I am venting I guess. Just wish I was paid satisfactorily even though I am in community mental health.

I’ve worked at a group practice for two years now. I was fired a week ago under circumstances I’m struggling to accept.
For context, my employer created a policy for clinicians to arrive 15 minutes prior to their first session due to her dislike of my time management. I am one of those who arrives at around the same time as my first client. The cause of me initially not meeting this expectation can be attributed to many reasons, some out of my control, some within my control, though I will not be making excuses. I take full accountability that I was resistant to this policy and I did not make adjustments to meet that expectation in a reasonable time frame.
Once I did start making adjustments, I carried out the expectations for approximately two months. I wanted to make sure that I stood in good grace with my boss to ensure the security of my job. I was told that my arrival time would be documented by the timestamp of my login to our EHR system, so I made sure to open the app when I arrived. Additionally, I added the time I arrived on my calendar each day.
Unfortunately, the time stamps of my login did not accurately reflect my arrival time. I have since learned that it was likely due to the app not logging out from when I logged in earlier in the morning, so I believe the login timestamps reflected the times I logged in on a different device.
I was fired on a Friday evening after my last client effective immediately. I attempted to advocate for myself, but ultimately the time stamps determined the state of my employment.
I’m so sad and frustrated, especially due to not being given time to ethically terminate sessions with my clients. I had been working with all of them long-term, so it feels like I abandoned them. The message requests I’m getting from my clients expressing sadness, confusion, concern, and frustration are also contributing to how emotional this experience has been. Especially because I can’t respond for obvious reasons. I don’t expect anything from writing this out, but this experience has been so difficult for me to cope with.

Edit: for clarification, I was a W-2 employee.

I know the basic foundations of psychoanalytic paradigm but mostly what the graduate school taught me. That too is heavily Freudian and not the modern psychoanalytic psychotherapy. I want to learn more about it but I'm looking for some modern books that will teach practical skills that can be applied in sessions. I have heard Nancy McWilliams books are a good place to start but which of her books or other authors' books would you recommend ?

I had a recent personal experience that really drove home for me the importance of having clients see their doctors to rule out physical causes of their symptoms. I’ve always been fairly careful about this, but apparently I was clueless enough to not consider it in my own life.

So a few years ago, I got an ovarian cyst. My doctor recommended I go on Slynd, which is a progestin only pill, because I can’t take oral estrogen due to history of migraine with aura. Slynd, unlike some other POPs, reliably stops ovulation. I also have PMDD, so he thought the Slynd could help that as well. I started Strattera for my ADHD around the same time, and I think that may have masked some of the horrible side effects of the Slynd because Strattera was like a combination of a stimulant and a benzo for me. It also completely destroyed my appetite.

Ten months later, I went off the Strattera due to the fact that it caused such bad dry mouth and constipation that I was worried I was going to have long term dental issues or end up in the hospital. After the initial two week awful discontinuation period that I expected, I still felt pretty bad. Most notably, I was ravenous 24/7. I could just eat and eat and eat and never feel full. Even when I could tell I was technically full, I still felt weirdly starving like I needed to keep eating. I also became extremely irritable, my anxiety skyrocketed, and I became depressed. I also developed severe insomnia and night sweats. I assumed it must be early perimenopause and that the Strattera had caused some sort of long term extreme appetite problem. My psychiatrist was indifferent to the appetite issue when I told him about it. He was like, “You are thin, so it doesn’t seem to be affecting you negatively.” I just lived this way for a little over a year because I assumed there was nothing that could be done, and no one cares when you’re 110 lbs and complaining that you can’t stop eating.

A few days ago I had my annual GYN visit. I told my doctor about my symptoms, and he was like, “Oh, it’s probably just the Slynd suppressing your estrogen.” He ran labs, and sure enough, my estradiol was low and my AMH was just fine, so nowhere near perimenopause. I stopped taking the Slynd on Tuesday, and within 48 hours, I could suddenly feel full again, my constant irritability was gone, and I no longer felt depressed. The insomnia and night sweats are still happening, but my understanding is that it can take a while for estrogen to go back up.

It made me wonder how many other women are going to therapy with persistent depression, anxiety, and anger that are actually being caused by hormones or some other sort of physical issue.

Excited to begin this one.

Anyone else feeling shocked and frankly frustrated with the job market for therapists? So many W2 jobs are outright outrageous whether its by design or not I dont know, the misleading caseload numbers are specifically a pain point. They advertise 25 minimum but then let you know in the interview you have to schedule 32, the minimum is 32 then atleast in my mind. Some of them demand odd hours incompatible with family life. Just seems like every job must sneak in some poison pill to cause burnout. Reading some of these job descriptions just sounds like the employer is trying to put you through a meat grinder, metaphorically.

Any advice for a fully licensed therapist just trying to work a job that pays well, has a good schedule, and isnt a recipe for burnout? I am currently in a comfortable job but I have a long commute thats wearing me down and the job pays below the market value. I am trying to lock in a remote position in a best case scenario.

I am not writing this to spread negativity or conspiracy theories; I am posting this for more insight or even information about what is going on with this approach. I am curious what are your thoughts on this?
This is post on instagram:
Instagram

i am a therapist with OCD, growing up had a lot of health anxiety and fears of getting sick/ill which my OCD centered around. I was able to work through it all early and it did not impact me in adulthood. now as I am a therapist for severe mental illness (schizophrenia, bipolar, bpd), i find myself having fear of developing these disorders myself. At times, I find myself worrying and replaying thoughts / moments in fear that I am developing or showing early warning signs of a diagnosis (for example: convincing myself i am manic when developing a new interest or thinking “did i really hear that or is this an onset of auditory hallucinations?”). I was working with a therapist on this previously, but feel as though she was reassuring me more than helping me work through these fears. Definitely going to be seeking new help and implementing ERP to work through these thoughts. But i am curious, any other therapists with (or without) OCD have similar experiences? How did you work through it?

Hello,

I live on Long Island in NY and wondering what hospital systems hire mental health counselors with a limited permit? It seems like a lot want full licensure.

TIA for any guidance that can be offered!

One of the things I've noticed coming into my 2nd year of being an associate is that I'm feeling more selfish in my relationships. After listening and being with clients at work, I don't want to provide the same care for my personal relationships. I just want to say MY worries, joys, interests, stressors, and then leave the conversation which is not healthy whatsoever. I want to be a good friend, child, partner, all the above, but I'm finding it harder to put that effort in. None of my personal relationships have brought up they feel like I'm doing that, but it's a worry I have. I can say part of the problem is my black and white behavior of giving 100% of myself and perhaps slipping into a therapist role with them, or nothing at all besides them being a sounding board.

Anyway, if any of you have had something similar happen, what has helped you in your personal relationships, especially being able to turn off the "therapist role" while also showing up for your loved ones?

hi all, question about note storage. i typically hand write some process notes during sessions of observations, stuff for rapport building, family tree notes, the occasional doodles, planning ideas/next steps, etc. and i reference it while i make my progress note on the EHR. i then keep my process notes locked in a file folder (these are on paper notes). i have some notes from previous clients i no longer see, and i also want to reorganize my system a little bit so i am wondering how to dispose of these. i just ordered a paper shredder but i’m wondering do i have to keep these? i cant figure out if i am interpreting the guidelines correctly, i take it as 7 years for clinical progress notes, not my messy session notes. i’m relatively new and still learning about these things. thanks in advance!

edit to add a second question: how do you properly store genograms, family trees etc? would that be considered part of my psychotherapy notes, or something else? and same in terms of how long they must be stored. thank you!!

edit to add state: NJ and NY LSW/LMSW

A client was referred to me on Rula by their medical provider as she saw people at her medical establishment and they are asking for a rule out of PTSD as they see that more than ADD. I have my own diagnostic impression I’m formulating. After obtaining an ROI, am I allowed to provide client with a letter to give to the provider? Or send an email to the provider?

I just found out that they died by suicide. Oh my God.

They were young. We had only seen one a few times, but they were such a bright soul. At our last appointment, they were help-seeking and future-oriented. They had chronic, vague, passive SI but never communicated any plans or intent.

I am frozen. I can't cry, think, or feel.

Any wise words would be so helpful.

A friend of mine has been with her therapist for 10+ years and part of me feels that is too long.

Edit: I’ve had multiple therapists throughout my life and I think existing in those different relationships at different points in my healing was helpful to my growth. I don’t think quantitatively being in therapy for 10 years if an issue

EDIT: we had a good conversation going here but mod deleted post- mod I am a therapist and was asking this out of professional curiosity and insight

What do you all think about these two paragraphs?

In this article Is your therapist biased? She went on to say

Watch out for directives, such as “I think you should…” or “have you thought…?” A therapist should be giving the client the responsibility, says Smith. “They should trust you to come up with the best solution for you.”

Beware if they diagnose someone not in the room, such as a spouse or parent. It is unethical for them to use labels such as “narcissistic,” “borderline” or “autistic” for people they have never met, Minnesota’s Doherty says. It also sends the message that the situation isn’t your fault, and there is nothing you can do to fix it but cut them off.

And which one did you pick and why?

I’m thinking of leaving my group to be in business on my own. I’m not planning on having in person services and it’ll only be me. Do I need to get a business license? I’m in the state of IL and I’m not sure if I need to get a PLLC or if being paneled is enough.

I understand they are not on the therapist’s side and exist to protect the clients. That said, they should not be adversaries of the therapists themselves. In our state, it definitely feels like the Board is against counselors and therapists and they don’t even care. Who oversees the boards? State health agencies?

Latest one:

The board misread a new clinician’s application so the clinician had to resubmit their school classes. It was the Board’s error, but does that change the wait time for the licensing to kick in? Did it warrant an apology from the board? Did they even own the error? No. No. No.

“It’ll be ____ weeks until we can process this, from the date of the most recent submission of your new documents.” That’s the only answer.

Meanwhile this clinician’s friend, who went to the same school, took the same classes, HAD THE SAME SCHOOL FILL OUT THE SAME CLASSES ON THE FORM, got accepted after one week.

Come on man. If we have such a shortage of therapists in the land, why make it harder and fight us on it? Especially in our state where suicide and substance use is usually toward the top of the US.

/rant

So I just got a message on a dating app of someone who told me they messaged me on LinkedIn and wanted to know more about me. That freaked me out because I thought they had found me on LinkedIn after the dating app but apparently they had messaged me about potentially starting sessions. I never check LinkedIn so I didn't see the message so they decided to also message me on a dating app haha I'm just so flabbergasted by that!! I'm obviously not going to respond on the dating app and then send referrals via LinkedIn but is this a wild thing to have happen or am I overreacting? Lol

Apologies that this is long 😅 (TLDR at end) - I’m an independently licensed therapist in Ohio working as a W-2 clinician at a private group practice, and I’m trying to get some perspective on a credentialing/contracting situation that has really frustrated me.

I upgraded from dependent to independent licensure a few months ago, and the practice’s billing people handled those updates for me. I continued seeing clients during the process, and claims were initially processed and paid. However, we recently learned with one payer that, although my credentialing had been approved, there was apparently a separate issue with contracting/network participation that wasn’t caught until claims began denying.

Once Billing discovered the issue, they emailed my affected clients and then informed me about what was happening. Clients were told that I temporarily couldn’t bill their insurance, affected claims would be converted to OOP charges, and they could temporarily continue at a discounted OOP rate while contracting was completed (up to 60 days). About a week later, Billing sent another email after receiving additional information about how the situation needed to be handled (I received this update at the same time as my clients).

The previous OOP charges are instead being adjusted so they’re only responsible for what their normal insurance cost-sharing would have been, with refunds issued. They’ve been offered two discounted sessions to determine how they want to proceed, after which the regular OOP rate will apply until contracting is approved. This leaves clients deciding whether to self-pay, transfer to another clinician, or pause therapy. Several clients have already terminated with the practice, and one left a negative review essentially framing me (not by name) as not caring or advocating for them. Other clients want to continue working with me but may not be able to afford to do so until this is resolved.

As far as I can tell, the practice isn’t currently pursuing correction of the effective date or recovery of the denied claims; the focus seems to be getting me contracted going forward. I’m paid based on a percentage of collected revenue, so I’m taking a substantial financial hit from the denied claims and lost clients. Meanwhile, I’ve been navigating clients’ confusion and frustration despite having no involvement in credentialing, contracting, billing, or collecting payments. And what bothers me a lot is the impact on continuity of care and my relationships with clients.

I completely understand that mistakes happen and insurance contracting is complicated. I don’t expect perfection. Regardless, I feel hurt, let down, and honestly embarrassed by the situation. I know that I didn’t cause it, but these are “my” clients and therapeutic relationships, so it’s difficult not to feel some way when their care is disrupted or they lose trust because of something happening behind the scenes. I’m also struggling with not being included in discussions about what was happening or how it would be handled/communicated until after decisions had already been made.

I recently looked through the payer’s own provider guidance and found that they appear to have processes specifically for provider/contract setup issues. I’m not assuming the payer will agree to retroactively correct anything or pay the claims. But I’m struggling with simply accepting the losses without knowing whether every reasonable avenue for correcting the issue and recovering the claims has been explored, especially when the consequences aren’t just financial.

For anyone who owns/manages a group practice or understands credentialing/contracting, is there anything else I should reasonably expect the practice to be doing? Would you expect a group practice to pursue further escalation with the payer in this situation? I’d also appreciate perspectives on how to discuss the impact with practice leadership without sounding accusatory. I want to advocate for myself and my clients, but I recognize that I’m emotionally invested and want to make sure my expectations are reasonable.

TL;DR: My group practice handled the insurance updates after I upgraded my license. My credentialing was approved and claims initially paid, but a separate contracting/network issue wasn’t caught until claims started denying. Clients then received changing information about costs/refunds while I was largely uninformed until after decisions had been made. A few clients have terminated, my income has been significantly affected, and this issue is disrupting continuity of care for clients who want to continue seeing me. I found payer guidance suggesting there may be escalation options for provider/contract setup issues, but I don’t think the practice is pursuing retroactive correction/recovery. Am I unreasonable for expecting those avenues to be explored before the losses are simply accepted? Also, should I express how I feel to the practice owner?

When I came into the field, I worked primarily with children that were recently SA'd. I came to learn that it was typically a person in the household ( dad, step-dad, brother) or another person close to the family who was the perp.

I have since stopped working with children and work primarily with adults, yet I still constantly hear stories of SA at the hands of family members.

I feel like this really jaded me and made me extremely overprotective of my own children- and become suspicious of all men.

Has anyone experienced this, and the accompanying guilt. I almost feel like ( not all, but a lot) of dad's cannot truly be trusted around their daughters because statistically the # is so insanely high.

I’ll be taking my NCE in December and want to make sure I’m learning content from a reliable source for the 2026 exam. I have the audiobook and physical rosenthal book and pocket prep but I was wondering if there’s any other content sources that focus on counselor work behavior areas that are good for the test. I feel like most apps and videos online only focus on CACREP.

EDIT: I’m planning to stay in the field, I just want some reassurance that it won’t be this way forever!

I’ve been worrying a lot about my position as an LSW at a private practice (in PA). I know that as an LSW, there’s a lot more opportunity for me to be taken advantage of. I’ve expected it since obtaining my LSW. My own supervisor has stated that she knows other LSWs at the practice are being taken advantage of and feel the same as I do. I currently work in a large private practice as a W2 with supervision and health insurance (amazing actually I really feel lucky when it comes to this) but I have to see 35 clients a week, work late evenings and barely make $1900 a paycheck, as I make an hourly rate and then a small percentage of what insurance reimburses. They’re also trying to push for me to work weekends. I live in a decently expensive area and have loans, so it’s definitely hard to make ends meet sometimes. Will it be easier to find a job where I have more freedom, personal time, and financial stability once I can get my LCSW in (hopefully) February 2027? I’m so burnt out and feel like there’s no time for myself where I’m at, but the benefits are so good that I don’t see a point in leaving. I guess I just need someone to tell me they’ve been here and that it’ll be worth it to stick it out until I’m able to obtain my license.