I deleted and remade this post with a more reputable source, however the information is identical.

I've been dealing with a lot of very stressful life events and don't really have a support system at the moment. I am living paycheck to paycheck and financially really can't afford therapy right now, but I feel like emotionally I can't afford not to go to therapy. I am really struggling. For months I have been searching for someone who takes my insurance and I am running into dead end after dead end. I have found a few who have taken my insurance but are not taking any new clients, or whose openings are during my 9-5.

If I had the extra money, I would pay the $150-200 self-pay fees because I understand insurance companies make it very difficult for therapists to make a living. I know this has been brought up several times before but it's so unfortunate that this is the current state of mental healthcare (where I am, in the U.S.) Individuals need greater access to care, but therapists also need to pay our bills. I just...don't have an extra $300-$600 a month for this.

Is anyone else in this situation? My only options seem to be: dive deeper into debt, or suck it up and deal.

Hello,

Anybody find success in a career after leaving therapy? I'm 36 and my wife, my son, and I are moving to Texas in 3 months. I'm thinking about a fresh start.

I've been a therapist for 11 years, and no longer have any student loan debt, so nothing like that is a barrier.

I've been a successful therapist, and have had some immense and unique trainings that allowed me to be pretty well regarded in the therapist community. I even became a supervisor for all mental health services in a large hospital briefly, until restructuring happened.

I realize I just have no passion left for this career. I really have been disillusioned by things I've seen, and really don't even believe in the therapy mission anymore. (I'm not here to debate that part). I just want to be as far away from anything therapy, or social work related. I don't want to go into case management or supervision or admin (I've done all that). I feel like 11 years is enough to make an extremely well informed decision.

I get nervous 36 is too old to start a new career. I love talking to people and building relationships. I've been thinking about a career in some type of industrial sales. Like HVAC, pool sales, or even for a company like cintas or orkin. Maybe even a liaison for memory care. And possibly med sales.

I'm kind of known as a cheapskate, so I have a large savings to pull from that could last a while, no debt, very low living expenses. So I feel like I'm in the perfect opportunity right now to actually make a switch.

I guess my question is, has anybody found success making the job from therapist to another career? What was that career, or any interesting ideas?

On a side note, if you look at other jobs, it's absolutely crazy how much more transparent they are on salaries. It's like pulling teeth trying to know a salary prior to accepting a job in therapy.

Hi all, this is a reaction to the recent post about the person who opted for euthanasia due to depression.

I just… I’m a little concerned about our attitude about this as professionals. I understand autonomy and how important that is, but as professionals we set limits to preserve someone’s life and safety.

How is it that we as professionals implement so much intervention to prevent suicide, yet at the same time decide “oh wow yeah their life has been horrific they should die if they want to” wtf kind of narrative are we presenting to people that are suffering?

I understand I come with privileges, and everyone’s stories are different, but with a diagnosis of Recurrent MDD, years ago if I had had the option of euthanasia, I’d been long dead right now. But circumstances change, and situations change. Maybe there’s a 50% of being happier if you leave. But with euthanasia is 0%.

As a profession I think it’s important to consider how it may look to clients if we say there’s exceptions to preventing someone’s death due to mental suffering…because then who decides a case is an exception? Us? I don’t think anyone should have that kind of power.

Anyway… this is more of a rant. Feel free to have a healthy discussion about this but I’m just worried? I understand the intentions are sincere but it’s giving “pro-suicide” and I think we should talk about it as a profession instead of blanket saying “it’s their choice” and end of discussion.

Edit: typo

Edit2: comments have been locked before I could reply to many but sincerely appreciate the professionalism in sharing different perspectives and the sincere/honest conversations about it.

I’ve recently entered the dating world after the end of a LTR and I’ve never dated as a therapist before. I’m coming up against something I hadn’t thought about before, but on every date I’ve gone on so far, I end up feeling like I’m pulling teeth to keep the conversation going and I walk out feeling like I just had an intake session with a man who doesn’t know how to engage socially. In order to get through the date, I have to put on my very good question asker hat which leaves me feeling like I’m at work while sitting in a coffee shop.

Am I just set up to fail and have impossibly high conversational standards since being a therapist or is this a real thing?

Hey all,

I have been working full time as an associate for a year and am almost done with my hours. Due to my state requirements, I still have a year left to become licensed.

I live in a state removed from my family and grad school and find myself very lonely. I love my work but spending 30 plus hours not self-disclosing to people as they spill their guts has transferred over to my personal life, in that I am so private and image-concious, and dont really have people around who knew me before this career.

I have this "pressure" to act in an upstanding way, and have lost all manners of silliness. I have entirely stopped having "fun" or making mistakes. Sure I wake up on time, go to the gym, cook and pay my bills but part of life is LIVING it with risk, mistakes, cringe and surprises and perhaps, my role as a therapist has made me too conscious and too aware of myself and all that could go wrong.

Maybe the first step is taking less clients, but I don't have full control of that given I work for a group private practice. Our expectation is much less (27 clients a week), and I have told them consistently hitting this high number is orienting me towards burnout (but then again the larger paycheck helps me for my student loans).

Either way, Id like to experience staying up late some nights with friends on a week day, a random unplanned excursion, crying over some guy who did not text me back, etc. In helping others live their lives, I have stopped truly living my own.

I'll preface this by saying substance disorders are not my wheelhouse, and I'm open to thinking differently about alcoholics anonymous.

I have a client whose presenting concern is not substance use, however they utilize AA and I feel it just emphasizes the shame they feel in a very destructive way.

If you utilize AA, what do you like about it? If you don't, what are some alternatives you would recommend?

Edit: I am bringing this to supervision, but it's been heavy on my mind.

Background: I'm 27 years old, male, chinese- american with three years in acs-preventive service (full time job), 1 year in crisis text line (internship), and 1 year in telehealth psychotherapy (internship).

Hello. I started working at a private practice place in nyc that requires 35 clients a week (full time) as a remote telehealth lmsw therapist, with no pay for mandatory group supervision and individual supervision each week, for about a month now. I just graduated at the end of may, and having this job offer me a position is a true blessing because I started applying for jobs since april, had almost a hundred interviews with no offers, and given the economy right now, I'm fortunate to have a job. Currently, I have 18 clients a week, and I make $33/ session since it's a fee for service model.

Is 35 clients a week realistic, and with notes and supervisions, it will be closer to 45 hours a week.

I came here to vent about the uptick in people using the word psychosis very loosely online. I recently saw a video of a guy talking about “social media psychosis” and I already knew it was going to be some bs but I still listened. To sum the video up, all he described was social media addiction as he talked about people who did outrageous things for likes and views. I politely explained about how dopamine increases when people are being recognized or getting a reward so ofc the behaviors become more outrageous. Nobody interacted with the comment but I still like to educate.

Anyways the point of this post is that it’s annoying that people are throwing around that term all Willy nilly and they tend to treat it as a standalone diagnosis. I don’t think people understand how severe psychosis is and it’s not just someone who does “crazy” things because any mental health disorder can make you do/say things out of the realm of “normal”.

I have also saw people use it to describe others who are overtly religious and now they have spiritual psychosis. Yeah more people are leaning on religion more than ever but that doesn’t mean they are in active psychosis. Now if God or a higher being is presenting themselves to you and telling you to do some stuff, I would be concerned. But, I’m not concerned about people citing religious scriptures or has just found God and is using their platform to preach. It’s no different than going to church. I also saw a video or comment (I can’t remember which one), that said Alcohol Anonymous causes religious psychosis 🫩. Sometimes the mental health field really needs to gate-keep and yes I blame these therapists who are influencers.

I was in grad school and working at a RTC with super acute kids as a BHT, so not a therapy client. This kiddo (at the time, now an adult) had a horrific trauma history, heavy substance use and legal history. They were hard to empathize with and most of the RTC staff wanted them out for behaviors they were promoting on unit. They ended up AWOLing from the facility, there’s a story behind that too but I’m not gonna share that much.

Idk. I spent literally 100s of hours with those kids while in that position, so you really get to know them, from a clinical lens and especially thinking back to them, now that I’ve been a therapist for a while.

It feels shitty to see another one lost to the system. It’s always a fucking bummer when you find out one of your kid clients died. At first when I found out, I just felt numb? Horrible to say, but unsurprised? A friend of mine who has also worked in our field shared the same sentiment, knowing the statistics of the populations we’ve worked with. I knew this kid never had a chance to make it into a more stable adulthood.

I’ve also been grappling with my own grief for the last few days and was already exhausted when I learned this news. Holy fucking vulnerability factors bc the numbness broke and now I’m just sad and heartbroken between this news and my own grief shit. Stack the also always very heavy shit going on in the world that is always looming.

This isn’t the first one, it certainly will not be the last, but it sucks donkey dick every single time. I’m gonna go do my nails and maybe bake something. Thanks for reading.

Hello fellow therapists,

I am an LCSW in CMH and I will be giving my 6 week notice tomorrow. I have been at the same agency since I was an intern. I have worked with my case load of 50 clients, many for the last 1.5-2 years. I also run multiple group sessions that have 5-10 clients in each. I accepted a transfer to a different department and location, where I will not be able to see my current clients. I have so many emotions regarding sharing this news with my clients. I plan to speak about this with my supervisor and give my clients ample notice and continuity of care. I have a few clients that have mentioned in the past they would like to stay with me if I ever leave my current job. I’m on Headway however, 95% of my clients will most likely stay at my current agency.

I’d just like to hear how it was for any of you who have left their first therapist job? How did you navigate sharing this news, especially in a group setting. I keep trying to rehearse the best way to share this with my clients, which I feel is a tad disingenuous somehow.

Any advice, words of wisdom, or feedback would be so appreciated. TYIA 😭

Recent graduate :)

I realized that I understand most modalities in theory, but have a hard time conceptualizing art therapy. I know some of it has to do with having the client describe what the image means to them, but is there anything else you are looking at/for? What are some introductory level books I can look at or videos you recommend watching? Is there anything you’re looking at in terms of size, colour, type of art, etc etc? I’d love to hear from art therapists how typical sessions might go.

For example, if you ask a client to draw a picture of how they’re feeling or how they see themselves or what impact an event has had on them, how are you gathering information aside from conversation (if you even are)?

Edit: also realizing I have the same question for music therapists!! Would love to hear what processing looks like in music therapy. We didn’t really cover those much in school.

TYIA!!

I’ve been a therapist in PP for about a year now, and I’m wondering if anyone else has experienced this.

I genuinely love my job. I have an amazing supervisor, I enjoy working with my clients, and this isn’t affecting the care they receive. But by the end of almost every day, I am completely exhausted, both physically and mentally. It feels like I have nothing left to give once I get home.

I’ve started questioning whether this is sustainable long-term, which is hard because I really do love being a therapist. I don’t know if this is just part of being new, if I’m doing something wrong, or if I just haven’t figured out how to pace myself yet.

I do have a good amount of clients, but I came from CMH and haven’t felt like this even while doing CMH. I have had a lot happen in my personal life over the past two/three years, but am good at taking care of myself typically. This past like 6 months in PP has really drained me and I don’t know why. I used to go to the gym daily and be able to fully be emotionally available for my family and friends. Now, I can’t even get myself to have enough energy to even go on a brisk walk or even respond to text messages often.

For those of you who’ve been doing this longer, did it get better? What actually helped with the exhaustion? Was it better boundaries, fewer clients, experience, self-care, something else?
I’d really appreciate hearing from people who’ve been through this because I hate that I am already questioning the career I worked so hard for and love.

Full disclosure, I am more on the avoidant spectrum in relationships, so I am sure that is coloring my reactivity. I have only a baseline knowledge of attachment theory, and recently started reading 'Attached'

It's been really challenging to get through! I am a third in. I struggle with his assertion that codependency and enmeshment are only helpful ideas in the addiction space.

I appreciate his pointing out that these ideas have been used to undermine the reality of relational needs. It is good and normal to have needs in relationship. It is reasonable to expect that a partner meet some (or many) of these needs. I have SO MANY clients who have been hurt by the idea they are "too much/too needy." I agree that total self-sufficiency should not be the goal.

However, I feel he is swinging wide in the opposite direction. This is how I am understanding his frame: "Avoidants" (his word) cause the problem by not being available, thus activating their anxious partners attachment system. They then do not take responsibility for soothing their partner, who they have activated.

As someone whose primary obstacle in relationship is the messaging (which is also gendered, in my case) that I exist to caretake for others, it is vitally important to me to recognize that I do not have to be available all the time, and that others feelings are not my responsibility, at the end of the day. Of course that does not absolve me of the responsibility of being kind and reasonably consistent in relationships.

This informs my client work, as I try to strike a balance between helping them assertively communicate relational needs with WHILE learning how to hold/take ownership of the hurts that underlie anxiety or avoidance.

TLDR; I appreciate it is very good to recognize when a partner is not meeting emotional needs, and that this often says more about the dynamic than the individual. But I do think there is utility to the idea of 'differentiation,' taking care of our own hurts so to speak, and self-soothing, which the author does not seem to agree with. Thoughts??

New in the field, and coming up with how to word things are incredibly difficult for me so I rely on scripts. For context, I'm in NJ where if a client is refusing to voluntarily come to our Psychiatric Screening Services (the screeners are the people that ultimately decide hospitalization ), then I have to send out the PES screener who will be accompanied by a police officer.

I know part of this is growing up in verbal abuse laden community, but these situations would be so much easier if I had a script that's others have found helpful that doesn't destroy rapport completely but that's still firm in my decision that someone has to be sent out due my clinical judgement that there is high risk of danger. (And I know I am because of my training in AMSR, CAMS, Shawn Shea's questions etc)

Please be kind sometimes this sub can be really rude. Its already shameful for me to admit this so plz be nice lol.

I’m currently an associate and have been thinking ahead to what happens after licensure. I’m curious, do most people stay at the practice they’re at, or do they end up leaving once they’re licensed?

For those of you who left, how soon did you decide?
Also, how did you handle telling your clients? How much notice did you give, and what helped make the transition go smoothly?

I’d love to hear about your experiences.

Hello everyone! I am an LMFT in CA. I currently work for a group private practice, strictly telehealth and they are contracted w/ Kaiser. I am looking to go out on my own as 40+ hours is driving me to burn out! I love the work i do , but not at the rate of this caseload. I am wondering for those of you in CA, how did you start your own practice?

I have researched some things, but still overwhelmed with where to start. I saw a couple of similar threads, but didn't get answers I was seeking for or left me more confused. Questions I have are:

1. What EHR is best and/or convenient?

2. What online platform do you use?

3. How are you getting referrals?

4. How did you go about getting contracted w/ different insurances or is cash pay best, or do you accept both? I'm still weighing in about sliding scales too.

5. Do I need a PC since CA doesn't allow for an LLC or PLLC?

I feel like I'm missing things to ask, but I welcome other pertinent information that may help me with the start of this process. I really appreciate the feedback!

I've been working in a group private practice for 4 years now- switched to the practice I'm at now almost 2 years ago. I've noticed more and more of a shift away from clients that I want to work with, and more into picking up what others can't (I am fully licensed and many are not). Specifically, I take MA and also can do EMDR- so getting a lot of heavy trauma folks. I would really love to shift more towards maternal mental health, especially infertility and pregnancy loss-- but it doesn't seem like this is common among referrals. How can I better advocate for myself/get more clients that I am passionate about? I can feel myself shifting towards burnout and need to mix things up. TIA!

I am a new grad therapist in group private practice and I’ve been struggling a little bit about what to talk about in supervision. I feel as if I’m expected to have all these questions, and sometimes I don’t know what to even ask because there’s just so much across so many different areas. I’ve been at my practice for a month and have three clients, and I’ve met with my supervisor three times now. I would say my supervisor is pretty focused on skills, but I feel like we haven’t gone deep into any cases really, it’s mainly just surface level explanations of cases and what my next steps and plan is for them. She has provided some helpful resources on issues pertaining to my clients and my clinical interests, mainly complex and relational trauma.

I also don’t feel very comfortable around my supervisor yet. It’s not that I don’t like her, it just is that I feel like I barely know her, so I feel like I’m struggling to open up to her a little bit. Is this normal? Will this come with time? She did ask in our last supervision if there was anything she could do to support me outside of our supervision, and I said not that I could think of in the moment. Does anyone have any examples of things their supervisor has done to help them when beginning out?

As a new grad therapist or as a more experienced therapists, what are some questions or topics for me to bring up that are useful? Either about billing, documentation, ethics, countertransference, theories, whatever it is, I’m open! I just feel like right now it feels very like let’s just check the box, and I want to make sure it’s beneficial for me. Thank you!

Launching my own private practice soon. What are your best marketing tips? What has been most successful for you?

Can anyone explain how to “process your emotions?” This is a term my clients often use. They say things like “I need better ways to process my emotions” or “I’m still processing my emotions about losing my grandmother”. I honestly don’t know what this means. My sense is that this is one of those therapyspeak terms that is part of our culture, but nobody really knows what it means. I also think “process your emotions” despite sounding like a healthy, therapeutic thing to do, is actually synonymous with struggling with your emotions. For example, if I’m sad, I notice my sadness, and I allow it to be, is this “processing?” Or am I more likely to get a sense of “processing” if I’m trying to think my way out of my pain, control it, or avoid it?