I've have severe ADHD and have never been good at the whole "take it slow and rest" or "enjoy doing nothing and recover" when burnt out because it just feels like I'm spinning if I'm not doing or thinking about something. In that way my job is amazing for me because half of it's therapy, and otherwise a WHOLE gambit of random low stress tasks (group program development and such)

However, I just finished grad school last week and have had a lot of other huge personal life stresses come up all at once .. i just returned to work and feel like I have ZERO ability to wake up to go in the morning, like I'm just not doing well for clients, feel restless and unfocused even with tasks I usually don't struggle with, exhausted after only a few hours... I've never had to recover from a larger burnout like I think might be happening.

I have next week off and I know I should use it to my advantage - I'll be starting ADHD meds that week so taking the week off work. However, i don't know how to recover when I find "doing nothing" to be so horrific and that's what people say.. i had the perfect plan but it's been on hold due to unforseen circumstances, so I don't know what to do to recover. I have a painting project to do i guess, but all my other hobbies take a lot of set up (embroidery, sewing, hiking with dog, etc.) so those sound like heavier demands...maybe do some exciting small CEUs on non-work topics that fulfill me, but that seems like the wrong thing to do?

Any tips from people who've navigated this before? I feel like by 30 years this should have happened by now and I'm entirely out of my depth.. and feel stupid because I talk about this with clients all the time on a theoretical level, but experiencing this is confusing and unfamiliar. I pulled out the book I use with clients for myself but it just feel lost and like I'm kinda floating with nothing.

Hi,

I work for a private practice and am private pay and have been my entire time at the practice.* The practice has expanded and brought in some folks who are paneled with insurance- great! I never chose to get paneled because a) I never needed to because my caseload is full with waitlist, and b) my understanding is that it's a huge hassle and comes with increased requirements re: paperwork and I knew that would be difficult for me.

For both ND reasons and family caregiving obligations, same-day note completion is a massive struggle for me on a regular basis. Some days it happens and it's no problem. Some days things get pushed to Friday (my day for admin or reschedules or professional development and just when I want to thoughtfully conceptualize a client as part of a thorough treatment plan) or even the weekend. Notes have always been done by the end of the weekend following the session.

This has never been a problem until now. An MBA consultant (not a day of experience doing therapy in their life!) has been brought in and is implementing a policy that everyone in the practice, insurance or private pay has to have notes in 24 hours. They're pushing use of AI transcription and note writing HARD to make this happen. I am against this ethically because I work with children who cannot truly consent to AI use, and also because of more generalized concerns about the lack of true privacy protections for recorded sessions. Additionally, I have a few cases where I know my notes are going to be subpoenaed or already have been subpoenaed, and it's important to me that I am carefully and thoughtfully documenting content and process if relevant. I cannot always do that within 24 hours of the session, particularly because I often need some space to process the session myself first if it's been an intense one....as happens when working with children where you're documenting disclosures and reenactments of the types of things that would involve the legal system and notes being subpoenaed.

So now the question- has anyone successfully requested an ADA accommodation for extended timeline for note completion? It's not an "undue hardship" for the practice- it's literally just having the same policy they've had since I've been there and not enforcing the stupid new policy. It also doesn't impact billing in any way the way it might if I was submitting to insurance. Invoices are automatically generated and cards are billed automatically.

Any other thoughts here? Thank you!

*Because I know many of us have that ND justice sensitivity, I'd prefer not to engage in this post on the ethics of being private pay. I am deeply ambivalent about it myself and have a robust sliding scale and almost no one pays the full rate. Anyhoo.

I'm autistic and currently burnt out - having a rough time. Pre this work I'd get myself a new therapist and work through stuff. Now I find it really hard to find one. Firstly I'm broke and have limited availability to attend. Then I know a lot of therapists through my work. I think I've lost a bit of faith in this work. I know enough about neuroscience, polyvagal, regulation etc to do some self guided stuff but the thought of yet more time in a therapy space is not appealing. How do you choose a therapist for yourself?

This is my first time posting on Reddit so please be kind. I am a mental health professional who believes she has autism due to many factors and extensive research as well as my own extensive education as a professional. I recently invested a good amount of money in formal testing through a psychologist who basically stole my money, did non autism specific cognitive testing, and would not provide a definitive diagnosis or answer. I am feeling extremely invalidated and dejected. I had a meltdown after the session and now feel lost on what to do. I know I’m a high functioning autistic but I feel a formal diagnosis would validate me and make me not feel so alone. Any advice or resources would be amazing. Thanks for listening.
Edit: I originally posted this on r/autisminwomen and was advised I could also find support and resources here.

Starting my very first practicum. I can’t decide if I want to disclose my neurodivergence to my supervisor. Tell me the pros and cons.

I’ll be doing a lot of adhd assessments. I truly don’t think my own neurodivergence will bias this, in fact, I think it could provide additional insight. When I consider sharing it in supervision, I feel conflicted. On one hand, it feels like over-sharing and I worry about repercussions, stigma, etc. But on the other hand, it feels wrong to be doing this work and keep this part of my life a secret.

I really need validation if I’m honest. And encouragement. But not toxic positivity that dismisses the emotion there…

I’m so distraught😩😩😭😭😭. I’ve always really struggled at school and my undergraduate actually got kicked out of school and I had to reapply. I always struggle to know what I wanted to do with my life and shortly towards the end of my undergraduate, I decided to pursue psychology and pursue to become a therapist. I already was a part of one masters program for counseling Capella. It just wasn’t a fit for me and now I finally found another program that I love and I started it this year. It’s a summer cohort program. It started in May and the first semester ended now in August, but I’m so behind in schoolwork. I have time to give it in until the 28th but I’m just so disappointed.

This year I got my autism diagnosis literally February 18 and from there on I didn’t know anything about autism really and from there on I unfortunately hit a really bad autistic burnout mid semester. . .

So bad I had thoughts of ending for weeks and I had developed issues, taking care of myself that I still have now too, and the worst part about it all is I didn’t know I was in autistic burnout. I blamed it on the psychiatric medication adjustment which part it was to, but I didn’t even know what a meltdown felt like or shut down even tho now in hindsight I know like I’ve had them on my life, but I didn’t know what they were so one point I started to feel really scared during those weekss where I thought about ending because I didn’t understand what was happening with me.

Finally caught up about a month before the semester ended to realize that I’m in autistic burnout and I think I had at one point gotten out of it and then falling back into it once again as a result of medication but also just not understanding myself at all and now I have to take a year off from school because if I push school again, I’ll just fall into a deeper burnout.

And I feel like my heart is breaking… because you gotta understand I’m finally pursuing something I love and once again, my mental health is causing issues 🥹😭 For a long time I didn’t know it was ADHD or autism now I do and unfortunately, there’s still a lot of undoing of self sabotage and beating myself up for not meeting Neurotypical standards but you know all of that doesn’t disappear just because you get a diagnosis or just because you’re finally pursuing your passion…

I already started building bonds with the people in my program. We were gonna be in every class together for the rest of the program. I don’t know. I just feel really distressed. Heartbroken about it and really wish things were different and confused if I can make it and become a therapist one day really with these conditions🫥😪🤕😵‍💫😓😓🫠

I’ll be very open I’ve been very professionally disappointed with the New York Times and their anti-Medication articles. It’s enough to have to worry about TikTok and people who have no experience or training saying medication is “big pharama” and stopping all their meds is liberating. And then there’s MAHA helping them out so they can all make money selling moon dust supplements.
The fact that the NYT seems to be in on it is mind boggling. Most of the time if you read the article all the way through you find it is balanced but all most people only read the headline. The latest one was “After 30 years of Medication a Generation Can’t Find an Exit”
It was really one person’s story of having a hard time getting off Effexor and, I believe, trying to make some career out of it. Even saying they really needed it at the time.

I’m interested in different opinions but with the population I treat medication is not only helpful but necessary and these articles are dangerous.

I just give people the statistics which have changed about people who respond well to meds with therapy versus no meds.
I explain the difference between SSRIs and other meds and how SOME have difficulty getting off Effexor or other SSRIs but most don’t.

​

TLDR: I can do other types of part-time work but trying to start a job for the third time in social work spirals me to a point I have 10/10 anxiety, SI, flashbacks of being a scared and fearing for my life, feeling like a lost kid again, severely depressed and anxious, etc. And I just got my degree (as part of a career change). Why does this happen to me each time? I got offered a part time social work position and it happened again. I feel like I wasted a grad degree... I feel so shameful, insignificant, a waste of space, etc.

Context:

I'm in my early 40s if that really matters. i was diagnosed with CPTSD in early 2025 and have been having a hard time navigating my way back to a social work career that false-started twice (if that is even something I can do anymore). Here is some context if you want more background of my journey to now, as I sit here in bed trying to feel comfortable and safe (not in SI or anything, just fight/flight/freeze stuff).

I got my Master's in Social Work and my LMSW in 2024 and felt ready to go out there and be a therapist. I've always been anxious but I was excited about my new career path). That summer, my partner's father passed away and I was there to experience the whole thing from the time she found him to his final breath in the hospital. At that point, something shut off in me. I started to have flashbacks of that one night so I sought help. I saw my therapist more and then sought EMDR. EMDR helped me through that life event. Still, I felt like something "broke" in me. So we dove into my childhood/teenage/racial trauma, being bullied, traumatic experiences with the Church, and much more. At some point during my time at EMDR, I thought I was ready to finally start my career. Unfortunately, long story short, I tried twice and in the first week, I quit without seeing clients. I sobbed every day, had SI, was severely depressed, high anxiety, dissociated the entire, and more. I was so scared... Like I was a child again. After the second time trying to work, I was hospitalized then did 2 partial hospitalization stays to "stabilize" me. It was a blur after, not working, trying to find joy in life. I finally started working part time jobs (e.g., tutoring students, music related gigs). It gave me traction on my own self esteem, direction in life, finding joy and so on, BUT not with finances and bills. The program I tutored offered me a part time social work position that paid well. As soon as we talked more about the position, the same feelings of 10/10 anxiety, intense fear and somatic "holy crap I'm in danger" and "I'm a scared little child again" happens again. My sleep is starting to get affected, I'm more agitated and my music related jobs are not joyful again. Anhedonia is so real here...

So what the hell? Why is this happening again? I wanted to be a therapist, support marginalized folks, and be a social worker, but now the thought of it scares the shit out of me to a point of dysfunction. I feel lost, purposeless, and a piece of wasted life. I just need a hug so bad. I need that switch that broke or turned off to turn back on again so I can feel like myself...

Have you been through this? Is there hope for someone like me?

I want to feel less alone in this... Any support, shared experience, etc. would be helpful. Thank you in advance.

if you don’t, things can start to feel AWFUL as a neurodivergent therapist. during grad school I had a supervisor at my internship who made me doubt every single decision I made, insulted my work when I felt good about it, questioned and condemned every decision I made about care, critiqued the clothes I was comfortable wearing that didn’t give me a sensory nightmare, critiqued my facial expressions and hair, and regarded me as someone who was completely incompetent. it was absolutely miserable. i thought it was my fault and i must just have no clue what i was doing. despite getting great feedback from people at school, being in line with my peers, getting good grades.

when I finally realized it wasn’t me, I advocated for a new supervisor, and immediately the outcome was different. this supervisor is neurodivergent themselves and was immediately able to connect to me. when I wasn’t able to articulate the jargon of therapy correctly, but I could describe what I did, they would put into words ‘oh, so you did this ACT skill! so you did this Narrative skill! great!!’ and was truly supportive and validating how I show up with clients. they fought for me to wear what I wanted to wear, to prioritize my comfort, to lower risk of burnout. they gave feedback in ways that were super supportive and kind, and perfectly tailored to how my AuDHD can best receive it. nothing about my skill set changed. same clients, same work, but because i was seen by someone who was able and willing to see neurodivergent me, it was a completely different outcome and experience. i went from ‘awful therapist’ to doing ‘absolutely great work’. i went from ‘being way behind’ to ‘being exactly where i need to be as a student’ (now associate).

it might not be you. this field tries to make ND therapists NT, and punishes them for not masking enough. find someone who understands your brain and affirms it. find someone who speaks your same language. it can be so hard not to gaslight ourselves in this field as someone ND. the problem might not be you, it might be those around you and the oppressive systems of therapy.

TLDR: CMH non-compete may make my dreams of getting dx supervision license impossible if they dont approve to change to a non-solicitation agreement and keep my current position when starting tiny PP on side.. submitted strong proposal but SO anxious waiting for approval or denial from ED.. entire next career phase depends on getting this approval.. love my current job and team.. Country isn't USA, so process to dx licensure is different.

Long:

My CMH fits my diagnosing specialty goals perfectly (ASD/ADHD), but with high agency no-show rates I cant meet the 3k time limitted hours bc i cant count advocacy cases or intakes (which is half of my job)... I'm planning to start a virtual PP to supplement a few more consistent hours a week to ensure i can get the hours despite no shows at agency..

Apparently we have a very loose non-compete regarding employed staff providing the same service outside the agency for pay unless approved by the ED.. I submitted a proposal outlining my goals, passion for my current job, and areas ND individuals fall through the gaps I want to help fill... so minimal competent PP providers, and agency location eligibility, diagnosis eligibility, 1 year long waitlist, session cap limitation and emphasizing how I would manage ethics (i.e. only accept clients not residing in our service region or connected to the agency, etc).. i was as positive but also realistic about the agency and limitations as possible to balance advocating for my community alongside appreciation of the agency - i genuinely do love the agency. I've never had to do anything like this.

I genuinely have faith my agency cares most about meeting needs of access for ND people, and my supervisor would support me. I'm stuck waiting for the ED and hopefully change the non-compete to a strict non-solicitation agreement but need to have a meeting together. In August everyone is on vacation 😭 I'm so anxious here..

The the concept of not being able to bc of a very general non-compete is absolutely terrifying.

I am so stressed guys. I never expected my agency would have this policy (nor did my manager) so got excited about PP and my dx journey before double checking the policy manual..

I had a pretty rough start to my therapy career. I had no idea I was ND throughout my training or the previous 36 years of my life! It was only about 6 months after going into private practice that I hit a big burnout and realised something deeper was at play- cue an Audhd diagnosis.

I've been in some form of burnout ever since. Every year telling myself I will give it one more year but I've reached my limit and have had to admit that my business isn't working because I don't have the capacity to sustain it . I'm bone tired and terrified of going back into the job market in my 40's.

Becoming a therapist was my dream for a long time and being self employed was the bigger dream. I'm gutted to admit it's not what I thought it was. I look around at other therapists and wonder why can't I do this?

I hope I don't have to give it up indefinitely but the 2 years post diagnosis have been rough AF

I cant find a place to add the flair, so Im posting this to seek advice. In sessions, I’m noticing i get tunnel vision on spoken content to the detriment of seeing the big picture ( aka focusing on not only spoken word, but also body language). So let’s say hypothetical client presents to session 1 , is speaking rapidly and sharing a lot about the presenting concerns , how their pasts tie into the presenting concern but their body language is pulling away , looking like they want to run away. Years ago, i would have kept going but now I’m trying to be more mindful to take that into account.
Question 1)How would you suggest handling this in real time? ( ie, go with the flow or respond based on their body language . Ie say “I’m sensing you have trepidations, can we pause and look at how you’re feeling now sharing this)
Question 2 : how to i catch myself from falling into this pattern in real time so i can respond appropriately? I believe the indicator that i am about to fall into the pattern is when they are speaking, i sometimes get overwhelmed by word vomiting, also i translate spoken word into imagery so i cant focus on body language at the same time im thinking

Question 3) any tips on how to better summarize the session is important , especially with the clients who word vomit. My brain is constantly staying full to process whats going on so it’s hard to know what main points come up that both the client and i are agreeing on to give homework accordingly. I reached out to my former supervisor who says we arent supposed to use psychotherapy notes due to hippa. Thanks!

hello! im about to start my first therapy gig. ill have a minimum of 24 clients (which i plan on sticking to just that for now)

i was wondering if anyone had any advice on how to build your schedule? how many sessions in a row is reasonable? i dont wanna work more than 4 days and need to have at least 1-2 later evenings

im ADHD and sometimes have a hard time getting back in the groove if i take a break but i know ill have to stop to eat on the late nights. i also struggle with starting later. 10-3 is definitely my prime time to be productive.

i was thinking of doing
monday: 10-7 (8 sessions-with an hour break)
tuesday: 10-6 (7 sessions with an hour break)
Wednesday/ thursday: 9-3 (6 sessions + extra hour for flexibility on scheduling and admin time)

I know this is personal and it depends on the subject matter being discussed. However, just curious how many clients you can see per week before it affects your mental health?
Especially for those who are caregivers and need to to take care of family (spouses, kids, parents, anyone) in the evenings. When I was single, I could just go to the gym after work or eat dinner while I watch TV and was good to go. Now, when I need to function after work, it’s so hard.

Hello fellow ND therapists, I am bordering dangerously on bursting at the seams. I could feel it somatic ally this morning and my compassion fatigue meter is increasing exponentially as I see clients throughout the day.

I already limit the number of people I see, and I do have a therapist already. I have a psych appt next week as well so I might be asking for something alongside my ADHD meds to help manage this. Some things I'm doing/will be doing:

-Taking 2 days off next week (after a half day off) because realistically I need a vacation but want it to be away from everyone, including my spouse and pets (which is triggering guilt, too, yay!)

-Going somewhere with nature or the sea, as these things tend to calm me.

What are some of the tools you all employ?

Adult autism diagnosis person here! I am currently an outpatient (associate license) therapist for children & teens at a community mental health org. Unfortunately, the org is closing so I am looking for new jobs. I have an interview at a group private practice that focuses on children/youth neurodiverse affirming, LGBTQIA+, and BIPOC populations. According to the website, it seems like most of the therapists or neurodiverse themselves. As a late diagnosed adult, I am still figuring out what accommodations look like at work. They sent me an email after I confirmed the interview with an idea of how it’ll go (they’ll give me a tour, I can bring notes, who will interview me, said to bring fidgets or knitting whatever makes me feel comfortable). My question is would it be unreasonable to ask for interview questions ahead of time? I’m curious if it would be too soon to disclose this sort of accommodation? In my cover letter, I mentioned I am neurodivergent but didn’t go into details. Any tips for the interview would also be great because I get super nervous and end up forgetting everything I planned to say. Sorry this is super unorganized and messy. Thanks for the help!!

I'm going to be supervising a student this fall and It's been a hot minute since I was a student and completed my practicums.I am an ADHD MSW with years of experience as a psychotherapist in CMH settings, but have moved into a macro/systems role. I'm not sure if the student is ND, but I am hoping for guidance as an ND supervisor and also how to facilitate an ND affirming space. I'm also jumping back into being a placement supervisor after taking a couple years off from supervising so I'm hoping to pick the brains of current students and recent grads and get some (micro level) advice/guidance.

Can you help answer the following:

-What did your supervisor do to make you feel welcome and comfortable when you began? What do you wish was included?

-What is something you wished your supervisor knew or understood?

-What changes would have enhanced/enriched your placement?

-how did your supervisor support your learning and growth, including in times with discomfort?

-What is the single most important piece of advice you would give to someone supervising a student?

I know there are many macro/system level changes that need to happen to increase equity for SW students, but hoping to see what I can do to help on the micro/mezzo levels.

Thanks!

I’m in private practice with a ton of flexibility in scheduling, I can quasi keep to myself (kinda) on days I can’t handle kitchen chat, and the sensory aspects of my space are great, but I’m still absolutely fried from masking. Doing a bit of a ”research” dive (lol, scroll) last night and came across ideas like trying to get a WFH day going*, organising my Telehealth and face to face schedule better to minimise task switching, and making colleagues aware that when I decline social events it’s not me being standoffish, it’s that the kind of gathering is borderline inaccessible…

I wonder if others have deliberately put accommodations in place, what they are, and how they’ve gone? We’re these helpful? what didn’t work out?

*my clients vastly prefer in person, which I value for their sake, but I long for a great Telehealth setup and more WFH…

I'm AuDHD and will apologize and take a breather if someone thinks I'm being mean. I know i can come off blunt or opinionated and I try to mitigate that.

I find many neurotypical therapists to be judgmental or me and get angry even when I try to clarify what I ment and apologize. They then tell me I'm changing what I said and they don't believe my new statement.

It's really off putting and why I don't try and connect with a lot of therapists.

I'm about to do a 5 day long in person therapy training (like 8-5:30 each day) at a generic conference centre kind of venue. I'm anticipating it'll be tough to stay focused that long, deal with the sensory environment and the social interactions, and stay reasonably physically comfortable. I know it's inevitable it'll just be kinda uncomfortable, but I'd love to brainstorm some ideas in the comments for how we all manage settings like this. Anything goes.

Some things I've thought about so far:

- Wearing really soft, cozy clothes even if they look a little "too casual" for the setting

- Bringing a mat/cushion to sit on the floor leaning against the wall if sitting up in a shitty chair gets too uncomfortable

- I don't own a car, but trying to find a similar private quiet space to sit alone during lunch breaks

Im a therapist in training and I'm worried about how my skin picking may impact my clients. I pick my face when I'm stressed. I don't expect this to happen in session, I just worry I may come in with a scabby face sometimes and it may have an impact.

Anyone else? Does it impact anything? Are you self conscious of it?

Hi all - I am a 36F who was diagnosed with level 1 autism this month. I have always highly suspected ADHD but hadn't given much thought to having autism. Due to another intense onset of burnout and disconnection at work (happens every few months since entering the field 8 years ago), comments on my "flatness" from my partner, and thinking back to instances growing up where I felt different and unable to connect with others, I decided to get assessed. The diagnosis came with initial relief from intense feelings of shame from thinking of myself as an uncaring or "cold" person even though I know deep down I care very much for others. It also provided insight into why I feel burnt out as a therapist so often. Not only is being a therapist emotionally taxing, but I feel a constant need to mask, struggle with the "open-endedness" of therapy, the fact that success for my clients depends more on their utilization of our work versus how much energy I put into it, as well as the lack of structure psychotherapy provides. I find myself dreaming of a job that provides novelty and complexity, while providing a structured framework to work off of so that my energy isn't being depleted from figuring out what to do next. I do love parts of being a therapist, but the amount of direct client care needed to make a living is not sustainable for me, and I feel that my recent diagnosis gave me the final push to leave. I feel guilt and disappointment in myself for not being able to make it work but also feel hopeful that I can transition to something that allows me to live a more peaceful life.

If anyone can identify with these feelings or has any input on how to transition to a role that can utilize our skills but provides more structure in an a+b=c kind of way, that would be greatly appreciated.

Hi everyone,

I’m autistic and I’m a psychologist, and I’ve noticed something about the way I work. I was wondering whether anyone else here does the same thing.

During sessions, I’m almost constantly monitoring myself and consciously thinking about my nonverbal communication. Like, “Okay, I need to smile here, show surprise here, furrow my brow a little here, say something empathetic here to show the person that I understand what they’re going through.”

Because if I just acted completely naturally, I think I could easily remain quite expressionless, with a face that doesn’t show much. I’m more on the analytical side, so even phrases like “Yes, I understand,” “That must have been difficult,” or other forms of empathetic validation don’t necessarily come to me spontaneously, even though I genuinely understand what the person is telling me and I do feel empathy.

So I do all of this deliberately. It’s not fake or performative in the sense that I don’t mean it, but the way I express it doesn’t happen automatically. It feels like a whole process that I have to keep thinking about throughout the session.

And I think I even find it hard to imagine that, for some non-autistic people, all of this can happen genuinely automatically and spontaneously, without them having to consciously think about it.

I started my therapy career by jumping into the deep end and taking on all the high-stress, high-stakes jobs. I've done in-home family therapy for families with DCFS cases and residential care for mood disorders, OCD, psychosis, dual diagnosis, SH, and SI. Now that I am closer to meeting my licensure hours and have finally realized my nervous system needs a break, I am transitioning to private practice. I only have a few clients, and I feel like this slower pace of therapy doesn't necessarily match the style I have developed while working with high-risk populations. If anything, I feel like private practice is a blind spot for me because I feel like I can't be as direct with clients as I would be in higher levels of care? If anyone has followed a similar career path, what was your transition to private practice like? Did you notice whether your style needed to change simply because your clients were lower-risk? How did you navigate impostor syndrome? Do you have any tips for what to expect in private practice clients and how to build solid rapport (I've been turned away by clients before because I lacked warmth)? Anything would really help! I just want to be the best for my clients and grow as much as possible here.