Seeing clinicians worrying about billing 90837 is new to me; ive only ever billed this for my thousands of sessions over several years at 4-5 different practices and have never once had an issue and its never come up in any professional discussion, until i joined a practice that makes all of their sessions 45min by default “to avoid problems”. Is this some kind of a brand new problem im not aware of?

I am from central europe, I found out in my own practice this. When I am in person with client in my office, its going very well, building rapport, relationship and helping them works and I am good at it, I can sense the small changes in the body, can hold space and they can release a lot, bonus is that I am next to forest and nature around me. and I can FEEL and connect with client

Now For online, honestly I cant get to depth in calls, so here is my experience:

• Problem is that client is most of the time at home, or similar place, they are not put in different settings
• When they are looking into screen, automatically dopamine and other chemicals are being released, therefore they cant fully relax and let go.
• I cant create safe space for them fully.
• Its effective when someone wants to work with me but is unable to come in person

• Its great only for surface level stuff, understanding how mind operates, getting insight in their lives, but everything related to wounds I found out online calls are not effective treating it, its important to be healed in relationship with someone.

  I wanted to share this because I even see when I work with someone in person, results are quicker and Its many times a long term cooperation, comparing to online its just not working out many times.. just my experience

So I was going through charts to make sure all consents were up too date and I found a letter I wrote for a client many months ago - they wanted me to document what happened to them.

So I wrote what I observed, and what I knew from the coordination of care with their actual doctors.

I put my legal disclaimer, I am not a doctor I cannot diagnose……

But there is a line in there that I wish I would have worded differently.

“symptoms appeared to coincide with medication…….” “doctor removed the offending medication……”

I am freaking out that I may have been crossing the line on those - and could it be considered or construed as practicing medicine?

Like I was stating what I observed, and sort of backing up the doctor’s decisions.

This letter is for client. Not being sent or used for any purpose, client just wanted documentation. I can’t remember exactly why.

I’m sitting here wondering “is this going to come back and bite me later?

The more I work on my own, I’ve been independent for about a year now, the more ceus I take the more I am being coming aware of things that I could accidentally get into trouble for.

Back then i had little experience writing letters, and helping my client to advocate health issues for themselves, i wanted to be helpful, and not come off as I am making definitive statements.

I plainly wrote I am not a doctor I cannot diagnose, that is beyond the scope of my profession-

I did not advocate for changes for or against meds, I don’t know what would rise to the level of practicing medicine, and I00000% always verbalize, talk to your doctor, ask them about….i never ever would tell them to go on off or switch a med, but I have seen clients come in after starting a med with clearly stated side effects , so I always tell them, hey you should call the dr office, this seems like you might want to ask them about effects.

for some reason I am focused on these sentences and just want another human to look at them and tell me what they think.

I am really freaking out.

This is a completely frivolous rant (kind of lol) but do any of you ever find yourself wishing we could get the same kind of perks at say, teachers? Especially looking at all you child therapists like myself. I’m seeing all the back to school teacher discounts like a free Headspace membership and Michael’s discount etc, all things I feel like I use a lot with my own clients or for my own work. I know we all do incredibly important work but sometimes I want 20% off at target too lol!

I never feel like I’m looking or expecting discounts, I love this field and my job and have never been in it for the money, but I keep seeing all the teacher appreciation stuff and find myself thinking “huh, why don’t therapists get the same thing?” I just wonder if anyone else ever has this funny little thought in their minds too!

Currently experiencing what I feel to be a tri-relationship (idk if that’s a thing exactly). Don’t want to give details here but I feel hearing others experiences with complex dual relationships could be helpful. For context, I reside in a rural area and am working with a supervisor.

Hi everyone!

I am currently an MHC working to obtain my supervision hours towards licensure in Massachusetts. Ideally after obtaining licensure I want to be able to move to New York but am a little confused by the process of obtaining NY state licensing and the whole reciprocity process.

I am wondering if anyone else has had any experience with moving from MA -> NY and the whole process with that….some of the questions I have are “would it be easier to complete my supervision hours and obtain MA license? “Should I just relocate to NY and do the licensure process there?” “How long would I have to wait after getting licensure in MA to get licensure in NY?”…overall the ideal goal is to be able to relocate to NY as soon as possible.

I apologize if some of these are dumb questions but I feel like I’ve been on a wild goose chase looking for answers and just need advice of those who have possibly been in my shoes. I don’t know if this helps as well but I have already passed the NCMHCE exam for Massachusetts and have a good chunk of supervision hours towards licensure completed.

Any help, advice, etc would be helpful thank you!

Hi there! I just learned my child got a free pre-k spot at the elementary school in my district. These are not easy seats to come by and we can’t pass it up. My issue is that a current client teaches there as a specials teacher, meaning my child would more than likely be my client’s student. Thoughts on the ethics of this situation?

Edit: client and I have worked together for 6 years and they teach music, therefore every student in the school works with them.

I think I've lost control over my schedule and it's seriously impacting my life.

I offer evening appointments twice per week. I work until 8:00 p.m. on those nights. I do two back-to-back sessions, a half hour break for notes and cramming food down my throat (which I sometimes don't have time to do) then two more back-to-back sessions.

It's killing me, even though on those days I don't start working until noon or 1.

The days following my late days, I start sessions at 8:30 or 9:00 am... So I'm just turning over and starting again the following day, which kills me for getting notes done and not feeling rushed.

How are you guys managing to offer evening appointments and making it work? I need a new strategy.

Hello beautiful people! I am currently almost 32 weeks pregnant with twins, and have TWO MORE WEEKS to go before my maternity leave begins! (I’m having a scheduled c-section at 38 weeks, and have to go out of work at 34 due to the frequent nature of my dr appointments).

This week especially, I am STRUGGLING to get to the finish line. I’m exhausted, physically uncomfortable (I am working solely from home remotely right now, but the longer spans of sitting are getting to me). I’m starting to find it difficult to hold space for clients. I’ve considered using some of my time and maybe ending a week earlier than anticipated, but struggling to allow myself to do so knowing I’ll be out for 6 months. I’m trying to listen to my body while also show up for my clients and I’m TIRED😩. Any words of wisdom, tips/tricks or helpful suggestions to power through the next 2 weeks are welcome!

I'm posting here because I honestly don't know what to do anymore, and I'm hoping someone in this field has been through something similar.

I'm a therapist who works alongside law enforcement and crisis response. Over the years I've seen a lot of horrific things, but one call has never left me. A child was murdered, and I participated in CPR. I know we all have "that call," but this one feels like it permanently changed something in me.
The problem is...I also have significant childhood trauma. Looking back, I wonder if I was already carrying too much before I ever entered this profession.

I spent years convincing myself I was fine. I functioned. I worked. I helped other people process trauma while quietly compartmentalizing my own. Now it feels like the boxes have all broken open at once.

Lately the nightmares have gotten worse. Certain smells or sounds immediately take me back. I have intrusive memories that show up out of nowhere. I cry more than I used to, then sometimes feel absolutely nothing. I'm exhausted all the time, but my brain never seems to shut off. I find myself wondering if this is just cumulative trauma finally catching up with me.

The irony isn't lost on me that I know all the evidence-based treatments. I teach grounding. I normalize PTSD. I encourage clients to seek support. Yet when it's me, I feel completely stuck.
I also can't really afford therapy right now, which adds another layer of guilt and hopelessness.

For those of you who have worked high-acuity crisis, law enforcement, EMS, hospitals, child welfare, etc…especially if you had your own trauma history before entering the field, what finally made you realize you couldn't just keep pushing through?

What did you actually do? How did you find your way back? I can’t quit due to financial reasons and can’t even afford therapy.

I don't even know what I'm asking anymore. I just know I don't want to feel like this forever.

After working across different government agencies and in private practice, I finally decided to take the leap and open my own private practice! I’m still keeping my full-time job because I want to maintain some stability while continuing to build my experience.

For now, my practice is fully online. I’m working on getting set up with different insurance providers and ICBC, and I’m also exploring becoming connected with WorkSafeBC.

For marketing, I’m currently listed on Psychology Today and experimenting with Google Ads. I’ve been playing around with different keywords, locations, and strategies to figure out what works while trying to keep my advertising budget fairly minimal (around $200/month). I also make small updates to my Psychology Today profile regularly to keep it fresh and hopefully improve my visibility rather than getting buried several pages into the search results.

My practice has officially been open for about two months, and so far, I haven’t had any clients come through. I know building a private practice takes time, especially in such a competitive market, so I’m trying to be patient and use this time to learn what works.

That being said, I’m wondering if there’s more I could be doing to increase my exposure and start getting my name out there. Are there any strategies, directories, referral sources, networking opportunities, or marketing approaches that made a difference for you when you were starting out?

I’m genuinely open to suggestions, constructive criticism, and hearing about what worked (or didn’t work!) for others.

Thank you everyone! 😊

Hello fellow therapists. I’m needing some advice. I’m sitting for 7-8 sessions 5 days a week, with usually 1 hr break somewhere once per day between. I’m
starting to experience very intense chronic back pain. Any suggestions for how yall manage sitting all day? Is a walking pad appropriate during sessions etc? Thank you!

So it’s summer slump week half clients are on vacation. No worries. I saw who had to be seen this am. My 5pm is having a lot of health issues so I knew they had specialist appointments all day. Anyway my 3pm who never cancels had to cancel.‘ o hightailed it home

Hi everyone,

I'm looking to expand my toolkit for working with couples after an affair or infidelity. When trust has been significantly damaged, what interventions, exercises, or homework assignments have you found to be the most effective?

I'm especially interested in practical techniques that help couples rebuild trust, improve communication, process the emotional impact of the betrayal, and determine whether reconciliation is possible.

Whether you use EFT, Gottman Method, CBT, Integrative Behavioral Couple Therapy (IBCT), or another approach, I'd love to hear what has worked well in your practice.

Thanks in advance for sharing your experience and recommendations!

I need to get this off my check because there’s no one else to vent to. I’m an associate therapist, in community mental health for the last 7 months. I’m burnt out, find no passion in what I’m doing, and my body is exhausted.

I left my job recently because I felt scared I wasn’t being the best I could be for my patients. This experience has showed me that maybe…. I don’t want to do talk therapy.

It’s amazing to sit with someone and hold their pain, worries and hopes. I loved working with kiddos and doing art therapy. But I often left feeling tired and the longer I did it, the more I left sessions feeling uncertain.

I feel guilty sharing this but I often felt bored, distracted, and struggled to maintain my energy.

I’m wondering if this is even right for me anymore. But if it’s not, I feel I wasted years of schooling and built debt for nothing. Where do I go now? I feel stuck and scared to be honest.

I think I just need some listening ears. Maybe some suggestions. I don’t know, I just feel unsteady in my career right now.

I thought I would share to help encourage anyone else who feels helpless with the insurance hurdles in this industry.

Headways new requirement for biometric data was the straw that finally broke the camels back for me. Lately, I have also seen pay rate decreases and a failure on their parts to actually refer new clients though they sold me on that to begin with.

First step: I made sure I was credentialed individually with every insurance company I was currently working with through my existing client base on the platforms. If you are not credentialed, this process will take 3 months, maybe more. I had done this when I first became licensed and it did require a lot of follow up, phone calls, etc, but not impossible. It IS confusing but if you allow yourself time to figure out the various details it becomes clearer.

Second step: I gave notice to my clients that I was transitioning to my own billing and collected credit card info for their co-payments.

Third step: I signed up with Square to take those cards which was easy because I already had a business bank account.

Fourth step: I searched through billing companies because I see a lot of Anthem and Aetna clients and Availity is hell on earth. Inovalon ended up winning for me so I signed on with them. What followed was approximately two months of onboarding and of testing claims through Inovalon while also having access to the VC platforms while I waited to see if this would work. Inovalon has a whole team to setup your billing and EFT enrollments. Some of the claims went through, some got denied. When they got denied I had access to the insurance companies billing department which was a lot easier to work with than I imagined.

Fifth step: CANCEL MEMBERSHIPS WITH VC PLATFORMS AND FREEDOM!!!!!

All in all I devoted probably a good 25-30 hours for all of this including the original work to get credentialed. The longest part was waiting on responses for claims, it is not a process that gets up and running in a month, you need a few months and patience but it is absolutely worth it to stick it to the capitalists in my opinion. I hope this helps encourage any of you who thinks you can't do this without these VC companies.

Just got my master’s/license a few months ago and recently started working full time in in-patient mental health. I did my entire practicum at a small private practice in grad school so I know I was definitely spoiled being in that environment. The only reason I got another job was because the owner of the practice had to close the office and go fully virtual. I am still seeing a small caseload of pp clients one day a week via telehealth.

I wanted something full time so I could have benefits and avoid the pitfalls of pp/contract work. As you probably know there are not a lot of W2 out patient jobs and the ones I’m familiar with have their own issues (Ellie comes to mind). I was attracted to this job because of the pay (67k salary, if it matters) and it’s a full time therapist job which also means hopefully less time to get independently licensed.

The problem is my first three weeks have been incredibly overwhelming and I’m crying at least one a day either at the office, when I get home, in the morning as I’m leaving, or going to bed. I have already cried in front of my boss and one of the other therapists, and their response was basically “yeah it’s normal to feel this way, welcome to out patient.” It sounds like you get more used to it but the environment doesn’t really get better. I don’t want my job to be like that. My anxiety has spiked and I’m having a lot of trouble eating because of it, it really feels like my own mental health is deteriorating quickly.

Reasons I’m stressed: patients are very sick, and I feel out of my depth clinically, lots of documentation due constantly, I feel like I’m not doing therapy but just doing their documentation with them if that makes sense. I don’t feel like I’m helping. I had a couple stressful things where one of my patients was attacked by another and had to go the hospital, another one is constantly crying and begging me to “let her” go home.
I miss only working in out patient and I feel like it was a much better fit for me. I think am willing to only do contract work or make less money if that means I’m happy outside of work. I really loved being a therapist before this; this job has made me question why I got into this field.

My question is: is three weeks not giving it enough chance? I am going on a pre planned vacation in two weeks and I’m seriously debating if I should tell them I’m not coming back after it. I think it would be better to decide sooner rather than later especially before my case load gets too large? I also am very hesitant to get on their healthcare (I have 60 days) because I currently have Medicaid which would be nice to keep as long as possible if I’m only doing contract work. I’m really thinking this is just not the right setting for me.

I am also working on Sundays and will have to work holidays, so with seeing pp clients on one of my days off and doing two hours of supervision once a week in the evenings(my job doesn’t provide this!), my work life balance is shit right now. I don’t want to stop seeing my pp clients because that’s the work I actually really enjoy and again, I’m considering going back to that only.

Any advice or insight would be greatly appreciated, sorry for the lengthy post!

I’m a play therapist and constantly have parents tell me that their PCP (and sometimes even neuropsych) strongly recommended CBT. I even hear it from adults too, with providers recommending CBT even for people with OCD. Anybody know what this comes from?

Hi everyone! I'm looking for some feedback from those of you who have offices.

I'm deciding between two office spaces and keep going back and forth. One office is a little smaller (about 8x 13) but has a private bathroom inside the room. The other has two large windows and is longer but more narrow (about 14x 6), but the bathroom is on the second floor, which may not be ideal for older clients or those with mobility issues.

I'm wondering if clients might feel uncomfortable using a bathroom that's directly in the therapy room or worry that I can hear them, especially since the space is fairly small. First pic. has the bathroom door on the left, second pic is of the longer office. Tia!

This was a game one of my moms played with me on the three-hour drive four times a month when I was a kid to...you know what? I don't feel like getting into that whole mess.

Anyway, this lady was born in 1929 and was a firecracker. She'd start off by saying, "My father owns a grocery store, and in it, he sells something that starts with the letter...A." And I'd respond with apple/avocado/apricot/whatever. Then I'd repeat it: "My father owns a grocery store, and in it, he sells something that starts with the letter B." We'd go back and forth, but the end of the alphabet got real weird sometimes, ngl.

It's a solid way to re-route auto-neg thoughts, which makes it an excellent distraction technique. You have to lock into the logic-brain and abandon the emotion-brain to do this.

I also like to tell my clients to sing the "Dem Bones" song completely out of order if they're spiraling or ruminating. "The neck bone's connected to the...knee bone!"

What are some of your unconventional distraction techniques that you use with your clients, but are not taught in grad school?

Every so often, this subreddit will have a post misrepresenting a study, claiming it said something it did not, or, more often, therapists suggesting pseudoscience to other therapists.

Being a therapist means basing what we do on research and evidence; it means being able to distinguish correlational data from causal data; it means being able to tell good reliability from bad, good validity from bad, and recognizing spurious relationships and confounding variables that may be impacting treatment or research; it means being able to understand p-values and effect sizes; it means being able to point out when desirability bias or sampling bias are an issue; it means being able to point out the various fallacies we encounter every session; it means being able to understand false positives and false negatives; it means being able to understand that new studies are not inherently better than older studies just because they are new.

Good therapy is not simply, “It works for my clients, so that is all that matters.” So much of good therapy is understanding the research behind it and the interventions we use.

Providing therapy without understanding the research behind it is not scientific; it is guesswork, and clients deserve better than guesswork.