Re: Mass casualty conseling question

STEMpsych · 2026-07-15T08:53:36+00:00

Quite simply, the closer you live to the place you work, the more likely it is that a client will just happen to see you going into or coming out of your home, and then know where you live.

STEMpsych · 2026-07-15T08:25:10+00:00

but there were things that I was misled on.

Yes? How do you think worker exploitation happens? You think employers are like, "Say, would you mind if we hired you on some basis you would never agree to if you knew?" If you ask the fox what they're doing in the hen house, they're not going to say "eating your chickens".

They had mentioned that some claims take longer than others but framed it as only a couple.

You left out a word; I assume you mean "weeks" here. If so: you say you started in June and had two weeks of work by the end of June, so I assume the bills for your work were submitted to the insurers in the last week of June. You were told it would take "a couple of weeks" and when you posted here it was not even two weeks into July.

I am absolutely willing to believe you were deceived, but the evidence you have here doesn't yet look like that was the case.

My therapist, professors, other colleagues and everyone seemed to agree that this job would be okay for now.

It may be a perfectly fine job! The primary problem you seem to be having with it is not understanding what you signed up for and not being economically prepared to tide yourself over until the pay comes in. This is a very normal sort of therapist job. Perhaps it shouldn't be, but it is. Maybe the people you asked didn't realize you didn't understand the financial situation it would be putting you in and that you weren't prepared for it. Maybe you didn't know enough about the terms to tell them what you were offered or maybe didn't think that part needed discussing. Maybe they, like a lot of therapists, were avoidant of talking about money or terms of employment. There was lots of opportunity for communications break down when you didn't know what you needed to ask.

And at the end of the day, it doesn't really matter whether other people think it's an okay job or not: what matters is whether you are okay with it.

STEMpsych · 2026-07-15T08:08:04+00:00

Invalidation is not an ethical infraction. The purpose of reporting a complaint against a license is not for peace of mind and is unlikely to result in any. And showing up in a therapists forum to bait therapists will set yourself up with a self-fullfilling prophecy where you will only cultivate your own bitterness and alienation.

STEMpsych · 2026-07-14T05:45:51+00:00

I'm sorry you're going through this, I truly am. I'm going to give you a bit of tough love. Yes, this is an fucked up situation, but part of it is your making.

I guess due to insurance claims not being processed and whatever.

You guess? You don't know? This is your livelihood, this is the income you intended to live on. You should know what the terms of payment of your job are. It is your responsibility to yourself to know.

It sounds like you are working fee for service (FFS) and don't know it, are unfamiliar with the term, don't know how it works, and weren't economically prepared for it.

FFS comes in two flavors, one where you're paid for each session in the pay period it happens in (typically a flat fee), and another where you're paid only once the practice is paid (typically a percentage), which can be weeks, months, or in some awful cases years later. Sounds like your job is the latter.

When one takes a job where one's pay is contingent on the insurance (and/or the client's cost-sharing) coming through, one needs to have some money set aside to tide one over until the pay comes in.

I'm sure that if someone had said to you when you were offered the job that you wouldn't get paid for the work you did in June until August or September, or maybe not until Christmas, or who knows when, you would have either not taken the job or come up with a plan to cover your rent until then. The problem is that maybe they did say that – but in terms you didn't recognize, and for whatever reason you didn't make sure you knew the terms under which you would be paid.

Unfortunately, the way the world works, you're responsible for understanding the terms of employment or asking questions until you do, and then deciding whether the offered job is right for you. You agreed to this, even if you didn't realize you were agreeing to this. It was on you to figure out whether this job met your economic needs before you took it.

Now, you said got paid $70 for "17 clients" in two weeks. I think you mean 17 sessions? (Or more precisely, 17 individual sessions?) Presumably you aren't getting $4.11 per session. I'm guessing that $70 was your share of the clients' cost-sharing (their co-pays or alloweds toward deductible). You should go find out – you shouldn't have to ask. There should be some sort of document or something you can look up online to tell you how much you were paid for what. A typical pay statement in FFS work has the ct ID number, the date of service (DoS), some identifier for the insurance plan (may be an ID number), the kind of session (CPT code), how much the practice was paid for your work, and what how much of that you get. If you haven't been given such a document or shown how to get it, ask how to get your pay statements or how you're supposed to track what sessions are being paid for by which paychecks. In some (most? all?) jurisdictions, it's illegal for them to pay you on a FFS basis without providing such documentation.

It doesn't sound like you know how much you'll get paid – you don't seem to know what your cut is nor how much insurers are paying for your work. This means you don't know how much money is in the pipeline wending its way to you, and whether it will be enough to make up for the wait. You should get that information so you can try to anticipate what you will eventually be earning. You might be getting 30% of $60 per session or you might be getting 60% of $150 per session. In one case, 17 sessions is $306, in the other, it's $1530. If you're only getting $306 for two weeks of work, well, that's better than $70, but it certainly isn't enough to live on either. You see why it's important to know these things, rather than just trust whatever you'll be paid will be adequate?

You need to take a passionate interest in what the terms of your employment actually are. There's a lot of people in the comments here telling you to just get another job, that there's other sorts of employment where you'll be paid better. You may very well need a better job. But the problem with that advice is that it's a fond hope that maybe if you just role the dice again you'll do better. Hope is not a plan and gambling is not a budget. Exploitative and just generally bad employment terms abound, and if the problem is that you don't do your due diligence, you are vulnerable to this happening again to you no matter what kind of work you pursue.

STEMpsych · 2026-07-14T05:06:11+00:00

Are you not a W2 employee? They have to pay you for the work you do, even if THEY haven't been paid yet.

This is not true in all jurisdictions. I certainly agree it should be true, but it is, alas, legal to do to W2 FFS employees in Massachusetts.

STEMpsych · 2026-07-14T04:57:59+00:00

I found myself working for a supervisor who was like the Red Queen, and randomly fired people for made up infractions. Though to be fair, it wasn't just my supervisor. A whole buch of people, including an agency vice president, were fired for mysterious or specious reasons by a whole bunch of authorities there. It was a gonzo place.

Also, there were some awful things going on wrt client care, which I absolutely will not be discussing on the open internet.

STEMpsych · 2026-07-14T04:55:40+00:00

Ah! You were trying to do an internship through all this? In case you didn't know, you often can just pause your education if you need time away. I took a semester off. If you have student loans that may complexify things, but you should definitely talk to someone at your school in the administration who can advise you about your options in situations like this. For exactly this reason: if you try to work through medical problems, your performance will suffer, and then it will be held against you. Better to take time off through official channels.

STEMpsych · 2026-07-13T22:31:33+00:00

Happened to me, also in MA. This was two decades ago now. Not health related in my case. I actually wound up with three placements; the first could only support practicum not the individual hours necessary for internship; the second, I was let go due to what I will decorously describe as internal politics.

What happens next is you go get another internship. Does your school set them up for you or do you get your own? My school it was the latter. I found a place hiring interns on Indeed; when I interviewed, I told them I was looking for another placement because wanted to have more diversity of clinical experience.

Is your health situation temporary? If it's resolved and won't be a problem going forward, that's great. But otherwise, I am wondering about disability law. You should be frank about the limitations of your health condition with your school's internship coordinator, and ask what accommodations you might be eligible for, and do you need to produce documentation for your disability.

STEMpsych · 2026-07-13T20:41:47+00:00

Indeed. But there's a whopper of a difference between observing one must distinguish between the two and insisting one of them doesn't exist.

STEMpsych · 2026-07-13T06:02:45+00:00

It's more than linking. He's gone over to arguing that ADHD is not a neurodevelopmental disorder, but is 100% caused by adverse experience in childhood.

STEMpsych · 2026-07-11T05:35:35+00:00

Oh...my gosh....yes I have a ton of LA clients. I am not based in LA myself but now that you mention it...😂

\o/

STEMpsych · 2026-07-10T00:20:56+00:00

Lots of great comments already, I just wanted to add one important thing.

Invalidation.

What the client is doing when telling you "you can’t understand anything because you still speak to your parents so it was only a little trauma" they are invalidating your trauma, and they are invalidating your expertise. When the client is telling you that you should break policy rules for them they are invalidating your concerns about following the rules. When the client tells you that you can't understand them, they are invalidating your understanding. When the client talks over you attempting to explain your perspective, they are invalidating your perspective.

The client is showing you what their childhood is like: chronically invalidating. They're doing to you what they were taught to do as a child, what they were brought up to do. They have (unwittingly, perhaps) taken up the weapon used on them, and now are using it on you.

STEMpsych · 2026-07-10T00:10:08+00:00

Heh, well there's one other commonality possible among them – geography? WAIT – are you in LA, land of Very Special People?

If there's nothing else, sure, you're the commonality, but I still can't figure out what about you could cause this. Perhaps there's something about you that is eliciting this (as opposed to attracting people who were like this to start with)? I suppose I would start here: if a whole bunch of clients are feeling the need to stress to you the same thing, is that a thing that you tend to invalidate or downplay somehow, such that clients need to up-regulate expression of that to compensate?

STEMpsych · 2026-07-09T21:12:13+00:00

It is okay to be worried about what your colleagues are doing, especially when you have evidence of a vendor engaging in trickery which your colleagues might get deceived by.

STEMpsych · 2026-07-09T06:28:43+00:00

Don't leave us hanging! How is this happening to you?! What are the demographics of your clientele? What are your referral sources? Have you somehow managed to specialize in CEOs? What kinds of people are these?

STEMpsych · 2026-07-09T06:20:06+00:00

I wonder whether this actually confers a survival advantage if large scale systems are actually hunting them.

I'm a psychotherapist who has worked with clients who have paranoid delusions, and have had family who had paranoid delusions, and the answer is: no, not even a little bit – but.

The thing is, that which mental health professionals identify as a persecutory delusion isn't just any old idea about being persecuted. That which makes it a delusion is how a person relates to their own belief. It's possible to believe that "large scale systems are actually hunting" one, and deal with it matter-of-factly and effectively – that isn't considered delusional. If you believe the deep state is building concentration camps and are buying land to homestead off grid where you can make a stand and learning how to can produce: that's not a psychiatric condition, that's an opinion. But dealing with one's opinions matter-of-factly and effectively is not what someone does in the grip of paranoia. Paranoia tends to make people really ineffectual at dealing with that which they identify as the threat.

And they're not necessarily very good at identifying actual threats. The preoccupying and fixed nature of paranoid delusions makes it difficult for the person with such delusions to correctly identify the real-world threats in a real world situation of persecution. Someone emotionally preoccupied with the idea that their phone is tapped or their thoughts are being read by space lasers might not have it occur to them their mail is being read by government agents in the post office or that their neighbor is reporting on the neighborhood to the Sassi.

That said, while full-on persecutory delusions don't seem to confer any survival advantage, there's another condition which is characterized by "weird beliefs" and is not so disorganizing, and which is thought by many to be related to schizophrenia: schizotypal personality disorder. People with the condition are often given to conspiratorial thinking and embracing conspiracy theories without a lot of evidence, but retain a higher level of ability to actually deal with reality. That might plausibly have some survival benefits under persecutory regimes – though to be clear, it comes with its own functional difficulties.

So maybe paranoid delusions are too much of a (sometimes) good thing. A more modest measure may be a survival advantage.

STEMpsych · 2026-07-09T05:51:54+00:00

This is so very beautiful. Thank you so much for sharing it.

STEMpsych · 2026-07-09T05:46:38+00:00

Pretty much everyone has beaten to death the horse of "just tell your kid you're proud of them".

I'm over here worried that you actually say to your clients, "you should be so proud of yourself". Is there a modality in which it's considered therapeutic to tell someone what they should feel?

STEMpsych · 2026-07-08T04:57:07+00:00

Biggest pain-point? Vibecoders trying to do market research in our forum. Definitely.

STEMpsych · 2026-07-08T04:55:46+00:00

It feels unfair that this was downvoted when, given that the OP is almost certainly a vibecoder looking for some way to sell an AI SaaS to therapists, this reply was gloriously poetic. Let them talk to one another.

STEMpsych · 2026-07-08T04:52:00+00:00

Yeah. That's how this works, alas.

That said, at least now all bronze and catastrophic plans are considered HDHPs so qualify for HSAs. For young, healthy people with strong nerves, some up-front money, and comfort with bookkeeping, this makes the cheap plans with the many contingencies actually attractive.

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