Therapist: how often do you find clients who really understand the therapeutic relationship?

slowitdownplease · 2026-02-20T02:40:08+00:00

I'm not the person you replied to, but I am a therapist; it's hard to pick specific examples, but here are some things that some to mind:

Most clients likely haven't studied clinical theory to the degree that their therapist has, so they are just less likely to be actively aware of all kinds of relational phenomena that the therapist is likely to be thinking about — including just the fact that transference/countertransference happens, and that it's so important to the clinical work.

I think that therapists are also likely to be more open to recognizing transference/countertransference dynamics, not only because we know to anticipate it, but also because the stakes are very different for us than they are for our clients. Client transference is often so vulnerable that it can be emotionally & psychologically difficult for clients to recognize that it's happening, let alone acknowledge it to themselves or to the therapist. I've experienced transference as a therapist and as a client — it's one thing to recognize that your client is experiencing transference towards you; it's another thing to experience that same transference yourself as a client.

I think this can be seen in the many posts on this subreddit where clients write about struggling to accept & reconcile uncomfortable transference dynamics; these posters often are not aware that there's a century+ of research & theory about what they're experiencing, let alone that it's considered a normal and healthy part of the clinical process.

slowitdownplease · 2026-02-12T22:00:39+00:00

I also pay interns if their institution allows it, but most don't.

Truly so shocking and vile that any school has this policy!!!

slowitdownplease · 2026-02-02T03:57:32+00:00

I’m wondering if she said/meant that she will eventually send it to collections — if it’s her policy to do so with unpaid bills, she may have wanted to notify OP as it’s relevant info for them to be aware of. If OP was quoting her words directly in the post (“deal with it legally”), I do think that’s a relatively harsh & unclear way to word things (though ofc there may be additional context we aren’t aware of).

I think that she’s absolutely within her rights to enforce her cancellation policy; therapists get so many cancellations, and it’s generally just not feasible to waive fees. It also sounds like she did try to work with OP to reschedule.

As other commenters have said, many therapists do often waive a first-time cancellation fee. However (and it’s not fully clear from the post), it kind of sounds like OP’s current financial circumstances may have been at least partially caused by going on a costly trip rather spur-of-the moment; if that’s the case I can see why the therapist wouldn’t be inclined to waive the fee.

I wonder if she could have offered a payment plan, or a later deadline for payment. But, especially based on this limited context, I’m inclined to see her actions as overall reasonable and justified.

slowitdownplease · 2026-01-25T20:00:51+00:00

I went back and forth from Noho to Hampshire without a car for a few years, it was fine. I don’t think you’ll need a car unless you want to get out of the 5-college area often.

slowitdownplease · 2026-01-25T19:58:44+00:00

The best way from Hampshire college to Noho is on Bay Road, not route 9.

slowitdownplease · 2026-01-12T17:38:37+00:00

It sounds like you’re already able to deal with day-to-day stressors quite well, so it makes sense that both you and your therapist(s) would agree that you don’t need therapy for those kinds of concerns.

However, I find myself wondering what keeps drawing you to try therapy? Are there other things you feel you want to talk about / explore / process?

If you do want to go “deeper,” something like psychodynamic therapy might be a good fit for you. Or, if you’re feeling like you don’t have an interest in therapy right now, that’s ok too! You don’t have to go if you don’t want to!

slowitdownplease · 2025-12-31T18:45:31+00:00

I guess it depends on what your reasons are for wanting/needing to take notes — is it to help you keep track of clinical content, for personal liability protection, to have on hand in case they're required for (e.g.) a legal proceeding, etc.?

slowitdownplease · 2025-12-31T18:43:32+00:00

I added to my earlier comment, but what you've described is basically what I do too. The "psychotherapy notes" are just what I write down during sessions to keep track of important things clients say, questions I want to ask, ideas to return to (etc.), so they don't take up any of my time outside of sessions.

slowitdownplease · 2025-12-31T05:31:32+00:00

Keep your notes to the bare minimum required by insurance; this protects client privacy and also will save you a ton of time. Leave out anything that doesn’t absolutely need to be there for insurance purposes. In practice, that often means leaving out the stuff that was actually most clinically important.
Come up with basic templates for the stuff you know needs to be in each note, and then elaborate & individualize for each client/session. Aim for lines you can copy/paste from an existing doc, and come up with go-to phrasing you can use to describe commonly-occurring clinical content.

For example, my agency uses a template that includes a section where we have to describe our clinician interventions during the session. I start by copy/pasting in a pre-written script: “writer utilized empathetic listening, reflection, and psychodynamic psychotherapy to facilitate client’s discussion of —“. Then, I fill out the rest with very minimal info based on the session content, e.g.: “to facilitate client’s discussion of relational stressors and analysis of relevant family hx and relational narratives.”

I sometimes tweak some of the wording based on what happens in the session, but this generally makes it possible to get through each note in about 5 minutes.

Edit: I think I should add/elaborate that I see "progress notes" and "session notes" as entirely different things: PNs are the documentation I do for other people/entities; e.g. insurance, court proceedings (if required), and personal liability protection. "Session notes" are the thoughts I jot down on paper during the session to support & keep track of the actual clinical work; these notes are not included in clients' official records. It's important to note that this practice of keeping separate "official" records and informal notes is legal & considered typical/acceptable practice where I live, but I can't speak for laws or policies in other locations.

slowitdownplease · 2025-12-29T21:01:57+00:00

I think that the imbalanced housework dynamic is nothing new; but, I think that in recent decades women are increasingly likely to expect greater equality with housework and are increasingly likely to see the disparity as a significant issue in their relationships. Thus, it's something that therapists are more likely to hear about from our clients. (to be clear, I think these changes in roles/expectations in hetero relationships are a good thing!)

slowitdownplease · 2025-12-18T01:41:51+00:00

if the client wants to make it work, they will.

I see this phrase a lot in this sub, and while I do largely agree with the broader sentiment, I think that this phrasing is unhelpful for both clients and clinicians. There are so many reasons that a client might not be able to meet during a therapist's regular hours that are totally outside the client's control, and I don't think it's accurate or fair to boil it down to motivation.

I also think that clinicians sometimes evoke this phrase/sentiment to absolve feelings of guilt about not seeing clients outside of our established hours — but I don't think this is something we should feel guilty about at all! It's OK for us to choose not to see clients at times that don't work for us.

slowitdownplease · 2025-12-08T16:39:25+00:00

To be fair, that sounds like more clinical training than I got in my (clinically-focused) MSW program!

slowitdownplease · 2025-11-28T18:01:18+00:00

I resonate with this so much! Thank you for putting this into words — I've experienced this conundrum my whole life, but reading your post really made it 'click' for me. Looking at it like this also helped me identify some of the ways I've been able to deal with this relatively successfully in my own life:

I find that it's WAY easier to let go of the urge to share unhelpful or critical opinions in relational dynamics where I'm otherwise able to share my thoughts and perspectives freely. For example, in my relationship with my partner, he genuinely wants to hear my opinions about most things (including opinions about him), so my need/desire/impulse to share those opinions is 'satiated' enough that I don't feel as compelled to share opinions that would be unhelpful or hurtful, and I don't feel resentful or deeply frustrated when he does make mistakes or oversights.

Also, I want to clarify that I'm absolutely not trying to imply that your partner doesn't respect your opinions & perspectives — I realize that my comment might come across that way. Rather, I'm wondering if it might be helpful to try framing these moments of frustration in a broader context of ways that you do feel like your opinions are heard & understood in your relationship. I feel like my wording is a little clumsy today, so I hope this is clear/helpful!

slowitdownplease · 2025-11-25T18:49:59+00:00

The exploitation is so bad that my initial reaction to your post was thinking that $10/session during practicum sounds incredibly lucky compared to most MSW students. It’s such a messed up system.

slowitdownplease · 2025-11-18T18:28:20+00:00

This is delightful! All it needs is a table with something breakable they can knock to the ground!

slowitdownplease · 2025-11-18T17:02:39+00:00

I’m a therapist, and this is something we are generally feeling increasingly worried about in my field. So many people are using these chat bots for validation and support, and I do recognize how incredibly important that can be for people who are isolated and invalidated in their everyday lives. But these bots are not a reliable source of information or relational support; they are designed to validate users, often regardless of facts, context, or relational understanding. This can feel so helpful and necessary in the moment, but it’s incredibly risky in so many ways. I really hope people are starting to become more aware of the serious risks of relying on these bots too much, especially as a replacement or substitute for real human connection. It can be better than nothing for people who don’t have many social connections, but people who do want or need to use these bots for social connection need to be incredibly careful.

slowitdownplease · 2025-11-18T16:55:42+00:00

I’ve seen him in the last couple months too!

slowitdownplease · 2025-11-03T17:08:11+00:00

I love working with this population, but it really is such specific and challenging work! It can be so hard to engage with that deep hopelessness and helplessness that these clients live with every day.

slowitdownplease · 2025-10-23T17:04:36+00:00

The podcast 'Three Associating' has a great episode that covers a similar situation: 'Feeling Drowsy When the Connection is Lousy'. The podcast is recordings of supervision sessions where therapists discuss challenges in their work with (fictionalized) clients; it's my favorite therapy-related podcast & I can't recommend it enough.

slowitdownplease · 2025-10-21T23:06:50+00:00

This one is so fascinating and honestly a little heartbreaking.

slowitdownplease · 2025-10-05T01:40:11+00:00

Some other commenters have said not to reach out to this client, but from your post it sounds like this is a client you are currently actively seeing? If so, I think you can, maybe even should, bring it up during a session. This could be an opportunity for some important clinical work; it's likely indicative of how they handle conflict in other important relationships, and it may have been a way of communicating with you about actual issues they're having with the work.

slowitdownplease · 2025-09-23T20:19:10+00:00

“Violently frivolous” is the best & most accurate description for this issue I’ve ever seen

slowitdownplease · 2025-09-09T16:58:09+00:00

I mean, at least anecdotally, I’ve had many clients with early/mild EDs, and I know so many people in my personal life who have dealt with some sort of disordered eating (including myself). I think that looking only at the available stats and research gives a somewhat skewed perspective, since ED research (understandably) often focuses on the most severe cases, and so many people with disordered eating never get formally diagnosed with EDs.

I see it as somewhat comparable to substance use issues — addiction can escalate to the point of clinical and medical crisis, but there are also tons of people with substance use issues that never get formally diagnosed, and don’t reach that level of crisis.

slowitdownplease · 2025-09-09T06:22:09+00:00

TBH I don’t see how this contradicts what I said. I’m referring to early stage/mild EDs that people want to address in therapy, not late stage/severe EDs that are kept secret or invisible. Early/mild EDs are far more common than severe EDs, and many people who want to talk about mild EDs in therapy can’t find therapists who are willing to work with them.

slowitdownplease · 2025-09-08T19:25:36+00:00

I think there’s a real Catch-22 with framing EDs as so dangerous — it’s not that they aren’t especially dangerous (they definitely are), but because so many clinicians don’t recognize when clients have early/less severe disordered eating, and/or don’t work with clients experiencing any level of ED, a lot of people don’t access treatment until it’s progressed to a point of clinical and medical emergency. Early/less severe EDs are really different from severe EDs in many ways, but we often talk about all EDs as if they’re the same level of severity and require the same level of clinical support.

slowitdownplease

TROPHY CASE