( edited to add, this isn’t a real person, so much as a collection of a few scenarios )

Does it even matter the cause? It’s likely all three, but Im finding an increasing number of young adults who would prefer to just gripe about life and sit in the basement On their phones and their parents have no wish to make their child uncomfortable.

I lost my patience a little this week and blurted out to an older teen that life is hard, and uncomfortable and there’s always things that adults don’t want to do.

I know PDA has such an internal struggle, so wondering what strategies you might use when someone literally says “No” to every suggestion or solution focussed strategy. It’s all gotten so much worse since the pandemic.

I signed the updated Headway provider agreement before the rollout was paused. I emailed my representative to clarify whether the agreement was still binding given the CEO's decision to pause the rollout the following pushback. They said the previous agreement currently applies until further notice, that providers will have an opportunity to review and sign a revised agreement, and that I should contact their legal team with any further questions.

First off, I know I shouldn't have signed without doing more research, and I'm really kicking myself about it. It was a busy day, and I went into ADHD mode trying to check something off my to-do list without thinking it through. I'm learning a hard lesson and will be taking future agreements to my lawyer before signing, so please be kind!

I'm now wanting to leave Headway, but I'm concerned about potential contractual restrictions around continuing to see my existing clients independently.

I'd appreciate constructive advice on how to navigate leaving while protecting both my practice and my clients. I'm relatively new to Headway, have only a few clients through them, and am paneled elsewhere. I don't plan to take on any additional clients through the platform.

Thank you.

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...

I am about to sign up as an "independent" provider (PMHNP-BC) with this company, and I want to know whether it is worth it. Does anyone else work for this company as a prescriber? If so, how do you like it? The pay is already a turnoff, so I'm not completely sure.

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.

Hi there, looking for a bit of advice on integrative psychotherapy. Have been working as a therapist (psychologist) for about 5 years now and have learned a lot from a lot of different psychotherapies (through training, reading, supervision and my own personal therapy). These include EMDR, ACT, MI, IFS, Schema, CBT, Narrative, person centered.... the list goes on. It feels a bit like dating, I flirt with one, then get the ick when I discover some big flaw and move on to the next shiny thing that shows promise of being "the one" therapy I will love forever, then the cycle repeats. I just can't seem to settle, leaving me unsatisfied without a therapeutic "tribe", but with options open.

So I call myself an "integrative" therapist but don't really have a framework in which to integrate with. I'm sort of just pulling together ideas from different modalities while using person-centered style counseling at the core. I'm always case conceptualizing and bringing in these interventions with intention, but it does feel pretty "vibes" based at times, which doesn't sit well with my perfectionist brain. I have been looking in to Process Based Therapy as a way to structure my work a bit more, but then is this just the next "shiny thing" that will be ultimately unsatisfying, probably...

I'm tired of buying and half-ready text books. I like learning about new modalities but it often feels like my knowledge is a mile wide and an inch deep because I can't commit. I feel like what speaks to be most is just straight up person-centered counseling (I am a big believer in common factors theory), but I am struggling to devote time to it as there is always at the back of my head "but what about XYZ therapy?".

My question is if there are any therapist out there that share this experience, can you please come forward and tell me how you're working through this process or how you have come to terms with it? Is it just about accepting yourself as a generalist, or did you find a way to pick and commit to a therapy and if so, how did you do that? Or some other option I haven't even considered!

Over the last 2 days, I’ve had two intakes ask me to fill out their short term disability and/or FMLA paperwork. One wanted me to fill it out by Monday (asked on Thursday, posting this Friday) because that was his original return to work date. I declined and stated I would ask my supervisor for protocol. The other intake stated her PCP told her I would do it. I have never met either before.
My supervisor stated that I would need to refer to a higher level of care, and that I shouldn’t feel pressured to fill out paperwork.
Ive never had to fill out this paperwork before, so I’m nervous about it no matter what. My last place of employment had a policy that only the medication providers can fill it out, but there’s no strict policy at my new place.
What are your policies for paperwork? I’ve stayed I could provide therapy notes and treatment plan, as well as progress letters later on.
I’m an LPC-MHSP for reference

ive been thinking about designing some fun and creative materials for self reflection activities and journal prompts. but im not really sure of where to or how to sell it. any thoughts and suggestions?

I just started The Patient on Hulu and I’m interested in what you guys think.

How would you react in comparison to the therapist in this show? Different, similar, etc. and what theories do you guys consider in this “case?”

I’m seeing a lot of mixed things about working at LifeStance Health as a therapist- a lot of negative, but also people saying that it’s gotten better in the past year or so, and I’m curious what others’ experiences have been working there. Are you able to keep a full caseload, even during slower times of the year like summer, and is there a problem with no-shows or late cancellations? I’m worried about not making my goal salary of at least 75k per year. My understanding is the requirements for number of clients used to be different, for example seeing at least 30 clients whereas now it’s 27 for full-time. Please let me know your experiences, especially Wisconsin people!!

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

Hi all - I had mentioned in a previous post that I'm happy to review psych today profiles. I'm sure I'll regret this but feel free to DM me and I can give feedback.

I've been in the field for over 13+ years in a niche in my own pp and have a 6+ month wait list and had this consistently. Many people helped me to get to where I am so in my home state in the Midwest so I mentor those who are new to pp and help them tweak their marketing free of charge as a way to give back and pay it forward.

As therapists there's plenty of work to go around and I always am happy to support fellow therapists and earn that good karma.

Edit - I'm making my way thru the profiles and am on central time so bear with me as I get thru them all!

Okay, I had a little breakthrough today and wanted to share! 💛 I've been feeling pretty down about the amount of student loan debt I racked up between undergrad and grad school. It’s a heavy situation. But today, after taking a moment to ground myself and reflect, something clicked and it totally shifted my mindset to a much healthier mindset! I'm not going to view my debt as a mistake or a burden anymore. I'm choosing gratitude instead. Back when I was in school, there weren't these strict caps on student loans, so I was able to get the exact degrees I wanted. And honestly? I'm thankful for that. I’m thankful that I leveraged the system to get what I wanted. Everything has gotten so much more expensive since then, and getting a degree isn't going to be as doable for people now as it was for me. Present and future students are not going to have it as good as we did and sadly, some won’t be able to complete their degrees without the cash to do so. Even after all these years, there's no other career I wish I'd chosen. I love being a therapist, and every dollar I earn comes from doing it. Some people are stuck paying off loans for degrees they never even finished, so I really do feel lucky. So here's my plan: I'm going to use the tools available to me, like IDR, to work on paying it off, and I'm going to stay thankful that I get to do what I love every single day, because this is what I'll be doing for the rest of my life anyways! So remember, your student loans are just a very expensive receipt for a career you (hopefully) love ( LCSW, LPC, LPCC, LCPC, LMHC, LMFT, LADC, LCDC, LMSW, PhD, PsyD, MD, DO, PMHNP) Frame it. Cry a little. Be grateful ✨

For therapists who use worksheets - do you tend to do them in session with patients or give them for homework? If you give them for homework, do they get done. Historically I haven't used many worksheets, but I am finding that some patients really benefit from seeing it in writing v hearing in session. The content seems to have more recall.

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.

mostly kidding

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.

Any recommendations would be much appreciated. Thank you

Be careful who you trust with your clients’ most vulnerable stories.

Make sure it’s not a company with deceptive practices and dishonest marketing. Ultimately you are the liable Covered Entity in the eyes of HIPAA and they might have made sure you consented to “the exclusive jurisdiction of the competent courts of Tel Aviv-Jaffa, Israel” for any disputes.

I think this program is set to destroy small and medium private practice and CMH. My opinion is that this will led to low-moderate risk clients being funneled into AI based platforms that are accepting the proposed $7.50 monthly per active client. This will lead to a reduction in CMS payouts and a loss of clinical options for clients. Major insurance companies will follow, dropping rates, creating their own AI platforms, and slashing the number of providers in their network.

I haven't seen anyone post about this so maybe I am missing something here but this looks extremely ominous for the mental health private practice 5 year outlook. I wouldn't be suprised if we start seeing the effects of this with in the next year or two. If you have details please chime in.

I’m a pre-licensed therapist (LPC) in the Chicago area and could use some perspective.
Job A (signed): Private practice group, Therapist I, W-2 but paid per session: $45 per completed full session. It’s 150$ per session I’m getting $45. It’s about $34 for a 38-52 min session, $22.50 for 16-37 min). Minimum 20 patient hours a week and 30 hours recorded. Cancellations are paid at 50% of the no-show fee, and only if it’s collected. No guaranteed minimum while building a caseload. Evening or weekend availability is required. Benefits start after 30 days. A friend there is 4 months in and still short of his caseload quota, struggling financially.
Job B (offered a few hours after I signed A): Community mental health agency, W-2, $36/hr for 32 hrs/week (M-Th, 9-5). Paid for all scheduled hours, including cancellations, documentation, and meetings. No current productivity minimum, though HR said expectations could increase. Benefits start after 60 days; I’m still confirming details.
I’ve never worked in community mental health and I’m interested in the experience. By my math, Job B pays about $59,900/year guaranteed. Job A would be around $33k-$50k my first year depending on how fast I build a caseload, and would only match B at roughly 26 completed sessions a week.
My questions:
For those who’ve done community MH, is there anything I should watch out for? (Productivity creep, burnout, supervision quality, etc.)
Is it a bad look to withdraw from Job A after signing the job offer letter before my start date? The letter says at-will and non-contractual, and I’d give about 6 weeks’ notice.
Would you take B, or is there a reason to go with private practice?
Thanks in advance!

:: Informercial Voice::

Hey! Would you know anyone here studying for the MFT clinical exam? Well, I am and I desperately need assistance. 🤭

On a serious note; I didn’t pass the first time by 5 pts (ugh!) and I’m retaking it in early December.

I’ve been doing crisis work and case management for years and I think that’s actually been part of my struggle with the exam lol.

I’m so used to approaching things from that perspective and not necessarily how the exam wants an MFT to approach things. Treatment planning was my lowest area so I definitely need more practice with that.

I’m looking for maybe 1 or 2 people who would be down to meet on Zoom once or twice a week between now and early December. Mainly to go through practice questions together, especially treatment planning, discuss why we picked certain answers and talk through the ones we got wrong. I feel like actually talking through the clinical reasoning with someone else would help more than just studying by myself.

Also if there are any supervisors or LMFTs here who know of other associates preparing for the exam or who might be willing to help us work through some clinical scenarios, please let me know.

Feel free to comment or DM me if you’re interested!

Hi all. I'm a second-career student (10+ years in business) in a LMHC master's program in Massachusetts.

I'm planning my practicum and internship and would love input from people who've been through it.

Long-term goal: My own private outpatient practice.

What I'm weighing for placements:

ER or crisis triage: fast-paced crisis evaluation, risk assessment, deciding level of care. Lots of diagnostic exposure, but you see people once and rarely follow anyone over time.

PHP or IOP: structured, higher-acuity work with group and individual sessions over several weeks.

Outpatient: ongoing individual therapy, building a caseload, the closest match to private practice day to day.

Part of me thinks a higher-acuity setting would make me a sharper, safer clinician later. I'd learn assessment, risk, and what each level of care actually looks like. Another part thinks I should get as much ongoing therapy experience as possible since that's what I want to do long term.

Questions for you:
If you're in private practice now, which training setting prepared you best? What do you wish you'd had more of?

Did crisis or higher-level-of-care experience make you better in outpatient work, or was it a detour?

Has anyone had trouble getting crisis or triage hours counted as direct service for their degree or LMHC?

If you could redo your practicum and internship, what would you do differently?

Any advice for a career changer coming in older, with young kids and another on the way?
Thanks in advance.

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.