If you are a licensed therapist working for a VC company like headway, grow, alma or anything of the sort, you need to leave. Not only are you getting screwed over but you are screwing everyone else over. Private practice can be successful on our own and insurance companies are taking advantage of everyone! The only way that we can combat this is by working together. Everyone needs to stop taking insurance. Everyone needs to stop working for these companies. I know starting a private practice is scary, but it is so possible and it is not hard once it is started. Everyone is going to continue to complain about pay and what mental health services look like in the future until everyone stops people pleasing and sacrificing for the billionaires. Rant over 🙄

Hello all! I’m here to spread OCD awareness. I’m attaching an article and an excerpt below

https://www.centerforanxietydisorders.com/blog/adult-ocd-symptoms/

“Generalized Anxiety, Health Anxiety, and the ‘Just a Worrier’ Label
If a therapist ever told you that you have generalized anxiety disorder (GAD)and left it there, you are far from alone. It is one of the most common swaps clinicians make when OCD is not obvious 8.
The overlap makes sense on the surface. You worry a lot. Your worries feel excessive. You have trouble letting them go. That description fits GAD, and it also fits OCD, which is exactly the problem.
The difference lies in the texture. GAD worry tends to move across real-life concerns like money, family, or work deadlines. OCD worry sticks to a specific fear and demands a specific response. You do not just think about the stove; you go back and check it. Or you picture it, in your mind, until the image feels safe.
Health-focused OCD gets mislabeled as hypochondriasis or health anxiety even more often 8. Take the marketing director who has been told for years she is just a worrier about her health. She is not. She has a compulsion loop around body sensations, and no one has ever asked the follow-up question that would have caught it.”

People will never understand the struggles of being a therapist unless they are one. The job choices are not very good and it has nothing to do with the clients and everything to do with the companies. The low pay, the high case load, some micromanment, hard to get jobs its ridiculous. I still love being a therapist but this year has been tough. Worked for a private practice with a beautiful office all management was virtual. It was good at first but the pay... omg it was one that only pays when the insurance pays. They were so supportive at first with good retention rates. But when going through some unexpected traumas then health issues they didnt care what the reason was then gave fewer and fewer clients until saying they ended my contract. My hemoglobin was dangerously low and had to get a blood transfusion but they did not care or try to understand. Then trying to get a job after this has not been easy i was also at a hospital but it closed down a few months before the private practice ended the contract. Finally got a job then the pay is low. Almost no job job is w2 and if it is the pay anywhere from $40 to about $50 per client. Then it takes forever to start seeing clients because of the insurance panels. You would think in a large city in Texas this wouldn't be the case but it is.

My wife and I saw YCSE last week and while we both loved it (would recommend!) I found myself not loving it as much as her or seemingly most folks given what I've seen from others online in their reaction to the documentary. For the record, I would give it 3 out of 4 stars and think it was a fun/crazy/sad/interesting watch- but I feel there's definitely something I'm missing here!

The reason I'm posting this here is I wonder if part of the reason I don't seem to be as blown away by it as much as others is due to my work as a therapist. Maybe its due to having worked in addiction where I think you kind of develop a nose for bullshit, but I found myself being so unconvinced by her affect, rhetoric, and apparent confusion regarding her conviction and prison sentence.

My wife mentioned she found herself being pulled in by Holmes and was mentally building a case for her during the doc, which was interesting to me because really at no point did I ever have that feeling. I'm curious if that's due to working with people who often are either lying to themselves or others about their actions.

This is in no way meaning to dehumanize Elizabeth Holmes and not appreciate the difficulties and trauma she has endured. I think many things here can be true at the same time!

Curious as to other therapist's experience watching this doc.

Has anyone else received this? I am quite irritated that they’re claiming I cleared their documentation review and still have to provide more. Every note for the next 30 days feels excessive and is definitely moving the needle more regarding leaving Headway (obviously in combination with the updated agreement fiasco).

I’m curious to hear your bold statements that had a purpose/positive impact.

As for me, I had a first session with a new client who 5 minutes in stated “this isn’t going to work, you’re too young for me and I have a lot of life experience” to which I replied “can you imagine if I had to be all the things my clients are in order to be helpful?”… they were bought in after that and scheduled recurring appointments.

Let's say the individual client is fairly new (less than 4 sessions) so you're still building rapport. They came to therapy to navigate the relational challenges they are experiencing (partner has complaints about them). When they start to describe the relationship history you hear stuff that sounds to you like love bombing, hoovering, cycles of idealization and devaluation, cheating, and emotional abuse -DARVO, double standards, lying/gaslighting, efforts to isolate client from friends.

Client doesn't use any clinical language like I have to describe these things nor have they ever said they think the partner could be abusive. Client overall seems like they are trying to present all the information in a balanced way and not trying to make the partner look like the bad guy.

Typically I think I would tread lightly and not be super direct about it at first since I don't have the rapport quite yet. I would probably focus on their own experience and what is healthy relationship dynamics and let them draw their own conclusions about the treatment they are receiving.

However there's another part of me that feels pulled to be more direct and to do that "faster" than I usually would. If it looks like a duck and sounds like a duck, why can't we just say hey I might be wrong but it seems like it could be a duck? I am also aware that my own bias or personal experience could be clouding my clinical judgement. It took me a really long time to name what I was experiencing as emotional abuse in my own relationship but once I finally did, that clarity in naming it was really important and helpful as far as me establishing boundaries etc.

Thank you for any feedback & 2 cents!

I’ve been in practice for a couple of years and have been working a caseload of around 20 clients consistently - I’m certainly just a baby in this field and have been experimenting with lots of different modalities while trying to discover my clinical voice. I’ve always been told that the relationship is the most important thing and have worked hard to build good therapeutic alliances with my clients - I have a high retention rate, lots of positive transference and I genuinely feel we’re doing good work together, however, recently out of the blue, I have this unsettling feeling of wanting to push all my clients away - I have a strong counter transference about not wanting them to rely on me and I’ve recently gone into this problem solving/solutions oriented approach that seems to be a way of creating distance. I’m usually more relational/psychodynamically informed but lately I just don’t have the energy or desire to monitor my clients defenses, explore attachment wounds, hold space for processing and lend my nervous system to them. I feel like a mama bird desperate to push the babies out of the nest…I know this shift is a response to my counter transference but I’m wondering if it’s also a sign about what direction I should go in as a shrink…

I’m not the type of shrink to endlessly validate my clients while watching them repeatedly hit their head against a wall - I’m going to call out their defenses (gently of course) and help them see the parts of their pain and suffering they must take responsibility for if they want to heal…I don’t wish to stay in a stagnant dynamic where clients are regressed for years just for the pay check (too many shrinks are guilty of this).

I used to feel like I had an idea of what therapy was but I’m realizing I actually have no idea what it is, which im sure is playing into my counter transference…

My question is how to deal with this??

Anyone relate or have a name for this phenomenon?Burnout? Growing pains? Existential crisis?

Just curious.

Other than you truly don't want to, of course. I'm speaking more to the people that would like to open a practice.

(I fully understand not everyone wants to and in no way am I suggesting that everybody should)

It seems like many of us received the 2 week notice from Lyra today - where we are required to begin billing / documenting within their new EHR platform to work with their clients.

I feel strongly that this is an overreach on Lyra's part and would like to work collectively to respond via the appropriate channels with a unified 'no.' We don't need to immediately terminate, but I do think a large group of providers reflecting the same message on or around the same day would give us a greater chance of creating an alternative work flow where Engage use is not mandatory.

I did want to get collective feedback about what concerns they have. I would like this to focus primarily on where this requirement might violate 1099 contracts. So far, I have identified:

1. I am an independent contractor and my contract explicitly agrees that Lyra cannot control the means or method by which I perform under this contract. (this is also an IRS definition, so they must comply with this) ETA: this is not as clear cut as I thought before my OG post!
2. Mandating that I switch to Engage for record-keeping / billing impedes my control over HIPAA-compliant business operations, for which I hold 'exclusive liabiltiy' in the contract.

I am happy to hear others concerns to incorporate into a letter template!

Even if you don't have additional concerns, please comment / upvote if you are in support of a mass reply, so that others can more easily find this discussion. Thank you!

I'm in my last year of a mental health counseling program and doing my internship at a private practice. It was my first choice, and I'm thrilled to be there; however, those of us who were placed at private practices are really struggling to get clients. Our faculty and site supervisors say this has never happened before.

My classmates who are at CMH sites and campus counseling centers are already maxed out on clients and expecting to end the semester with well over the required number of hours, while we're in danger of having to do an extra semester at a different site just to graduate (which I truly cannot afford to do; I'm already drowning financially just trying to afford gas and tolls to get to my current site). We're all offering pay-what-you-can sessions and seeing some clients at no cost, so it's not about money, and we can see telehealth clients anywhere in the state.

Is this a nationwide trend in the US? We're really trying to figure out what's going on, and everybody's panicking.

I work in a setup where I mostly see young people (late teens to young adults), the population which is not known to be very inflexible to change (at least theoretically). The organisation pays me so the service is free for these people.

One thing I have noticed in some of them (that doesn't happen in older clients or clients that pay you) is that these people are so resistant to change.

Firstly, they think that therapy is a quick-fix-miracle-drug. That they could come to me and tell me about things and I will fix it all.

Secondly, the concept of insight is lost on them. Whenever they learn about a pattern that we discover or bring to awareness in a session, their response is mostly, oh we kinda already knew that.

Thirdly, they rarely implement anything you suggest. Worksheets, regulation techniques, or just any suggestion of trying out a new thing or a different way or a lifestyle change is mostly seen as "what's that gonna achieve" response.

It has gotten to a point where I had to spell it out to some of them that you have to be an active participant in this process. Low mood needs to be brought up, emotions need to be regulated, relationships are something you need to work on. It all requires work and sometimes action needs to come before motivation. But it gets so frustrating at times because I feel like I'm putting more work than they are and I know it may lead to burnout.

Have any of you encountered it? How do you deal with it and what do you think is the reason? Keeping in mind that I come from a part of the world where the concept of therapy is quite different.

LCSW in NY here looking for just a few more clients. Licensed in NY, CT, VT, teletherapy only. Have tried ones that aren't paying well unless you hook yourself solid (Better Help for example). I just need 4-5 that can pay at Headway rates more or less. I do my own billing right now and take Medicare. Ideas?

I am a couples therapist and looking to compile resources for clients to help reduce shame around sex. A plus if it is geared towards the 50yrs old and up crowd! Thanks in advance!

We need to keep the momentum going because we need Headway to stay in their place vs the exhausting cycle of outrage and acquiescence to the growing influence of venture capital on independent mental healthcare.

So no, we cannot afford to let this conversation die simply because Headway’s CEO apologized, paused the rollout of its proposed agreement, and suggested that clinicians had reasonably interpreted its provisions in ways the company never intended.

Holy gaslighting!

Then the CEO also disclosed that his wife had suffered a miscarriage that week and attributed his lack of oversight to that personal tragedy.

While his family’s loss deserves compassion, a tragedy occurring that week does not explain how an extensive legal agreement was drafted, reviewed, approved, and distributed in the first place.

And quite frankly has no place in this discussion.

Because as therapists, we should recognize the uncomfortable dynamic created when a deeply personal disclosure enters a conversation about institutional accountability.

Yes we can walk away but not before we cut them down to size by exposing their deplorable tactics.

We can extend empathy without allowing it to replace accountability.

So let’s be clear nothing has been resolved.

The October 19 coverage in Behavioral Health Business was a start.

But the story is much bigger than one contract or a $9.99 fee.

Here are the issues I believe deserve serious investigative attention:

1. Independent practices being squeezed out. VC-backed platforms dominating paid search placements and competing with individual clinicians for Google visibility, Psychology Today traffic, and prospective clients.

How many small practices have lost revenue or closed as a result?

1. The erosion of independent contractor status. Clinicians classified as 1099 contractors while facing increasingly restrictive documentation, administrative, and operational requirements.

At what point does this degree of control warrant worker-classification scrutiny?

1. Patients and clinicians paying for platform mistakes.

Incorrect patient charges, billing errors, delayed reimbursements, denied claims, and financial consequences that fall on clinicians and patients rather than the companies responsible.

This practice allows Headway to actually get more money for those sessions than insurance would pay them. Multiple that across 80k clinicians and we can see why they won’t stop this practice when it’s their error.

1. Contractual overreach. Headway attempting to secure sweeping rights to clinicians’ names, images, voices, and professional content, including rights that could survive termination.

2. Financial liability being transferred onto clinicians. Insurance audits, extrapolated clawbacks, indemnification provisions, and potentially devastating repayment exposure while ever so quietly dismantling clawback protections.

3. Loss of control over our own practices and patient relationships. Restrictive contractual provisions, barriers to changing platforms, patient portability concerns, and potential disruptions to continuity of care.

4. The consolidation of power over mental healthcare. Venture-backed intermediaries gaining increasing influence over patient discovery, credentialing, billing, reimbursement, and access to insurance networks.

5. The takeover of clinician search visibility and professional identities.

Independent clinicians are increasingly competing with heavily funded platforms across Google, Psychology Today, Zocdoc, and other search results for the very patients we are trying to reach. We’re being pushed toward dependence on companies that have the resources to outspend and outrank us.

These companies recruited us with promises of independence, better reimbursement, administrative freedom, and the ability to build sustainable practices.

Now we’re being asked to accept increasingly restrictive terms as the cost of accessing the very infrastructure we’ve become dependent upon making it a slow bait and switch.

At what point does a company that was supposed to support independent practice begin controlling it?

Headway did not pause its proposed agreement until WE pushed back.

We organized. We contacted leadership. We demanded answers. And the CEO acknowledged our concerns and reversed course.

Collective advocacy works.

But an apology is not contractual protection.

A paused rollout is not a permanent victory.

And a revised agreement is not necessarily better simply because it’s less objectionable than the one it replaces.

Because that may have been the plan all along.

Here’s my ask:

If you have contacts in national media, investigative journalism, healthcare law, professional associations, or legislative offices, please share them.

If you’ve experienced financial losses, billing failures, restrictive contracts, declining referrals, or threats to your practice’s independence, document your experience.

Contracts. Emails. Screenshots. Payment records. Financial impact.

We need evidence that journalists, regulators, and legislators can investigate.

Please protect patient confidentiality, and feel free to add other industry concerns in the comments.

I’m not interested in destroying companies.

I’m interested in ensuring that companies like Headway stay in their lane.

Because without us there is no them.

We can’t allow them to become so powerful that independent clinicians can no longer operate without them.

And if we don’t organize to change that system, we’ll spend the rest of our careers adapting to whatever terms it imposes on us.

As a BIPOC therapist living in a predominantly white area and is trying to connect with BIPOC clients, you have no idea how good it feels when a new client says with relief, “I’ve been searching for you.”

I am so freaking grateful that telehealth has allowed me to connect with clients near and far across my state who make this career feel so rewarding. My mission as a therapist has always been to be a source of healing and liberation for my fellow BIPOC community.

That being said, I’m SO tired of the telehealth slander. The access it provides is incredible, especially for marginalized folks who don’t have access to the resources or therapists that meet their individual needs. Telehealth isn’t perfect but not everyone has the privilege of finding a therapist who understands their lived experiences in their own backyard.

Hi everyone, just wanted to come here to rant & see if anyone has some words of encouragement or shared experience. I am about to graduate from my MHC program this December and have been at my internship site since my first day of practicum. During my interview a year ago, my supervisor told me she typically hires her interns, and while I understand that was not a promise, I truly dedicated so much of my time, personal money, and energy to not only my clients, but my internship site as well.

With just 2 months shy of graduating from my program, I’ve learned that I may not be getting a job offer from my site. My supervisor said she has no room to take on new clinicians despite her about to hire 2 new interns. Now I understand what this might really be about. Her interns work for free while she would have to pay me and the other intern in my cohort who has also been with here for months. From a business standpoint, I get how its cheaper to hire interns, but from a supervisor standpoint, I think her lack of loyalty is truly degrading. I have never gotten bad feedback from my supervisor, she has praised me for my punctuality and my commitment to coming in office despite me living an hour away, I have driven to different cities with no financial reimbursement to pitch the practice to prospective clients.

I understand that as an intern, many of these tasks were required of me to acquire the hours needed to graduate, which is fine. What bothers me of course is the feeling of rejection, but also that if this is truly a financial concern on my supervisor’s end of not being able to afford me as a clinician, then she has known for some time that she was not going to hire me. Now I feel stressed to apply for LP positions with the rest of the Fall 2026 graduates in an already competitive field. Also, important to keep in mind, she has not even directly told me herself, but I heard it from the other intern at my site who was also not offered a job because they met for supervision when I was not in office.

Hello all!

I’m noticing something about my therapy style sometimes, and want to check it as opposed to making an assumption.

I suppose I am what you would call an HSP with SPS, according to Elaine Aron, which is part of why I became a therapist in the first place. That said, I also am emotionally quite sensitive. It’s an aspect about myself that I truly cherish and it has wonderful results a great deal of the time. However, there are occasions in session where we will be discussing heavy trauma around needs for the self (I am a mostly trauma focused clinician, or at least, it seems that is what finds its way to me) and I notice a significant emotional response from myself.

It is never overwhelming, never dysregulated, and there are times clients do not notice that I have shed a quick tear or needed to dab my nose. Sometimes I will call attention to it, in the sense that I will check in with my clients to see what they are feeling around the experience and the responses so far have been overwhelmingly positive. I model that my emotions belong to me and the session is their session, meaning I will always be regulated and holding space within it, however I am also very human and feel moved by their experiences.

That said, I don’t want this to be a stumbling block one day, for any client who may feel uncomfortable. It hasn’t happened yet, but I want to make sure I’m putting in the work to keep the environment the absolute safest for any and all. Does anyone have any suggestions for internal grounding that might help with managing those moments?

This December, I'll graduate and begin the process of registering as an AMFT. I'll be continuing at my middle school practicum site 2 days/week until May, but I would like to start looking for what's next, especially if I can have a bit of overlap in the spring.

I'm interested in learning more about perinatal mental healthcare. Would it be off-putting to reach out to clinicians within this niche in my community to offer to buy them a cup of coffee to learn more (likely after the holidays)? I don't expect anything from these meetings directly, but would like to dip my toe into the real world of the field and glean enough information over the next few months to point myself in the right direction.

In addition, if you know of any resources (of any kind) that would be helpful for learning more about how to position myself and my resume in the application and interview process, I would be very grateful!

Hi everyone! I’m preparing for my private practice and was wondering what your experience has been with client demand during November and December.

Do you typically see an increase in new client inquiries during the holiday season, or does it tend to be a slower period because of travel, family commitments, and the holidays?

I’m trying to plan ahead and get a realistic sense of what to expect, especially as someone starting out in private practice.

I’d love to hear about your experiences. Does the trend differ between November and December, or does it vary quite a bit from year to year?

Thanks in advance!

Edit: Thank you all who are sharing their experiences. I'm also trying to figure out when it would be wise to take some time off and vacations. Again thanks for your perspectives.

Hi! I am a relatively new, pre-licensed counselor and I have been looking for a place for support from fellow mental health professionals. I heard about the discord server, but am unable to find an unexpired link. Would someone be able to provide that? Thank you, folks!

My late cancellation and no-show were $75 for 48hours. It used to be $50 for 24 hours notice.

I’m reassessing the fee. Even wondering if I will have a late cancel fee at all, or move it back to $50. And do $100 for no show.

What about you what has worked? (Including those who don’t charge, and are in private practice!) have you reassessed along the way?

I feel like I just keep on making mistakes as an intern. Marked a case as low risk when it should’ve been medium and it will now affect the client. Feel like shit, I don’t deserve to be at the site, all the negative thoughts. I’m wondering if anyone else has had experiences like this. How do you go about it? I know I need to be mature and grow but it’s eating me alive