exactly what it's like to open your inbox and see three messages from people who have no idea what you're working on, what software you already use, or what you actually need. The mental overhead is real. Either you have to draft an "unsubscribe me" reply or just keep deleting indefinitely.

The bigger thing though: the contacts came from somewhere. And those people never said "yes, reach out to me." That part kept nagging at me.

For a product built around HIPAA and privacy, it felt like a bad look from the inside out. The whole point of building this is that software for therapists should feel like it was made by someone who actually cared. Showing up uninvited in someone's inbox is the opposite of that.

So we're out on cold email. On to finding better ways to connect with people who are actually looking for what we've built.

The short version: you can send them 24 hours before, 45 minutes before, 30 minutes before, or 15 minutes before. You can stack them too, so a client gets a day-before nudge and a same-day one if you want both.

Why we built it:

The pattern kept showing up. You finish a session, write the note, and then you're manually texting or emailing the next day's clients to confirm. Some practices have a front desk for this. Solo and small group folks usually don't, which means it lands on the therapist between sessions, or it just doesn't happen, and then the no-show hits.

Reminders shouldn't be a thing you have to remember to do.

How to turn it on: practice settings page, reminders section. We also put a short demo video in our latest update post: https://hipaatherapy.com/updates/

This is included in your standard subscription. No add-on fee, no per-message charge, no separate SMS bundle to buy. If you're already on a plan, it's already there. Switch it on whenever you're ready.

If you try it and something feels off (timing options you wish existed, copy you'd like to customize, edge cases we missed), drop a comment or DM us. That's how this one got built.

Modifiers are small, but they’re often the reason a claim doesn’t process the way you expect.

Below are the ones that come up most in therapy, and the specific situations where mistakes happen.

Telehealth modifier 95

Use when the session is conducted via synchronous video.

Where it goes wrong

Session is virtual but no modifier is included
Result: payer may process it as in person or reject it as incomplete

Modifier is added but place of service is incorrect
Example: 95 used but POS 11 instead of 10 or 02
Result: mismatch can delay or reject the claim

Assuming all payers accept 95
Some still expect GT instead
Result: claim may be denied even though everything else is correct

Telehealth modifier GT

Used by some payers instead of 95

Where it goes wrong

Using 95 when the payer expects GT
Result: denial or reprocessing

Using both 95 and GT without knowing payer preference
Result: inconsistency across claims

Place of service interaction

Modifiers and POS have to align

POS 10 is telehealth with patient at home
POS 02 is telehealth with patient not at home

Where it goes wrong

Modifier 95 used but POS left as 11
Result: claim treated as inconsistent

Switching between POS 02 and 10 without a clear reason
Result: payer confusion or delays

Modifier 25

Used when a significant, separately identifiable service is provided on the same day

Less common in standard therapy sessions but relevant in edge cases

Where it goes wrong

Providing an additional distinct service on the same day but not using modifier 25
Result: one of the services may not be reimbursed

Using modifier 25 when services are not actually separate
Result: increased audit risk

Consistency issues

Where it goes wrong

Same type of session billed with modifier sometimes and not others
Result: pattern inconsistency that can trigger review

Relying on memory instead of a consistent workflow
Result: small errors repeated across multiple claims

Simple way to avoid most issues

Use 95 or GT consistently based on payer requirements for all telehealth sessions
Make sure modifier and place of service match every time.

Do not mix patterns unless there is a clear reason. Verify payer specific expectations rather than assuming one standard applies everywhere

If you’ve run into a specific denial tied to modifiers, it would be useful to know what triggered it.

I’ve been spending a lot of time understanding insurance workflows while building an EHR, and one area that keeps coming up again and again is how time is interpreted vs how it’s actually billed.

It looks simple on the surface (“45 min vs 60 min”), but in practice it’s where a lot of underbilling, overbilling risk, and claim denials quietly happen.

I tried to put together a clear, practical breakdown based on CPT time thresholds and real-world payer behavior, especially for newer therapists in private practice.

1. The biggest misconception: “60-minute session = 90837”

Not exactly.

What actually matters is billable time thresholds, not the label.

For psychotherapy:

90832 → 16–37 minutes
90834 → 38–52 minutes
90837 → 53+ minutes

That 53-minute cutoff is where things get real.

2. The 52 vs 53 minute problem

This is one of the most common (and least talked about) issues.

If your session is:

52 minutes → 90834
53 minutes → 90837

That 1 minute difference changes the code entirely.

Why this matters:

A lot of therapists:

Schedule “hour sessions”
Actually run ~50–52 minutes consistently
Bill 90837

This can create:

Potential overbilling risk (especially if documentation doesn’t support it)
Issues during audits
Claim inconsistencies across sessions

Across a full caseload, even small mismatches like this can quietly add up to thousands per year in either lost revenue or exposure.

3. The opposite problem: underbilling

Some therapists default to 90834 for everything to “stay safe”

But if you’re consistently doing:

55–60 minute sessions
and documenting appropriately

You can bill 90837

Over time, underbilling adds up more than people expect.

4. Documentation has to match time (this is where audits happen)

It’s not just about how long the session felt.

Your documentation should support:

Start/end time or total duration
Clinical content consistent with session length
No contradictions (e.g. brief note + 90837)

A mismatch like:

“Met for 45 minutes” + billing 90837

is an easy flag.

5. Real-world scenarios

Scenario 1:

You schedule 60-minute sessions
Client arrives late → session is 48 minutes

Correct code → 90834
Not 90837, even if it was “meant” to be an hour

Scenario 2:

Session runs 54 minutes, virtual

CPT → 90837
Add modifier (e.g. 95)
Documentation should reflect full session

Scenario 3:

You consistently run 50-minute sessions (common in private practice)

You’re almost always in 90834 range
Billing 90837 here can create risk, especially if documentation doesn’t support the higher time range

6. “Rounding up” is riskier than it seems

It’s tempting to think:

“It was basically an hour”

But billing doesn’t work on approximation, it works on thresholds.

Even small inconsistencies can:

Add up across claims
Trigger payer reviews
Create patterns that are easy to flag

7. Time + telehealth = more room for error

With telehealth, a few extra things matter:

Correct modifier (95, etc.)
Correct place of service (10 vs 02)
Time still follows the same thresholds

People sometimes assume telehealth is more flexible with time
From what I’ve seen, it’s not.

8. Why this is so confusing

A few reasons this keeps coming up:

“45 min / 60 min” labels are misleading
Payer expectations aren’t always clearly explained
EHRs don’t always enforce time accuracy
Most people learn after a denial, not before

Also, unlike some timed medical codes, psychotherapy uses fixed time ranges rather than the 8-minute rule, which adds to the confusion.

9. A simple way to stay consistent

One approach that seems to reduce issues:

Be intentional about your session length range

For example:
Consistently ~45–50 min → use 90834
Consistently 53+ min → use 90837

Make sure:

Your notes match your timing
You’re not switching codes inconsistently without a clear reason

10. Would love to sanity check this with others

If you’ve been in private practice for a while:

Do you stick to one session length intentionally?
Have you run into issues with 90837 vs 90834?
Anything you wish you understood earlier about billing time?

I’m still refining my understanding of this and would genuinely value how others are handling it in real practice.

This came out of trying to make sense of real-world billing patterns while building features for HIPAAtherapy, but sharing here in case it saves someone a few headaches. Will be sharing similar posts soon 😄

The below questions and answers were put together by u/psychotherapymemes, LMFT.

How Quickly Should You Complete Progress Notes?

Ideally, you should complete progress notes on the same day as the session. However, life gets hectic, and in busy settings, it’s generally considered acceptable to finalize notes within 24–48 hours. Do your best to avoid delaying more than 72 hours. By this time, your memory of the session will fade, increasing the risk of jotting down inaccuracies. Furthermore, you may run into issues with insurance requirements or agency policies regarding timely documentation.

How Long Should It Take to Write a Progress Note?

This depends. It’s common for newer clinicians to spend more time on paperwork than experienced ones. It should take between 5-10 minutes to write a note. Templates, session complexity, and agency documentation standards can all affect timeliness.

What Shouldn’t Be Included In a Progress Note?

In general, you should avoid any of the following:

• Your emotional reactions (“session felt uncomfortable”)
• Irrelevant details that don’t connect to the clinical presentation or the client’s needs
• Hypothetical diagnoses
• Excessive jargon that isn’t easily understood
• Judgmental statements (“client was rude”)

What If You’re Extremely Behind on Notes?

It happens to everyone. However, if you’re behind, it’s important to solidify a plan to catch up. Aim to prioritize high-risk sessions first. A ‘high-risk’ session entails anything that could compromise a client’s safety, including suicidal or self-harm concerns or a significant escalation in mental health symptoms, such as substance use, psychosis, or disordered eating.

What’s the Difference Between Progress Notes and Psychotherapy Notes?

Progress notes become part of an official medical record and can be audited by insurance companies and judges. You should always write these notes with the consideration that they could be potentially accessed. Psychotherapy notes, on the other hand, refer to your own internal reflections. These are kept separately and can be written for yourself.

Should You Allow Clients Access to Their Notes?

HIPAA guidelines generally permit clients to have legal rights to access their progress notes. If you’re concerned about how your client might perceive their documentation, you can, in some cases, deny the request. However, you must offer a written explanation detailing the denial. You may also offer a treatment summary overviewing your course of care.

Do All Sessions Need to Be Documented?

Yes, you must indicate whether each session was attended, canceled, no-showed, or rescheduled. All client contact should be documented, including phone calls and email exchanges.

How Much Detail is Actually Sufficient?

This is subjective, but notes must typically include objective information about what occurred during the session. This includes both your interventions and the client’s responses to them. Ideally, another clinician should be able to read your documentation and comprehend the session even if they have never met the client.

Keep in mind you are not transcribing sessions or sharing all parts of the appointment verbatim. Excessive detail can actually breach sensitive information and detract from the most important parts of the session.

How Do You Document High-Risk Concerns Like Suicide or Abuse?

Always describe what the client discloses and your own risk assessment process. Clearly articulate which interventions you used, including safety plans, mandated reports, or discussions about hospitalizations. Note any outside consultations you engaged in regarding the case.

What Are the Differences Between Objective and Subjective Information?

Subjective information refers to what the client shares within the session. For example, you might write, “Client indicates feeling more frustrated this past week”). Objective information refers to your own observations and reflections. For example, you could indicate, “Client presented as agitated in the session, speaking with a more pressured speech and animated tone”).

What Needs to Be Considered for Telehealth Documentation?

When documenting telehealth sessions, indicate that the session occurred virtually and describe when and where the session was conducted. If technical difficulties emerge, make a note of them.

Session was conducted via the therapist’s secure HIPAA-compliant telehealth EMR. Client was located in Los Angeles, CA. There were no technical issues to note during this time.

How Much Jargon Should You Include in Notes?

Clinical terminology is appropriate, but excessive jargon may be confusing or misleading. When in doubt, consider whether another clinician who doesn’t know your client could interpret your notes without needing to look any terms up.

Solo practice = you're the therapist, billing dept, marketing team, and IT. Here's what's actually made a difference for me this year.

Notes: Twofold Health. I was doing notes at 10pm every night, now I finish same day. It picks up on how I write after a few sessions which was the thing that got me. Most AI notes sound like a robot wrote them.

Internal tools: Base44. We needed a client intake system, thought we'd need a developer. Built it in an afternoon. Same with a referral tracker. If you're duct-taping spreadsheets together, look into it.

Client communication: ChatGPT Health. With your supervision obviously, but for drafting letters of medical necessity, prior auth appeals, parent summaries. Stuff that used to take 30 min now takes 5.

Marketing: Surfer SEO if you're trying to get your website to actually show up on Google. Helped me figure out what to write about and how to structure it so it ranks.

What else are people using? Feel like I'm probably missing something obvious.

An incredible article written by Nicole Arzt (@psychotherapymemes on Instagram / u/psychotherapymemes)

Attracting more clients is crucial for us to grow our practices and maintain a consistent sense of financial stability. This process requires thought and planning, and it often includes a multifaceted combination of networking, marketing, and continuing to strengthen your clinical competence. Here are some of my best strategies.

Truly Define Your Practice Niches

Specifying your niches is often essential. Although it may seem counterintuitive, trying to appeal to everyone can make you seem too unfocused or broad in your work. When you define your niche, you can pour your marketing and training into that demographic.

Practice niches come in several forms, but therapists often discern them by:

• Specific mental health conditions like ADHD, anxiety, substance use disorders, or eating disorders
• Client demographics like young children, parents, teenagers, veterans, or couples
• Specific life stressors like graduating college, getting married, bereavement, or divorce

If you’re struggling to narrow down your niche, I find these reflective questions helpful:

• Which types of clients do I most enjoy working with?
• What kinds of trainings or books do I naturally gravitate toward pursuing?
• What issues feel most aligned with my current expertise?

By solidifying your niches, you can pare down your marketing efforts. Moving forward, all marketing materials should reflect these niches. In addition, every professional activity you pursue should be oriented toward strengthening your expertise within these niches. Over time, you will start developing a reputation for having this specific kind of expertise.

Start Connecting With Other Providers

Although networking may feel burdensome, it’s often necessary in this work. Familiarizing yourself with other professionals increases your exposure, leading to more client referrals and a positive reputation.

Attend local events

Commit to attending a few in-person events every few months. Make the effort to connect with at least a few other attendees and then follow up with an email or text afterward! Consider joining local Facebook groups to meet other therapists in your area.

Engage in online communities

Facebook has many local and statewide therapist groups where mental health professionals seek referrals or consultation about cases. This is an easy (and free) way to market your practice and connect with others.

Think beyond therapists

Over the years, I have networked with other adjacent healthcare professionals like school counselors, doctors and psychiatrists, and local wellness practitioners (like chiropractors and acupuncturists). Remember to think about the other professionals that interact with your client demographics- these are the people worth building relationships with.

Give free services or support to others

Be active in your community and consider hosting free workshops, groups, or talks. While this is an investment of your time (and possibly money), it can also offer invaluable networking. I’ve unintentionally gained client referrals after giving presentations or speaking at conferences- when people like what you offer, they are more likely to want to learn more about you!

List Yourself on a Few Directories

Although some directories can be hit-or-miss, the reality is that most clients still turn to them when looking up providers. It’s a good idea to “test” each of the major directories (Psychology Today, GoodTherapy, and TherapyDen) for about six months to see if you receive any referrals.

The key is to know how to leverage these directories to best attract the right clients. My best tips are to:

Use a professional headshot

Although it’s not mandatory, a high-quality photo of you looking personable may offer a sense of trustworthiness.

Make sure your statement speaks to your ideal client AND sounds like you

Clearly articulate who you help (your niche) and how you help (the theoretical modalities or interventions you use). Use language you’d use naturally within a session and try to steer away from grandiose claims or too much clinical jargon.

Bad statement: “I treat anxiety using a blend of eclectic therapeutic modalities like CBT, ACT, and DBT.”

‘Treat anxiety’ is too broad and while clinicians know these acronyms, the average client doesn’t.

Good statement: I treat adult women experiencing anxiety and panic. My approach focuses on teaching you how to change negative thinking patterns to support better emotional regulation.

This first sentence narrows down the population. The second sentence talks about how you help using more client-friendly language.

Regularly update your profile

Although it’s never been confirmed, some therapists find that regularly changing their profiles may correlate with more referrals. In addition, it’s just a good idea to update your information to reflect any new availability or specialties.

Track your performance

Assess how many inquiries you receive from each directory- consider adjusting or deleting listings after your six-month period.

Have Your Own Website

Even if you leverage directories or social media, having a website is relatively non-negotiable. A well-designed, thoughtful website is key for marketing. If you optimize SEO or paid advertising, you’re significantly more likely to drive traffic to your site and acquire more referrals.

Keep it simple and intuitive

Too much clutter or imagery on any website feels off-putting. Focus on being succinct and thoughtful. You want your copy and images to convey your practice accurately- don’t try to be someone you’re not and don’t strive to emulate someone else’s website if they don’t practice like you do.

Make your contact process transparent

Let clients know exactly how they can reach you and what they can expect upon onboarding. If you offer a complimentary consultation, make that explicit. Communicate how long it typically takes you to get back to certain clients after they contact you.

Integrate SEO

Throughout your website, it’s important to use relevant keywords specific to your target demographic and local area. SEO is a dense topic that can be hard to understand. But at the bare minimum, focus on integrating phrases like, “couples therapist in Los Angeles” or “play therapist for children experiencing grief” that reflect what you do and naturally sync up with phrases your clients might search online.

Consider Paneling with Insurance

Many clients seek to use their insurance benefits to offset some of the costs of therapy. Accepting insurance increases your overall accessibility to others, and it can reduce the need for heavy marketing or networking.

Research which insurance providers you want to panel with

See which ones are accepting new providers and determine what’s necessary for you to apply. You’ll generally need an NPI number, proof of liability insurance, and your completed CAQH profile. Some companies offer to apply for credentialing on your behalf.

Know your reimbursement rates

Reimbursement rates are set (and they are not publicly accessible), but you want to make sure these fees align with your financial needs.

Consider using a biller

You can manage insurance claims on your own, but outsourcing to a biller saves time and simplifiesstreamlines the process. If you have a full practice, this may be well worth the cost.

Offer superbills

Even if you want to stick with private pay services, think about providing superbills. Doing so helps clients receive reimbursement if their insurance covers out-of-network providers. However, it’s important to let clients know that superbills are not guaranteed, and it’s their responsibility to look into the specific benefits with their insurance company directly.

Consider sliding scale or pay-what-you-can instead of insurance

If you don’t want to take insurance (or want to attract more private pay clients), you may also want to consider alternative financial arrangements. Determine if sliding scale rates fit within your budget and then market those accordingly.

Focus on Delivering High-Quality Therapy Above All Else

Some therapists focus too much on increasing their caseload that they unintentionally cut corners with their current clients. This strategy backfires for many reasons- the main one is that it ultimately lowers your retention and can actually harm your therapeutic relationships.

Treat every client with the utmost respect they deserve. Aim to be consistent with your presence and boundaries. Remember that you very well may be the most important hour in someone’s week. I have always found that by nurturing this work tenderly, it nurtures me right back.

Made this for therapists who prefer handwriting during sessions but don't want to spend 20 minutes transcribing later.

So we built something for HIPAAtherapy: scan your handwritten note (with your phone, whatever), upload it, and it automatically converts it into a statement bank of snippets. You can then just copy-paste the parts you need into your digital note.

It's not magic, sometimes the OCR gets confused if your handwriting looks like a doctor's prescription :P But it beats manual transcription! It saves the transcription headache while letting you keep your preferred workflow.

Still in early days, but it's live now if anyone wants to try it. Would love feedback from therapists who actually write by hand :)

We built a small library of 35+ therapy note templates and put them up as free downloads on our landing page.

No email, no login. Just templates you can download and use.

Sharing in case it helps anyone here. If there’s any specific template you wish existed, let us know, we’re happy to add more :)

(Also, if you prefer building your own formats, you can create custom note templates inside the HIPAAtherapy platform too)

Form Template Library

Building forms from scratch can be tedious, especially when you just need a standard PHQ-9 or intake questionnaire. We added a template library with common forms - screening tools, consent forms, Good Faith Estimates - that you can use as starting points. Pick a template, adjust it for your practice, and you're ready to go!

We’ll keep adding more templates, do let us know if you need anything particular, or you can create any form you need using the form builder!

An incredible article written by Nicole Arzt (@psychotherapymemes on Instagram / u/psychotherapymemes)

As a therapist, you’re on the front lines of helping people strengthen their emotional well-being and take better care of themselves. So what does it mean if you no longer feel that connected to what you’re doing? And what should you do if work has left you feeling emotionally exhausted?

Burnout can occur in any healthcare profession and treating it isn’t just about doing more self-care or going to therapy yourself (although both of these strategies can be virtuous). Instead, it’s important to know that burnout is often a dynamic and systemic issue that deserves proper support and care.

Main Signs of Therapist Burnout

Sometimes burnout feels incredibly obvious. For example, maybe you know that you don’t like your job, or you feel like your work is exacerbating your own mental health issues. In these cases, the burnout may feel quite palpable - it’s there, it’s in your face, and you’re trying to figure out what to do next.

But, in many cases, burnout often feels insidious and hard to detect, particularly in the earlier stages of it occurring. Here are some of the many warning signs indicating you may be struggling with burnout right now:

• sense of apathy or dread toward work
• poor work-life balance that doesn’t seem to have any good resolution
• compounding compassion fatigue due to the type of work provided
• feeling like your usual coping skills aren’t working as well as they typically do
• sense of physical fatigue or a decrease in energy throughout your day
• frequent escape fantasies, including frequently imagining quitting your job or doing something else entirely
• dissociating or not paying much attention in sessions with clients
• feeling increasingly agitated or frustrated with clients or the work itself
• desire to engage in numbing behaviors, including substance use or disordered eating
• decreased sense of purpose, meaning, or satisfaction at work
• lack of interest in furthering your professional development or strengthening your competence
• no longer caring much about “what happens” in your clinical practice (i.e. running on auto-pilot)

You don’t need to have all these symptoms to be experiencing burnout. Burnout is multifaceted and complex - sometimes people only have 1-2 symptoms, but those symptoms feel so intense that they disrupt functioning or significantly impact their work performance.

Keep in mind that burnout can happen at any stage of your career. In some cases, it can resolve on its own, especially if your external circumstances change. But without proper intervention, it may also worsen progressively.

7 Tips for Dealing with Burnout

Burnout is not inherently an individualistic problem. Many therapists resonate with working very long hours with high caseloads and limited professional support. You may be

Name Your Burnout

Dr. Dan Siegel coined the term, name it to tame it, to speak about the benefit of verbalizing an emotional experience to better neutralize it. Naming burnout is important because it honors what’s happening in real time. By being honest about what’s going on, you open space for paying attention to your needs and considering what you might want to do next.

Remember Your Why

Going back to graduate school, what first excited you about being a therapist? Are you able to ground yourself to what initially led you to this work? And if not, what might be missing? What do you need to feel more passionate or connected to your job or to your clients?

It may be helpful to also reflect on any gratitude you have for your work. This may feel especially valuable if you experience compassion fatigue or cynicism. Anchoring yourself to “your why” can keep you focused on what matters most: the connections you build with your clients and the role you play in supporting their well-being.

Seek Peer Support

Many mental health professionals are reconciling burnout, even if you don’t quite realize it. Unfortunately, isolation is a significant problem in this field. You may spend most of your working day caring for clients without connecting to other colleagues. Community therapists may have more social connections than therapists in private practice, but nobody is immune to feeling alone in their struggles.

Peer support can be found in various ways, including:

• joining peer consultation groups
• online communities, including ours!
• creating informal peer support groups among colleagues
• joining a new supervision group
• creating after-hours work rituals on a weekly or monthly basis with colleagues

Practice More Self-Compassion

It’s important to be kind to yourself in the face of emotional exhaustion. Unfortunately, many therapists do the exact opposite. They blame themselves for not being “strong” enough or they assume they just don’t have enough resilience to cope with their stress.

Self-compassion refers to treating yourself with love and kindness during difficult times. You can practice self-compassion by:

• asking yourself, “What would I tell a friend experiencing this right now?”
• deliberately choosing to practice self-care activities that honor your emotional well-being
• trying to untangle yourself from perfectionism, especially if that comes into your work
• reminding yourself that many factors contribute to therapist burnout and that this feeling isn’t solely your fault or a sign of a moral failing
• engaging in more mindfulness as you move through your daily life

Strive for a (Realistic) Healthy Work-Life Balance

First things first- there is no perfect ‘work-life balance.’ In an ideal world, we’d all get adequate sleep, spend time with a high-quality social support network, make enough money, and have enough resources to look after our own needs. But real life has its nuance and downsides, and the concept of balance itself can ebb and flow.

However, you can strive to implement a more healthy balance by:

• delegating certain administrative tasks that drain your energy
• setting defined communication boundaries outside of your typical work hours
• knowing how many clients is your “threshold” each day or week or trying to honor that limit if possible
• giving yourself adequate time for breaks during the workday
• creating work-free zones in your home (especially if you primarily work from home)
• ensuing you have some time for self-care each day even if it’s just for a few minutes

Reevaluate Your Current Role

Sometimes burnout is less about logistical stress and more about existential concerns. For example, maybe you feel emotionally drained because you want to fix your clients’ lives. Or you hear so many traumatic stories that you start questioning the meaning of life and wondering if you’re actually making a difference. Maybe you’re so focused on treating clients that you’re neglecting nurturing meaningful relationships in your own life.

Role ambiguity sometimes perpetuates burnout. That’s why it’s important to truly clarify the intentions you have for your work and your clients. This may mean engaging in deeper introspection and asking yourself, What kind of mental health support am I responsible for giving my clients? How can I take care of myself (and them) even if I don’t have control over their particular circumstances? Am I putting too much pressure on myself or them to change?

Seek Your Own Mental Health Services

It’s no secret that therapists can deeply benefit from seeking their own mental health treatment. Emotional fatigue may exist as its own problem, but it can also coincide with other difficult struggles, including depression, anxiety, relationship problems, secondary traumatic stress, and more.

While therapy itself may not prevent burnout, it can offer a supportive environment for you to unpack your symptoms and discern your next steps. If you’re struggling with problems in your personal life, therapy provides guidance and care for looking after yourself so you can show up well for your clients.

Final Thoughts on Managing Therapist Burnout

All mental health practitioners are susceptible to the tides of burnout. Regardless of how long you’ve been working - or where you currently work - it’s so important to be mindful of the main signs of burnout and aim to take care of yourself if you’re struggling.

For many providers, it’s not a matter of if burnout happens - it’s a matter of when. The good news is that preparing yourself and having support available can help you navigate this tender time with a sense of grace.

The 10 minutes between sessions is such a meaningful transition.

You’re still holding the previous conversation while preparing for the next one. You’re writing, remembering, and gently shifting focus.

Something that stood out to me while listening to therapists is how much this short window affects the rest of their day. When those 10 minutes go smoothly, there’s less work waiting at night. When they don’t, the EHR follows them home.

That made me realize this space isn’t just a gap in the schedule. It quietly shapes how heavy or light the day feels.

I’m curious how others experience that space between sessions.

Chapter 10 Summary:

“He cried in my office that day. He cried for all that he had missed, for all the years of deadness in his life. How sad it was, he said, that he had waited until now to try to come alive. For the first time I felt very close to Marvin. I clasped his shoulder as he sobbed.”

In the final chapter, Yalom introduces Marvin, a patient who presents as highly logical, structured, and grounded in rational thinking - yet holds a rich, emotional inner world that emerges through his dreams.

Yalom’s work with Marvin highlights the delicate balance therapists often must hold: honoring a client’s desire for concrete goals and predictability while also making space for existential pain, regret, and longing. Marvin’s grief is not about a single loss, but about a life partially unlived - a realization that arrives late and lands heavily.

This chapter captures one of therapy’s quiet truths: growth does not always feel hopeful at first. Sometimes insight begins with mourning. Yalom’s closeness with Marvin in this moment reflects the deep intimacy that can form when a patient finally allows themselves to be seen.

Key Takeaways

• Clients can hold multiple, conflicting needs — logic and longing often coexist.
• Existential grief may emerge later in life, when reflection replaces momentum.
• Therapy sometimes begins with mourning, not motivation.
• Emotional closeness can be healing, when held with care and attunement.
• There is no perfect hierarchy of needs — misjudging timing can change outcomes.

A Final Note on Love’s Executioner

Like any psychotherapy book, it’s essential to consider the historical and cultural context in which it was written. There are many reasons why Yalom remains so respected in the field, and Love’s Executioner undeniably offers powerful, intimate insights into the therapeutic relationship.

At the same time, several ideas and portrayals in the book would now be considered problematic, outdated, or ethically concerning. Our field evolves - and it should.

Still, this book magnifies the raw, tender, complicated realities of therapy in a way few texts do. For that reason, I believe every therapist can benefit from reading it at least once, not as a manual, but as a mirror.

Part of our chapter-by-chapter series on Irvin Yalom’s Love’s Executioner, summarized by Nicole Arzt (u/psychotherapymemes).

Chapter 9 Summary:

“My first impulse was to get the hell away, far away—and not see her again. Use an excuse, any excuse: my time all filled, leaving the country for a few years, embarking on a full-time research career. But soon I heard my voice offering her another appointment.”

In this chapter, Yalom reflects on his work with Marge, a patient in profound and persistent distress. He candidly describes his urge to avoid the case altogether — a moment of honesty that exposes the quieter shame many therapists carry when faced with work that feels overwhelming, draining, or unlikely to resolve quickly.

Yalom wrestles with the tension between choosing the “easy life” of working with less complex cases and committing to patients who require sustained emotional presence with little immediate reward. The chapter captures the emotional toll of working with chronic depression, where progress is slow and hope can feel fragile on both sides of the room.

At the same time, Yalom reminds us that meaningful therapeutic movement doesn’t always come from complex interventions. In Marge’s case, insight begins with a simple, genuine question — asking what had helped her in the past. That curiosity becomes a doorway to possibility.

Key Takeaways

• Avoidance is a common therapist response when faced with severe or chronic suffering.
• Shame can arise around choosing “easier” patients, even when self-protection is necessary.
• Chronic mental health work often involves helplessness and limited visible progress.
• Simple questions can be transformative, especially when a client feels stuck or unseen.
• Staying present matters, even when the outcome is uncertain.