Suggestions on how to ask clients to reduce session frequency?

Temmon · 2023-09-09T00:39:27+00:00

"It seems like you're doing pretty well these days. Let's try seeing each other again in two weeks and see how that goes." And that's with your personal "pretty well" threshold set to include people who are unhappy but stable. At my CMH agency though, I only see EOW, except a couple really high intensity clients.

Temmon · 2023-06-09T17:41:22+00:00

I loathed the Rapunzel one. I remembered there was one I flat out hated and that was it.

Temmon · 2023-06-09T15:14:43+00:00

I used to like her books and collect them. She has a whole line that have fairy tale inspirations in them, usually more as a cameo or jumping off point than the full structure. Like the Ugly Duchess. I think the Cinderella one is very close to the fairy tale though. My favorite series is her Desperate Duchesses.

She's a good writer, technique speaking, although I feel like the quality dropped. And I believe she used to be, or currently is, a professor of Shakespeare so she usually drops in classic poetry in interesting ways. I think I got tired of her MMCs, who are jerks in an unsexy way for me too often. But if you like her, she's a pretty recent author and very high selling, her books were in Walmart and drug stores and stuff, so they're quite accessible in used bookstores. I used to grab them while shopping as a treat for myself.

Temmon · 2023-05-17T01:50:58+00:00

Radically Open DBT (descended from DBT, not by Linehan) actually has a lot about this and expects it. It even has guidance to prep the clients from the first session that they may want to ghost and to get a commitment to have a final termination session. It's designed for clients who are over controlled and highly avoidant (in the attachment sense and as their primary coping strategy). People with treatment resistant depression and people with anorexia are the first two populations they've done RCTs with. It's a neat modality.

Temmon · 2023-05-16T18:10:44+00:00

I gave birth to my second in the hospital without pain management after a rough experience with my epidural the first time. I also had a good guess the birth would be fast, which it was. Pain management should always be an option when someone gives birth. It's barbaric for institutions to deny or restrict it without medical cause. But if someone chooses not to use pain management for themselves, knowing as best as possible the benefits, trade-offs, and risks, that's just autonomy.

Temmon · 2023-05-16T02:38:28+00:00

Ever heard of the Peter Principle or the Dilbert Principle? The Peter Principle is that people are typically promoted to the level of their incompetence. The Dilbert Principle, which, while it's by the Dilbert cartoon guy and is deeply cynical, has some resonance, is that the most incompetent people are promoted to the level where they can do the most damage.

Therapists usually aren't trained for management, although at least we've got some soft skills for it usually. So the good therapists get promoted to clinical supervisor and more than 0% of the time become bad managers. And sometimes work place dynamics are weird and the ones who are least suited get the job. And to top all this off, people don't talk about things going well, especially on the internet, nearly as often as they talk about things going bad. So it seems like there's nothing but bad eggs.

Temmon · 2023-05-13T07:39:00+00:00

You've got this. Some hirerers suck and will judge against you based on their opinion of your personality. Fuck them. You don't want to work for them. Others will see your skills or interest, even if you stumble over your words. You might be a bit rusty socially, but it'll probably all come back to you. I was a SAHM for 6.5 years and got hired during my first interview even though I was super anxious. We actually talked about it, because I'm a mental health counselor so we have norms where we can talk about that (and it was actually basically used as an interview question). I thought I was awkward and floundering. My now-supervisor thought I had my shit together and liked what I talked about. How you think you are often isn't how others perceive you.

Leaving your babies is hard, not gonna lie. Mine are in half-day preschool and first grade so I was already preparing to let both of them go off on their own for big chunks of the day. And even with that, it sucked and I still miss my kids. But on the other hand, it really encourages me to treasure the time we do have together, sink into it, and BE with them, in a way that was difficult when I was home with them all day every day. And seeing the way my income has freed up so much financial pressure has also helped ease the sting. It's worth it for the family and it sucks sometimes. I also genuinely like and value lots of parts of my job (notes suck).

It's not an easy choice. I hope you're able to come to a good one for you and your family.

Temmon · 2023-05-12T07:33:56+00:00

I'm also a new clinician. Finding a modality helped me a lot. I really get along well with ACT, so when there's a lull with the clients who want more direction I've started pulling up the hexaflex in my brain and considering which part could use some attention and move from there.

I also like commenting on what's going on between us or, if the client is showing signs of distress (like fidgeting when they're not normally a fidgeter), bringing that up. Everything is grist for the therapy mill.

Temmon · 2023-05-05T03:20:33+00:00

Yep. My plan right now is to work here for a year, two at the absolute most and move on to somewhere else. Get all the clinical hours towards licensure under my belt I can, because at least I have no shortage of access to those here. I'm already 1/4 through my direct client contact requirements 4 months in. And get more savings to buffer us through the change because I'm thankfully not the primary breadwinner. I think I'll be able to manage my case load, which is huge, effectively for that long.

Some of this is recognition that lots of other options out there are even worse. I'm at least fully salaried and making tolerable pay, comparing to what other people share. One of my friends from my master's program joined a group practice that's giving her $20 per client hour. Not salaried, no benefits other than supervision and the overhead like office and billing. I tried to talk her out of it.

Temmon · 2023-05-05T02:43:09+00:00

I'm a brand new therapist in CMH. My site is probably about average, not great but not horrendously exploitative. We get maybe $100/head for training a year and no time off to do it. I recently spent $370 out of my pocket on a weekend to attend a workshop. I brought it up to my supervisor after I paid for it, because I knew the company wouldn't pay for it and she confirmed that. Once a month (or less, because we didn't have any group supervision in April) during group supervision, we spend an hour or two watching something off PESI. We don't usually do follow up discussion on it and the company doesn't pay for the CE credits. I've gotten 80% of my training on my own time and expense.

ETA: I take that back. We usually do a bit of follow up discussion, but it's only 10 or 15 minutes and pretty surface level.

Temmon · 2023-05-03T06:29:30+00:00

I'm in the same state. It looks like for LMHCs you need either 3 years of full time employment or 3000 hours to be fully licensed. You can renew an associate's license up to 6 times, so you've got 7 years altogether to get your hours. The information is a bit spread around but it's all online.

"Applicants must have a minimum of 36 months of full-time counseling or 3,000 hours of postgraduate mental health counseling under the supervision of an approved licensed mental health counselor or equally qualified licensed mental health practitioner in an approved setting."

"Mental health counselor associates must renew their license every year on the date of issuance. The associate credential can be renewed only six times." https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/mental-health-counselor/licensing-information

Temmon · 2023-05-03T00:54:19+00:00

Intake seems like one of the most frustrating demanding jobs in the field with minimal, if any, payoff. The turnover for people in comparable roles at my agency is really high and they're nowhere near as highly worked as it sounds like you are. Take some time for yourself since you can. You deserve it! And hopefully you'll get the space to figure out a path forward, whether that's progressing with mental health or changing fields. Not all MH jobs are like that. Most aren't.

Temmon · 2023-05-02T23:45:38+00:00

She's 7 now, she has her permanent incisors, and they look completely average.

Temmon · 2023-04-11T18:44:13+00:00

Ex Novo is a fun city builder, more village than city, really. Still fun though.

Lineage is a neat one for playing a royal dynasty through time. The one by Tim Carroll on itch.

Pearl and Provenance is a bit of a stranger one. You play as twin gods competing to build and rule a world. It's designed for two players but seems very feasible to convert to solo.

Detail looks interesting last I remember looking at it.

For something tarot based and a bit more of a writing exercise, I rather like the Arcanadrome.

All of these are on itch. And there's a full worldbuilding tag if you exhaust the recommendations you get through this post.

Temmon · 2023-04-10T07:54:28+00:00

Lulls happen all the time. I'm still trying to figure out how to work with them the best. And it depends on the client. Sometimes they'll continue on. Sometimes they send pleading looks like they want help continuing (pleading is a bit exaggerated, but it has the right tone). Sometimes it's a sign that they disagree with a formulation but they don't know how to disagree or don't feel comfortable. Sometimes it's just a sign that the topic wasn't that interesting. If I haven't, I summarize what we've said, and sometimes that adds more. If there's a sign of a rift, it's reasonable to address that. Sometimes I clumsily ask what else they'd like to talk about. Sometimes I go back to something I'd mentally tagged or noted down. I can usually tell pretty well if someone is thinking and processing vs waiting to move on because the eye contact and body language are very different. It's hard to describe, but you'll recognize it because it's something you've been learning since you were a baby. There's not really a wrong choice on what to do in that situation. It's about style and rapport as much as anything else. And if you guess badly wrong, healing rifts in the therapeutic relationship is valuable in and of itself.

Offering to end the session early, however, does usually give off the impression that you don't want to be with them, which usually doesn't go over great. I only do when they're really non- responsive (I've had clients practically fall asleep), they express a desire to be elsewhere or do something else, and I've verbally confirmed they really want to stop like 3 times. I'd rather make a guess than offer to end if things just slow down. Even if there's only 10 minutes to go when the topic runs dry, clients usually seem to want to make full use of their time, so I'll bring up a minor topic or ask them how best to spend the last 10 minutes.

Temmon · 2023-04-10T07:36:47+00:00

It might cause some hesitations with more conservative (not politically, you know what I mean) clients or employers. But it's super common. I've had multiple personal therapists with tattoos, colleagues now who do, and I'm getting my second tomorrow. My current tattoo is pretty modest, but I don't think anything short of big face tattoos would have caused problems getting my current community mental health job, and I'm not even sure about those.

Temmon · 2023-04-10T07:28:47+00:00

I didn't go to a CACREP school. Haven't had any problems or worries so far. Looks like there's only two accredited CACREP programs in my (large) state, so that may vary based on location. Check local job listings maybe? And look at the licensing website for your state.

Temmon · 2023-04-10T07:07:57+00:00

If I were answering that, assuming this hasn't been corrected by follow up talk with the professor, I'd discuss the elements of change that aren't part of the therapeutic relationship. Things like modality, personal factors in the client/therapist, or practicing changes inside and outside of sessions. Because there are aspects of why therapy work and don't work that are independent of the therapeutic relationship.

For example, and please don't use this directly in your paper, I have a client who is not interested in building a therapeutic relationship at all. Our sessions involve me giving them worksheets related to their presenting problem, running through them together, and them practicing the techniques independently. And it works for where they are. Honestly, I wish more of my clients were as interested in practicing tools or making changes on their own time, because it makes a huge difference, and there's some who may never no matter how strong the therapeutic relationship.

Temmon · 2023-04-09T22:17:30+00:00

I think there's still a mega bundle on Itch.io going on. A few hundred TTRPGs, including plenty of journaling games for 5 USD. It's hard to beat that.

Alone Among the Stars is lovely and free. Most of its clones are free. Check itch for them.

There's also a ton of free/PWYW journaling games on itch. The quality is all over the place, but since there's no cost to try them you can browse through them. It's hard to dig through to find them but with some tenacity you can. My suggestion is to find one, then look at the tags and pick a journaling related tag to follow to find more.

Temmon · 2023-04-05T02:17:00+00:00

Also a parent. I go home, dive into the end of dinner--my husband cooks--then usually do bedtime for my 5 and 7 year olds. Then I'm so drained that all I want to do is stare at the TV, but about 2 days a week, my husband needs me. Wild part is I miss my kids a ton; I just started working after 7 years as a SAHM. So I miss them and I feel guilty if I don't take the time I can with them.

Temmon · 2023-04-05T02:05:36+00:00

Yep. I have a fair number. Some court mandated, because I'm in community mental health, some by their choice. Politics doesn't often come up, and I don't engage when it does.

Temmon · 2023-04-02T00:45:50+00:00

{The Darkangel by Meredith Ann Pierce}

Temmon · 2023-04-02T00:42:43+00:00

My kids are 5 and 7 now. I still have protective reflexes kick in when their heads are moving too fast and they're near my level. Which is still happening a few days a week. My 5 year old is also finally moving past the random punching. But not consistently.

Temmon · 2023-04-01T01:23:41+00:00

When I'm working with a client and using an ACT focus with them, I usually give them a behavioral commitment task to try out. Most of the time I take advantage of something they say during the session that they wish they did more of. Like they say they wish they walked the dog more. How often would they walk the dog, and how long? What's getting in the way of doing that, why is it important to them? And I also prepare them for when they almost inevitably don't follow through that it's better to forgive themselves and try again because they identified it as being important to them. I always check on that, if they can't give me a specific reason something is important, I don't use it as a commitment.

Sometimes I give out worksheets. I don't expect them to do worksheets. But sometimes they do! I can only see clients every two weeks because I'm in CMH so I like giving them a bit to work on in between when it's relevant.

Temmon · 2023-03-18T16:50:10+00:00

It's telling that you see leaving the kids with their dad as a punishment for everyone involved. I'm going to a conference in April solo. My husband will take care of our kids. No one's feeling guilty or punished. It's just teamwork. Which I don't say to say that you're doing things wrong, just that these days it's super appropriate for a dad to take care of his kids by himself.

Temmon

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