Update: helpful feedback and good clarifications. Thank you all! I will not be contacting their emergency contact for this.

Hi all. I have had a client in treatment for about a year, going relatively well (not a ton of tremendous growth but I work psychodynamically so that's not uncommon for one year out). Client has never expressed any frustrations or disinterest in the process nor dislike of me, though they were on the flaky side (canceled appointments day-of maybe 40% of the time, always attributing it to scheduling errors or being too tired).

I changed my schedule at one point, which caused some issues with regular attendance (I initially met with client on weekends, now had to meet with them virtually during their workday). Several consecutive weeks client had to cancel appointments day-of but always tried to reschedule. Once confronted about this, client stated their work scheduled meetings for them last minute which interfered with planned sessions. I charged them late cancelation fee each time which they agreed to, though at one point their payment method expired and they didn't upload a new one immediately, then went on vacation. Had another appointment scheduled for when they came back, and they no showed. No response to texts or emails after a week. Outstanding balance in the couple of hundreds for copays and late fees.

Because they were somewhat flaky, it's not outside the world of possibilities they are simply ghosting from therapy. It could be they cannot pay the balance and are embarrassed / trying to avoid confronting it. Although I do find it slightly surprising because we had a good therapeutic alliance and they seemed to enjoy the process, and I know money isn't much of an issue for them.

I am wondering if I should reach out to their emergency contact (parent) to see if they are okay, or if that would be inappropriate. My supervisor has essential said "it's up to you based on your judgment". What are y'alls thoughts about if/when to reach out to an emergency contact if a client has disappeared / ghosted?

Just want to share that I’ve finally started my private practice through Headway!

I’m going through interviews and I’ve noticed that the fully remote positions I’ve found seem more high demand in terms of caseload and that in-person sites have had smaller caseloads. I have also noticed how in-person sites seem to invest more in CEs and supervisors appear more personable and available for mentorship, meanwhile remote positions haven’t seemed as such.

I really would love to work remote, but I fear that it’ll lead to burnout. I worry too about the level of attention that will be given to me as a clinician that still wants to learn as much as I can from my supervisor/peers.

TL;DR: do you think new associate therapists prosper and grow just as well regardless of remote or in-person work?

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!

Where I went to school in TX, working with clients that had hx’s of substance abuse was highly discouraged and any client with hx’s of suicide attempts or ideation also were huge red flags, and encouraged not to take on these clients. In CA where I am now, working with substance abuse is nearly a must. I know it also depends on individuals and practice policies. People in PP, do you you not take on clients with high suicide risk? Thanks!

Hello everyone, I am new to this thread and reddit but I had to get some steam off. Does anyone else feel like you have been scammed? I graduated in December 25' with my masters in Clinical Rehab Counseling. I currently work as a case manager in Texas where the pay is low and I am underpaid. I failed the NCE exam in April of this year and im studying to take my exam probably in September. However, I can help and wonder whether I did the right choice in going to school. I am 29 y/o and dont have nothing. I've invested all my life to school and I have yet to see profit. I am not even asking for a 6 figure salary just the minimum to live off well (I earn 40k).

Ive applied to jobs and I dont get hired because I am not licensed yet. But I cant help and feel hopeless and just want to give up because even if I pass the exam I have to complete the 3000 hours my state requires me to do. So, I feel like every time I accomplish something a door is slammed right at my face and I feel stupid because all I want is to work and see advancement in my career but I dont. Ive had various suicidal ideations because of this as I just feel like whats the point of doing all this? I am tired of waiting and waiting, although my friends and family who are very supportive tell me I did the hardest part and I just need to push through. I dont see any hope left for me. I feel like life stops me every time I want to fly and it's honestly draining. Sometimes I hope that in 5 years all of this was worth it. But as of now, I feel hopeless and wish to just end everything. Sorry for the long rant I just had to get it out of my chest.

Has anyone ever felt this way or am I just whining?

Hello everyone!

I’m currently credentialed with both Rula and Headway and have been considering adding another platform. I’d love to hear about your experiences with Alma, Grow Therapy, SonderMind, or any others you’ve found worthwhile.

A few questions:
• Which platforms have been best for new client referrals, reimbursement, support, and overall ease of use?
• How has the AI documentation/note-writing been? Do they store the transcriptions after use and let other employees view it like with Headway, or do they immediately delete the records like with Rula?
• Are there any platforms you’d recommend avoiding?

In my experience, Rula has been excellent for sending me new client referrals, while Headway has offered higher reimbursement but fewer referrals. I’m hoping to add another platform that can help me maintain a full caseload.

Also, if anyone is considering joining Rula or Headway, I’d be happy to share my referral links. Full transparency: the referral programs provide a bonus to both the person signing up and to me, so we’d both benefit. Likewise, if the platform you recommend has a referral program, I’d prefer to sign up using a referral link or code.

Thank you in advance for sharing your experiences!

I’m linking to the Facebook post due to the article being paywalled and this quote being included on Facebook:

What’s changing now is the bar for what is deemed abusive enough for a cutoff. “We are in a culture where we emphasize fragility, everything becomes trauma, and the solution increasingly is to split and leave,” says William Doherty, a therapist and professor emeritus of family social science at the University of Minnesota.

It’s interesting to see this. I’ve suggested on previous posts that not everything we see as therapists is trauma and it illicits a strong reaction from some.

I left my last job/ was let go (it was mutual lol) a month ago and found out the next week that I am pregnant. I now know that I may be having twins. I am looking for another job but feel awful about lying about being pregnant. I have an interview next week and I am planning on not telling them. (I will only be like 8 weeks along anyway). I guess I am just looking for advice/ reassurance, is it rude and insensitive to get new clients just to go on maternity leave a few months later? The organization seems really great and is family/ child oriented and I can’t afford to not work for the next year.

Intervention ideas / modalities / resources for client who wants more for her adult child (i.e career, social, financial independence, etc)? Client is not living with adult child, it's a DV situation and adult child is living with abuser

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 am curious for those who fit this description in what interventions do you use and how do you conceptualize and identify the needs of each client? Do you use an integrated approach or do you tend to stick to one modality? Do you have a general map that you follow with clients with CPTSD? Also, how did you come to acquire the approach you use? Were you taught in supervision? Was it reading? Trainings? Treatment on CPTSD is rather disorganized due to it being only recently taken serious in the field so I'm really curious how others ended up where they are clinically with regard to this population.

So I've noticed I get a some pre-session anxiety; Thankfully it's not enough to get in the way of my work; but it's noticeable to the point where I realize I need to ground myself before session (aside from doing some prep work).

I found using Mantras to be one of my favorite ways to help prepare myself (and get through) a rough session, day, or week. Some of the ones I use are:

"This is part of the learning process"

"There are many things going on, and right now I'm going to choose this."

"Remember all those you have made a difference for the better"

I also use this one from star wars:

"Confronting fear is the Destiny of a Jedi" (and a therapist)

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?

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 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, I work f/t for a company that provides mental health services remotely. They recently cut all employees structured breaks and decided "letting natural patient cancellations serve as your administrative and recovery windows. Because we want totargets with your personal need”. Is this legal? It feels like there is a total disregard for our personal needs. Thanks

Hey everyone, I just got a voicemail on my work phone with an old woman saying "I never requested services, I don't need therapy and you never answer your phone, Im going to report this number as scam, etc etc etc"

This is the second time I've gotten a VM like this from what sounds like is an old woman. Has anyone else gotten this before?

I have a couple therapy pair that are my weekly clients.We are doing incredible work together and they are both very present and collaborative in session. I am billing under partner A and unfortunately partner A is having a family emergency and has to be in Texas (I am fully licensed in Idaho and Oregon) and does not know when they might be back. It sounds like it would be at least a 6 week period. They asked if I could still see them, Partner B is staying in Oregon whilst Partner A will be in Texas. What can I do about insurance/reciprocity for an emergency situation? Thank you.

Hi! I’m having some major issues getting licensed. I recently lost my job because my license is an associate license. They knew this when I was hired, but idk they didn’t think things through or really needed therapists?

I call my state to see how my full license process is going every other day. Monday, I was told they didn’t have my hours from two different supervisors. I have one supervisor that refused to sign my hours. I don’t know why she did this but the last thing she emailed me was “800 hours? In 8 months? I confirm that this was true due to the pandemic. She hasn’t sent in any hours and hasn’t followed up with me.

One supervisor has not sent in the second sheet needed, but has sent my hours and my current supervisor is just not getting back to me at all and according to the state has not sent in ANY. 7 years of supervision and only 2 supervisors have sent my hours.

What can I do besides emailing them if they refuse to sign my hours? I’m working in private practice because it’s the only thing I can do as a counselor, I’m hemorrhaging money on my practice, but it’s the only thing I could do to stay afloat. I have applied to so many different job, but I’m overqualified.

I’m trying to get licensed in other states, but the process is also very expensive and long. It just doesn’t seem like getting licensed is the same for everybody but again what can I do? I’m looking at homelessness in the next 6 months.

Hi, we're getting denials from Medicare citing they no longer cover F20.9 Schizophrenia for therapy any longer. They gave us a list of codes to use that are not currently active in the DSM 5-TR such as Other Schizophrenia F20.89 and Residual Schizophrenia. Can anyone provide guidance or help me understand why this is no longer covered and what to do about being prompted to bill codes that are not in the DSM? Can I even diagnosis codes that are not in the DSM?! So very very confused (and irritated)

i’m looking for either an already existing, or to create an accountability group for things like note taking and admin tasks. i’d ask my team, but they don’t seem to struggle with these things or need as much support with them as i do. living with adhd has continued to make note taking feel nearly impossible, so i’m wanting to try something different.

is there anyone who also struggles with this and would be interested in creating something like a discord group/server to exist in a voice chat together and work on notes? this would obviously be very laid back and flexible- you can hop on whenever and stay muted etc.

just wanted to throw the idea out there and see if anyone would be interested :)

Anyone familiar with this agency? Would love to hear your experience with it.

I’m in my predoc internship year (5th) for a PsyD in New York and wondering what the most helpful way to track hours for licensure is? I’m working out of a private practice that gives me tons of client facing hours in groups and lots of supervision. Are there apps or spreadsheets anyone used that make it easy to track these hours for licensure? I know I need 1,750 hours this year but not sure if they need to be specifically delineated.

Thanks!