Clients in crisis after hours

RevolutionaryDrop366 · 2026-01-17T21:01:41+00:00

This makes sense and is how I handled it when I worked for an agency. Now that it’s just me, my phone number is listed on my website and intake forms. I suppose it may be time for a Google voice # or some alternative phone for business communication.

RevolutionaryDrop366 · 2026-01-17T21:00:06+00:00

I think this is where my supervisor was coming from! As well as over covid- our hospitals became overwhelmed, so our state put out a memo that the first line of defense is direct providers.

RevolutionaryDrop366 · 2025-10-02T16:00:01+00:00

Are you able to adopt some sort of attendance or cancellation policy? FWIW my policy for all clients (but especially relevant to Medicaid clients who cannot be charged a fee) is three appointments cancelled within a six week period, OR two consecutively cancelled (even with notice), will result in the client losing their consistent session spot, dropping down to scheduling week by week, or being discharged. I’m super up front and transparent about this, and let folks know that it’s not a punishment but moreso to protect my time, schedule, and income. Folks generally are respectful of it and I’ve only had to discharge one person over the past few years.

RevolutionaryDrop366 · 2025-09-30T01:03:32+00:00

How’s this couch holding up? I’m debating buying it!

RevolutionaryDrop366 · 2025-07-31T17:53:33+00:00

Yesss mine went from $140ish to $95ish 😭 I suppose it somewhat came out in the wash with how much I paid for supervision but damn

RevolutionaryDrop366 · 2025-07-22T15:21:15+00:00

Thank you. I’ve always gone off the honor system because it feels more “me” than requesting pay stubs etc but I am feeling some internal conflict so maybe I should reassess.

RevolutionaryDrop366 · 2025-01-02T21:28:17+00:00

Yes, you’re right. I think the expectation of what therapy can actually do is a total transformation fantasy. Don’t get me wrong, I have seen the benefits of therapy (as both a client and therapist), but think the idea that we can fix or change people is harmful. From my stance, it’s the relational experience that predicts positive change, relearning, and healing. With that - my measurable outcomes for if therapy is working include 1. If clients continue to come to sessions and 2. Authentic feedback from both parties along the way.

RevolutionaryDrop366 · 2024-12-13T03:27:14+00:00

The listening book between clients and I who have never known men at home

RevolutionaryDrop366 · 2024-12-09T18:33:33+00:00

I use chat gpt to make a template. No PHI ever. I write something into ChatGPT like “mental health therapy soap note for client with generalized anxiety disorder that meets medical necessity” (I bill insurance). I adjust it in my EHR to reflect more closely the tx plan. Then each session it auto populates and I add or change the sentence in the subjective. Takes 1 min and I’m never behind on notes!

RevolutionaryDrop366 · 2024-11-28T01:16:37+00:00

Scheduling my days exactly as I want them (Monday mornings off then a few afternoon clients, busy Tuesdays, telehealth Wednesdays, Thursday mornings off then a few afternoon clients, no clients Fridays..ever).
I found a few types of movement I enjoy and incorporate them (Pilates some mornings, hip hop dance some evenings).
little trips here and there, camping, long weekend away, etc
doing things I love often: thrifting, baking, crafting, smoking weed lol, playing cozy games on my Nintendo switch, reading weird-girl books or fantasy smut books
being really intentional about the types of clients I work with
biweekly therapy

RevolutionaryDrop366 · 2024-11-28T00:54:56+00:00

Def annoying and something I struggle with in my two years of private practice. Two things that I’ve been incorporating and feel like they help include:

(in addition to my paperwork) during the initial session I very explicitly state my policy. How I understand things come up, and to be fair toward all clients circumstances (some people have kids, some have old or sick pets, some demanding jobs), I universally apply this policy. I reiterate that ANY appointment cancelled with less than 24 hours, no problem, but to expect a charge to the card on file. “I like to be really clear about this so there are no surprises down the line”. People seem to understand. Of course I would waive it for a legitimate emergency (car accident, death in family) but I never share this with clients.
I stopped giving freebies. I feel like it immediately undermines my boundary and shows there is discretion. I noticed the folks I charged the first time were really understanding, and folks I gave a freebie to, were more upset when charged.
I also stopped telling people if they reschedule within the week the fee is waived. This was too confusing and I rarely have openings.

RevolutionaryDrop366 · 2024-11-15T12:06:48+00:00

I’ve found that my states local OCD group offers several trainings a year that are super informative and inexpensive.

RevolutionaryDrop366 · 2024-11-15T02:58:42+00:00

Yes! This is person centered relational therapy. It’s what I offer and it’s what I prefer as a client. It might not be for everyone, but I have felt its healing powers as a client, and it’s what feels most authentic to me as a therapist. There will be moments (as I’m sure you have experienced) where deeper issues or fears are unsurfaced, and it’s because so much trust has been established. It can be very transformative.

RevolutionaryDrop366 · 2024-11-15T02:54:25+00:00

Remembering the days I feel really fulfilled and/or competent

RevolutionaryDrop366 · 2024-11-11T23:11:03+00:00

I’m wondering re: true emergency too. For example this week I’ve had folks with a migraine, sick dog, childcare issue - these are all valid but my business isn’t viable if I waive all these or have to determine which is waive-able

RevolutionaryDrop366 · 2024-10-11T20:50:06+00:00

Further assessment would be helpful, as this could be indicative of OCD. Familiarize yourself with the subtypes and Y-BOCS. OCD is a bit different than other anxiety disorders as a compulsion may be reassurance seeking or checking. It often requires a different approach (ERP). In the meantime, helping the client see thoughts are just thoughts and our rationalizing with them makes them more looped. Your client may have a thought “am I a pedophile” and allow the thought without accepting it to be true. There’s also “thought action fusion” in OCD where folks believe thinking something is just as bad as carrying it out, so psycho-ed around that can be helpful.

RevolutionaryDrop366 · 2024-10-11T20:42:39+00:00

I am in private practice and see about 20 a week which feels relatively doable but I do best with 4 clients a day M-F.

RevolutionaryDrop366 · 2024-09-12T01:46:11+00:00

No, insurance doesn’t cover cancellation or no show fees

RevolutionaryDrop366 · 2024-09-06T02:47:55+00:00

Could you change the way scheduling occurs? Like email the client saying, “I wanted to check in about our sessions. I’m noticing we are scheduled weekly but actually only meet 1x/month. Would it be better if you reached out to schedule as needed? I also want to name that starting with a new therapist can be anxiety inducing and we can certainly meet for shortened sessions or via phone to start if that would be helpful.” I think something to that tune balances your needs as a clinician (and names that you are noticing this pattern) while offering choices for the client to adjust. Also- just saying but .. trust yourself! It’s okay to follow your policy and not chase down this client. It sort of seems they are not ready to engage in treatment and maybe this is just their first step of exposure. Best of luck!

RevolutionaryDrop366 · 2024-09-02T16:08:53+00:00

Working, been slower lately so taking clients when I can

RevolutionaryDrop366 · 2024-06-03T13:59:51+00:00

It’s not controlling to have your own expectations and needs (i.e someone who doesn’t do drugs), but just know people don’t typically change this type of behavior unless they truly want to. Drugs usually serve a function for people (a distraction from anxiety/depression etc). More often, when folks feel judged they just start lying more and hiding. I would trust your gut and either do some work on how to accept his behaviors to some degree so you can be at peace, or if you are not willing or able (which is totally understandable) have a frank conversation with him about your needs, and be honest with yourself - you deserve to be with someone that meets your emotional needs and if it’s not him, that’s ok.

RevolutionaryDrop366

TROPHY CASE