So, I've been reflecting on some of the therapist discourse on this here bird app and have some things I want to say about how this problem is systemic. (I know, shocking!)

Anyway, have a thread: 1/17

A common criticism of therapists here has been some take on "sometimes therapy cannot be contained to a 50-minute session." While therapists often offer longer sessions, the issue seems to be that clients feel upset/hurt when they are "cut off" due to being out o time. 2/17

I understand this - I have had both sessions with my therapist that either ran over or had to be stopped without a great resolution point. It doesn't feel good for either client or therapist and certainly isn't ideal in any way. 3/17

The problem, of course, is that if we extend one client's session, we're taking time from another and that adds up over the course of the day. The only way to truly avoid this is to allow long gaps between appointment times to allow more flexibility to extend sessions 4/17

Sounds great right? Schedule 50 minute sessions but have 30-60 minutes in between to allow time for a few minutes of extension/wrap up, or if it's not needed, time to work on documentation, run to the bathroom, have a snack, etc. 5/17

Except that time is money and that leaves hours of wasted time during the day. Agencies don't like that because it's not "billable" time and because it limits the number of clients therapists can see. 6/17

Agencies would either have to hire more therapists to see the same number of clients (because caseloads would drop due to having more open time in the schedule) or take fewer clients, run a waitlist, etc. 7/ 17

I can tell you right now, that's not likely to happen because we live in a capitalist society. Even if it did happen, agencies would likely lower pay which would discourage therapists from working there. 8/17

So the other option is to go see a clinician in private practice - they have more control over their schedules, etc. This is one of the reasons I was drawn to private practice - I can pick the times that are good for me, not the agency. 9/ 17

But it's the same problem. If I wanted to run a private practice that made enough money for me to live on I wouldn't be able to do that with that sort of schedule on insurance payments due to the low rate of reimbursements. 10/17

In general, insurance rates are way lower than the market rate. And most contracts stipulate that you cannot disclose the rate to others (I'll do a thread on this BS another day) 11/17

This means that I either have to set a private pay fee that will allow me to make enough money to live without taking on more clients or charge for "90 min sessions." That restricts access to people who really need quality therapy but can't afford that private pay rate. 12/ 17

And then they will have to seek care with an insurance provider or through an agency/non-profit which is when we're back where we came from.

It's a shitty loop where therapists can't really win. We're seen as greedy if we have small caseloads and charge for it. 13/17

But we're seen as negligent/problematic/inaccessible if we accept less pay and have to pack caseloads in order to live at a low rate of pay.

How can we win? Either we are valued or you can give us grace when we're up against the wall. 14/17

There are too few of us, too many people in need, and too many limitations and issues in the in-betweens. Therapists are leaving the profession because of this and even then are being shamed for being negligent! 15/17

If therapists can't make enough money to live on, we can't justify the cost or student loan debt and so fewer will enter the profession.

We're on the same side! We're fighting each other instead of the system that created the issue. 16/17

The in-fighting has to stop. We have to come together to challenge the real obstacle.

And in the meantime, let's try to be kind to each other, okay? 17/17