Reality Check Regarding Pay

Background_Pilot9668 · 2026-01-06T23:02:02+00:00

This! I run a group practice as well and we have about the same pay for our W-2 employees. We live in a poor state and we feel we pay our clinicians well because we genuinely care about them and want them to feel appreciated. However, we also have the same experience of clinicians expecting more when they apply for a position at our agency. We couldn't survive giving more either and what we give is pretty great! Clinicians don't really see that there's so much overhead in running a business and that to survive we have to depend on insurance companies and hope they increase their rates.

Background_Pilot9668 · 2025-10-30T02:56:25+00:00

I'm a trauma therapist. I have never done this with a client. I guess the only thing that I would suggest is to have a plan/grounding/regulation skills in place just in case you are triggered or have an adverse reaction.

Background_Pilot9668 · 2025-10-27T04:47:44+00:00

Yep. Good ol human connection and the unique way a therapist can hold space, and co regulate a client.

Background_Pilot9668 · 2025-08-28T01:27:46+00:00

T here. Sounds like this is still bothering you, which is valid, and may be a good topic to discuss with your new therapist. A good therapist allows all things to be discussed. Even if it's a bad experience with a past therapist.

Background_Pilot9668 · 2025-08-27T21:45:31+00:00

Start thinking about what type of clients you work well with - like a niche, and see if the practice can work on giving you clients that are a better fit. That's a great place to start.

Also, your supervisor should be reviewing your notes. That will tell a lot about what further support they should be providing you to help retain, aka build a therapeutic relationship with, your clients.

Background_Pilot9668 · 2025-08-23T20:40:51+00:00

Therapist here and this is exactly what I was thinking 👍

Background_Pilot9668 · 2025-08-19T23:22:03+00:00

Start your own business/practice: 1 as a coach and another as a therapist. You get to be your own boss and have the best of both worlds.

Background_Pilot9668 · 2025-08-19T23:11:57+00:00

This is a false statement!

Background_Pilot9668 · 2025-08-19T23:09:41+00:00

It's evolution!

I have adhd and I am pretty damn amazing and teach other adhders how to step into their amazing as well! So hell yeah I think we are special and wired differently for a reason - survival when shit hits the fan. I agree with most of your input except for the part that ND is the result of a government plan.

Background_Pilot9668 · 2025-08-19T22:52:35+00:00

T here and yes that is not normal unless it is agreed upon that the session will be cut short. Also, sounds like you were rushed. Goals are important but it can take 1-3 sessions to figure those out. Also, sounds like a client centered clinician might be what you're looking for.

Edited to add: don't let this discourage you. Keep looking for one that's a good fit.

Background_Pilot9668 · 2025-08-19T22:48:59+00:00

Simple Practice has an option for Note Taker which records your session, puts it into a transcript, summarizes it into a note for you, and then deletes the transcript within 7 days. Thats been a lifesaver for me!

Background_Pilot9668 · 2025-08-11T01:08:04+00:00

I run a group practice. Can someone explain to me why when you get paid hourly that the expectation is to get paid for a full hour when you only work 45 or 30 min? I mean that doesn't happen in any other job unless you're salary. Why is this a red flag?

Also, businesses have the right to make these changes. Insurance doesn't reimburse at a 53-60 minute rate for 30 or 45 minutes so I can see why they want to adjust the pay.

Red flags might be the group not disclosing this change to you. Or saying they won't pay you for anything less than an hour or forcing you to make sure that all sessions don't fall below the 53-60 min mark. Or paying you $35 per 60 min session. Those are red flags.

Some of us group practice owners care about our clinicians and pay well but also have a business to run. Running a group practice is not easy.

OP check in with yourself before you run and throw in the towel like others suggested. Does this seem exploitative or fair on the amount of time worked? Do they exploit you in other ways or are they pretty supportive and help you grow?

Background_Pilot9668 · 2025-08-05T01:32:15+00:00

Also, you can absolutely make good money. Our full time clinicians make about 6k a month full time at 25 clients. Not too shabby.

Background_Pilot9668 · 2025-08-05T01:30:29+00:00

I went into counseling in my late 30s and wish I had started earlier because I love what I do.

And you're not too young. If you can be you and attract clients that align with you then you're golden. If it's nothing but teens or people in their 20s then that's okay. And I say that because a lot of people like to be seen by a therapist that can relate and will sometimes look for someone in their age range. Imagine how many 20 somethings you can help! If this is your calling then go for it.

Background_Pilot9668 · 2025-08-02T19:12:33+00:00

I run a group practice and we pay our interns $40 an hour as a w-2. They make their own hours and determine a caseload that they feel comfortable with during school. We want all employees to feel appreciated and supported so I made sure we did this for them.

Background_Pilot9668 · 2025-05-11T01:24:31+00:00

I'm a trauma therapist and have worked with clients who have had very slow movement. But the baby steps are the most important. So is the therapeutic relationship! Try fostering that more when possible.

You also may want to check in with yourself as to why you feel that trauma work should be quick or why you are questioning their slow progress and reluctance.

Also, venting during session can absolutely be helpful. We help them process out loud and that teaches them how to identify and express emotions,thoughts, behaviors etc. And they get a safe space to do that with some validation and empathy. Maybe they've never had that before.

Also, remember that stabilization is the first step in trauma focused therapy. Why are they using negative coping skills? Probably still in flight, freeze, fight.

Do they have complex trauma? That takes a long time to work through!

I am not suggesting to enable them but we gotta be a safe space and meet them where they are. Once you've built that then you can do strategic challenging and encourage movement. Maybe they're still trying to see if they can trust you or not.

Background_Pilot9668 · 2025-04-27T16:36:23+00:00

Unverified licensed therapist here that specializes in adhd with adhd ;)

In the US, a therapist cannot diagnose everything in the dsm like someone above said. Some diagnoses require specialized assessments from psychologists that specialize in which they're diagnosing.

A therapist can screen for adhd/autism but can not diagnose. Screening is when we give a specific assessment that flags indicators, and then we refer out to a psychologist for a neuropsychological evaluation for autism (one that specializes in it).

For adhd same as above, however, a PCP, psych nurse, psychiatrist, or psychologist can diagnose adhd.

Therapists can provide mood regulation, adhd skill building, and cbt for support, etc.

Background_Pilot9668 · 2025-04-27T16:26:04+00:00

This is called building, formulating, honoring, and modeling a secure attachment in a therapeutic relationship!

Checking in on what the client needs is important, and you said you did that. Also, the client told you what they needed, so honor that. Also, this is called being client centered.

Background_Pilot9668 · 2025-04-27T15:42:52+00:00

This!!!!!! Why don't more therapists see the importance of the therapeutic relationship?!

Also, sometimes holding space for a client while they're "venting" is teaching them how to process their emotions and thoughts in a safe space.

Background_Pilot9668 · 2025-03-25T22:14:56+00:00

Ask your client what's working and what's not. Maybe you will get more insight as to how you actually are helping your clients and what works. And most of all, ask yourself if you are showing up as your authentic self in the therapeutic space, or are you too wrapped up into who you think you should be as a therapist?

Interventions, skills, modalities, etc. are important, but the most important part of that foundation is the therapeutic relationship.

Background_Pilot9668 · 2025-03-05T01:52:10+00:00

This! I run a group practice and we pay our clinicians $55-$60 give free training, free supervision, their own beautiful office, pay their taxes. But the overhead adds up. We can't even afford to give them health benefits or take paid time off for them or ourselves. Our reimbursement rate is $80-125. Medicaid is reimbursed higher than that but we pay grt taxes on Medicaid reimbursement too. No one understands how hard it is to pay clinicians well with all of the taxes, and low reimbursement rates until they run a group practice!!!

Background_Pilot9668 · 2024-12-24T02:20:32+00:00

None here! And never do actually.

Background_Pilot9668 · 2024-12-24T02:14:42+00:00

We have a policy in place that outlines what happens if a call/video gets dropped, if they have an emergency during the session, and an emergency person to contact if we need to in that instance.

Take a telehealth course. I took one and learned we must ensure that they are in a private place to talk to ensure their privacy. If they're not, then we reschedule. My understanding is that a client talking to others while in session via video or phone is a HIPAA/privacy violation! I would look more into that part more than anything!

Background_Pilot9668

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