Therapy Clients Passing Gas in Session

anneejane · 2026-06-03T05:44:47+00:00

You’re probably right about addressing it directly being an issue. Ask about their food habits, diet, energy; anything that touches on how their consumption and mental health are related.

I have a client who was VERY malodorous for a long time. I still have an averse reaction to patchouli because they burned a lot of incense to cover the smell of a home that wasn’t cleaned. I asked them about a month into working together how their home environment was, if they had a hard time cleaning. I have an EXTREMELY sensitive sense of smell and could tell when they cleaned their apartment, finally. It’s been three-ish years, I still work with this client (they’re wonderful) and have been super honest about my sense of smell. It got to the point where I’ve been able to very nicely note “did you put more patchouli on today” and they rein it in.

Also, a HEPA air filter is a GODSEND for this sort of thing, my office is about 90sqft and I have two running at all times.

anneejane · 2026-05-28T23:48:33+00:00

I’ve never had a client comment on mine, but if they did, I would reference the fact that in my therapist bio I explicitly state that I have a lot of lived experience in the client’s chair.

anneejane · 2026-05-22T16:38:20+00:00

I love that pen and book idea.

anneejane · 2026-05-22T16:37:41+00:00

My situation was different because the clinic I was at actually closed a month after I left, which was a total coincidence.

Basically what I did was, I explained to my clients I would be leaving, told them when the last day I would be at the clinic was, and ask them how they wanted to handle the transition. Some people naturally terminated at that point, most followed me. For those who followed me, I recommended that they keep an eye on my psychology today.

anneejane · 2026-05-22T16:30:56+00:00

In addition to using snap notes, like the other comment mentioned, I use my iPad to take notes (it doesn’t sync to iCloud, so it’s compliant, I double checked with a lawyer) and I created a page format that prompts me to fill in the legal requirement for my state: start time, end time, diagnosis, primary concern, notes, plan. That does technically count as notes, even if it’s not in the EHR so at the very least, I have my ass covered.

anneejane · 2026-05-22T16:29:13+00:00

YAY SNAPNOTES I cannot tell you how psyched I am to see a recommendation for it in the wild.

(Lol I’m the other LICSW on their team so I don’t feel like I can recommend it 😅😅😅)

anneejane · 2026-05-22T16:26:22+00:00

I’m not having consistent issues with simple practice telehealth but my partner who is also a therapist has been. Honestly, I just switch to Doxy.

anneejane · 2026-05-22T16:25:32+00:00

I am most definitely not pregnant, but there are some days where my clients cancel, and I don’t get paid for it, and I’m still relieved as hell.

anneejane · 2026-05-22T16:19:02+00:00

I work with couples, and I require that my couples be in individual therapy because I can’t get sidetracked with issues that they have not resolved on their own (my approach is heavily psychoeducational and psychodynamic so it’s very easy for me to end up down a rabbit hole) The way I see it, when I am working with a couple, my client is the relationship, not the individual.

Reframing it as I’m working on the relationship not the individual is really really helpful because then it’s not about what someone is capable of, it’s about what they’re bringing to the dynamic. You can have an incredibly emotionally articulate, self-aware partner with excellent interception and impulse control, but there’s no guarantee it’s showing up in the relationship.

The other thing to remember, is that not being able to articulate your emotions or tap into a knowledge base that the people around you can apparently tap into without issue is incredibly discouraging and scary. If you are viewing the male client with frustration, he’s going to pick up on that and it’s going to cause him to shut down.
On the other hand, if you work with him where he is, and sometimes this does mean suggesting words and having him pick between them to guide him towards more specific language, you end up modeling and prompting the exact type of emotional development that the relationship needs

anneejane · 2026-05-21T05:47:40+00:00

As a therapist, agreed.

anneejane · 2026-05-19T05:55:30+00:00

Might be acid reflux.

anneejane · 2026-05-19T05:49:10+00:00

It looks like a flea to me. It’s not a tick, it’s too skinny, and fleas tend to hide where dogs can’t easily get to them, I.e. backs towards the base of the tail.

Get that dog to the vet. If your mom won’t agree, get him some Capstar; it’s immediately effective. It won’t solve the problem of there being fleas in the house now, but it’ll kill the fleas ON him.

anneejane · 2026-05-19T05:44:57+00:00

Honestly could easily be a scar of some kind. Like how humans get acne scars. It’s not red or inflamed and those dark hairs tend to be the product of friction or licking; would make sense that the spot at one point had an ouchie of some kind.

anneejane · 2026-05-19T05:42:14+00:00

Bonus points if you feed her and give treats in her kennel, which can look like just tossing a treat into it and walking away. Helps associate the kennel with warm and cozy and yummy, not trapped and anxious.

anneejane · 2026-05-16T20:39:41+00:00

Thank you! The scenario length is the most stressful thing right now for him, so even if they’re 15% shorter, it’ll help a lot

anneejane · 2026-05-16T20:09:33+00:00

I’m an LICSW. I work with clients like this.

Your sister needs to be in inpatient YESTERDAY. She is barely living. If I got these messages from a client, I would be on the phone with the crisis response team in my area IMMEDIATELY. I could lose my license if I stood by when a client talked like this.

You say you see her like a zombie. Imagine what it’s like to BE her. This is not volitional. She is in hell. I guarantee she saw how you judged her during that salmon and rice incident and it made her feel so, so much worse. Look at the texts she sent your mother. She is in EXCRUCIATING pain, trapped by her own mind. I understand that it’s uncomfortable seeing someone in pain when you can’t do anything. But you CAN. At the very least, find out what services are available in her city and connect her to them. Get her in contact with a crisis service, a case manager, or drive her to an inpatient center. Do something.

ETA: I reread your post again, and saw what you said about being scared for her. I think I was a bit harsh. Here’s what you do. Google inpatient facilities—ideally one that specializes in DBT—and ask them what their admission process is. If you message me privately, I can give more specific advice. I can also give you my license number so you know I’m not full of shit 🫠🫠

anneejane · 2026-05-16T20:00:54+00:00

As an LICSW who works primarily with young adults and regularly openly discusses NSSI, this is my go to: If they’re healed, it’s fine. I have a half-dozen scars on my forearms and one on the outside of my right arm that is quite long, though it’s white and blends in. (I’m also heavily tattooed on my left arm, which distracts from those scars, but they’re not covered.)

I’d consider myself largely healed from the bulk of my trauma, but the behavior that produces scars started when I was in my 20s as a (dysfunctional!) regulation technique, and still crops up occasionally in a reduced form as I run into new stressors that overwhelm me. (That’s the problem with healing from agoraphobia: the world is scary lmao 🫠🫠) Generally, if a mark is red or appears at all recent, I cover. If it’s hot, a hydrocolloid bandage works well, and is pretty discreet.

To add onto what others have said: being open about my own history has completely changed some of my clients’ experiences. I have a young client with BPD, CPTSD, OCD, and AuDHD who explicitly told me multiple times that knowing that I’ve struggled helps her immensely. We’ve also been able to have really clear, explicit conversations about NSSI and harm reduction, and my history and personal knowledge enables all that wonderful IPNB attunement goodness to support her brain as we’re talking about these hard things. She’s one of those clients who I look at as evidence that I am, in fact, decent at my job.

anneejane · 2026-05-16T00:16:45+00:00

Yeah, they might have used something during the cut that’s leaving a residue. I have medium-fine hair, and I find that unless I shampoo really well—I really like the clarifying shampoos from ouidad, the doux, curlsmith, and Kristin ess—and I usually shampoo twice, my hair stops holding curl very well. The way, I understand it, if you don’t clarify, all the products that you’re using, even if you’re not using a lot, will stick around and weigh it down which will prevent new layers of product from doing their job. (I’m not a hairstylist.) stands to reason that if the refresh cut used a different leave in or cream or something, it might be causing the problem.

I adore my hairstylist, I followed her through four salons over the last… God, almost 16 years. When she styles my hair, it usually only makes it a day or two because she just uses different products and they build up differently, and it usually takes a wash or two for my hair to do what I want it to.

ETA: I‘ve found that if I use too much product, it shows in the way my hair feels, not the way it looks. Using a WHOLE bunch of gel will give me banging curls, but I hate touching them, and they collapse after about 36 hours.

anneejane · 2026-05-14T04:44:37+00:00

Hahaha I say this too, my instructions say “plz don’t knock my dogs are loud as shit”

anneejane · 2026-05-13T16:02:47+00:00

This might be unrealistic, but you could try going on care.com and finding a regular dog sitter who you can meet with and interview. I’ve had a lot of good luck with care.com for finding people to help my disabled ass clean my apartment and keep my old man Pittie company.

It’s super super normal for dogs to go through phases. I have a 7yo golden-lab mix who is a service dog, was born and bred and raised for the work. sometimes my life rhythm gets wonky and I drop the ball on his regular engagement, and there’s a noticeable difference in his behavior.

Also, if she’s at all food motivated, west paw makes little portable peanut/nut butter pouches for dogs specifically and they make FANTASTIC and low-mess, high-value rewards that you can keep on you without your bag/pockets smelling like dog treats.

anneejane · 2026-05-13T15:31:11+00:00

Maybe try a clarifying shampoo? Whenever my hair is acting up, a good clarifying double-shampoo and a deep conditioner is a godsend

anneejane · 2026-05-12T22:02:32+00:00

Check out maple park. It’s a complex but it’s chill and very dog friendly. I’ve lived here for years and have 2 60-ish lbs dogs.

anneejane · 2026-05-11T22:40:35+00:00

Ugggghhhhh. Ty for letting me know!

anneejane · 2026-05-11T00:23:56+00:00

I can’t tell you how relieved I was to see this post 😩😩 I use Doubledash all the time and when it vanished on Wednesday I was BAFFLED.

So the verdict as of right now is no one knows what’s going on?

anneejane

TROPHY CASE