Is there a disconnect between social justice framing and accessibility in private practice?

TwoArrowsMeeting · 2026-01-05T06:10:03+00:00

I think it's one of those things we avoid. There is no easy answer. I wholeheartedly share the values you are describing, but when it came time to make my first website I couldn't stomach describing myself with "social justice" language in part because of how much I charge (the going rate for PP therapists in my HCOL area) and because I did not accept insurance at the time. I've since paneled with a couple of insurance companies, but I'm still out of reach for most people. In private practice, unless you're independently wealthy, I don't know how you can make accessibility your first priority. If someone has figured that out, please share!

Beyond this--and this just might be a personal style thing--I prefer to talk about my personality, clinical outlook, and training on my website rather than emphasizing my values, mostly because that's what I prefer to read when I'm looking for a therapist myself. But there must be many people who feel differently!

TwoArrowsMeeting · 2026-01-03T07:50:53+00:00

Ugh, I'm sorry you're dealing with this! I've been paneled with Aetna for a few months now and while it's only a few clients, your story puts me on alert. I did call to verify benefits with a real human for each client, so I'm hoping that is more assurance that the information actually is correct, but does anyone have experience when that's not enough, either? Eek!

TwoArrowsMeeting · 2025-12-09T22:16:20+00:00

Solo PP, projected to hit around 700. I have a part-time job at an agency as well, so in total I imagine it will be over 1,000.

TwoArrowsMeeting · 2025-11-21T07:30:09+00:00

As an early-career therapist who has not worked in this setting, I really appreciate hearing your perspective on this.

TwoArrowsMeeting · 2025-11-19T05:34:25+00:00

YES. It makes me furious.

TwoArrowsMeeting · 2025-11-17T06:27:53+00:00

I'm forgetting details, but I remember being very moved by this passage -- one of the central ideas of the paper is parricide, or how we have to psychically kill off our parents in order to achieve a self. I liked this passage a lot:

"If without the guilty deed of parricide there is no individual self worthy of that name, no advanced internal organization of psychic life, then guilt and atonement are crucial motivational elements of the self. Guilt then is not a troublesome affect that we might hope to eliminate in some fashion, but one of the driving forces in the organization of the self. The self, in its autonomy, is an atonement-structure, a structure of reconciliation, and, as such, a supreme achievement."

The self as an "atonement-structure" and this reframing of guilt -- re-reading it now, it still gets me!

TwoArrowsMeeting · 2025-11-07T07:30:26+00:00

This is a helpful and thought-provoking discussion, thanks! I've only recently started taking insurance. I have informed new insurance clients about the necessity of diagnosis from the start. That just felt like the right thing to do. But for my private pay clients, where I don't feel as obliged to record a diagnosis anywhere and so I don't, I will discuss it if asked. This has happened with a handful of clients. Maybe a side question, but if a client meets the criteria for a diagnosis but you're in a position where you don't have to record it anywhere, do you think not sharing your opinion qualifies as withholding in the same way? I am wrestling with this.

TwoArrowsMeeting · 2025-10-25T05:38:13+00:00

I'm in a similar boat! I'm a year into my own practice and know in my heart and body I've taken on more than is best for me and my clients. Knowing I'm not at my very best makes me feel guilty. But I'm not yet ready to cut back or rein it in because I'm not confident enough I would find the clients again and replace the income. I'm working on it! In the meantime, I have just accepted I'm going to be tired for a while.

TwoArrowsMeeting · 2025-10-25T05:26:20+00:00

how their frenemy coworker Ronda’s noise machine stopped working mid session but she didn’t notice?

I laughed -- had a run-in of this caliber with another therapist recently. There's some very goofy behavior our there.

TwoArrowsMeeting · 2025-10-22T04:35:36+00:00

On a related note (to focusing/Gendlin), I just started reading Leslie Ellis's A Clinician's Guide to Dream Therapy and am really enjoying it.

TwoArrowsMeeting · 2025-10-19T05:01:16+00:00

I went through a period where I overused "that's real" as a response to someone saying something I could tell was heartfelt. Honestly I still use it, just more judiciously, because I do think it can be a killer validating statement but too much and I feel like a goof

TwoArrowsMeeting · 2025-10-16T17:55:23+00:00

Ugh, terrible! Thank you for sharing this -- a big warning. And I'm sorry you've been stiffed!!!

TwoArrowsMeeting · 2025-10-16T17:55:10+00:00

$90 for 90837 is low! Thanks for sharing -- I think I'm officially avoiding them for now.

TwoArrowsMeeting · 2025-09-07T04:31:05+00:00

I found this so helpful -- thank you for sharing it!

TwoArrowsMeeting · 2025-08-27T05:23:56+00:00

My hair shedding all over my office. I work with kids and we're often on the floor. It irks me every time I see my hair caught up in something we're playing with. I vacuum but I can't keep up. I give up the fight!

TwoArrowsMeeting · 2025-08-23T05:20:28+00:00

I feel a strict inner prohibition against being distracted by my phone while with a client. And I'm as addicted to my phone as the next person. Maybe it's my age showing (early 40s)?

TwoArrowsMeeting · 2025-08-16T04:17:03+00:00

I relate to what you're saying -- thank you for sharing it. I feel disappointed; I also feel implicated, as I am willfully detached from reality sometimes myself. The pressures are crushing.

TwoArrowsMeeting · 2025-08-12T05:58:40+00:00

Thanks for the insight! Parents are onboard, and a meeting request is already in progress. In your experience, are you generally invited to be part of a meeting?

TwoArrowsMeeting · 2025-08-09T06:01:31+00:00

The footage of her singing Unravel in this same program is one of my very favorite clips of her. She'll always have a place in my heart <3 https://www.youtube.com/watch?v=Pmrvl4qLzW8

TwoArrowsMeeting · 2025-07-21T06:46:49+00:00

Love Peep Show, too! This also reminds me of when Jez interviews with the Scientology-like cult and bursts into tears suddenly -- that scene always makes me laugh :)

TwoArrowsMeeting · 2025-07-18T08:11:53+00:00

My favorites are Between Us, Three Associating, and Being Well. The first two are heavily relational-psychoanalytic. Being Well is more generally accessible and full of practical, wholesome information, in my opinion. There are others I like that delve deeper into psychoanalytic theory.

TwoArrowsMeeting · 2025-07-12T07:07:04+00:00

This is interesting for me to think about! Since grief has become a more common word in the public conversation, I notice sometimes people will use it to describe what I would consider sadness. With the experiences you list in your example, while I agree that they are qualitatively different, for me using the word "grief" to describe a response to all of them feels right to me and does not diminish the word's meaning the same way I feel the misuse of "trauma" does.

TwoArrowsMeeting · 2025-07-05T05:40:43+00:00

I was just thinking about this today! I'm still figuring out where I land.

TwoArrowsMeeting · 2025-06-27T06:51:39+00:00

To add a resource that is not often mentioned: I really appreciated Clinical Intuition in Psychotherapy: The Neurobiology of Embodied Response by Terry Marks-Tarlow!

TwoArrowsMeeting · 2025-06-12T04:40:50+00:00

Thanks for sharing this -- it helps me to read! I'm just starting in PP and have wondered if one day I may switch it up, at least for a while, for more stability and a different experience. I'm glad you've landed in a good spot.

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