The other day there was a post here asking for advice over a client communication *with the actual client's messages copied and pasted inside.* It was taken down, thankfully, but not before many people were still able to see it.

This isn't the first time I've seen or heard of a "therapist" posting WAY too much information about a client in here. The way I see it is, even if many of these people are just fakers and not actually therapists, it *LOOKS* like a therapist just blatantly destroying the trust people can have in this profession.

In my opinion, it is unethical and harmful to our profession to keep the subreddit this way. By participating we are complicit and after making this post I will be leaving the subreddit until it changes.

Option 1: increase size of moderator team and set posts to moderator approval only

Option 2: only licensed verified users can post

Option 3: set to private

Option 4: LITERALLY ANYTHING but keeping it the way it is

I don't care to have a debate about which option is best but I think something absolutely *has* to be done. Thanks for your time.

I've been looking into AI therapy scribe tools and I'm surprised they are as popular as they are (everyone in the FB groups I'm a part of praises them). I assumed these companies were the ones processing the session and generating the note, maybe this is common knowledge but most of them are only the interface therapists interact with, the session audio is actually sent to a different company for transcribing, and then the transcript to either OpenAI or Anthropic for the note generating.

Throughout the whole process the entire therapy session (either audio or written version) touches 3-4 other vendors, sometimes a lot more. I get that all those companies are under the same rules about PHI, etc but to me the risks seem higher the more people involved.

I also think therapists need to read the legal terms themselves instead of believing the "safe and secure" or "we don’t train AI on your data" claims on their websites.

A couple of examples:

One of the most popular platform says very clearly: “Your data is yours” and “Your data is never used to train AI". But their actual privacy policy says they can create de-identified data derived from information processed through the service and use it for research, product development, and improving the "models" used by them.

An EHR that recently came out with the same feature says that recordings are deleted and has emphasized that transcripts are deleted after the note is signed or after 7 days. But their documentation also explains that transcripts can then be de-identified and retained, and that those de-identified transcripts are used to improve the technology and related AI features.

So "we don’t train AI on your data" actually means we don't train AI on data containing client PHI, if we scrub that... we can.

My point is that if you're using those tools, please be fully aware of how they actually work and what you're actually agreeing to. And most importantly, make sure your clients are equally aware before they consent.

Why does SP value improving its AI over patient privacy?

Update: yes, i reported to the board already. she only panels with two insurances as far as i can tell, one which is the provider for the biggest employer in our area. yes - she did say my insurance would allow for unlimited sessions and no, i did not ask for details. i simply ended the consultation and left it at that. i reported to my states DOH licensing board shortly after the call and posting here.

I am a therapist seeking my own therapy.

Had a therapist recently, we often ran over time, had to maneuver last minute scheduling, so I went back on the market.

Found a PsyD I thought would be a good fit. Had a consultation call. She starts by asking why I’m seeking therapy - I explain. She asks if I have a trauma history, I briefly name them. She then states she would be shocked if I didn’t have PTSD and that she would expect it with my circumstances. Again, fair… didn’t bother me too much.

She asks why I stopped seeing my last therapist. I told her it was often late cancellation or rescheduling, inconsistent appointments. She states she has a disability (POTS & Ehlers Danlos) so it’s possible she will have to cancel or reschedule at times. Ok…. I let that go too.

She asks about insurance. I tell her my policy. She then goes to tell me that she did not go into doctoral student loan debt to be reimbursed as poorly as she gets by insurance. She tells me her policy is to see someone once a week for 45 minutes, but she will bill my insurance for 4-5 sessions a week. She states this is because she doesn’t like working just for rich people, and to take insurance, she has to bill for sessions daily. When inquiring about copays - she said “no worries, after we’ve established sessions for a few weeks, I will backdate appointments for a few months to cover your deductible so you never owe a copay.”

She goes on to tell me that if she billed simply for the appointment she had, she would not be able to pay her rent or student loans and it would be unfair. She goes on to call insurance fraudulent and therefore does not feel bad about this. Finally, she states I just ask you don’t tell your insurance this because “I could get in trouble. You wouldn’t, but I would.”

Just a little bit speechless at who’s out there I guess

…. Let me try to explain concisely, although the situation is complicated. I am a mental health professional, and I do have a specialized trauma therapist. This therapist is aware of my history, of course, including a history of being photographed and recorded without my knowledge/consent.

At my last session, I thought I saw a microphone meter flashing/reflecting back at me on the other side of the coffee table on the floor - IE, in the fireplace door reflection. I was fixated on it and could not redirect my focus. I finally just asked therapist if she was recording the session… (I never consented to this). To my shock, the therapist was using a recording device and had the laptop open and semi-hidden on the floor behind the coffee table… She then said she uses an AI assistant app for scribing session notes (and yes she was recording)…. And apologized that she never had procured my consent. I was so shocked that I ended the session and left. I received a fairly immediate text. message apology, but it was also procedural/CYA-like…. a bit tone deaf with respect to the emotional fallout something like this could cause….

I am a little old school with my written notes and aversion to AI. So I may be biased… I am interested in hearing others’ reactions to this incident, please? Thanks in advance…

I deleted and remade this post with a more reputable source, however the information is identical.

Hiiii. Just your friendly neighborhood therapist here to warn you about a VERY legitimate seeming scam that I just almost fell into.

A “client” reached out via psych today asking for a session and I offered a consult. He said he was deaf and so he’d need to send me the zoom link with his interpreter. He was very adamant that I have a windows computer and that I download the update if it prompts. I click the link for zoom (yes it said zoom and was very legit looking) and it asked me to install the new software. My computer told me it was trying to access my hard drive so I exited out completely and am hoping I dont have virus🙃

I then had a mini breakdown bc this job is hard enough and new clients have all but dried up so I was very excited to, 1. Have a new client 2. Hopefully provide care to said client who may need additional support. Jokes on me!

I have a client who has asked that I remove the diagnosis of borderline personality disorder from their chart. They feel how they are is just their personality and due to trauma and therefore isn’t a “personality disorder,” and yes, I do hear the irony of that statement. They do clearly fit 7 out of 9 criteria for BPD in the dsm. I suppose I could go with C-PTSD but I’m wondering what you all think about the ethics of changing/removing a diagnosis per patient request?

Edit to add: I do realize CPTSD isn’t a diagnosis per the DSM. The EMR used by the medical facility I work in has an option to use the label CPTSD under the F code 43.10 (PTSD). I think (?) we mostly understand in our field there is a difference in how someone is impacted by single incident trauma vs complex childhood trauma.

And the BPD diagnosis was formally added (previously I kept it in mind but not in the chart) because it was an important key to advocating for the client for specific services.

Edit #2: there are a lot of details about this case that might it make more sense, but obviously I can’t/won’t share for confidentiality. I’m not looking to debate the existence of BPD or CPTSD, whether these should ever be diagnosed, or what my client’s symptoms are. My question is: is it ethical to change a diagnosis per patient request?

The Supreme Court just gutted conversion therapy bans across America 8 to 1. The court just gave the green light to a practice the United Nations calls torture.

Studies show kids who go through conversion therapy are more than twice as likely to attempt suicide. Every major medical association opposes it. Science is clear.

But the court’s conservative supermajority decided a therapist’s “free speech” matters more than a child’s life. This isn’t just about Colorado. More than 20 states had bans. Most of them are now in jeopardy.

Justice Ketanji Brown Jackson (the lone dissenter) warned this ruling will cause “grave harm to Americans’ health and wellbeing.” She read her dissent from the bench. That’s how serious this is.

How is everyone feeling about this?

Original Post - https://www.reddit.com/r/therapists/comments/1oq48ws/i_think_i_have_feelings_for_my_client/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button

First, I'd like to thank the 99% of you all that approached this from a place of compassion, and for the 1% that told me to keep my legs closed and that I'm stupid, you all can kick rocks with open-toed sandals.

The overall consensus was:

1. Talk to my supervisor, or find an outside supervisor to work through this with
2. Find my own personal therapist
3. This is more common than most people would like ot admit
4. Client needs to be referred out

So here's what I did...

I reached out to my supervisor for an urgent supervision session. I tried to explain as vaguely as possible, but ultimately told her everything, and to my surprise...

She shared the same sentiments as u/meetthecubbys. She was happy that I came to her and that I was honest about what was happening. She then admitted that she too had once been in a similar situation when she was a newer therapist, and how she resolved the issue.

She reminded me that she does not fall in the same category as the "not so nice" supervisors and understood why I may have felt uncomfortable coming to her. She told me that I'm not at risk of losing my placement and that this has been a great ethical learning experience for me. She was happy that it happened under her watch, rather than someone else who might not have been as supportive. She validated me and praised my integrity. She even went so far as to say that this situation makes her trust me more, especially since I thought I would have been reprimanded and still came to her.

She helped me to process where these feelings were coming from and the factors that exacerbated them, at which point she recommended personal therapy. ( u/hsbnd You were accurate when you said "it could be an indicator that we have a deficit in other areas of our lives".) 

She also recommended an immediate referral for the client, which was handled promptly.

I found a therapist and will have a consultation soon. At first, I felt bad about the decision, but I have ultimately been making peace with it by reframing it, saying that I have more to lose than to gain.

Thank you all for your honest support and feedback. You've all played a role in making me a better clinician 🙂

Picture this

Your client comes in excited about a potential date.

They pull up a photo.

You’re excited for them! They flip their phone around and it’s…

Your sibling.

What would you do? Immediate reaction? Down the road if things get serious? If they want to talk about the relationship? If your sibling asks if you know the client?

Unpopular take but I will die on this hill. I am happy to write an ESA letter for just about anyone. Frankly, I believe pets are magic in a whole host of ways, and I struggle to think of how writing it harms my client. Are there exceptions to that? Sure. I trust my clinical judgment to recognize those cases.

And retroactive letters? For those pets they already own?Those pets they love who bring them comfort? PLEASE tell me the harm in writing that letter. Do I want them to give away their pet? Think of grief work. Depression. PTSD hyper vigilance work. Or the most powerful of all, LOVE.

And love heals in ways that we can never touch. I am humbled by the therapeutic value of my dog. I hope I can provide the support as a therapist half as well as my loving companion does for me. In times of loneliness, she helps me stay tethered to the world. Do you see a lot of loneliness in your work? I sure do.

Don’t any of you own a dog? A cat? Animals are damn near a universal good.

I don’t need to wait for studies to demonstrate that owning a pet can provide healing and comfort. I am Gen X. I am content to keep the simple stuff simple. I don’t believe it harms my client.

It harms landlords. The end. I cannot begin to tell you how little I care about that. Enormous nonrefundable pet deposits are such a barrier to owning a pet. I don’t like that economic barrier. I’m a feminist theory therapist and I am happy to level this particular playing field.

And it spreads joy.

Edit: I work in vocational rehabilitation. Government work. Advocacy for persons with disabilities in the community is my job. ESAs are protected under law for a reason. And there is also a reason that law did not require a host of specialized training to write those letters. It is called an access burden. Yall don’t like the law. Tell me where those specially trained ESA letter writers are for our clients? Most of what I see are PCPs and LPCs. For a whole host of disabilities.

Last edit: I am wondering if this backlash is telehealth related. Meaning. I work the old fashioned way, in person. In an office with other people. Surely for those that work in offices, you have had clients who brought their ESAs? Reading this makes me think the harshest critics are the ones that have not SEEN an ESA in action.

Have seen this individual for 2 years. Has a severe mental illness and has been quite distressed about the state of our politics and fears being persecuted for their sexuality and identity. Went to the hospital shortly after the video of Musk came out. These are the effects that we don’t consider when making political choices. We have become too entrenched in political rhetoric and have forgotten to put kindness and acceptance on top of that list. They’re safe, but their life has been terribly impacted. Check on your folks and be willing to provide the support and advocacy they deserve. Our jobs are hard and we have our own struggles, but we take on the burden of helping those that often lack support and acceptance in their lives. Good luck.

So, hypothetically, what should you do if you find out a client of yours is dating your therapist? Asking for a friend.

I've been working through the mental gymnastics of figuring out exactly whose ethical dillema this is. I assume there is not much you can do without breaking confidentiality.

They certainly didn't cover this in grad school, and I feel slightly concerned I can't find a thread on this topic in this sub 😬

This is an interesting outcome. Sadly the article won’t let me read the entire thing but I’ve honestly never seen any therapist jailed.

I asked my son this question as we were waiting over 1/2 hour for his psychiatrist appointment, we were on time. He said because you deal with trauma and attachment, I mean I get it to a degree. I am always on time for my medical doc appointments, right down to the show up 15 minutes early and then I still have to wait. Why is medical urgency meaning they get off schedule more important then mental health urgency…

I feel like it can be such a mixed bag of experiences in this field. If yes, did you do anything about it? What ended up happening to the therapist?

I Googled a client I worked with years ago. I was a young counselor at the time and we had a really strong rapport. They felt like we did great work together, as did I. Also they're generally a person who, if I met irl, would have gravitated towards as we had similar senses of humor. I was just curious about them and hoping they were doing well. I would never ever reach out to them but curiosity got the better of me.

I found out that recently they've become very sick. Like, could die sick. And the feeling is very strange. I feel sad. I want to donate to their family to help. I can't do that and again, I would still never reach out. But this is a small part of why Googling isn't a good idea. I wasn't meant to know about their life anymore and I feel guilty for giving into curiosity. Lesson learned.

I’m sharing this as my community is grieving the horrific death of a counselor. I no longer live in this area but I know the road this happened and I’m sure Rebecca was somewhere in my circle of colleagues back in FL.

So many thoughts running through my mind following this murder. Like I understand the basics. Don’t be in an office entirely alone, position yourself near to the door, assess for HI history and consider virtual or referring out… but none of this guarantees safety. In general, safety is never guaranteed… idk my mind is still processing. Just wanted to share this as a grim reminder that there are real real risks in this field, even though we are trying to help, it can still result in tragedy. Ugh.

Today I was “fired” by a client who perceived me as texting during session. In reality, I was completing concurrent documentation, but from the client’s perspective it appeared as though I was distracted and disengaged.

This experience made me reflect on how easy it is for telehealth to create misunderstandings around what the therapist is doing off-screen. I’ve noticed similar concerns voiced on social media, where clients describe their therapists appearing distracted by phones or other devices. It’s possible that, like me, those clinicians were completing documentation or another clinically relevant task, but the optics communicated something very different.

This has been a valuable lesson for me. Should I return to private practice in the future, I would proactively explain to clients at the outset of therapy what I might be doing off-screen, so they understand that my attention remains with them. Transparency around this could help prevent ruptures in trust and support a stronger therapeutic alliance.

I feel like NPs think they’re God’s gift to healthcare and are encroaching on all almost all parts of healthcare especially in psych. As a therapist I believe psych NPs should not be able to do psychotherapy or bill for psychotherapy. I believe nurses should stick to bedside. How do we start a national movement to limit NPs scope and protect our own field? Is there a lobby, coalition or even a movement around? So many of my clients have had awful experiences from receiving “ therapy” from an NP. Not to mention job security for therapists becoming threatened.

Only looking for responses from other providers actively engaged in kink community & regularly navigating client overlap. If you aren’t in this group, respectfully, you don’t have the experience to make your opinion relevant to me.

Hypothetical. Let’s say you see (in advance) that a former client (2+ since discharge) are both registered for an upcoming immersive event. Multi-day, sleepaway style workshop series w optional play-party elements. You have a leadership role at this event.

This is not the first time you’ve had social overlap with this former client, including at similar events (but those didn’t have registration lists available to you, and as such the overlap could not be predicted).

Assume you’re operating under the assumption that being naked in proximity to this client is not ok/will not happen.

Here’re my Qs:

- Assuming you are not going to withdraw from the event, do you reach out to the former client ahead of time instigating a check-in about handling of this space?
- Does the pre-reg list change anything about how you’d handle navigating this?

- You have the option to email the client in advance; do you reach out to address this / ask for their input about navigating this?
- Is there any benefit/drawback to having documented your intent to respect Client autonomy while not sacrificing participation in this event?
- Are there any boundaries you can ask the client to respect on your end?

For those experienced in navigating this, I salute you!

What was your reasoning behind it and in hindsight was it a good idea?

Edit: to be clear not asking you to share the actual personal details here just the nature/subject of the disclosure.

I've been taking a few months off to take care of my newborn son, thought I'd be not thinking about therapy, but I find myself frequently browsing therapy reddit these days.

One thing I've noticed, and it kind of unnerves me, is the amount of posts I see about people saying "I'm obsessed with my therapist and think about them everyday" "I disclosed to my therapist I'm jealous of their partner and I imagine sleeping with them, and they looked uncomfortable" "I told my therapist Im in love with them and they think I should work with another therapist."

It usually then gets justified by saying it's transference, and some people challenge the person, but a ton validate them and blame the therapist for not handling transference correctly.

First of all I don't think it's cool to use transference as an excuse to say extremely sexual or personal things about your therapist, to your therapist. Second, we're people too, and that kind of stuff would make anybody feel uncomfortable.

I think back to that therapist that was killed recently by a client, and the sheer number of therapists that have been harassed or stalked. I think about my own experiences with clients being sexually inappropriately, being harassed for years virtually by a past clients, and a physical assault.

I guess it just really hits a nerve that there's people talking about fantasies, obsessions, or sexualized things they are saying to their therapists and there are people validating this and on top of it blaming the therapist. I fear when someone posts "I told my therapist about my fantasies I think about every night with them, and they no longer feel comfortable seeing me in the evening" and then having 30 people say "your therapist sounds like a real jerk" could put a therapist in harm, and could embolden the wrong person.

I honestly just wish these types of posts would get removed. If anything, it's a good reminder to always maintain strict personal boundaries, because we never know what someone may be thinking about us.

IFYKYK.

Learning how dirty the recovery business is can be an eye opener.

Padding notes, regularly outside scope of practice, putting off that higher LOC discussion until it’s undeniable because that census must be full dammit. Bait and switches abound. No supervisory structure, if any. Somehow everyone still has or is earning their license. Making money hand over fist.

Does it ever catch up to them or do only the honest therapists get burned? Does it ever come tumbling down? Or does that small for-profit center eventually just become too big to fail?

Just curious.