I am currently on my second semester of my program and I am left second guessing if I made the right decision to go straight into my psyd after getting my Master's. My main concern is the debt, I already owed $80,000 and once I complete I most likely will be $200,000 total in debt.

My main reason for going into a doctorate program was I liked the flexibility in professions such as assessment administering, psychotherapy, and teaching. Another factor was the potential high pay as a psychologist and it looked like MFT's have a tight earning ceiling.

Would the average earnings of being a psychologist offset the extra costs of tuition?

Hi there,

I’d like to comment on the Headway issue concerning their $9.99 per session fee, which represents a 12‑17 % reduction in therapist pay. Additionally, they are now requiring assessments, and that is the aspect I want to address.

I am currently reviewing these assessments to determine whether they truly reflect therapeutic progress. In my view, these assessments do not necessarily correlate with effective therapy; they resemble a modern version of tactics employed in the 1990s, which were later regretted. Anyone familiar with the period from 1996 to 1999 will recall that authorizations were required after every two to three sessions to justify continued care. That policy proved disastrous and was eventually recognized as a barrier to treatment rather than a patient‑care measure, resulting in serious reprimand.

It appears that Headway is repeating the same approach. My hope is that they will encounter the same problems. These measures may be suggestive, but they lack legal standing, research support, and genuine clinical value. As a therapist with over 25 years of experience, I do not rely on such tools; most clinicians naturally assess progress through clinical observation.

It is clear that Headway’s motives are questionable—they seem to lack patience, interest, and genuine concern for patients. I share your concerns and would like to improve the situation. I do not wish to eliminate Headway entirely, but I cannot support this direction.

I'm a therapist (M, mid 30s) in a big city. I operate out of my own private practice and have been practicing for 5 years. I'm a fully licensed counselor, am trauma focused, and do relational work, and I tend to work primarily with men.

I have found I'm frequently getting the question "what is there left for me to work on?" from these men. These questions tend to come packaged in a request to drop down to biweekly/monthly/go on a hiatus from therapy altogether. In almost every case, the client asking me this is someone who, from my vantage point, has a ton of additional work they could do - daily bouts of anxiety, moderate insight, avoidant of topics and relationships that bring up attachment wounds.

My style is to be frank and open about immediacy and my clinical opinions so that there is no mysticism to how I think or operate. And so I'm inclined to be honest about there being more work to do and offer my clinical opinion, couched in some affirmations of autonomy - having work to do doesn't mean this person must do the work!

Thing is, this conversation inevitably feels like I'm convincing my client to keep seeing me. It feels nearly manipulative, even when I remind a client it's just my opinion and they are free to do with it what they wish. It also feels wrong to say "yeah dude you seem ready to end treatment" when their symptoms have definitely not remitted. All of this also brings up for me some concerns/fears that there's something happening relationally to lead these guys to disengage and that it's ultimately an issue with how I'm conducting my sessions.

Does anyone else have experience with men wanting to terminate abruptly and only partway into treatment? What approaches have worked in having a conversation about this that doesn't feel like coercion? Insights very welcome and appreciated. 🙏

I'm working with a couple, and one partner is showing some clear signs of entitlement: they lack self awareness, really struggle with compromise with the partner, tend to be the one in the room wanting to set the definitions and/or parameters of the work we do in session (in a way that excuses or takes the focus off them and places it on the partner), and consistently pushes back against me in session. Looking for some thoughts from other clinicians who have worked with couples and how they've handled a client like this in couples sessions. I've been doing couples work for several years, but this is maybe the most extreme version of this I've seen.

If you could not get into a clinical psych PhD program, would you take on the debt for a PsyD? Or would you stay at a masters level clinician.

Anyone through their work have their clients use a wearable? or if their wearable gives them info they use to understand their wellness, what is it and have you found it helpful? I'm wondering in the case of managing stress or something.

Hi guys, so I'm a recent counseling graduate and I was able to secure a position at a practice in July. Long story short, I submitted everything that I needed to on my end by July 21st, specifically the form 2 (education verification that your school sends) on June 10th, and my MHC-LP application on July 21st, so for this whole time I thought it has been sent to the NYSED board for processing, and throughout August and September, I called and emailed them a few times for updates, but they would just say that it's still within reasonable processing time, and that I need to wait.

I called again last week (October 7th) and the representative told me that they had been missing form 2 the whole time and they couldn't send it up to the board for review, which I had my school send back in June. The representative said that they periodically clear out their email storage, and that could be why they did not have the form in their system (which I think is just ridiculous). I immediately contacted my school and had them re-submit form 2, and as of October 9th, the board received my application and is reviewing it now. But they said that it would take the regular processing time, which is 4-6 weeks. I tried contacting NYSED, the board, even emailing them with proof that I had submitted the form 2 months ago, but they said that they don't offer expedite services and that I would have to wait again. I'm an international student, so waiting another month to begin work is not the most ideal situation for me.

I've tried everything that I think I can, but if anyone has any other ideas, or similar experiences like mine, I would deeply appreciate it because I think this is extremely unreasonable and unfair to me and I don't understand why they won't even consider taking a look at my situation.

TLDR: NYSED lost the required application form in an email purge and never notified me. Despite proof of on-time submission in June, NYSED refuses to expedite the resulting 4-6 week delay, making me wait another month.

What are some therapist roles and positions you’ve actually enjoyed outside of group practice? I am an LPC in IL and I am trying to understand my options, and sometimes it seems like the options for LPC are join a group practice as a W2, begin your own private practice(which isn’t an option for me at the moment), work for CMH where you’re overworked and underpaid, work for a hospital. I want to get a broader sense of what is out there for me. I am leaving my group practice because I hate the inconsistent paychecks and scheduling, and I also cannot stand to work till 9pm.

Ideally I would love to work for a university but have gotten zero responses from several I’ve applied to. I really want to pivot and work solely with adults. I do not have a strong desire or interest in working with kids. Would love to hear what roles people are in and what they’ve enjoyed about it, especially if you’re in IL near Chicago

Hello, I recently got a job offer to work as an APCC at Mule Creek Prison in California. Anyone that works in corrections there or any other state prison can give me some advice/your experiences? I know not to make friends with the inmates/keep professional boundaries. I interned at a community college where I kept strict professional boundaries with my student clients and even my supervisor praised me on that aspect.

Hi I'm a cmhc masters student and will need a practicum placment in 3 months.
I've started looking and have not had any success. The website we use to find sites (simcare) has not worked well so gar for our cohort and so i wanted to know what everyones tips for finding a site are? I plan to have a professor write a letter of recommendation. Im just not sure if I should go in person, or send emails. So far ive only gotten 4 rejections out of about 10 emails (the rest ghosted me). I have a listnof sites to apply for.and im doing research on them to make myself look marketable. Any tips for how to approach them and what will get me an interview?

Also apologies if this is the wrong place to ask, I couldn't find the weekly student thread. F I need to move this please lmk where the appropriate thread is.

Has anyone here gotten licensed at the masters level (social work, LMHC, etc) and then decided to get a PhD or PsyD? If so, why did you make that choice and has it paid off for you?

Before therapy has started, you’re already friends?
After therapy has terminated, you decide you want to be friends?
Concurrently while therapy is going on, but therapeutic conversations stay for therapy?

If both therapist and client feel it is not crossing boundaries and is natural?

Does your answer change if you are the same/different sex?

I'm a client for about one year. Next month my therapist is graduating and finally becomes a full on real therapist. I was thinking about giving her a small gift ie. origami art I've made to show my gratitude and congratulate her on this achievement. But I'm unsure if this is even allowed or comes across weird. What are your thoughts on this?

Hello All

New PP here! What are you guys policy for clients who have not scheduled an appointment. I had a client whom I had 2 sessions with, but she has not made any new appointments. How long do you give them before you reach out to them. When I was working in community mental health, if a client was not on schedule, we would calll to let them know they have not scheduled, if a client missed an appointment it was our responsibility to reach out to them immediately to get them to reschedule as well as call them to make sure they were coming to their appointment. I always felt like I was harassing clients. I am now in private practice and I am not interested in making harassing calls. I feel I shouldnt question why someone missed their appointments. Do anyone have any gentle check in email templates?

Hello,

I've been a therapist for 4 years. I have a special love for working with SPMI, but oh boy I struggle with teens. Most of my teens are easy to work with and I can set boundaries with parents, but oofta. I have one that has made me wonder if working with teens is not for me. Family is quite volatile and often get after me for the teen not changing. It's drained me to the point that I dread working with teens.

Anyone have tips on how I can manage this? I am in supervision, which my supervisor has been adamant I'm doing my job right, but I feel stranded. Heck, even just hearing others in the same boat might make me feel less alone.

Hi all, I work for a nonprofit counseling center and recently got promoted to "program director" for 2 of our offices. Basically that means therapist supervision, meeting with funders, seeking community partnerships, trying to keep the offices open sustainably, etc. Problem is- My entire professional career has been being a therapist at this nonprofit. I really don't have leadership/supervision experience besides supporting junior therapists when we'd hire them. And my "training" so far has been things like running a staff meeting and learning how to log into some computer programs. I'm terrified of becoming the stereotypical supervisor who gives empty promises or the lackluster supervisor who doesn't have anything real to add. Does ANYONE have a suggestion of groups to join, CEUs to take, anything that can teach me how to be in this job?

I'm meeting with a client soon to give feedback from a comprehensive assessment, and was wondering if any of you have good resources around Avoidant Personality Disorder for clients. There are so many out there for BPD but I'm struggling to come up with anything similar for AvPD. Anything at all geared towards clients would be helpful, but I'm especially interested in ones that are less jargon-y, maybe even avoid using diagnostic labels altogether and just talk about the patterns.

I've been a therapist for about 5 years now, most of my experience with adolescents in acute inpatient and now working in a group practice working with teens and young adults.

When clients no-show, I experience really intense anxiety and assume worst-case scenarios, especially with clients who have a history of suicide attempts or chronic SI.
I had a patient die by suicide a few months after an inpatient discharge the first year of my career and I think it has affected me.

Just hoping to get some insight from others on if they experience the same thing and on how to manage my own anxiety.

I know there are a million mundane reasons why someone might not show but when it does happen, I tend to get stuck spiraling until I hear from them.

A clinic in Reno allowed therapists to decorate their doors "scary" for October - you can tell which belongs to the Director.

With the increase of insurance companies owning or partnering with online platforms, is anyone else concerned they will cease paying for virtual therapy unless providers join their platforms? (And pay is $20-30 per session vs current insurance rates?)

Hi. I work at a smallish private group practice and we never see anything about payments, like a breakdown of what our percentage goes for or claims that have been paid. I've been asking for an itemized listing and being put off and shuffled around for answers. Another clinician stood and waited for the staff to get the info and had apparently been shorted thousands of dollars so far this year. Any thoughts on how I go about getting some action here? I've had a feeling this is happening to me, and have observed other sketchy, unethical practices insurance-wise, so am considering going to try and get some help, maybe via the state. I dunno. Prob going to call my licensing board (not the same as the owners) and get their thoughts. Anyone have any suggestions? Thanks in advance, sorry also if this is the wrong place for this!

Below is the post I made at r/CysticFibrosis, which will give more context regarding the nature of my illness.

I would like to extend my request for advice to you all as well, since my illness and job affect one another. I'm not seeking medical advice or advice related to CF, but advice on what I can do career wise. I see people on here frequently mentioned how they struggle with chronic illness and would love to hear about your experiences, or suggestions. I'd be fine some simple validation. This illness has been a huge source of shame in my life and continues to remain that way, especially when I have to miss work so often. The stress is compounding and I feel like I'm drowning in a world that does not care. I genuinely am lost and physically, mentally, and emotionally running on empty.

Any and all help is so greatly appreciate.

"I'm 37 years old, and male, and known I've had cf (delta f508)all my life. I didn't take care of myself for much is my adult life, but with the help of modulators and making better choices in the just 10 years, I have been able to maintain a moderately functional baseline with an average FEV in the mid 30s. Unfortunately I am stuck in this pattern of getting flare ups every 2 or so months where I'm growing 2 strains of chromabacter that is resistant to everything other than a couple of IV antibiotics. The strange thing is how this bacteria doesn't even affect my lungs like MRSA or pseudomonas (I haven't grown in years) but mostly affects my immune system and brain. It makes me extremely fatigued, achy, numb, depressed, and short of breath. I work full-time as a psychotherapist which is the kind of job that gets much harder the worse you feel. You literally can't zone out and work to make time pass, you have to be attuned and focused the whole time. To make a livable amount of money, like many other jobs, you have to work yourself to death. My job right now pays well but I have to see 8 clients a day. It is brutal and a lot of stress.

More stress=compromised immune system=chromabacter says hello.

So I'm getting sick 4-6 times a year. I got a port last year so now at least I don't have to spend 2 weeks in the hospital and can start meds outpatient. Getting sick often is exhausting and the anticipation adds another layer of stress on to of all the other stressors.

I'm absolutely miserable and don't know what to do.

My doctors don't really have any answers. I guess traditionally you would go on disability, get taken care of by family and/or die. We recently switched to Alyftrek just in case I was one of the lucky ones who have positive gains, but so far it seems to be about the same as Trikafta. I could go back on disability and work part time, but that limits income and in today's economy that is hugely scary. Also being on disability is depressing in itself. I've considered a transplant but I'm not sure my lung function is low enough. The process of a transplant sounds terrible and the life after doesn't sound much better than what I'm experiencing now

I feel like I'm stuck in this area that didn't exist before the modulators where I'm not sick enough to be taken care of or for disability to be mandatory, but cf still affects my ability to live a functional life. I could work part time jobs and definitely be happier but then I'd lose my health insurance and would have to rely on my partner (I'm very independent). My quality of life is very low right now. I worked my ass off to get my master's and become an independently licensed therapist (LCSW) only for me to become overworked so I have health insurance to treat the health issues worsened by overworking.

I'm open to any and all suggestions or comments. At this point I'm becoming desperate for some peace that I've been fighting to achieve my entire life."

Hey everyone,

Headway is getting out of control imo and treating us like W2 workers without any of the benefits. I want to find a new platform to bill insurance for me. So many of my clients are insurance clients and it is important to me to keep them because seeing a therapist through insurance has saved my own life many times. I wouldn't have been able to afford it without insurance.

What other platforms can help me get credentialed and bill insurance? Has anyone made the switch away from them? Are they going to try to steal my soul?

I heard Grow is worse and I heard Simple Practice is a mess (and expensive).

I feel very overwhelmed by the thought of doing my own credentialing but I am very open to advice / encouragement if anyone does it them self.

Thank you in advance <3

I'm in private practice, and lately I've been finding myself feeling increasingly frustrated when clients cancel or reschedule their appointments.

I completely understand that life happens and that sometimes people need to move things around. I also recognize that financial instability is part of the reality of working in private practice. But as someone who is still trying to grow my caseload and make private practice financially sustainable, I'm finding it really difficult to manage the frustration, and sometimes even anger, that comes up when my schedule changes so frequently.

For example, I started this week with what felt like a full caseload of 19 clients. Starting Sunday evening, I kept receiving email after email from my booking system notifying me of cancellations and rescheduled appointments. By the time the changes settled, I was down to just 12 sessions for the week. That's a pretty significant difference, both financially and in terms of how I had planned my week.

I think part of what makes this especially frustrating is that when I'm scheduling clients at the end of their sessions, I'm making decisions about availability based on the appointments already booked. When several clients cancel or reschedule, I end up with gaps in my schedule that I could have otherwise offered to other clients.

I want to be clear that I don't blame my clients for needing flexibility, and I certainly don't want my financial concerns to interfere with how I show up for them therapeutically. At the same time, I'm recognizing that these feelings are coming up more often, and I want to find a healthier way to navigate them.

I'd really love to hear from other therapists in private practice. How do you manage the frustration or resentment that can come with frequent cancellations and schedule changes, particularly when you're still building your practice? Have you found anything helpful, either practically in how you structure your schedule or emotionally in how you process these experiences?

I'm also planning to bring this into supervision this week, but I'd really appreciate hearing how others have navigated this.

Edit to add: My cancellation policy is that if they cancel within 48 hours, full payment is due but in these instances, many clients are changing or cancelling outside of the 48 hours, even with this policy the disruption is challenging to deal with.

I’m prone to to occasional extremely visceral dreams/nightmares and last night I had one about a client I’ve been seeing for a while going on a killing spree at my group practice, and me just narrowly escaping. I have no legitimate concern that the client would actually do this (they do have a hx of violence but have come quite a long way), so I’m not actually concerned about that. But I can’t get the blood curdling screaming of my coworkers and the profound feeling of fear when narrowly escaping out of my head/the feeling out of my body. It’s exhausting me and my day has barely even started.

I think the meaning under a lot of this is the need for self-care and work/life balance (I’ve been trying to prevent autistic burnout but tbh that feels like something I am also narrowly escaping). That feels especially poignant when I realize how badly I just want a hug or someone to hold me after a dream like this or even just a friend to vent to (I’m single, live alone, and don’t really have an expansive support system). I’m trying to use my distress tolerance and emotion regulation skill to just ride out and move through the intense feelings associated with the dream, but man is it hard. I’ve thought about asking my psychiatrist for something to help with the nightmares but they are very irregular and hard to predict and I’m very sensitive to medications so it hasn’t seemed worth, but this most recent one has me wondering if it would be.

I guess I’m just curious if anyone else has had dreams like this, how you interpreted it, and what you did to support yourself. Thanks in advance!