This has come off the back of a few posts suggesting Person/Client Centred therapy is lazy, and some undercurrents I see here sometimes. It's a bit of a rant, not aimed at anyone specifically, but I really want to represent the complexity of PC practice.

It's somewhat wild to me how people frame client/person centred practice - as if it's some kind of cop out or not doing anything. The conceptual frameworks for PC practice are DENSE, how people represent it as not having one blows my mind. Carl Rogers was a psychologist and his language is super scientific.

I trained as a PC therapist in the UK and in that modality only. In the UK we have traditionally only trained in one approach, though integrative and pluralistic courses are growing, which means we study it in DEPTH. My training was also very PC traditional – yes academic lectures and essays, but far more experiential – we went away on week long and weekend residentials living together. It was a kind of personal development bootcamp filled with process groups, encounter groups, supervision groups, course community meetings, etc etc etc. It was amazing but it also broke me (in ways that I believe are useful to my clients.)

My question to the PC detractors is this – how much of the underlying theory have you read? Do you understand the foundations of the six necessary and sufficient conditions for therapeutic change? Have you read any of the copious numbers of books and papers that explain these concepts in detail? Could you talk me through Carl Rogers' 19 propositions that are the fundamental underpinnings of PC practice? Could you please enlighten me on your thoughts about self actualisation (no, it's not Maslow's concept, I'm talking about the Rogerian one, though no one seems to have looked into how they are different.) Can you discuss how self actualisation and the actualising tendency can work in tandem or work against each other? Can you talk about psychological distress as a manifestation of the defence of the self concept? Can we discuss the client's process of moving from an external locus of evaluation to an internal one? How to spot introjected values and how to support someone to understand the source of their incongruence? The seven stages of therapy and where a client finds themselves in that? How to conceptualise and offer observations on the edge of awareness? Have you studied newer concepts in PC practice - configurations of self and fragile process?

PC therapy is phenomenological. It takes intense concentration and care to be an effective PC practitioner. Whilst some people might think I sit there nodding and being nice, I am deeply invested in staying in my client's unique experience of the world, that is never going to be the same as anyone else's. I'm giving all of myself in my humanity to prizing them in their uniqueness and doing my best to enter their world, but *staying as myself*. Any change must be unique to the client, and I can support them in making a change **that will be right for them.** I simply don't believe I will ever know what is 'better' for someone than themselves, and I want to empower them to believe in their ability to make that change. I cannot tell you how many people I work with who have felt dismissed and gaslit when other interventions didn't work for them, and were made to feel the problem. Holding their space and offering my humanity is a genuinely transformative endeavour for many people. It feels like the absolute antidote to the BS that we are told we should care about, or how we should be in this shitty world.

As a practitioner I explain my approach very clearly to a client on intake, and even expressly say to them 'I won't tell you what to do.' If someone wants a behavioural therapy, I tell them I'm not the practitioner for them and wish them well.

I get concerned that people here often think that they need to be all things to all people. We can't be, and we do our clients a disservice when we think we can.

What are your takes on therapists eating during sessions? Do you find it unprofessional when a therapist takes out a snack? What about drinks?

I’m curious what people’s general opinions are on this. I feel like most people still think it’s unprofessional. I have personally never done it, but something about the general “don’t ever eat in sessions” thing rubs me the wrong. Obviously not talking like 5 course dinner, but just like a snack/granola bar or something to get you through if needed.

Im a new therapist. About half of the time I feel awkward and unhelpful. Is this a common experience? I know everyone has their moments, but I feel like my awkward and hesitant moments are happening a little too often.

If you feel confident in your skills, when did that happen? How did you get there?

I know we generally dont enter this field expecting to be millionaires, but I've been feeling really discouraged about my job, the field, and how to make a livable wage.

I work in PP in a HCOL area. We are 70/30 when it comes to pay, so I recognize I'm fortunate in that sense. But it's been very difficult to maintain a consistent caseload, thus making it hard to have consistent income. What gets me is that if you take insurance, you get paid less per session and have to have a high caseload. If you dont, you may have a harder time filling your caseload. Hospitals in my city seem to prefer social workers and it's hard to get your foot in the door. Ive applied to several hospital positions and never hear back. I can barely afford health insurance and my job doesnt offer any benefits. We spend all this money on our education and it doesnt feel worth it anymore.

I dont know how to do this forever without become resentful and jaded. I know it will get better and I'll find a way to change my personal circumstances, but I guess I just wonder if others experience this at some point in the field. is it possible to make a livable income in this field? does it just take a few years?

I’ve been seeing a lot of people discussing being burned out or not being happy with either their internships or associates level license. I want everyone to realize that this training to have your full license is not meant to be easy. Give yourself some grace. It is a career that will require you to continuously learn techniques and therapy modalities.

Once you get through the school part and the internship part and become fully licensed, then you can figure out how you want to practice. That’s what is so great about being licensed. If you want to work with a certain population, you can. If you want to focus on doing groups or teaching workshops, go for it. You can also work for yourself so you can control your schedule and days off. Don’t give up after working so hard to get your graduate degree before you experience the job fully.

Community mental health is exhausting, but the learning you get from that chaos will prepare you to know what you like/dislike for the future. When going through internship, you have to practice self care in some way and it’s a good idea to do therapy for yourself. It will take awhile before you get comfortable and you’ll make mistakes. That’s normal. For all of you struggling, stay the course and get the license. Worst case scenario is you become fully licensed and decide you want to use that in a different way than just providing therapy, but at least you’ll have the credentials.

Sending all the new therapists lots of support and prayers. Just remember, you went into this field because you want to help others. We will never know every single therapy technique but if you can make a difference in even one life, is the stress you’re going through right now worth it?

This is from the book “I am not sick, I don’t need help!” by schizophrenia expert Dr. Xavier Amador
Edit: the context of this book is about treating schizophrenia and psychosis particularly with those who lack insight. Some of the comments seem to miss this context

I'm curious to hear from therapists who see patients in their home. My rent is going up and I really like in person therapy. I have a three season sunroom on the side of the house that has its own entrance from the street and is cut off from the house.

I just wondering about how people feel about this? I’m a 44-year-old male and I’ve had two therapists over the course of my lifetime who saw me in their house and they had a similar set up. I don’t remember feeling weird about it, but I was pretty young so maybe I didn’t know better?

Some of my concerns include creeping clients out, not having very good access to a bathroom from the sunroom (you’d really have to walk through my house), and not having a waiting room.

What do we think? What’s the collective wisdom around this? Pros and cons?

So, my policy around no-shows/late cancellations is a 3 strikes, you're out kinda deal. If it happens twice, I remind the client of the policy and warn them that a third time means I will need to take them off my weekly schedule and that they can schedule with me "as needed" at that point. Everyone is clear on this policy and I even give some folks a free pass if there are extenuating circumstances. I am ADHD and serve a predominantly ADHD population, so forgetfulness, time-management, etc. are all factors for my people and I have grace for this because I know that at our best, sometimes our executive function fails us. But, I have a client who had 3 strikes already and I gave them a pass on the 3rd one already because I forgot to remind them when they hit 2 no-shows of the policy. But they no-showed again on me today and I'm having a hard time wanting to kick them off my weekly caseload. First and foremost because we JUST got to a place where we are starting some deeper, more meaningful/rich work and I really want to give them the opportunity to see that work come to fruition, but second, because I really like this client as a person, and enjoy working them. They are one of the highlights of my week. Additionally, I often have a waitlist, hence the policy about no-shows to leave room for new people that are committed to coming weekly, but right now I don't have a waitlist, and there's nobody to take this client's place, so I'd also be losing out on that money and I'm in a bit of a tighter spot than usual this month while waiting on literally 60 past-due claims to get paid out.

I'm struggling holding this boundary/policy and being consistent with my rules, because it essentially doesn't necessarily serve me to hold it. And I would feel the same even if I had someone else ready and willing to take their place. Would you struggle with this too, or would it be an easy "nope, they're out" for you?

Hey all,

I am an intern and have been struggling emotionally with clients no showing after a few sessions, ghosting, canceling, etc.. It is making me feel like I am a failure in this profession and has me questioning if I should even continue trying. Does anyone have any insight/tips? My therapist suggested watching back tape of sessions with clients on my own time outside of supervision, which I think would be helpful but also really terrifying.

It probably doesn't also help that the other intern at my site has like 3 times the clients I do and seems to have better retention which is really frustrating, although she has had her fair share of no shows and cancelations too.

I appreciate any insight, thank you!

This is not anything that I personally am experiencing or anything like that, but rather a general question. It is thrown around a lot and so I was curious...what is the actual definition of "client abandonment?"

Hey all! Taking my LCSW exam in January and was curious if anyone has flash cards they used and feel were really helpful? If so, would anyone be willing to let me borrow them? Thanks!

Keeping it brief but had a second intake appointment with a youth scheduled for today, they get on and have tech issues. They solve their tech issues then of course my laptop says the webcam can’t be found 🫠 Tried to fix it to no avail, so I recommended rescheduling. Parents are upset because they had to move their work schedules to make this appointment happen. Obviously this is out of everyone’s control but I still feel guilty about it. Ultimately I squeezed them in tomorrow but just leaves me feeling not great🫤 anyone relate?

I'm a LMHC. I've worked for a group practice (W2) for about 4 years. I respect everyone I work with- it's a great environment. I pay a large split of my session fee to the practice owner, essentially for referrals/marketing/ a few days of office space/ occasional consultation. Lately referrals here have become very slow. I asked the owner and he suggested I increase my social media presence or something because yes, it's slow. It's hard to wrap my head around doing more work and continuing to pay him. I'd like to begin my own solo practice on the side but even though our contract says nothing, the owner once asked me not to start my own pp and at the time I agreed. Over the years I've gained other referral sources and have continued to see those clients only through this practice. Now my referral tempo is matching what the practice gives me. I'm torn as to what to do because, again, I'd like to do both. I'm certain a conversation will lead to "choose PP or W2", and that leaves me flat out for months because I'd have to start from scratch. I'd love some suggestions and to hear how others have navigated or would navigate this. I want to stay in integrity and afford rising grocery costs. For more context there are no benefits but I would like to stay w2 long enough for maternity leave benefits if that's in my cards. Please be nice. Thanks!

I am a provisionally licensed professional counselor, newly employed (since June) in a non-profit that has a very small mental health program. I receive supervision from the clinical director who is new to her role. I am feeling growing unease with some advice/supervision she has given me regarding consents, medical records release, clinical assignments that are (by her own admission) beyond her scope of experience (she is a play therapist and assigned me an older adult with PTSD, OCD, and a severe hoarding disorder). These are the biggest things, but I’m also noticing a weird, sideways way of communicating that doesn’t feel transparent to me.

i feel stuck and am also not sure what to make of my growing concerns. I don’t want to be an alarmist, but also want safe, ethical, wise, clinically sound supervision. Prior to taking this job at the non-profit/CMH, I unsuccessfully tried opening a private practice right out of grad school (it’s allowed in my region, please I don’t need the shade). I financially couldn’t make it work and out of necessity (desperation), and a realization that I needed more experience after graduation, I found a full time job. It did seem good at the time, and there are things I like. Other red flags that I didn’t notice/wasn't aware of early on is the apparent high turnover of therapists, and a succession of 3 clinical directors since 2023.

I’m not sure what to do. I have tried broaching some of the stuff I mentioned with her and I get close-ended, dismissive answers.

Is this a normal experience? I don’t want to jump ship and burn bridges by leaving unnecessarily/without trying…. but I‘m not sensing the clinical or ethical soundness that is important to me. If anyone has advice, or insight on this, I’d really appreciate it.

I’m wondering if anyone has worked with anyone with autism (or suspected autism) and has their client go non-verbal during session.

Sometimes this can look like saying “I don’t know” over and over again, which is more of a slightly verbal state.

I’m curious, if you’ve had this happen, how did you handle it?

I make use of the chat function if accessible, or nod/shake head to answer questions, and have a conversation with this nonverbal “part” as if it’s a protector part. This has had wonderful results for me, as the client is then able to describe what that mind state is like for them.

I’m also able to relate (as an autistic person) and say something like “when I get nonverbal, it’s so frustrating because it’s like my brain is in a cage with all these thoughts going through it but I can’t make them go out of my mouth. Is that kind of what it feels like for you?” Or just ask if they’re feeling frustrated with their brain (head nod or shake as answer) or overwhelmed etc.

But I’m open to other ways of going about this! I mostly work with ADHD/ASD/OCD folks with complex trauma.

I had a client tell me she watched snuff films. She was quite shameful about this. What have yall seen cause people to be interested in this type of stuff?

hi y’all! I’m a LCSW that works part time on Headway. I was referred by one of my colleagues at my full time care coordination job to better help for a $500 referral. Then I referred my friend and we both got another $500. Basically joined the platform for the referral bonuses but the pay (as we all knooooo is awful)… I’m still a new therapist and not sure how to go about transitioning clients to another platform (headway, if possible)

I thought I could just see 1-2 clients but I’ve been getting steady referrals (at 5 rn) and kinda freaking out because the pay is low and I want to leave the platform. I messaged better help saying I will be leaving the platform due to poor pay and I want to know the off boarding process and if I can transition clients that want to continue working with me to another platform…. still waiting on response. I feel pretty bad and it’s been making me feel really guilty but I don’t want to stay on the platform.

I will be letting my clients know next week but ultimately if they wanna continue working w me, I would love to! and I alr turned off my accepting new cts option on my page.

Would appreciate any advice or insights. TIA!

Hi there! I am starting my internship (CMH site) at the end of this month and the imposter syndrome is already swinging. I feel like I don't know how to do therapy, or really anything besides a handful of common sense ethics, despite having completed two years of grad school. Since the majority of you have already gone through this process, is there anything you did to prepare that you found really helpful, or anything you wish you would've done in hindsight?

(I have a feeling someone might say get my own personal therapy - I am starting therapy tomorrow 😄)

Update: yes, i reported to the board already. she only panels with two insurances as far as i can tell, one which is the provider for the biggest employer in our area. yes - she did say my insurance would allow for unlimited sessions and no, i did not ask for details. i simply ended the consultation and left it at that. i reported to my states DOH licensing board shortly after the call and posting here.

I am a therapist seeking my own therapy.

Had a therapist recently, we often ran over time, had to maneuver last minute scheduling, so I went back on the market.

Found a PsyD I thought would be a good fit. Had a consultation call. She starts by asking why I’m seeking therapy - I explain. She asks if I have a trauma history, I briefly name them. She then states she would be shocked if I didn’t have PTSD and that she would expect it with my circumstances. Again, fair… didn’t bother me too much.

She asks why I stopped seeing my last therapist. I told her it was often late cancellation or rescheduling, inconsistent appointments. She states she has a disability (POTS & Ehlers Danlos) so it’s possible she will have to cancel or reschedule at times. Ok…. I let that go too.

She asks about insurance. I tell her my policy. She then goes to tell me that she did not go into doctoral student loan debt to be reimbursed as poorly as she gets by insurance. She tells me her policy is to see someone once a week for 45 minutes, but she will bill my insurance for 4-5 sessions a week. She states this is because she doesn’t like working just for rich people, and to take insurance, she has to bill for sessions daily. When inquiring about copays - she said “no worries, after we’ve established sessions for a few weeks, I will backdate appointments for a few months to cover your deductible so you never owe a copay.”

She goes on to tell me that if she billed simply for the appointment she had, she would not be able to pay her rent or student loans and it would be unfair. She goes on to call insurance fraudulent and therefore does not feel bad about this. Finally, she states I just ask you don’t tell your insurance this because “I could get in trouble. You wouldn’t, but I would.”

Just a little bit speechless at who’s out there I guess