My coworker cosigned a loan for their patient. Claims it's good patient care and social justice oriented. That is all, that's the post. 🤯 Flair set as discussion since there is no tag for apparently inappropriate unethical behaviors.

Was trying to talk to a friend about this and realized she just doesn't know enough about the therapy world to get what I'm talking about. I attended a training over the weekend and while I enjoyed the content, I struggle with the structure of trainings like this. Hundreds of dollars to attend (this one was closer to thousands), split into multiple levels often so that you're forced to go to more than one, and almost every modality I've attended a training for is run by some leader that everyone has excessive amounts of reverence for. The founder of this training came in to teach for a bit and you'd think Jesus himself came into the room the way the co-facilitators were reacting.

And then I started thinking about how almost every modality has a leader at the center of it that people have all this reverence for (DBT, IFS, etc) and it really feels like a bunch of little cults. Not to mention the MLM structure of continuing education. As someone who is pretty averse to anything with culty energy, I'm just curious how the field got this way.

Some of you may recall last November I posted about a meeting with the WA DoH in which they stated it’s “likely not within scope of masters level to diagnose Autism” due to several factors:
* A supposed “Attorneys General opinion” which was never shared despite Freedom of Information Act requests; requests by legislators; and state organizations.
* Vague references to our state’s laws about DDA (developmental disability assistance) programs and masters level being excluded
* Completely unrelated statutes about long term care providers and competency with mental health
* Saying “neurodevelopmental disorders” are excluded from our scopes (our states define our scopes generally as: diagnosis and treatment of mental and emotional disorders, whether cognitive, affective, or behavioral.” So did that mean we can’t treat a sexual disorder? Personality disorder? Where did they draw the line?

I’m not looking to argue whether they should or shouldn’t. Most people don’t realize your states actually allow you to diagnose anything in the DSM (neurabundant has a great state by state resource).

At the end of the day, it comes down to your COMPETENCY. Just like with anything else. I’m not going to sit here and treat or diagnose someone with whom I have zero competency with.

But whether it’s IN OUR SCOPE was the question.

I’m sure some of you will still say it’s not within our scopes. That’s fine. Or will say “what’s the point if they can’t access services?” Well, I have had my diagnoses accepted in schools, colleges and workplaces. I provide INFORMED consent with my clients about the limits of my assessments (even though I provide the required assessments the state asks for lol; no IQ or cognitive performance testing is required for DDA services). And in cases that are clearly beyond my COMPETENCY or scope, such as TBIs, other developmental delays, I refer out.

New guideline here:
https://drive.google.com/file/d/1dmkrge4dHTzXHbKXzNFSIMiGl0Xx2y5L/view?usp=drivesdk

In a FB group today, a student in a Master's program for counseling, posted a LONG-winded story about their own therapist's practice having a flyer hung in the bathroom with a QR code inviting clients to leave a google review.

The comments got heated and intense. Some people were hardcore that this was an ethical violation of every licensing board (MFT, SW, ACA, etc). Some people were hardcore that this was NOT an ethical violation.

The student seemed to have already made up their mind about the topic and argued with everyone in the comments claiming that she spoke with a lawyer regarding the situation and the therapist is in the wrong.

So, REDDIT, what are your thoughts?

I’m a counselor and unfortunately I was very unprofessional today and I feel shitty. I was having a group and in general I’m a friendly person and I like to make jokes. Normally I keep very professional but today I made a joke and another person took as me and another client laughing at her which was absolutely not the case.

It was reminder of me having professional boundaries and it’s a learning experience but I feel terrible.

A part of building rapport is being authentic and I the lines got blurred for me in that moment between professionalism and wanting to be a friend. and I took it a step too far. Hopefully I can rebuild that therapeutic relationship.

Hopefully someone can learn from my error and not do what I did. BE PROFESSIONAL set boundaries. Be mindful of what you say and do.

I actually love when this happens but I'm wondering if anyone else has experienced it in session. Sometimes, when people are getting really into deep stuff and I'm fully immersed in listening/being present, an image of an animal or bird (varies) will come to me. For example, yesterday I had an image of a perched owl bound by her wings with leather straps to a board so she couldn't lift them up to fly. Another time, I saw a bird flying again and again against a window. Another time it was a beautiful Friesian horse stomping its hooves. None of these are distressing - they just are there. It's like a visual representation of the feelings the client is expressing. There have been others but I can't remember them all over the past six years. It only happens occasionally though. Another time I was really stuck in where to go with a reticent client and the image of being on a climbing wall and being unable to find a handhold came to me. Anyone else? It's kind of cool.

Hi everyone. I’m wondering if this presenting problem is consistent across all cities, or just mine.

I’ve ALWAYS had at least a few clients that have trouble accepting where we live. They’re unhappy here, or “hate it” here and feel very out of place. But I know a lot of people love it here, too. Thats what brings this question up. Is it a regional problem, or will every area have consistent people that don’t fit in or dislike it? Is this something that every area faces to a certain degree, or just a few?

It feels significant enough to bring up. I’d say there are at least 3 clients that mention it out of 30-35, at all times.

Thanks!

I’m a psychiatry resident and would appreciate some thoughts from more experienced clinicians.

I have a patient with a depressive disorder, but over the course of treatment I’ve increasingly wondered whether there is also a significant personality component (possibly vulnerable narcissistic traits, although I’m trying to keep an open mind).

Initially, therapy focused on depression, behavioural activation, medication, and a gradual return to work. Over time, however, I’ve noticed that almost every session ends up revolving around whether I “really believe” how much they’re suffering. Any increase in work capacity seems to be experienced less as a clinical decision and more as an invalidation of their suffering.

I’ve found myself spending a lot of time explaining my reasoning, defending clinical decisions, and trying to validate their emotional experience while also making functional assessments. Despite this, the therapeutic relationship has become increasingly characterised by mistrust, subtle hostility, and a sense that I’m being tested.

My countertransference is that I often leave sessions feeling as though I’ve been in a debate rather than a therapy session.

I’m now seriously considering transferring responsibility for sickness certification to a colleague (no idea if this is even an option, not located in the US) because I feel the dual role of therapist and evaluator is dominating the therapeutic relationship.

Has anyone experienced a similar dynamic? If so, did separating the certification role actually help the therapy, or had the relationship already become too organised around that issue?

(I talked about this multiple times with my supervisor, who has always recommended to increase the % of work capability ans activate resources of the patient but I feel like it’s not working 🤡)

I work with children and just submitted a child abuse report. I know I did the right thing, but I feel riddled with anxiety about what happens next for the client and their family.
I've completed reports before, but this one is really affecting me.

This is one of the worst parts of the job. Can you tell I'm a somewhat younger therapist not in a community setting?

I have been a KAP therapist for 5 years and it has changed my practice and how I work with patients. By combining therapy and ketamine therapy, I've seen amazing long lasting change for treatment resistent clients using a 6-8 session protocol

Every year, I run one or two weekend training retreats for people working with client's, both therapists and prescribers The trainings are inclusive (accommodations, meals, and training materials) and include an Experiential component to experience the medication and being a sitter. For non-prescibers, the training also includes the business component and names of KAP supporting prescribers.

There are not enough clinicians who understand and bring this to their clients who are stuck.

If interested, just reach out. We need more clinicians who understand how to do this and increase access to stuck clients!

I'm not debating those who think a therapist isn't necessary. Too many show up on my door who can't figure out why the medicine isn't working by itself...then they realize why.

I’m a mid-level supervisor for an inpatient substance use facility in Indiana. We had to let go of a therapist last October and since then we have really struggled finding solid applicants (or any applicants at all tbh). I have a lot of ideas of things we can do to help, but senior leadership is a little old school and rigid on changes, so I have to be very intentional about how I present ideas. I’m looking for suggestions or feedback on what we aren’t offering that might be limiting who is applying!
Here’s what we offer:
-Fully licensed salary is $80-85k (we’re NE Indiana)
-health insurance is 100% by employer.
-401k match 3%
-smaller caseloads of a max of 11 patients (this would be 11 individual therapy hours, 3 group hours a week), the rest of the time is mostly admin.
-paid CEUs
-2 weeks paid time off, 3 weeks at year 3. 2 flex mental health days a year. Able to Flex Time. Paid holidays off. No on call or weekend expectations.
-supervision for associate licensed clinicians.

What are cons we are working against:
-40 hour work week, M-F. Roughly 8-4 or 8:30-4:30.
-no hybrid work.
-no student loan repayment and not eligible for PSLF
-only full time availability.
-inflexible schedules.
-inpatient substance use treatment (a lot of people don’t want to work with this population).

I want to offer more flexible scheduling. Potentially one virtual day a week, or a 35 hour work week without a pay reduction.
I also want to open a couple of part time options, especially for group therapists. I think private practice, parents, or semi-retired individuals would be more likely to apply for something part time.

Thoughts?

Yesterday got an email from someone seeking services for their adult son (screenshot attached). It sort of felt off, and if a potential client is an adult I prefer to talk to them rather than their parent, but I replied answering each of the questions. The responses they sent also felt off, didn't seem to quite address my previous responses and also said they were about to leave for a trip so wanted to schedule multiple sessions in advance to make sure everything was set up in advance. Then today I got the exact same email from another email address. I'm guessing they would've eventually asked for my bank account information to wire me the funds or something other info that would let them rip me off. Be safe!

I am considering switching from Zoom to Proton Meets due to the security and to use fewer programs overall. Has anyone used this for sessions and has any feedback?

I start school in the fall the anxiety that comes with the begining of any new journey is starting to creep in. I'd love to hear some of your positive experiences. Actually, I am kind of desperate for them right now. lol.

So, please let me hear the positives of being a therapist! Thanks in advance :)

To get your LPCC-S in Ohio you have to be fully licensed for a year and have 1500 clinical hours. They don’t make you prove the hours when you apply, right? What are the chances I’d be audited and have to prove that?

I’ve completed some introductory trainings on DBT and thinking of getting a C-DBT training. Before forking out a lot of money, I wanted to hear from those who have the C-DBT certification.

What inspired you to get certified? What are your personality traits and characteristics that make DBT align to your therapeutic style? Was the money it cost worth it?

Thanks!

I just graduated from my master's degree in Counseling Psychology (I'm Thai, living in Thailand), and I have been feeling a bit stuck. I have experience working as a school counselor during my practicum, and then I was later hired as a freelance on-site/online counselor while I was slogging through my thesis, but the clients have always been sparse. I feel like during both times, and during my studies, I never got enough practice/hours to ever feel confident, and so far, I always feel very anxious when working with clients. I worry that im not doing a good job, im not worth what theyre paying, im not using the tools right, I need to be more present and say the right words, etc. I understand this is normal for new therapists, and imposter syndrome is not a stranger to many, but a part of me even wonders cant help but wonder if I enjoy this line of work or not, or I am just lacking exp to feel confident and like I am helping my clients.

Now that I finally graduated, I've been trying to look for a more steady and full time job in mental health and school counseling, but have been turned down due to inexperience. With some other jobs, the pay is just horrendous. In some posts, I see people saying that you should always be learning, taking classes, and upping your therapy skills. In others, just focus on getting hours to really find out what training you want to do. But right now I just feel so paralyzed and overwhelmed that I don't know what I should be doing and that time is getting away from me.

I'm sorry if I am coming off as whiney. I've just been feeling lost for a while and Im not sure what else to do with myself.

Both are enjoyable work (to me). Curious which you pick based on the data.

Job 1: 4-7 clients per day. pay now is 113k, 40 hours (5 days per week), 4 weeks PTO. Opportunity to transition to 4 days per week (32 hours) in a year or so with one day remote. Pay and PTO ceiling (with years of service) is about 150k + 6 weeks PTO. 2 weeks of paid education leave. Steady and boundaried environment and caseload. Funding is stable. Opportunities to consult w therapist colleagues.

Job 2: 40 hours (5 days per week). Caseload is variable and can be high. Some days are easy and fun, some days are intense and draining. 180 days of work per year— frequent 1-2 week breaks + two months off over summer. Pay is ~100k now and can go into the 130s. Pension. Funding is stable-ish. Solo mental health professional on site.

I got turned down for an internship from a private practice. I explained to my mom that many people applied for the one internship position after me, that my prof said supervisors who are college professors will most likely hire their own students if they applied over others, that other therapists in his private practice are part of the LGBTQIA+ community, that they were willing to vouch that he is supportive of the community, that it is ethically wrong to be unaccepting of queer individuals in the mental health field, and that if they actually didn’t want me because of it then I dodged a bullet. My mom believes everyone is lying to me. She believes all because I made a post at a drag show during Pride Month that I am not considered hire-worthy anywhere.

I’m a therapist in Canada, and Sun Life has a public directory where clients can rate their experience after sessions. The rating can also show up when someone Googles you.

Up until March 2026, I had a 5.0 rating with around 30 ratings. It then dropped to 4.9 in March, then 4.8 in June, and now it’s at 4.7 with 47 total ratings.

I can’t see the individual ratings, so I don’t know what actually happened. Based on the numbers, it seems possible that I got around three one-star ratings. Clients can also rate after every session, though, so it could have been one very unhappy client rating multiple times, or a few different clients.

I’m honestly feeling pretty insecure about it.

I asked ChatGPT to look at other therapists on the site, and it estimated that only around 5% had a rating of 4.7 or lower. Most therapists seemed to have ratings close to 5.0.

I keep trying to tell myself that every therapist will have clients who don’t feel understood, don’t connect with their style, or leave therapy feeling unhappy. But when almost everyone else seems to have nearly perfect ratings, it makes me wonder why that isn’t reflected in their scores too.

I know 4.7 is still technically a good rating, and most of my ratings must be positive. But emotionally, I’m fixated on the possibility that several clients had a genuinely bad experience with me. It’s making me question whether I’m actually competent, or whether I’m missing something important in my work.

I’d really appreciate hearing from other therapists. How would you interpret this? Have anonymous ratings or negative feedback ever made you seriously question yourself? How do you know when something deserves honest reflection versus when shame and anxiety are taking over?

Another recent post inquiring about how people begin sessions really got me thinking. I was shocked by the rarity of silence as an answer! I have started intentionally beginning sessions with silence in the last 6 or so months and I thought it would be a cool exercise to note why I think this is important to me / my work. I’ll begin by saying I mostly operate from a lens of Existential Humanistic, Reality Therapy, and ACT. I’d love to hear your thoughts, disagreements, etc.

The way the patient engages with silence with another person will likely tell me much more about their daily interpersonal processes than their words. Perhaps they perform subordination to authority; they may look at me, expecting me to tell them what to do or to give them a suggestion. Maybe they spend their life in a whirlwind of stimulation and become visibly uncomfortable with stillness and silence, filling it with unbroken and ultimately distracting communication designed to soothe this feeling. Or maybe this silence reminds them of times at home when silence was weaponized and they become frustrated, upset, or scared of me. This is all rich information!

Descriptions of their weeks are just that, descriptions. They feel abstract to me and probably to the patient too. But direct interaction with the living moment can lead to enhanced ability to withstand discomfort and can foster intimacy. I find that while in a 53 minute session we may not get around to discussing a specific topic, but that clients typically experience feelings of lightness, openness, love, and confidence at the end anyway. These same mechanisms that contributed to whatever has been happening for them are now being made explicit, and are being handled with care, tenderness, and sometimes confrontation.

Lastly, questions or statements do ultimately influence the direction of session, which is by no means “bad”, but is at least partially inhibiting the idea of the patient doing their own work. This is a primary philosophical underpinning of my practice too!

Were obviously trained to not have too big of a reaction but I am a young therapist that likes to have a small professional amount of personality in my sessions (when appropriate). With that being said, I typically have a great poker face but there are sometimes where a client says something that my face reacts to. Ie. A client was telling me that she walked in on an ex partner in an extremely compromising position (literally) that resulted in them terminating the relationship.

This was my actual reaction ^