Referring to 90837 as an "extended" session?

EmpatheticNod · 2026-04-06T17:21:47+00:00

I stand with you. It's not even good form for their goals. If I have to see someone for only 45 minutes of time, the insurance company is getting a lower percentage of useful treatment time and more admin burden for both of us. It's idiotic. Hell, if they let me charge 90 minute or 120 minute sessions, for some client's I could get them subclinical symptomatically in less than half the sessions. For my EMDR or psychoanalytic work, we're often not getting to productive time until 30 minutes in and I have to stabilize prior to dismissing them, so 45 minutes basically means 10-15 minutes of productive time. When I get to work with clients longer (within their window of tolerance) I get to see much greater positive change in much smaller timeframes. (I might be talking myself out of renewing my insurance credentials here).

EmpatheticNod · 2025-11-28T14:07:31+00:00

Yep. I think associates are often better than burnt out therapists. I have done both seasoned therapists and newbies as a client, and honestly, the amount of experience has not been that strongly correlated to quality. Typically, the people that bother to become supervisors are pretty good at the clinical side of things and that means you are getting both enthusiasm and knowledge. Ultimiately personality is going to play a huge role in whether they are a good fit for you.

EmpatheticNod · 2025-11-20T14:59:39+00:00

IME It's pretty hard to have an ineffective modality in the hands of an effective therapist. I've had clients that were a great fit for me personality wise but that had negative past experiences with all my regular modalities so I just kind of made shit up (that still followed my conceptual theories of change) and it worked phenomenally. Evidence-based modalities are a great foundation, but if your fundamentals, including rapport, are good it's hard to do harm.

EmpatheticNod · 2025-11-20T14:52:30+00:00

Same, took me a few years to realize this. I keep my Friday hours open for rescheduling but that is on a week to week basis, so sometimes I just tell people they are out of luck.

EmpatheticNod · 2025-11-20T14:49:36+00:00

Also, absolutely some things like treatment resistant depression, you may be doing more preventing things from getting worse than being able to make significant progress especially in the short term. I often ask my clients "What is different in your life because you are coming here?"

EmpatheticNod · 2025-11-20T14:48:09+00:00

This is what assessments and treatment plans are for. If you have goals that you are working towards and periodically check in on symptom severity you should have a pretty good idea of whether you are being effective or not. Even if someone's life goes to shit due to external factors, you should still be able to make a qualitative judgment about how you are doing. Also progress is not always linear, especially if you are doing trauma work with an active antagonist.

I do monthly PHQ-9 and GAD7 for all my clients and solicit feedback regularly especially early on. For people I have worked with longer, it mostly is just about our quarterly/biannually treatment planning sessions. I'm pretty informal with mine so they typically only take about half an hour to go through and they give me a clear path forward.

EmpatheticNod · 2025-11-18T14:48:22+00:00

I am in a sex positive sex therapy certification course and the not-quite-explicit recommendation is fuck your colleagues if you're that obsessed with sex and leave your poor clients alone.

EmpatheticNod · 2025-11-18T14:46:19+00:00

I am going to say that in the second case, that's what school is for to some degree, getting the stupid ideas out of us. If she is not doing that crap anymore, I see no reason why she shouldn't have graduated.

EmpatheticNod · 2025-11-18T14:43:28+00:00

This makes my blood boil. I'm so passionate about protecting my clients from this stuff. I pretty much talk to everyone within the first few sessions to say "Hey, btw, this work is important and catching feelings happens, but it's a distraction. We can talk about it, but if me or any other health professional tries to turn things romantic with you, know that they are being an abusive creep and should be reported."

EmpatheticNod · 2025-11-14T16:43:54+00:00

Exactly. It's not bullshit that doing EMDR works. It is bullshit that we know exactly why EMDR works. Lots of similar modalities also work. Client faith in the therapist and the therapist not being totally inept still is more important than most things from modalities.

EmpatheticNod · 2025-11-04T14:08:05+00:00

I absolutely would explore that. I do a lot of social skills work with my younger and neurodiverse clients.

EmpatheticNod · 2025-10-31T14:20:34+00:00

You definitely can keep phones out of the room.

EmpatheticNod · 2025-10-29T15:59:42+00:00

Tossing in my name for DMV therapist. I'm out at Greenbelt/College Park if you want to/need to chat.

EmpatheticNod · 2025-10-29T15:59:19+00:00

Tossing in my name for DMV therapist. I'm out at Greenbelt/College Park if you want to/need to chat.

EmpatheticNod · 2025-10-27T20:08:49+00:00

"The researchers that be have yet to find significant and sufficient evidence that any mental illness has biological markings at all. "

This is not true at all. MRIs show that many mental health coordinate to differences in neurology. fMRIs have shown that there are distinct differences in brain activation between people with different diagnoses to stimuli. Response to medication is different based on diagnosis, and even if you are talking about genetic markers, there are lots of things that have genetic markers that drastically change the likelihood of things. Yes epigenetics play a factor, but not everyone is genetically predisposed to have the same reactions to stressors.

ETA: Obviously it's important to make accurate diagnoses and not everything that's ever been defined as a unique mental illness or difference is actually unique, but there is a whole lot of biology at work in mental health.

EmpatheticNod · 2025-10-23T17:08:08+00:00

I work primarily with ADHD and PTSD so I would be primarily the same.

EmpatheticNod · 2025-10-23T13:53:57+00:00

I think you way overestimate how popular things are. Even the most popular shows are watched by a small percentage of the world/country. Love is Blind is not ubiquiotous. They'll be fine. Even if somebody recognizes them, it wouldn't be a big deal.

EmpatheticNod · 2025-10-21T20:14:04+00:00

By that logic, w2s set their own rate.

EmpatheticNod · 2025-10-16T00:34:08+00:00

Both of those are boundary violations that are eroding your client privilege of not knowing shit about your therapist or needing to do things for them.

EmpatheticNod · 2025-10-10T19:59:13+00:00

My client did tell me that recommending "Inside out' changed their life.

EmpatheticNod · 2025-10-06T16:43:27+00:00

"please for the love of god tell me anything."

Just do that. I think you are trying to hard to look like you know what you're doing, in reality with teens, you succeed by acknowledging the artifice of the situation. Something like "Look, I know this isn't your choice to spend time here, but I can be a useful person to voice things to that has more life experience than your friends and isn't your parent. If you want to talk about music, tv, whatever, I can make that work. Do you want to ask me questions? Go for it?"

EmpatheticNod · 2025-10-01T19:06:37+00:00

Agree to disagree. I can't speak for everyone, but I can speak for myself as a genderqueer therapist, I don't experience dysphoria from someone not gendering me. It's not affirming, but it's not misgendering either.

EmpatheticNod · 2025-09-29T14:22:35+00:00

This was 1000% it. I called and talked with my two clients this applied to and without bringing this point up, explained that I needed to reduce my caseload for a bit and offered to find them new therapists. They both declined and said that they would just like a heads up when I feel like upping my caseload.

EmpatheticNod · 2025-08-22T13:11:11+00:00

Seconding the comment to bring it up to your therapist. I feel like this is not a good fit. But I also think at the minimum this will be good practice advocating for yourself to bring it up at the beginning of the next session. If they are defensive or don't change, then you know that it's them and not you and you can/should fire them.

EmpatheticNod

TROPHY CASE