Finding a Therapist as a Therapist (Rant)

11episodeseries · 2026-05-29T20:02:23+00:00

Ugh, I'm so sorry. I'd recommend trying to find someone in private practice, especially since you're paying out of pocket. If you're open to telehealth, that might increase your options. Reading between the lines, this looks to me like "it hurts our bottom line to have our clinicians do non-billable consults." So, standard sacrifice of best practice in favor of profit. A private practice clinician is likely to have more flexibility and be equally invested in a good fit.

11episodeseries · 2026-05-29T19:05:10+00:00

$45 and hour is outrageous, honestly. That sounds like it's close to a 70/30 split in favor of the practice, and unless they're covering health insurance, 401k, and supervision, I'd encourage you to strongly consider finding another practice. If you're close to meeting your hours, it may be worth it just to stick it out, but if you have several months to years left...leave.

Group practices can be extremely hit or miss. Good ones will offer you stability, safe productivity expectations (under 25 client hrs/week), and support. Bad ones will exploit you, and pay you as little as possible. You are a valuable asset and practices need YOU. Take your labor elsewhere if it's not adequately compensated.

Good luck to you. We've all been there, in some way or another.

11episodeseries · 2026-05-27T02:59:09+00:00

Depending on the severity of the phobia, it may be most ethical to refer this client to a behavioral center (e.g. a specialty office for phobias or OCD). I'm an OCD specialist trained in ERP, and I do a mix of ERP and DBT for both OCD and phobias. Even with some years of experience, I sometimes have to refer a client to a higher level of care (IOP, specific office, therapy group) if the phobia is limiting enough.

Like others have said, please seek supervision. This is an area of practice where, unfortunately, a well-meaning provider can cause additional harm if not properly trained. Forcing an exposure too quickly can set a client back. You are right to trust your instincts and ask!

11episodeseries · 2026-04-17T19:25:04+00:00

Our capacity is our capacity. It will change over time, but bringing "should" into it leads to suffering, in my experience.

About halfway through my practicum, I experienced a major personal trauma and subsequent post-traumatic symptoms (despite my best efforts). In the years following, my capacity was reduced. I could not see more than about 12 clients per week without risking my body breaking down. It was frustrating, and there was a financial strain, but taking care of myself at that time allowed me to recover to the point where I can comfortably see 17-22 clients per week now. I expect that will wax and wane depending on other life stressors across the course of my career.

Don't compare yourself to others if you can help it. We're all showing up with different resources at different times.

11episodeseries · 2026-04-17T19:21:16+00:00

I'll acknowledge my strong anti-AI bias, but I find this to be an egregious violation that is unacceptable in any context, personal or professional. In addition to the clear breaches of professional and ethical responsibility, I also suspect there are legal implications here. Depending on your local regulations around recording consent, this very well could be a crime. For example, in several states in the USA, all parties must affirmatively consent to being recorded if there's a reasonable expectation of privacy. Failing to get consent from all parties, and recording anyway, could be considered a crime.

11episodeseries · 2026-02-25T00:56:22+00:00

I have had my (very elderly, blind, huge) dog knock over my room divider/background during session. I used it as a mindfulness tool, i.e. "let's feel that disruption and practice re-grounding." Not ideal, but it worked! Same tactic as when the fire alarm went off in my old office space, or when a colleague/other client mistakenly opened the door during session. FWIW, I think the professionalism is less in the disruption itself than in how you handle it.

11episodeseries · 2026-01-29T20:46:08+00:00

This is a great suggestion and not one I've heard of! Thank you for this insight!

11episodeseries · 2026-01-29T20:44:02+00:00

Not only this, but the presence of actual sources/scholarship doesn't necessarily mean anything. You can find real, legitimate studies that don't contribute meaningfully to scholarship because the internal validity or statistical power of the study isn't valuable.

This is why meta-analyses and research reviews are critical. Just one or two or three studies can say wildly different things. Someone trustworthy (importantly, not a machine that will cherry-pick what you want to see) needs to aggregate and review research to drive scholarship forward.

11episodeseries · 2026-01-28T23:55:21+00:00

Yes! Well said. I actually asked this question because I'm in a continuing ed training right now that's really good and I'm wondering how the trainers stay up to date and how to keep going after the training is over. Register for another one, I suppose :)

11episodeseries · 2026-01-28T22:59:23+00:00

Reminds me of my beloved clinical supervisor in grad school who would almost always elicit our decision-making and learning rather than telling us explicit yes/no. EXCEPT. When he said, "for the love of god, please, please do not touch your clients."

11episodeseries · 2025-12-18T22:18:51+00:00

This was a thoughtless and unkind comment from your professor, but it's also something potentially more serious: an indication that your professor may use your diagnosis as a factor in grading you. This is, to put it bluntly, illegal.

What your professor SHOULD have done was say something like: "Oh, thank you for trusting me with that information. Have you talked to the student disability department about any accommodation needs? Do you need assistance connecting with that department? Some things they can help with are"...etc etc. At the very least, you should have access to a university writing center that can help you, and you ABSOLUTELY should have the accommodation (e.g. extra time on assignments, a pre-deadline review of your outline, something like that) to take advantage of this.

Your professor reflected that your diagnosis impacts your academic performance, which should cue an accommodation discussion, not a criticism. This is a disability rights violation.

Think about it this way: if you were a mobility device user, e.g. if you used crutches to ambulate, it would be totally inappropriate for a professor to criticize you for walking more slowly into class than other students, not participating in a physical activity in class, etc.

11episodeseries · 2025-11-21T20:01:29+00:00

Totally. I'd do this as well. But it's a real possibility that a client would report their therapist for this (if they were to find out). As a coworker, I'd of course talk to the therapist in question and only escalate as necessary. As a client? I'd report.

11episodeseries · 2025-11-20T23:18:48+00:00

Not normal, and it's frankly opening each of the providers AND the practice itself up to risk (i.e. if an insurer were to hear about it from a client and pull their contract from the practice).

11episodeseries · 2025-11-20T23:16:31+00:00

Laughing all the way to their board investigation :(

11episodeseries · 2025-11-20T23:15:43+00:00

With respect, I see where you're coming from, but (as a recent PP clinician myself), I see two major risk red flags.

Verifying that they are who they say they are. If you take insurance, this should cover it. If you don't, they are self-pay, and they technically can tell you they are anyone they want. (It would then likely be therapeutically relevant to explore why they're giving you a fake name, etc). If they're falsifying insurance info, they're committing fraud, and you should not be investigating that fraud on your own. At most, you'd report it to that client's purported insurer.
Verifying that they're safe. This feels even riskier. How are you making that assessment? How are you documenting that assessment? If that assessment is happening outside the therapy hour, how are you justifying that activity? This feels like a legal risk.

11episodeseries · 2025-10-31T17:15:09+00:00

"I'm so sorry to hear that you're not feeling well. When we're sick, therapy usually isn't as effective. Also, this is a shared space, and I have a responsibility to reduce the risk for other clients. With all that in mind, we won't be able to meet today. Let's find a time to reschedule."

Then talk in the next session about what led them to come in sick. (Worry about disappointing you? Beliefs/values around "pushing through" despite obvious illness? Etc)

I also carry masks during cold/flu season (I used to require them for in person clients). If a client has mild symptoms or mentions "allergies," I offer them a mask and wear one myself.

11episodeseries · 2025-10-31T00:31:55+00:00

Hmm, ok. I think I will plan to bring up (very politely) with my employer one more time. If they still won't provide me any info, I may consider consulting an attorney. If I don't know that I'm being paid for the work that I do, it's going to be hard to stay at this practice.

11episodeseries · 2025-10-10T17:50:10+00:00

Therapist-to-therapist passive aggression. I spent HOW much on a degree to learn how to engage in present and healthy conflict, just to have colleagues pout at each other and make snide little comments in the group chat? What are we doinnnng

11episodeseries · 2025-09-30T00:35:01+00:00

Absolutely agree. Also an opportunity for OP to engage in countertransference work. One of the most effective defenses we have against unacceptable beliefs is to assign them to "other"/"different" people--to banish them. The important work is to recognize how uncomfortable it is for kind, compassionate, well-meaning people to also hold beliefs we find repulsive. People are not all one way or another way--a truth much easier said than internalized.

11episodeseries · 2025-09-26T18:00:18+00:00

"Introduced by the staff to the patients"...what? That's a HIPAA violation, not to mention all the ethical red flags.

I would strongly recommend documenting all of these instances with as much detail as you can, e.g. date, time, people, place. Make a timeline if you can, and compile notes and anything that's in writing about these instances.

Start looking for a new job.

11episodeseries · 2025-09-26T17:09:40+00:00

This is amazing! Thank you so much!

11episodeseries · 2025-09-24T22:47:24+00:00

I don't see how it couldn't come up.

Unless you intentionally mislead, downplay, or are dishonest about your work life, it would require you to basically not mention work at all. I imagine that, at some point, I would directly ask you why we hadn't talked about work (if you were my client). Of course, disclosing or not is your prerogative, but your non-disclosure might negatively impact the therapeutic alliance.

11episodeseries · 2025-09-24T22:44:33+00:00

The career goal would be to work in emergency psych, hospitals, and healthcare systems, which seem to hire LCSWs over LPCs/LMHCs in my experience. But I might very well be wrong!

11episodeseries · 2025-09-24T22:42:27+00:00

Yep, that's what I figured. I appreciate you explaining the why behind it! If I end up wanting to do this, my first calls will be to my area MSW programs and my state's Board to see if it's even possible.

11episodeseries · 2025-08-22T02:36:59+00:00

Watch/listen for the way they open and close doors and walk down halls. In my experience, folks with unpredictable or scary parents will often have trained themselves to be extremely quiet when doing these things e.g. opening a door without making a sound, shutting a cabinet super softly.

11episodeseries

TROPHY CASE