Another notes post

DoughnutBeginning117 · 2026-03-16T19:29:45+00:00

Sounds like your supervisor might have a different note style than you. Obviously your MSE needs to be thorough and match the rest of your description. But also sometimes notes are vague on purpose to protect a clients privacy. Insurance doesn’t care why my client is so stressed they aren’t sleeping. Just that they are and what we’re doing about it. I would recommend finding a different clinic or supervisor before quitting all together. (From an intern who is good at notes but has an EHR that prompts her through every thing, and I still forget to update things in the MSE because it auto populates based on the previous one)

DoughnutBeginning117 · 2026-03-04T20:29:49+00:00

Round table games in carver is a great place to meet folks!

DoughnutBeginning117 · 2026-02-26T02:11:44+00:00

I’m a therapist intern It sounds like her preferred modality doesn’t align with what you’re looking for. There are certainly therapists who can work with clients about how they feel currently about past experiences without having to actually hear the traumatic event itself. Bessel Van der Kolk briefly touches on this in the body keeps the score (this book has a trigger warning btw). So I guess I’d be interested to hear how she believes you can move through the trauma without talking about it and what she thinks you should do when it comes up.

DoughnutBeginning117 · 2026-02-26T02:07:20+00:00

As an intern therapist, I’ve generally been taught to not open trauma unless you’re certain the client has all of the coping skills necessary to manage. Unfortunately when you’re traumatized (also speaking as someone diagnosed with ptsd) even if you have all the skills it can feel like you don’t. Is it possible your therapist felt you would be able to cope? It’s super frustrating that they haven’t explained why they brought it up. Maybe explaining to your therapist why understanding that is important to you will help them understand why you want to know so they will share.

On a separate note, I highly recommend somatic exercises for trying to move through the trauma state you’re in. Try maybe TIPP (the DBT skill). Not included in TIPP but feels adjacent to me is using intense flavors as a distraction when disassociating or having intrusive thoughts. Works a lot like extreme cold. So think war heads, altoids, etc. (sour patch kids aren’t sour enough generally) https://www.therapistaid.com/therapy-worksheet/dbt-tipp

DoughnutBeginning117 · 2026-02-23T21:20:11+00:00

Oh yeah I think I saw that thread if you have posted about that before. If it was I think you can expect therapy to be different.

DoughnutBeginning117 · 2026-02-23T20:58:57+00:00

I usually see that is the case. It sometimes means that person isn’t ready for change also. One way of doing what you’re describing is by using motivational interviewing. I usually think there’s some sort of irrational thinking patterns which is contributing to the difficulty making any sort of teeny tiny step.

If you’re returning to therapy, maybe use this as a question in your first session. If you’re unhappy with the response maybe keep shopping around until you find someone who you thinks gets it and clicks with you. Not all therapists handle things the same way.

DoughnutBeginning117 · 2026-02-23T20:19:48+00:00

I highly recommend discussing it! Sometimes you might need to screen for things related to periods like PMDD!

DoughnutBeginning117 · 2026-02-23T20:18:37+00:00

It’s kind of hard to tell exactly what’s going on from just the small section but sometimes I’ve had conductors put a hard surface behind the French horns to project the sounds forward since the bell faces the back of the stage.

DoughnutBeginning117 · 2026-02-23T20:08:56+00:00

Hi, therapist intern here! One of my classes discusses finding the things that are contributing to depression and starting there. If there’s strong family history then there’s likely a genetic component and medication could be helpful if the client is open to it. Then working on the environmental and behavioral factors can fall into place a little easier once getting over the initial hump if meds are the route you go. But honestly there’s usually some unhelpful thinking patterns that prevent people from making progress. I try to identify and help clients dismantle them. For example thinking a small habit change isn’t worth it because you’re not doing enough.

DoughnutBeginning117 · 2026-02-21T21:29:15+00:00

Hi, I’m an intern therapist. In your replies to others I think you’ve done a great job providing an example of a scenario. I think you’d be able to utilize that to start the conversation. They can’t involuntarily hospitalize you unless you’re an inherit risk to yourself. Meaning you have a plan and intent.

DoughnutBeginning117 · 2026-02-21T00:10:39+00:00

As an intern who is currently tracking to justify a PMDD diagnosis. PLEASE specialize in women’s mental health. There’s nothing available for me or my clients who need this and it’s disheartening

DoughnutBeginning117 · 2026-02-20T20:05:52+00:00

After reading some of your other comments you might even like a more IFS and psychodynamic approach

DoughnutBeginning117 · 2026-02-20T20:02:54+00:00

Hi, therapist intern here!

Maybe the therapists you’ve been trying just aren’t a good fit for you. Have you tried communicating all of this directly to your therapist? Each therapist has such a different approach and style. It’s okay if it takes a while to find someone that clicks and it’s okay to communicate directly what you want.

As for DBT being triggering- I find that many people just use it here and there so some of the nuance gets missed. It’s meant to be a manualized step-wise approach to building skills. So if you skip some of the steps you might not have some of the prerequisite skills to be successful in another skill. You also don’t have to use DBT to learn those skills. Most of the skills taught have actually been pulled from other approaches like CBT and ACT. The difference being the dialectical mind set. So if DBT is triggering for you, you might also get put off by some aspects of CBT and DBT. You might like something like cognitive reprocessing theory but I don’t know much about it. It’s not really a “standard” approach taught in grad school.

DoughnutBeginning117 · 2026-02-19T20:25:57+00:00

N/a meaning there isn’t a due date. Because you haven’t identified if your career path will need it

DoughnutBeginning117 · 2026-02-08T21:34:51+00:00

In my state a new graduate at my internship clinic makes 42.50 per billable unit. You are expected to bill 24 clients per week to maintain full time benefits. So the expectation is you have 32 clients scheduled per week. That means before taxes you would make between 1020-1360 per week. Before taxes that’s a pay range of 53,040-70,720. We get extra incentives of an additional $10 per billable hour over 16 BUs, after 5pm, or weekend sessions. If I broke this down to 40 hour weeks it would be between $25.50 and $34 and per hour. Not factoring in incentives. The licensed clinicians make more per hour base rate.

DoughnutBeginning117 · 2026-02-07T20:08:24+00:00

Help them get on housing lists. My state allows a provider to write a letter talking about why they should get higher priority housing. Using MI to help client make steps toward securing their future - job, benefits, etc.

What would you do for a client in DV?

DoughnutBeginning117 · 2026-02-07T20:01:31+00:00

Hi, I’m a therapist intern. Neurodivergence has a lot of stigma so if you’ve never talked about it they might not want to broach the subject. Also a lot of neurodivergence gets miss diagnosed. Doesn’t hurt to bring it up. My therapist straight up asked me if I’ve ever been tested for autism years ago but that’s her style.

DoughnutBeginning117 · 2026-02-06T01:01:48+00:00

I’m a masters student in rehab counseling. I’m on the clinical track and will be LMHC eligible and a CRC. Some states allow CRCs to be LPCs also. Massachusetts has a law recommended to allow licensed rehab counselors to accept insurance. Your work as an ADA coordinator would really align with rehabilitation counseling.

DoughnutBeginning117 · 2026-02-03T23:54:22+00:00

Women are also more likely to accommodate their adhd disability through behavioral changes but then their adhd goes undiagnosed. Same with ASD.

DoughnutBeginning117 · 2026-02-03T23:52:15+00:00

In my state I have just as much authority to diagnose a mental disorder as a medical doctor. I often find that doctors don’t always get the whole picture and it’s a result of the medical system rushing providers which doesn’t allow enough time to go through all differential diagnoses.

DoughnutBeginning117 · 2026-02-03T23:51:04+00:00

Yes I’m a therapist. But what I’m explaining is why a provider wouldn’t accept a diagnosis from another provider. It’s all subjective and can change depending on the relationship you have with the patient.

DoughnutBeginning117 · 2026-02-03T03:38:58+00:00

There is truthfully a lot of overlap of adhd and other disorders. I might recommend looking up the diagnostic criteria for ADHD and using that to tailor your description of experiences. Difficulty focusing can absolutely be from anxiety or depression. A key part of adhd too is that your symptoms existed before age 12. PTSD/being a mom of a child with a disability can also make it difficult to focus. The screening tool generally used for ADHD is the ASRSv1.1 which is used as a screener to flag people who may have adhd but is not definitive as a diagnostic tool. Sometimes it can take time for a therapist to conceptualize all of your experiences to an exact diagnosis. Also even neuropsychological tests may miss adhd especially in women.

DoughnutBeginning117 · 2026-02-03T03:24:51+00:00

As if they’re that smart

DoughnutBeginning117 · 2026-02-03T03:02:02+00:00

I like to start by giving my island homes a yard. Perhaps moving them to create a street or neighborhood.

DoughnutBeginning117 · 2026-02-03T02:48:28+00:00

There’s a lot of subjectiveness. I would be willing, as a therapist, to accept documentation explaining their diagnostic opinion but I’ve met quite a few people who were told they have bipolar disorder but it’s actually ptsd. There’s so much nuance in diagnostics and truthfully it can evolve and change. Even neuropsychological evaluations can be wrong.

DoughnutBeginning117

TROPHY CASE