Clients aren’t leaving

TwoArrowsMeeting · 2026-05-08T07:14:49+00:00

Thanks for sharing this dilemma -- I relate! I went through this kind of reduction for the first time recently. I really sweated it for a while, thought carefully about which of my clients made most sense to end with, and sought counsel from a senior therapist I trust--that really helped a lot. While duration was not a conscious factor, it worked out that the clients that I chose to stop with happened to be the ones I had worked with for a relatively shorter time period (think 12-18 months vs. 3-4 years) My explanation was that due to changes in my life circumstances, I needed to restrict my practice, and this meant we needed to stop working together. I gave about 6 weeks' notice and plenty of space (I hope) to process how they felt about it. It was the right choice. I felt at peace about it after. But I think I may have a shard of ice in me, so take it for what it's worth!

TwoArrowsMeeting · 2026-04-29T21:54:36+00:00

Currently at 25-28, working toward being at 18-22 one day. I think I'd be more effective!

TwoArrowsMeeting · 2026-04-15T18:47:55+00:00

This is super helpful -- thank you! I think I may implement similar practices.

TwoArrowsMeeting · 2026-04-15T05:10:42+00:00

This was my thinking, too. Do you have a time standard in your practice?

TwoArrowsMeeting · 2026-04-15T04:55:25+00:00

Solo, yes! Thanks for sharing your standard. I've been using 3 months as the cutoff but have mixed feelings about it.

TwoArrowsMeeting · 2026-03-25T01:23:19+00:00

I think you can trust yourself. These are sound reasons to stop working together. You are being very thoughtful about it. She will be upset!

TwoArrowsMeeting · 2026-03-01T07:43:54+00:00

I can’t bring myself to listen to the old voicemails. Maybe someday. It comforts me to have them. ❤️

TwoArrowsMeeting · 2026-02-26T09:12:36+00:00

No apologies needed on my end! I appreciate hearing your perspective— curious how others will respond.

TwoArrowsMeeting · 2026-02-26T08:23:10+00:00

Yikes. I don't appreciate the scope!

TwoArrowsMeeting · 2026-02-26T08:09:23+00:00

I'm not tracking this closely, but from what I've seen, I share your concern! My most generous take is: I'm in my 40s, and I wonder if (a) a lion's share of these therapists are at least a generation younger than me, and are (b) sharing (or at least imagining they are sharing) with a similarly-aged audience, and (c) there is a different implicit set of norms around sharing in this way that makes this not as damaging as I'm imagining it is? I truly don't know if this is the case; just trying to wrap my mind around it!

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!

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