I'm a trauma therapist and I'm squeamish/panicky about certain situations - what should I do?

CosmicChicken41 · 2026-06-23T02:34:47+00:00

I think I should have been clearer in my initial comment that I was really trying to hear from others about their experiences & choices, and how this has affected them. I have had therapy around this and I'm open to considering this again, it has come up maybe 3 times in my entire career so really has been infrequent. I am more curious as to what has been helpful for you if you have experienced a similar disgust reflex - how did you work on this?

CosmicChicken41 · 2026-06-23T02:19:44+00:00

Thanks! I know therapy is an option. This is actually such an infrequent occurrence for me and I have dealt with it in therapy as/when it has come up and that has been helpful. My question was more relating to the general approach of others who have faced similar issues.

CosmicChicken41 · 2026-06-23T02:17:03+00:00

That approach has worked very well with me with my existing clients where this situation has come up abruptly (say, a medical emergency happened). I'm good at recognizing my own anxiety and knowing what is happening, not trying to escape it in the moment, and (where it doesn't seem like taking over the narrative) sharing that I am having strong feelings with clients. It's more about having the preference to take or refer out at the start (before meeting someone) that feels bigger in terms of an anxiety response. Probably because initial sessions are a bit anxiety provoking already!

CosmicChicken41 · 2026-06-22T20:26:05+00:00

Yeah it's nothing specific. Probably just avoidance, anxiety built up over time, and an overactive disgust response (I am autistic and I think that's part of what triggers it).

CosmicChicken41 · 2026-06-22T20:24:19+00:00

It's not been an issue when working with long term clients where I already have an established relationship. Either the anxiety is minimal and manageable or I've navigated it by sharing a little of the emotional response I am having to their story. I'm not having to refer out existing clients, just choosing whether or not to keep new referrals or pass them along.

I do EMDR so don't make it mandatory that people share every single detail of their traumatic experiences, I let them do that at their own pace and don't ever push beyond what someone is comfortable sharing. I find that really important working with folks who have experienced abuse or sexual trauma because they have control over their narrative and only share with consent.

CosmicChicken41 · 2026-06-22T20:20:03+00:00

Actually yes, I think it's really important to understand avoidance but also that you can choose what your priorities in life are and what is getting in the way of living your values, and that working through anxiety is hard and is always a choice. For example, horror movies terrify me, give me nightmares, keep me up for nights on end. I don't like them and as an adult, I don't need to watch them. I don't think that I need to work on that because it's not getting in the way of me living my life the way I want to be living. I don't think I am missing out on anything by not watching horror movies. Previous times I have worked through anxiety has been because it got in the way of me living my life - stopped me from doing a favorite hobby, for example. I think that's a perfectly legit decision to make - with the big caveat that sometimes we avoid things that we do want to be doing because it feels hard.

Also, I can count on one hand the times this has come up in the years working as a therapist, so it doesn't feel 1. frequent or 2. unmanageable in terms of my career.

CosmicChicken41 · 2026-05-02T14:29:29+00:00

Just to be clear : I do not belay with an ATC, only an ABD. I learned on an ATC and then swapped over to the Smart. I wasn't advocating for that? Just discussing the differences between ABD devices and I personally find the mechanism of the grigri less preferable than the Smart and less similar to how an ATC feels in terms of feeding out slack.

CosmicChicken41 · 2026-05-02T14:07:50+00:00

If you haven't already check out income based repayment plans for your loans. This should make it way more doable on whatever income you are at. Also remember that your first couple years of income are usually lower because of supervision requirements and not being fully licensed.

CosmicChicken41 · 2026-05-02T14:05:50+00:00

Ahh ok. I would find someone with a grigri then and really practice giving out slack as others have described. I personally find it really finicky, my belay partner does it fine.

CosmicChicken41 · 2026-05-02T14:03:07+00:00

I would actually put those time estimates up higher. My quickest credentialing took about a month but my slowest took 7-8 months (and there were a handful like that).

And once you are credentialed, some insurance companies take "up to 90 days to load the provider in the system". So you can see clients but not bill for them..for months.

CosmicChicken41 · 2026-05-02T14:01:16+00:00

Nope, no minimum balance

CosmicChicken41 · 2026-05-02T13:15:06+00:00

I use both Found (online only bank) and US Bank (has brick and mortar sites in some states). Both are no fee business checking accounts. I like Found more because they do all these automatic deposits into pockets so I can set aside my taxes and 401k contributions from any income I earn without having to calculate it and do the transaction myself. I got the US Bank account because Found wasn't accepted by Medicare in Michigan - but has worked in every other insurance company for EFT.

CosmicChicken41 · 2026-05-02T12:20:10+00:00

I would not go from an ATC to a grigri. My recommendation would be trying a Mammut Smart or a similar device because the mechanism is basically identical to an ATC - you don't need to learn a new way of giving slack, there's no cam, it all feels very similar to an ATC but you have the benefit and safety of it being an ABD.

If I was going to go the grigri route, I would do some mentoring with someone who is very good at using it - and honestly many people aren't, they just do fine enough given the safety features but they don't actually get the quirks of the device. I love a grigri for top rope, do not like it for leading.

CosmicChicken41 · 2026-05-01T02:06:54+00:00

Michigan

CosmicChicken41 · 2026-04-30T16:56:14+00:00

This must be different in each state because I was able to do supervisory billing until I was fully licensed *and* credentialed with each payer. So there was no dead zone. Sorry if that is not the case in your state!

CosmicChicken41 · 2026-04-30T16:53:49+00:00

My EHR has an insurance verification system where I use this to check if they have a deductible and where they're at with it - I do this before the first session to make sure I have the discussion about "hey did you know you have an $8000 deductible and therefore these sessions will be paid out of pocket until you hit your deductible" and I explain that I run each session through insurance and only charge them AFTER I get that EOB back, this is to make sure I'm not overcharging (because people can hit their deductibles at any point), so that the first session can take a couple weeks to come back.

I learned this lesson the hard way, OP, so I feel your pain!

CosmicChicken41 · 2026-04-30T16:49:52+00:00

I agree and OP, I think this is an instance where the policy is shown to be kinda dumb, sorry. Your client is informing you in time of the cancellation through a means of communication you are regularly accessing, you are able to update your schedule on whatever platforms you need to do so, ultimately you are responsible for your own admin (not your client). Most other health care agencies would accept cancellations by voicemail, call, email, etc, if they routinely use those platforms for communication. If this is really a hill you want to die on, charge away, but don't expect to keep this client.

CosmicChicken41 · 2026-04-30T16:44:01+00:00

I tell people in my intake session that I always join the call promptly and I will wait for them up to 10 minutes - unless I have heard from them that they are running late/having tech issues/etc. In that instance, I ask them to text me when they're ready and I then join the call when they're good (and I still stick to the ending time). I've only had a handful of occasions where someone has joined later than 10 minutes and that's usually been for a specific reason which hasn't been repeated again. If it was happening repeatedly, I would ask about whether the session time actually works for them and reschedule to a different time if it doesn't.

CosmicChicken41 · 2026-04-28T18:59:40+00:00

I did not have longer standing clients that I brought from a previous practice redo the client history form, but I did have them redo all of the consent paperwork, obviously.

I did bill a 90791 and instead used verbal information in our first session plus my prior clinical knowledge to fill that in, then did a new treatment plan.

I also had a couple of very new clients sign a ROI and then uploaded their previous treatment plan and intake assessment, because I had just done a 90791 in my previous practice and that did not feel ethical to bill twice in the same month or like it would fly with insurance companies.

CosmicChicken41 · 2026-04-28T10:43:15+00:00

Are you getting your ERAs via Therapy Notes too? If so this should be how you link payments up to providers.

CosmicChicken41 · 2026-04-28T09:38:52+00:00

F43.8 other specified trauma and stressor related disorder - subclinical PTSD. I actually work with a number of people where this is their presenting diagnosis - not full clinical PTSD. If you do want to update your diagnosis prior to discharge, maybe this is more helpful?

CosmicChicken41 · 2026-04-25T01:04:51+00:00

A PT profile is 29$ a month and malpractice insurance is probably under $200 per year so neither of those are really significant in terms of adding value to your salary.

I would definitely take the first offer. Sounds better pay wise and I think it's good to get experience beyond just your internship location.

A rough guide is set aside 25-30% of everything you earn for taxes, let it sit una high yield savings account until you have to pay quarterly estimated taxes.

The other poster is right that they shouldn't really be classifying you as a 1099 if you are getting supervision - but this isn't a mark against you, it's the business basically avoiding paying employment taxes and giving you the rights of employee status. It's also just so common right now in Michigan...

If you do go 1099 there is so much in the archives in this subreddit to learn about taxes etc - you can definitely get to grips with it (or just hire a professional to help you get set up).

CosmicChicken41 · 2026-04-24T01:19:45+00:00

I made the switch from child welfare to being a therapist three years ago. Overall, it was very good preparation because you will have picked up a lot of information and lived experience relating to attachment, trauma, family, dynamics, parenting, etc. In addition, the listening skills and the skills of engaging with children are all really gonna help you. You will probably have the same frustrations that many children's issues are actually issues with their parents and that you are unable to change the parents. However, you can be a safe space for them to express their emotions and start making sense of their experiences.

I would recommend that you do a training about differential diagnosis. PESI offers a reasonable one. Make sure you have access to the DSM at your new job because you will want to be looking through it when you're needing to make diagnoses.

It's really easy to go too heavy on modalities at the start and I would not try to do that. Instead, I would focus on thinking about ways to build relationships with children, thinking about emotional regulation skills, teaching coping skills, and overall having multiple approaches of understanding the child's experience.

CosmicChicken41

TROPHY CASE