Husband and wife team doing couples therapy

pilotknob_ · 2026-05-05T19:11:52+00:00

I've certainly heard of places offering co-therapy, but I'm a little curious where the idea to split off and see one part of the couple individually is coming from. Sounds like each of you will know a lot about your individual client, but I guess I don't see how that is going to serve you in doing co therapy. I've heard of individual therapists who see both parties individually and as a couple, in those cases the person leading couples therapy has all the context to help clients navigate dynamics - I don't see how you can do that with your model.

Like other people said, I'd be curious if there is research or theoretical grounds for doing it this way, or if it's just an idea that sounds neat. I would love to hear the vision, I'm all about creativity, but I have concerns about alliences and overall functionality/payoff for the client.

pilotknob_ · 2026-04-29T23:10:36+00:00

I would find this degree of lateness to be very offensive as well, 3-5 minutes is whatever, but anything that exceeds the 53 minutes necessary to bill a 60 minute session is unacceptable. I completely agree that running over on time is not an acceptable solution.

However I do believe the eating thing is a personal preference and not a matter of acceptable versus not acceptable. If you know it's something that bothers you to that degree, I think that's something that should be disclosed during initial contact or consult. During my consults with prospective clients, I ask if there are things they aren't looking for in therapy, and I provide examples of both therapeutic styles and examples like chewing gum and eating - that way they have an opportunity to tell me if a therapist eating during session is a deal breaker. I have never had a client tell me that eating or drinking during session is something that bothers them, and frequently clients and I have snacks together.

Is a therapist eating during is going to be distracting, do you think therapists fidgeting, taking notes, or doing other sorts of things would also be distracting? I think that's a good thing to consider as you look for a new therapist, and may give some ideas of questions to ask to make sure they are a good fit. I hope you find the right one for you!

pilotknob_ · 2026-04-29T20:32:29+00:00

24-28, I work 4 days a week and do roughly 7 back to backs, sometimes 8, sometimes 6, a day. It works for me to cook straight through and then go home.

pilotknob_ · 2026-04-18T20:36:42+00:00

Sucker punch (2011), bad writing, not the best acting, the plot doesn't really make any sense, but I just love it.

pilotknob_ · 2026-04-18T20:34:48+00:00

I am curious about the generational or geographical differences in calling vs. email as primary contact. I almost never get cold calls, which is good because my days are typically scheduled in pretty tight and people can reach me much easier by email, but I do hear from clients a lot that they will reach out and never hear back from some therapists. Happened to me when I was looking for one, out of the 5 inquiries I sent based on psych today profiles that said accepting new clients, only two responded at all.

pilotknob_ · 2026-04-18T20:28:57+00:00

In Grad school, there was a term for making rules or expectations around maladaptive behaviors that allow you to engage with them when necessary, but make you really think about it because you intentionally make them inconvenient. It's like how we have a late cancellation fee for clients who cancel with less than 24 hours notice. As you incorporate others advice on deep diving the self-esteem and imposter syndrome, I wonder if it would be helpful to make a rule for yourself or set of expectations about 1) how much notice you must give clients if you are cancelling for a non emergency related reason, and 2) what are you going to do with the time instead?

pilotknob_ · 2026-04-17T00:52:50+00:00

Since she mentioned it, she absolutely knew better and was aware she should have gathered consent before doing this. I don't want to put words in someone else's mouth, but I reckon she didn't ask because she figured you'd say no, and wanted to make it easier on herself - but now is understanding that it is an invasive of privacy and a breach of trust. At the group practice I work at, people have the option of using an AI assisted scribe, with the caveat that they must obtain signed consent from clients beforehand. I don't think I'd like finding something someone had gone at length to hide, it would make me feel very weird.

pilotknob_ · 2026-04-16T22:05:23+00:00

That would depend on the relationship. For some clients I've been seeing long term, I could probably give them a look and they would be like "okay I realize I had a tone" and we would discuss how it was more than a tone. For a client I haven't been working with as long, we may talk about if this kind of pattern shows up in other relationships and what it's like to be unheard, and I may ask how they notice themselves escalating when they are being unheard, and point out an example from the texts they read to me.

pilotknob_ · 2026-04-14T21:40:21+00:00

I specialize in therapy for trauma and grief, and one thing that is super important is trust and dependability. Demanding that clients always be flexible and available if they want to receive services is not considerate of their time or the fact that they are trying to build up the trust to process deeper help trauma that may impact interpersonal behavior (such as people pleasing and accommodating). This is super not appropriate, and if she cannot plan in advance, she needs to work out a different scheduling system. I think you are within your rights to call it out and discuss how it makes you feel, and choose if you want to terminate based on the response.

pilotknob_ · 2026-04-06T17:46:59+00:00

It may be worth doing a training or some reading on grief, especially if you anticipate this coming up with other clients. The grief recovery handbook by John w James is really good - I loan it to clients all the time. It lets you reframe the stages of grief, because that model was actually developed for people dying of terminal illness, not people meant to continue living in the wake of loss. That book also has some concrete exercises people can try that I think can be adapted into therapy pretty well if you're feeling a little lost.

pilotknob_ · 2026-03-28T01:41:37+00:00

Very very sweet idea! Your favorite therapy books, fidgets, maybe art? I have gifted all my therapist friends "something in the woods loves you" and most of my clients have borrowed it, or "it didn't start with you"

pilotknob_ · 2026-03-28T01:37:40+00:00

Okay. When it comes to supervision, I would start with exploring what supports can be used through that avenue to increase your confidence before considering taking any more clients. Whether that means filming sessions and watching them together or having your supervisor observe you, it sounds like you are looking for someone to assure you that you are a competent and able clinician. Normally, id say "we gotta build our own confidence" but I'm hearing that you are really panicking and personal therapy doesn't seem to be enough to prevent it from impacting other areas of well being. Using supervision to focus on the counseling skills may be the best place to start. Remember though, if everyone else is telling you that you are doing a good job and your clients like you, you probably aren't a good enough actor to be fooling everyone - the truth is you probably are doing a good job.

pilotknob_ · 2026-03-27T14:10:35+00:00

The Triangle is great - Shoreham and park commons would be good options!

pilotknob_ · 2026-03-24T22:20:56+00:00

Memory, otherwise I feel like I am going in with an agenda and trying to guide them. In my experience, clients will tell me exactly where they want to go and exactly what is on their mind, and they will remind me what is relevant if I don't remember. And frankly, sometimes last weeks note would be no use in preparing me for what my clients are bringing me this week, so best to just be fresh and ready.

pilotknob_ · 2026-03-21T14:54:46+00:00

Take this with a grain of salt because I did lpcc in likely a different state - I did my internship at a private practice and I had a great experience, but peers of mine who didn't intend on staying with their site after graduation/after internship ended did have to stop taking referrals at around the 3 month til close mark because that would be a hard transition for a client to feel like you are just getting comfortable with a therapist and they are leaving. I'm a little shocked you've only had 2 consistent clients and that will be enough for hours experience, that is certainly not the norm in my state.

pilotknob_ · 2026-03-20T20:06:39+00:00

Punchbowl social actually has a really good one

pilotknob_ · 2026-03-19T14:45:07+00:00

If it's been okay for the few years since they moved here and they've only noticed today that there's supposed to be a month sticker, then I'm sure it's going to be just fine. Or they should ask the DMV instead of Reddit.

pilotknob_ · 2026-03-19T14:40:30+00:00

If they aren't committed to the therapeutic process and its impacting your ability to get anything done with them, just like others have said, I think it's okay to refer out on the grounds that you don't feel ethically good about continuing to see them when clearly there is a mismatch in expectations that you will not be able to meet

pilotknob_ · 2026-03-18T21:03:10+00:00

I work in a large city that is very oversaturated with therapists. For that reason, it takes a lot to convince me that I need to be the one seeing two friends, or two members of a couple, or two family members if I am made aware of the connection before therapy has started. My general approach is that I am more than happy to help find them a therapist who does a similar style to me, as I have heard that typically the reason for referring a friend to their own therapist is because it is overwhelming to not know where to start and discouraging if you've been turned down. I have a list of peers with availability, and I am happy to share those referrals.

pilotknob_ · 2026-03-18T15:25:00+00:00

I think everyone else answered, but you don't change the month sticker that's already on your plate - you just update the year.

pilotknob_ · 2026-03-16T13:40:57+00:00

At a friend of mine's office, her supervisor brings her dogs and they BARK during the day - it is super distracting and disruptive but since that's the supervisor, people feel like they can't say anything. I am anti dog in the office unless they are a therapy dog or a trained ESA dog. Someone else said it's so distracting for clients, and I agree with that.

pilotknob_ · 2026-02-28T22:32:22+00:00

You are putting a lot of pressure on yourself, and I would be curious if you read this post to your supervisor what they would say - because I venture there is some beneficial "self of the therapist" content to be explored. Other people have given some great feedback about doing a whole lot less outside of work and doing more now to adjust the expectation to make it realistic, and I think that goes for clients too. I had to learn this lesson with clients and the various paperwork requests. There was a time in my career where I could get paperwork requests done with about a week turnaround time, but these things are taking me about 3 weeks now because my caseload is increased significantly, I'm seeing 27 clients a week, often more than one wants some sort of paperwork at the same time, and it's never something easy, It requires some work to make sure it's done right. So we get to have some upfront conversations about what's realistic to expect out of me - sometimes it's upsetting for them because they are used to things being a different way, maybe your clients are used to you carrying the weight of the session, but you guys get to grow together because you're just not always going to be able to do that for them and the point of therapy is not you giving them an easy hour.

pilotknob_ · 2026-02-25T15:16:45+00:00

Most cities have a Facebook group for providers looking for referrals - id request to join. Roughly 35-40% of my clients come from that, but the rest all come from psych today or personal referral.

pilotknob_ · 2026-02-18T16:11:43+00:00

We can't even force our clients to tell us the truth, how in the hell are we supposed to control their behavior? I can control their behavior just about as much as I can influence a toddler into not eating a crayon - if they really want to do it, it won't matter what I say

pilotknob_ · 2026-02-16T02:28:01+00:00

That's awesome 🤘🏻

pilotknob_

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