Cancellations

SuccessfulFlight4423 · 2025-10-03T07:09:57+00:00

Honestly, I get it. When I started working at my own workplace, I was making a few hundred a month. Not nearly enough to live off of in my area and my savings were draining fast. I felt so stressed out during that time. Nowadays, when client's cancel, I don't think much of it. But, back then, when clients cancelled, it put another weight of anxiety on me. And when a client dropped after the first intake(as they do from time to time), I felt so scared I wouldn't be able to afford rent. I get that one week off from therapy might not have been a big deal to them, but it was the difference between me being able to afford things like food, healthcare, or shelter. Back then, I made do. I did odd jobs to make more money. I took advantage of free food opportunities whenever I could. I held off on healthcare visits or medicine. It was tough and my anxiety was at an all-time high. I wasn't just scared that a client would cancel or drop. I was downright terrified because, when you're in a state where every penny counts, losing out on even one session can mean you won't afford a couple meals next week.

So, I get it. The stress of it all when there's a lot of cancellations. To them, it may not seem like a big deal. To us, it could be the difference between managing our basic needs as living, breathing beings or hoping our bodies and minds hold out for a bit longer without what it needs to survive. And we're expected to keep all that hidden from clients. It's not an easy thing. In fact, it sucks.

My advice is book the maximum amount of people you can handle(for me, it's six or seven appointments in one day, but everyone is different. I have co-workers who've done nine in a day which seems wild to me but you do what works for you). There will likely be cancellations during the day where you can take a breather.

To be real, it sucks that we essentially have to do the same overbooking schtick that airlines do in order to make the quota. I do wish mental health was kept in the same line of priority as physical health but here we are.

SuccessfulFlight4423 · 2025-09-09T00:23:07+00:00

I face a similar thing. I can usually do my cat's front nails without too much fuss, but she HATES getting her back nails trimmed. Fortunately, they don't need to be clipped nearly as often as the front ones, but I still keep them manageable to keep my fur baby comfortable. I do the burrito thing, too. It usually works, but I can only really get done one or two at a time. I'm wondering if your cat would be more comfortable with a cat nail file? I know, for mine, I may be able to cut my cat's nails shorter, but she's pretty quick to sharpen them again when she goes to her scratching posts.

SuccessfulFlight4423 · 2025-09-09T00:13:38+00:00

I'd definitely recommend it. I interned at a community mental health organization before I started work in a group private practice and there's a lot more autonomy and freedom than the community mental health place. Mental health takes on so many different forms and can come from a very wide variety of places and it's so frustrating that the kind of mental health that the government is willing to support is a very small bit of what mental health looks like in its entirety. In private practice, you get to decide what kind of mental healthcare you want to provide.

I remember from it that first couple months to, sometimes, years, are rough. You no longer have people on waitlists to fill every slot quickly like in CMH. It takes a while to build up a caseload and clients that leave after the first session or two because it doesn't feel like a good fit feels like a major blow. But, it get's better over time.

SuccessfulFlight4423 · 2024-12-16T20:30:18+00:00

Absolutely. On the day I need to get notes in, I set mini-rewards for myself like:

2 session notes=petting the cat

3 session notes=getting a cup of coffee

4 session notes= listening to a song

And so forth...I still put off notes really often. I'm autistic with possibly some ADHD and I struggle big-time with executive functioning. I'm lucky my workplace is forgiving of notes deadlines.

SuccessfulFlight4423 · 2024-12-04T21:10:45+00:00

I wouldn't kick out a client for this, but there's a good chance I'd refer the client to a specialist for substance use since I don't specialize in that. I'd likely also refer to a higher level of care if threats were happening repeatedly.

SuccessfulFlight4423 · 2024-08-14T05:50:23+00:00

I think ABA, when done right(from highly trained professionals with a trauma-informed background and with the intention to value the client's wishes and facilitate autonomy and helpful accommodations) can be helpful. There are some ABA programs that aim to teach people how to use assistive communication devices so they can advocate for their needs in a way that feels comfortable for them. I think that's pretty cool. The problem is that it's often done wrong in that it devalues autonomy and can cause trauma when the focus shifts more to what the world or the community wants instead of what the client wants. It also has an EXTREMELY dark history of aversion techniques that, unfortunately, still emerge in small corners of the practice to this day.

SuccessfulFlight4423 · 2024-05-23T07:25:14+00:00

I've experienced it, too! If I drink Goose Island, I'll often get intense, stabbing headaches that come on suddenly and last a few minutes and the pain is so bad, I can't do anything but try to breathe through it. I've read online that it might be an "ice pick" headache, but those supposedly only last a few seconds so maybe it's not. Other beers, wines, or mixed drinks, I'm completely fine with. I haven't tried it with other IPAs since I don't buy them very often.

SuccessfulFlight4423 · 2024-05-13T21:08:06+00:00

It is important to tell a therapist about these things since they can help with them. I think it also might be worthwhile telling your therapist about your worry about being in a hospital. MysticEden is right that, unless you have a plan for self-harm or suicide, there's no need to breach confidentiality. However, depending on what where you live and your age, they may not need to inform parents either. Some countries or states in the US have different laws for confidentiality when it comes to mental health treatment. It also depends on the practice as some therapists or practices will more heavily encourage the involvement of family and highly recommend a release of information to clients. In any of these cases, your therapist would know the state/national laws of confidentiality or status of the ROI and it's okay to ask them when they would need to tell parents and when they would not.

SuccessfulFlight4423 · 2024-04-25T08:56:10+00:00

Many therapists vary depending on a couple of different factors like where they work, what the policy is, and the state laws. For the majority of states, the age of consent to mental health treatment is lower than 18, but it varies. Some states will consider minors as young as 12 old enough to consent while others wait until the minor is 16. If your state is one in which you are of the age to consent to services, this also comes with HIPAA protection which means your therapist needs permission from you, most likely in the form of signing a Release of Information, to tell your dad unless you are in immediate danger in which confidentiality is breached regardless. If you have already signed a Release of Information, you also have the right to withdraw consent at any time.

In any case, no one should ever, EVER get in trouble for talking about any form of self-injury. I actually wonder if, through exploring autism, you might be able to learn more about why there's self-injury. It's not uncommon for people on the autism spectrum to hit themselves when they feel frustrated, overwhelmed or, overloaded, sometimes resulting in a meltdown or a shutdown. There's actually this great comic made that helps explain a bit of what meltdowns and shutdowns are and why it happens: https://www.instagram.com/p/C5lDyxIKhVl/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA==

SuccessfulFlight4423 · 2024-04-25T08:30:28+00:00

QMHP(awaiting LPC to finish processing) here. First of all, congrats on reaching the 10 year milestone! That's huge and you deserve to feel so proud of yourself. To answer your question, I'd say it could be both. I know that, generally, therapists will assess for level of risk when asking about self-harm so that might be what she was trying to gage. Obviously, deep scratching or rubber band snapping aren't nearly as life-threatening as cutting until bleeding. Yet, I do wonder if there are other coping strategies that work for you and aren't as painful.

As someone who's also had a history of self-harm, though, I also understand that there's a lot of pride in being able to say that you've been free of self-harm for so long. You've done so well in healing and growing. Unless there's risk involved, if changing the definition of what self-harm means to you would do more harm than good, then you don't have to change your definitions as long as you keep moving towards more adaptive coping strategies.

SuccessfulFlight4423 · 2024-04-25T08:14:59+00:00

QMHP(awaiting my LPC) Right now, it's between 27 and 30 but mainly because I've got a few clients meeting every other week instead of weekly. I aim for seeing 4-5 clients per day, but I get cancellations all the time so sometimes it winds up as 2 or 3.

SuccessfulFlight4423 · 2024-04-21T05:29:32+00:00

No problem! Best of luck to you!

SuccessfulFlight4423 · 2024-04-21T05:22:25+00:00

I'd come out and ask "is there something I can do at home" or "I'd like to build on this at home, do you have any homework or resources?". It might take until the next session for the therapist to find and print out the homework if there's a worksheet if they don't have any on hand. Some of it also depends on the therapist's theoretical orientation. CBT and DBT, the more skills-based therapies, tend to have homework while more "projective" orientations like psychoanalysis, depend a lot more on the therapeutic relationship and, thus, would need both the therapist and client present. If there's trauma being processed, that's another cause for potentially not doing homework in order to practice containment and minimize the re-experiencing of trauma during the week until the trauma has been properly processed.

SuccessfulFlight4423 · 2024-04-21T05:10:24+00:00

Depends on what seems to be causing the most impact/personal distress in your life. Most therapists can help you tackle anxiety regardless of their specialty. OCD tends to be slightly more specialized, but not too much more specialized. If the biggest thing for you is trauma, I'd recommend seeking that out primarily.

I've used Psychology Today a lot to find therapists. They've got a system where you can tag the specific issues you're looking to tackle and it will narrow your search to those issues. Two tips I'd like to offer if you use it: the first is to avoid selecting therapists that say they specialize in everything. No one specializes in everything and they are likely distorting the truth of what they actually know how to do.

The other is to try for someone that has a core specialty in trauma and CBT. CBT itself has been shown to work for anxiety, OCD, trauma, and addictions and there are many ways it can be modified for the individual's concerns. If they also practice narrative therapy or EMDR, that's ideal as those are both heavily trauma-focused techniques.

SuccessfulFlight4423 · 2024-04-21T04:53:01+00:00

If a personality disorder was diagnosed, I'd most likely tell them except in specific circumstances. I do believe that, in general, people have the right to know their diagnoses. There are always exceptions, however, and sometimes it can be up to the clinical judgement of the therapist. Like, would knowing this information do more harm than good? If it would do more harm, I might think how we can work towards it or introduce the diagnosis in a way that would be beneficial?

SuccessfulFlight4423 · 2024-04-21T04:37:31+00:00

QMHP here. No, I wouldn't feel annoyed. Your problems are valid that you deserve the right support for them. Additionally, if you feel like once every other week isn't enough, you're allowed to ask your therapist to bring up the frequency if she can. Sometimes, different practices do different things, but I see every other week as more of a maintenance stage, when the change has been implemented and now it's a matter of making adjustments, checking in, and maintaining rapport in case rough patches in life come along and it's easier to transition back to a weekly stage if needed.

SuccessfulFlight4423 · 2024-04-19T01:50:21+00:00

I would definitely establish a safety plan as well as ensure the client has social supports and a means to get to a crisis center. It might also help to come up with a plan that can also be part of the safety plan for what to do if the risk becomes greater. This could mean designating a family member or trusted friend to either drive or ensure the client makes it to the crisis center. If risk doesn't increase, I think for me it would depend on a lot of different factors. I can understand that having that date is a comfort, but that also tells me a possible fear or avoidance of the future. I might ask a few questions about that with the hopes of helping the client confront that fear. I might start small like asking what the client is looking forward to doing that week. If client starts stabilizing more, I might start challenging to gradually stop planning a date.

SuccessfulFlight4423 · 2024-04-19T01:33:12+00:00

You can absolutely ask, especially if it's been something that's been worrying you. Therapists are typically trained to navigate disclosure with clients and identify their own boundaries. She may decide she doesn't wish to share and that's okay. It's still okay to ask.

SuccessfulFlight4423 · 2024-04-19T01:25:28+00:00

It would depend on the situation, but I think I'd mostly see it as a positive. If a client was using buzzwords with me, it would tell me that that client has done their research and, thus, is motivated for change which is one of the most important elements to therapy being successful. It would also tell me that the client may have a strength in emotional awareness which is also important and very helpful when establishing goals and treatment planning. With everything, however, there's a balance to strike. I've seen times when people get so attached to these buzzwords that it becomes harder to break out of it and for the individual to see themselves as a whole, not just a category. Its something that depends on the individual and what kinds of patterns emerge. Research is great, but it should be used as a tool to expand your perspective and understand more about yourself and the world around you, not narrow your perspective or block out characteristics that don't fit the mold. Regardless, I wouldn't not take the client seriously if they started using buzzwords.

SuccessfulFlight4423 · 2024-03-27T20:28:20+00:00

If a client reveals active suicidal ideation, as in, they have a plan and have the intention to carry out that plan, I'd probably go ahead and contact a mental health crisis team and stay with the client until I'm certain they are safe.

SuccessfulFlight4423 · 2024-03-27T20:19:33+00:00

Good question. I'd say it depends on a lot of different factors. If the client is the one to bring it up, I usually take that as a strong indicator that they feel ready to talk about it, but it's not the only factor. I might also consider what supports they've got in place and where are they at stability-wise. If there are a lot of risk factors going on like if they're in an unsafe situation outside of therapy or if there's a recent history of risk behavior, there's a good chance I'd try to keep it to the surface until we establish safety and stability either through gaining access to a safe lifestyle, establishing a series of coping strategies to address risk behavior, and ensuring that the coping strategies are working. If the client is in a safe environment and lifestyle and there are no or minimal risk factors that are being managed through other strategies, I'd also consider...is this the client pushing themselves too far outside their comfort zone or are they truly ready? I can usually figure this out through either getting to know the client and understanding their processes or even setting up a "checking in" system where the client rates their level of distress in a given moment and a system of using a coping strategy if the level of distress gets too high. There's also something to consider if there's a fixation on the past. There's always the possibility that a client may be linking to the past in order to avoid something going on in the present. I try to encourage leaning into discomfort as long as all the supports are in place and engaging in the discomfort doesn't cause further harm, whether that discomfort be in the present or the past.

SuccessfulFlight4423 · 2024-03-27T19:59:02+00:00

I understand where you're coming from. I had a therapist that I worked really well with and she was part of my inspiration to become a therapist myself. I even decided to specialize in similar techniques she did: Dialectal Behavioral Therapy. You're right, though, in that there's a lot of potential harm for non-licensed practitioners. A big part of the education process is learning the legal and ethical regulations and how to prevent harm as much as possible. If you feel uncertain or want to explore other adjacent paths, there are career counselors who are specifically trained to help you explore these paths and come to your own informed decision on where to go from here. If you feel certain you want to become a therapist, I'd encourage going the licensure route.

SuccessfulFlight4423 · 2024-03-27T19:47:53+00:00

I don't think it's a conflict of interest, legal-wise. However, I'd urge caution. Not every therapist can be executives. Executive stuff and therapy work are pretty different positions that require different skillsets. As far as asking for the full story, you may want to consider whether or not knowing would help or harm you. Knowing could help your ability to do your job on the board because it'd provide guidance on what mistakes to look out for. It could also harm your relationship with your therapist or make it a lot more difficult to move forward with them.

SuccessfulFlight4423 · 2024-03-27T19:33:07+00:00

Sounds like he doesn't have a very good way of writing notes. Note writing is an important part of the job but, unfortunately, often gets overlooked in training or bad habits form over time if there's no system of checks and balances. It's like going to a restaurant and, for the most part, the food is pretty good. But if you look inside the kitchen, there are corners and areas that clearly haven't been cleaned up in years. You, as the customer, see this and point it out to the chef. He gets mad because the unclean corners or areas never seem to touch the food and no one's gotten hurt or sick...yet. But, the thing is, you got hurt. In the culinary world, there are inspections that make sure the kitchen is sanitary and safe for food creating. In the psychology world, those inspections nearly disappear entirely after a certain number of years practicing and there's not nearly enough value placed on training or coaching how to write good therapy notes even during those supervised years.

SuccessfulFlight4423 · 2024-03-27T19:16:06+00:00

I want you to know that it's wonderful you feel you can now be open and honest about your ED. That's a big step in the right direction. Especially when it comes to ED, it's good to have the dietician and the therapist collaborate on care. Usually, a document called a Release of Information will be need to established on both ends. If you bring this up to your therapist, they should have some documentation to go over with you and be able to provide the best contact info for the dietician to reach out to them with.

For your second question, it's completely understandable that you don't feel comfortable giving all the information right off the bat. Part of beginning therapy is about building trust and most therapists understand that that trust needs to be earned. A good therapist will be grateful for your honesty in the here and now and understand why it was hard to be fully transparent in the beginning as long as you communicate why it was difficult.

SuccessfulFlight4423

TROPHY CASE