r/therapists • • 1d ago

Weekly student question thread!

5 Upvotes

Students are welcome to post any questions they have for therapists in this thread. Got a question about a theoretical orientation and how it applies in practice? Ask it here! Got a question about a particular specialty? Cool put it in a comment!

Wondering which route to take into the field of therapy? See if this document from the sidebar could help: Careers In Mental Health

Also we have a therapist/grad student only discord. Anyone who has earned their bachelor's degree and is in school working on their master's degree or has earned it, is welcome to join. Non-mental health professionals will be banned on site. :) https://discord.gg/Pc95y5g9Tz


r/therapists • • 10h ago

Weekly "vent your vibes" / Burn out

1 Upvotes

Welcome to the weekly Vent your Vibes post! Feeling burn out, struggling with compassion fatigue, work environment really sucking right now? Share your feelings here to get support.

All other posts feeling something negative or wanting to vent will be redirected here.

This is the place for you to vent and complain WITHOUT JUDGEMENT about any stressful work situations going on at work and/or how much you are feeling burnt out doing this work.

Burn out making you want to change career? Check out this infographic by one of our community members (also found in sidebar) to consider your options.

Also we have a therapist/grad student only discord. Anyone who has earned their bachelor's degree and is in school working on their master's degree or has earned it, is welcome to join. Non-mental health professionals will be banned on site. :) https://discord.gg/RdZj8tABpc


r/therapists • • 21h ago

Discussion Thread The new Elizabeth Holmes documentary is the best depiction of unexamined countertransference I've seen, and the fix in the film is basically supervision

795 Upvotes

Spoilers for You Can See Everything.

Nathan Fielder goes in openly skeptical of Elizabeth Holmes and says on camera that he thinks she committed fraud. Then he moves into her guest house for a month. He eats her food, sees her at her most vulnerable, and finds they share an awkwardness in social settings. She sends him off with "you got this," as if he's the one going to prison.

By the end he's openly sympathetic toward her. The film leaves open whether that's insight or whether he was drawn in. What gave me chills is that he never seems to notice the shift as it happens. The person who catches it is Amanda Seyfried, an outsider with no relationship to Holmes, who asks whether his reenactments are protecting her.

That's the job of supervision and consultation. Nobody has to say "you're wrong." Someone outside the relationship just has to ask the question you can't see from inside it.

I do a lot of high-conflict co-parenting and family court work, and this is the trap I watch for in myself most. The parent I spend more hours with, the one who is warmer, more articulate, or more like me, starts to feel like the credible one. Closeness feels like information. Often it's just closeness.

How do you catch your own drift before it ends up in your notes? Do you have a "Seyfried" in your consultation group?


r/therapists • • 9h ago

Meme/Humour What’s the worst part about being a therapist? (You can’t say notes)

74 Upvotes

I’m curious to see how many people have the same answer as me.


r/therapists • • 2h ago

Rant - Advice wanted How to work with with poverty/live-free-die-young mentality?

12 Upvotes

I work in community mental health, specifically with teens-young adults experiencing homelessness/at risk of homelessness/poverty as well as court mandated clients (who are often experiencing poverty as well). It’s also a very diverse population.

My big struggle here has not been as a white person counseling BIPOC. I feel the education I got as well as the general work I’ve been doing in my personal life to become more educated about issues of race leaves me feeling pretty good about my ability to work with a racially diverse population (with the knowledge I need to constantly pursue more education of course).

The part I was surprised to struggle with when entering this niche is the “live-free-die-young” mentality and the general futility clients in this population feel. There is no future thinking. Even when opportunities do arise for them (for a job, housing, getting their driver’s license/transportation access, etc.) they often let the opportunity pass by, or low distress tolerance makes them “give up” (e.g. I had a client who got a job, but the first day she wore the wrong clothes and was sent home to change. Instead of changing, she just didn’t go back, and lost the job. The thing she did instead was helping a stranger with resources she really didn’t have the means to spare.)

I grew up middle class. There were a few years (lost a biz around 2008) where my parents really struggled and relied on gift cards from their church, but they were always good at hiding the effects of that and I never even found out about it until later, so I never really knew true feelings of financial insecurity. I also always had a pretty high-achieving personality (eldest daughter, lol) and even when I began struggling severely with mental health as a teen/young adult, I pushed myself (probably too much) to “achieve.” I had dreams for the future and worked toward them even when I was severely ill/suicidal/etc.

So this “live-free-die-young” mentality is really foreign to me. This population faces so many real barriers, but there are also so many self inflicted barriers as well. I’ve also seen the “I don’t want to work” issue that leads to the “lazy” stereotypes about those in poverty, but I know it is so so much more than that. I had a client who literally said “my life has been hard enough already, I don’t want to work hard.” Which is so true…but I don’t know how to help in cases like this. I’ve been reading The Broken Ladder which has helped me put words to these phenomena, but treating clients like this is a totally different matter. There are true barriers but also a learned helplessness/lack of drive or ambition that I just cannot understand. (If you want out, take the opportunity to get out when it comes!) We also have a transitional housing/tiny home program to offer people the opportunity for housing stability while they find a job/get on their feet. Most do, but a few of them have this mindset of “I have a couple more years here, I have plenty of time, I’ll figure it out later” (our cap is 24yo). And I have clients who do get jobs who complain about the hours when they’re only working part time and I’m like…how are you going to support yourself if you quit even part time jobs in retail/service industry that are “too hard”? I hope I don’t sound like I lack empathy here. I have so much empathy for these situations/mindsets, I just have no idea what to do about it.

I am working on this in supervision, but it’s more like my supervisor and I are learning together rather than her already having experience with this. (She’s PP.) Has anyone worked with this population or lived this life and have advice? I am so often at a loss on how to help without sounding like a tone deaf pick-yourself-up-by-your-bootstraps person.

Edit: would also love resource/book/podcast recs if you have them!


r/therapists • • 18h ago

Ethics / Risk Interesting caution from online therapy provider regarding hippa compliance and smart devices

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210 Upvotes

Unplugging it isn’t enough for an a-l-e-x-a device to be hippa compliant? We have to spell Alexa in our house or it turns off the music. Strange times.


r/therapists • • 29m ago

Licensing UGH! SO CLOSE..

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• Upvotes

So upset but so happy at the same time. This was my 2nd time taking this exam. My first score was 468 and now 494. I will pass the 3rd time!


r/therapists • • 34m ago

Theory / Technique Morbid curiosity

• Upvotes

Hey everyone. I work with a lot of extreme trauma and dissociation, and something I notice in some folks is a history of morbid curiosity. Just feeling drawn to a lot of heavy topics or things like having a history of consuming disturbing media from a fairly young age. Is this something you've encountered, and how did you conceptualize this as a part of their history? How did you work with this further?

Of course, morbid curiosity is also something that probably most people experience in some way across their life. I'm tempted to think that some part of them is drawn to heavy themes because they may resonate with aspects of the content, but it feels like I could be missing something more indirect. It's often associated with some pretty unregulated internet usage from a young age. I'd also be curious to hear from those that work with children/adolescents about whether any of these things are developmentally normal or normal-ish.

Edit for clarification: I'm referring to content that is typically graphic in nature and often recreating extreme abuse that people have lived through. Torture, sexual themes, etc. (also note to mods if this isn't an appropriate topic here I understand)


r/therapists • • 26m ago

Ethics / Risk Supervision Changes - MHC-LP

• Upvotes

Hi there, I have been providing supervision to an MHC-LP for about 5 months. The supervisee requested an immediate change in supervisor and my practice granted their request. (They said it was a question of "fit.") I am listed on the paperwork as the supervisor of record until a new supervisor can be approved by the state. The practice owner asked me to sign off on hours in the interim but I refused since we are no longer meeting. I am planning to reach out to all parties to make sure there is a new supervision plan happening, and I've reached out to the state to inquire what else I need to do. The state can take a while to respond so I'm wondering if anyone else has ever been in this position? What should I be doing?


r/therapists • • 22h ago

Wins / Success Colorado Ends Twelve-Step Mandate for Parolees, Opening Door to Secular Recovery Options.

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209 Upvotes

Effective immediately, the Department of Corrections will end the twelve-step mandate, with the parole board instead referring parolees to “peer support networks,” which include secular programs such as SMART Recovery and LifeRing, instead of requiring AA, NA, or any other twelve-step program.

This is a win for the people of Colorado, client's self-determinism, the First Amendment, and our secular society!

Alcoholics Anonymous (AA) and other 12-step mutual-aid support groups have been acknowledged as "religion-based" programs (1) by numerous circuit, district, and state supreme court verdicts. Therefore, it is unlawful for a government employee or agency to coerce someone to attend AA or any other 12-step program.

"We held that the First Amendment is violated when the state coerces an individual to attend a religion-based drug or alcohol treatment program." (1) This is because the courts have found AA to be a "religion-based" program and its "meetings are intensely religious events" and its activities "must be treated as religious" (1,2,3,4). This is partly based upon the fact that "the twelve steps are based on the monotheistic idea of a single God or Supreme Being" (5).

  1. Hazle v. Crofoot, 727 F.3d 983 (9th Cir. 2013). https://casetext.com/case/hazle-v-crofoot-5
  2. Inouye v. Kemna, 504 F.3d 705 (9th Cir. 2007)
  3. Kerr v. Farrey, 95 F.3d 472 (7th Cir. 1996)
  4. Warner v. Orange County Dep’t of Prob., 115 F.3d 1068 (2d Cir. 1997)
  5. Office for Civil Rights. (n.d.). Frequently asked questions regarding twelve-step recovery programs for recipients of Justice Department financial assistance. U.S. Department of Justice, Office of Justice Programs. Retrieved from https://www.ojp.gov/sites/g/files/xyckuh241/files/media/document/twelvesteprecoveryprograms_faqs.pdf

Secular Self-help Groups

  • LifeRing
    • A secular, abstinence-based, anonymous, non-judgmental recovery group.
  • Secular Organizations for Sobriety (SOS)
  • SMART Recovery
    • Focuses on evidence-based using CBT; empowerment-based.
  • Sober Faction
    • Non-theistic sobriety through The Satanic Temple (TST); includes transgender panel and 'memento mori' focused meetings, among others.
  • Women for Sobriety (WFS)
    • Creates a safe space for women using compassion, connection, empowerment, love, respect, self-worth, and acceptance.
    • Emphasizes personal control and developing a self-identity as a competent woman rather than as "an alcoholic".

Faith-based Self-help Groups

  • Celebrate Recovery
  • Dharma Recovery
    • Buddhist-based and renunciation-based (abstinence) recovery.
  • Overcomers Outreach
    • Christian-based
  • Refuge Recovery
    • Buddhist-based

r/therapists • • 11h ago

Theory / Technique The Frame of the Psychotherapy and How Our Theoretical Knowledge Protects Us and Our Clients

19 Upvotes

I've been thinking about how therapists handle difficult emotional reactions to clients and would be interested in others' perspectives.

Clients may be angry, provocative, demanding, manipulative, sexually inappropriate, or simply difficult to be around, and our own histories and sensitivities make reactions inevitable. The question is how we use them.

I'm analytically trained, and understanding personality, defenses, transference, countertransference, and relational patterns helps me explore what's happening rather than simply taking it personally. For example, some male clients relate to women in highly sexualized ways. That can be uncomfortable but may also be important clinical material: can we help the client recognize the pattern while maintaining appropriate boundaries? At times, however, firm boundaries or termination are necessary.

What interests me is the distinction between having a reaction and letting it determine how we practice. We all have limitations and populations we may not be equipped to treat. But when does routinely taking a client's behavior personally signal a need for self-reflection rather than a reason to reject the client?

How do others distinguish between a reaction to work through, a legitimate boundary issue, and a client or population we should not treat? How much do theoretical knowledge and emotional maturity factor into that judgment?


r/therapists • • 1h ago

Employment / Workplace Advice Office with no waiting room

• Upvotes

I have a nice office space and may eventually build in a designated waiting room, but currently there is none. There is a bench by a garden on the property, but otherwise I was planning to have patients either wait there on the bench or in their cars in the parking lot and text when they arrive. I would then text them when ready or just open the door and let them know I'm ready in-person. I've heard others have good luck with this strategy. Does anybody have a similar setup? If so, how well does it work? Do you try to stagger appointment times or not? Any other suggestions?


r/therapists • • 1h ago

Licensing Free/low-cost California LMFT exam prep resources?

• Upvotes

Hi everyone! I’m currently unemployed (practice abruptly closed) and looking for the best free or very low-cost resources to study for the California LMFT exam. Paid prep courses just aren’t in the budget right now.

What helped you pass on your first try? I’d be so grateful for any free practice exams, study guides, YouTube channels, study groups, or other resources!

Poverty-line folks deserve to pass on the first try, too. 😂❤️ Thanks so much for any tips!


r/therapists • • 4h ago

Discussion Thread Does specialising really help your practice?

3 Upvotes

I heard recently someone saying that if you specialise that it increases your client intake. It seems counter intuitive but at the same time I can see some logic in it.

So what's the deal?


r/therapists • • 6m ago

Theory / Technique Trainings, Conferences, Retreats worth traveling to…

• Upvotes

Just what the title says-I’m looking for In-person trainings, conferences and retreat worth traveling to in order to expand my repertoire. 🥰

Thanks


r/therapists • • 1h ago

Billing / Finance / Insurance Anyone has experience with IFHP audit?

• Upvotes

Running a private clinic and have received audit request for IFHP clients. I had many clients as my referral networks started working so well. Feeling stuck, stressed and exhausted in collecting all the documents. Anyone has experience with IFHP audit? There are clerical mistakes. Notes were drafted on same date as session but signed late. Im spiralling. It's just not me, I feel responsible for all my staffs as well. Its livelihood of many.


r/therapists • • 1d ago

Discussion Thread What Does A Career In Mental Health Even Look Like Anymore?

83 Upvotes

With Headway and every other telehealth company up to incredibly shady and predatory business behavior, mental health programs being defunded, massive student debt, and pay being generally terrible for therapists depending on level of work experience, I'm really struggling to define what a career in mental health can look like for myself and the students that ask about being a therapist.

I haven't been a therapist for very long (only four years. Half in college mental health, half in private practice), but it seems like every year there's something new that makes it harder to be in this profession. I don't want to sound negative, but I am struggling to find something akin to career stability for the future when it feels like we as a field are getting run over with god awful policies, clawbacks, and AI creeping in like kudzu.


r/therapists • • 2h ago

Licensing Taking the CA LMCE/LMFT clinical exam - any tips?

1 Upvotes

The time has finally come! I’m almost to the other side and am so ready for associateship to be over with 😅

I’d love any tips or tricks or advice from fellow CA testers! I have the TDC study guide and have been studying quite a bit, but I’ll take anything you folks have to offer!
Thank you in advance :)


r/therapists • • 12h ago

Ethics / Risk Community overlap as a therapist with a therapist

5 Upvotes

What do you do, as a therapist, with a very similar (pretty much the same tbh) specialty/focus, as your own therapist, when you inevitably run into your therapist (or your client) at a networking event, training, etc? What about if you run into your therapist or client at other community events, or when you have multiple points of shared community overlap?


r/therapists • • 16h ago

Employment / Workplace Advice Help me succeed! Inpatient psych

8 Upvotes

I am accepting a job at an inpatient psych unit. First job out of graduate school. I want to do therapy but I think starting here is useful for me to learn diagnosis and sharpen skills to be a great therapist. The hospital is undergoing leadership change and I was told 6 months for it to straighten itself out. Should this make me nervous? Am I making a good career choice? I really need this job and CMH is not appealing to me right now and I have to get my hours in. What advice do you have to help me succeed? Should I be afraid of the nurses?


r/therapists • • 1d ago

Wins / Success How has a client expressed gratitude (or given you a compliment) this last week?

45 Upvotes

Something which was significant/ memorable for you.

Why was it poignant (arousing deep emotion, moving)

How did you respond to yourself (inside your own head/ heart)?


r/therapists • • 17h ago

Support Therapist who are moms how do you navigate your career?

6 Upvotes

I'm a FTM and my baby is currently 2 months and currently I'm a SAHM. Before having her I was working at a private practice part time and working towards a PhD. Now all of that is gone and although I am INCREDIBLY lucky and grateful I get to stay home and care for my newborn I am having such grief about not having my career and the identity I've had for the past 3 years and I don't know when I could return to practicing or continue my education. My husband works 12 hour shifts and we cannot afford a nanny or daycare at this time. Ive been trying to explore remote career options or try to figure out how I can do private practice while also caring for my newborn. I just don't see a light at the end of this tunnel and with my baby being as clingy as she is I don't see other options for my career.

For therapists who are moms and maybe had a similar experience how did you navigate your career or building up your therapist identity again? Any advice or uplifting is welcomed. TIA


r/therapists • • 18h ago

Employment / Workplace Advice Those who got licensed in multiple states

6 Upvotes

Did it actually help with bringing in more income?

I am considering more states, but wanted to weigh pros and cons before I do


r/therapists • • 18h ago

Employment / Workplace Advice How can I continue to see my Kaiser NorCal clients once I leave my W-2 position?

5 Upvotes

I am a California LMFT moving into private practice from a non-Kaiser W-2 position. Several of my Kaiser NorCal clients have asked to continue with me. I’m weighing my options. For those seeing Kaiser Permanente NorCal clients right now, which route actually works (a platform like Rula, a group practice, or is direct contracting still possible)? Thank you.


r/therapists • • 1d ago

Rant - Advice wanted Eating in CEU Zoom Call

16 Upvotes

Good morning,

I am a new clinician and currently in a CEU zoom call with about 5 other people. I am fucking starving. How inappropriate would it be if I ate a small meal while on camera? Or is it less appropriate to just turn my camera off. Let me know