r/therapists

Trigger warning as this mentions topics of sex. I'm an associate and maintaining a stable caseload has never happened yet so I'm in no place to be picky with clients. I know we still need to show up for clients regardless of what concern brought them in.

I really struggle with clients when talking about sex to the point where pretty much 90% of my clients are talking about their sex-lives. Nothing against sex in particular, I'm aware it's a normal human thing and can impact an individual's mental health so I'm required to allow these conversations. The struggle might come from a sheltered upbringing or trauma or whatever, but it's not something I've been able to solve immediately. Talking about other people's sex lives has been causing me panic attacks & nightmares in my outside life, and I've been using my lunch breaks to go throw up sometimes. I've asked my supervisor for support, and she excitedly said I had finally found my niche and that I could later become a sex therapist because of this.

I really don't want this and know I'm not allowed to drop or transfer any of these clients. I don't know how to build up a tolerance to hearing about these topics.

What are some ways to be more empathetic to clients and to be able to actually communicate empathy better? Obviously it doesn’t come natural since I didn’t grow up with empathetic parents and I’ve don’t my own work around that. I think some of my clients think I just don’t get it or dont understand their problems when I do get it but I can’t seem to always find the words in the moment. I also do EMDR sometimes and need to be more attuned to clients as I tend to miss things. I later think about the session and realize what I didn’t do and can be hard on myself about it. Any suggestions or books I can read or ways to communicate better would be great. I’ve been doing this almost 10 years and it gets harder for me as I get older. TIA

I’ve noticed that a lot of people (including myself at times) have certain expectations about therapy that may not always match reality.

From a therapist’s perspective—what are some common misunderstandings clients have about how therapy works or what it can realistically do?

I have a client that I’m feeing increasingly uncomfortable in the room with. I’ve been seeing him for about a year. There’s only one other time I’ve had this feeling with a client and it was someone with what my supervisor thought was undiagnosed ASPD who had begun stalking me.

My client now keeps pushing some personal boundaries and last week asked me if I was alone in the office. Our clinic is small and I was, but I said I had fellow clinicians down the hall. He asked as he was leaving so I didn’t have time to process the question with him.

I‘ll chat with our clinic owner about this client but I wanted to get some peer feedback from other clinicians too. I’ve got good rapport with this client and I don’t think he’d hurt me, but I can’t shake the feeling that I’m not safe.

There is revenge porn of me on the internet. I've tried to get it taken down with no luck. Im honestly terrified a client or colleague is going to find this and that its going to affect my career.

If a client were to ever see this and they were to say something, how should I handle it?

The fact that I cant get this taken down and that modern technology can link my face to my identity is really messing with me. What can I do to protect my career?

The owner of the private practice that I'm part of, who is also my supervisor, wants us to actually go through with the session even if the paperwork isn't complete and there isn't a payment method on file.

Which ultimately means you get ready and lock into therapy-mode, just to sit there waiting for the patient, up until 15 minutes in case they're late, when 99% of those who ignore all contact attempts and don't complete their intake paperwork don't end up showing at all.

I just think this is kind of silly. The last private practice was with would cancel appointments if the paperwork wasn't done 24 hours in advance. Which I feel is normal, ethically-correct, and an even just good way to establish boundaries as a clinician. I feel like this way is a waste of time and can even contribute to burnout.

I have a close friend who is also a therapist. We use Marco Polo to talk on a near daily basis and she is probably the person I talk to most outside my husband. She calls our conversations her verbal journal. But I’m struggling. She uses a lot of therapy language when we talk and things become exhausting if I say something she doesn’t like. She becomes rather mean and accusatory but if I ever say “hey this comment hurt my feelings” then she says things like “I’m sorry you misunderstood my intentions” and is really cold.

I have no idea how much of this struggle is related to her being a therapist, but I don’t have these exhausting repair conversations with anyone else. Even my marriage is easier. I feel like she wants the emotional energy I give to my clients but also doesn’t want me to say anything therapeutic like but also not the directness I use with friends but needs me to give substantial feedback and get it exactly right or I’m attacking her… I’m tired y’all.

I’m a doctoral-level extern. I had a supervisor last year tell me I need to learn how to “deal with life when it happens” because I asked for time off after putting my cat down. Not to be dramatic, but this cat was my best friend and closest family member. I didn’t tell her that, but she said that she saw clients in the middle of her divorce and cried during their sessions. She said she would leave it up to her clients whether or not they wanted to keep the session instead of rescheduling. I had many other issues with this supervisor, but this particular one stuck with me and I wonder all the time whether I actually did something wrong or if my clinical judgment is correct. I ended up seeing one client the day I had to put him down because of her comment, but I canceled the rest of my appointments for the day because I couldn’t handle it. I feel like I never got a good answer about how to handle this kind of situation moving forward. How would you guys handle this?

I flew back from Europe to the US today and made myself watch a movie that I have had a hard time making myself watch in the comfort of my home.

It’s profoundly discomfiting. At one point I pulled my pashmina over my head so my seat mates and

any passers by couldn’t see any nudity. But it’s based on a true story. A disturbing story about the advent of our field.

Anyone seen it? Anyone WANT to? This would be a very intense discussion focus I would think.

My husband and I are therapists in community mental health and I'm just looking for services we could join or pay to remove our address and personal info from online. Thank you!

I’m a fairly new therapist, and today for the first time I had put the wrong date in my calendar for a couple, which left them waiting without me in the office.

I called immediately when I became aware, apologized and offered a session the following week(which they accepted) but I just feel sick about the mistake and keep replaying it.

Any perspective from others who have been at this longer than myself? How do you forgive yourself??

Hi guys, I'm a 25 neurodivergent male and a therapist. Last night i made an incredibly stupid mistake. I met a "girl" on a dating app and after a while we started sexting. I sent a video of me.. you can guess the rest.. and after a while "she" came back and said that if i don't pay money she would send the video to my friends and family. I didn't pay (obviously) and i blocked them immediately. It's been over 24 hours and i haven't been contatcted again. Trust me, in this moment i don't need a lecture on how stupid and gullible i was, i'm beating myself up non-stop about it and it is a lesson i've learned the hard way and mistake i will never make again.

This entire episode has massively shaken me up, i'm not eating or sleeping and i'm in a constant state of paranoia over whether they'll search for more info about me/find my number. I've taken all the steps to prevent this but what i'm really embarrassed about is the fact that all of my training has seemingly gone out of the window at the moment, i can't seem to escape this state of panic that i'm in and i'm feeling extremely emotional. The old negative thinking patterns around me ADHD/Autism are creeping back and i feel like i'm sinking right now. I've come so far in my training and built up so much resilience but right now it doesn't seem like 'therapist me' is very present.

Any advice, familiar stories, tips would be massively appreciated.

I responded to someone’s post a few days ago with an answer that I want to make a bit louder because I’ve been thinking about what I said a lot since then…

there’s a trend here to chalk up burnout and/ or needing a lower caseload ‘than normal’ to either trauma, lifestyle imbalance, needing more supervision, or neurodivergence.

what if, instead, we decided that it’s really flipping weird and a-typical to be able to have six or even five 50-minute long trauma or negative affect-focused conversations a day and feel like you are in your ‘zone.’

I’m sorry but I think if I went to a grocery store and selected 20 to 30 random people, maybe one person would say that sounds appealing. More likely, nobody.

The fact that there’s some gold standard for caseload is absolutely ridiculous given how strange this job is. And what it takes to do it. And while I commend and support people trying to find a reason for why it’s too much sometimes, I also want to give folks some grace. And tell them they don’t have to fish for some pathology to explain why they can’t do it all day.

And i say this as a nuerodivergent person.

I’m a student counseling intern at a private practice. I work with young children through older adults. Any recommendations for things I should keep in my office now that I have one? Especially things that are helpful to have on hand for clients and things that will help me get through my day. Or any fun stuff!

I'm curious how others handle this. When a pretty reliable client cancels a session (through an online system, not directly reaching out via phone/email) but chooses not to reschedule, do you reach out to see if they want to reschedule the next week? This is for clients who don't have recurring sessions pre-scheduled. Tbh, my brain usually goes to worst case scenario that I did something to upset them the previous session and they are politely cutting ties with me forever. Afterall, I've left a therapist this way before because I didn't want to tell them directly (I was young and not yet a therapist). I usually give them some space and then in 2-3 wks of not hearing from then I will reach out to see if they want to continue with sessions. This has always resulted in them choosing to continue, but then I get in my head about them just doing so to please me... But I also don't want them to feel like I don't care or forgot about them. I also need to reduce my caseload anyway, so it wouldn't be the worst thing if they didn't return. Ugh, I'm torn...

My supervisor really encourages me to practice self care throughout the week and especially weekends. During the week that is maybe getting my nails done I am self employed and have a lot of freedom. Also means when I’m home I’m home. Also I attend my AA meetings during the week. My husband and I are both in the program. Anyway this past weekend was a blast. My husband is in school to become one of us and he had a lot of work over the weekend. He’s dyslexic so I assist him with reading and typing. He dictates I type. Anyway we completed his work and still managed to go out and have fun. Yesterday we did our favorite spring time activity stocking fish. We live in central Pa and have tons of beautiful nature at our fingertips. When we first moved here we were outside every other day and every weekend. We made a pact this summer we will get back to that. I’m talking like going fishing all day then eating burgers on the back of our pick up. Well we are members of a gun and rod club. Liberal rednecks we call ourselves. We love this time of year. We stock fish with our uncle and we enjoyed!

So I work a contract gig and am on the cusp of getting licensed, and I’m puffing up steam after 40 hr work weeks. I’ve always strived for 40 because that was the standard for full time.

Then I realized something. Without benefits, is the 8 extra hours worth it? Especially when I can manage my expenses. And without a 401k, why am I running myself into the dirt. Especially when I’ve been praying for 32 hour full time gigs when I do look for work.

So considering how burnout is in our field, do any of yall strive for 40+ hours? Would love some perspective

I have been supporting this client for many months, she is only 39 and have had a number of unsuccessful IVF treatments. She has never had a good relationship with her body throughout her life as she used to be a "chubby" kid (her words) and she has always gained weight very easily while she didn't like sports. Now she can't shake off this feeling that her body is constantly letting her down, no matter what she does for it while battling with infertility. Do you have any tips for me to work with her relationship with her body? Anything somatic, etc? I have given a lot of validation, tried cognitive reframing, psychoeducation, etc. but I feel helpless, something she feels too, due to the nature of this complex issue.

This might be a hot take, but I've seen an uptick in tweens, teens, and young adults asking me about an autism diagnosis in session. I don't believe I have the authority or specialization to diagnose autism anyway, so take this with a grain of salt because I'm not super well educated on the topic, but most of them seem more congruent with social anxiety to me. Before anyone comes for me, I have been encouraging them to seek professional diagnosis from someone more specialized/able to diagnose, rather than steering them one way or another. I make sure to keep all of this to myself so it doesn't bleed out to my clients.

Not only have I seen this with clients, but also colleagues and other acquaintances in my life. I'm aware that autism has historically been more underdiagnosed, especially amongst females, and I do embrace the benefits it can bring to those who truly need it. But I wonder if more people are gravitating towards an autism diagnosis to help write off their quirks and/or anxieties and sensitivities that come up in social situations? Or even to write off their overall sensitivity to energies around them, the world, stimulation, etc, that might just indicate that they're sensitive/intuitive rather than autistic? It also makes me wonder if it helps people feel like they can be less accountable for their own growth; for example, instead of learning coping skills for their anxiety and practicing being social, exposing themselves to different situations, etc, they just kind of stay stagnant or stuck with the excuse of "Well I'm autistic" or "It's just my 'tism."

This might be part of my own bias, but I felt like something was wrong with me when I was a teenager. There was a period where eye contact was hard for me and I would turn beat red if anyone looked at me. I felt terribly awkward in social situations which caused me to have hyperhydrosis and sweat a lot. I've always been very sensitive to the world around me and people's emotions, which I now see as a strength rather than a limitation. Maybe if I was younger now, especially with everything that circulates on social media, I would have wanted an autism diagnosis too. But my therapist at the time diagnosed me with social anxiety, which gave me a sense of relief and a direction to move towards in treatment. It felt more able to be resolved, whereas I know autism is a lifelong condition that you can learn how to manage overtime, but ultimately have to live with. Basically, it felt like something I had that can be worked on, rather than all of who I am as a person that I just need to accept. As an adult, who still has social anxiety crop up every once in awhile, I'm thankful I was never diagnosed with autism because I truly don't feel like I have it.

TLDR: Are more people nowadays leaning towards wanting a diagnosis of autism or self diagnosing it as a way to write off being quirky, anxious, and sensitive?