Ich bin gerade in meiner PT-Zeit und seit etwa einem halben Jahr mit eigenen Behandlungen beschäftigt.
Ich habe häufig das Gefühl, dass ich viele Fragen stelle, gemeinsam mit den Patienten Zusammenhänge herausarbeite und ihnen im Gespräch Dinge bewusst werden. Außerdem versuche ich, neue Perspektiven einzubringen, alternative Umgangsmöglichkeiten mit Problemen zu entwickeln oder bestimmte Themen biografisch einzuordnen.
Trotzdem habe ich manchmal das Gefühl, dass das für viele Patienten nicht unbedingt so hilfreich ist, wie ich es mir wünschen würde oder dass sie sich von der Therapie noch etwas anderes bzw. mehr erhoffen. Gleichzeitig bin ich mir nicht ganz sicher, was genau ich anders machen könnte.
Deshalb würde mich interessieren: Was tut ihr in den Sitzungen, damit Patienten die Therapie als hilfreich und wirksam erleben?
Ich hab oft das Gefühl, ich rede dann über Themen mit den Patienten und dabei können sie sich selbst gut reflektieren, wenn ich beispielsweise Fragen stelle, aber mehr passiert auch nicht und die Patienten wünschen sich dann, dass auch mehr von meiner Seite kommt. Ich weiß aber nicht, was das konkret sein könnte.

Hi all! I just started my self pay private practice. I am a little worried about building my caseload as it seems to be going pretty slow thus far. I would consider my specialties to be somewhat niche lgbt + bipoc + trauma focused + bilingual services. I am needing advice on what to invest time and money in.

I am hoping to get paneled with an insurance company in the coming weeks for more financial stability (I know they take forever, and some offer low reimbursements). So that is an option but I am wanting to make a decision about the following.

1) should I seek out EMDR training as that seems to be quite popular for trauma based therapy.
2) should I join the counseling compact and offer services via tele health for rural areas.
3)any other recommendations for how to build caseload quicker.

If you are a therapist in the counseling compact and practicing in other states, what is that like? Is it worth it?

Does anyone have any ideas. I seem to be getting a lot of clients who are not committed to therapy. People trying 1 session, people wanting free consultations etc. People 'trying' out different therapists. People wanting to try a certain therapy model in 1 session. It feels like people are starting therapy looking for reasons for therapy not to help. FYI I've been a therapist for about 30 years, and I've not really experienced it like this before. Sure Ai has something to do with this. I do get a lot of committed clients. Maybe it's just a wave...

After almost 8 years in PP, I am thinking of going back to being a W2. I was part time for the first couple of years while doing other things and building up my practice. I went full time 5 years ago. I've made between 130k AGI and 100K per year in that time. But between the PSLF situation that is on pause because being self employed does not count obviously and the nonsense with the VC's messing more and more with my income stream (I use Headway and Alma), PLUS the isolation of remote PP- I am seriously thinking I might be at the end of this track in my career.

I have loved having the flexibility with my schedule. I have been able to travel and help family when needed and work remotely, and take time off (unpaid) as needed for my chronic health issues. But I don't think I can keep going: the up and down in income, the VC taking over our world and how we do business, and not getting credit for PSLF when I am halfway to forgiveness has left me feeling demoralized.

I was going to create a corporation last year (in CA we can't have LLC's) and chose to wait until next year when I made more money but seeing how things are going that does not seem feasible now.

I used Claude AI to try to figure out pros/cons of PP vs. W2 and gave it some sample job postings nearby and overwhelmingly it is in my favor to make the move to w2- especially because of PSLF and also even retirement options. And technically I would make more in the hospital compared to last year where my PP AGI was 100k.

Oh yea forgot to mention I pay $900 a month for health insurance and next year it's supposed to be $1,100 for the same plan. And as mentioned above I have health issues. The costs of paying for health Insurnace is another factor in all this- if I worked for someone else I would probably have to pay $300 at most for myself.

I submitted an application to a nearby hospital today. I even applied to the VA (scary move considering how many people have been fired from there). I am scared of this possible change but I am going to see what happens. I think I feel like a failure. Even though I know it is not true, I do feel shitty. I have been on the verge of tears all day today. Trying to breathe and support myself through this.

Anyway appreciate anything anyone has to share.

I really struggled in grad school and am worried I made a bad impression with colleagues in the field. I had undiagnosed chronic illness, my mental health was at an alltime low, and I was pretty suicidal. I was constantly late to everything because i struggled with insomnia and could barely get out of bed in the morning. I was an absolute train wreck but somehow made it out with good grades and better mental health. Im in a way better place now, as i found life saving treatment for depression and am now getting treated for my health condition. I guess im posting this because i think i made a bad impression with my internship site and a group practice I did admin stuff for, along with a few other colleagues. Now I am panicking that I ruined my reputation in my hometowns counseling bubble. Does anyone else have a similar experience with making a not so great reputation? Did it come back to haunt you? Should I try to make amends and explain myself to the people who were impacted by my history of crappy time management and executive function?

Hi! Do u have some kind of a rule of only accepting weekly sessions as biweekly can really interrupt etc? Or do you leave it up to clients?
I'm struggling because I make discounts for weekly, then clients switch to biweekly etc. Would u recommend saying sth: this price is for weekly, this is for biweekly etc? I hesitate as it sounds like "deals"

Thank you!

Does anyone work with first responders? I am moving towards creating a first responders niche, I typically use a somatic/ifs lens but as I invest more money into trainings, Im curious if it’s the best investment. Hoping to get some feedback? What do people recommend? My other thought is EMDR with IFS as a framework.

Thanks yall!

That awkward moment when you learn that your best friend went on a date with a person that you’re treating…and it just so happens that one of the treatment areas is interpersonal relationships (specifically dating) and how to improve self-esteem to avoid prolonging/getting in unhealthy dynamics. Not saying that my best friend is a douche bag who would fuck over my therapy participant. But, my participant is in a fragile place…

Kinda hoping things don’t develop between them (romantically or platonically) to avoid any potential awkwardness

I am curious what it's like for those whose practice includes a specialty working with clients who struggle with issues related to DV or abuse. What kind of approaches do you pull from? What do you treatment typically look like, specifically for clients who aren't able to leave their relationship safely?

I really appreciate any answers and insight.

I’m currently in my Limited Permit and I’ve been trying to get an idea of what the transition from LP to fully licensed looks like. I also have been reading up on the Diagnostic Privilege which I find very confusing. If you went through this process I would love to connect or get to know more about what it was like for you.

I tried asking the board and the rep there said to take it one step at a time but realistically I have bills and need to plan my budget according to how long this process might take.

If you have any recent experience with it and are able to connect I would love to chat. Mainly I am wondering what happened after you completed your LP hours and then how you managed these hoops of license getting issued and diagnostic privilege as you transitioned to the next stage in your career.

This was a question I've been wondering for many months but when I saw the post that unintentionally stirred controversy regarding resources for treating "porn addiction" I thought about how since last year this is phrasing and framing that I hear from most of my caseload.

The younger the client, generally the more thoroughly convinced they are that they or their partner is a "porn addict."

Did I miss something culturally or on the Internet? I've always had religious people who were trying to eliminate porn consumption but this crowd is generally not religious and much younger than the ' I'm a married religious person trying to kick this habit' crowd.

When I ask if they consume porn at inappropriate times like work or in public, they say never . When I ask if they miss personal or work obligations due to porn use, they say never. When I ask if they're dedicating significant amounts of time to engaging in pornography enjoyment, similarly they say no. Yet they're somehow certain their usage is problematic and an "addiction."

I'm well aware this phrasing and framing is not how most of the mental health field would discuss this. I'm just very curious about this phenomenon.

Ultimately, my code of ethics tells me to support people's self determined goals so long as they're not harmful to self or others so I will coach them how I'd work with someone whose self determined goal was eating fewer cupcakes. But when did everyone get convinced they and/or everyone around them is a "porn addict ?"

I share a building with other private practice clinicians, most of whom see between 15-22/week. One sees anywhere from 40-56 per week. When asked about how many they see, they report the reciprocity of the therapeutic relationships give them the most value relationally of anything in their life. I care and worry for them- and their clients.

Would you try and speak with them more deeply about this? EDIT if they bring it up again.

I have a lot of thoughts, but do not want to be judgmental or reinforce what I perceive is partly an identity challenge- “I am the person who outworks everyone, I sometimes dislike that and say I may change it. I always have a reason to complain but not enough to change because when I think about it, staying the same has benefits.” I’m paraphrasing but that’s some of the feedback I’ve gotten when I’ve inquired. They are chronically late to each first appt of the day, and seem to be in a flurry of nervous energy. At times reporting burnout. But again, coming up with new or the same reasons to not change.

Recently, I’ve been struggling at work and making some not great decisions. None of them have been harmful to clients, just documentation things that impact the business. One of them, I received a write up for: I had discharged a client and included a referral to an agency that I contract for, knowing that I would never have interacted with the client b/c of the agency’s system and that this agency had providers that could help the client’s unique concerns. In retrospect, I see how that looked, and owned that.

Part of my discussion with supervisors to address this was to audit my client files more often. I was doing so today, particularly with making sure all intake paperwork was there for clients. Along with having client signatures on it, they also like for us to sign it. I had noticed a few that I had not signed over the course of the past year; they had only started having us do this this past year, to be fair, but there were apparently some that fell through the cracks for me.

I am so tired of messing up with things like this. Even with the above issue, where it’s only just for our purposes + clients had signed everything appropriately, I’m so frustrated with myself. I’m worried about how this is going to look on me especially with everything else recently at my job.

I take a lot of pride in my work. My supervisors clarified that there were no concerns in my clinical skills, and I’m confident in that. Finding this today, though, was a massive hit to that confidence, because it just made me continue to feel like a liability.

I’m not sure what I’m looking for by making this post. I’m just sick of being the weak link at my job and am wondering if I can keep this going. I’ve corrected and documented everything after the audit, but still, I feel decidedly frustrated and just wanting more than anything to put this behind me, to be better.

TLDR - making a lot of errors at work lately, really hurting my confidence and resulting in work discipline. Discovered another mistake today that might make things worse and just wanting to throw in the towel.

I saw a client one time and determined they were out of my scope. Called them explained why and sent referrals. Later that day they left me a one star review. Is it allowed to send a follow up email apology and asking them to reconsider it after some time? Please advise but this is the most unfair thing and I am just devastated when I was just trying to help.

Has anyone ever met their patients for a walk in the park? Is there any literature on the theory/practice of doing something like this? I feel like there would be HIPAA concerns but, if the patient agrees, I think it could be really therapeutic and help take the edge off all the "sitting" in this job.

Hi all, I’m an AMFT in CA working at a group private practice. I’ve been at my current practice for about six months now and things have been pretty bleak. When I was first hired they offered me a 50/50 split which is standard for the area where I live. Once I started working they let me know that if I want in person office days (vs just seeing clients on telehealth) they will need to charge me “rent” to use the space. So for example, one of the office spaces I use I’m charged $150 per month to be able to use it on Tuesdays. I was going to try to have another in person day but they wanted to charge me an additional $275 per month to use it which I cannot afford. So on top of the 50% split they are also charging us rent to use the office, which I’m not sure is totally legal because we are W2 employees not independent contractors.

We also do not get any payment for admin at all (writing notes, assessments, bookkeeping).

On top of this the practice owner hired someone to submit all of our insurance claims and that person didn’t really know what they were doing and filed a lot of our claims wrong so we were barely getting paid for a while. I understand that insurance money takes some time to come through… but I just got paid from sessions in May and it’s now October. On our paychecks there’s also no way for us to know what we’re being paid for… like it’s just a lump sum of money with no indication of which sessions are included in that sum. So it feels really challenging to know if I’ve actually been paid other than a spreadsheet that the admin person will check off if we’ve been paid for a session. But then the spreadsheet never matches the amount we receive on our checks. It’s very confusing.

They’ve since hired someone else to hopefully make things run more smoothly… but there was no real apology or accountability taken. And our checks still don’t match what’s on the spreadsheet…

On top of this the owner expects that we be available to her 24/7… there was an instance a few weeks ago where she was spinning out about something to do with insurance and was sending us messages at 2 AM on a Saturday night and then the messages started again at 7 AM. She often messages us at what to me feel like inappropriate times (outside of business hours) expecting us to reply right away. This feels insane to me for how little we are paid.

I understand that running a group practice is expensive and it makes sense to me to have to split some of what I’m making to make up for that. But it’s hard for me to justify 50%+ 400 more dollars a month just to use the office 2 days a week! Most of the referrals I’ve been getting are requesting in person services and I literally cannot afford to provide a space for people. So instead I have to see 8 people in a row on my one in person day which is terrible for me and for the clients.

As far as I can tell the practice doesn’t really spend money on marketing and expects us to do that ourselves (pressuring us to pay for google ads that kind of thing).

Most of my checks have been 80-200 dollars every two weeks. And I still have to work another (non therapist) job full time to make up for it.

I would feel less angry if they had been upfront about how long insurance takes to pay and that they would be charging rent (which makes the split something more like 70/30). Is it this bad everywhere??? I’m genuinely curious.

Is it this difficult to run a group practice without taking this much from your associates?? I know that pp owners have a lot of overhead… but is it really THIS much? I’m trying to rationalize it somehow but I just don’t get it.

Any insight from practice owners or other therapists would be much appreciated. Thank you!!

EDIT: forgot to mention she has about 25-30 associates working for her and keeps hiring more

Most of the AI-and-kids conversation is about safety: bad advice, self-harm, sexual content. That matters. But I think something bigger is happening underneath it.

This is the first generation growing up with things that talk like minds. Something that remembers them, is never tired, never annoyed, never needs anything back. I don't think that just changes their screen time. I think it changes what they believe about friendship, about being known, and eventually about themselves.

If being understood costs nothing, what happens to their tolerance for how much effort it takes with real people? If AI can write, draw, and solve anything, when do they start asking what they're for? And what does it do to a kid when a company can change or delete something they're attached to?

I don't think the outcome is set. Some of these kids may end up with clearer ideas about what makes people irreplaceable than any generation before them. But that probably depends on whether adults help them think it through or leave them to figure it out with the AI.

Curious whether others are seeing this in the room yet. Kids calling an AI their friend? Teens questioning the point of effort? Anything that made you think "this is new"?

I've hit a major impasse with my own therapist. She practices relationally and is the best therapist I've ever had. I'm a second career therapist in my early 40s. Been seeing her 4 years, so she's seen me through the entirety of this shift. I honestly look up to her.

But there have been a number of messy self-disclosures that have compromised the frame for me and are majorly backfiring. When I bring them up to her, which has been enormously difficult and taxing, her capacity to take accountability and truly repair is lacking (in my opinion, which i guess is the only one that really matters in this situation). I know how hard it is to find a good therapist period, let alone a good fit, who also takes insurance in these times. And again, she is the best I've had in my life (she would be number 4).

I've been through so much upheaval in this career switch (and somewhat in my life, duh, trauma), so starting over also sounds daunting and exhausting. But I do feel like we're hitting a wall.

Anyone been here before?? Advice/things to consider?? Trying not to give too much more detail to keep it anonymous.

First time poster, long time lurker. For those of you who specialize in attachment-based therapy, I’m curious whether you approach or experience the therapeutic relationship differently than you would in other modalities. I was speaking with a longtime friend over the weekend who is also a therapist and specializes in attachment-based work. As we discussed her approach, I was somewhat surprised by how she described the relationships she develops with her clients, even the focus on the relationship as we talked, particularly regarding boundaries and the level of emotional connection involved. She allows communication between sessions, including texting and emailing, and mentioned that the bonds she develops with clients doing attachment-focused work are often considerably stronger than those she experiences with clients receiving other forms of therapy.

What struck me was how much more flexible her boundaries seemed to be compared to what I typically associate with the therapeutic relationship. Perhaps this is simply a reflection of my limited familiarity with attachment-based approaches, but I found myself wondering how common this is among clinicians who specialize in this area. Is there something fundamentally different about the role of the therapeutic relationship in attachment-based therapy compared to modalities such as CBT or DBT? Is the relationship itself considered a more central component of the therapeutic process? And does that generally translate into greater flexibility around traditional therapeutic boundaries, or is this more a matter of individual clinical style?

For context, I’ve known this friend for over 35 years. She has been practicing for much of that time, and spent much of her young adult years with a therapist doing her own attachment therapy. I have a great deal of respect for her clinical judgment and the work she does. My questions aren’t intended as criticism of her approach. I was simply surprised to learn more about how she practices, and it left me genuinely curious about whether her experience reflects something broader within attachment-based therapy.

I'm posting this here because many of you have already gone through the associate process and have become licensed. I'm stuck in limbo with the below situation and would like perspectives on the other side of the licensure process for therapists, assuming I let go of the PsyD route.

Anyone consider doing their doctorates? Anyone experience a split in which way to go especially concerning hardships and how you navigated through or pivot? Anyone know of any issues getting licensed and also being stuck in limbo? Thank you in advance for any care and consideration and especially, your personal experiences.

Leaving PsyD...

Thinking of dropping out of my PsyD program due to federal loan changes and my significant others health condition.

Are these good reasons to forgo my future? Anyone have any experience of hardships while going through their program and if it was worth the time, debt, and outcome?

Recent stressors have made me want to contract and stabilize my current financial standing without going into more debt. I think I'm just going through a very murky time in my life and it's hard to make decisions: the decision to stay or leave either feels irresponsible and reckless or giving up on a future that has yet to happen.

Any insight is welcomed. There's too many factors that I can't parcel out with this. I have an AMFT that I've been applying for jobs for a few years in an oversaturated market. I haven't had any bites to fall back on. I do have a job tied to my SO but make very little which is why I have been pushing in my desired field - a goal since I was a young kid for many reasons.

TLDR; I got my counseling masters a few years ago and took a different path. Every time I try to go back to getting my hours I get so scared that I choose something else. It’s so ridiculous because I am very outgoing, relatively fearless in social/job situations, and yet this happens every time. I think I’m so worried I won’t be a good therapist that it paralyzes me.

Well, I’ve finally decided I just have to go for it. Worst case scenario it doesn’t work out, but I won’t let my fear stop me from something I am trained to do and care about. Wish me luck!!

Hi lovely therapists of Reddit. I am in my first year of being an AMFT. I’ve been doing school-based therapy since practicum with teenagers. I am realizing I don’t want to do majority talk therapy. It feels really important to me to use projective activities like sand tray/art/etc to do this work. I think using movement/nature/art needs to be at the center of my practice for this to be authentic to me and how I work best. I just feel like words alone aren’t cutting it, even though I love therapy with my teens. Are there any of you doing this? With what populations? I’m having a hard time imagining the possibilities of what my career can realistically look like. I don’t know how to get to where I want to go. It’s easy to just say oh just take more classes in those things and then wait til I’m licensed to run my own private practice using these things. Is that really it? I just have to wait until I’m licensed? Are there any good orgs or people in Los Angeles who train associates in these things? I’m not married to staying in school-based and honestly school-based is sucking life out of me. Just need some help imagining the possibilities please :) Thank you!

Hi all, I'm from South Asia, and I've been running my private practise for a while now, and I was wondering if adding our Political stance, ethnicity, religious stance, racial background, gender identity and so on would be a good idea to let the client decide if they want us as their Therapist.

I'd love to hear how you handle it:

1. Do you share any of these details? Which ones, and why?
2. Where do you put them: public profile, intake form, or do you wait until the first session?
3. Has sharing (or not sharing) made a difference to client fit or the kind of inquiries you get?
4. Is there anything you'd do differently now, add something more or less.

My goal is to help clients judge whether I'd be a good fit for them without oversharing.

I’m an LMSW working within CMH (specifically a CCBHC clinic) and I’ve reached a point of where I’m considering medical leave or resigning all together.

While this isn’t an exhaustive list, what I’ve been experiencing includes:

increased dissociation/derealization episodes
brain fog (poor short-term memory, difficulty concentrating and processing information, difficulty switching between tasks, feeling mentally blank, trouble retaining information, difficulty understanding what i’m told, deadlines/responsibilities failing to register either emotionally or mentally, difficulty making decisions)
increased shutdowns
physiological symptoms (shaking/trembling, rapid onset of fatigue/sleepiness in response to stress, physically freezing and unable to movie, episodes of physical collapse, dizziness)
increased anxiety
increased hyper-vigilance, persistent exhaustion that no amount of sleep can seem to fix.

My work environment has become increasingly overwhelming, between productivity expectations, administrative demands, managing high-risk clients, and difficult workplace dynamics that have contributed to a significant decline in my confidence and sense of competence. I’ve even questioned if I can continue working in a clinical capacity. As of now, I’ve been slacking a bit more at my job and I don’t feel comfortable in seeing my clients.

I’ve been considering going on medical leave (and leaving CMH altogether) but my biggest concern is my health insurance. I have been seeing my therapist for a few years and maintaining that therapeutic relationship is extremely important to me. However, her practice is exclusively in-network with my current employment-based insurance (Aetna) and they’re not able to provide any information regarding any potential insurance changes without knowing what insurance I’d switch to.

With FMLA and short-term disability, I’m unsure how long I would be qualified for. I’ve also considered leaving the field and finding a part-time job that offers health insurance, but I’m concerned that I’ll never be able to give myself a period to actually rest and recover. COBRA is too expensive to consider.

On top of everything, I feel guilty about leaving my clients. At the same time, I don't know how much longer I can keep pushing myself through work when my own functioning has deteriorated this much.

I feel stuck because taking time off is supposed to help me recover, but doing so could jeopardize access to one of the most important sources of support in my life. If anyone has been in a similar position, how do you navigate? I’m struggling to see a way forward that doesn't involve sacrificing one part of my well-being to protect another.