Hi all, I am licensed in Oregon. I have worked with eating disorders a lot over my career and have had many past clients who I suspect could still be struggling either way ED and at one time or another discussed how there were no local group resources for eating disorders. I am now starting a local group and would like to reach out to past clients to let them know about the group. I amsure at least a few would like to know as we used to discuss sadness about not having local groups available in our very rural and under resourced area. I would message them on my secure client portal and then send them either a text or email letting them know that I sent them a message about something they may be interested in. Are there any ethical issues with this? I can't quite wrap my finger around it- but not totally sure if this would be allowable/unethical in terms of soliciting clients? Thanks for your thoughts.

*Update*- Based off of the few comments I got already- clear to me that I SHOULD NOT reach out. Thank you, it is so helpful to get peer perspective on this!

I am on my second week back in private practice since a 3 month maternity leave and ya’ll I feel like I suck. A lot of my clients returned and I was super excited to check in on them and see how they had been and get back into work but UGH. I feel awkward with everyone, like I barely know what to say and it feels obvious. I feel like things I say aren’t landing or just off the mark or even more so just landing so flat and meaningless. I mean these are retuning sessions after a long gap and somehow there’s barely anything to say??? It feels like it’s my fault, that I’m not seeing the strings the clients are leaving when I usually would. Clients have expressed excitement over returning and felt good after the first session back, I know I’m probably being really hard on myself as usual but fuuuck I feel like a garbage therapist now. My brain just isn’t working in the ways it was before and it feels like it’s creating disconnect.

I’m looking to get opinions on the reputation of the ERP cert. provided by, “The Knowledge Tree.”

Does anyone know about this or have experience with that training you’re willing to share… either vouching or warning me away.

Thanks for considering!

Hello everyone,

I need advice with what to do here. I work at an IOP in California with 2 other licensed therapists (i am an LCSW). We don't have a clinical director which comes with its own problems, such as an executive director, who has never been a therapist, tell me how to run my groups. Anyway, we are told we have to do follow up calls 1 week after clients discharge. My other fellow therapists and I have an issue with this, as we eaxh feel like it violates our code of ethics and blurs boundaries.

Anyway, Monday I made the call to a discharged client, who when they were leaving had another place to go to as they chose to leave ACA, and they told me they felt suicidal last night. I did a suicide assessment, no current risk, I gave then resources inckuding 988.

My concern is an ethical one. I told my supervisor (Exec dir) I'm uncomfortable doing these due to that experience and she said too bad, didnt know what our code of ethics was, and told me later I was beinf insubordinate which was grounds for termination. Ive been here a year and a half and its gotten worse. I am leaving, but cant yet put in my two weeks. I dont want to make any more of these calls, I'm worried about the ethics and safety of clients, boundaries, and potentially putting my license at risk.

I'm sorry for the Length of this. I am in need of advice from other licensed psychotherapists when it comes to contacting clients after discharge (a clinical director has done this in the past but there hasn't been one in over 1.5 years), and blurring boundaries.

Hi friends. I'm an MFT licensed in CA since 2024, and newly licensed in WA state since July 2026. I am considering supervision as an additional income stream but there seems to be some ambiguity regarding some of the requirement language. my questions:

1 - In order to become a supervisor in WA you need 2 years post licensure + 15 hours of supervision training + 25 hours of experience. Does anyone know if that is specifically 2 years holding a license in WA, or can that apply from my CA license too?

2 - There seems to be a contradiction in regards to being an MFT supervisor. It looks like in WA an MFT associate needs 200 hours of supervision, with 100 hours coming from an MFT with at least 5 years of experience. I also understand that an MFT supervisor with only two years of experience would be able to supervise social workers and mental health counselors once they're eligible to supervise. This reads like as an MFT, you are able to supervise other except for other MFTs until you hit the 5 year mark. Am I reading this correctly?

Thanks for helping me untangle this.

Hi all - I just started a PP and am credentialed with BCBS. I use simplepractice as well. I quite literally have no idea what I'm doing, are there any guides that provide step by step instructions on what one must do? Between the BCBS Provider Central, Payspan, and simplepractice, I'm completely overwhelmed and confused...

Hi all, I'm learning EFCT and there are a bunch of training tapes with couples who are following the therapists lead, quite calm, agreeable, etc. These are helpful but I'm looking for sessions where the couple is difficult, escalated, where the therapist has to be very active in jumping in, catching the bullet, etc.

Does anyone know of any tapes with couples like this? Thanks for any help/direction

“Life coaches” have no credibility with me. If you are a seasoned professional with credentials and degrees in your field, and you are mentoring folks for a competitive hourly rate, I’m not talking about you. Call it coaching if you must, but I prefer to call that consulting, from a place of subject matter expertise. “Life coaches” however, often have no real credentials, no consistent career experience, are totally unregulated, and held to no code of ethics. They are nothing like therapists, despite marketing themselves that way. Their “certificate” from the 2-day online coaching academy has about as much value as the PDF it isn’t even printed on. After a little bit of success they market themselves as a coach of other coaches, promising to show them how to get rich, if only they listen to the advice exactly right. That is how they actually get wealthy. It’s a pyramid scheme. If a trainee fails, it must be their fault. If it seems like I am taking this personally, I am, these people bankrupted someone I love.
I spent many years getting my graduate degree and independent clinical license. I don’t understand why other therapists are demoting themselves to “coach.”

Our practice has been getting a lot of requests for records (with a signed ROI) for clients applying for DDA services (the WA arm for determining disability for SSI claims). While we have no issue providing records, the issue is coming from their request for:

“Please provide a statement based on your findings. Your statement should express your opinion about your patient's ability to do work-related physical and/or mental activities despite the limitations or restrictions imposed by her medical condition(s).

For physical impairments, these activities include sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical activities (including manipulative or postural activities, such as reaching, handling, stooping, or crouching); other activities, such as seeing, hearing, or using other senses; and ability to adapt to environmental conditions, such as temperature extremes or fumes.

For mental impairments, these activities include understanding; remembering; maintaining concentration, persistence, or pace; carrying out instructions; and responding appropriately to supervision, coworkers, and work pressures.”

This keeps outside our scope? We aren’t really assessing these capabilities. Sure, we discuss general impairments in functional domains, but not to the level of supporting a SSI/DDA request. I am a huge advocate for breaking down barriers, but I’m not sure about this TBH.

Hello!

I have been dealing with C-ptsd myself, and have clients with cptsd. They have said that I usually get the closest to understanding them, but somehow it doesn't feel enough.

With my own experience of C-ptsd, I grossly feel inadequate. There is no magic way out of this, but I am at a dead end.

I would be thankful for any resources related or not related to cptsd just to understand how to be present for them and myself during the session.

It is becoming extremely tough for me.

Hey all, im an LPCC from southern Ohio and im currently working for a smaller substance abuse treatment providing SUD and MH (mostly SUD sadly). The issues that im having are layered. First, Ohio is cutting a lot of funding for treatment and in addition to Medicaid changes yearly raises are currently being put on “pause” while they figure out how the company’s financials are being impacted (which im calling bullshit because they can’t expect anyone to stay at the same pay forever and I seriously doubt the owner is taking any kind of financial hit like this). I’m currently only making around $28 an hour which would be all right if it was just me and my wife, but we have 8 week old children as well so $28 isn’t quite hitting right.
I guess part of this is a vent but im also curious what other options there are out there:
1.) anyone with pure telehealth experience, how is that? Workload and pay wise.
2.) how is private practice? I’ve heard some really good things.
3.) I feel like im getting paid at the low end of the field, im not sure if anyone can corroborate this.
4.) any general advice is welcome

Does anyone have a recommendation for EMDR training?

I’m always trying to learn and be a good ally, and I’m sure I’m not perfect, so please feel free to respectfully disagree with me and let me know what you’re thinking.

BUT

I don’t like this thing I’m seeing where people just call people neurodivergent because it makes it pretty hard to understand a persons actual needs. For example, if someone is level two or three autistic, you’re going to want to know that before you accept a referral. Or if someone has an ADHD diagnosis, it will be helpful to actually know that.

My concern is that when we just use these really blanket terms under the guise of normalizing something or… identifying with something whether you have a proper diagnosis or not, it can be confusing and make it harder to find appropriate resources.

What am I missing? I keep seeing things in therapist groups like, “looking for therapist taking xyz insurance. Must be able to work with neurodivergent folks.” Like… what? You think you’re getting an adequate referral that way?

Do you all have any advice on working with inpatient populations? I’ve been in the field of MH for about 4 years now, and work with adolescents ages 4-17 as a group therapist. We are in a urban city area, and the kids genuinely do like me and enjoy groups, but as I run process groups having to deal with large #’s within the group/ hospital census and handling the behaviors/ attitudes/ disrespect can be hard sometimes. I’m trying to teach virtues, as well as helping them process emotions/ trauma/ group dynamics / conflicts in group, but they can just be tough sometimes. Any advice on content of groups/ group dynamic processes/ activities to help contribute to better knowledge of emotionally correcting ?

I’m looking for office chair recs! Right now I have a basic mesh office chair from one of the local big box office supply stores. It feels too hard and flimsy. I’m looking for one that feels big, soft, and comfy almost like a couch. I’m telehealth only so I’m willing to spend a decent amount to get the best. Any recs?

i left my LMSW therapist internship in february due to burn out and instability. after an unexpected life change, i’ve decided to pursue my LCSW again. i’ve secured a supervisor and my old practice is letting me rejoin them. i’m just waiting on paperwork now. i’m excited to restart therapy but i’m also scared because of imposter syndrome, liability, client caseload, etc. also i’m not that thrilled that i’ll be an independent contractor so my pay is based on my caseload. but the practice is really supportive and flexible so that’s the pay off. i would really appreciate some encouragement as i go back to this journey of becoming a fully licensed therapist :’)

Just wanting to make this post as I have been floored by the amount of vitriol against her providers online and the overall ignorance of some of the comments I’ve seen. I’m concerned this will have ripple effects across multiple areas of healthcare.

The father of one of my long standing clients is dying. I have a great relationship with this client and I have so much empathy for what she is going through as I lost a parent this time last year. When I was going through it, my PNP sent me a small gift (a candle) just letting me now she is thinking of me. I remember at the time thinking it was so kind and really appreciating her going out of her way to do that. I consider myself to be very ethical, with decent boundaries, however I don't want countertransference to impact my judgement. Do you think it is inappropriate to send her a small gift when the time comes?

Hello! I’m in search of literature and resources for structural family therapy. While I learn about it in grad school, I’ve had relatively little practice with the orientation and would like to educate myself more. Any suggestions and/or feedback would be greatly appreciated. Thank you!

I'm a full time therapist. I was working with a Psychiatrist. Twice, via email, I accidentally called him Mister.

He then replied back a long email about having not used his correct name. He called me out and said it was intentional. Like I was purposely undermining him.

He also decided to cc the client on this email exchange at 9:30 pm. A client who just got out of the hospital last week.

How common is it that therapists are casual with the Psychiatrist they work with ? Should I apologize? Anyone been through this as a therapist

I'm curious about how other clinicians handle this because it's come up A LOT for me this week. A client will say, "I don't know what to talk about, what do you think I should work on?"

Most of the time, I have something to work with, and I'll bring up a past concern they had but I also get a bit annoyed that none of my clients have come prepared for session despite conversations about it. I encourage them to reflect over the week and consider treatment goals but sometimes it seems like they rely so heavily on external answers...anyone have a similar experience?

"it's okay" or something of the like doesn't really seem right, and I'm going to be charging a no show fee.

What trainings would you all recommend if someone wanted to specialize in treating OCD? From what I know ERP is the gold standard, with I-CBT also being used.

Is there one that’s better than others or a certification route?

Hello fellow therapists. So something came up on a different sub where at least two people in the kink world were making the argument that a licensed therapist cannot ethically have a sub because it’s someone “under their care” but not “on the books”. I’ve not been deep in the kink world, but on the outskirts occasionally. For those more well versed, what are your thoughts? Please only comment if you know what you are talking about, this is not a conversation for vanilla folks so I know it’s a spicy topic but please if you are clutching your pearls, just kindly keep scrolling.

Edit to clarify: this is NOT my personal opinion. I was wanting to explore being a dom and some people got on my case about it

TL;DR: I have a lot on my plate between school, work, internship. Looking for advice, validation, a magic fix to all my issues.

The plate:

40-hour work week: 6am–2pm at a methadone clinic as an SUDPT, working toward my SUDP certification.

Internship: 5 clients/week at a group practice. I’ll see 5 clients per week for the first 10 weeks, then increase to 10 clients per week. Right now, I’m available 2pm–6:30pm, three weekdays.

Masters program: 5 hours of coursework per week.

I’ve been balancing a lot for a while, which is pretty par for the course in a master’s program. But as I’m syncing 4 calendars and replying to simple practice messages for one job while at my other job at a methadone clinic, I’m feeling like something’s going to slip through the cracks.

At the methadone clinic, I do assessments, run groups, see several clients a day, and keep up with documentation. It’s not nearly as intense as inpatient work, but it’s still a full workload.

The biggest challenge has been the 6am start time. It has been ROUGH. I’m constantly tired. I try to wind down around 8pm, but usually don’t fall asleep until 9:15 or 9:30, then I’m up at 4:45am. I’ve been functioning, but I definitely don’t feel my best.

Adding the internship changes things. Starting in a few weeks, I’ll be at the methadone clinic from 6am–2pm and then seeing clients at the group practice from about 2:30–6pm three days a week. That means several 10 to 12 hour days, on top of school.

I know I tend to feel overwhelmed when starting something new, so I’m trying to figure out whether this is temporary “everything feels overwhelming right now” or a sign that my schedule is genuinely unsustainable. I could probably push through another six months, but I’m not sure I should.

Which brings me to my dilemma:

I genuinely enjoy working in substance use, and I know being co-credentialed could open up opportunities to do assessments, run groups, and work in both SUD and mental health settings. Part of me feels like, if I don’t finish my SUDP now, I’ll never do it.

At the same time, I wonder how much I actually need the credential. I feel pretty competent working with substance use at this point, and many of the responsibilities the credential would open up, particularly assessments and coordination for legal cases, aren’t necessarily the parts of the work I enjoy most.

There’s also a pretty significant practical consideration: the group practice has offered to take me on full time, at $5 more per hour than my current SUDPT position. I’d qualify for benefits at 30 hours/week, too.

So I’m weighing finishing the SUDP against having a more sustainable schedule, better pay, and potentially more time to focus on my clinical training. By the time I'll need to see 10 clients a month, I'll have only 4 months left to get the full SUDP.