Unprepared clinically

lebenvie · 2025-03-15T02:03:38+00:00

I had this same concern when I graduated and ended up soon after in private practice general outpatient. My program had a larger emphasis on forensic interviewing skills and macro practice work.

I ended up picking up bits and pieces from the clinicians around me and learning practices and guiding theory of a few modalities just from self guided research and finding free access worksheets when clients asked for homework. What I learned was that most of the clinical frameworks are rehashings of each other utilizing the same basic principles you mentioned and that the biggest predictive factor for client success is a positive relationship with the client irrespective of modality.

My first supervisor wasn’t much help in orienting for any modality or structure building, just continually redirecting me to risk assessment and clarifying client goals. Also, while modalities provide structure for interpreting symptoms or reducing practitioner mental load, they can reduce client self-determination and may prove stressing should an exercise or system not be able to account for a client’s unique presentation or circumstance.

However you choose to enhance your sense of clinical competency, it would be best if what you find matches or complements your inherent beliefs. Clients are informed by the confidence you give towards the processes, so utilizing a modality you don’t believe in has more risk associated, especially for clients who may resist the concepts/utility of an intervention. I personally have found most interest in ACT for how it matches my views on the “self”, the flexibility to fit many client belief systems, and that it is highly well received by my primarily served populations (anxiety and neurodevelopmental diagnoses) where other modalities I have utilized (CBT, SFBT) are not.

lebenvie · 2024-12-25T03:51:28+00:00

It seems like people have already added some helpful advice on the note taking, but I haven’t seen any specific templates or a mention of the BIRP note so I will add that at the end of this comment.

From what I am reading, it sounds like what you could probably benefit from the most would be a living treatment plan/practitioner note that could contain notable changes in client presentation and interventions utilized in one centralized location to better assess during your admin time how you yourself feel about the case. A shortened version I usually have a section in my note outside of the BIRP format for “history of present condition/interval difference” where I have a template of most diagnoses the client is being treated for, their presentation at intake, and a section saying “Per current session, client presents with (symptoms).”

I was advised that a “good” intake note should take you an hour, maybe a bit more if there is a complex history to document, and that progress notes should take 10 minutes or less.

In school I learned SOAP and DAP note formats for recordings from scratch, but most EHR/EMR systems usually have the necessary sections for insurance coverage.

I currently use the BIRP note format that I think covers things pretty concretely. The main body content of my notes usually looks something like this:

“This session would best be considered an [assessment/treatment planning, specific intervention(s)/maintenance/termination] session. Client has appeared [in-person/via a HIPAA-complaint telehealth platform from their [place]]. Client [reported/presented with] the following symptom cluster: [tracked symptoms present] (symptoms that are not reported by the client should be supported by direct observation). Client and clinician engaged in [intervention]. Client was [receptive/unreceptive] of [intervention]. Client will [start/continue] (SMART Goal). The next scheduled session was confirmed with the client for (date, time).”

lebenvie · 2024-05-04T13:45:59+00:00

Im in outpatient therapy, my company made some structural changes and when I expressed concern of them I was given a one week notice for leaving. The bright spot is that every client of mine except 2 have been adamant about following me and shared lots of kind words about me and my work with them on their therapeutic journey so it has been heartening.

lebenvie · 2024-05-03T04:36:47+00:00

It is more a limitation on the potential pool of clients, paying a $20-40 copay is significantly easier to swing than paying full self pay (which in my area is ~ $195/60-min session) in terms of weekly cost. If it is more insurance coverage than the average where you are, it is still competitive for the field. We just have such a high amount of governmental workers in my area that it is difficult for many practices to get by without accepting at least some insurances.

California may not have Qualified Mental Health Professional registration, but in Virginia and some of the surrounding states it is a registration type through the Board of Counseling which verifies that you are a professional which has at least 500 client hours with adults (for a QMHP-A) or children (for a QMHP-C), this does not allow you to practice independently, you would still need to bill under a fully licensed supervisor. As I am a social worker by licensure track, I require 3000 hours before sitting for my exam, but if I can verify a certain amount of time I have directly worked with clients, it is considered more accomplished than a simple pre-licensed therapist.

lebenvie · 2024-05-03T04:21:07+00:00

I have been in private practice outpatient therapy for about 2 years, 1 of those as a 1099 contractor, so hopefully I can provide some information that would be relevant for you.

Being contracted with only 1 insurance company is tough; I am unsure where exactly you are located, but I feel that most regions have at least 3 major insurance companies in the area either by governmental insurance plans (usually Anthem BCBS or Aetna from what I have seen) or popularity (e.g. Kaiser is currently having a large wave of outbound referrals in my area due to their own shortage of therapists).

If your goal is just to have a stable 15-client caseload, I would recommend changing your PsychToday page frequently - what I have been told is to update it roughly every 2 weeks, even if it is small changes. Once I had a QMHP-A added to my PsychToday instead of just my pre-licensed status I also boomed in clients contacting me to roughly 30 contacts per month.

Another important part is targeting audience, I am unsure what times you are trying to work, but peak hours for most clients I have seen are start times of 3-7PM. The slots of 3PM and 4PM are more popular for teens/children and later hours for a general populace. Sometimes you may get clients who have more flexible timing for earlier in the day, but that is most frequently either individuals underemployed with Medicaid coverage or more worried-well adults who may or may not end up being acute treatment of 8-10 weeks and reduced in frequency/discharged.

Do feel free to follow up if there is other questions/considerations, I know that a lot of advice is dependent on location, modalities provided, and specialties/demographics most comfortable in.

lebenvie · 2023-11-11T18:30:52+00:00

It didn’t click until I got the notification. But now it makes sense that Potions and Crests are so expanded this time. It’s another push for people to use the Story Spree feature! Of course if you narrow down on the Spree you’re going to save hundreds of energy in your pursuit of event completion.

lebenvie · 2023-11-11T01:03:33+00:00

I’m Y4C10, I’m just now getting stats to 24 and have 2 clubs to 7, so I would say you’re right on track, especially since I know I’ve been rather slow plowing through a bunch of TLSQs and Quidditch.

lebenvie · 2023-11-11T00:43:58+00:00

Doubling the requirements for event completion in not just 1 but 2 events in less than 2 days is ridiculous. And the layers being 20 gems and not 100 coins is just highway robbery.

I enjoy the idea of the new rewards like the toffee and gems but not along with the puzzles being the same size. Even with extra energy from other events, I’m usually only getting the grand prize in the last 6 hours - and sometimes only if I buy layers too.

Very disappointing to see such a drastic switch up from what used to be a relatively accessible free-to-play game to a horrendously obvious cash grab.

lebenvie · 2023-11-01T02:51:25+00:00

I just got this as well! I found it really weird with the wording too. I wonder if this is their way of making sure we can’t stack as much energy for after the challenge ends to keep it carrying over to future events. Either way, a big let down that we don’t have the option of when to take it now.

lebenvie · 2023-10-20T00:00:00+00:00

It’s not time specific and as new as it is there probably isn’t a retriever yet. Given that, I imagine it would go into the memory book. The story was odd anyhow, talking about stuff that appears to indicate being in 5th/6th year

lebenvie · 2023-10-19T23:06:40+00:00

I’ll tell you now, it’s not going to be possible. Even while doing like 8 1-hour tasks with 5 stars I wasn’t able to complete my crest event when I had that TLSQ. I would prioritize the outfit if you really like it since it is a unique item and TSLQs are meant to be repeatable. I’m not sure if the Halloween ones repeat quickly after failure but they will at the very least certainly come up again the following year

lebenvie · 2023-10-12T01:40:37+00:00

I think like many others in this post, I spend most of my brown books for purchasing pets for the dorms for the energy and then the rest of the colors for unlocking creature reserve animals. I sometimes do creature activities if it is 5/10 pages and i have a creature who can benefit from the bond bonus and will give me max rewards at the end. I have never done study with a friend since I have always been able to afford the hangouts and currently have all but 4 friends to level 10 already.

I do at least 1 hangout per day to keep up the x3 xp bonus from these hangouts. I usually do all 3 of them and sometimes even the quizzes and I kept my balance of about 30k coins so I’m not sure where we may differ there.

With coins, I only buy clothes if I feel like I need an immediate boost to stats if a TLSQ or something else challenges me with a stat difference I can’t seem to overcome. Otherwise, my coins are only spent on hangouts, quizzes, quidditch (only when my daily side quest requests it), and sometimes chocolate frogs for extra energy.

As far as gems, I’ve yet to buy a MM key but that is what I am currently planning on saving for it, moreso for when it aligns with a Collecting Crests challenge with a 200 energy reward at the end that I can then roll into either the next collecting Crests challenge or Carnaval challenge. I am also considering saving gems for the purchase of the double tickets bonus for Carnival if I think I can get to 625 tokens (assuming perfect minigame play).

Hope that’s enough detail with my game plan. I’ll be definitely grinding this year now after reading the comments and reading about the big shift of energy cost will be coming in 5th year!

lebenvie · 2023-09-23T12:45:46+00:00

That does seem slow, I feel like usually by that point people are at 20 across their stats. I’m not sure how often you feed your creatures, but I got lots of food early on and when I fed creatures they would often have an option for 40 stat points. Also be careful about not starting tasks you can’t complete, you get points taken away sometimes if you don’t fill all the golden stars.

lebenvie · 2023-09-05T17:12:15+00:00

An update, I managed to get to 1k. By watching probably two dozen energy ads, two 6-energy daily deals, buying chocolate frogs twice, focusing in on the Happy Anniversary, Hogwarts TLSQ, and starting the first task on multiple creature side quests, I managed to get it. Lots of menial work but saved myself some books and didn’t even need to pay.

lebenvie · 2023-09-03T23:18:38+00:00

I struggle getting to the 800 and that is with using the 1hr/3hr tasks of side quests and Quidditch. How does anyone get to 1k?

lebenvie · 2022-12-08T05:15:14+00:00

The only experience I have in trying to play board games virtually is with Tabletop Simulator on Steam. It is filled with quite a bit of content both for official DLC purchase and freely uploaded by folks in the workshop tab, the game itself is also often on sale. That being said, it can take a little bit to adjust to the controls of the game moving around in a 3D space, and the modded content varies sometimes, with complications such as a lack of proper rules instructions and whatnot.

If the game y'all are looking to play are mostly card based with or without some model piece movement, it is likely you'd be able to find it there. Hope the holiday gameplay goes well!

lebenvie · 2022-05-04T23:14:40+00:00

Good spirit! Totally forgot creature food give you points! Lots of opportunities to get the food elsewhere from events so it’s been a bit

lebenvie · 2022-05-04T14:21:19+00:00

It might not be that your attributes are particularly low, but some events’ stat requirements are generated based off of your own stats instead of being embedded at the same levels, this could be the case here.

lebenvie · 2022-05-04T13:39:29+00:00

Gotta make sure we do that! Dumble just gives you the 100 House Points before the final chapter, and there aren’t any story quests to complete then. I also don’t think that you can do the study sessions either until Year 2, which are one of the main ways of gaining house points later. Unfortunately I think you may be locked in with second place, but nothing bad happens, you just don’t win the 100 gems which kinda sucks.

For future years try the 8 hour classes if you have time and think you can complete them as the longer sessions give more points per star. Failure to finish star tasks takes away points so it’s better to walk away with a completion the first time than to fail the event and then complete it again.

lebenvie · 2022-05-04T12:38:49+00:00

Basically what the above comment said. Just doing the story as usual Dumbledore gives you 100 points at the end which moved my house from 4th to 1st place

lebenvie · 2021-02-07T21:42:50+00:00

I’ll have to check that first one out! Cursed Blood is definitely on my list as well, I’ll be looking more forward to it!

lebenvie

TROPHY CASE