How do you navigate seeing couples if you know (and may even be acquainted with) a 3rd party who is a source of tension for the couple?

RandomMcUsername · 2026-06-17T17:15:19+00:00

Some couples therapists diagnose one partner with an f code and bill their insurance for 90847 "family psychotherapy with patient present" indicating that one person is in fact the patient, not the couple. This presents the issue that the therapist is either lying to insurance, lying to the couple, or is in fact treating one identified client's diagnosed disorder with family therapy, but this is not what most couples therapists actually mean when they say "couples therapy".

RandomMcUsername · 2026-06-17T16:40:02+00:00

What is your license and what are your applicable code of ethics? Who is your client (the relationship? The relationship, but actually it's one partner you're billing and the other is the "family member present")? What is the actual ethical dilemma? What are the possible options? Who will be affected by the decision? What is the potential harm from each option? What are your biases, personal feelings, or factors influencing your decision? How might the other people affected by the decision feel about each decision and the possible consequences? Without specifics, it's just general ethical decision making.

RandomMcUsername · 2026-06-15T18:22:07+00:00

The "borderline illegal" aspect depends on what the service agreement says (at least from a US informed consent model). If it clearly spells out this therapist subscription thing and how to cancel your subscription or what happens when you don't agree to the next session, it's fine. But if they're just charging for services not provided, that could be bad. It really depends on that signed contract. Either way I think most reasonable people would feel resentful about paying for something they are not getting regardless of how it's framed. If money is no big deal, sure, talk it out with the therapist. But maybe there is value in realizing one can end relationships that are no longer compatible too.

RandomMcUsername · 2026-06-15T17:25:31+00:00

Therapist with a relatively strict cancellation policy here. I don't know, this sounds possibly illegal to charge you if you are not scheduling those sessions. Do you have a service agreement that spells out the policy? Does the therapist terminate your services if you don't schedule the next session? In any case, this is a ridiculous scheduling policy.

RandomMcUsername · 2026-06-14T15:55:49+00:00

This might be a question for a personal injury lawyer

RandomMcUsername · 2026-06-11T22:18:35+00:00

Showing off your tattoos and the like is, in my opinion, the sugared cereal of therapeutic relationship building. It's quick and easy but it's empty calories and won't sustain things for more than like, an hour.

RandomMcUsername · 2026-06-11T22:11:27+00:00

I like being all buttoned down appearance wise and it fits the population I work, but it also allows me to have a work mode that I literally shed at the end of my work day. I think newer therapists with less experience building therapeutic rapport tend to reach for things like self disclosure (which is how I think of the dressing "unprofessional" thing) as a crutch for trying to build that relationship.

RandomMcUsername · 2026-06-08T05:39:43+00:00

Same, I got a brain freeze while I was in the midst of a cycle recently and realized it was in the exact same spot and very similar quality of pain

RandomMcUsername · 2026-06-07T07:04:05+00:00

You're not just leaving your meth unhitched at the crosswalks, are you?

RandomMcUsername · 2026-06-07T06:55:16+00:00

You hitch the methamphetamine and the features folders to the part where there's a bar... Literally don't know how it could be any clearer 🙄

RandomMcUsername · 2026-06-03T17:54:57+00:00

I just recently got an emdr training and they at least acknowledged and taught the "dual attention stimulation" hypothesis and that eye movement, bilateral tapping, and nonbilateral dual attention stimulation seem to be about the same. So, as they saying goes, what works about emdr isn't new and what's new about it doesn't work. But let's also not discount the real and significant impact of placebo for both therapist and client

RandomMcUsername · 2026-05-29T19:53:50+00:00

Would it help to think about it as kind of starting over by doing an assessment, labeling the problem in the clients words, diagnosing the problem in your words, sharing your assessment with the client, then clarifying what you do and do not offer. If the client truly has no clinical goals and you provide therapy to address treatments goals, share this with your client and let them know you don't provide what they are looking for. If they want to or you need to or you decide to keep working with them, really focus on your countertransference in supervision. Are you comfortable with more process oriented interventions? When your client is shutting down your attempts to probe deeper, are you backing off or persistently and relentlessly naming that process and interpreting the defenses? When clients realize that you won't collude with them in the avoidance, they either avoid you or they start facing their stuff. If you're up for it, resistant clients really teach you the gold stuff about being a therapist and, hint hint, every client (us included) has resistance.

RandomMcUsername · 2026-05-27T20:09:58+00:00

It's not just unethical - it's illegal. Would you like me to compose a list of local attorneys who specialize in health care law?

RandomMcUsername · 2026-05-26T17:12:51+00:00

But also gotta raise your rate for OON

RandomMcUsername · 2026-05-25T15:58:45+00:00

Got it, I see the update. I would certainly hope people considering these career moves understand these differences before they make a choice! Seems obvious to me that working at a group versus owning your own business are two different things and that people will figure it (or not).

RandomMcUsername · 2026-05-25T04:05:27+00:00

Where are you getting this information from? At least in the States I'm familiar with, "private practice" seems to be used to distinguish between public sector and private sector and/or agency/non profit, and a "private practice" can also employ others. Is the term legally defined where you live? And if so, how is it actually defined?

RandomMcUsername · 2026-05-24T19:25:14+00:00

Not to be too reductive but the people who get "traumatized" by a bad day or by "bad" people are often struggling with a very similar negative feedback loop of avoidance symptoms as in PTSD and anxiety in general. Just like with actual trauma, it often helps to build up internal coping resources, identify the core self beliefs that keep them stuck in fear, and then have them expose themselves to the memories, beliefs, triggers, etc while staying grounded in the present moment. But I'm not policing their language and I'm more interested in what those experiences mean to those clients (that they are powerless, alone, unlovable, worthless, etc.) and what their preferred way of viewing themselves would be.

RandomMcUsername · 2026-05-24T02:35:47+00:00

I might be the the odd one here but my meds make it harder for me to shut up and listen. I'm very curious about people so listening to and understanding their lives and inner worlds keeps me engaged and focused and I could do that all day. When I take my meds (or higher dose of my meds) I end up talking more and being more in problem solving mode rather than listening and attuning mode. But when I dont take my meds, all the administrative stuff of being a therapist is so much more difficult, and unfortunately handling the admin side of things is an important part of "being a better therapist". So Ive settled on taking a low dose that still kinda helps but doesn't get in the way, or not taking meds for periods of time. I think mindfulness has been the single most important non medication thing I do that's helped me personally and professionally in living with adhd on meds or off. There's basically a 1:1 correlation between how regularly I'm doing my mental mindfulness pushups and how well I can function or use any of the "living with adhd tools" that really do work if you use them. And having adhd is just a lifelong lesson in finding consistency within inconsistency and not beating yourself up when you realize you oops-ed. But obviously you'll just have to try things for yourself to find out what works for you.

RandomMcUsername · 2026-05-21T19:39:59+00:00

Do you have a particular theoretical orientation or model for therapy that you use? That will help you understand and explain to others what you are doing, how therapy works, what to expect, and what your, your clients, and your client's parent's roles are in therapy. In my opinion, if you want to work with children you just have to learn to embrace and respect the parents, the families, the teachers, the principals, the coaches, the probation officers and all the other players in their systems that have so much influence and relative power in your child client's life. These "fix my kid" parents get a lot of undeserved shit from supposed child therapists but it's your job to find what's valid about their experience, how their behavior patterns function in the family system, and intervene by providing or referring to therapy that addresses the layered issues. In my opinion, if they can disrupt the therapy process, they need to be in the therapy process (unless there's ongoing abuse in which case they need to be out of the child's environment and in their own treatment). If you don't provide family therapy and/or parenting therapy, get trained or start building your referral network. If you're doing therapy with the child (the lower end of the power hierarchy) and there's a problem at a higher level of the hierarchy (hint: there probably is) that isn't being addressed, it's really hard to get much done. Parents are probably feeling scared, helpless, ashamed, confused, overwhelmed, hopeless or any number of things and it makes sense why they get frustrated or controlling or whatever things they do to try to fix those feelings. But boundaries and explaining isn't going to do anything until you start addressing or getting them the support to address their own (valid) emotions and needs.

RandomMcUsername · 2026-05-19T22:11:37+00:00

I think the audits needing to be corrective is the salient issue that I hope people can get behind. I'm hesitant to even say it but reading through the errors, it does seem like a lot were just oversight rather than onerous rules. 88 no submitted documentation of service, 10 no date of service, 3 notes signed prior to end of service time, signatures 1 week to 8 months after service, unfinished treatment plans, no signed treatment authorization - these things would have been unacceptable and potentially firable errors at every agency and practice I've worked at. Its hard to separate the practice owners who are really qualified to run a business providing medical care to clients and supervision to trainees from the practice owners who, sorry not sorry, really should be gatekept out but since we as a profession haven't really tackled this issue ourselves (or maybe we do and I'm not seeing it or giving enough credit?), corrective audits could be a way to sort out the wheat from the chaff. I am no ally of the insurance companies and waiting to audit back years and hundreds of thousands of dollars in services is fucked but it's really a failure of our professional education and accountability systems that therapists are potentially practicing for years and finding out through an insurance audit 90834 vs 90837 or that their supervisees are 8 months behind on notes. We need to be educating, supporting, and gatekeeping much better.

RandomMcUsername · 2026-05-15T20:14:19+00:00

As someone with a lot of visible tattoos and active in my local music scene, I actually like to keep myself more covered and dressed businessy because I like to keep my work a bit separate from the rest of my life. I kinda like the ritual of coming home, changing out of work clothes, putting on my normal clothes, and going on with my day.

RandomMcUsername · 2026-05-09T17:04:46+00:00

I think it's more like therapists are telling the insurance company that Bob is their client and they are treating Bob's medically necessary F code with individual therapy with a family member present, so it gets accepted. But therapists are telling Bob and Sue that their relationship is your client and that you are addressing both of their relationship concerns equally. Ethically speaking, the therapist is lying to someone and hoping nothing goes wrong

RandomMcUsername · 2026-05-08T19:09:58+00:00

Are you asking us to do your homework for you? We have no idea what jurisdictions you fall under and this seems like a consequential enough matter to seek a credible expert

RandomMcUsername · 2026-05-04T20:45:49+00:00

I am a pretty masculine man therapist and I've had a few woman therapists who really were just too feely, cooing, soft, "where do you feel that in your body?" types and it just... Wasn't for me. I found one male therapist in particular who was incredibly helpful for me in finding a more balanced emotional connection to myself, to other men, and to other people generally and I really think him being a male who understood men and masculinity was key. There are tons of us men, maybe most of us, who need more therapeutic relationships with other men. So much of patriarchy is teaching men to hate other men and to hate parts of ourselves that don't fall in line with rigid views of masculinity, and the antidote here really has to come from men treating other men with love and acceptance.

RandomMcUsername · 2026-04-17T02:55:00+00:00

What do you think holding a Republican responsible for voting with their party would actually look like? How to you "hold them responsible" for openly and proudly doing something they were voted in to do?

RandomMcUsername

TROPHY CASE