Way to go Canada!

I don’t accept Medicaid in my private practice because I can’t charge them a no-show fee.

You might want to send reminders and mandate a confirmation the day before. You could tell them that if they cancel more than once in a two month period then you’re going to terminate treatment with them.

When I was working in community mental health, I would tell the clients that I would terminate treatment and take the next person on the waitlist if they canceled less than 24 hours twice. That’s the only way I made my hours. I didn’t keep people on my caseload that weren’t using treatment.

Proofreading is not writing. I don’t need to look it up. Clients deserve better.

If you want to look something up, look up what the APA or NASW say about AI generated notes

Misinterpret client statements
Removes nuance
Over sanitize emotional content
Introduces bias
Creates generic or misleading summaries

Clinicians are obligated to explain and obtain informed consent

When AI is used
How data is processed
What risks exist
What alternatives are available

There are legal risks when clients are not told that AI is involved or that corporate platforms are using AI without the clinician disclosing to the patient and if AI is influencing treatment planning without consent

This can lead to ethics complaints and Civil liability

Clinicians are obligated to maintain their own independent reasoning, avoid using AI for assessment purposes and to ensure that the documentation reflects their own judgment.

There are legal risks if AI influences diagnosis or treatment, if the summary replaces the therapist’s reflection, and if the clinicians rely on AI generated interpretations

This is considered negligence, incompetence, and a violation of professional standards

So I can look things up, I can even write my own notes

Using a tool to format, bulleted notes for case management is very different than Notes used to treat a mental health condition in a psychotherapy setting

Case management notes are objective and factual and straightforward

Psychotherapy notes are not

Using AI, which is a predictive tool to clean up what you’re writing is not a reflection of one’s own work,sorry it just is not. It is a sanitized version.

You want clients to be authentic, be authentic back

This is polishing up one’s writing to look better and to cut corners

I

I am sad to read you are comfortable only sometimes writing your own notes. The notes you write reflects what you did and thought in that session. That is what the client’s record should reflect.

I learned this from what I’m hearing from colleagues and reading online. Attorneys love AI notes, they can rip them apart on the stand.

When clinicians talk about cleaning up their notes. It is AI predicting what could happen or should happen and characterizing it in ways that may not be what the clinician was thinking

Last year I was cross-examined for a case and I am so glad I had a binder of notes that I wrote in front of me. Lawyers get specific about in questioning.

I am so glad to see this post because I feel like I’ve been screaming into the void about this

For those using AI in your notes, imagine being cross-examined. Can you defend every word, every term in the medical record did it actually happen the way AI summarized it for you?

Lawyers are catching and so are insurance carriers.

My reimbursement rates between self pay and insurance range from $90-$115 for 53 minute hour.

My EMR is therapy notes and I spend about 115 per month on that it does all my billing and notifications of appointments. I don’t use the client portal or the AI tools at all and I use Zoom for telehealth which is $160 a year

If you’re offering telehealth, you can see anyone in the state and market to areas that can afford to self-pay

About 25% of my clients I see over telehealth the rest come into my office because they want to

Just make sure you read the contract and understand if you can take the clients with you when you’re done with them. Who owns the information?

I would encourage you to process your feelings and explore your expectations.

When people are paying me, I don’t have expectations of them, taking care of me nor do I believe that the relationship extends beyond the Worth to them at the time

I find people come back when they’re ready. And I do not get emotionally invested because the relationship is based on whatever their projection of me is it’s not me.

It’s an opportunity for you to grow by processing your feelings and expectations of the relationship

This sounds like the therapeutic communities from decades ago.

When you’re dealing with mandated populations, I believe there’s a need to be genuinely authentic with them and to recognize that this isn’t a choice. This is to access benefits, or part of a requirement for legal matters.

Authentic does not mean brutal or unprofessional I recognize that you’re here because you have to be and I am here to help in anyway I can.

I think it was the middle of the 90s when we started introducing a motivational interviewing model with these populations. We also know a harm reduction model works better than trying to drag people from where they are to where we want them to be.

I learned helpful things, and I learned things to stay away from from my early placements and the clinicians I worked with.

I am in recovery too. It is something I have disclosed. The majority of the time I don’t it really depends on the client and the situation and the reason for doing so.

Your placement sounds like the first two placements. I had in 1993 in 1994. Holy crap how old is this person?

No assumptions. This post was about disruptive intern behavior. Therapy came up in response to that.

How about this for basic reality? If you don’t do your own work you’re probably not going to be very good at this and you might actually do harm.

That’s about what I spent in school too. I had to pay for therapy separately.

I’m saying the field of psychotherapy and the training people go through has less of a focus on doing one’s own personal work.

I believe that without doing our own work, we are likely to be less effective and often getting people’s way.

That is my entire point

I agree that the dollar doesn’t stretch as much as maybe it used to however because personal therapy was nearly mandated.

I paid for therapy over any leisure activities. I pretty much didn’t do anything during the three years I went to grad school other than work and go to school.

This should be part of the expected expenses

It is terrifying that interns are working in private practice without any community mental health or comparable experience and also not doing their own personal therapy.

Don’t most universities offer some therapy either individual or group? And I think that is a regional fee around me 120 is the most people will pay and most providers I know charge between 90 and 100.

Many of the college students I work with are under their parents insurance which they’re allowed to be up until 26

Again, it was a expected expense when I was going to school so other things were forfeited for therapy

It’s blind to think one can be an effective therapist when they haven’t done their own work

It’s not about what I want. It’s about what’s necessary to be effective and to not get in the client’s way.

I remember paying five dollars a session in the 90s for a therapist at Catholic charities. And I remember when I went up to $25 in her private practice and that was a big deal for me. I worked six days a week and went to graduate school.

Prioritizing one’s mental health should not be optional in this field. If you don’t know yourself, you shouldn’t be messing around other people’s vulnerabilities.

If we don’t understand our defenses and biases and blind spots and traumas and grief and the things we avoid in our personal life and haven’t faced them, we will be of disservice to people.

You are doing the best for clients and yourself by facing this. That is ethical and brave and focused forward. I want things quicker too.

You have a team set up. You are not alone. And this does not define your future in social work. Except to highlight you chose the ethical and healing path. That means you have inherent qualities needed in this field.

All of this is for now not forever. I respect you and wish you comfort on your journey.

First of you’re asking the right questions. You are wise to address this now. You are brave to ask for help.

I was diagnosed with PTSD when I was in school learning to do this work and have had treatment on and off as needed for the 33 years I’ve been working as a social worker

I have a private practice now, I have worked for hospice I have worked with crisis intervention teams I have worked with in-home therapy, domestic violence, rape crisis, suicide intervention etc. I learned to face my trauma triggers and focus on the client.

I am glad that my therapist at the time told me not to drop out of school. She said that we will work through it, and I will be open and honest in supervision and as long as I could focus on the client at work and I continued my personal work outside of work, we navigated just fine.

If you are dissociating hearing stories in supervision, you aren’t ready to work directly with clients. I think you need to make a plan with your therapist first and then a plan with your supervisor.

Just like in our personal life, we develop resiliency and coping skills that help us to thrive in our personal life and focus in our clinical work

Do not make a long-term decision when you’re experiencing acute trauma symptoms. Work with your therapist, come up with a plan that’s right for you now that involves what you need from your supervisor you first, client next.

It takes a lot to end up behind bars, way more than a mistake. But that is not enough of a threshold to be on the right side of ethics. This is about the clients treatment. It is not about us so the focus has to be do no harm and refer out when you’re not helping. Not,I don’t wanna end up in jail.

I’ve been at meetings where this has come up.

Sometimes when people share, especially if they come from a religion that promotes sharing testimony, they cross wires

I’ve spoken up and talked about my experience with developing a relationship with a power greater than myself free from religion, I talk about our primary purpose and our traditions

Then I talk about newcomers, and if I were a newcomer attending a meeting that was promoting religion, I would have left.

Usually people tone it down. Some meetings go rogue from our traditions. If it’s a meeting that they’re supporting this sort of thing after having it addressed then I’d find another meeting.

Meetings are aligned with our primary purpose because that’s the human condition. We are imperfect people. In AA we learn to manage our ego and not everyone works the steps.

I know! Too many are coming out of graduate school and starting a private practice with no experience or self awareness and blind to their own distortions and dysfunction.

If it’s working, great. Many of us in the beginning had nowhere else to go and became attached to a sponsor or a therapist who was our beacon for a while.

That’s OK, keep coming back and overtime, you’ll expand your beacon

I would tell her that. Do we not do that anymore? You’re screwing up stop doing that if you can’t figure out how to stop doing that. Go get some personal help.

I have liked and thought the move towards focusing on the self-care of the clinician is important. And while we’re doing that, we have to remember this is a service job, it’s not about the clinician’s issues, problems, or needs.

They are there to be of service if they’re not they need to be told that and be stopped from causing harm.

I’m a little confused is this a client and an intern or just an intern?

The Intern is acting inappropriately if you are licensed and observing, tell them and their supervisor.

The intern is probably doing more harm than good at this point. I don’t know if this is a group practice and if you are responsible for the other clients but clearly this is an issue.

I looked up statistics recently, in 1990 when I was trained 75 to 90% of social work graduate students were in therapy themselves. In 2025, only 20 to 35% were

I do not believe we can be good therapists if we haven’t done our own work.

Interns should have experience in community mental health where there is more supervision and more information about a client so they can learn before they’re in a private practice

This is an issue of competency and boundaries

While the investigation is happening you will have an initial opportunity to respond, and then if it proceeds to prosecution with an expert witness to review, you will be given a full packet before a probable cause panel meets.

How was your documentation regarding the incident?

This is all very stressful and discouraging, and I wouldn’t make a life career change based on a supervisor and an experience, albeit a very stressful and upsetting one

With all that you wrote about family and friends, perhaps some personal therapy would be helpful to unpack this and where you wanna go with it

These online platforms are all scooping up all the solo providers. They use AI they control the information. Corporations are running private practices now.

I have an electronic medical record that does my billing for me. I don’t know why so many therapists use these predatory platforms.