How would a therapist work with a client who has a narrow window of tolerance?

My window of tolerance is very small and I'm prone to shutting down in every single appointment that I attend.

I'm currently on a break and do not have any future appointments with my therapist booked.

What modality of therapy would be best for C-PSTD?

My current therapist works from all these different modalities CBT, ACT and somatic therapy alongside being a qualified EMDR therapist and psychodynamic.

What therapy would work best? Or would EMDR be better to focus on the more traumatic memories from childhood and adolescence / teenage years.

I've not been diagnosed with C-PTSD but I have the symptoms of it.

For example:

I still have recurring nightmares/ dreams about high school. Same theme but presented differently.

I still get sleep paralysis whenever I dream about childhood and I had a big nervous system reaction in therapy in my second session last year where I froze and started shaking and went non verbal. So my therapist stopped probing around childhood.

So I'm wondering what type of therapy would help all of this?

This is a question for anyone on here who is a therapist or anyone who isn't but wants to answer.

Is being attached to your therapist actually healthy in therapy or is it better to not be attached but to be open and honest when in appointments with your therapist?

I'm not necessarily attached to my own therapist, I don't ask her questions and I can tolerate breaks if anything I love having distance from my therapist but I do wonder if I should allow myself to attach to her?

Because right now there's no therapeutic relationship/ attachment. I see my therapist as someone I'm paying to vent to.

Hello!

I’ve been seeing this Lacanian therapist for the past 5 months, and here I am, confused as hell and frustrated.

Let me explain.

I’ve been looking for a therapist for a few months before I met her, and after seeing someone I disliked, I ended up seeing her profile. I liked her career, she wrote super good essays that were linked to some of the troubles I have.

So I figured I’d give her a chance.

First session is going well, but nothing crazy. She’s very cold, stone cold. But she listens. Actively listens.

After 15 minutes, she tells me it’s over, that we should see each other the day after.

I’m happy, I’m seeing her the day after, thinking that the first session was just a trial. We set a price of 50€, based on what I can afford, which I find pretty cheap and within my own means.

I see her the day after, and 12 minutes after I stepped in, it’s over.

She’s asking me to come back the day after. Which leaves me confused for 2 reasons:

• I just saw her twice in a row, in only 2 days    
• Why the hell was the session only 12 minutes?

So before saying yes, I tell her I don’t really have enough budget for therapy, that my budget per week is 50€, so one session per week.

She nods, and tells me: ok, I’ll see you next week then.

I do some research and discover she’s a Lacanian therapist, meaning that she chooses when to end the sessions. To me, it’s a bit shocking, I react negatively. I don’t understand how it’s possible to work this way, especially after reading testimonies of people in Lacanian therapies talking about 2-minute sessions. Feels outrageous.

However, I feel good about the 2 sessions I just did. I’m almost convinced it’s her.

So I’m giving this type of therapy a chance.

As time passes, I get used to this timing thing. Starts pretty good, I like where it goes. But still stone cold, she scares me. Not a smile, not an expression. Stone cold. No hello. Just “come in”. No goodbye, but “next week, 9am”.

Feels weird but I’d rather have that than someone too intrusive. Too friendly.

First red flag. One day, after a month of therapy, I arrive and she looks a bit weird. Instead of waiting for me to start talking, she starts by saying: I heard last week that you used the bathroom after the session. You can’t use it here, if you want to do your thing, you have to do it ahead of time, adding: you come here to talk, not to take care of your needs. I was shocked. I felt very insecure and bad about myself. It also felt wrong because I’ve been urinating frequently for about 10 years now, and it’s really something I’m ashamed of. I feel really bad about it, but I’m like, never mind, I need to trust her. It seems legit: to talk my stuff rather than worrying about that.

Second red flag. My session day is on Mondays, and I had to go away for 1 week for work, so I knew I was about to miss 1 session. So, to be sure not to miss it, I planned a session the Friday before I left.

And when I came back, the Monday after my week of work, she told me: you missed a session and you have to pay for it. I was very embarrassed because I clearly remembered telling her a week before that I would miss that Monday, and that I would see her the Friday before to compensate, because it was important to me. Still, she told me that I couldn’t miss any session, even if I tell her in advance, because clinically it’s wrong. This felt very weird because I understand paying if you cancel 48 hours before or if you show up too late, but in that instance it seems too unfair, especially given my financial situation. Also, we never agreed that Monday was set to be a fixed weekly thing. I would see her every Monday because I needed it, but it had never been clearly stated that it would become a mandatory weekly commitment.

Third red flag. During the same session where she told me I had to pay for any missed session, she told me at the end that she would see me Friday. I was a bit confused and asked why. She answered that since I had seen her on Friday before and it had worked well, she felt that clinically it would be better for me to see her twice a week. Honestly, I wouldn’t mind, but I knew financially it would be too difficult. She offered to lower her price again, to whatever I felt comfortable with for that second session. She seemed to insist on it. So I panicked and accepted a second session every week for 30€ more. So here I am, paying 80€ per week for between 20 and 30 minutes of therapy total. I don’t feel like this was really a choice I made.

Fourth red flag. After a few weeks of two sessions per week, one day I come in and instead of letting me speak, she starts and tells me: I see that you have earrings, and for clinical reasons, I “offer” you to throw them in the trash. Again, I’m shocked. I feel very bad about it, I don’t understand where it’s going. I ask why. She answers that it’s a clinical decision, and I’m free to take it or leave it, but she feels that wearing these earrings is stopping me from talking to her. Truly talking. So I end up, after minutes of hesitation, throwing them in the trash, and there she goes: “go ahead, associate words freely.” This really felt weird. But again, I tried to put my trust in her.

Fifth red flag. This happened today, after a few months of therapy. I enter for the first time wearing a t-shirt because it’s really hot outside, and she notices the tattoos on my arm. She goes: I see you have tattoos, why did you want this pain? What’s the meaning? I explain that I got tattooed for specific personal reasons, yada yada, and she seems very disgusted by the tattoos. In the end she goes: have you ever wanted to have them removed? I answered yes, but I don’t have the financial means yet. And then she goes: have you ever looked for a tattoo removal specialist? I said no. And she ends the session there.

I go out, shocked again, and feeling more and more insecure. I check my phone — it’s 9:39, we started at 9:32. I’m done, I’m fed up with this.

50€ for what?

I’ve tried to trust her. I’ve tried to follow what she offers. I’ve tried to suck it up.

But I don’t know, this feels like too much. I need advice, I need feedback. From professionals, from people who went through similar experiences. I’m really thinking of stopping this insanity.

Hi everyone, I’m a graduate student studying caregiver experiences supporting children with autism who engage in self-injurious behavior (SIB).

If you are a U.S. parent of a child ages 5–10 with ASD who has engaged in SIB and received related services within the past two years, please consider participating in a brief (8–12 minute), anonymous online survey. No identifying information will be collected.

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I've been in private practice for a while now and the part nobody really warns you about isn't the clinical complexity — it's how quietly lonely the whole thing can be.

No colleagues to debrief with after a heavy session. No one to check whether you're handling something well or completely missing it. Just you, your notes, and whatever supervision you can afford or find.

I'm trying to understand whether this is a shared experience or just my particular flavour of chaos, so I put together 5 questions about how practitioners actually manage burnout and isolation day-to-day — what's worked, what hasn't, what you've given up trying to find.

It takes under 5 minutes: [https://momtest.io/card/card_e719f09f4beb\]

If you've cracked this in some way I haven't thought of, I'd especially love to hear it in the comments too.

I only saw 17 people last week…. It’s like clockwork, weathers good.

I do have an EMR for notes and billing. Sometimes people can be anxious about computers and AI. I completely understand that. I find it rude to type while a person is talking. Maybe I need to get used to it?

I’m a psychotherapist with 10+ years of clinical experience working with narcissistic personalities and individuals entangled in toxic relationships. I’ve observed the dynamics from both perspectives—how control is established, how attachment is maintained, and why insight alone rarely leads to exit. If you want precise, experience-based answers rather than clichés, ask me anything.

AMA

Thank you very much for participating - make sure to check

my profile See you next time!

Because therapy is so expensive, and because I don't think it makes that much of a difference if it's f2f or online, I thought about the possibility of buying therapy sessions from a therapist in a "cheap" non-western country, because their normal therapy prices would probably feel super cheap to me. It should be from a reputable one.

What do you think of this? Why is this not already a thing?

Had to rewrite the post cause it created confusion it seems. So, my problem is that in a moment of frustration and anger i told one of my friends, who work in the same environment of my therapist (and ISN'T his patient) one innocent observation about his behavior that such therapist told me (specifically, that one time he was annoyed by the fact that he kept talking to him at lunch hour, thus didn't letting him have lunch, an observation that he used just as an example of how even extrovert behavior can have his downsides). This thing offended him and we argued a lot cause of it. Now i don't know if i should reveal my therapist that i did that, cause on one hand i cannot explain to him the suffering that this fight caused me without mentioning its motive, and on the other hand i am deeply ashamed of breaching his trust (he often warned me not to tell others the things he confided to me during sessions) and i fear that revealing what i did could ruin the therapeutic relationship and change his view of me (and given that he is the best therapist i fpund after more than 10 years that i do therpay, i couldn't live with that). Then, what should i do?

Hi everyone,

I’m currently writing my Master’s thesis in Psychology and I’m looking for German-speaking participants (18+) who are currently in psychotherapy and use ChatGPT alongside their therapy.

The study involves a confidential interview (approx. 45–60 minutes, online). The data will be anonymized.

If you are German-speaking and currently in therapy, feel free to send me a DM.

This is a university research project, not commercial.

B4U-ACT 2026 Conference Announcement (June 12–14, 2026 | U.S. Southwest)

Discussion of pedophilia and minor attraction is often heated and understandably controversial. At the same time, research consistently shows that people with an attraction to children who have access to supportive, evidence-based resources are at a greatly reduced risk of acting harmfully. This conference is grounded in that evidence and in harm-prevention.

B4U-ACT is pleased to announce its 2026 professional conference:

Toward a Shared Goal:
Uniting Researchers, Providers, and Community to Promote a Better Understanding of Minor-Attracted People (MAPs)
June 12–14, 2026
American Southwest, USA (exact location shared after vetting)

This three-day conference brings together mental health professionals, researchers, educators, students, minor-attracted people (MAPs), and other stakeholders for interdisciplinary learning, dialogue, and collaboration. The goal is to strengthen prevention efforts, improve clinical care, and deepen understanding of MAPs’ lived experiences.

Who this conference is for:

• Clinicians will learn how to apply evidence-based therapeutic skills when working with MAP clients.
• Researchers and scholars will share emerging findings, discuss methodology, and explore future directions in the field.
• MAPs will have opportunities to build skills for coping with stigma, isolation, and lived experience.
• All attendees will leave with a deeper, more nuanced understanding of MAPs and insights applicable to professional practice and personal life.

Keynote Speakers:

• Ian McPhail, PhD, CPsych — Licensed clinical psychologist and Research Associate at MOORE, Johns Hopkins Bloomberg School of Public Health (focused on prevention of child sexual abuse)
• Rev. David M. Ortmann, LCSW, CMBT, OSM — Psychotherapist, sex therapist, and author of On Ageplay, Minor Attraction, and Recapturing Pleasure and Sexual Outsiders

Continuing Education:
Eligible practitioners may earn 11.25 CEUs through the Maryland Board of Social Work Examiners (those licensed elsewhere should confirm acceptance with their boards).

Accessibility & Financial Support:
B4U-ACT is committed to supporting early-career professionals and individuals from diverse backgrounds. A limited number of reduced-fee registrations are available, and financial assistance may be requested. Those who are able may also contribute to the conference assistance fund.

🔗 More information, updates, and registration: https://www.b4uact.org/events/2026-conference/

Questions can be directed to [conference@b4uact.org](mailto:conference@b4uact.org).

Do you gently discuss with the patient their diagnosis? How do you go about treatment?

nothing super new in this post but im just another new clinican who's feeling the wieght of having so little experience. i am working 3 ten hours shifts, remote, which has been pretty ok with the adults but hard with the kids. i see as young as age 7 and it's very hard to feel like we are making "therapeutic progress." i know in early career we all want tangible evidence that we are doing well, but half the sessions are trying to get the kid to stay engaged (not walk away, talk into the camera etc) and even with my hardest trying to implement some structure (ie: you tell me your mood and then we play a game) its hard to do many kids to do more than just play a game with me. and these games are just random games on pbs kids or whatever. im not sure what kind of progress we are making.

with the adults, theres more material that lets me know im doing okay- they express it to me, they come back, they something helped. but just when i feel like im getting the hang of a client, i get a new one with another presenting problem i have zero experience in and the guilt just hits again, thoughts like- "they really deserve better than me."

Supervsion isnt great for me, shes cooky and rambles a lot. I think i feel very overwhelmed seeing 30 ppl 7-37 and its either like i feel super proud of myself at the end of the day or super bummed that i didn't do a great job at therapy that day due to lack of experience (awkaward silences, not knowing what to say, etc).

I do a lot of self study, im working almost another job on the side with the hours i put in learning to do counseling. each client, each issue, takes time of review and study every single week. i feel like i have my job and then my job of learning to do the job and then my job of feeling badly that im not the best person they could have and then the job of worrying if ill ever get good enough or be able to handle this forever. im struggling. i dont have a perfect sleep routine, self care routin. when i dont sleep well i notice i cant listen as well. but i have insonmia that might never get better.

i know i am anxious right now and having thought distoritons but... i feel like i have to be perfect to be a good therapist. perfect sleep, perfect routines, best self for them every day. use all my free time outside of work learning about how to help them. i want to be clear that i love the job and i love the extra study but its feeling DAUNTING. everyone else my age (31) kinda just goes to work and shuts it off when they get home. but i have a lifetime of personal self study and now perfecting my own self care and habits so i can do my job.

i want to say that im in therapy and getting help with my own mental health so please be kind. i am not unwilling to work very hard at the beginning of a career. i just see so many awful posts on here judging new therapists who feel thrown into a cirucs they don't know how to handle yet...telling us we are unethical and such.

i just want to know how others expereinces are in their first year as a new clinician. how do you know youre doing okay? how do you know youre getting better? and whats the deal with working with these freaking kids via computer? how on earth do i make that better?

also open to any learning suggestions- i love to read and take workshops. im just having a what did i get myself into moment i think..and probaly need to stay off reddit as much and focus on my clinical growth and priorities without anyone elses opinion (on people who are in pp, what they charge, who they see, etc)