I am treating a male adult. He was in a relationship with someone quite abusive and decided to leave her. (The breakup never quite happened) Soon after, he started having panic attacks and became depressed. He was overwhelmed with feelings of guilt.

He is now exhibiting symptoms of psychosis. He is absolutely sure of his false beliefs and can not talk about anything else. I am at a loss. I'm not sure what's the point of our sessions anymore.

I am strongly suggesting psychiatric treatment and medication, but he strongly refuses. He is convinced he is right and the rest of the world is wrong. His family is involved as well, but no one can reach him.

He is not a threat to himself or others at this point, but I don't know how ethical it is for me to continue seeing him. We have reached an impass, and I don't think talk therapy alone can heal him.

Any advice would be appreciated.

Hi everyone- taking recommendations for the above.
After just a few months in the vc companies, I’m
trying to get things settled up to move away entirely. Taking any feedback too! This process is daunting

I have been supervising an MHC-LP weekly for about 5 months. I thought everything was going fine and that they were benefitting from our time together and the resources I provided. I enjoyed it and I sincerely thought they did too! I was wrong. They had reported at least two crises of confidence. The first was at the beginning when their caseload rapidly increased and they felt overwhelmed, so we strategized that they would ask the practice owner to limit their caseload. The second was about a month ago when they started feeling that they "didn't know what they were doing" in couples work and "didn't think this was the right career" for them. At that session, we discussed clinician self care and training options. They also reported that they were headed out on vacation, so we discussed how maybe that was warranted.

The next session (or the next-next session) after their break, they reported they were experiencing anxiety in supervision. I asked if there was anything I could do to address it - change my working style or format? I worked with them to find a solution and we decided to amend the format to give them a greater sense of ownership over the process (they specifically said that me asking questions "made them go blank") and agreed to limit the supervision time to allow them to self regulate before and after. I also reiterated the need for self care. We had one more session after this, in which we discussed a complex case in which they again felt out of their depth. I also normalized this experience and provided resources/guidance/advice.

We didn't have another session after that. An hour and a half before our next scheduled supervision, the practice owner emails me to say they requested a switch and my supervision would no longer be needed. The practice owner requested a meeting and prior to that meeting I put together a summary doc of my supervision notes for whomever the next supervisor would be. During this meeting, the practice owner was very supportive and friendly. They told me that the supervisee told them that I was "steamrolling" them and that there was a "modality mismatch" and that I "misinterpreted their anxiety." Also, that "my approach was overly manualized." I shared with the practice owner that I understood that that was their experience, but that I didn't quite understand the "modality mismatch" because they are practicing CBT, DBT, and EFT, all of which I'm trained but not certified in, and that we don't use manuals. I also said that my style is direct and assertive and I could see how that might come off as steamrolling, especially with someone junior who's concerned about their competence. I asked how long they had been feeling this way because it seemed to me maybe like a few weeks - since their crisis about a month ago - but the practice owner didn't know. I felt blindsided and confused, but resigned that this was their choice and it's a learning opportunity for me.

After the call, I reached out to ask about process for updating the supervision docs with the state. The practice owner says that there's an issue with the gap in supervision while they reassign so could I sign off on the hours in the interim. I'm not meeting with the supervisee, no longer have chart access to their notes, and I believe the practice owner will be supervising in the interim. I don't feel comfortable with this. Aside from the ego blow - someone I thought I was helping has declared me profoundly unhelpful - and the loss of income (I was paid well for the supervision), it feels like an ethics violation for me to sign off on hours I'm not meeting with the supervisee. Also, it feels like something the practice should have addressed this with the supervisee when they requested the switch as part of properly managing a transition to a new supervisor. Of course I plan to sign off on all hours I met with the supervisee but not beyond my termination. Am I overthinking this?

Hello! Student counsellor in Scotland here. I am just wondering if any people who work in the area could recommend me some placement suggestions for my 100 hours. I am very interested in working with people who are at the end of life / entering hospice, people with bereavment and loss (inc child or pregnancy) anything to do with end of life in any capacity. This is my calling because my background is working in palliative care and it was the most wonderful job, but I am changing career to therapy now after many years of social care and casework.

Do you know of any charities or organisations who take students, even for just a limited amount of hours?

I'm able to drive so anywhere in the central belt is easy for me to reach and I'd consider going further afield as well.

What I can't do- working directly with children, working online for the entire placement.

Thank you in advance for any ideas.

I know we aren't a traditional therapist in the sense that we are licensed to practice, can't design our own treatment modalities or diagnose. But we do carry out ABA therapy under the supervision of a behavior analyst. My goal is to become a licensed clinical social worker though, so I'm doing this while working towards that

I had a 30 min exploratory meeting with a rep from Rula who told me they would pay me $70 a 60 min session for CO. It took everything in my soul to not spit out my water and end the meeting right there.

Meanwhile, I’m working on getting credentialed with Medicaid myself & they pay at least $100 for a session. Fuck the health tech companies, grab a few good insurance panels, your drink of choice, and spend 6-8 hours getting your stuff together and you can do it yourself.

The only outright benefit is if you’re looking to get initially credentialed fast the companies are great for that, and I’d still encourage you to submit your own apps while working for the companies.

Has anyone successfully billed G codes, for example, G47 for unspecified insomnia, along with a 90791? I truly could not support any other diagnosis in the entire book and had to go with that but wonder if it will be denied.

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 looking for experiences of others who have done this as as well as what your thoughts about it would be both ethically and in general.

I am in a kind of unique position where I have my therapy skills as well as significant social media and promotion skills, and I have hosted workshops and conferences locally related to social media, helping businesses and therapists grow their own presence.

I am considering venturing out on my own into solo private practice, but the worry is getting enough clients. I don’t have much of a network when it comes to other therapists to mutually refer to and such.

So I was thinking, what if I started workshop series or conferences in my area speaking to my ideal client demographic? For example, a four week series on setting boundaries in relationships/ standing up for yourself( for women), or a series on how to stop people pleasing. I haven’t given a conference much thought, but it would probably be a bit broader, focused on women in general, and I could potentially bring in some yoga practitioners or sound bath people to make it a more holistic sort of a thing.

Anyyyyyway. The idea is that I think I would have better success advertising things like that locally on social media more than I would have success just advertising myself. And then hopefully some of these people would turn into clients. From what I know about social media, it’s actually incredibly difficult to get clients as a therapist locally in your area from social media, so that’s why I’m not just turning to that automatically even though I know a lot about how to grow an account.

All of that to say, I just never hear about things like this so I’m not sure on the ethics or whatever. The workshops would absolutely not be group therapy. None of this would be therapy. But at the end of all of them, there would be a sort of self promotion about if you’re interested in individualized work, you can contact me here.

Thoughts? Comments? Would love any feedback

Hi! I am a MFT (marriage & family therapy) student and am looking to compile a list of books to read to further my education. I would love your best book recommendations that you feel made you a better therapist!!!

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 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.

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).

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!

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?

Maybe this is coming off the back of some harder sessions today; but lately I have been really struck with uncertainty around my performance as a therapist.

For context I am about 3 years post grad with an MSW, and just over a year of being fully licensed with my LCSW. I spent the first three years in an OP psychiatric hospital setting and recently transitioned to a group practice. About half of my clients made the move with me from the hospital setting to my current practice.

I have always felt a sense of imposter syndrome through my graduate program, yet when I would express this I was universally met with “you’re doubting your capabilities” and people reassuring me that I have a “natural presence” and way with joining people. Some weeks I will have sessions that feel productive, and a part of me starts to feel like a good and decently competent therapist.

Then I have a session like I did today, with a longer term client processing a breakup and subsequent abandonment trauma, feeling in such distress and repeating over and over how they don’t know what to do or how to be. As much as I can offer tools to down regulate intense emotions, validation, and positive regard in the session - I still walk away feeling like I am missing something and not being a good therapist. I think in those moments I feel overwhelmed by a sense of helplessness, or that I should know what to do and I don’t.

Is this imposter syndrome? How do you know you are actually cut out to be a therapist? What if I am genuinely not good at this role, but because my supervisors and peers are so validating I wouldn’t be told if I was not fit for this?

Is this par for the course?

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.

Just what the title says. I'm looking for someone who is willing to message me to talk about their experiences leaving Grow Therapy. I'm looking to leave and want to talk to someone about what to expect on a certain issue. TIA

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.

Not everyone needs therapy.

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

Sometimes when I'm working with clients that struggle with eye contact, I think how nice it'd be for them if I could put them on the couch facing away from me...

I am mid-job search and have committed to getting a NJ LAC to open up my options. I have a few questions Im hoping someone can provide insight to to clarify some things and prevent me having to call the boards.

Context: All of my hours thus far (1.5yrs worth) are in PA with PA supervisors. MS in clinical counseling, CACREP accredited program. NCE taken and passed. I do not have an LAC in PA.

Questions:
Do any of my PA hours count for NJ licensure (assoc or full)?
If I get my PA license before completing NJ criteria will I be able to get reciprocity to fulll licensure or will I have to complete the LAC?
Will NJ hours count toward my PA license?
Can I get LAC reciprocity in either state from the other?

Job hunting is so hard right now as a pre-licensed, and this will hopefully allow for more job options. If anyone has any insight to these licenses or any leads in the PA/NJ border area, please!

Thank yall in advance

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.

I’m starting my own private practice and am getting credentialed with different insurance companies. It’s been a pain in the ass and today I found out that the “Entity Identification Number” given to me by my state when I incorporated is not the same thing as my “EIN” that all the forms are asking for.

I’ve got a whole bunch of denials due to that mistake and never filed for a federal EIN. I go to do it today and the website says it’s experiencing difficulties and can’t process my request and to call their number. I call the number and it’s a bot that tells me they aren’t processing EIN requests over the phone and to go back to the website to do it.

I feel like pulling my hair out. Any advice on starting this whole thing up is welcome because who knows what other things I don’t know. I’d also love to hear any of your frustrating stories as you started your practice. Thanks in advance for the support!

I am finally going to break up with simple practice as my EHR, but am hesitant on where to go from here. For therapists who have made the jump, what EHR do you find to be most user friendly? Im nervous about this big change and getting used to a new system, but I feel like they are becoming way too expensive. I don't use AI for notes and don't need or use any of their new features like the insurance "navigator" etc. I have ADHD and hate admin tasks like this, so I truly appreciate any/all insight!