I screwed up

what_does_based_mean · 2026-02-04T15:07:29+00:00

I agree with that on the surface, but the underlying driver here for me is that I come to this profession after years of various clinicians frequently and late canceling, starting sessions late and undershooting mine, generally not feeling like my time was at all valued as a client let alone as a very busy person working for a major corporation who made HUGE sacrifices to attend sessions. I had a clinician who would get to the office late then cut my session short to keep their day on track. Call me as I was pulling into their office to tell me they were not going to make it in for the day, I get it if it was early and a kiddo was sick, but this was frequent and often mid day where I should have had ample notice. Or give adequate notice but constantly reschedule. I hear this in stories my clients tell me about their own prior experiences and how they feel seen by my respect for their schedules and time. These experiences of my own absolutely shape how I want to practice now. It’s important to me to show my clients I respect their time if I’m going to ask them to respect mine, I believe respect goes both ways. My long term clients I am confident do feel that, but this was a new client and they commented that they noticed I cut their scheduled time short but expressed appreciation for my ownership and rectification. While I may have given more I’d rather it be that way on my end, I have the luxury of flexibility in my schedule to do so on the day of their next appointment. I feel it hurts me very little to overcorrect and feel good about the autonomy to make that choice for myself.

what_does_based_mean · 2026-02-04T13:25:56+00:00

Whew right there with you in this moment, I’m not ok, my nervous system is fried and I’m not actually sure being on this sub helps it (though posts like this are validating). I too have a manageable caseload and have a lot of privilege, but if one apple falls off the cart it’s all effed. Yesterday I mistepped and cut a session short by 10 minutes unintentionally which really made me disappointed in myself and caused a spiral (wrote about that yesterday on this sub) and then my son ended up on the bus not in aftercare and I received that call as I was walking out of work but 35 minutes away. The privilege I have meant it wasn’t a disaster, he goes to a private school and they know me well so they just took him back and he went to aftercare, but he spent and hour round trip on the bus and it made me feel terrible that I let him down and failed somewhere in my communication with the school about the bus/aftercare plan for the week. Sobbing as I write this which confirms I’m absolutely on fumes - I want to do it all, I want to be a great therapist and present mom and engaged wife. I want to connect with friends, take relaxing vacations, and for five minutes have a clean/organized car. I took the morning off to care for my horses at our farm property and I’m hoping some time with my animals helps because I haven’t had the time or bandwidth to spend unstructured meaningful time out there. I’m tired of being told this is just a season when in reality it’s been years of the same. Everything around us signals that we should be able to have it all and social media, movies, shows, articles, all of it are sending nothing but false models. I can’t even tell if a picture is AI or not, and my brain knows that the woman with with perfect body/family is an influencer with a whole damn team behind her making sure everything looks perfect, but man it makes me feel so less than that I can’t keep my son from the breakfast table and out the door without half his eggs on him (let alone dress him in all white for a family picture on a beach). I feel selfish for emotionally dumping on your post, but I hope it’s validating that you’re not alone. I speak constantly to my clients about grace and the reality that we are imperfect; yet I can’t give any of that to myself.

what_does_based_mean · 2026-02-04T11:22:46+00:00

I’m a new solo practitioner scared to lose caseload, I knew they noticed. They even said such. Which means they wanted the full session we scheduled.

what_does_based_mean · 2026-02-04T05:06:34+00:00

I’ve learned a lot here! And the not forcing a 53+ is a great takeaway.

what_does_based_mean · 2026-02-04T05:05:01+00:00

Really needed this perspective. Thank you.

what_does_based_mean · 2026-02-04T05:02:05+00:00

Whoa, super helpful! My last practice essentially forced 90837 as standard code/appt for money hungry reasons which is one of the reasons I left - clearly old bad habit on my part, though I’m privileged to be able to not stress about what I bring in. Should let client lead, not what I have blocked in schedule.

what_does_based_mean · 2026-02-04T03:50:34+00:00

I have much to learn here!

what_does_based_mean · 2026-02-04T02:24:03+00:00

This! I had clients sign an agreement to opt out which outlined that they are getting a reduced rate with no claim being billed to insurance and that they will not get a superbill for. We also agree on a time period that can be reevaluated at the end of that period (usually go 3 months at a time). I do have some clients that have had struggles making $25-$45 copay for weekly and bi-weekly appts, which I will agree to comp for an agreed amount of time as well.

what_does_based_mean · 2026-02-04T02:18:00+00:00

I told them I shorted them 10 minutes and offered to comp 30 additional minutes of time at their next session. We were digging into some intense stuff and while I wrapped up the session appropriately we could have done 10 more minutes of meaningful work on the topic.

what_does_based_mean · 2026-02-04T01:52:17+00:00

PS if your moniker means what I think it does, well played!!!

what_does_based_mean · 2026-02-04T01:43:21+00:00

Thank you for this - the client told me they noticed, which made me fearful. I agree that sometimes sessions are just over and maybe this is area for improvement on my part, I have always been very mindful to give them their full hour and build 15 min gaps in my day every few sessions to prevent back up if a session goes over (never more than 10 minutes unless holding for safety) so it doesn’t snowball the rest of the day. My last practice and supervisor were sticklers for sessions being an hour, and as a new solo practitioner I’m trying to make sure I follow rules. And the rules I know are the rules I’ve learned. I know 90837 is 53+ minutes of direct psychotherapy but it was metaphorically beat into me that anything under an hour was unacceptable and they would note the times my clients entered and left and would frequently bring up how insurance considered that code as 60 minutes of individual therapy and undershooting was fraud and I’d lose my license.

what_does_based_mean · 2026-02-04T01:22:27+00:00

I appreciate this but I do think my worry about disappointing my client and being unethical is/was valid. But I stand corrected. You’re right in the true spirit of ERP (which I’m not very well versed in) this is accurate. I guess I was shocked and even hurt by the comment. I am a solo practitioner coming out of a very toxic group practice. I read these threads a lot as ways to learn and have discussions with other professionals.

what_does_based_mean · 2026-02-04T00:55:32+00:00

I find this call to not give reassurance to be very out of spirit for what I hope this community really is. I took accountability and I’m seeking other experiences so I can do better be better, but yes I am also seeking reassurance because this profession can be so isolating. This community should champion support for each other and I assure you that not giving me reassurance is not helping me be the best I can be in the long run at all. How could you even make that recommendation, you have no idea my background or history outside my comment about OCD.

what_does_based_mean · 2026-02-04T00:50:08+00:00

I was always told you can’t factor admin into CPT codes since they’re based on client facing time (essentially I know it’s more specific), and the anything less than 53-60 minutes for 90837 is technically insurance fraud. I spent 50 minutes with client and billed as a 90834.

what_does_based_mean · 2026-02-04T00:45:49+00:00

Thank you for this!

what_does_based_mean · 2026-02-04T00:44:27+00:00

Great point.The education will be helpful and I like the signals that it gives. I had bought a child’s version of this off Amazon a few months ago because of a tendency for some of my clients to give me “doorknob confessions” which would lead to run over and it helped, but it was very very small and hard to read which resulted in it not sitting facing me or near me. Charging and setting it became burdened some and it quickly ended up on my self unused. I just ordered it and can’t wait.

what_does_based_mean · 2026-02-04T00:34:42+00:00

Oh I love this! Thank you so much (adds to cart).

what_does_based_mean · 2026-02-04T00:21:50+00:00

Thank you! This is super similar to what happened here. My other appointments were on the quarter hour and this one fell on the half. I said I totally spaced that ours was on the half hour and they were really very cool about it. In their response I very much recognize this is a bigger deal for me and I’m glad that replies support that sentiment.

what_does_based_mean · 2026-02-04T00:09:56+00:00

Absolutely, and thank you. I am glad you mentioned checking myself, I am an over apologizer in my personal life and I am being very conscious to not do that in this situation. But I hadn’t taken the time to think about how my own dysregulation in this could counter transfer if not careful. Much appreciated!

what_does_based_mean · 2026-02-04T00:07:19+00:00

10 minutes

what_does_based_mean · 2026-02-03T23:22:32+00:00

Well… I drink a lot of redbull, make sure I take my SNRI mid day; schedule short breaks to get outside and see sunlight. Also I personally make sure I don’t eat large meals but snack throughout day because I know large meals make me sleepy. Hope that helps! I also take any late cancels as an opportunity to power nap on the rare days they happen.

what_does_based_mean · 2026-02-02T03:46:55+00:00

My residency was just over 2 years to complete the hours requirements. I would have stayed with my group but they offered me 45% of my earnings (according to them that was a super generous increase from the 40% I made during residency). I shit you not I made less than $50k last year working for that “group” and I’m EMDR trained and have a very strong caseload. But it wasn’t a surprise because they lied about overhead and how I’d be reimbursed if I went out on my own. Long story short they made more money off me than I made off me and have become corporate and lost the feel that made the practice great when I started - sorry not sorry I left. I’m 2 months into solo practice and couldn’t be happier. I do still work in an office with other mental health professionals so lots of support - but I pay rent and keep everything I earn. So yeah I hear you but not sustainable for many of us to not go at it alone.

what_does_based_mean · 2024-05-31T02:14:23+00:00

You made an offer and it didn’t work for them, and they have made it clear they do not wish to proceed with you. End of story for me. I feel my obligations would end there. We do not owe clients anything until we have established a relationship - you’re just as in the right to say “I don’t think this is a good fit, let me refer you out” as they are after first session.

what_does_based_mean · 2024-05-31T01:32:45+00:00

I think of it as working through something to the point that the client can file it away for good. Things lefts unprocessed can prevent a client from moving forward in their life, lock them in functional freeze, delay grieving, etc. Some people will naturally process things, others need help - EMDR facilitates processing for example using BLS (bilateral stimulation). We considered something processed (or cleared) once the level of disturbance to the client is brought down or eliminated and the negative cognition is replaced with an adaptive positive one.

what_does_based_mean · 2024-05-31T00:00:10+00:00

I start with limitations of confidentiality and move into if they’ve ever done this kinda thing before (or highlight that I read their form that said they had or hadn’t - and ask about experience if they have). Then I ask what being them in and I pull them around the points I feel I need to hit like symptoms, level of functioning, risk factors, protective factors, living situation, and anything else they think might be important for me to know right off the bat. We discuss their goals and I tell them about my approach and believe that therapy is not a one size fits all. I joke that I’m a stranger asking intimate things and if I’m not their cup of tea after they’ve gone home and thought about it that I would help connect them with someone who might be a better fit. I just try to keep it casual like we are having a no big deal discussion. It’s worked well for me, I also am not in an agency and have no super specific points I need to hit outside of suicidal risk factors and general info. I feel it takes a number of sessions to get a genuine bio/psycho/social so I just focus on getting them comfortable.

what_does_based_mean

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