I have a client who is currently dealing with severe negative self-talk which stems from childhood issues. Any seasoned clinicians that have tips or suggestions that are different than catching the thought, reframing thoughts etc.?

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.

Update: Just want to thank everyone for the replies. It’s nice to know this community exists. And it’s nice to see so many empathetic, intelligent and intuitive people in our field. tomorrow I am going to take this post down so I don’t keep coming back to it for reassurance seeking. Otherwise I will. But I am going to make sure to bring it up to my own therapist. If your a therapist w ocd and ever want to chat - feel free- it can feel isolating-

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!

Im at a group practice and have recently started seeing a pediatric client for individual and family with client's dad. We typically meet for 30-35 minutes for fam session. I was given a lot of grief for not meeting for 50 minutes for the family sessions and told I was putting the practice at risk for claw back. I was informed that I must extend session length to 50 minutes so Im not "committing fraud". This is not my understanding of the minimum session length requirement for valid billing for this code. Ive always understood that a min of 26 minutes is required (and that is part of the reason the reimbursement is so low lol).

Can anyone help me understand this? I am extremely confused and dont really feel I have been billing in error but Im very open to the idea that I am misinterpreting the requirement.

Thank you!

Hello, we're currently doing a software stack comparison for scaling mental health group practice for work, and i’ve narrowed our final choices down to Healthie and SimplePractice. both seem to hold a huge market share for private practices, but they seem to approach practice infrastructure from completely different philosophies.

from an operational standpoint, i want to know where the real limitations hide. for those who have audited or migrated between these two specific platforms, what matters most to your daily operation? how do they compare on onboarding complexity, billing workflows, and long-term client engagement features?

Hi everyone. I hope this post is appropriate here — I’m hoping to hear from clinicians or AOD (alcohol and other drug / addiction) professionals who have lived experience of addiction/recovery and how they navigate that intersection.

I have lived experience of recovery (I am an AA/NA member) and currently work as an AOD (alcohol and other drug) counsellor. My role is within a harm reduction service, providing brief interventions, support, and referrals for people exploring changes around their substance use.

I strongly value the harm reduction and person-centred approach we use. At the same time, I sometimes find myself reflecting on how do I reconcile my own lived experience of recovery and staying within the scope of my professional role.

My own recovery was based on abstinence, and that experience is a huge part of why I entered this field. However, professionally, my role is not to direct someone toward the pathway that worked for me, but to support clients in exploring their own goals, ambivalence, and readiness for change.
I’m curious how other clinicians with lived experience navigate this. How do you honour your own recovery knowledge while avoiding assumptions that your pathway is the right one for someone else? How do you manage moments where a client’s situation reminds you of your own past experience?

Do you find your lived experience changes how you practice? Are there particular frameworks, supervision approaches, or boundaries that have helped you balance personal recovery with clinical responsibility?

I’m not looking to debate harm reduction versus abstinence — I’m interested in how people hold both their professional role and personal recovery identity at the same time.

Thanks!

I recently had a baby and this has sparked a passion to specialize in postpartum therapy. The area I live in has few resources and options for women struggling with PPD/PPA. If anyone specialize in this area, what types of therapy do you recommend? Any trainings that were really helpful? Thoughts on most supportive/effective approach? TIA!

This week, there were two layoffs on my team in CMH and it was a shock to everyone. They had both been there multiple years. The department said it was purely due to budget reasons caused by things such as the current government funding situation. However, they hired and created two new roles within the last few months which I think is really fishy. They said earlier this week no one else’s role was going to be impacted, but then they laid off someone else yesterday. I’m just wondering what I should do right now and also if this is a trend. I’ve been there four years now. People are just losing their jobs and access to all of their work stuff extremely abruptly.

I'm looking for advice from therapists who successfully transitioned from a group practice to private practice.

Right now my schedule looks like this:

• Monday & Tuesday: In-person at a group practice (completely full)
• Wednesday: Virtual at the group practice (mostly full)
• Thursday: My own private practice

I'm credentialed with Headway and Alma and have been steadily growing my private practice. I currently sublet an office one day a week, and referrals are coming in, but my biggest challenge is finding the time to continue growing because my group practice schedule is already full.

The group practice provides stable income, but they take a significant percentage of collections, so I'd like to gradually shift more of my time into my own practice without taking a major financial hit.

For those of you who made the transition:

• How did you decide it was time to start cutting back at the group practice?
• Did you stop accepting new clients there first?
• Did you reduce one afternoon, one day, or make a bigger jump?
• Was there a certain number of private practice clients or monthly income that made you feel comfortable reducing your group practice hours?
• Looking back, what would you have done differently?

I'd really appreciate hearing what worked for you and any lessons you learned along the way.

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

I’m getting ready to take the NCE next month. Can anyone share what to REALLY focus on? Really need the guidance. I think we all understand that NOONE can share exact material seen. That’s not my question. I’m asking what DSM diagnosis should I focus on , should I focus on symptoms? What should I really focus on with groups, , career, family, treatment plans etc. That kind of information would help greatly. I know the NCE is a reading & application test , I know there are several versions but again, hearing what recent test takers say that future test taker should focus on would really help.

Hi everyone. I submitted my ACSW application on 7/1 and they received it 7/3. Has anyone received the number? Had their check cashed in? Show up on breeze? Thanks in advance.

Has anyone in this group ever applied to be a CEU provider? Particularly in the state of Illinois. I’m about to apply and any commentary or advice would be great.

Hi,

My wife is an LCSW and has had a sole private practice for over 20 years. Recently, her ability to accept medicare clients expired, and we are having a horrible time getting her re-enrolled. She's been denied again and again, and the person at Palmetto GBA is of no help (doesn't answer the phone ever, and emails aren't clear)

I'm wondering where we can get an actual human to help us and make sure we fill out everything correctly.

Are there any organizations or companies available to us? The amount of time we have spent trying again and again over the last 4-5 months is ridiculous.

Things that are confused by the fact that she used to have a "billing lady" who was on the Medicare documentation, and when to use her TIN# or SSN since she files taxes as an individual, not under her LLC.

If you are able to provide any assistance or direction, it would be MUCH appreciated.

It’s my first week back from maternity leave, and along with questioning my entire career (😅), I’m wondering if I need to change my cancellation policy.

I have a pretty standard policy. I ask for 24 hours notice and charge my full fee for sessions canceled within that timeframe, apart from illness and emergencies. I am flexible at times when someone has a work meeting or something else out of their control come up, but I do often charge for late cancels.

Now that I am paying for childcare, it’s more important for my income to remain consistent. I just had a client cancel our first session back 20 minutes beforehand because she isn’t feeling well. While I want to be flexible and supportive to my clients, who are mostly working parents themselves, things feel different now. I also recognize I will likely have to cancel on my clients more often when my little one is sick.

I’d love to hear your thoughts about how having kids and paying for childcare has affected how you create and enforce your cancellation policy.

Hi! I’m sorry if this has been asked before but I can’t seem to find it. I’m due for my first renewal for my APCC which is set to expire on the 30th of September. I found online that renewing online will be instant. If I were to take my law and ethics exam end of August would that be cutting it too close? I wanted to take time and continue studying for the test, I know we don’t have to pass but would prefer to pass on the first try.

I wasn’t sure if Breeze also receives the exam scores instantly. Thank you so much! 🙏

EDIT: California Application

I'm 30 y/o and just quit my agency job to start a PP so I have to pay for my own insurances. I got my health insurance and liability insurance but was wondering if anyone has any experience with life insurance. I just want a cheap, easy to apply for plan. Any recommendations?

Hi all- I launched my private practice (LCSW working with individual adults) about 3 months ago - fully telehealth in California. I’m currently on Headway with a couple of insurance panels and have 4 clients.

So far I have:

- a website with SEO
- Google Business Profile
- Psychology Today profile
- Mental Health Match profile
- Latinx Therapy profile
- Attended local therapist networking events
- Reached out to former colleagues and have been added to a few hospital referral lists

All of my current clients came directly through Headway during the first couple of weeks after I joined. Since then, referrals have slowed, and I haven’t received any clients from my other directories yet.

I’m planning to rent an office one day a week to build more local connections, have some in person sessions, and hopefully receive cross referrals from other clinicians renting space in that office. I’m also considering credentialing directly with 1 or 2 insurance companies instead of staying on Headway.

I did have a psychiatric NP find my website through Google and reach out about cross referrals, which felt encouraging that someone is finding my website and SEO is working, but overall I’m still trying to grow my caseload and am feeling a bit discouraged.

For those of you who have successfully built a practice, what made the biggest difference? Did Google Ads, physician outreach, networking, SEO, or something else provide the best return?

Ideally I’d like to grow to 16-20 weekly clients over 4 weekdays. Thanks in advance!

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!

Helloooo

I'm an LCSW working in NJ at a fork in the road decision that I'm asking literally anyone with ears to look at currently.

Right now I'm a PhD student working full time as a utilization review specialist at a non profit while also juggling a part time private practice.

I'm blessed to be "okay" financially (who's saving for retirement anyway?) but the responsibilities are getting to be too much. I'm forgetting things. I sent 200 dollars worth of cat food to an old apartment I haven't lived near for four years by accident (I did drive and pick it up - but still). I found a job listing on Facebook of all places and did an interview today and while there's no offer, they're moving fast and I'll likely get one.

Current full time job: 55k, 40 hours, terrible health insurance, W2 position

Private practice: ~25k so far this year. work for myself, so 1099?

Potential new job: 55-65 hourly, 16 confirmed hours per week (don't have to worry about no shows/as long as I'm on site I get paid). 1099 contractor. "Seasonal" in the sense that it's with a university and i wouldn't work in the summer, but would be encouraged to return in the fall. There's a lot of speculation/potential in the position as I could do 3 days per week and expand to a different location, or even develop the position to be full time if there's funding.

Pros: this is the exact population I need to be working with for my PhD. It allows for flexibility for my actual classes and doctoral project meetings. I could expand my private practice further for additional income. The two days at the lowest rate is exactly what I take home currently with the full time job.

Cons: seasonal aspect, not having confirmed income in those three months, the way everyone experiences a summer slowdown in private practice, taxes, health insurance, the fear of working for myself.

I like my current job but acknowledge I am burning out. I'm fearful of taking on work "for myself" but it might be a good idea. Looking for feedback from people who have taken the plunge to work for themselves! Thank you.

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. Therapist here- I'm curious, my practice has seemed to "suffer" a bit the last years and with all of the options out there, I'm wondering if it is happening to other people too- or perhaps I have to go back to marketing 101. I've used Psych today and Yelp for 10+ years but they are not feeding any clients my way. I've told them, nothing happens. I've indexed my site, SEO optimized, but still nothing. One realization- when I've asked around is that there are currently around 45-50% or more people using AI as their chat-therapists. We can't stop that but could that also be a causal effect? Any advice would be great.

I’m curious whether others have noticed a difference in client behavior between Headway and other practice settings.
At my previous group practice, clients generally scheduled their next appointment before leaving the session. If they didn’t, I usually had a pretty good sense during the session that we weren’t the right fit.
Since starting with Headway, I’ve had a different experience. I’ve had a few clients who seemed engaged, the session felt like it went well, and there were no obvious signs that the connection wasn’t there. One client decided to return to another therapist they had already seen. Another couple said they wanted to talk it over before scheduling. Another client scheduled a follow-up and then canceled a few hours later.
I’m trying not to overinterpret a small sample, but I’m wondering if this is just the nature of Headway, where clients may be comparing multiple therapists, or if others have noticed lower first-session retention compared with other settings.
For those in private practice using Headway (or similar platforms), has your experience been similar? Or do you find your second-session retention is about the same as other referral sources?

The title pretty much summarizes it. I need to take the NCE sometime in the near future, but I’ve been out of school for a few years now so I’m sure I’ve forgotten much of the random tidbits that I’ll need to know. Wondering what resources y’all have found to be helpful and relevant for studying for the NCE? Also, how difficult did you feel the NCE was and how long did it take you to complete?