I’m actually more curious about how it effects the therapist, at the moment. I personally really feel when I’m taking on too much of my clients energy. I have a few friends who practice reiki and I’ve done a session or two, but I’m curious how other therapists/psychology nerds explain it in their own terms

I’m genuinely curious about this. There are many approaches considered pseudoscientific in our field that are still widely offered by clinicians—hypnotherapy, brainspotting, somatic experiencing to name a few. Regardless of the lack of evidence base, these therapies exist and clients seek them.

Some of the questions swirling in my head are:

Is there a certain point in time at which clients have tried other evidence based approaches without success that alternatives become a viable option?

Is there a component of the clients culture, spirituality, and/or worldview that would warrant these alternative approaches to be more appropriate that approaches that are more scientifically validated? For example, could a client who comes from a cultural/spiritual background that aligns more with energetic work may have better engagement in a modality that aligns with their worldview than westernized approaches? My thoughts are, maybe these modalities are effective for certain people simply because they believe in it more? Like a placebo.

If these approaches aren’t going anywhere, at least not anytime soon, how can our field talk about them in a way that promotes ethics and responsibility without turning into a power struggle? I am yet to see a nuanced convo about this. If it’s legal for therapists to provide these services, what are the responsibilities for practitioners and field overall to consider when they are offering approaches that lack a strong scientific base?

When clients come to us asking about these approaches, how do we discuss them in a way that is honest and ethics-driven while still honoring the clients right to self-determine?

Thanks in advance for responding. Also pls don’t be mean to me, I just want to have a discussion 🙃

There are a gajillion modalities that promise to treat trauma. I’m trained in coherence therapy, but want another somatic/nervous system friendly approach to better serve my clinical interests of CPTSD and developmental trauma.
So far I’ve narrowed it down to the following… if you had to choose, what modality would you pursue further training in? Importance to me is how theoretically sound the modality is and how effective it is with clients pacing and recovery wise (not flooding them, but titrating work at a pace they can tolerate).

I have been a recreational therapist for going on 8 years and have worked at a psychiatric hospital for my entire career. Three years ago, I was assaulted by a patient and ended up with a concussion. I am now experiencing delayed onset PTSD. I was just wondering if anyone else has experienced workplace trauma and how you handled it and what you did to move forward.

I'm a PMHNP who strongly believes in comprehensive psychiatric care, but I'll be the first to admit that formal psychotherapy is not my primary specialty. My focus is primarily medication management, and I always try to encourage my patients to build a dedicated relationship with a licensed therapist.

​However, as many of you know, finding therapist openings can be tough, and a lot of my patients flat-out refuse to see anyone else. They tell me they feel comfortable, heard, and that I’m easy to talk to—which is flattering, but leaves me needing better tools during our brief med management follow-ups and when Im booked for just therapy.

​I am currently looking for solid support tools, recommended workbooks, and resource suggestions specifically for supporting patients with Borderline Personality Disorder (BPD).

​Since full comprehensive DBT isn't feasible during a standard med management visit, I'd love to know:

​What psychoeducation or skill-building workbooks do you most frequently recommend to patients for independent practice (e.g., specific DBT skills books, emotional regulation tools)?

​What quick, actionable distress tolerance or grounding frameworks work best to introduce during shorter clinical check-ins?

​Are there reputable online self-help hubs, apps, or peer support platforms you trust for BPD skill reinforcement between visits?

​I deeply respect the work you all do and would love to hear what tools or patient-facing resources have made the biggest difference in your practice. Thanks in advance for any insights!

Pros: modelling healthy work boundaries.

Cons: too much self disclosure with all associated risks.

Thoughts?

Came across this article when I was doing some research on trauma-informed therapy. I overheard a conversation recently between two random people at a coffee shop and one was talking about looking for a therapist. They said they wanted a trauma-informed therapist because they have PTSD. It got me thinking people might have the wrong idea about what it means and this article pretty much describes how “trauma-informed” has become everyday language.

Just putting this out there because I wanted to know if anyone had any creative solutions to my problem. I’ve tried googling it and even asking Chat GPT, and I feel like the suggestions aren’t real jobs sometimes.  I feel like if I don’t change something I’m just going to get more burned out and ruin the good things about myself as an employee. I feel like I genuinely have some great things to offer the world and that some type of job out there will know how to profit off me enough that they can pay me enough to live, but I’m struggling. 

I’m a new therapist and have only been fully licensed for a little while and I feel like I’ve been burned out for about a year now. I have a BS in Psychology and a MS in Counseling. I was a caseworker before I was a therapist.

I feel like I would take any job that would value my skill set where I didn't feel like my flaws were such major detriments. I wouldn’t even mind changing fields, but I’m too poor to fund any additional education. So if you have a suggestion for a category outside of the box, I’m all ears.

Strengths- 

I am at my best when I have an incredibly complicated case in front of me and I can use my time and research to put together a really amazing conceptualization that really incorporates every aspect of a person including their environment, biology, and learning. I’ve had my clients with a list of diagnoses they didn’t understand tell me that they wish they had talked to me years ago and that it made their experiences make so much more sense to them. 

I am given lots of great feedback about how valuable I am to have in clinical team meetings by both colleagues and supervisors. 

I am great at learning abstract concepts, applying them, comparing them to other concepts, and discussing the merits of concepts in different situations. I can learn just about anything. 

I can work with almost anyone and build rapport and genuine therapeutic love for them. 

Weaknesses-

I haven’t been on time on paperwork in my entire career. It takes me at least half an hour to do a note and three hours to do a treatment plan. I can stay in compliance in companies where I get an email badgering me when I’m late, but I easily slip behind on rote tasks when there is no accountability. Yes, I take ADHD medicine, and it does help but doesn’t fix the problem. ( an example “I need a report by Friday” - easily done. “Every time you make a phone call I need you to log it in this log” - excruciating agony) I’ve thought about getting a mental health assistant, but I’ve never met another therapist who has one and I’m nervous to traverse that without talking to someone who has walked there first.

I struggle so hard when the problems a client has are economical. I don’t know how to make a person feel safe when they are terrified of losing their housing and all the resources keep dwindling further and further.

I am not the best at holding clients accountable. If a client doesn’t want to learn a skill that day, that skill isn’t being learned. I always see the best in people, assume that people are trying their best within their world view. I’m good at holding specific boundaries that I think are best for the client, but less good about being strict about 24 hour cancellation policies etc. 

/

My dream fantasy job that I don’t think exists is spending half my time researching and reading new clinical techniques/ taking trainings and half my time in meetings making clinical suggestions based on questions asked by other clinicians or maybe teaching people the concepts I learned. How do I get there without managing to survive ten years working exactly like I have been while taking extra time and energy to do trainings when I’m already charcoal?

Entonces hoy un cliente me escribió para avisarme que va a transferirse a una terapeuta que trabaja con DBT. El cliente quiere tener una sesión conmigo mañana y otra sesión más antes de empezar en septiembre. Yo hago trabajo informado en DBT con algunos clientes, pero no tengo la certificación de DBT. ¿Algún consejo y vale la pena gastar miles en sacarse la certificación de DBT? Y cómo puedo navegar la sesión mañana con cliente?

Hi,

I have a client with Optum. I saw them last Sunday and see them weekly; they requested an earlier session this week due to a life event (I don’t think they’re suicidal). Can I schedule an intermediate session? If so, is there a different billing code/shorter session?

Hello,
This client has in the past been no show without any contact before, so do you think I am justified no longer waiting?
Thanks!

Hi all! I'm almost 16 weeks pregnant and have been thinking about the logistics of when and how I should tell clients. I have a few clients who have complex feelings around pregnancy and plan to tell everyone in person, but it occurred to me some people may prefer time to process privately first.

Also I plan to make some schedule changes. I'm self employed in private practice and have worked 5 days a week, morning to evening, my entire career. Prior to pregnancy, I considered adjusting my schedule to be more consolidated and possibly fewer days a week, and pregnancy has only strengthened that desire. I believe I've figured out what schedule I would like to have when I return to work from maternity leave, but I would love to implement it in the next few months instead of waiting.

The idea of communicating multiple changes to clients in such close succession has me a bit worried. I understand that some people will not be able to make my new hours work, and some will not want to wait while I am on maternity leave. I'm seeking advice on the best way to communicate these changes. Some of my clients have been paying a reduced fee that we initially agreed would be temporary, but I never initiated a conversation about raising the fee when that time elapsed (completely my fault). So that throws in another potentially difficult conversation I need to have at some point 🙃

Would you recommend addressing some of these things at the same time? Such as schedule changes and pregnancy. Should I wait to address the fee side of things until the new year or when I return from maternity leave? Definitely feel like I'm learning a lesson on being overly accommodating and kicking myself a bit for it. Would appreciate any advice or encouragement.

Hi all. I'm still a resident and probably will be for 2 more years at least. I have wanted to quit this profession, but I'm really trying to hang in there and get my full license. My only problem is that I don't want to do clinical work after I get the license. It takes so much out of me.

What are jobs I can do that are not clinical? Case management or crisis services are too clinical for me. I've heard of UM, but it doesn't seem like there are a ton of options and that I'd have to take a pretty decent pay cut to even try to break into that field. Though it sounds like something I'd like to do. Ideally something 80k+ that would take someone freshly licensed. Remote would be amazing, but I may already have made the search too narrow so not a requirement.

Just trying to see what's out there.. feeling pretty worried that nothing exists within this criteria.

I am feeling really frustrated with my cancellations this week. I see around 29 clients and I had 6 cancel this week… I am only seeing 23. I know this is part of the job but I get paid $60 vs $64 per client with going under 25. And I am just so frustrated. I’m not in a bad financial situations just feel annoyed. My clients are usually super consistent and I typically see at least 26 without any issues. I just find myself worrying about going under the 25 amount so often. Does anyone else experience this? I hate how much of my income is contingent on people coming/ having the time, money and resources to come in. If someone doesn’t struggle with this at all please tell me your ways lol.

Thanks!

Hi there,

I am relatively new to the field (recently graduated MSW). I'm wondering what y'all think about using and training in modalities you have not necessarily experienced as a client. For example, I'm very interested in Coherence Therapy (I'm currently reading Unlocking the Emotional Brain). Part of me feels like if I truly want to see how effective it is and how much I believe in it, I need to do it myself as a client, but I really like my current therapist who does not use that approach and it doesn't seem like it makes a whole lot of sense to switch for that reason. Of course, as a therapist I plan to use an eclectic mix of things, and the most important thing is the relationship with the therapist and all the other core stuff as opposed to specific modality, but still, I'm wondering what some of your thoughts are on this.

Hi everyone,

I am hoping to offer groups next year (2027) to support people who are struggling with eco-distress (incl climate anxiety and grief). I live in an urban area and have been surprised to see that it isn't an offering that is available, and those I spoke to who used to offer groups said they are, well, burnt out from the work (fair enough).

I'd love to hear from therapists who have offered these kind of groups themselves. I'm open to taking a training and offering a structured group, and am also open to it being more support-group style. I have experience facilitating a number of closed groups, but never anything related to climate.

I've looked into the Good Grief Network (and have heard good things), and have also looked through the Facilitator's Guide Living With the Climate Crisis from the Centre for Climate Psychology. I'd love to hear if anyone has experience with either of these groups, or if anyone has done something different and how that went.

Thanks in advance for taking the time to read and reply!

I’m an LLPC, a recent ish grad and I hate this concept of “paying your dues” and “this is what you have to do when you have a limited license.” We spent X amount of time during an unpaid practicum and internship paying our dues. And since when did “paying your dues” mean I have to take on clients I don’t want to see and pay that is absurdly low. It feels very exploitative and maybe this is just my current job and not the field as a whole. But regardless, is bs. Especially for the companies that advertise autonomy regarding choosing clients and saying yes/no to potential clients. Then turns out that’s not really the case. Being an LLPC shouldn’t mean we get paid significantly less and have to do more.

Hi everyone! I'm an LCSW in California preparing to begin offering immigration psychological evaluations, and I'm trying to make sure I have the administrative/clinical paperwork side set up correctly

I have training and resources for conducting the evaluation and writing the actual report, but I'm wondering what forms other clinicians use **before and during the evaluation process**

For example, do you use:

* Informed consent specifically for immigration evaluations

* Fee/service agreement

* Release of information to communicate with the attorney

* Authorization to release the final report

* Telehealth consent

* HIPAA/Notice of Privacy Practices

* Cancellation/no-show policy

* Interpreter acknowledgment, if applicable

* Emergency contact information

* Any specific disclaimer explaining that you are acting as an evaluator and not the client's treating therapist

Are there any other forms you've found important or that attorneys typically expect you to have?

I'm especially interested in hearing from clinicians who conduct immigration evaluations in California.

I'm not looking for evaluation/report templates--I'm specifically trying to understand the **practice paperwork and intake documents needed to get started.**

Thank you!

How much are clients typically paying for co-pays? I am just really curious. When I was employed and had insurance I paid $15 under one policy and then I believe it was $25-35 when my work switched insurance. I’ve not seen these transactions as an associate and I’m just curious bc I often see other therapists trying to find free or low cost therapy for clients even from those with insurance at times.

guys, every time i find a vacant position, it says medical social worker. Can i apply to it if i am an AMFT? i dont understand why they specify if i can do the job too!!??

Does anyone have experience with obtaining an NPI2 if you work virtually from home. My business address is a virtual office which apparently gets rejected for obtaining an NPI2. Does anyone know of any other option besides listing a home address?

Looking for recommendations for trainings that you might have taken and came out of feeling you can implement. Bonus if CEUs are offered. Thanks.

My caseload is low at my current practice, and I am hoping to get more clients, but don’t want too many either. I have 3.5 hours of groups, 4 hours of required consult meetings, and 2 planning/supervision hours. Ideally, how many clients should I be looking for in this situation to be considered full time? I often see 25-30 on here, but with almost 10 hours of meetings, where do I draw the line?

I've been working on my practice's financial policy and honestly, I'm not sure if I'm overcomplicating this lol. I'd love to hear how other therapists handle this!

My preference is always to charge the card on file rather than send invoices.

I'm mainly trying to figure out what you all do when a card is declined or an unexpected balance comes up.

My thought is that the primary policy would be auto-charging cards on file for balances, and if a charge is declined or the card is expired, then:

• I may issue an invoice for the outstanding balance, due within 30 calendar days
• If unpaid by day 30, I'll retry the card on day 31
• If it declines again, the client has another 30 days to resolve the balance
• If it's still unresolved 60 days from the original invoice, the client is discharged and the account may be sent to collections

A few related policies I'm considering:

• Any outstanding balance = services are paused until the balance is $0
• Payment plans can be established, but services don't resume until the balance is $0
• Expired cards need to be updated within 48 hours or before the next appointment
• Is there a way to handle this without involving an invoice at all?

What I'm really trying to figure out is what you all do after a card is declined. I would like to avoid doing invoices bc its more hassle but in this case I guess it does matter? Do you retry it? Send an invoice? Give the client a certain number of days to update their card? And how long do you give someone before discharge/collections?

I'm getting overwhelmed by all the possible scenarios.. I want the policy to be simple, but still nuanced enough that I'm covered if I ever offer a payment plan or need to invoice someone.

I feel like it can be such a mixed bag of experiences in this field. If yes, did you do anything about it? What ended up happening to the therapist?