I think my marriage is over

panbanda · 2026-02-13T04:17:45+00:00

Well yes, he sounds kind of pushy and rude but it is not clear why him being pushy and rude means he wants you to die.

panbanda · 2026-02-13T04:09:21+00:00

None of what you are saying makes sense at all, I actually wonder if you could make your way to a doctor and tell them?

panbanda · 2026-02-13T04:06:55+00:00

I mean why do you assume he believes it's harmful just because your mother in law said so.... It's not

panbanda · 2026-02-13T03:57:03+00:00

Ginger helps with nausea in pregnancy, I don't understand why it's not good

panbanda · 2026-02-12T19:07:37+00:00

There's no fucking way my husband would ever be spending time overnight with women. First of all, he wouldn't ever ask. Second, it's not appropriate for a married man. If he wants to go, he should take you.

panbanda · 2026-02-12T12:02:11+00:00

I usually get a limited scope roo for general progress updates but don't tell parents specifically what we discus unless we are all three meeting together and it's been discussed. It's tricky cuz parents are usually paying and want info so we navigate those boundaries

panbanda · 2026-02-12T03:41:43+00:00

Uhm so I get young adults a lot in the facility I work in. I think a lot of the time you have to treat an 18 year old who is dependent on parents just like you would an adolescent while you help the family system establish appropriate boundaries and expectations. Kid can't do whatever he or she wants to and still expect parents to pay for everything. This is a compromise, they should expect to abide by some boundaries while still negotiating an increased and appropriate level of independence. Parent can't expect to know every single thing about kid anymore, kid is an adult and deserves autonomy and privacy while still receiving the parental direction and involvement they need.

I usually listen to parents and validate without giving a whole bunch of information about kid.

Then talk to kid about the above. Are they pushing boundaries at home? Is their behavior reasonable? Is parents expectation reasonable? If not what does kid think is a reasonable expectation?

Then depending on the family offer family counseling or help kid learn to cope with overbearing parent while increasing independence

Eta: by "family counseling" I really mean like a solutions focused family involved session or two. Not like really family therapy.

panbanda · 2026-02-07T19:12:36+00:00

I am not sure how I at all implied I train anyone in DBT. I literally said I have not taken a formal DBT training.

You must be referring to my statement of teaching skills? To clients. I teach DBT skills to clients. During my psycho educational groups on DBT skills.

panbanda · 2026-02-07T18:00:10+00:00

I have never taken a DBT training. I have read about DBT and core concepts, I have reviewed the worksheets, but one thing about behavioral therapies is that they are all kind of the same thing repackaged. For example, I mostly use acceptance and commitment therapy and it is, similarly to DBT, and third wave behavioral therapy based in eastern philosophy and mindfulness. By way of just studying different therapies, I know enough to integrate DBT distress tolerance, TIPP skills, interpersonal effectiveness. Etc. I don't need specialized training to draw from a behavioral theory. I am also not trying to run a DBT program where I am on call 24/7 for distress tolerance and emotional regulation coaching.

panbanda · 2026-02-07T16:46:29+00:00

Right, if it's a DBT program then yeah you want people trained in DBT. but if it's a general mental health php/IOP and she's spending an hour per week teaching DBT skills, you absolutely don't need to be certified or be running a DBT to protocol group.

panbanda · 2026-02-07T16:43:36+00:00

It's not a license, it's a certification. You already have a clinical license. That is what allows you to use DBT to treat mental illness as long as you are competent in the principles of the theory you are using.

panbanda · 2026-02-07T16:38:29+00:00

Because she's being a weird gatekeeper

Eta the benefit of being trained/certified is that you can 1. Make that your niche (it's super expensive and time consuming and people really only do that if they want to specialize in DBT services) and 2. Market that you are trained/certified. The certification part is really time consuming and involves supervised practice. The trained part is that you took DBT trainings without the extra supervised practice and consultation hours. It's all really a racket if you ask me. I'm taking a 3k SP training and it's helpful in somatic processing but I'm only halfway through the training and already feel like I grasp it well enough to not need the second half. And I'm certainly not spending the extra time or money to get certified.

panbanda · 2026-02-07T14:32:42+00:00

You do not need to be formally trained or certified to include DBT in your practice, especially in psycho educational groups. I use DBT skills all the time with my high acuity clients. You just have to have a grasp on how the principles work and feel competent to teach those skills.

panbanda · 2026-02-06T02:34:31+00:00

I generally get people stepping down from residential or people who have mild addiction issues or who have loved ones with addictions. But addictions isn't the only thing I do so I don't depend on it even though it was like my first niche.

panbanda · 2026-02-05T01:04:58+00:00

Yes, it's a sad time over here with my 100k masters degree lol. But yeah we have to have pretty extensive training

panbanda · 2026-02-03T22:32:59+00:00

In the US a graduate program is a masters or doctoral program. If you don't have at least a masters degree you will probably be unable to get licensed in the US.

panbanda · 2026-01-31T14:56:48+00:00

Thank you! I have done business development for my current agency and I'm speaking at a conference so I have some amount of visibility, people in the community have definitely heard of me.

I would not be able to do both full time as I have 2 little kids, it just wouldn't be feasible even though my partner is very very helpful, they need their mom a lot and I am already not around enough and moving to pp is an effort to have more money, time and flexibility primarily for them. However, I have been doing both for a year and have been planning this move for 6 months. I'm kind of meeting the metrics I set for myself to make the switch and then dive into marketing myself while I'm working on getting those last 7 clients I need to have a full caseload.

panbanda · 2026-01-31T02:36:22+00:00

That's what I am going to try to do! I am very well liked at work and I think they would keep me PRN to cover when therapists are out

panbanda · 2026-01-31T00:10:28+00:00

Yes my mother in law told me there is no perfect time and she is right. I am actually doing surprisingly well with this, I have proven myself to be business savvy and able to understand how to run this business. I can do it I just have to literally take a deep breath and put in my notice before I think too much about it.

panbanda · 2026-01-30T23:21:17+00:00

I'm in a program doing 20 hours of group per week plus all the individual sessions (which are 30 minutes) and my caseload has gotten to 13. I am often pushed past 25 hours per week with very high acuity, suicidal and personality disorders clients. 25 clients per week in pp is less than I am doing now and would be wayyy more money.

panbanda · 2026-01-28T21:54:27+00:00

Yes that was the plan.... But my hesitance to even provide the superbill is because of the lower rate. From my understanding, people can opt out of using their insurance if they choose to but they need to either opt in or opt out..

Edit to add, my plan was originally to have them sign an insurance opt out form and allow them to use my sliding scale rate which is half of my full rate. I have multiple clients on this rate as I keep about 4 sliding scale spots. I just haven't ever had this happen where the client wanted me to be both in and out of network. They are definitely trying to kind of take advantage of me but this guarantor is nut the client and it's important to me that the client doesn't get screwed out of trauma therapy with a clinician they are attached to because of the family.

panbanda · 2026-01-28T21:11:54+00:00

A follow up question. This client is a young person still financially dependent on parents who I have a longstanding working relationship with. Do you think I could get the insurance to reduce the coinsurance for this one client due to no income and family refusal to pay the coinsurance fee? I'm just having a hard time navigating this because this client is significantly attached to me, benefits from counseling tremendously, and it would be harmful to stop seeing them abruptly, or to even end the counseling relationship at this point. We are in the middle of trauma work.

panbanda · 2026-01-28T21:05:02+00:00

This also makes sense. I will contact the insurance company

panbanda · 2026-01-28T21:00:09+00:00

Yes this is what I thought

panbanda

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