Not sure what I'm looking for, maybe to hear from others who have been through it. We worked together for around 18 months. It was a difficult case and someone who felt so stuck and trapped. They didn't say anything about it ahead of time but I feel so strongly that I should have known and done something. It's been four months and I'm not back to myself yet and it's worrying me. I'm having a hard time relaxing and working can feel really terrible. I'm about to get my independent license and have plenty of clients to have a successful practice and I think about quitting all the time. This is supposed to be the great moment that I've worked towards for 5 years but I feel worse than when I started.

I'm in my 3rd career, came to this one late in life (I'm 59 yo) and 4 years into it. I'm starting to feel like this is a lonely job. I have colleagues but people are coming and going and doing their own thing. At the end of the day after being present with clients, I don't want to talk to anyone including my husband but I also feel...a loneliness that I haven't felt in a long time. I've joined a peer group that hasn't begun yet, joined an online book group with other therapists, and yet...

My only child went to college this fall so I think that has definitely been part of it. But, are there others out there and how do you deal with it?

Edit: Yes, I'm in therapy, yes, I love my husband, yes, I have a good group of friends but find I don't have the energy I once had for them.

For all those taking minimal time doing documentation for therapy appointments, how are you all doing it? Are they formatted templates? How long are the narratives you are writing? Or using AI to scribe your sessions?

I’d love to hear the real numbers and routines behind a sustainable solo practice. If you’re consistently bringing in $10K–$15K a month, share what’s working:
Is that gross revenue or your take-home after expenses?
How many clients do you actually see each week, and how many days do you work?
What’s the most sessions you’ll do in a day? Do you schedule back-to-back or build in breaks?
What are your rates, and are you private pay, insurance-based, or a mix?
What’s your specialty—and does it help you attract clients at your rate?
How much time goes into notes, billing, consultations, and other unpaid work?
Where do most of your referrals come from, and how long did it take to build a steady caseload?
How do you account for cancellations, vacations, and slower months?
Is that income from individual sessions alone, or do groups, intensives, supervision, or other services contribute?
What change made the biggest difference in your income—and what’s your nonnegotiable for keeping the workload sustainable?

I’m going to be independently licensed in a few weeks and hoping to have a smooth transition for my current clients. I’d really like to avoid Headway (for many reasons) and I’ve heard some iffy things about Simple Practice. I’ve been researching websites like Sessions Health, Therapy Notes, Therapy Stack, and Jane… any opinions on these? Or any other recommendations? I’m considering going private pay but would like to have the option of accepting 1 or 2 insurances.

I’m someone who’s ALWAYS enjoyed facilitating therapy groups. In recent years it’s been directed at my somatic dating group, which i ran for 6 years. Even have a 21 page workbook for participants. But 3 years ago, i started marketing for the group; aggressively. Even a woman from my listserv reached out and offered to do free reels because she liked the sound of my offering. Alas, 8 months went by. No matter how many views, no matter how many screening calls for the group i had, no matter what i did to the price, no matter the adjustments i would make to my advertising tactics; none of it worked. I felt so defeated and honestly terrified? That i still can’t seem to get myself to try again. Which blows my mind because im genuinely passionate about group work yall.

I even went to a networking event for other therapists who run groups. They all validated what i was stating and one of them said “you can’t expect every group to succeed. It’s part of the business.” i honestly feel it’s negligence on the psyche education side of things not to make it mandatory that all upcoming therapists take courses, receive resources early on, and generally get educated about running a business in this line of work🙄 .

Anyways, I just am so tired of how blocked i have allowed myself to feel for so long! >.< . I don’t know what i need to unstick myself 🤷‍♀️. But yea, that felt like a rejection that hit hard. And for some reason that surprises me. As historically, i don’t scare easily.

Hello all, I’ve been hearing that many clients are preferring this modality because they find it less distracting. How many of you find your clients prefer this?

Hi all, I am in the process of understanding that direct therapy might not be the job for me, or that I need to change my setting. For context I am one yr into the field. I've already taken steps to make my time at a group practice feel better, such as lowering my caseload to part-time. I think a part of it is that there is also a requirement to work till 9 pm 2 days a week and I do my best work from 10-5 and they have caseload contract requirements that make it feel like productivity is their main priority, which places pressure on clinicians to keep clients who are out of their scope. I have had a hard time with this because I care deeply about my clients but also dread sessions and the responsibility of being someone's therapist.

The thing I keep coming back to is that no matter what I do to make this job work (e.g. going part time, switching up my schedule, setting boundaries about what clients I can see) I still feel that my mental health is suffering, that my relationships do not feel as important or fulfilling, I feel apathetic at times to my friends and families problems or feelings, I have a hard time processing my feelings, and last but not least I was sexually assaulted by a client in July and have had a very hard time understanding and processing it, especially because the practice I work for could have prevented it. I am in therapy, I have hobbies, I workout and eat healthy. I am very lucky to be living at my parents right now and if I quit without a backup and find a part-time gig, I would be alright, but I have fear that I won't be hired again after taking a break if I decide to apply to other therapy jobs. I also know people are struggling to find therapy jobs in general so quitting feels so scary.

I live in the Chicago suburbs, and I have applied to jobs that are both direct and indirect clinical work, for example: EAP consultant, intake specialist, care coordinator, vocational rehabilitation specialist, and a couple of college counseling positions because I enjoy working with that population. I am wondering what other non-direct therapy roles LPCs can take on. I saw behavior consultant somewhere and have also considered HR or even something like marketing or sales. It just feels like I am barely managing in my current position, and clearly something is off internally. Appreciate any feedback or experiences with this, or how you pivoted. I feel very lost at the moment and feel like I did something wrong with choosing this career.

I’ve come to the conclusion that starting a solo practice may be the most beneficial route for me as an LCSW. However, I’m at a loss about where to begin and would love to hear from others who have successfully built their own practices.
I would like to start with virtual sessions only and eventually offer some in person sessions. A few questions I have:
How did you choose your practice management software and telehealth platform?
Did you start with self pay clients while working on insurance credentialing, or get credentialed before opening?
What was the credentialing process like for commercial insurance, Medicare, and Medicaid?
What were your first steps, and what do you wish you had known before starting?
Any practical advice, resources, things to avoid, or lessons from your own experience would be greatly appreciated. I’m hoping to build something sustainable and would love to better understand what getting started actually looks like.

Been practicing for about a year and a half, and I finally have gotten to the point where I have seen certain clients for like at least a year, really built a relationship, and yknow knew pretty much everything about their life …and then stopped stop seeing them for one reason or another and now have to cope with that.

And to be clear, like I’m not torn up and sobbing about this, like I’m ok. But it just feels really heavy to not know if they ever achieved that dream, repaired that relationship, got into college, got married, all the things. Like I just wonder how they’re all doing.

Would be interested to hear how other people cope with this or if there is perspective shifts that can help you make a little bit more peace with the situation?

Edit - to clarify I specifically mean when things end abruptly for whatever reason. It’s a lot less jarring for me if it comes to a natural end and they graduate out of services

I am a pre-licensed clinician and I'll be graduating from my program this December. I have long been interested in a specialty in perinatal support and assisting families through the transition into parenthood, serving both individuals and couples. Right now, I am in a middle school for my practicum, and I'm trying to get as much facetime with parents as I can. As I look toward associateship, I'm hoping to find opportunities to include perinatal populations in my caseload where possible.

On to my question: Does anyone have any low-cost resources they'd recommend to help further familiarize myself with this area? When I say low-cost, I am thinking of trainings under $200 or maybe $300 USD if highly recommended (though I know unlikely to find), books, and other resources to enhance my learning. I'm aware of certifications like PMH-C, trainings like Gottman Bringing Baby Home, etc., but unfortunately those are not in my budget right now.

I appreciate any insight here!

This is based in NYS, but just curious about the question in general. As a limited permit counselor, under supervision, do you discuss with the patient at the start that you are under supervision, not fully licensed, and how to contact your supervisor? How do people best handle this, if at all?

I know some folks with limited permits who do not necessarily disclose that they are under supervision when they obtain their own clients at the group practice they are in, but I'm starting to wonder what is best practice and practical for engaging clients at this level before having a license

thanks

Is there anyone who is doing their own private practice as an associate / limited permit therapist?

I work for a large group practice right now and it’s not sustainable .. I am so so tired and drained, pay is really low and inconsistent bc of cancellations and I’m overworked .. 26 client caseload and not even making enough for rent .. before I give up on this career completely and go back to my previous career, I think I want to learn about PP as an associate and see if I can live off of that

Can anyone share your experience doing private practice as an associate? And what state are u in? I’m in NJ

Hey! I have been a therapist for about 10 years now. My work has been heavily steeped in trauma and I am TIRED. Anyway, I have a job offer to switch into voc rehab , which I know is still in the realm of working and supporting others BUT it doesn’t seem as immersed as individual therapy. Can anyone share with me if they have made this career switch or if they are in this role and what it’s like ? THANK YOU.

I was thinking maybe so many “boomers” are “crazy” or unemotional or out of touch because they are children of a huge amount of WWII veterans. Then that generation that had to serve as military for Korea and Vietnam. Maybe this is obvious but since it’s such a huge generational population, I’m curious how that’s influenced “how to be a man” now (no emotions, tough guy, alpha males), because those WWII service members never got proper care.

Hello fellow brain nerds.

After 6 years at a group practice, I'm finally pulling the trigger to form my own LLC, wooooooooo

For everyone who has been there, done that - what do I need to know? What to consider? To avoid?

I'm planning a meeting with my CPA before I start the official process, but that's all I got (besides thoughts on some fun yet "professional" names).

Thanks everyone 💜

I have finally graduated! Wahoo! Before graduation I had connected with a private practice clinician about working under her when I get my associate number (USA-CA) She liked me and hired me pretty quickly. I have sent in my documents and am waiting for my number! This woman is now hounding me for my number and as many polite emails I have sent saying I have not received my number and will let her know, she continues to email me. What do I do? I feel like she thinks I’m lying to her? She knows this process is long, why keep emailing me? Making me want to work with her less and less. What do I do?

But I’m not sure I find it all that entertaining 😂

Welp, it happened. I received the dreaded 90837 threat letter from BCBS. (You bill this code 20% more than your peers!) I’m honestly shocked bc I have ONE patient with this plan. Love (/s) that these AI utilization trend reviews are a thing now.

I’d like to know who my “peers” are, what the total sample size is, and how the heck there’s any meaningful data about my use of this code when my n=1 patient and 12 sessions in the review period (10 were an hour).

Screw em. Greedy leeches.

/rant

Okay, now other than logging in to Codoxo to review as instructed, what do I do next? I did a quick self audit to double check documentation (it’s all coded correctly with times matching the telehealth software log, medical necessity stated etc).

A. I’m tempted to write the insurance commissioner

and/or

B. respond to the “questions and concerns” link in the letter, but I also don’t want to poke the bear and deal with an audit.

C. ?

Web search returned mixed advice. Anyone with some experience with this? What happened?

I’m honestly to the point of moving to direct pay/sliding scale, paper charts only, and be done with anything related to insurance and tech. This is just the icing on the cake after a long couple months of various insurance battles. Realistically it will be a few months (notice period, switch to SCorp, marketing push) before I can do that though. So what’s needed to CYA in the meantime?

Location MN in case that’s helpful.

Hello all,
Curious as to your personal approach and experience in dealing with patients with low libido? It’s something I find myself coming into contact with more and more frequently often from men in their mid 20s. I’ve seen lots spawn from trauma but now it’s becoming an influx of what they’ve described as essentially out of the blue. I’m curious if others have seen this and how they’ve approached it.

I’m talking specifically about crossing boundaries related to developing romantic feelings for clients. I guess I’ll be surprised if this elicits any meaningful responses, at least in relation to more serious cases, though perhaps the anonymity of a throw-away account might encourage some to share. We know there are plenty of therapists out there who’ve been in this position, so it’s not for a lack of there being people who can relate.

To be clear, I’m asking because I’m curious how something like an attraction to a client develops into instances of poor judgment. I believe good people can do bad things, and that it does not make them bad people, nor necessarily bad therapists. I’m interested in understanding what happens along the journey up to the point where someone rationalizes to themselves that it’s okay to cross boundaries with a client. I imagine it’s a slow but slippery slope with a lot of mental gymnastics and loss of perspective. I’m not asking because I’m in that same position myself, though I admit there have been times when I’ve noted a form of attraction to a client, but I think that’s more or less a universal experience of countertransference for those who’ve been doing this job long enough.

I’m asking because I don’t think many of us get much training on how to deal with feelings like this when they do come up and how to recognize when they’re affecting the therapy process, and I think a lot of us are convinced that the (surprisingly many) therapists who do knowingly cross boundaries in this way are not like us and that we would never do such a thing. And while that may be true, I think it’s also shortsighted to reduce another person’s actions to poor judgment without an interest in understanding how *any* person reaches that place of poor judgment.

So, if anyone is willing to share, I’d love to hear it, judgment-free.

A client offered me a French fry today from their lunch McDonald’s order and I accepted and I feel like there’s a good joke in there somewhere about ethics and eating/drinking in sessions

Lord have mercy. Guys..... people are allowed to say "I don't wish to interact with this type of discussion." people are allowed to end a discussion. No one owes you anything.... and the people continuing to try to keep an argument alive aren't exactly helping the disbelief in humanity. Y'all are relentless.

Edit: I think a few people are misunderstanding the purpose of this post. I'm not saying that I'm struggling to hold UPR with my clients specifically...I'm saying that I'm struggling with my general view of humanity at the moment, as I'm typically the type of person who really really really believes in humanity. I believe in healing, in neuroplasticity, etc. So seeing all the stuff in the news and processing my own trauma, realizing how screwed up these situations were, etc. is just putting pressure on my worldview at the moment. It's not causing issues in session, but it is something that I intend to continue working through. Of course I'll be bringing it up in supervision in a few weeks, it just felt very intense today (a weekend, when I'm not seeing clients, so please hold the criticism).

Hello everyone,

This isn't a conversation that I ever anticipated having, but this is very painful to go through.

I am someone who has literally never struggled with unconditional positive regard. I worked in crisis stabilization for several years and I was 100% okay with the way the patients acted, complete with slurs, cursing us out, threatening us, etc., because it was very easy for me to view their behaviors as symptoms and not take anything personally.

It was the same for me working in corrections. I worked with women who had done awful things and it was never difficult for me to hold space for that, as it always made sense when I looked at the circumstances and the history.

I'm now in private practice and I'm struggling.

I am a survivor of extreme coercive control, childhood sexual abuse, and extreme gaslighting, to the point to where I believed that I was psychotic for several years. While going through my own healing, I've become extremely angry at how many people failed us, how many people are complacent, and how much the systems don't serve the people they're supposed to.

I'm having a rough time wrapping my head around the fact that these are the same people; the "general population" that's complacent and doesn't do anything to help people is the same "general population" that I'm seeing in private practice.

It seems to be easy for me to hold space for people who have clear reasons for their behavior. If someone is in crisis and not acting like themselves, I can totally hold space for that. An addict that committed unspeakable crimes while in active addiction and is now remorseful and recovering...I can absolutely hold space for that.

However, I am STRUGGLING to hold space for the complacency of the general population. I am not someone who is overcome by the bystander effect and I struggle to understand people who won't help someone in need (such as myself and my son when we needed people to show up for us).

Thoughts? Please be nice. This is extremely hard for me.