I currently am in private practice and I can’t see myself going back to community mental health or hospitals. I have worked in both and really wanted to stick it out for pslf but I just couldn’t, case loads and acuity was too high and I was exhausted and burned out wanting to quit only a year out of grad school. I have a lot of respect for those who work in those settings and make it work but for me I just couldn’t. I do make more in private practice but it’s far from enough, it really does highlight a ton of the problems with the healthcare system in the US.

I got into this field after going through a rough time from 17-20. Was discovering childhood trauma, attempted suicide, stuck in self destructive patterns, got raped and then attempted again before I finally decided it was enough and I was ready to put in the work for myself. The therapists I worked with were life saving and I still have them to thank for supporting me in the lowest points in my life. Once I was out of that funk I graduated college and decided to go to grad school for counseling so I could be that person for someone else.

Hmm, probably the emotional toll it takes on me. I’m naturally an empath and emotional, so sometimes it feels like everything is so heavy and I’m barely holding myself together. There are times when I can’t get a certain client/story out of my head and it can really dampen my mood.

I’d say the other hardest thing is having to terminate a client when I believe they are not a good fit for me or need someone else in a different specialty. I’ve had a few really resist this and try to persuade me to “let” them stay and it is hard not to feel bad for referring them elsewhere

1. Proud of you for seeking out therapy and good luck!

I have worked with vets and really enjoyed my work with them! I find the mindsets of veterans and active service personnel quite fascinating

1. As far as getting the most out of therapy my best advice is go in with an open mind and ask questions. It’s ok to feel nervous or not want to open up right away - one of the most important parts of therapy is building the therapeutic relationship so that there is a foundation of trust. This takes time!

If there’s ever anything that you are afraid to say to your therapist because it might be too much or you’re worried about being judged - remember that we are trained in a way that is nonjudgmental because if we were there to place our judgments on you, it wouldn’t do anything to help you. And I promise we’ve heard worse/ weirder (;

Also don’t be afraid to ask to switch topics, change directions or ask why you are doing something. I like to inform my clients on how I see the process in my head so that they feel involved in their own treatment. But it is helpful when the client chimes in to ask if we can switch directions to something they feel is more important. It’s their treatment after all.

Absolutely! So many people don’t know what going out alone to just exist around others means because they hold themselves back for various reasons. I think we as a culture also box others out which makes it a lot harder/more intimidating for someone to just approach someone and strike up a conversation. Not to mention so many have a fear of rejection which can stop them from ever trying, it’s kind of a self sabotage loop.

And the internet can give us a false sense of connection when in reality, it’s just not the same as being with others in person.

If billing through their insurance, I HAVE to give a diagnosis otherwise insurance will not pay. There are plenty of people who are dealing with general lifestyle problems or job stress that don't meet clinical criteria for most diagnoses, but there are also diagnoses that can be given that don't indicate a severe mental health issue. Adjustment disorder is a big one that I use often when I am first starting to work with someone but they don't quite meet clinical levels of distress, anxiety or depression. There's also unspecific depressive/anxiety disorder where their symptoms align partially with MDD or GAD (most popular diagnosis) but not all the way. I personally hate diagnosing and believe the system we use to diagnose is highly flawed for many reasons, but I do it for insurance purposes which unfortunately rules how I can practice.

It's hard to say as I think the advice would different depending on what you're looking for.

If you're struggling with guilt and shame around the attraction, work on practicing a nonjudgemental stance towards yourself and remind yourself that judging ourselves doesn't actually help us.

Find support groups, online or in person, to have a safe space to discuss what you are dealing with. This topic is so highly judged and stigmatized that finding some relief and connection with others can be very helpful.

Fear is what stops a lot of people with pedophelia from seeking out therapy because of the fear they'll be reported for even having thoughts. Thoughts are not reportable, we can only report if we feel you are a risk to yourself or others or if there is active abuse occurring. If your worry is that you would be tempted to offend if you are around children, yes this might raise alarm bells in the therapists head but if working with someone knowledgable on the subject they should know how to navigate this without reporting you.

I can definitely see where you're coming from here and can't deny that I've seen this as well. To me, the most important part of therapy is the therapeutic relationship and finding a good fit between client and therapist. This doesn't always guarantee that therapy will be productive, but it certainly helps. I personally thing graduate school trains us in such broad, general contexts that we really fall back on the empathy and validation when we might not fully be sure where to go next. Our internships are where we learn specified treatments but even then, some are not very thorough. For me, I always have a running list of topics to look up, books to read, articles bookmarked, continuing ed classes I want to attend...but by the end of the day I'm exhausted. It's unfortunate because I know I want to learn, but with a large caseload and a full waitlist and everything that comes with managing that...I just don't have the time to expand my clinical knowledge as much as I'd like. Not trying to make excuses for us therapists, just giving some insight into what I experience (:

That’s a good question! Depends on their goals, really.

If they are afraid of sex as a result of the trauma they likely need to process it with a therapist. If after that it is still a problem, working with a sex therapist on reconnecting with your body and sexual side might be best.

Yes, not very often though. Most have some sense of something happening though they can’t say what. Some are also just unaware certain experiences were considered traumatic until I tell them it was

Ugh the dreaded CPS calls, honestly I get nervous anytime I have to do it still. Best advice someone gave me on this is that it is your job to report it and THATS IT. CPS handles it from there and it may not even be investigated, things get screened out all the time sadly. I also am very blunt in my informed consents about my duty to report and what this might mean/look like. I also involve the clients parent in the call if at all possible. I’ve had parents take their kids out of therapy, teenagers get angry at me and some never come back. It’s hard, no way around that.

Hard? Hmm I think the internal work I had to do on myself was harder than anything. The skills and counseling came quite naturally to me though I had been through quite a bit of my own therapy. But working on your own biases, dealing with transference/countertransference, and staying non judgemental is a constant thing you have to work on. My best advice is find a good supervisor who you feel comfortable sharing whatever questions with, big or small. It made a world of difference going from a supervisor who I was afraid of being judged by to one who I literally can say anything to and know he’ll support me.

Needs more research but it sounds promising!

I think it means exactly what they meant it to - contact them to schedule an appointment when needed because they are confident in you to manage on your own and know when you might be needing extra support.

Most therapists have a waitlist and need to clear up space every once in a while. This isn’t them abandoning you or cutting you off, more likely it’s them feeling you’re doing a great job but keeping the door open for the future.

Hmm that’s an interesting question! I’m gonna go with learning and practicing a non-judgemental stance towards yourself. That way you can try things and even if they don’t work out you don’t immediately turn into judging yourself or knocking yourself down for failing.

I think when it comes to those people it’s good to remind yourself it is not your responsibility to make them see it. Every time you bring it up to them it is planting a seed…it may take a while for them to realize it though. Flowers don’t bloom the same day you plant the seed.

Look into dual licensure in your state - as a school psychologist you might be eligible for a counseling license with minimal extra training/supervision. I think it could be a decent side gig but you’d likely have to do private practice to make it work on your own schedule. It also just depends on your own lifestyle and balancing it all.

I have a home office and an actual office I go into most of the week. Personally after Covid I kind of despise Telehealth unless necessary, I just don’t feel like I’m the best I can be online vs in person.

And while traveling while doing some sessions on the side sounds appealing, check your state laws and requirements. In my state both me and the client have to be in that state at the time of services.

Oh god I hadn’t heard of people claiming to be getting actual “therapy” through TikTok..I’ve seen my fair share of therapists on TikTok that provide educational videos and such, but I do think there are some who take it too far in terms of misusing the place of privilege we hold as therapists. We have to be careful what we say especially on public platforms because people see therapist and automatically think what we’re saying must be accurate or helpful or whatever. It’s not always the case. I know a lot of great therapists, but I also know some pretty bad ones too…

I do not believe you can get the benefits of individual therapy on tik tok and would feel confident debating that with anyone lol

Ha thanks I do try to!

Well I’ve only been practicing since 2018 so I’m not sure I can speak to the clients from previous decades other than from what I’ve read in case studies and such. Obviously I saw a huge switch in focus once Covid hit, it’s all anyone talked about…the fear, the isolation, losing loved ones without being able to say goodbye. It was extremely difficult to try to support people through a time where I too was scared and had no more answers than anyone else. As you can probably imagine social media really has impacted people, we’re constantly finding more ways to be connected online and get more information. This year I’ve had a lot of people talk about the election and what it might bring. I’d say overall from 2018-2024 I’ve seen more clients (especially young adults) pathologizing behaviors that are “normal” (I don’t like to use that word but its what fits in this case). I think society is getting better in terms of being more open about talking about mental health, but that doesn’t mean every little quirk, preference, or pattern of thinking/behavior is diagnosable or a symptom of a disorder

For me it’s depressive disorders, especially when it’s treatment resistant. Depression is constantly working against the person and it’s just such a hard thing to pull yourself out of. Sometimes it feels like I’m working with a brick wall and nothing gets through to my clients. Plus, they have to do the work outside of session to implement what we talked about but that is just so hard when you’re depressed. I can’t make them do anything, they have to want to change and want to get better.

I don’t consider myself a specialist in any area except sex therapy but that is because I have done extensive training and extra education to learn it. I like working mostly with anxiety, grief, ambiguous loss, and trauma responses.

Yeah it is hard! But it is the ethical thing to do when I feel I can no longer work with someone or give them the care they deserve. It sounds really cold and heartless to them sometimes, but it is what it is

That's a great question. A lot of it can be determined through body language and nonverbal signs. Seeing how they react if I question something about the story or point out a small inconsistency. People who just have poor memory won't feel guilt/shame around it but a lot of the times someone who is actively lying and trying to deceive will have this unexplained sense of guilt. There's no one way to do this and it certainly takes a lot of time.

I take a fairly direct approach with my clients and explain how frustrated I am with the system along with them. I try to offer lower rates for cash pay so that if they are able to we can cut insurance out of the picture. It sucks when insurance stops paying or denies more sessions.

absolutely. I enjoy bringing out the DSM in session and going over criteria with clients. I think it can be really helpful to help them understand all that goes into a diagnosis and why they do/don't get diagnosed with something.

If what you are referencing is adjustment disorder then yes, that is a valid diagnosis coming from reactions to a major life event or change.

I believe I averaged 22-24 clients a week when making about 55k. I was in a group practice where 45% of my billings was given to the group practice and I took home 55% of them. So if I was reimbursed $100 per session, my take home would be $55.

My contracted rate at that time with insurance was $200 for an intake assessment and $150 for a 53 minute therapy session. Each reimbursement rate different by insurance, ranging from the lowest being $68 and the highest being $132. I had a few cash pay clients which I would charge $110 for, which some clients with insurance would opt to do because that was cheaper than their actual copay due to ridiculous deductibles.

I have been in therapy consistently since college for my own mental health concerns and to have my own space to let it all out. For me it is a necessary part of taking care of myself so that I can be a good therapist for others!

Yes, usually I build up the trust and rapport just like with any other client while keeping an eye on any inconsistencies in their story/symptoms. If I get enough "evidence" I will confront them about it (in a very gentle way so I don't scare them off). This is quite precarious cause if I am wrong, it can be extremely damaging to the individual and their perception of trust.

Oh yes, biggest one is the way health insurance works in America and how they get a say in how much treatment a client is allowed

So sorry for you experiences. I have worked with individuals recovering from RA, not necessarily torture though. And yes I have worked with those who are fragmented, it's incredibly delicate work and takes a lot of time, trust and patience.

So h happy you've found a great therapist (:

I do not practice EMDR (the training is too expensive for me to afford right now) but I refer clients to EMDR professionals all the time and they do amazing work. I tried EMDR personally years ago when it was a more novel approach and it wasn't my thing, but that's how it goes for any treatment is it is not going to be effective for everyone.

Yes I do! I have consistently seen a therapist since I was 20 and decided to turn my life around. I see mine every other week and am on a mood stabilizer and anti anxiety meds. Therapists need therapy too!

Can you elaborate a bit? Therapists reject you because they lack the experience in what you’re dealing with?

Yes I’ve struggled and still do with my mental health. I explained it in more detail in one of the comments above if you’re interested. But my own process certainly helped me understand the importance of what we’re taught in school. It was pretty bizarre to talk to some of my cohort members that had never been in therapy themselves, I thought all of us would’ve been lol.

I got my BS in psychology (4 years) and my MS (2 years summers) in clinical mental health counseling. After that I needed 3000 hours of experience under a supervisor (took me roughly 1.5 years) and then I was finally fully licensed. It sounds like a lot but it all makes sense once you’re doing it. I did this all consecutively, though looking back I would’ve taken a year break between undergrad and grad school to work and save $$.

I still have days where I question if I can do this anymore, I day dream about jobs you can go home from and completely detach. It’s hard, but you figure out how to manage it all and I still go back to work every day cause I care about my clients and know my own thoughts questioning if I can do this aren’t reflected in reality because I am doing it

Goodness what a terrible situation I am so sorry.

Assuming you haven’t already, get in contact with a lawyer and see if there is anything you can do to get some of this back…I can’t imagine there isn’t some way to get him to fork something over. Also look into free law clinics around you, they are usually run my law students for free just to help give advice.

I’d also seek therapy if you can, find a space to be able to let out every thought and feeling you have about this. Bottling it up won’t do you any good. Stay connected with your support system in every way you can and don’t be afraid to ask for help

I think I know what you mean, and from my perspective it’s a lot easier to ignore your own faults when deep down we have a sense of insecurity that someone might find them out. A lot of people are afraid to do the actual work and look at themselves in a realistic but critical sense. It’s very hard to admit we are the “toxic” one or the unhealthy one.

Can you elaborate what that is?

I have lots of conversations with clients about things they hear on TikTok/online and breaking down how pop psychology is not actual psychology…if that’s what you mean?

Oh yes it does, but it’s gotten a bit easier with time and practice. I have a pretty strict end of work routine that helps me decompress and leave my work at work. My 20 minute drive home is my time to think through anything that is still lingering and then once I turn my car off I need to put it away until I work next. Sometimes I drive extra laps around my block to have more thinking time. If I get home and it’s still in my head/can’t let it go then I will journal and do some of my own work to figure out what is making it so sticky. Then usually talk to a colleague about it for support (:

yeah those kind of larger philosophical ideas can be helpful for some but I too get a bit overwhelmed by them. I think it puts pressure on us to achieve this higher state of being that (for me at least) feels almost unreachable most days.

You're totally fine asking for a bit of advice on how to navigate this all, I'm happy to share my thoughts or perspectives in hopes it helps you even a little bit!

haha oh, yes I do love my job! It's not easy, there are days/weeks where I question if I can do this for the rest of my life or if I am even good at what I do. But overall I am fulfilled by it and seeing client's success always warms my heart! I keep a journal with the kind words that clients have said to me about how our work together saved them or changed their life. I re-read those comments whenever I'm feeling down about work.

Totally fair, I think some of it is the therapists own pride in not wanting to admit they aren't able to take on every case. We too want to be seen as capable so it is vulnerable to admit that

Secrecy as in remain anonymous? Not that I'm aware of. Technically no one has to know you are in therapy (assuming you are an adult) besides you and the therapist. If you are worried about the therapist judging you, don't feel pressured to tell them about this stigmatized problem you are experiencing right away. Take time to build trust with them, let them get to know and understand you, and then when you feel comfortable explain how you have a concern about something you are dealing with but are worried because of the stigma or possible judgment around it. Remember it is not our job to judge you for anything you share with us, if we did we wouldn't be able to effectively help you.

Yeah that's not uncommon. I myself am diagnosed bipolar I and manage with medication and therapy, but it took a long time to realize I needed it. Don't try to convince him when he is hypomanic, it won't make sense because it does feel so good. Once the hypomanic episode is over, try to acknowledge some of the consequences of it (like missing school/work, impulsive decisions that have consequences, etc.). Try to stay away from problem solving those consequences for him, even if it is hard to see him struggle with it. You don't want to enable the behaviors by always helping him clean up the mess he made (even if it is a result of untreated bipolar)

yes I have

That's hard, honestly I would be encouraging you to practice boundary setting if you feel that what they are telling you is too much for you to handle. You are allowed to do that and honestly holding that boundary can help them realize that the things they are sharing should be addressed with their therapist. Even if they go to therapy and say "my friend isn't willing to listen to me anymore" the therapist should dig into that and try to figure out why that could be, hopefully leading to the topic.

hey that's what I'm supposed to say! lol

Look into different nonprofits and organizations who do things to support adults with ADHD. I've had a lot of people find this one in particular helpful: https://chadd.org

Online tools to help stay organized can help as well. Goblin tools ( https://goblin.tools ) was created by neurodiverse people for neurodiverse people. It has a bunch of different tools to help organize to-do lists, help you break down tasks into smaller chunks, etc. I use it regularly and show my client's it as well!

I mean there are studies on the long term effects of stress on the body, I'm sure there is even more specific information out there as well. I often think about how a lot of mental health disorders impact our ability to meet our basic needs which in turn effects our physical health. Plus, the body and the brain are connected so it would be hard to argue they don't impact one another!

I'm guessing the typo means "won't medicate for bipolar"? That's a tough one, I personally believe the best chance at managing bipolar is the combination of medication to keep mood stable while also working in therapy to learn skills on regulating emotions, learning warning signs to manic/depressive episodes, and working on sustainable healthy habits. That's not to say that therapy alone won't be useful, it is just a lot harder when dealing with manic/depressive episodes at their full intensity

That you get a say in your own treatment! Ask questions like why are we doing this? what's the purpose of this activity/homework? can you explain to me what this helps with? You have every right to know what is going on and the course of your treatment. If the therapist isn't willing to explain it, I'd be concerned. Along with that, if there's ever anything that your therapist says that makes you uncomfortable or strikes a nerve, please tell them. It's not gonna hurt their feelings and it is really helpful for us! Remember that therapy is typically 1 hour a week or every 2 weeks...the majority of the work you will do is outside of the therapy office and that is on you. If you aren't seeing the desired changes/progress, ask yourself if you are actually doing the work outside of session to practice the skills and reflecting on whatever you're working on. Good luck!

I mean I am human so yes, sometimes judgements come up during session. We're trained on how to work through our own judgements though so that it doesn't interfere with treatment. There have been a few very specific circumstances where I have voiced my judgement as a way to help the client gain insight into how they may be perceived...this is not common though

I don't view it as too fucked up to fix, but I have had clients where it was extremely difficult to work with them for a variety of reasons, some of which they were in control of and some they were not.

I'm familiar with the light and dark triad traits, though I don't quite know what you are referencing in terms of transitional disorders or adjustment therapies?

hey there! The idea of a career change is always gonna be intimidating but we only live once and if you feel drawn to it I would go for it. In my grad program I had multiple people on their 2nd, 3rd or even 4th career and the oldest person in my cohort was 75! It was so fun to learn from people with different life experiences and what perspectives they would bring to the discussions. Seriously, I think it's wild for anyone to expect to do the same thing for their entire life...like come on! There's so many interesting things!

While I agree that the 2ish years of school and 2ish years of supervised experience sounds intimidating, it went by so fast for me. There isn't really a way to shorten the time it'll take, but my best advice is make sure you have a supervisor who you feel you can trust and that understands and respects you as a human being AND a therapist. This made the world of difference for me.

Straight out of grad school I made about 55k in private practice which to me was competitive for the area/state that I'm in, just to give you some perspective. Comparatively I was offered about 45k salary in a hospital setting, 38k in a community mental health role. They all have their pros and cons which I can elaborate on if you'd like, but this is just my experience.

Honestly, getting to be fully licensed is a lot of work and there's no way around that. And even then, you have to get a certain number of hours of continuing ed every 2 year licensing cycle so the work never stops lol. You're signing up to be a "forever" student in that sense, but I found everything so interesting that it motivated me to do the work, you know? Plus, all the stress, tears, frustration, and questioning your own capabilities ends up being worth it when someone tells you that you saved their life or that you helped them turn their life around. Those moments are so rewarding and I still cherish every single one of them, so much so I started a journal where I write those things down so that the days when I'm not feeling the best or I've struggled, I can remind myself that I can and have done good.

I suppose it depends on who you ask because some theoretical perspectives believe personality is set in stone when we're born and some say we can control it and change it ourselves. I tend to fall closer to the side of we have some ability to change it but not completely. Unfortunately there has been a large trend of pathologizing "normal" behavior especially people labeling others as narcissists for what they perceive as self-interested behavior. There's nothing wrong, clinically speaking, with being excited after a presentation or daydreaming about success...honestly it makes me happy to hear you experience this!

I’d probably work in some psychoeducation about attachment theory, assign some reading and see if either of them related to anything in the reading. Ideally they would recognize their own behaviors, but it would be more likely they’d point out how the other is acting/behaving cause it’s easier to recognize. Then I’d have each of them sit with that and probably dig a little deeper into the validity of how their partner perceives them in hopes they would be able to recognize it in themselves

After looking her up and reading a few things very briefly I would be referring her to a higher level of care, residential eating disorder program perhaps before starting any work together.

No, I have a waitlist

Ok gotcha, I think bipolar and anorexia are two diagnoses that therapists get a bit nervous around if they don’t have specific knowledge in that area. Yes there is always a first time and that’s how you learn, though they may assess you to be a higher risk case which would discourage them from learning as they go with you. Again, this is just my thoughts I don’t know if it is actually true.

The other thing that comes to mind is just the fact that your case does sound heavy at first glance. Most of us are over worked and exhausted which can make us shy away from opportunities to learn more about new disorders and treatment methods. This isn’t because of you, it’s because there is far more demand for services than we are able to provide.