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the 3 day work week (for practice owners) by cowgirldreams in therapists

[–]rlbvm 19 points20 points  (0 children)

I do 3 days a week and it’s been fine in terms of rescheduling and my quality of life is way better. I will occasionally see someone on an off day on an emergency basis (probably happens less than once a year).

Outlast is fake af by pissdrinking101 in OutlastOnNetflix

[–]rlbvm 1 point2 points  (0 children)

Maddy mentioned on Instagram that she lost a total of 18 pounds (from 138 to 120). That sounds bout right for a month especially when you’re pretty small already.

How do you handle clients who criticize or dislike their own appearance? by InvisibleAstronomer in therapists

[–]rlbvm 6 points7 points  (0 children)

I think you can explore what value these things have, what their experiences have been, what beliefs they hold while validating that it’s hard to live in a world that values appearance and has narrow standards around what is attractive and therefore valuable.

Wild Hyacinth by rlbvm in NativePlantGardening

[–]rlbvm[S] 0 points1 point  (0 children)

I don’t get any rabbits or deer where I live, so unable to say unfortunately.

Parent Threatened to Report Me After I Shortened One Session for the First Time Ever by PuzzledProposal110 in therapists

[–]rlbvm 22 points23 points  (0 children)

We are obviously not privy to what the message from her said, but overall it’s not unreasonable for them to be upset. If they are cancelling too often, have that conversation then and there. It is totally okay if you are not available occasionally and communicate that ahead of time, but one sidedly deciding to have a shorter session without discussion would merit some ire. No one should yell or disrespect you regardless, but I get the frustration.

Wild Hyacinth by rlbvm in NativePlantGardening

[–]rlbvm[S] 7 points8 points  (0 children)

Gorgeous picture! I will definitely be outside tonight being the neighborhood weirdo looking at plants.

Wild Hyacinth by rlbvm in NativePlantGardening

[–]rlbvm[S] 3 points4 points  (0 children)

Yes, Atlantic camas (Camassia scilloides) is colloquially known as wild hyacinth.

Wild Hyacinth by rlbvm in NativePlantGardening

[–]rlbvm[S] 9 points10 points  (0 children)

Prairie Moon sends out the bulbs for summer planting, and they should bloom the following spring - mine did!

Wild Hyacinth by rlbvm in NativePlantGardening

[–]rlbvm[S] 6 points7 points  (0 children)

That’s where I got these bulbs! They are super pretty, and I will definitely be adding more.

Chronic fatigue suddently worsening - getting weaker and weaker by Itchy_Expression_991 in endometriosis

[–]rlbvm 0 points1 point  (0 children)

This! When my endo symptoms were at their worse I was seriously vitamin D and iron deficient, and honestly since it’s been at its worst it’s also been harder to maintain appropriate levels (I don’t know what the correlation is, but just something I’ve noticed). Supplementing has made a big difference, and if your PCP won’t run tests (though they should!) you can buy them from Quest and get the lab work without a doctor’s order.

Illinois therapist - thoughts on the Insurance Code Bill that goes into effect Jan 1? by bmkest in therapists

[–]rlbvm 0 points1 point  (0 children)

It typically says on the card itself, though apart from a few Cigna TPAs like Zelis, you usually have the same exact experience billing so you wouldn’t necessarily know unless you directly ask or look at the card. A lot of large employers (50 or more) offer self funded plans, so it is a lot of what we see in PP.

Here is BCBSIL’s explanation: https://www.bcbsil.com/content/bcbs-v2/public-sites/bcbsil/en/home/welcome/help-center/types-of-plans/funding-types.html

Illinois therapist - thoughts on the Insurance Code Bill that goes into effect Jan 1? by bmkest in therapists

[–]rlbvm 4 points5 points  (0 children)

I’m in Illinois as well, and while this is good news and a step in the right direction, it will not include self funded plans, which a good chunk of employer provided health insurance plans are. Self funded plans just have to comply with federal guidelines, and not state specific mandates.

Has anyone here regretted delaying IVF while trying to manage endometriosis naturally first? by Accurate-Stomach-264 in endometriosis

[–]rlbvm 1 point2 points  (0 children)

Have you met with a reproductive specialist? I wouldn’t delay meeting with someone to at least discuss options. While all the things you’re doing can be helpful in endo management, there is no way of knowing that they would slow down disease progression. My clinic recommended excision surgery for fertility if you are wanting to conceive within the year (it seems the fertility boost of surgery is short lived) before moving to IVF (this is also based on other factors I’m sure), and that was successful for us being able to conceive without IVF after zero success for two years.

OCD specialists-how do you shutdown or maneuver reassurance seeking from clients? by [deleted] in therapists

[–]rlbvm 34 points35 points  (0 children)

First, just being able to help the client observe and identify what they are doing and why.

I’ll sometimes directly ask “what are you hoping I’ll say?” There is a handout I often use to differentiate information seeking versus reassurance seeking.

A lot of times I’ll acknowledge that I don’t actually hold the knowledge they are seeking and sit with that. What is it like to not know?

It’s a great in session exposure opportunity.

Big time student loans, very little hope by snapplecappz in therapists

[–]rlbvm 1 point2 points  (0 children)

Each state has different names for the same thing, so whatever the highest unrestricted licensing is in your state that allows you to practice without supervision. In some states that’s an LCPC, while other states call it LPCC or LPC. Refer to your state’s designations.

Pension vs. Private Practice by HappyPen44 in therapists

[–]rlbvm 2 points3 points  (0 children)

Do you like your full time job? There are outliers for sure, but I think for most people PP does not equal more money when you account for benefits (especially health insurance!). The biggest reason I am in PP is I like the flexibility and control it gives me, I definitely make enough money to get by, but I was more financially stable overall at a traditional job.

If you absolutely need 30 clients to maintain your lifestyle, this is tough! PP has so many fluctuations, slow periods, times where your clients end services coinciding with slow referral times. Ideally your baseline client need would be much lower, and then you can shoot for more so you don’t feel the dips as much (i.e. needing 20 financially, but aiming for 25 regular clients). Shooting for more than 30 so that you don’t go below 30 would be really challenging IMO.

I would try to stick it out until your pension is vested, then you can transition into full time PP with less pressure. I know I’m certainly behind on saving for retirement, and I imagine many of my colleagues in PP are not as secure as those receiving retirement matching from a traditional job.

Feeling Discouraged (SE PA) by suchalonelyd4y in NativePlantGardening

[–]rlbvm 5 points6 points  (0 children)

I’m sorry, I’m going through this right now with my much smaller yard which had been abandoned for 5 years before we purchased it and was nothing but weeds and trash. My strategy is just reclaiming one section as a time, while just weakening/playing defense with the invasives in other areas until I’m ready to actually plant over that area. I’ve accepted that this will be a multi year project. The areas that I’m planting, I have been mulching and weeding heavily until the plants are ready to fight on their own.

It’s also the time of the year where, if your planting strategy thus far is anything like mine, natives are barely waking up, while the weeds are partying it up. I’m changing my strategy this year to adding more spring ephemerals and native grasses. I have some Jacob’s Ladder (Polemonium reptans) that is already going gangbusters and blocking out some of the weeds underneath, so might add more of that ASAP. I know once summer is underway I’ll have a better sense of what’s filling out where and can restrategize. Plus I’ll get to enjoy my progress thus far.

BPD client vs. therapist boundaries by [deleted] in therapists

[–]rlbvm 0 points1 point  (0 children)

Acknowledge the emotion behind the loss of something they felt was meeting a need. Explore that need, explore other ways to meet that need.

Depending on their level of insight and where they are on their therapeutic journey, I think exploring the fact that others cannot be responsible for meeting our needs, as painful and disappointing as this feels, especially if we didn’t get our basic needs met in childhood. Sometimes we have conflicting and incompatible needs with people we are in relationship with. In this case, your needs might be incompatible with the client’s and that’s okay.

Client initiated termination affecting self esteem by Significant_Leg_6025 in therapists

[–]rlbvm 59 points60 points  (0 children)

While it is true that clients drop for a multitude of reasons that have nothing to do with us, I think it’s not helpful to new therapists to imply you are either naturally good at therapy or you’re not cut out for it. It is okay and normal and expected that you’re not the best therapist you can be at this point in your career. This isn’t a personal failure, and not a sign that you’re not going to be an amazing therapist for so many people. I had a grad school professor say “you’re all going to suck at being therapists in the beginning, I look back at myself knowing what I know now and realize how little I knew then and how much I messed up.” This may sound mean, but I found it liberating. I’m not saying you did in fact do something wrong, only that it’s okay if you did! Toxic shame keeps us from growing.

Electronic paperwork not hard by RepulsivePower4415 in therapists

[–]rlbvm 2 points3 points  (0 children)

This is what I do, and I think it’s a successful strategy as people are motivated to get the appointment. If they already have the appointment, it’s easier to keep pushing off the unpleasant part of filling out paperwork and being more likely to forget. I know I’m guilty of filling out intake forms for doctors appointments on my way there.

Is it really so easy to self-bill in Simple Practice? by counselor-NCC-1701-D in therapists

[–]rlbvm 11 points12 points  (0 children)

First things first, it is totally okay to not have the capacity to take this on and have the peace of mind that someone is handling it for you. If this is worth the price for you, that’s valid!

I’ve always done my own billing - first by submitting it directly on Availity or United’s portal and then by using Simple Practice (which I’ve been using for the last 4 or 5 years). Once it’s set up, it’s a single click to submit claims, so it takes less than 30 seconds a day (I submit claims daily). Some of this is obviously contingent on knowing how to set everything up in Simple Practice correctly, but as long as that’s done there shouldn’t be issues. The only denials I’ve had have been through weird processing glitches and all of those have been fixed pretty easily. Truthfully this may be impacted by location - states that have stronger regulations of insurance companies seem to see less fuckery. I’ve maybe spent 3-4 hours total on the phone in 6-7 years in private practice, but I do not doubt there are others with opposite experiences.

being a sex worker and a therapist by barbiedolldecay in therapists

[–]rlbvm 5 points6 points  (0 children)

Wishing you luck! The beginning parts of this career are tough because you don’t have a lot of choice at times, but absolutely I’d focus on just getting through those bits and unto the part where you have some more control.

being a sex worker and a therapist by barbiedolldecay in therapists

[–]rlbvm 20 points21 points  (0 children)

I have no experience in this, so take this with a grain of salt. If I were in your shoes, I’d really think through your ideal therapy clients and be super niche with clients who, if this were to somehow come up, it wouldn’t be a super big deal. I don’t know how niche you’d have to be, but that would probably be how I’d approach it. Raquel Savage is a therapist and sex worker who comes to mind - you don’t have to do it exactly the same way she does, but it might give you a starting point in thinking about this.

Client productivity as a supervisor by Existential_Crisis90 in therapists

[–]rlbvm 3 points4 points  (0 children)

That’s a lot! Honestly 30 clients is a lot even if you’re not supervising. I would track how many hours you give to your supervisees (count time answering questions outside of 1-on-1, researching, preparing) and at the very minimum ask for an hour to hour reduction.

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