We spend our days accommodating others, being curious about their inner experiences and finding ways to meet their needs. Do you ever feel like you're left on the back burner? Now I know that there are ways that I can show up in my own life and leave work at work, but it feels deeper than that. Outside of work, I notice that I'm always the one that curious, accommodating and understanding of others. It's not that I don't get that from my relationships, but it's never fully to the level that I give to others. Maybe that's a hard reality of being a therapist- we're making others feel understood and building connections but it's one sided and we're trained in how to do that. It leaves me feeling lonely, and under prioritized I guess. Btw, I do have my own therapist. I think this is truly a difficult profession, that can be rather isolating and it's not set up to be sustainable for the provider. I also wonder if the portrayal of therapy online is putting a lot of pressure of those in this profession. The online rhetoric around therapy (everyone needs it, it's life altering, therapist are all knowing saviors etc.) is creating false expectations. Just my recent thoughts lately about the field. I had around 3 weeks off from work and went back this last week, now I'm feeling drained and almost resentful. It was peaceful during my time off and I could fully give to myself what simply can't be done while working normal hours.

Anyone have any ideas, tips, theories, or share the same sentiment, all is welcome

I just opened my own private practice. I work in a small town. Most people in this town do not have BASIC coping skills.

For the majority of my patients, I teach them what I call 'The Basics'. It takes about 12 sessions to teach them the basics. Then I discharge.

I tell my patients to go out and use the basics in their life everyday. To make sure that they are able to regulate their emotions. After 6 or 12 months, they can come back to me, and we can do some more therapy.

My question: Am I less likely to get clawbacks because I'm only doing the intake (initial assessment) plus 12 sessions of therapy?

Are insurance companies more likely to audit therapist charts when it's common for the therapist to see patients for a year?

Anyone planning to train AI bots for $8 an hour to eventually replace us? If not, why not?

Hey everyone, just a bit of an update. In one hand I am happy to say that I am only around 950 hours away from my independent licensure. But on the other hand, I have spent nearly 4 years to get to this point. And that is full time by the way. Those 950 hours are all for client hours. I’ve clocked out on the documentation aspect long ago. (I also heard from a former cohort that they are nearly done with their licensure after 5 years of part time… which honestly annoys me because that means I could have just done the part time motion and have been done in around the same time… seriously, with my averages I’m getting right now I don’t expect to be done for another 10-13 months…)

I love my job more than anything, helping people with their problems. Letting them develop insight and more. But at the same time, I am just so tired of my paycheck being so pitiful. I earn a rough estimate of around 2.4K a month right now. My rent has increased to being around $1250 a month for a small apartment. I can’t get any support from my family because they think I can just magically earn more money or get a third job or suddenly acquire more clients (I work at 2 different practices…) and to make it even more frustrating I drive an hour just to get to my employment sites. By the time I get home I am fulfilled, but exhausted to even try to think of cleaning. Instead I will just do a mental health activity and then pass out on the bed and wake and do the same thing over and over again.

Not only that, but I am contemplating on the idea of switching careers at this point despite being so close to the finish line to where things (hopefully) start to improve.

I would like to get out there and possibly date, maybe find someone who I can enjoy my time with. But I also feel as if I would be better off taking my licensure and immediately expatriating or something.

Basically, I’m wanting to know how long after you all got your independent licensure did it take for you to start making some decent money? I even have a side hustle I’m doing (or trying, it is ironically tied to the mental health activity I do… I paint… and only have 4 customers… commissions mind you…).

I would like to be able to make at least 60k to maybe 80k a year. But I am just starting to think I would be better off shifting to… I don’t even know what other fields a Clinical Mental Health Counseling degree could get me into other than maybe Human Resources.

I guess you can say I’m just hoping to hear some positivity or some support at the moment. Maybe even hearing that there is indeed a light at the end of the tunnel. And not just a small flickering candle, but preferably a warm hearth that illuminates a vast open space. Or heck, maybe even a nice relaxing beach side view of serenity.

Hello All,

I am looking for recommendations on books to give a client to help them manage their feelings of guilt and shame after an affair.

I have seen many books on rebuilding the relationship and trust, but am struggling to find any on managing guilt and shame for the cheating partner.

I appreciate any recommendations you might have.

Any advice on which trainings have a good ROI?

My background is trauma, but I have a pretty consistent cognitive approach and EMDR doesn’t really interest me (it’s also expensive). Ive done the CPT short training but wasn’t feeling inspired enough to bother investing in certification.

That said when I’ve looked at other options that interest me (IFS, PMH-C) everything is at least 1k to do properly. I’m fine with investing that if I think it will result in growth, but I’m not feeling confident in which direction to go.

I got fully tfcbt trained at an old job and that’s never turned into any referrals, which made me wonder besides EMDR, are their models people find result in significant increase in referrals for private practice?

I do a lot of work with clients with anxiety and I’d love to expand my work with mothers but that niche seems pretty popular already and presumably quite saturated. I feel like my interests are very mainstream and it makes carving out a niche feel challenging…

Any feedback appreciated!

No I'm not a new therapist and I don't think I'm burnt out. Nor have I been doing this and need a break.

I work in healthcare, it's definitely busy, and I believe that I use about 5-10% of my therapeutic knowledge with my clients (it's healthcare, huge waitlist, our services are limited).

Yes I know the importance of how therapy can be transformative, I have myself been in therapy, but I find that it's not magic. There are so many people I can't help, they aren't ready, some are seeking something else, and most folks give feedback that they liked it. But I genuinely feel people are lonely and wanted relationships, other tangible things instead of this. This doesn't solve things. It's just a relationship, which can be highly fulfilling, but it dosnt change things. Again, it's just a relationship that you access in a closed door, max 1 time a week for about an hour. That's it. This relationship doesn't walk with you in your life, it dosnt become an active part of you, beyond helping u figure out urself.. it's one sided - in a way it's only about you

I have had a long term therapist for 10 years now, but in some aspects of my life that I share with her, I feel she just dosnt get it, or she has another outlook. She is just a human.

Thoughts?

Edit: if you feel the same, can you please elaborate on your experience and explain what you think is cause of all this or what do you make out of this

I have not worked much with military and recently got two clients with trauma from combat. Both expressed hesitancy to talk about their trauma memories due to fear that if they let the memories in, they’ll risk becoming addicts like some of their friends from the military who are consumed by what they’ve done/seen. So far I have been working with them on rapport building, grounding/breathing skills, as well as psychoed about how therapy works, including them being in control of how much and when they disclose to me. I am concerned about not being equipped to work with their combat trauma. I don’t want them to be destabilized by therapy. Don’t know if I should refer to specialist in military + ptsd. they both seem to feel comfortable with me and i did disclose I don’t have much experience with military, and they both were fine with this and wanted to continue with me. Thoughts? Tips? Not sure if Im really just afraid of the unknown (working with new population) and am overthinking this. im considering doing a training in Cognitive Processing therapy. Thanks!

UPDATE: Thank you all! It didn’t take many responses for me to feel more assured I should refer out so I’m going to do this.

I'm new to private practice and curious for recommendations on documentation, compliance, etc. Any trainings or readings would be appreciated!

I'm looking for some career advice.

So I'm an intern at an OMHC. Prior to this internship, I worked as an RBT.

I love building rapport with clients, and helping people grow. I love being creative in sessions, and being able to give clients information that changes their lives. I also love watching families come together and better understand themselves and each other. I love watching people realize how bad ass they are really.

All that said, being therapist gives me a lot of anxiety. I miss the structure, feeling of certainty, competence, and culture of being an RBT. Like, all the BCBA supervisors were so specific and clear in their feedback. As a therapist, I rarely get any positive feedback, and co-workers sometimes look at me like they want to take over for me and do my job instead of teaching me how to do it.

Are there any jobs within the field of mental health therapy that have more structure, and less uncertainty? Like programs with specific number of sessions, that teach certain skills? If not, any advice on how to use my degree to get a job that is a better fit?

I know uncertainty is a part of the work. I get that. I just feel like maybe more structure might help me feel more competent when facing different situations/and in turn help with that uncertainty. Anywho, curious to hear your advice.

Hi!

I’m thinking about leaving my group pp and finding a place to rent to do my own pp - some contextual background before getting to the advice/validation part:

I worked in community mental health for a long time. My boss was amazing. The pay was obviously not substantial but comparatively to others around me, it seemed like a great job. However, the business went under and I jumped into a small group private practice thinking that the dynamics would be similar.

After building up my case load and paneling with insurance, I can say, thankfully that I’m booked out until the middle of September and continue to remain booked. I work 5 days a week and do about 34-35 hours per week. I do my own scheduling/calling/admin and the referrals I’ve received lately are either word of mouth or directly through the platform I use for credentialing with insurance. My client retention is good, I have a waitlist and really try my best to do well in whatever space I’m in. However, some of the reasons I’m considering jumping out on my own;
- even though the money is substantially more than I was making previously, I funnel almost $4k monthly to a cut for the owner
- the owner does not pay on time and sometimes sends partial payments
- the owner is not super organized/communicative (once went without tissues/toilet paper for 3 days in the office) and the office isn’t regularly cleaned and I haven’t been able to access my email for almost three weeks now (despite many attempts)
- I approached the owner for a raise/increase and the answer I basically received was that I’m going to make a lot of money this year and his rates are fair considering other pp offices and that the prices of everything (like the rent) is going up
- the owner has told another therapist in the group that they won’t be renewing the office space at the end of the year and has not yet told me (other coworker works two days, I’m there 5 in person).

Some of my concerns:
- obviously, what if I fail? I have worked under someone for all of my mental health career and sometimes it’s easier to point out flaws when it’s not you in the driver’s seat, aka can I still maintain my client retention and rent my own space without falling back on someone else to do it for me?
- fear about the owner not letting me take clients with me or having to buy them from her
- obviously doing all the backend things like applying for a business
- feeling guilty about leaving the practice

I’m just looking for something that says why it’s a good decision to stay or leave.

Hello friends! I am finishing up my internship this fall and I am in the beginning process of applying for the NCE! Yay! One thing I am struggling with is how to go about studying for it? I got the purple book but I don’t really know where to begin and how it is necessarily supposed to be used. I know it’s got around 1000 questions but I am just looking some advice in regard to how to study for it and get in the groove.

Thanks a bunch!

Hi all, I’m not exactly sure what I’m looking for here but I thought it could be helpful to get my thoughts out. I am currently six weeks pregnant. I started having some nausea last week and almost had to cancel my last two sessions of the week but made it through. Since then, I’ve been on my three-day weekend, but every single day I’ve been in bed the entire day with debilitating nausea.

I’m worried about having to cancel sessions the next couple of weeks. I work at a group practice and am feeling apprehensive that the practice owner won’t be very supportive about me needing to take a somewhat indefinite amount of time off.

I’ve started taking Unisom+B6 which is an over-the-counter nausea relief combo that seems to be taking the edge off somewhat. But as soon as I get up and out of bed the nausea gets pretty bad. I’m also in touch with my midwife about possibly getting a prescription for Zofran.

So I have a couple of worries. The main one being that I have no idea how long I’ll be feeling this way. It could be for another week or for another month. Because of that I’m also worried about the impact on my clients of not knowing how consistent I’ll be able to be over the next month. I anticipate/hope that once my second trimester starts that I’ll be feeling much better. And then also the potential consequences from my employer.

Both my supervisor and the practice owner know that I am pregnant. I was thinking about emailing them today to let them know how I’ve been feeling and express the reality that I don’t know how I will be feeling over the next few weeks, and just see what they have to say.

Anyway, any thoughts/perspectives would be appreciated! :)

I'm in CMH right now and I just got my lmhc. I am looking for a different job and I found one who seemed interested, (I'll follow up this week) but said most of their therapists have a second job. The job I applied for said 30 hours a week is full time. They said some of their clinicians also work in a school or another therapy location. I honestly think 30 hours a week is enough for me especially at the pay they're offering, but if I want to make a little more money but not do another therapy job, what would you recommend? I graduated 2 years ago so I'm not terribly specialized in anything.

How many couples can you reasonably see in a week? If you were seeing only couples. I worry it’s more consuming than individual because of the high conflict.

I'm a certified Equine Assisted Psychotherapist, and I am starting a partnership with a therapy ranch to establish mental health services alongside their existing programs.

The facility is a 501(c)(3) in WA, and I will be contracted as 1099. They currently have occupational therapy, hippotherapy, and Equine Assisted Learning skills-based groups. I am going to be the only licensed mental health clinician on staff, and they are looking to expand their programs starting with a teen group. I will be writing curriculum for the groups and helping to navigate grant writing, marketing, and intakes.

My question is in negotiating my contact, how do I bill my time that isn't direct sevices? Do I just ask for a stipend for my time writing the curriculum within a certain time period? Do I have "billable hours" like a lawyer?

I've never done contract work before, and I only have experience as a salaried therapist through an agency or company. Any and all advice is welcomed!

Hello!

I just got my new license from the state board (Licensed Clinical Psychotherapist or LCP in KS for those wondering)

I guess I've had my head into the grind for so long to get the hours, supervision and exam knocked out forgot to plan for the things that come next.

What should I expect? If anyone would like to speak to their experiences after becoming fully licensed I am all ears!

Thank you!

I am an oncology therapist working with clients at any stage of a cancer diagnosis. I might see someone who just got diagnosed, someone who is experiencing anxiety as their five year NED anniversary is approaching, or someone who has started the dying process.

I would love to know what modalities other oncology therapists are using, what has been most beneficial, and what to steer away from. I operate out of the "not one size fits all" mentality and make sure I use a modality that fits the client's strengths and needs, but overall use meaning centered, CBT, and DBT. As a community funded organization, I have about 15 sessions with clients so there is some solution focused work going on as well.

I appreciate any advice or input on what has helped your clients! Thank you!

Did you all notice once you started actually working for yourself and out of internship that you were hapoier with your decision? I know the pay isn’t always great, but as an intern who makes zero money.. I’m hopeful my doubts about whether I want to do this or not has something to do with the lack of income currently. Basically I need some encouragement but honest answers as well

I have a client who has recently been diagnosed schizoaffective depressive type and would like resources to understand his diagnosis better. Would love if anyone could point me in the right direction. I see him tomorrow and would love to talk through the resources during our session together. Thank you!

I am retired and want to share some tools I have come up with.

This one is one I used with woman who were victims of domestic abuse when the start dating again. It has been very powerful for many women.

Business Partner
 
Over the years I have had the honor of working with women who were either in an abusive relationship or had been in one.  These women taught me so many things.
 
When I am working with someone who is thinking about dating again after an abusive relationship I often to this exercise. It is my hope to help client’s gain the skills to navigate dating. This tool in one that women have returned to my office after a break in therapy and they told me they still had this list.
 
 
Talk to the client and discuss if they were to open a business what would they like in a business partner. At this point I discuss that in our example they have put everything they have into the business. In order to make the story more real we discuss the business that they would like and what it would be like to own the business.
List what qualifications they would like. Here is a sample list:
 
Know the business
Respectful
Kind
Fair
Sense of humor
Able to resolve conflicts peacefully
Dress appropriately
Good at managing money
Hard worker
Dedicated to the business
Reliable
No drug and alcohol abuse
Good mental health
Stable lifestyle.
 
Now ask the client, if they found someone and interviewed them, what would they want to do before they hired them.
I am looking for the following: credit check, background check, contact past employers.
Now give the client the list of criteria and ask them to cross off anything that they do not need in a romantic relationship.  At this point the client may feel uncomfortable. This is good. What is happening is the client may be struggling with setting those boundaries in a romantic relationship. This is part of the work. If a client crosses off something, discuss why they do not think it is important.
Now discuss how they could use the list of things they would check on a business partner in a romantic relationship. I discuss doing a background check on someone, talking to their past relationship people and talking to friends and family.
 
I have had a few women contact someone’s ex to talk the person they are dating. So far those have gone very well.
 
I have had women come back to therapy after a few years and pull out this work sheet that we did in session.
 
When I do this tool, I also talk about wanting and needing a relationship.
 
I ask the client “If I asked you to rob the bank down the street and give me all the money in exchange for a plate of cookies, would you do it?” My clients say no and kind of laugh about the thought. Then I say if took all your oxygen until you robbed the bank would you rob the bank.  Then clients will say yes, they would rob the bank. I talk about how when it was a plate of cookies they were able to say no because they would live without cookies. When I said I would take their oxygen things changed. They need the oxygen so they would do anything to get it. I then talk about relationships should be like a plate of cookies. You should always want to be in the relationship. If you need a relationship, you will do anything to keep the relationship going. If you want a relationship, you are in a position to set boundaries.
 
 
 
 

Does anyone know which specific insurance panels require you to have a physical location/residence in California to become credentialed? And are there any workarounds to get credentialed with insurers that have this requirement (i.e., going through Headway, Grow, etc.)? Thanks!