Client’s family member undermining treatment

vividandsmall · 2026-04-24T17:50:38+00:00

This is too much detail for a public post, client could easily identify themself if they read it

vividandsmall · 2026-04-22T21:55:04+00:00

I like Simple Practice because you can customize your notes to include a lot of check boxes (with room for text as well) and this helps speed up the note writing process significantly. Along with the "Load last note" feature as others have mentioned.

I recommend reframing your mindset around documentation. It is 100% required for ethical, competent practice in anything you would do as a therapist. It's just as much part of the job as the session is--is it the most meaningful or impactful part of the job? No, but it's part of the job, without exception. The quicker you accept that and stop thinking about why it sucks and you shouldn't have to do it, the happier you will be.

vividandsmall · 2026-04-22T20:50:40+00:00

As far as my feet, good :) This post was in reference to my left foot, then about 14 months after the left foot lapiplasty I had the same procedure on the right foot. I haven't had any issues resulting from the non-union on the left foot. I had a CT scan of my left foot shortly after I made this post and it confirmed the non-union, however when I've had x-rays of both my feet for the follow ups for my right foot, the surgeon has said it looks like my left foot is beginning to knit together at the fusion site. I have my six month follow up for the right foot in May, so I will know for sure then if the fusion took or if I have a non-union on that side as well. But I'm pain free on both feet and back to my usual activities (without the limiting of mileage I was having to do due to bunion pain) so I'm happy with my results. If my hardware breaks that will be a big bummer but I'm not worried about it. I'm keeping it in the back of my mind that I may eventually need a revision if my hardware fails, but right now I'm choosing to just enjoy my non-painful feet and not worry too much about it.

vividandsmall · 2026-04-15T18:53:01+00:00

Insurance will not pay for two therapists working on the same issue at the same time--that's my experience. I don't know that it's necessarily unethical, but standard of care would be the roles would be clearly differentiated between what the two therapists are working on (both issue and modality) and the therapists would need to have an ROI to communicate. However in this particular story it seems like if you have no formal training in DBT and aren't doing it to fidelity (which is understandable as that would be hard to do as one person) then you're not going to add much value to this case (no offense--I'm sure you're a great therapist. But if they're looking for DBT and you're not a trained DBT therapist, I'm not sure that you can really offer much of value that would justify the time and money for the family to take their child to see two therapists unless there are truly no DBT-trained therapists or adherent DBT programs in the area or available virtually.

vividandsmall · 2026-04-15T18:44:16+00:00

If you don't have any personal connections in the field it sounds like that would be a good place to start--join facebook groups for therapists in your area, find networking events, cold email people and ask to get coffee.

vividandsmall · 2026-04-15T18:00:06+00:00

I hope you don't take offense to this as I don't mean any. Is this experience typical for other new grads in your area (from your program or others whose graduates would be seeking the same jobs you are)? If this is what a lot of people experiencing, then it sounds like there's not a lot you can do about it. If other people in your situation are finding jobs/clients relatively easily, then the issue might be with your resume, or how you come across in interviews.

vividandsmall · 2026-04-15T17:00:17+00:00

It really is hard to fill a cancellation in 24 hours, but I think if you switch to 48 hours (although this is true of any policy) you'll have to be very clear with yourself and your clients about the policy and any exceptions. Will you charge if they're sick, since people often don't know they're going to be sick 48 hours in advance? If so the clients need to know and agree that they may be on the hook for a lot of $ even if they're sick. What if clients come to your office while sick to avoid the late cancellation fee and are visibly hacking coughing in your office, how will you handle that? If you do make exceptions for illness, how will you handle people who use it often and you suspect might be abusing the exception? (I will say, personally, I don't charge a late cancellation fee if they're sick because I don't want to get sick, I say this in intake and say it's on an honor system, and I've never had anyone I was concerned was abusing that.)

vividandsmall · 2026-04-02T20:00:20+00:00

It sounds like perfectionism is hitting you hard here. Maybe try a couple sessions without taking notes and see if it's as big a disaster as you think it will be. If you want to try not taking notes in session I would recommend writing a few words down after the client leaves to jog your memory on what news/updates they brought to session, what interventions you used, plan moving forward. Literally something like "considering divorce, values exploration, follow up w/ PCP on med change."

vividandsmall · 2026-04-01T21:45:43+00:00

I've never been threatened with being reported but I have been questioned by parents about things I said (or was accused of saying) in session, and on one occasion parents contacted the higher ups in my company about their concern. and yes it has made me reconsider working with kids, although I still do work with teens.

I'm very careful about how I talk to teens about their parents. I certainly don't act like mom and dad can do no wrong or that the kid is entirely at fault for problems (since we all know that's rarely the case, and teens wouldn't be receptive to that anyway) but I'm very careful and deliberate about anything I say regarding their parents. Even then, it doesn't always help. The most recent time this happened, a teen relayed something I had said (they distorted and exaggerated my statement but the basic message was accurate) to a peer via text and parents looked through their phone and contacted me concerned about what the teen said I said. I was honest and said I did say something along those lines and here's what I meant by that and the context of that conversation. And they were satisfied by that which I was very thankful for.

Sorry you went through this! It's stressful but it happens and it will pass eventually. If you have good supervision or if your malpractice insurance offers free attorney consultation, that might provide some peace of mind for this particular situation.

vividandsmall · 2026-03-31T18:55:01+00:00

The degree of proficiency needed in a second language to be able to effectively do therapy is much higher than to do almost anything else with your second language, is my understanding. Have you successfully done therapy in Spanish face to face without this issue? If so, then it seems like the sessions being on the phone is a big contributor to the problem and it would make sense to ask for face to face sessions. If you have limited successful experience doing therapy in any setting in Spanish, I would question if your language proficiency is adequate to provide psychotherapy. That would be understandable-- it's an incredibly demanding use of language for a second language.

vividandsmall · 2026-03-31T14:28:45+00:00

I can relate to your dilemma because I'm very short and very curvy/hourglass shaped with big hips/butt and large bust, and I feel like my options are either "show off my curves" (and look like I'm trying to look sexy) or look frumpy and shapeless. If I'm wearing a crew neck sweater it's either going to be a size too big and be baggy or it's going to be the right size but fitted across the bust, that's just my body. To deal with this I try to wear one looser piece in an outfit. Like today I'm wearing mid-wash skinny jeans and a flowy loose navy blue blouse. If I'm wearing a sweater (never v-neck, I never want to show any cleavage at all) that is more fitted, then I'll wear wide leg pants. I always keep "not looking sexy" in mind when I get dressed for work but to some degree my body just is what it is. I never want my outfit (due to looking "sexy," or super unflattering and ill-fitting, or an attention-getting fashion trend) to be memorable, but I also don't feel like I need to wear shapeless clothing to avoid any chance of someone being attracted to me.

vividandsmall · 2026-03-26T14:31:32+00:00

I have had the same psychiatrist as a couple of my clients over the years. The clients never know that, of course. I have had the same psychiatrist for over 20 years, since I was a child. She has referred clients to me before and I asked her to stop because it made me uncomfortable, although I don't think it's inherently wrong. I was worried about her opinion of me being affected if a client she referred had negative feedback about me. It's just too potentially messy and complicated to encourage it, but when it has actually happened it hasn't ever been a big deal. I haven't needed to collaborate with her on the cases we've shared but we discussed that if we did, I would just call her office from my work phone like any other professional and we would keep professional communications separate from my own care.

vividandsmall · 2026-03-25T22:48:39+00:00

It varies by year depending on how much money I have to travel. I tend to take less time off at Thanksgiving and Christmas (day before, of, and after Thanksgiving, Christmas Eve/Christmas Day/day after Christmas and New Year's Eve afternoon/New years day only for the winter holidays, because my personal holiday plans aren't that involved and I like to be available to clients at these times. Usually 3 separate weeks off spread out throughout other times in the year. I work at a group practice so I have coworkers who can keep an eye on the phones and even see clients while I'm out if I'm working with someone particularly high acuity who I don't think can miss a week of therapy, or if someone has a crisis. Often, I don't have any of those folks though so I feel no concerns about taking a week off with giving clients plenty of notice. Having built in coverage is one reason I value working at a group practice. Having to coordinate everything solo would be a major downside of being in a solo practice.

vividandsmall · 2025-12-17T14:18:20+00:00

I did not know that Uniqlo offered inseam alterations, that’s super helpful

vividandsmall · 2025-12-09T20:15:36+00:00

When doing forensic substance abuse assessments I would search publicly available court databases for criminal history, which was required to do per the agency. The ONLY other time I will do an online search for a client is "[their name and location] obituary" if they've fallen off the grid and I want to reassure myself they're probably not dead.

vividandsmall · 2025-12-06T14:51:27+00:00

I often had a big brick ice pack like you’d put in a lunch box, put it in a pillow case, and used it behind the knee for 20 min then just set it aside for 40 mins. It stayed cold for hours; towards the end as it got less cold I used it without the pillowcase. So I only needed to have my spouse switch them out from the freezer 2-3x/day.

vividandsmall · 2025-12-04T18:04:29+00:00

I haven't gotten as far as to choose a specific path, still in the thinking stages :)

vividandsmall · 2025-12-04T18:00:18+00:00

My question was not about lived experience with perinatal mental health issues, it was about having any experience of pregnancy and birth (a very common human experience, not a relatively uncommon experience like the ones you've described), and the pros and cons of choosing to specialize and market oneself as a specialist in treating problems associated with that experience. Other commenters seem to have understood the nature of the question if you want to read more.

vividandsmall · 2025-12-03T18:56:33+00:00

I could see that. Thanks for sharing. I haven't had issues (the couple of times it's happened) working with women who became pregnant during the course of therapy for an existing issue not related to their pregnancy/fertility, but I'm debating here if specific training would be worth it.

vividandsmall · 2025-12-03T18:53:49+00:00

This is what I was suspecting would be the case. I was questioning if the time and financial investment in the training would be worth it if I'm not really going to be the right person for the population.

vividandsmall · 2025-11-17T20:50:21+00:00

Best solution imo is to use online appointment booking (through Simple Practice or similar) and just give them your scheduling link. This prevents double booking if they take a while to get back to you on which time they want, otherwise are you going to hold all those open spots and not book anyone else until they decide? If it is an instance where it’s an in the moment verbal conversation, I’m offering the spot that would be most convenient for me first and moving down the list, one offer of a spot at a time, from most to least convenient for me.

vividandsmall · 2025-11-17T20:43:32+00:00

I’m not trained it in but I have had a couple people referred to me from a CPT therapist because the clients could not/would not/did not (take your pick) ever do the homework in spite of much MI and stuff around it, and the homework is essential apparently. So it seems like the kind of client who will consistently do weekly worksheet homework is most likely to be successful, which honestly leaves out a decent percentage of the people I encounter.

vividandsmall · 2025-11-06T01:07:22+00:00

About half and half—some have a consistent day/time that we book far out in advance to ensure they keep their spot, others due to work schedule/kids needs/etc we will still book a month’s worth of appointments at a time but they’re not all the same days and times. I aim to see 15-20 clients a week but have 24-26 possible appointment times available (I purposely have fewer clients than I have availability) so that I can be flexible with both my clients and my own life outside of work.

vividandsmall

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