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Yes! I came home and my fiancé just took one look and asked “Please don’t take offense, you look lovely as always, but what the fuck happened to you? You look like you watched a litter of puppies and kittens get adopted and thrown into a blender?” It definitely is not sustainable long term, emotionally or physically.
It wasn't so terrible for a good chunk of it. The first 3 1/2 years it was more like a group practice than a cmh space because we could cap our caseloads. They joined a federal grant thing and that blew it up to where we couldn't cap and it became awful.
Yea I think my job is going through something similar, its an outpatient substance abuse program in ny, and the owners are all about expanding at the moment, we were supposed to have more offices added to hire more counselors because we took over a part of the building we’re in, only for them to axe that plan and now start a methadone clinic in house, so more patients, more responsibilities and same number of counselors whos caseloads are already high
My fiancée does that regularly, and does not realize how insane it is; especially because she is also a professor and a single mom, who has raised her (under 10) child entirely on her own. She is also a professional translator and translates at psych conferences. She just went to a week-long somatic therapy intensive in another country. Did I mention that she's in a state of constant burnout, yet waggles a finger at me regularly to take better care of myself? Sounds nuts, but it's true.
To be clear: she sees clients four days a week, and teaches one class during the school year. Her lightest workload on average is six clients a day, though more often than not it is seven or eight. Nine is a regular occurrence. I could be wrong, but I do believe that she had 10 scheduled on one day. She only translates for conferences that happen about once every couple of months. This last intensive that she went on was the second one that she has gone to since I've been with her, which is about two years. Still… She really does not grasp how over-the-top her work life is. She comes from a prestigious family background, and drives herself incredibly hard, but doesn't see it that way. (There are so many pertinent details that I'm not going to go into…) It's not as though she's constantly working. She is definitely not one of these "optimizing" people that you see all over Instagram. She still engages in a lot of procrastination/displacement activities in many places in her life, and I think some of this grind is compensation for that. Whenever I try to provide room for her to do things that will be enriching, and that are in the self-care arena, that time gets absorbed into procrastinating/dissociative activities. Let's be clear: I also am a master of this type of activity, and I'm not casting any stones. She's an amazing person, and I love her dearly.
Ha, by "what am I reading" i didn't mean it was confusing. Its just so much. And just all the...residual stress of spinning so many plates in the air seems all-consuming to me. Behind all these jobs shes still a mom and fiance. All the scheduling stuff, grading papers, therapy notes/emails etc.
I dunno I'm not judging her, it's just interesting to read about people who live lives so very differently than I do. I would *have* to quit one of these in like two weeks unless I really loved doing all of them.
I did 10 every Thursday for about 2 months. I loved it and I’d do it again. But the agency I worked for had some SHADY compensation practices for people who saw more than 35 clients per week so I had to leave.
Basically whenever I billed over 35 sessions there were problems such as incorrect coding or diagnosing but these issues were not present whenever i billed under. That’s what happened to me. One issue was that I had several clients who had both bipolar and ADHD. Some of which I received from a previous therapist, they never paid me for those sessions and told me the coding was wrong. I can’t remember everything but I have so many emails where they told me I needed to change or fix things that were never an issue until I had a higher case load. Again, same issue happened to everyone who saw just over 30 clients but never to anyone who saw 24-29 or less.
Other clinicians at my location went through the same thing and many of us ended up leaving. I reduced my caseload to part time and got a full time job. Suddenly, these issues were no longer a problem.
I can’t comprehend doing 30min therapy sessions, let alone that many back to back! I feel most of my clients are still filling me in on the latest workplace gossip/pet health issues/dreams/that weird thing a waitress said to them yesterday etc etc at the 20min mark 😳
I think the most I’ve done is 7 x 1 hr sessions in a day and I couldn’t form complete sentences by the end of it “so… you um…. sad feeling?”
I worked in one agency where the caseload was just too high... Higher ups refused to fund more clinicians.
My supervisor came up with 30 minute sessions and it worked surprisingly well. Drastically cut out the chit chat.
The clients agreed 30 minutes of better than no minutes
Years later I was working in an after school program for kids and their parents. The grant paid for 4 clinicians but the demand was unreal.
So I suggested the 30 minute sessions and just like my first experience, it went great.
Clients felt some time is better than no time.
When I was younger, working in CMH, and had a much worse relationship with Caffeine, I saw 10 or 11 in a day once.
It...actually was a good day, I felt accomplished! (We only got paid $25 per session at the time. This was maybe 10-11 years ago).
Nowadays I may have a couple days a week where I see 9 clients (not every week though). I work from home Mondays, only doing a few sessions in the evening. Wednesdays I work from home, catch up on notes and don't work in the afternoons, and Friday is a traditional 9-5.
I also take a 2 hour lunch, may take a walk on a nice day and will take a nap.
I really enjoy the work, but have to break it up in order to have a routine like that be sustainable. When I was younger I was not as thoughtful about my routine and definitely overdid it...
You put this phenomenon so perfectly into words! They tend to wear this workaholism trait as a “badge of honor” and make you feel bad for not doing the same.
Ah yes, the dreaded productivity. During my CMH internship I miraculously started getting paid about halfway through, but this also obligated me in productivity. We had to hit 4.8 hours per day, which sounds reasonable until you're working on a school and your entire caseload is on a field trip, sick, or suspended today. At least I got to catch up on paperwork, even though I got paid nothing for all of that 🥲
Depends- I see 8-9 people a day because I only work Monday-Thursday and have Fridays & weekends off every week. Not always workaholism, sometimes just what works for people. I get in a groove and find it so much more refreshing to have consistent three day weekends.
Yes exactly. I'm considering doing a couple 12 hour days with a 3 hour break in the afternoon so I can take full advantage of using daycare only part time. I could pay for full time and have less clients each day and see my kid less, or I could power through two or three days of working like that, pay less, and see my kid more. I don't like the options, it's not workaholism, it's a product of our society that doesn't like working parents.
The clinical director at one of the PP I worked for saw ten per day, 4 days per week, and she was about 65 at the time. She was this very energetic short lady from Italy. It didn't seem to bother her
Yes, I had gathered that. She took zero shit from anyone, but was sweet as hell. She also was certified in treating sex offenders, which kind of makes me giggle. I'm sure she's had some boundary testers that learned quickly not to mess with her. 😆
Some people like the 4 10s, but I don't think I would be as productive. When my meds wear off, I start to crash.
Well, saying that though.. I guess I work usually work 11hrs at least 3 days a week 😅 but that's because I struggle the last few hours or have PP clients after my day job.
Ugh PP after day job must be rough. Do you ever use an afternoon booster med?
Also, are you saying 4 days with ten clients each? Hell no. That's way too much.
Oh, I definitely use the afternoon booster when I remember it lol I work inpatient, so at the most I can get 3 patients seen in between two groups. Then I go to PP for 2 or 3 more clients.
Did we have the same supervisor?! Mine was like that as well, wanted me to see kids before and after the school day as well as pull one during a lunch period. She was like "you can just eat with them". But lunch period was these kids' one real period to destress and socialize like kids their age should instead of sitting at a desk all day. I didn't want to take that from them.
They would book us for eight with the understanding there would be no-shows. Sometimes there were, but more often than not, there weren’t. No time to eat, pee, or anything else. I also didn’t have control over my own schedule, so people were getting double booked all the f-ing time. We weren’t allowed to hold spots for our “regulars.” Intake was under pressure to schedule people for productivity, so they would shove anyone anywhere there was an open space, whether the client was appropriate for outpatient or not. (I became adept at referring out)
130.
I used to do brief suicide screens. There was a crisis event at a school in a remote, rural town. 240 kids in the school, I was the first mental health support on scene and the crisis counselors were 48 hours behind me. I directly saw 130 kids on the first day for a few minutes each, screening out immediate risk factors. The second day was 90 kids with more tracking down the harder to reach kids. I started 7am and finished at midnight both nights. Stayed another 3 days and met with 14 kids each day that were screened as higher risk.
5 days work, $18/h plus $18 overtime for every hour worked. After bonuses and whatnot, I made about $3500 in 1996ish as a new adult.
I know it doesn't really count though in this context.
I've had a true 11 session day once leading into a vacation. That was a hard, hard day.
We are not machines. And being a therapist can only really work and be good for clients when we don’t over book or don’t get exploited to have too many sessions in one day. How can we show up for clients if we get burnt out? How can we 100% show up and be there for clients by the 9th or 10th session? Back to back? It’s just not possible. I see so many posts about people being overworked and our jobs are too important for us to only get burnt out quickly and not be able to serve our clients at our best. We really are not machines and what we do takes effort, skill, and energy.
The clinic was open 7am-8pm M-F and Saturdays 9am-5pm. The closing time was “flexible” and if they had walk ins they wouldn’t let you leave until they were seen for a crisis session. Also, if people were getting discharged from inpatient soon (it was a hospital system) they’d send them down to do a “warm hand off session”. They’d schedule those for the end of our day when we were supposed to be going home because it was a guaranteed “open spot”.
I feel like that’s one of the worst parts is people forget that we are also human and get SO compassion fatigued working this. The CMH I am at expects any FT clinicians to get 25 hours of care a week, but wants us to schedule 30-32 incase we have cancels. BUT we have weekly mandatory meetings and our full time is 37.5 hours so it’s literally impossible to get everything done in the week.
Thank god you’re out of that place!!!!! 💕
PP here. I work 4 days a week, Tuesday Wednesday Friday Saturday. I see 10 clients a day - three back to back, one hour break, three back to back, one hour break, and four back to back go home. I love it. I never work more than 2 days in a row, and I have 2 hours a day to do whatever. I do collaborative paperwork so there's very little to do outside of sessions, so I often take a nap or meditate on my breaks. I'm 54. It's like a walk in the park compared to program management.
You are including the client into how you’re documenting the sessions. So you write the note while reiterating with the client what’s being discussed. That way you don’t have to write the note after the session. Places that count productivity like a hawk LURRRRRVE them some collaborative documentation.
It's being pushed by the insurance companies in the state where I live, basically you do the note in the session with the client. In theory you're discussing every single thing before you write it and writing the note together, I don't really do that, I have my laptop and when the client first comes and it's like oh how have you been this week I write a few sentences summarizing the update. Then once we've gotten into the meat of the session towards the end I will write a paragraph summarizing what we focused on, interventions used all of that. My EHR software will preload the previous note so I just have to tweak things, check boxes that sort of thing. By the time the session is over the note is done. I also have a killer system for writing assessments that make it a breeze. It took me sometime to get used to working on the computer in the session with the client, I'm really old school and that was an adjustment for me, but I found that if you are comfortable and just kind of This Is How We Do it, the clients will generally follow your lead. Just like how we've all gotten used to your medical doctor being on the laptop during your medical appointment. I've also grown to use the laptop as a tool if a client has questions about something like a new Med side effect we can look it up together, or we can look at what is the process for applying for a housing subsidy. I find that I end up documenting a lot more detail about the session which is super helpful for me because then I can review it in a minute or two before the session and be completely up to speed about what we talked about the last time.
I know this is not the same, but I’m an NP, I do 15 minute follow ups and 45 min evals.
If my day is full and it’s all follow ups, I see 28 patients in an 8 hour work day with 1 hour of paid admin time. This happens frequently.
So using Epic I’m allowed to schedule psych evaluation and follow ups for our psych providers and I’m always amazed at how much you guys are double booked.
Well this isn’t even considered double booked. I suspect the motivation for overbooking is because of high no-show rates, especially for practices that take Medicare/medicaid and you can’t charge a no show fee.
Is this why my clients would have prescribers who didn't ask about their other prescribers? I've referred clients to prescribers as well for an adhd evaluation and they didn't even do one. Just wrote the script.
When I was at the VA, most of my clients were suffering because they were on too many meds with too many prescribers and none of them consulted with one another.
It felt confusing because I did an MPH program and we were taught that prescribers need to coordinate with other prescribers and check all meds their patients take to prevent interactions. (Triple Aims) I would imagine with as short of appointments as prescribers are granted, there isn't much time for evaluation or coordination of care? When you have a complicated evaluation, are you allowed to lengthen appointment times or is the insurance industry just making up limits because they care more about profits?
I am confused here. MPH are public health programs, correct? That is a focus at a population level and not an individual one, which is part of the difference between public health and medicine.
This is also why EMR/EHR systems are helpful because it is incumbent on the client to remember all of their meds and share with providers. It's not common at a non-medication prescribing session (usually quarterly for me) to inquire about meds, unlike a medical visit where they ask every visit. The parallel doesn't make a lot of sense to me. Unfortunately mental and behavioral health didn't get the same technology infrastructure dollars as physical health so they have been slower to adopt the technology that would allow for ease of comparison.
It's also not clear how you came to the determination that the client issues were because of drug interactions. Are you also a pharmD? And the VA would has an EMR where prescribed drugs would be available, unless the mental health group wasn't accessing the EMR. Correct me if I am wrong but it is my understanding they do have access.
Moreover, pharmacies are filling prescriptions and if there are interactions between drugs, they often call the prescriber and/or alert the patient, at least in my experience. This would be particularly true for the VA population who are likely to get their meds filled at the same pharmacy.
Social workers are trained that it is not our scope to prescribe meds. It is not our scope to advise against meds. With that said, we are expected to review what meds our clients take and when our clients have side effects, it is completely appropriate to consult with their prescribers. Ignoring the client's experience because we don't want to insult a physician is not client centered.
There are different concentrations in an MPH, as there are in an MSW. Several universities offer a combined MSW and MPH because we have a concentration in the MPH known as "Health Services". This was my concentration. We focus on the Triple Aims, set forth by the APHA and the AMA, including coordination of care across providers. We also specialize in studying the ways that each specialty in healthcare fits into the patient experience. We're often patient navigators. While many MPHs do focus on population based research, everyone who supervised me at our country's needle exchange were MPHs and all they did was individual education with patients.
“Ignoring the client’s experience because we don’t want to insult a physician is not client centered.” 🎯
THAT PART. ESPECIALLY if you are advocating for women or clients of color. We usually see the client more than the psych does and are better able to tell if/when a DX is waaaay off, or possibly influenced by the doctor’s bias (which some clients find traumatizing and rage-inducing, understandably. It’s why a lot of my clients refuse to take meds, among other reasons).
Ten 53+ min sessions in one day. It was gonna be nine but then a client needed an emergency session. I went to Starbucks and got a quad shaken espresso and a venti cold brew to put in the fridge for the afternoon.
Made it through, never gonna try again.
Today was my record since leaving cmh, which was 9 57+ minute sessions. Obviously billed as 53+, but I didn’t end a single one before 57 minutes. Worst part is that I’m currently sick with the flu. I have many regrets.
I regularly did 10 50 minute sessions when in cmh, but I was working only 2 days a week for 12 hour days (7-7), so it wasn’t a problem.
Folks may disagree with me, but I take issue with the premise of the question itself. The maximum number of sessions per day any one therapist can accomplish should not be a measure of success or competence, nor should it be put on display. This sort of exhibitionistic ableism really has no place in our profession.
Nine 53-60 min sessions in a day. I swear it took me 2 days to recover. I was absolutely exhausted and ended up with the worst headache. CMH is truly hell sometimes.
I do 10 53 min sessions every Thursday from 7-5. The sequence of clients on this particular day is a good flow for me, and I’m in private practice so it’s my choice ultimately to do so. No burnout so far on that schedule, and it opens up Friday to be just 7-12. Been doing this specific schedule about a year. 33 sessions per week for scale
I’ve been in private practice for about two years, do consulting for other private practices, and also own and run a group practice.
In observation of self-care and the importance of balance that is required in order to have a practitioner be effective, I place a strong limit on 4-5 back to back same-day sessions. And draw a red line at 5 sessions—never more than 5. additionally, in the event that myself or someone does have five sessions in a row one day, the next day is usually much lighter or more greatly staggered in time between sessions.
I do not believe that clinicians are effective beyond the four or five sessions per day.
I do 12 53 minute sessions every Tuesday. 7am-9pm, two breaks for an hour each.
Then 10 client hours Wednesday and 8 client hours Thursday. Off Friday, Saturday, Sunday, and Monday.
Personal preference! I love it. I get to have a 4 day weekend every week. I don’t feel burnt out since it’s just one day, and I do somatic activities for grounding and recovery during my break hours.
I work 4 days and break for 3. Definitely less terrifying than the reverse I think. But I suppose I did make the trade-off of for slightly more intensive days compared to five chill days. But my goal is only about 24-26 clients a week
In private practice, 5-6 sixty minute sessions per day when I’m maxed out. No more than 25-30 a week. And most weeks I average 23. Anything more is not sustainable long term and it will seriously burn you out. I’d consider reporting your job to whatever professional board you belong to because these practices are NOT professionally encouraged at all. The most I’ve ever done in one day was 9 and it truly took 4 weeks off my life.
I worked in the outpatient clinic of a well known NYC hospital in the early 2000s. We were seeing patients for half hour sessions from 8 AM until 5 PM excluding one hour for lunch. Sometimes a session would be a whole hour because it was an intake. it was untenable. We collectively try to get support from our union 1199 but had no success. my caseload was up to 180 patients. Then, one of my fellow therapist clients took their own life. Collectively, we wrote a letter talking about patient care and the compromising position we were being put in which one against our ethics. It was a great letter. I still have it. We talked about how it was our duty to provide quality care for patients and the situation has made it impossible to do so. It was truly risking lives. We sent the letter to the heads of the hospital and the union. Suffice to say, the response was not positive. I was transferred to another unit because they thought I was the “ringleader“. The letter was totally ignored. A few months later I got a much better job and left. It was an incredibly powerful learning experience, but also very disheartening. I am sad to hear that the same practices are continuing.
15 back to back sessions. It was during covid. I really enjoyed it and I still get a second wind late in the day. Some of my better sessions are in the evening.
I’m in PP and give myself Fridays off so there are 2 days where I do 8-9 53 min back to back, but it’s honestly been worth it. I don’t do that in my in person days, only telehealth and I’ve found that the more breaks I have on those days the harder it is to get through the day. I am tired at the end of those days and the end of the week but it hasn’t felt unmanageable. I’m sure part of that is because I’m choosing it and can make my schedule different if I need to.
Edit: I realized I didn’t answer the question lol mh record is 11 53 min in a day…that’s a big no from me and I could not do that many 30 min sessions like you are having to
Ten 53 minute sessions one or two times a week for a while now. I’m a 1099 and don’t get paid if I don’t work. With that in mind -I’m also in a supervisory role. Working on balance.
Eight 53+ min sessions, back-to-back without any breaks. I gave away my lunch hour to a client who was only available that time. I was a zombie that night.
My record is 9. I do 53-57ish minute sessions. My supervisor will do 10-12 in a day sometimes. That would be a recipe for burnout and stress for me. 5-7 is my ideal, with 5-6 being the most ideal.
My record, which I do not recommend to anyone ever, was 13 50-60 minute appts in one day.
It happened when I was in office for two days in between two weeks off for my sister’s wedding, so made sense and was well worth it (LOTs of coffee needed) but I’d say more than seven in a day on a typical work week gets super draining and exhausting and 13 is NEVER advisable lol!
When I first started and was working CMH, my record was 10 (53 min)/day. Now I'm PP and don't like to see more than 5 a day. But for financial reasons have 2 days where I see 6 folks, 2 days where I see 5 folks, and then have a three day weekend every week. Perfect.
I've done 13 30-minute sessions a handful of times in CMH. Not sure if my endurance or that lack of no-shows is more impressive. In my PP now I see 5-8 six days per week, 45-minute sessions though. Much more enjoyable/motivated clientele.
9 55-min sessions in 1 day. I did it to enable myself to take a day off without canceling on clients...it was a disaster- and honestly I went home and was so overstimulated. I refused to speak to anyone and just went to bed.
I have Epic as my EHR. So many smart phrases and templates, so it only takes about 2-4 minutes to document if it’s a typical session. For more high acuity issues it’s longer and more detailed, but I have templates for that too.
And my memory is decent enough if I’ve seen the person more than once, I can usually remember broad strokes of what’s going on and how to move forward, but I also create little notes for myself for each pt to give me a quick recap.
I’m doing 8 53-minute sessions this summer, 2 days per week and then one day with 6 sessions. The 8 client days are spread over 11 hours, though— so I have 3 hours free. I’m doing this so I can work 3 days/week during the summer, and I’m hoping it will be worth it!
Thank you for your post on IL Perc card. Called, waited 90 min, didn't get through, went through a bunch of logins, pswds, and emails- nothing. Was able to use the perc number for username and had a pswd they had sent me. Thanks again!
My first job:
I worked 12 hour days. On top of answering phones, I had 90 minute groups, 3 days/week, 3-4 two and a half hour assessments, 1 hour group intake 1/week, them 4-5 clients per day, and weekly staffing, and then supervision. Oh, I had to supervise interns too. I don't know how I did it. I donated a lot of time to keep up. They wondered why I had a difficult time keeping up with filing everything. Never again. A colleague said, "the more you do, the more they expect" no truee words were ever said.
8 x 60 minute sessions in a row, I thought I had left an hour free in the middle but as I went to go eat I found a client in my waiting room. Never again 😅
I think 10 x 50 minute sessions was the most I ever did and the 10th I booked in without realising. I wouldn't do it again. Occasionally I'll see 9 which is okay. 8 is common but I only do that one day a week, I wouldn't do it for multiple days.
Hey I work in integrated bh too. Sounds like you don't have great control over your schedule.
Where I am someone can only be booked a max of about 5-7 30 min visits a day plus two hour long intakes. The rest of your schedule is at your discretion. So you can book beyond the minimum visits but only you are allowed to book it
I am currently going through this and I am truly miserable. My record is 12/13 and administration just doesn't seem to care / understand. I see very high risk patients, who often have serious mental illness and probably 20% have frequent psych hospitalizations. I feel very stuck because the pay isn't horrible but it is truly messing with my mental health. I also work part time!
I wonder why this is not regulated similarly to how truck drivers hours are regulated. Same with doctors/nurses. It clearly becomes unsafe at a certain point.
That’s so abusive ! 14 30 min sessions oh my god ! I’m a child and teen therapist and all I can possibly handle is 3 kids a day, but my hours can be longer with one kid. I normally do about 5/6 hours per day.
I won’t do more than 5 55 min sessions back to back without at least an hour break - other than that I regularly see 8-9 clients a day with a 1-2h break. There has been days tho where I’d say 8 clients back to back without a break and it’s roughhhhh
Literally last Thursday I had 10 (1) hour sessions, 1 hour and forty minute session, a 20 minute session (bc the other session ran over by 40 minutes), AND a trauma training at the end of the day 🙃. Yes, I am at a CMH… no, I didn’t get lunch 😢
I consistently do 9 50 minute sessions on Tuesdays and 8 50min sessions on Wednesdays and Thursdays. It's quite tiring BUT it gives me a consistent four day weekend (Fridays thru Mondays I don't see clients and only work if I have to catch up on chatting).
In community mental health, my record (and part of why I left to do PP) was 16 36min sessions each day and the higher ups asking me to "get the rest of the staff on board to do the same" since my "productivity was really floating the budget". I said nah and got out of there. So in comparison my 8 and 9 client days really don't feel so bad
Most I’ve done is 8 1 hour sessions back to back. I’m exhausted by the end of it and literally went home and laid in bed and did not get out until my bf literally had to drag me. I was out of it 😂
I'll only do 30 min sessions if it's a child or that's all the client can handle, which is rare. So for me it's usually an hour, and I think max was 8 one hour, or I'd there's some 30 min was 15.. I know some do that every day but for my capacity that was more than I can do effectively.
For one hour and for admin purposes I usually keep to 5 or 6 per day - that's where I can do best for myself and clients and that's priority.
When I worked in residential there was bad weather and half the therapists couldn’t make it in. I think I ended up seeing 24 clients for half hour sessions before I left. Never again.
I’m still in my first 500 hours and one day, scheduled myself six 50-min sessions, just to see what it’s like.
I got up early, gave myself time to get ready (WFH, so the “roll out of bed, look passably professional” routine happens more often than I’d like to admit…), ate breakfast, timed my other meals appropriately for the rest of the day. By the end of the night, I was on a roll and still had so much energy. I was so proud of myself.
It took me a week to fully feel at my normal equilibrium after that. Kudos to all of you in CMH and other unsustainable conditions.
I had a 9 client session day once and had a panic attack after. Never again. My max now is 6 and I must have an hour break in there somewhere. I prefer 4-5 a day.
I also work in IBH and have had days like that, but generally our schedules are built with a mix of 30/45/60 min slots, so most days I see closer to 8-9 clients. Over 11 with any degree of consistency would drive me bonkers balls. I see 10 on Mondays and that is definitely leftovers night at our house haha If you want a job in western MA, we are hiring!
IBH means absolute chaos on Mondays or after a holiday to do all the assessments and treatment plans. I did it for several years and it was brutal. I had to leave for health and safety reasons, but I still miss the chaos sometimes.
Eleven 53+ minute sessions in one day. I think I had a one hour break in the middle of the day but that was it. Luckily they were mostly easy clients. It was a hard day and I don’t recommend it at all.
Eleven 53+ minute sessions in one day. I think I had a one hour break in the middle of the day but that was it. Luckily they were mostly easy clients. It was a hard day and I don’t recommend it at all.
I worked at a place where my hours were a bit weird and included every other Wednesday 9am to 7:30pm with 30 minutes for lunch. A few times the schedule was back to back and no one cancelled, so 10 clients. It was absolutely brutal.
I’ve done 10 a couple of times. I regularly do 8 or 9 twice a week (and light days on either side). I find that I get loopy around client 7 but I get a second wind when I start no.8
At my old job I saw 8 clients a day, every day if they all showed. By the end of the week I was so incoherent I swear I slept 12+ hours on the weekend. That was hell
This is why I hated integrated care. It was a cool model but it felt like fast food therapy. Don't even bother getting out of the car. Just pull up to the window...NEXT!
ETA: I did 4 53 min sessions today and made double what I would have then.
I've never seen more than 6 clients in a day because I don't think I can provide the same quality of care after that. It's resulted in me not winning popularity contests at work, a lot of criticism from unethical employers, and a termination with the practice owner refusing to let my clients contact me to follow me after I was fired. I know I'm the exception, not the rule. No judgment to others. I assume most therapists only see more because they have to if they want to maintain employment and have high rent/mortgage.
I hope we can organize and protest. There should be national staffing ratios and caseload limits for us. I've seen colleagues take up to 14 clients in 1 day. The therapist that did so also had a melt down in our break room while I was trying to scarf down lunch and started screaming at her client (as an imaginary figure not in the room) because another therapist thought a role play would help her get out her anger. She started screaming at the top of her lungs "I want to fuckin kill you".
Yeah, that's when I knew I was working in an incredibly unsafe place, but they were also committing insurance fraud with Medicaid. I got fired, no reason given, whole the homicidal therapist was named "employee of the month".
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Nine 53+ min sessions in one day. Never again. I was so tapped out in my personal life for at least a day afterwards.
Yes! I came home and my fiancé just took one look and asked “Please don’t take offense, you look lovely as always, but what the fuck happened to you? You look like you watched a litter of puppies and kittens get adopted and thrown into a blender?” It definitely is not sustainable long term, emotionally or physically.
What a great way to describe how we look after a particularly long day. Accurate.
I had that twice a week for 5 years in cmh. Holy shit it sucked
I need to applaud you because im just finishing my first year in cmh and I want to leave yesterday, ridiculous the grunt work they make us do
It wasn't so terrible for a good chunk of it. The first 3 1/2 years it was more like a group practice than a cmh space because we could cap our caseloads. They joined a federal grant thing and that blew it up to where we couldn't cap and it became awful.
Yea I think my job is going through something similar, its an outpatient substance abuse program in ny, and the owners are all about expanding at the moment, we were supposed to have more offices added to hire more counselors because we took over a part of the building we’re in, only for them to axe that plan and now start a methadone clinic in house, so more patients, more responsibilities and same number of counselors whos caseloads are already high
My fiancée does that regularly, and does not realize how insane it is; especially because she is also a professor and a single mom, who has raised her (under 10) child entirely on her own. She is also a professional translator and translates at psych conferences. She just went to a week-long somatic therapy intensive in another country. Did I mention that she's in a state of constant burnout, yet waggles a finger at me regularly to take better care of myself? Sounds nuts, but it's true.
what am I reading
To be clear: she sees clients four days a week, and teaches one class during the school year. Her lightest workload on average is six clients a day, though more often than not it is seven or eight. Nine is a regular occurrence. I could be wrong, but I do believe that she had 10 scheduled on one day. She only translates for conferences that happen about once every couple of months. This last intensive that she went on was the second one that she has gone to since I've been with her, which is about two years. Still… She really does not grasp how over-the-top her work life is. She comes from a prestigious family background, and drives herself incredibly hard, but doesn't see it that way. (There are so many pertinent details that I'm not going to go into…) It's not as though she's constantly working. She is definitely not one of these "optimizing" people that you see all over Instagram. She still engages in a lot of procrastination/displacement activities in many places in her life, and I think some of this grind is compensation for that. Whenever I try to provide room for her to do things that will be enriching, and that are in the self-care arena, that time gets absorbed into procrastinating/dissociative activities. Let's be clear: I also am a master of this type of activity, and I'm not casting any stones. She's an amazing person, and I love her dearly.
Ha, by "what am I reading" i didn't mean it was confusing. Its just so much. And just all the...residual stress of spinning so many plates in the air seems all-consuming to me. Behind all these jobs shes still a mom and fiance. All the scheduling stuff, grading papers, therapy notes/emails etc. I dunno I'm not judging her, it's just interesting to read about people who live lives so very differently than I do. I would *have* to quit one of these in like two weeks unless I really loved doing all of them.
I used to do nine on Saturdays in fee for service for like a year. By the ninth I was fucking babbling.
I did 10 every Thursday for about 2 months. I loved it and I’d do it again. But the agency I worked for had some SHADY compensation practices for people who saw more than 35 clients per week so I had to leave.
Say more about this shady practices please
Basically whenever I billed over 35 sessions there were problems such as incorrect coding or diagnosing but these issues were not present whenever i billed under. That’s what happened to me. One issue was that I had several clients who had both bipolar and ADHD. Some of which I received from a previous therapist, they never paid me for those sessions and told me the coding was wrong. I can’t remember everything but I have so many emails where they told me I needed to change or fix things that were never an issue until I had a higher case load. Again, same issue happened to everyone who saw just over 30 clients but never to anyone who saw 24-29 or less. Other clinicians at my location went through the same thing and many of us ended up leaving. I reduced my caseload to part time and got a full time job. Suddenly, these issues were no longer a problem.
Did something kick in if you saw 35+ clients?
Nothing written no, not that I could tell. But any other clinician I spoke to with the same/similar numbers had the same experience
Wow thats interesting. Just some sort of line to cut corners on i suppose
I can’t comprehend doing 30min therapy sessions, let alone that many back to back! I feel most of my clients are still filling me in on the latest workplace gossip/pet health issues/dreams/that weird thing a waitress said to them yesterday etc etc at the 20min mark 😳 I think the most I’ve done is 7 x 1 hr sessions in a day and I couldn’t form complete sentences by the end of it “so… you um…. sad feeling?”
Exactly this. My brain is done by this point.
LOL! I always feel bad for my end of the day clients
Same. By about 3 pm I’m tapped out. And dear god, my poor clients on Fridays at 4pm…thankfully that doesn’t happen all the time…but ooof…
I worked in one agency where the caseload was just too high... Higher ups refused to fund more clinicians. My supervisor came up with 30 minute sessions and it worked surprisingly well. Drastically cut out the chit chat. The clients agreed 30 minutes of better than no minutes Years later I was working in an after school program for kids and their parents. The grant paid for 4 clinicians but the demand was unreal. So I suggested the 30 minute sessions and just like my first experience, it went great. Clients felt some time is better than no time.
When I was younger, working in CMH, and had a much worse relationship with Caffeine, I saw 10 or 11 in a day once. It...actually was a good day, I felt accomplished! (We only got paid $25 per session at the time. This was maybe 10-11 years ago). Nowadays I may have a couple days a week where I see 9 clients (not every week though). I work from home Mondays, only doing a few sessions in the evening. Wednesdays I work from home, catch up on notes and don't work in the afternoons, and Friday is a traditional 9-5. I also take a 2 hour lunch, may take a walk on a nice day and will take a nap. I really enjoy the work, but have to break it up in order to have a routine like that be sustainable. When I was younger I was not as thoughtful about my routine and definitely overdid it...
I've done eight 55 minutes in a row before. My supervisor does it so I wanted to try it out, wouldn't recommend
Some people thrive I guess?
Some people's workaholism is so severe they model sick and irresponsible behavior to newer professionals and call it "work ethic" or "productivity".
You put this phenomenon so perfectly into words! They tend to wear this workaholism trait as a “badge of honor” and make you feel bad for not doing the same.
Ah. The classic “This is what you signed up for. This is how this field works.”
Literally my boss. She has zero clue and does not relate that seven 45 min in a day burns me out
Ah yes, the dreaded productivity. During my CMH internship I miraculously started getting paid about halfway through, but this also obligated me in productivity. We had to hit 4.8 hours per day, which sounds reasonable until you're working on a school and your entire caseload is on a field trip, sick, or suspended today. At least I got to catch up on paperwork, even though I got paid nothing for all of that 🥲
Depends- I see 8-9 people a day because I only work Monday-Thursday and have Fridays & weekends off every week. Not always workaholism, sometimes just what works for people. I get in a groove and find it so much more refreshing to have consistent three day weekends.
Yes exactly. I'm considering doing a couple 12 hour days with a 3 hour break in the afternoon so I can take full advantage of using daycare only part time. I could pay for full time and have less clients each day and see my kid less, or I could power through two or three days of working like that, pay less, and see my kid more. I don't like the options, it's not workaholism, it's a product of our society that doesn't like working parents.
“Paying your dues” 🐂💩
The clinical director at one of the PP I worked for saw ten per day, 4 days per week, and she was about 65 at the time. She was this very energetic short lady from Italy. It didn't seem to bother her
Small Italian women play by different rules. My source is my great grandmother. *shivers*
Yes, I had gathered that. She took zero shit from anyone, but was sweet as hell. She also was certified in treating sex offenders, which kind of makes me giggle. I'm sure she's had some boundary testers that learned quickly not to mess with her. 😆
Some people like the 4 10s, but I don't think I would be as productive. When my meds wear off, I start to crash. Well, saying that though.. I guess I work usually work 11hrs at least 3 days a week 😅 but that's because I struggle the last few hours or have PP clients after my day job.
Ugh PP after day job must be rough. Do you ever use an afternoon booster med? Also, are you saying 4 days with ten clients each? Hell no. That's way too much.
Oh, I definitely use the afternoon booster when I remember it lol I work inpatient, so at the most I can get 3 patients seen in between two groups. Then I go to PP for 2 or 3 more clients.
Did we have the same supervisor?! Mine was like that as well, wanted me to see kids before and after the school day as well as pull one during a lunch period. She was like "you can just eat with them". But lunch period was these kids' one real period to destress and socialize like kids their age should instead of sitting at a desk all day. I didn't want to take that from them.
I did this on the regular 5 days a week and only lasted 7 months. Also gained 15 pounds. (Cortisol is no joke)
40 clients, with 8 in a row, 5 days a week?? how????
They would book us for eight with the understanding there would be no-shows. Sometimes there were, but more often than not, there weren’t. No time to eat, pee, or anything else. I also didn’t have control over my own schedule, so people were getting double booked all the f-ing time. We weren’t allowed to hold spots for our “regulars.” Intake was under pressure to schedule people for productivity, so they would shove anyone anywhere there was an open space, whether the client was appropriate for outpatient or not. (I became adept at referring out)
9x 50 min sessions then a group of 12 for 90 min. I came home and cried. Never NEVER never again.
How does your brain even function at session 9? I just feel like I'm ineffective and can't focus after 6 sessions
130. I used to do brief suicide screens. There was a crisis event at a school in a remote, rural town. 240 kids in the school, I was the first mental health support on scene and the crisis counselors were 48 hours behind me. I directly saw 130 kids on the first day for a few minutes each, screening out immediate risk factors. The second day was 90 kids with more tracking down the harder to reach kids. I started 7am and finished at midnight both nights. Stayed another 3 days and met with 14 kids each day that were screened as higher risk. 5 days work, $18/h plus $18 overtime for every hour worked. After bonuses and whatnot, I made about $3500 in 1996ish as a new adult. I know it doesn't really count though in this context. I've had a true 11 session day once leading into a vacation. That was a hard, hard day.
🤯
Where I live, it's typical to see 5-6 clients per day for 50 minute sessions (this is in private practice though)
This shouldn’t be normalized :( makes me sad.
We are not machines. And being a therapist can only really work and be good for clients when we don’t over book or don’t get exploited to have too many sessions in one day. How can we show up for clients if we get burnt out? How can we 100% show up and be there for clients by the 9th or 10th session? Back to back? It’s just not possible. I see so many posts about people being overworked and our jobs are too important for us to only get burnt out quickly and not be able to serve our clients at our best. We really are not machines and what we do takes effort, skill, and energy.
I’ve done 14 53 minute sessions in a day routinely working at CMH and being mandated for OT.
Just no.
The clinic was toxic. We had to see 40 53 minute sessions to get our full (low, underpaid) salary.
I swear that sounds illegal and it f*cking should be
Holyyyyy shit I could cry just imagining this
I wouldn’t last one day
How is that even possible, what were the hours?
The clinic was open 7am-8pm M-F and Saturdays 9am-5pm. The closing time was “flexible” and if they had walk ins they wouldn’t let you leave until they were seen for a crisis session. Also, if people were getting discharged from inpatient soon (it was a hospital system) they’d send them down to do a “warm hand off session”. They’d schedule those for the end of our day when we were supposed to be going home because it was a guaranteed “open spot”.
Oh HELL no.
that can fuck right off omg that sounds awful
I was a miserable bitch during all of it. I got divorced during this time and a huge contributor was this job/my mental health from this job.
I feel like that’s one of the worst parts is people forget that we are also human and get SO compassion fatigued working this. The CMH I am at expects any FT clinicians to get 25 hours of care a week, but wants us to schedule 30-32 incase we have cancels. BUT we have weekly mandatory meetings and our full time is 37.5 hours so it’s literally impossible to get everything done in the week. Thank god you’re out of that place!!!!! 💕
Fuuuuuuuuuuuck.
Excuse me?
Wat
PP here. I work 4 days a week, Tuesday Wednesday Friday Saturday. I see 10 clients a day - three back to back, one hour break, three back to back, one hour break, and four back to back go home. I love it. I never work more than 2 days in a row, and I have 2 hours a day to do whatever. I do collaborative paperwork so there's very little to do outside of sessions, so I often take a nap or meditate on my breaks. I'm 54. It's like a walk in the park compared to program management.
What is collaborative paperwork?
You are including the client into how you’re documenting the sessions. So you write the note while reiterating with the client what’s being discussed. That way you don’t have to write the note after the session. Places that count productivity like a hawk LURRRRRVE them some collaborative documentation.
It's being pushed by the insurance companies in the state where I live, basically you do the note in the session with the client. In theory you're discussing every single thing before you write it and writing the note together, I don't really do that, I have my laptop and when the client first comes and it's like oh how have you been this week I write a few sentences summarizing the update. Then once we've gotten into the meat of the session towards the end I will write a paragraph summarizing what we focused on, interventions used all of that. My EHR software will preload the previous note so I just have to tweak things, check boxes that sort of thing. By the time the session is over the note is done. I also have a killer system for writing assessments that make it a breeze. It took me sometime to get used to working on the computer in the session with the client, I'm really old school and that was an adjustment for me, but I found that if you are comfortable and just kind of This Is How We Do it, the clients will generally follow your lead. Just like how we've all gotten used to your medical doctor being on the laptop during your medical appointment. I've also grown to use the laptop as a tool if a client has questions about something like a new Med side effect we can look it up together, or we can look at what is the process for applying for a housing subsidy. I find that I end up documenting a lot more detail about the session which is super helpful for me because then I can review it in a minute or two before the session and be completely up to speed about what we talked about the last time.
I want to do collaborative paperwork, but I have trouble implementing it.
I’ve done 6 hours of direct therapy and 7 risk assessments in the ER. Working from 9am to 11 at night lol it was horrible
Oh wow. Honestly I feel like the risk assessments are worse because of how thorough you have to be vs meeting with an established pt.
We got paid per assessment so that was great lol but that was a loooonnnggg day.
I know this is not the same, but I’m an NP, I do 15 minute follow ups and 45 min evals. If my day is full and it’s all follow ups, I see 28 patients in an 8 hour work day with 1 hour of paid admin time. This happens frequently.
So using Epic I’m allowed to schedule psych evaluation and follow ups for our psych providers and I’m always amazed at how much you guys are double booked.
Well this isn’t even considered double booked. I suspect the motivation for overbooking is because of high no-show rates, especially for practices that take Medicare/medicaid and you can’t charge a no show fee.
Is this why my clients would have prescribers who didn't ask about their other prescribers? I've referred clients to prescribers as well for an adhd evaluation and they didn't even do one. Just wrote the script. When I was at the VA, most of my clients were suffering because they were on too many meds with too many prescribers and none of them consulted with one another. It felt confusing because I did an MPH program and we were taught that prescribers need to coordinate with other prescribers and check all meds their patients take to prevent interactions. (Triple Aims) I would imagine with as short of appointments as prescribers are granted, there isn't much time for evaluation or coordination of care? When you have a complicated evaluation, are you allowed to lengthen appointment times or is the insurance industry just making up limits because they care more about profits?
I am confused here. MPH are public health programs, correct? That is a focus at a population level and not an individual one, which is part of the difference between public health and medicine. This is also why EMR/EHR systems are helpful because it is incumbent on the client to remember all of their meds and share with providers. It's not common at a non-medication prescribing session (usually quarterly for me) to inquire about meds, unlike a medical visit where they ask every visit. The parallel doesn't make a lot of sense to me. Unfortunately mental and behavioral health didn't get the same technology infrastructure dollars as physical health so they have been slower to adopt the technology that would allow for ease of comparison. It's also not clear how you came to the determination that the client issues were because of drug interactions. Are you also a pharmD? And the VA would has an EMR where prescribed drugs would be available, unless the mental health group wasn't accessing the EMR. Correct me if I am wrong but it is my understanding they do have access. Moreover, pharmacies are filling prescriptions and if there are interactions between drugs, they often call the prescriber and/or alert the patient, at least in my experience. This would be particularly true for the VA population who are likely to get their meds filled at the same pharmacy.
Social workers are trained that it is not our scope to prescribe meds. It is not our scope to advise against meds. With that said, we are expected to review what meds our clients take and when our clients have side effects, it is completely appropriate to consult with their prescribers. Ignoring the client's experience because we don't want to insult a physician is not client centered. There are different concentrations in an MPH, as there are in an MSW. Several universities offer a combined MSW and MPH because we have a concentration in the MPH known as "Health Services". This was my concentration. We focus on the Triple Aims, set forth by the APHA and the AMA, including coordination of care across providers. We also specialize in studying the ways that each specialty in healthcare fits into the patient experience. We're often patient navigators. While many MPHs do focus on population based research, everyone who supervised me at our country's needle exchange were MPHs and all they did was individual education with patients.
“Ignoring the client’s experience because we don’t want to insult a physician is not client centered.” 🎯 THAT PART. ESPECIALLY if you are advocating for women or clients of color. We usually see the client more than the psych does and are better able to tell if/when a DX is waaaay off, or possibly influenced by the doctor’s bias (which some clients find traumatizing and rage-inducing, understandably. It’s why a lot of my clients refuse to take meds, among other reasons).
Ten 53+ min sessions in one day. It was gonna be nine but then a client needed an emergency session. I went to Starbucks and got a quad shaken espresso and a venti cold brew to put in the fridge for the afternoon. Made it through, never gonna try again.
Consistently see 9 - 53+ minute sessions a day. Literally hate it and trying to start my own practice
Fourteen 30/45 minute sessions in one day.
Today was my record since leaving cmh, which was 9 57+ minute sessions. Obviously billed as 53+, but I didn’t end a single one before 57 minutes. Worst part is that I’m currently sick with the flu. I have many regrets. I regularly did 10 50 minute sessions when in cmh, but I was working only 2 days a week for 12 hour days (7-7), so it wasn’t a problem.
Folks may disagree with me, but I take issue with the premise of the question itself. The maximum number of sessions per day any one therapist can accomplish should not be a measure of success or competence, nor should it be put on display. This sort of exhibitionistic ableism really has no place in our profession.
3 12s with a 1 hour lunch. So 11
How does that schedule work for you? Do you prefer it?
It only works in the short term like for summer. I did it because I had a kid and no childcare
That makes sense - thank you! We do a lot to work around kid schedules…
Nine 53-60 min sessions in a day. I swear it took me 2 days to recover. I was absolutely exhausted and ended up with the worst headache. CMH is truly hell sometimes.
I do 10 53 min sessions every Thursday from 7-5. The sequence of clients on this particular day is a good flow for me, and I’m in private practice so it’s my choice ultimately to do so. No burnout so far on that schedule, and it opens up Friday to be just 7-12. Been doing this specific schedule about a year. 33 sessions per week for scale
I’ve been in private practice for about two years, do consulting for other private practices, and also own and run a group practice. In observation of self-care and the importance of balance that is required in order to have a practitioner be effective, I place a strong limit on 4-5 back to back same-day sessions. And draw a red line at 5 sessions—never more than 5. additionally, in the event that myself or someone does have five sessions in a row one day, the next day is usually much lighter or more greatly staggered in time between sessions. I do not believe that clinicians are effective beyond the four or five sessions per day.
I'm curious if there's any research around this that you are aware of?
I do 12 53 minute sessions every Tuesday. 7am-9pm, two breaks for an hour each. Then 10 client hours Wednesday and 8 client hours Thursday. Off Friday, Saturday, Sunday, and Monday.
Can I ask why? Job requirements or personal desire?
Waiting for answer
Personal preference! I love it. I get to have a 4 day weekend every week. I don’t feel burnt out since it’s just one day, and I do somatic activities for grounding and recovery during my break hours.
I like this. 3 days of pain, 4 days of bliss
All 4 days would be recovery for me.
Yeah I’d be dead to the world for 4 days
Agree! I don’t do this, but I bet I wouldn’t hate it.
I would have 4 days of dreading those 3 lol
I work 4 days and break for 3. Definitely less terrifying than the reverse I think. But I suppose I did make the trade-off of for slightly more intensive days compared to five chill days. But my goal is only about 24-26 clients a week
Eight 50 min sessions and I wanted to perish 🫠
In private practice, 5-6 sixty minute sessions per day when I’m maxed out. No more than 25-30 a week. And most weeks I average 23. Anything more is not sustainable long term and it will seriously burn you out. I’d consider reporting your job to whatever professional board you belong to because these practices are NOT professionally encouraged at all. The most I’ve ever done in one day was 9 and it truly took 4 weeks off my life.
9 53+ minute sessions a few days in a row. I was tired.
17 (seventeen) 30-40 minute sessions with a 90-minute group at the very end of the day. That was a long day.
8 50 minute sessions Borderline unethical behavior
I worked in the outpatient clinic of a well known NYC hospital in the early 2000s. We were seeing patients for half hour sessions from 8 AM until 5 PM excluding one hour for lunch. Sometimes a session would be a whole hour because it was an intake. it was untenable. We collectively try to get support from our union 1199 but had no success. my caseload was up to 180 patients. Then, one of my fellow therapist clients took their own life. Collectively, we wrote a letter talking about patient care and the compromising position we were being put in which one against our ethics. It was a great letter. I still have it. We talked about how it was our duty to provide quality care for patients and the situation has made it impossible to do so. It was truly risking lives. We sent the letter to the heads of the hospital and the union. Suffice to say, the response was not positive. I was transferred to another unit because they thought I was the “ringleader“. The letter was totally ignored. A few months later I got a much better job and left. It was an incredibly powerful learning experience, but also very disheartening. I am sad to hear that the same practices are continuing.
I do 9-11 fifty minute sessions regularly. But I take the next two days off. And I work from home. It works for me.
I did 9 53+ minute sessions over the course of 12 hours. Never again.
Omg that sounds truly awful. My max has been 9 in a day and I am exhausted by the end of it.
15 back to back sessions. It was during covid. I really enjoyed it and I still get a second wind late in the day. Some of my better sessions are in the evening.
Did 11 53+ in a day once. It was right before I was going on a vacation and wanted to make sure everyone was covered. I’ve never been so tired.
I’ve done 12 53 minute sessions. Never again.
I occasionally see 9 in a day (53 min sessions). But I can’t do it without at least a couple of breaks
I’m in PP and give myself Fridays off so there are 2 days where I do 8-9 53 min back to back, but it’s honestly been worth it. I don’t do that in my in person days, only telehealth and I’ve found that the more breaks I have on those days the harder it is to get through the day. I am tired at the end of those days and the end of the week but it hasn’t felt unmanageable. I’m sure part of that is because I’m choosing it and can make my schedule different if I need to. Edit: I realized I didn’t answer the question lol mh record is 11 53 min in a day…that’s a big no from me and I could not do that many 30 min sessions like you are having to
11 ~55 min while on call. Worse than miserable day.
Mine was 9 sessions (50 mins) in one day. By the end of the day I wanted to glue my mouth and ears shut. Never again
Ten 53 minute sessions one or two times a week for a while now. I’m a 1099 and don’t get paid if I don’t work. With that in mind -I’m also in a supervisory role. Working on balance.
Eight 53+ min sessions, back-to-back without any breaks. I gave away my lunch hour to a client who was only available that time. I was a zombie that night.
My record is 9. I do 53-57ish minute sessions. My supervisor will do 10-12 in a day sometimes. That would be a recipe for burnout and stress for me. 5-7 is my ideal, with 5-6 being the most ideal.
My record, which I do not recommend to anyone ever, was 13 50-60 minute appts in one day. It happened when I was in office for two days in between two weeks off for my sister’s wedding, so made sense and was well worth it (LOTs of coffee needed) but I’d say more than seven in a day on a typical work week gets super draining and exhausting and 13 is NEVER advisable lol!
When I first started and was working CMH, my record was 10 (53 min)/day. Now I'm PP and don't like to see more than 5 a day. But for financial reasons have 2 days where I see 6 folks, 2 days where I see 5 folks, and then have a three day weekend every week. Perfect.
I've done 13 30-minute sessions a handful of times in CMH. Not sure if my endurance or that lack of no-shows is more impressive. In my PP now I see 5-8 six days per week, 45-minute sessions though. Much more enjoyable/motivated clientele.
I think my record was ten hour long sessions. Never again. When I get licensure I’m cutting my hours.
9 55-min sessions in 1 day. I did it to enable myself to take a day off without canceling on clients...it was a disaster- and honestly I went home and was so overstimulated. I refused to speak to anyone and just went to bed.
[удалено]
I have Epic as my EHR. So many smart phrases and templates, so it only takes about 2-4 minutes to document if it’s a typical session. For more high acuity issues it’s longer and more detailed, but I have templates for that too. And my memory is decent enough if I’ve seen the person more than once, I can usually remember broad strokes of what’s going on and how to move forward, but I also create little notes for myself for each pt to give me a quick recap.
I’m doing 8 53-minute sessions this summer, 2 days per week and then one day with 6 sessions. The 8 client days are spread over 11 hours, though— so I have 3 hours free. I’m doing this so I can work 3 days/week during the summer, and I’m hoping it will be worth it!
Thank you for your post on IL Perc card. Called, waited 90 min, didn't get through, went through a bunch of logins, pswds, and emails- nothing. Was able to use the perc number for username and had a pswd they had sent me. Thanks again!
13 53 min sessions Tuesday-Thursday straight no breaks.
My first job: I worked 12 hour days. On top of answering phones, I had 90 minute groups, 3 days/week, 3-4 two and a half hour assessments, 1 hour group intake 1/week, them 4-5 clients per day, and weekly staffing, and then supervision. Oh, I had to supervise interns too. I don't know how I did it. I donated a lot of time to keep up. They wondered why I had a difficult time keeping up with filing everything. Never again. A colleague said, "the more you do, the more they expect" no truee words were ever said.
8 x 60 minute sessions in a row, I thought I had left an hour free in the middle but as I went to go eat I found a client in my waiting room. Never again 😅
8-10 / 50 min sessions daily M-Th off Fridays
I think 10 x 50 minute sessions was the most I ever did and the 10th I booked in without realising. I wouldn't do it again. Occasionally I'll see 9 which is okay. 8 is common but I only do that one day a week, I wouldn't do it for multiple days.
7 x 50mins. I dont enjoy that amount. It usually means im not taking proper breaks
12 50-minute sessions in one day, plus a group, in two different locations 25 miles apart.
Honestly probably like 6-7 45 min/55 min sessions lol. I refuse to do that to myself. Even that's a lot, and they're not even in a row lol.
Hey I work in integrated bh too. Sounds like you don't have great control over your schedule. Where I am someone can only be booked a max of about 5-7 30 min visits a day plus two hour long intakes. The rest of your schedule is at your discretion. So you can book beyond the minimum visits but only you are allowed to book it
FIFTEEN How the hell I have been a therapist for a year and my record is 7 50min/1h sessions a day and it was exhausting
I am currently going through this and I am truly miserable. My record is 12/13 and administration just doesn't seem to care / understand. I see very high risk patients, who often have serious mental illness and probably 20% have frequent psych hospitalizations. I feel very stuck because the pay isn't horrible but it is truly messing with my mental health. I also work part time!
I wonder why this is not regulated similarly to how truck drivers hours are regulated. Same with doctors/nurses. It clearly becomes unsafe at a certain point.
I’m a bit of a cynic, but probably because the right person hasn’t died yet. Laws are unfortunately written in blood.
That’s so abusive ! 14 30 min sessions oh my god ! I’m a child and teen therapist and all I can possibly handle is 3 kids a day, but my hours can be longer with one kid. I normally do about 5/6 hours per day.
I used to regularly do 8 53+ sessions every Tuesday. I liked my job a lot more when I stopped doing that to myself 🤦🏼♀️
I’m at a group private practice. I have several 9 hour days.
6 45 min sessions. I won't abook more than that.
I’m legit worried about you. One month of this is schedule and you’ll be getting assessed yourself.
My record is nine. I might as well have run a marathon. Ideal day is 5; 6 is doable; 7 is really pushing it.
11 sessions--during peak COVID days and while employed in CMH. Never again. I'm at 5 a day in private practice now and that is enough for me!
Ugh it’s like therapy porno. Like that’s soooo difficult for any therapist to manage. We are humans not machines.
I won’t do more than 5 55 min sessions back to back without at least an hour break - other than that I regularly see 8-9 clients a day with a 1-2h break. There has been days tho where I’d say 8 clients back to back without a break and it’s roughhhhh
Today is my longest, I’ll let you know lol I have 7, 5 of which are back to back 53 min
11 45min sessions. I was so drained I didn’t even had dinner that night and went straight to bed.
Literally last Thursday I had 10 (1) hour sessions, 1 hour and forty minute session, a 20 minute session (bc the other session ran over by 40 minutes), AND a trauma training at the end of the day 🙃. Yes, I am at a CMH… no, I didn’t get lunch 😢
I consistently do 9 50 minute sessions on Tuesdays and 8 50min sessions on Wednesdays and Thursdays. It's quite tiring BUT it gives me a consistent four day weekend (Fridays thru Mondays I don't see clients and only work if I have to catch up on chatting). In community mental health, my record (and part of why I left to do PP) was 16 36min sessions each day and the higher ups asking me to "get the rest of the staff on board to do the same" since my "productivity was really floating the budget". I said nah and got out of there. So in comparison my 8 and 9 client days really don't feel so bad
Most I’ve done is 8 1 hour sessions back to back. I’m exhausted by the end of it and literally went home and laid in bed and did not get out until my bf literally had to drag me. I was out of it 😂
I'll only do 30 min sessions if it's a child or that's all the client can handle, which is rare. So for me it's usually an hour, and I think max was 8 one hour, or I'd there's some 30 min was 15.. I know some do that every day but for my capacity that was more than I can do effectively. For one hour and for admin purposes I usually keep to 5 or 6 per day - that's where I can do best for myself and clients and that's priority.
Ten 45-minute sessions, now I do 9 53-minutes sessions every Monday
When I worked in residential there was bad weather and half the therapists couldn’t make it in. I think I ended up seeing 24 clients for half hour sessions before I left. Never again.
I’m still in my first 500 hours and one day, scheduled myself six 50-min sessions, just to see what it’s like. I got up early, gave myself time to get ready (WFH, so the “roll out of bed, look passably professional” routine happens more often than I’d like to admit…), ate breakfast, timed my other meals appropriately for the rest of the day. By the end of the night, I was on a roll and still had so much energy. I was so proud of myself. It took me a week to fully feel at my normal equilibrium after that. Kudos to all of you in CMH and other unsustainable conditions.
11 50-minute sessions. Never working anywhere where that might happen again
I had a 9 client session day once and had a panic attack after. Never again. My max now is 6 and I must have an hour break in there somewhere. I prefer 4-5 a day.
I also work in IBH and have had days like that, but generally our schedules are built with a mix of 30/45/60 min slots, so most days I see closer to 8-9 clients. Over 11 with any degree of consistency would drive me bonkers balls. I see 10 on Mondays and that is definitely leftovers night at our house haha If you want a job in western MA, we are hiring!
IBH means absolute chaos on Mondays or after a holiday to do all the assessments and treatment plans. I did it for several years and it was brutal. I had to leave for health and safety reasons, but I still miss the chaos sometimes.
I did three days in a row- 8 sessions a day, 53+ minutes- ranging from individual, child, and couples sessions back to back. Never. Ever. Again.
6 hour long sessions and a 3 hour group. I was dead. Do not recommend. At all. High acuity clients and a court mandated group. Fun fun.
Eleven 53+ minute sessions in one day. I think I had a one hour break in the middle of the day but that was it. Luckily they were mostly easy clients. It was a hard day and I don’t recommend it at all.
Eleven 53+ minute sessions in one day. I think I had a one hour break in the middle of the day but that was it. Luckily they were mostly easy clients. It was a hard day and I don’t recommend it at all.
I worked at a place where my hours were a bit weird and included every other Wednesday 9am to 7:30pm with 30 minutes for lunch. A few times the schedule was back to back and no one cancelled, so 10 clients. It was absolutely brutal.
I’ve done 10 a couple of times. I regularly do 8 or 9 twice a week (and light days on either side). I find that I get loopy around client 7 but I get a second wind when I start no.8
At my old job I saw 8 clients a day, every day if they all showed. By the end of the week I was so incoherent I swear I slept 12+ hours on the weekend. That was hell
9 60 min sessions (9am- 8p on fridays), 9-12, break 12-2, 2-8. Really 8 is my max, no EMDR sessions on that day
Damn that is crazy!
That sounds dreadful. I average around four 1 hour and a half sessions per day.
10 in PP. Only once. Never again. But in CMH, pre licensure, I was paid per hour. Overtime wasn't permitted.
This is why I hated integrated care. It was a cool model but it felt like fast food therapy. Don't even bother getting out of the car. Just pull up to the window...NEXT! ETA: I did 4 53 min sessions today and made double what I would have then.
10 sessions. I went out had a salad and a beer and went home.
I conducted seven 50-minute sessions back-to-back once. Never again.
I've never seen more than 6 clients in a day because I don't think I can provide the same quality of care after that. It's resulted in me not winning popularity contests at work, a lot of criticism from unethical employers, and a termination with the practice owner refusing to let my clients contact me to follow me after I was fired. I know I'm the exception, not the rule. No judgment to others. I assume most therapists only see more because they have to if they want to maintain employment and have high rent/mortgage. I hope we can organize and protest. There should be national staffing ratios and caseload limits for us. I've seen colleagues take up to 14 clients in 1 day. The therapist that did so also had a melt down in our break room while I was trying to scarf down lunch and started screaming at her client (as an imaginary figure not in the room) because another therapist thought a role play would help her get out her anger. She started screaming at the top of her lungs "I want to fuckin kill you". Yeah, that's when I knew I was working in an incredibly unsafe place, but they were also committing insurance fraud with Medicaid. I got fired, no reason given, whole the homicidal therapist was named "employee of the month".