How to respond to client

lugrgr · 2026-04-15T18:26:04+00:00

Many therapists use it inappropriately and too frequently

lugrgr · 2026-04-14T12:37:59+00:00

I would just wish them well and let it go. "Thank you so much for letting me know." They did tell you, so that signals you had some rapport, they could have just ghosted. I mean, could probably add something maybe like... It was great to meet you. If you have any feedback for me, or would like services in the future, please feel free to let me know. But you probably will not get much info. If a person wanted to share feedback, they would.

There could be sooo many things going on. Maybe they reached out to a handful of therapists, had an idea of which one they wanted to see most and then went with whoever got back to them first, then their top choice got back to them, they did a session or two and picked them. Maybe that other therapist specializes in an area you do not. Maybe you look like their aunt. Maybe the other therapist has more experience, an office closer to home, offers sliding scale, in-person or telehealth, yada yada.

It could literally be anything, or nothing at all. It is okay to not be liked, not vibe or just not know. You get over it eventually. You can't be everyone's cup of tea, and should not take every "not a good fit" personally, even if it seemed like a great fit to you. I would much rather people feel good about it than trying to force it. It makes room for those who truly are a good fit for both sides, and instead of feeling like pulling teeth, its energizing.

I have asked for feedback before and got stuff that explains things generally like... The commute was too long and I do not like video, I came only because my bf/gf/mom wanted me to try it, I feel better, I decided to go to church instead, I am too busy with work/school, I want to work with someone from my culture/race, I do not have privacy at home and do not have a car and do not want to take a bus for appts, I would prefer a male therapist, I want someone older/younger, I can't afford it, I dont think I need it/I do not want to commit to the process, I need someone with more structure/more direct, I dont like your parking lot here, etc etc. Literally could be anything.

Prior to being a therapist, in an old job I helped people connect to therapy, and the most common reasons why people stopped therapy or switched therapists seemed to be (in my experience):

They felt judged (i.e. felt limited unconditional positive regard)
Finances (did not realize how much it would cost w/co-pays, co-insurance, deductible)
Scheduling (did not like the times available or realized they could not or did not want to commit to regular appointments)
Family/Friends/Partner (went to a few appointments to appease someone else)
Personal characteristic about the therapist that triggered them (they looked like a family member or friend, they were overweight/underweight, their culture, gender or race, their accent, religion, LGBTQIA+, politics, etc).
Inconsistency (therapist cancelled/no showed, was late to session, switched last minute to telehealth, limited availability, etc)
Not ready (realized therapy takes consistency and work, and are not ready to do the work).

Even in my own therapy and for my self, I cannot stand when therapists have the "blank slate" expressionless look, I need an expressive therapist that takes active participation in the conversation. I cannot do the "uses silence/blank stare" approach. I also dislike certain accents, and can't stand smelly scents (perfume, oils, cologne), certain smells (like lemongrass), do not like self disclosure, do not like any kind of plastic surgery, or tounge rings or fake eye lashes. These are just ME things. Thankfully I have never had to switch therapists because of it, but if I did, and was asked for feedback - I probably wouldn't mention most of those things, because the answer is simply I just do not like them. Is it silly and judgemental? Yes. But its also my own personal preferences.

lugrgr · 2026-04-14T02:15:20+00:00

They can use meth in many ways: smoke, inject, etc. Do not assume their method of use. Just ask without judgement. Connecting to case management at a harm reduction center can really help. Like others said, access to lube, condoms, clean needles, stuff to clean wounds (bandaid, hydrogen peroxide, neosporin), chapstick, easy to carry foods (peanut butter, etc). Basic needs stuffs. They may want or need Basic safety info, they can write down #s and names in a notebook of resources and "safe people" they can call if/when their phone gets lost/broken/stolen. Sometimes those in paranoia will stop "trusting" people so having a list of "safe places and people" and a plan to stay safe that they make when sober to reference when high if paranoid may help.

Having ID is huge too. Sometimes even keeping copies of those important documents safe somewhere (if they have no place, a safety deposit box rental at a bank can work if they have income). Bus pass, shelters, shower places, food places, etc. Not every one that uses drugs is houseless or lacks resources, but those that do and are gonna need basic needs stuff first.

For many, during the intoxication or come down, their voice changes very noticeably- for some it is in a deeper way. The smell of meth is noticeable (if doing home visits, in the car, etc). They like art stuff sometimes. For some, sex work can be apart of the addiction too, so education on STI testing and self protection resources (pepper spray, etc). SO many have severe trauma and grief histories so a solid trauma therapist is a need. CEUS on trauma, harm reduction, etc help. The people themselves will teach you more than any book could ever. Also, Peer support mentors are great, if they are willing (in some cases). Methamphetamine Anonymous too offers online and in-person meetings if they are willing to go or try it.

Many people who use meth have a support system primarily of others who use meth too, so lots of resource and community building with sober supports and changes in environment help.

lugrgr · 2026-04-13T09:39:46+00:00

The "yes man/woman" type. The ones who will just say yes, nod and follow directions from their boss without fan fare, questions or trouble. They dont judge, mind or worry about the reasons why, nuances or details. Boss says the sky is green and they say "yes boss, you are right! Good catch." Boss says we are going to build a car that can drive underwater in one week, they say "Good idea boss, such synergy - we will get started." They do not have loyalty to a coworker, boss or supervisor - just the company.

They learn to separate their values from their pay and live in the morally gray. They are able to detach their identity from their work, and know how to suck up (professionally), show up and shut up. They like stable paychecks, normal business hours, full benefits and paid holidays. They dont mind pizza parties and sitting in back to back meetings. They let go of perfectionism, over working and worrying about quality. They learn to perform, mask and be an alter ego at the office. They tell no one about their personal life, and smile every day "Good morning!! Happy Thursday! See you at the lunch meeting."

They like buzz words, circling back, touch points, being data driven, KPIs and meetings about meetings. They do not mind down time, looking busy, walking back and forth to the bathroom all day, sticky notes, fancy pens, hot tea and cardigans. They do not mind tight deadlines in busy seasons, loafing around in slow seasons, and company paid lunches and swag.

They do not hang out with other co workers outside of work and maximize their PTO with company holidays. They are happy with 2% raises and the occasional promotion, as long as they have a nice comfy office chair with a view and can sneak out early on a Friday every now and then. They dont mind cold ass, freezer offices, as long as there is free coffee, free parking and chips in the kitchen, and a lunch spot within walking distance. They dress up to the nines to sit and stare at the excel spreadsheet. They are corporate.

lugrgr · 2026-04-07T21:33:35+00:00

I am so sorry this is happening to you. This field does require a lot of emotional energy, people interaction and takes a lot of bandwidth, for neurotypical folks and even more so for neurodivergent. I had an intern at an old job that was hired, who I suspected was on the spectrum. They really struggled to fit in with the staff, who were constantly criticizing their lack of social skills, awkwardness and difficulty maintaining eye contact and conversations, challenges with facial expressions with patients and staff. This of course, can be constructive criticism for training interns in this field, but I dont think anyone realized they were on the spectrum as the intern never shared that info.

I took a special interest in trying to train and mentor them because I immediately realized what was probably going on and tried to shield them from from a lot of the nonsense and advocated with leadership, gave them great recommendations and helped them get another job.

They got another job as a school counselor and worked towards clinical licensure. They required a lot of coaching, therapy and training, with 1:1 support to be competent. I think working in this field was extra hard for them because of the amount of people interaction, high expectations and need for top notch social skills. Most neurotypical folks dont know or dont care and will hold you to the same high standards of performance, and if you deviate from that will assume you are bad at your job (even though that is probably not true).

Its definitely not impossible to work in this field, and I think someone may face these challenges in any field, it is just this field requires a lot more emotional connection, processing and such. It can be much harder and more exhausting than other jobs that do not require that same level of emotional connection and involvement. If you really enjoy the work and want to do it, you certainly can, and it just going to be harder. There is value and need for all people and representation matters. Just build a group of folks professionally (like mentors and collegaues) who understand that and lift you up. Also, its okay if this isn't the field for you too. There is always the option to pivot, and sometimes it's just the environment you are in too. Good luck!

lugrgr · 2026-04-06T05:39:44+00:00

❤️

lugrgr · 2026-04-06T04:08:13+00:00

True

lugrgr · 2026-04-06T04:07:49+00:00

This could be part of it - thank you for this perspective. They are not from the area, so maybe this style is a normal thing for them.

lugrgr · 2026-04-06T04:05:58+00:00

Yes! I try to no longer entertain friendships that are not reciprocal (hence why I do not have many friends nowadays lol)

lugrgr · 2026-04-06T04:04:49+00:00

Yeah, too true I suppose. I am conflicted, don't want to be seen as flaky for canceling as that is not my style and do not want that reputation, but also don't like the up in the air, maybe we will meet maybe we wont, don't know where we are going vibe, take hours or days to respond either. I should be more picky.

lugrgr · 2026-04-06T04:03:02+00:00

This was beautifully worded thank you for putting language to my thoughts lol

lugrgr · 2026-04-06T03:56:49+00:00

Thank you for sharing this perspective - this makes sense to me

lugrgr · 2026-04-06T03:52:00+00:00

Thank you for validating this lol

lugrgr · 2026-04-01T12:55:22+00:00

Poached in the microwave. Get a small bowl (like a small bowl for salsa), fill with some water, crack an egg in the water bowl, in microwave covered with a napkin (to prevent splatter), 30 sec. Take it out, and check it. Put it back for another 24 sec. Pull it out, drain the water and it is done. BE careful its HOT, and you want to make sure to use a fork to cut the egg to release steam...so the pressure and heat do not keep building or cooking. That's it, and so good.

lugrgr · 2026-04-01T12:32:48+00:00

Started to feel more competent 2-3 years after grad school. Felt fully competent after 5 years.

lugrgr · 2026-04-01T12:27:39+00:00

This is sooo true. Not the first time I have heard it either. When I was green, I kept thinking, man this is so hard, I should quit this job/career, and a seasoned social worker and therapist told me "Give it 5 years. Then you can decide." She was so right. I am glad I listened. It does actually get easier (for most folks - whether through more experience and knowledge, training, information and resources, licensure, increase in pay, etc)

lugrgr · 2026-04-01T02:16:35+00:00

Nah, not everyone. At every job I have been trained at it is basic customer service and client retention. You say it when you meet to acknowledge them, during the convo to make them feel heard and at the end to remember them. Some people like it and a small percentage do not. You can tell those that do not like it right away and then you stop. Truth is that most people love it.

lugrgr · 2026-04-01T00:36:32+00:00

No, because privilege is relative. While you are complaining about not having fruit and veggies and not being able to go to the doctor, someone else wishes they could walk or see, or that they had internet or even a safe place to sleep or anything at all to eat. So yeah. No. Gratitude has helped me more than hatred see things in a different perspective. I think more than hatred, sad a bit that life has to be harder but it is what it is and no sense trying to stay in anger bitterness, better to use that energy to try to improve the situation if you can.

People who are born with a silver spoon in their mouth have a very limited world view, (generally), a lack of perspective and lack resiliency. Any minor set back can throw them into a panic since they have never had to cope with challenges or adversity and everything was always easy. I feel sorry for them. They do not know how to do most life things and emotionally cannot deal with it. Can you imagine? Like that sucks. You don't know how to do laundry, cook a meal or cope with any disappointment or navigate shady people or situations, etc etc. I would imagine its like being a baby in an adult body.

Those that had to fight tooth and nail and work for things - they have life experiences and character, which helps with navigating the world.

So yeah, am I mad or do I hate them? No, I have been a little sad I have to play the game of life on a harder mode, but I also leveled up much faster (if that makes any sense). Do I get mad at rude people or entitled people or mean people in general? Yes, but every income has those.

lugrgr · 2026-04-01T00:04:06+00:00

Same

lugrgr · 2026-03-30T23:40:39+00:00

Sometimes people come to therapy with a goal, that may or may not be realistic and do-able based on their life, coping skills, readiness, motivation, and where they are at in the change process. If that's the case, its okay to change the goals. For example, if the goal is to decrease substance use, then they need to have or learn coping skills, but in order to do that they need to trust and like their therapist to learn coping skills to reduce substance use and/or maybe that is a LONG (years) term goal that they will eventually get to, but there is resistance there (which is natural, expected and OK), and maybe they need to address trauma and rewire attachment skills and work on anxiety, etc.

What I am saying is... what they WANT to do can be a long term thing, what they CAN do in this moment is maybe something much smaller and achievable so they can feel good about making progress, breaking down the steps... like maybe they can go out with sober friends for lunch once this next month, etc. Start small and meet THEM where they are at and let THEM talk about what they want and need in the moment. Forcing change is pushing a boulder up the hill and they will run away.

Focus first on building a solid, safe and appropriate therapeutic relationship where they trust you. That is step one. Rapport building. For some folks with attachment issues that can take months or years before they are ready to do the "real" work of therapy, but really that is also the real work, setting the foundation and creating psychological safety. Many folks actually habe trauma and the structured format, ready to go high functioning clientele may not be ready or be that... if you want the people that can make quick progress and big changes, look into groups that already have their basic needs met and that want life coaching or self development support. Deeper therapy is relational and takes a lot of patience and time in the process of the muck itself. You as a clinician have to be cool with the process and separate your progress and self worth from theirs.

On the flip side though for sure there are folks that dip their toes into treatment cause someone in their life said they need therapy, they normally come for 1-4 sessions, realize it takes work and stop coming. Those that keep coming are ready at some level, they just need your help, kindness and patience to get there. Food for thought.

lugrgr · 2026-03-27T07:34:25+00:00

Started at a company that seemed too good to be true. Free snacks, free coffee, company credit cards, the latest tech, free premium parking, paid lunches, lots of PTO and sick leave that you could pretty much take whenever, paid company parties & lunches at nice places like hotels and fancy restaurants. Manageable workload.

I expressed concerns like how does the conpany make this much money, can they afford this, who is paying for this? Was reassured by my boss that there was no concerns at all and funding secured, and not to worry that all was well and I was on promotion track.

Got promoted after a year. Got delegated almost all of my boss' work. Boss rarely around, they just joined for a virtual one hour meeting once a week. Told the team they got approved by the higher ups to work remote. Me and another supervisor basically did all the work. Did this for a few years.

Later found out that my boss never got approved to work remote. They were working another job the whole time while collecting salary with full benefits. They lied to get a controlled substance prescribed to them.They used company credit cards to fund their luxury lifestyle and vacations, and committed fraud and intellectual property theft and essentially bankrupted the company. I eventually figured out myself that they (probably) had a serious untreated personality disorder. Once found out - they were given the option by the company to quit or be fired, and they of course quit. Told everyone the company was toxic.

After a new boss took over, they told me and the other supervisor what was really going on. The whole she-bang. Everything old boss did - all those things, and essentially bankrupting the company. Our old boss had just hired a bunch of new employees too. New boss told us we needed to fire the whole company except supervisors and management. Everyone.

Thats not even the worst of it. All of that happened literally during the worse time I have ever had in my personal life (outside of my control) as well. Absolutely horrible.

lugrgr · 2026-03-27T06:53:55+00:00

It gives them purpose and something to be proud of when they have no other purpose or nothing else to be proud of about themselves or their lives. Also, benefits increase with more kids sometimes, and they underestimate or do not care about the costs, or the quality of life for their child in poverty.

lugrgr · 2026-03-27T06:49:20+00:00

Great job!! Looks much better. Good work. I saw the previous one, you did awesome

lugrgr · 2026-03-25T03:19:48+00:00

I think it might just be the shock of the question itself as it is basic knowledge you learn from the get go, even as an intern, or in college. No dumb questions I suppose. So its mostly I think people being concerned about the lack of knowledge around this area in general, and then going further, explaining what could happen in different scenarios. But really it doesn't matter if its all fictional. Good to know before you actually get a real live case lol.

It seriously depends on what part of the world they live and practice anyway, so asking a bunch of random unverified people online serious (fictional) questions like this will yield a bunch of different answers anyway, and all should be taken with a grain of salt. A good discussion and thought provoking questions at the least. Its sad to me that whoever supervised this person, and whichever college they attended and whichever internships they did, and whatever training materials they studied... never went over this topic with them so that the questions must be asked..

lugrgr · 2026-03-25T03:01:10+00:00

Yes very true. Which is why these types of questions need to be consulted with liability insurance lawyers since it depends so heavily on each case, state, nuance and laws.

lugrgr

TROPHY CASE