Not everyone needs therapy.

I can’t fix normal. Some things just have to be endured.

Before signing Headway's updated agreement (I received notice today that I need to sign updated agreement by end of November), I ran it and the previous agreement through ai to get better idea of the changes that Headway is making within the Agreement. Here are the results and the reasons I will be notifying my clients of my decision to no longer work with Headway:

Biggest concerns

• Indemnity only runs one way now. In the original, each side covered the other’s mistakes. Now only you cover Headway. Headway no longer covers you for its own negligence or breaches.
• Your bio and photo license (new, II.E). Whatever content you give Headway (name, likeness, photos, video, voice) is licensed to it forever, worldwide, irrevocably and for free. Headway can alter or “distort” it, and you can’t review how it’s used. You also give up claims for defamation, invasion of privacy and right of publicity.
• Recoupment is now set by policies Headway can change on its own. The original had a defined process: set-off against future pay, or an invoice payable in 30 days. Now clawbacks follow “Practice Policies and Procedures, as may be amended from time to time.” There’s also a new audit clause. If a payer audits and extrapolates an overpayment from a sample, you’re liable for it. That liability is capped at what Headway actually has to repay, and only applies once appeals are exhausted.
• New Marketplace fee. Being listed in the directory and matched with patients is now an optional service with its own fee (Attachment D, amount shown in the portal). In the original, marketing you was part of the deal at no extra charge.
• Arbitration is required to get started. You must sign a separate Arbitration Agreement before you get access. It says there’s an opt-out right, so read that document before signing.
• The California addendum isn’t in the revised file. In the original, it struck the non-solicitation clause entirely for California providers. Ask Headway whether a California addendum still applies.
• New requirements:
  • Background checks on request.
  • Taking part in quality and peer review.
  • Releasing Headway from liability over sharing your credentialing information.
  • A promise that this contract doesn’t violate any other agreement you have. Check your Made With Love contract for this one.
  • Confirming the patient’s location and your licensure there before each telehealth session.

Term and termination

• The contract auto-renews each year unless either side gives 30 days’ notice.
• Without-cause termination stays at 30 days’ notice, or 60 days if you see Medicare Advantage patients.
• You must give 60 days’ notice before dropping any payer you’re enrolled with.
• Headway can deactivate you or end the contract after 12 months with no availability and no appointments.
• Headway can assign the contract to any of its affiliates. You’re bound to whichever of its 27 entities you work through.

The changes with regards to Headway now being the "owner" of whatever content you share about yourself, including your profile photo, is especially concerning given the takeover of Psychology Today by Headway and similar tech platforms.

• Whatever content you give Headway (name, likeness, photos, video, voice) is licensed to it forever, worldwide, irrevocably and for free. Headway can alter or “distort” it, and you can’t review how it’s used. You also give up claims for defamation, invasion of privacy and right of publicity.
• It doesn’t end when you leave. “Perpetual” and “irrevocable” mean Headway could keep using your photo, name or bio after you stop working with it. That could include ads that suggest you still see patients there, sending people away from your private practice.
• It isn’t limited to the directory. Headway can “license to others,” “publish” and “create derivative works” in “any media.” Your face or a video could show up in Headway’s marketing, or in a partner’s, without your OK.
• It allows alteration. The “distorted character or form” language lets Headway edit or recombine your content, and you waive any right to see it first.
• You can’t easily object. You release claims for defamation, invasion of privacy and right of publicity, so if something is used in a way that misrepresents you, you have little recourse.
• Reputation matters in your work. As a therapist, especially one working with trauma, gender identity and ketamine therapy, you’d want control over how your image and specialties are presented and linked to messaging.

Stay aware. Good luck everyone!!

Transparency note: I used AI (Claude) to review the full 25-page agreement and help put this summary together, because I wanted more people to know what's in it. I've included section numbers so you can check everything against your own copy, and I'd encourage you to do that. I'm not a lawyer and this isn't legal advice.

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1. Headway can use your name, photo, and voice forever (Section II.E)

What it says: Anything you give Headway (your name, headshot, bio, voice, videos) can be used by Headway forever, anywhere, in any form. They can edit or alter it, combine it with other material, and let other companies use it. You can't take that permission back, you don't get to approve how it's used, and you give up your right to sue if they use it in a way that misrepresents you or invades your privacy. This doesn't end when you leave Headway.

Why it matters: A directory profile only needs your photo and bio shown as-is. This wording goes much further. It would allow altered or AI-generated versions of your face or voice, used in ways you never agreed to, with no way to stop it.

1. Limits on your clients after you leave (Section V.F)

What it says: For 12 months after you leave, you can't encourage clients who came to you "through" Headway to stop using Headway. That includes clients who found you in the directory, and also clients connected to you through Headway's insurance networks, which could cover far more of your caseload than you'd expect. Clients you brought to Headway yourself are excluded.

Why it matters: The contract doesn't say what happens if you refer a client to a therapist outside Headway because it's best for their care, or if a client chooses on their own to keep seeing you after you leave. Ordinary, ethical transition planning could arguably count as a violation. That puts you in a bind between your ethical duty to the client and your contract.

1. Headway can take back money it already paid you, with no time limit (Sections III.C, VI.A, VI.C)

What it says: If Headway or an insurance company later decides your notes didn't fully justify a session, or the billing code you used, Headway can take that money back. The rules for this live in Headway's own policies, which they can change whenever they want. There's no time limit that we could find, and it continues after you leave.

Why it matters: You could be asked to repay money for sessions from years ago, under rules that changed after you did the work. To be fair, there are some protections: if an insurer audits a sample of your sessions and multiplies the result across your caseload, you only owe that after all appeals are finished, and only what Headway actually has to pay back.

1. Your records are your responsibility, even after you leave (Sections V.A.3, VI.A, VI.B)

What it says: You must hand over records within 3 days of a request, even after you leave Headway. Headway says the records are your responsibility to keep, not theirs. Whether you can download them after you leave depends on whatever process Headway has at the time.

Why it matters: Three days is very short if you're on vacation or sick, or if you've closed your practice. And if Headway's download process changes, you could be responsible for records you can't easily get to. Export your records before you give notice.

1. Insurance requirements (Section VIII.A)

What it says: You need malpractice insurance of at least $1 million. If your policy is "claims-made," which only covers claims filed while the policy is active, you must buy extra "tail" coverage after you leave, lasting as long as someone could still sue you. You also need general business liability insurance at amounts Headway approves.

Why it matters: Tail coverage can cost a significant amount when you retire or close your practice. And many solo telehealth therapists don't carry general liability insurance at all.

1. Other things worth knowing:

- Only you protect Headway (Section X). If something goes wrong because of your mistake, you pay Headway's costs and legal fees. Headway doesn't promise the same for its mistakes.

- Notices count even if you never see them (Section XII.G). If Headway emails or mails something to the contact info on file, it's legally "delivered," even if it went to spam or an old address. Update your contact info in the portal within 5 business days of any change.

- You must give 60 days' notice before leaving any insurance panel through Headway (Section V.B.2).

- Disputes are handled under New York law (Section XII.A), and through arbitration instead of court, under a separate agreement you can only see after signing this one (Section XI). Arbitration agreements sometimes have a short window to opt out, so look for it.

What's reasonable: Headway doesn't require you to work only with them or see a minimum number of clients, your pay rate can't change mid-contract unless you both agree in writing, and clients you brought yourself are protected.

What you can do:

- Download your copy. You can't copy text from the signing window, but this link worked for me while logged in: https://sigmund.headway.co/api-proxy/provider-agreements/documents/provider_agreement_individual:2026-10/pdf

- Before signing, ask Headway in writing (through the portal and by email) for the other two agreements, and for written answers to anything that concerns you. A written answer can protect you later.

- Check your marketplace settings and when the fee starts in your state. Headway's help center currently says it rolls out state by state starting November 2026.

- If the after-you-leave parts worry you, a one-hour flat-fee review with a healthcare attorney may be worth it.

- Share concerns like these with your professional association.

I work on an inpatient psychiatric unit in the midwest. I have a coworker who was recently hired about 1 month ago. He is trans and expresses himself through his clothing choices/ nails etc. Anyways, we have some kids (between the ages of 7-10) on the unit who have had some questions and have said things along the lines of "Are you a boy or a girl?" "Why do you have girl nails"
During these interactions, I've witnessed my coworker respond pretty intensely and say things like "I'm obviously a boy, are you dumb" or " Isn't it obvious?" or turn to me and say "Why would they say that??"

I can't speak for his lived experiences as a trans man and I get that being questioned about your identity is hurtful. I also think there's a boundary/ level of what's appropriate esp when working with young kids/ kids who are currently hospitalized bc of their mental health.

I'm not sure how to address the gender question's concern directly either bc I don't want to be offensive or come across as insensitive. I've had other conversations with him about his clinical judgement that he has not taken well.

That's it, the title. Just wanted to throw some positivity on the feed.

I heard a quote a few years back from a chef, it said, "Some days, this is just a job; other days, it is not." And that exactly captures my feelings towards this career. I am privileged to have these relationships with people I otherwise never would've met. Despite the hard parts, I am grateful to be in the chair across from whoever wanders into the office.

I recently changed jobs and as I work with a more diverse population, I am beginning to see I have a penchant for certain client populations, some that aren’t my cup of tea, and some I’m indifferent about. As I learn this about myself, I’m questioning if this is “normal” and sometimes if it’s ethical (for me, and for our field).
I’ve seen therapists say they prefer to work with a particular population. Examples: women going through divorce, kids who have experienced trauma, teens, PTSD, people impacted negatively by religious institutions, first-generation immigrants, veterans, etc.
What I don’t see, and this is the part I’d like to discuss, is therapists who don’t like working with a particular group. I’ve seen a lot of “That’s outside of my scope, so I refer out” which I understand, and makes sense to me. But what if it is in scope and one does have the credentials and skills, but you just really don’t like working with a particular subset? It doesn’t trigger any personal trauma. There’s no personal experience contributing to countertransference. What if you just really dislike working with men, or teenagers, or depression, or intellectual disabilities, or pregnant women, or criminal offenders, or anxiety, or SUD, or (fill in the blank)?
Is that an ethical gray area? If you refuse to take that subset as clients, is it discriminatory? Does it mean you need to learn/grow more, be more accepting/empathetic, have better UPR? Does it mean you’re just human? If it is veering toward unethical, how do you know? How do you bring this up in supervision, or with peers without sounding like a bigot or way too picky? Should you overcome it and accept those clients anyway? If so, do you just tolerate it as one of the cons of the job? If you do that and get too many of that type of client, how do you still love your job and flourish and feel fulfillment in your chosen career path? Am I overanalyzing? (Probably.)
I hope I worded that OK and it didn’t come across as offensive, ignorant, or judgy or anything. I would just really like to engage in some discussion on this topic, because I don’t see it come up and I’m feeling a bit alone thinking through this by myself. I still work with all the clients that come my way, treat them the best I can, and don’t have any big feelings surfacing. It's more the realization of "I simply don’t enjoy working with this population.” I’m not really struggling. It’s just not part of my day I look forward to, and I just want to question this and learn more from others in my field who might have felt this way on their professional journey.
This is on my agenda for supervision, I’d just like to see some straight talk (especially from more seasoned therapists and/or others who have switched from a specialized population to a more diverse one), learn a bit more, and organize my thoughts a little bit before I bring it up in the limited time space for supervision.
TIA for any discussion, feedback, or experiences! (I wasn't sure whether to flair this as "discussion" or "support." It could be both I guess.)

TL;DR - How do you navigate client populations you prefer not to work with?

has anyone had a client who does show up to the office right after that 15 minute grace period?

i once had a client tell me they weren’t sure if they’d make it before 5:15 and i let them know that i’d have to mark it as a late cancel if not, and then at like 5:17 i went to the receptionist to let them know i was heading out for the day and i saw the client come in right then 😵‍💫 so then i felt a little awkward and was like ugh am i really gonna be that person and tell them sorry no session (which how would you even approach that face to face), and i went ahead and had the session even though i was ready to go home lol

what do you do in that situation?

Headway is updating their provider agreements, and requiring that providers sign off by 11/17. They only let you review one document at a time, so I have only been able to review the first one so far without signing it.

There are some significant updates on the agreement that you are going to want to be aware of.

The most concerning sections, at least to me, are:

-II.E Provider Content. Provider may provide their name, biographic information, likeness, voice, image, photographic portraits, videos, recordings, pictures or other content (the “Provider Content”) to Practice for Practice’s use on the Provider Technology Platform and/or the Headway Marketplace. Provider hereby grants Practice, its affiliates, successors, and assigns, the perpetual, worldwide, royalty-free, and irrevocable right to use, record, reproduce, distribute, display, disclose, license to others, publish, republish, perform, and create derivative works from the Provider Content in any and all media now known or hereafter developed, in perpetuity, in whole or in part, in composite or distorted character or form, without restriction as to changes and alterations. This includes, but is not limited to, the right to use the Provider’s name, likeness, image, voice, and any materials (e.g., video footage, photographs, audio, recordings) captured or provided by the Provider for the Provider Technology Platform and/or the Headway Marketplace. Provider acknowledges that they shall not be entitled to any additional compensation or royalties for the use of their Provider Content. Provider hereby waives any right to inspect or approve the finished product, the use of their Provider Content, or any materials in which the Provider’s Content may appear. Provider releases Practice and its agents, employees, affiliates, successors, and assigns from any and all claims, liabilities, or damages arising out of the use of Provider Content, including but not limited to defamation, invasion of privacy, or infringement of rights of publicity, and from any liability by virtue of the exercise of any grants and authorizations hereunder, any blurring, distortion, optical illusion or use in composite form, whether intentional or otherwise, that may occur.

Summary of that - Your name, photo, voice and video can be used perpetually, sublicensed, and altered “in composite or distorted character,” with a release of claims. It survives termination (section IX.F). You also warrant you own the rights (section IV.A.12), which matters if your photo came from a photographer.

-X. INDEMNIFICATION
A. Provider shall indemnify and hold Practice, its officers, directors, employees and
agents, harmless from and against any and all actions, claims, demands and liabilities, and
against all loss, damage, costs and expenses, including reasonable attorneys’ fees, arising directly or indirectly out of Provider’s negligence, willful misconduct, breach of this Agreement, or violation of applicable law.

Summary of that - Indemnification in the prior agreement was two-way. Each side indemnified the other. This changes indemnification to one-way. Which means that if the practice (Headway) engages in some sort of misconduct, it is not agreeing to withhold responsibility from the provider. That seems like a weird change, and I don't have a good explanation for it.

There are other changes as well, accommodating for the shift to the importance of the provider portal.

I know that a lot people will respond to this with "get off the platforms". And fair enough - that's a legitimate response. But for those who are either still planning to be on them, or who are in the slow exit process, these are things you need to be aware of. I would love to get more clarity from Headway before the required signature date.

Soooo I’m sure we’ve all had an embarrassing moment, right?? Right??

I don’t have any in person clients right now, just telehealth. I also never have water nearby me and just go from session to session no issue.

It was not a particularly bad day, about 5 or 6 scheduled that day. My second to last session was going great. Then all of a sudden I start coughing… violently… couldn’t catch my breath. It was like something was sucking the air out of my lungs. I apologized to the client and for some reason I had my water bottle nearby so I paused to drink it.

Problem solved? Right? Nope. I temporarily lost my voice. And then I started coughing again! I was so confused and my client was just staring at me. My voice didn’t fully come back for the next 30 minutes. I kept coughing and drinking water to help. At the end I felt so embarrassed. This has never happened before! Thankfully my client was understanding but… what was that? My voice was super shaky and almost gone.

The only other embarrassing thing that’s happened was my contact literally falling out of my eye during session and I had to excuse myself to use the restroom to put a new one in (telehealth as well).

Welp. From now on I have my water bottle nearby in case I cough for no reason and lose my voice 😅

The new Elizabeth Holmes film is clinically fascinating and I’d love to hear different perspectives on the film. I kept thinking, is this dissociation? Or is this an incredible liar? Or is it - most likely - both at the same time? It was difficult to keep my therapist cap off when the dynamics and presentations were so intriguing. All takes welcome!

Today was a hard therapist day for me. Just really trauma heavy. I can only think of one other case so far in my career that hit me this hard.

Give me your best feel good movie I can watch right now to either cry or laugh, idc.

I got a call earlier this week from a provider with a client who has SI/SH/HI; the call was urgent and more or less went like “I have a client with SI/SH/HI and I saw you work with this, please contact this person at xxxxxx and take over their case immediately”. I got an ROI from the provider for this individual, contacted the individual, and found out that what they are seeking is well outside my level of care (I am single session weekly with hourly session outpatient, they want multiple days a week including weekends IOP/PHP), and I informed them of the program I run and the limitations that do not meet their needs/desires. Yes, I am highly trained in and work with SI/SH/HI, but through a nonspecific approach that does not match their presentation or desires for extensive care. I told the individual this much, and they said they would stick with their current provider.

Current provider contacted me AGAIN, saying “please take this individual and see them at an IOP level of care for their SI/SH/HI”. I told them I do not offer IOP levels of care nor does the practice I work at. The current provider said “Well they have SI/SH/HI and you work with that, so please take this client”. I said I do not offer the weekend availability or HLOC that this person is seeking. Current provider said “Do you know who does, who can offer IOP type of care?” and asked me for referrals for their client, AND asked what IOP even is… like, current provider with 12+ years experience didn’t know the full difference between once weekly outpatient and IOP programs. I asked what “IOP type of care” means to her and she said “weekend intensive programming between this persons 2-3 weekly sessions with me”. This provider has 9+ years more experience than I do, and said she called 988 in session with this person in order to provide SI/SH intervention. I thought we were all supposed to be at least baseline trained in crisis intervention and suicidality stabilization and deescalation.

Is this sounding bizarre to anybody else? I’ve only been in the field for 2 years and this felt bizarre for me. Felt like she was playing “hot potato” with this client. Made me very discouraged and sad. Current provider advertises herself as “highly trained in trauma intervention and highly trauma informed” yet calls 988 in session with a person expressing SI/SH.

I really hope to only be met with compassion and support here. I've seen conversations go off the rails with some people feeling that "tough love" and similar tactics will work. That is not welcome here.

I do a lot of crisis work, and a few days ago a client almost certainly completed in the middle of a virtual session. It was awful and painful, and I do not know the outcome yet, because I haven't been back to work since. The reason for that is my sibling attempted just a few days later. While they are physically recovering, I am becoming increasingly aware that the people around them have been unsafe. Their words, actions, and inaction almost certainly led to this. My sibling lives very far away and I am truly unable to be there with them physically. My sibling is disabled due to a severe and rare chronic health condition.

I have been told by my parent and the partners parent that the partners mental health is poor and they may be verbally abusing my sibling. The partner's parent lives with them and also expressed that they feel my sibling has a right to choose to end their life and has many reasons to have considered doing so, although they would never directly help. The parent stated that they knew my sibling was considering this, and when. They did not get help. My parent has a history of treating my sibling like a financial burden and I am concerned that there was either coercion or at least prior knowledge that this might happen on that end too. My sibling struggles to care for their own needs, and has never been connected to the appropriate resources in their area. I have offered but my ability to support is limited because they only share limited information with me and I live in a different state with different laws, resources, etc.

I am currently making as many calls as I can to advocate for them as they heal in the hospital so that they do not go back to this unsafe situation. However, I'm being blocked because I wasn't allowed access to speak with the care team since my parent has their own issues, including being controlling, secretive, and shutting down rather than dealing with the situation at hand. I have missed work for several days. While I'm being told that they understand, I am worried. I am worried I'll be seen or treated as unreliable. I am worried that, if I disclose any of what is going on, they'll trust me less because I have a lot on my plate already. I am upset because I want to be at work supporting other people. I am heartbroken and scared because the professionals that could save my siblings life aren't hearing me and getting the information needed to keep them safe.

I have my own therapist who I have seen twice this week. I'm on meds and see a psychiatrist to manage my own mental health. I have friends who I have told all of this to who are supporting and guiding me. I have even reached out to a hotline for immediate support. I'm also contacting the hospital on my siblings behalf and leaving messages for several departments. I called adult protective services. I don't know what else I can do but it is tearing me apart and I just don't know how I am going to be able to continue as a clinician after this. I don't know how soon to return to work because the whole situation is at a standstill.

I am not sure exactly what I need. Maybe this situation is so outrageous that no one else here can give me any input. I don't know how to pick myself back up and go to work. I am poor and can't afford significant time off. I also just want to get back to doing this work. I don't know how long is reasonable to stay away, and how to move through this situation with appropriate boundaries being both a loved one and a mental health professional. I don't know. I don't know.

Hi all,

Happy OCD awareness week! I have seen so many awesome posts online spreading psychoed on OCD and importantly, showcasing ERP, the gold standard tool to treat OCD. Please feel free to check out the IOCDF for great resources and newly published data on OCD/ERP. Next week there are still some openings for their 3 day advanced symposium on OCD comorbid autism/ADHD as well.

As a person with OCD and an ERP therapist, I felt inspired by all the posts I’ve seen online of people with OCD and separately, ERP therapists, documenting some of their most radical, “silly”, or shocking exposures they’ve participated in or conducted. I figured therapists with OCD and/or ERP therapists could share in that and leave our own sentiments here on our ERP highlights (without divulging PHI).

As a child during my own ERP some of the most memorable things I had to do: hold a bag of walnuts (I’m allergic), walk past a construction site and take deep breaths (I thought I’d die from inhaling the chemicals), and going for walks without my EpiPen (I thought a walnut would fall from the sky and kill me).

I was previously seeing a client pro bono while I was an intern. I was charging $35 for my other clients. I just became an LCSWA and I’m slowlyyyyy building my caseload. I have a couple clients because I’m still waiting for insurance credentialing.

I told the client that some of the fees were going to change once I was licensed and that I would be getting credentialed with their insurance. However, the client said their out of pocket fee for insurance is $90, which they said they can’t afford.

The LMFTA at my practice charges $25 reduced fee. So, I went along with that. Technically, because of overhead fees and taxes, I’m making $15 for that client’s session.

The client is also an evening spot, which I know is a popular time.

The practice I’m at charges $250 a session self pay but some of the LCSW’s charge $150 a session. My supervisor said the lowest she’s gone is $75.

I’m conflicted. I enjoy working with this client, but less than $25 an hour…sucks. She just signed the document about the $25 fee.

It’s something I’ve been thinking about a lot and I’m not sure if I made the right decision. Is it too late to ask her what she can realistically afford and change it? Would that be unethical?

Hi everyone,

I’m writing this because I’m at a loss of what to do. I(F25) have been recently diagnosed with autism. I’ve always had problems, specifically with authority and social interactions, but I’d always been told I’d be a good therapist, and after years of deliberation, I am working on my masters and am currently in Practicum.

Let’s just say, it’s going terribly.
I’m fine with clients. I have some good and bad feedback. It’s pretty general.

But the problem is supervision. I am apparently a supervisor’s worst nightmare. I asked a question in group supervision to my doctoral student supervisor that sent everyone in a tizzy. I thought my supervisor had a facial expression that implied she wanted to add on to what I was saying, so I turned to her and said, “I saw you made a face when I said xyz and I wanted to give you the opportunity to say what you wanted to say.” For me, I was trying to give her the space to talk because I didn’t want to exclude her in the conversation. To everyone else, I was “calling her out.” I totally understand now why it would come off like that, but I had started the semester by telling everyone I may struggle with this and would love to give immediate clarification if ever necessary. It was a simple misunderstanding, but it doesn’t seem to matter. My student supervisor and main supervisor have been extremely weird and standoffish, and they just cannot let go of it. I got my midterm review, and despite talking to them and apologizing, I’m still being seen as unprofessional.

I’ve been told my professional behavior needs work and if I can’t improve, they’ll be questioning whether or not I can pass practicum.
I don’t know what to do.
Everytime I fuck up something, I’m devastated. I want to do my best. I want to learn. But it’s like everytime I try to learn, it’s considered “odd” or “disrespectful”. I’ve told them my diagnosis but they’ve only asked what resources I have to improve.

It really sucks. I guess I’m just trying to learn how to navigate this. How were the practicum experiences of everyone else? How did you get through it? How can I keep learning without totally falling apart about this feedback and the possibility that I will fail practicum for my perceived lack of professionalism?

Any insight would be helpful. Thanks to everyone.

I need to either leave the field or drastically cut back on my hours. I understand that we see a post asking for other options in the field at least once a month but here it is again! I want something remote, part time, and away from clients. I’d do data entry for Pete’s sake if it paid me decent. Looking for suggestions either in the therapy field or outside of the field that are remote, flexible on hours, and pay at least $60/hour 😬😬

Thanks!

I am a 28 year veteran therapist in PA . I am tired of the grind of PP. anyone work for a company they love? Any suggestions. I can do anything at this point I just don’t want to run a business.

I am licensed and am looking for additional clinical input/perspectives on this.
I have a client that absolutely hates their ethnic culture, history and traditions and constantly spouts out hateful opinions that they deem as facts while degrading the resilience and struggles for generations. It is also the same ethnicity background as mine.

I don’t know how to support them because my empathy is almost empty and my own frustrations with them are growing increasingly unmanageable. I’m concerned they’d paint our people in such a bad light that we’re already working so hard to shift the narrative on. They say things like wanting our entire species to become extinct/non existent. They don’t report any specific plans or intentions to outwardly hurt anyone, but more so hold such hateful thoughts and hopes that it would happen.

I’m just so irritated with them now I can’t even find anymore words to try to open their perspective to a less hateful one. I’ve tried to suggest seeking peer related research rather than going down one sided, biased and non researched back material online but they swear all they find is true and that our culture and people should not exist and that our islands should all be seized and not put up a fight because we’ll lose anyway and don’t like that some narratives paint us as heroes for even trying to resist. Ugh I’m definitely triggered and am struggling to stay neutral with this client.

So I logged onto my telehealth session today, and my client had a really bad connection. Also, the room was very loud that she was in. It was so loud that it was distracting for me. Also, her baby was there.

She then told me she is at her relative's home. I could hear her relative in the background. I asked her if she had privacy. She said "Oh it's fine, it's just (relative). She knows everything about me." We tried to trouble shoot the WiFi, and she was able to get a better connection. I then remembered her relative lives out of state, so I told her I was unable to conduct the teletherapy session because of that. We rescheduled for next week.

Advice needed on what would you do if your client refuses to move rooms when you know someone else is listening? This client has pushed back and argued before about another issue, so I would anticipate pushback if I insisted she change rooms.

I’m a primarily ACT therapist, but I really appreciate the use of the here-and-now and relational work like that used in gestalt therapy, psychodynamic, or Yalom’s existential therapy, and I’m trying to learn and integrate it more into my work with my clients.

Some questions or interventions I currently use are:

• How is it like to share that with me?

• Sharing my own feelings (with careful consideration) about how I experience the client or the session

• How is it like to hear that? (in regard to what I just said)

• Use immediacy to explore the client’s experience with the therapeutic relationship

I had a session today where the client and I had a very open conversation about our therapeutic relationship, and the client expressed a desire for us to focus more on this type of relational work.

But, I need more ideas and questions I can use, so if you do relational work, regardless of the orientation, could you please share some ideas or questions you use? Any advice is appreciated.