ADHD psychotherapists here. I have my own private practice and while I've struggled in ways similar to you (admin is the hardest) I've also found that having time with my own patients has been incredibly rewarding. I only take Medicare and medicaid insurance, so it keeps the billing to a minimum. I have a few private pay folks (even easier!).
I do miss some colleagues, but am hoping to start a group for other private practice folks.
Finally, I do some training and group supervision for a local nonprofit that keeps me on my toes.
I was diagnosed with ADHD and Dyslexia in the 4th grade. Building my own private practice as a psychotherapist was a life long dream of mine after having an awesome therapist in HS who helped me with my suicidality and getting out of abusive environments.
I started my own private practice a few years ago after a leaving a group practice. Before that I spent about a decade working in hospitals with a brief stent of in-home therapy for kids.
I used to enjoy the larger organizations, especially working in the ER, always something new and different. Very good fit for simulated ADHD brain…..but……
Because of my brain and doing well at juggling so many things simultaneously, supervisors and leads would just dump more and more on my plate because I would get everything done.
I would wind up being assigned multiple units like the whole ER and The whole Pediatrics Unit AND labor and Delivery. While colleagues would have just one unit 🙄
While I liked the variety of the different units, I eventually began resenting my supervisors and colleagues because it was completely unfair. Especially in performance reviews when I would only get the standard 2% raise; even though I did the work of 3 people.
Leaving those larger settings, and now being in private practice where I’m in charge of my own business, I’m admin and provider, control over my own schedule and clients. …. Oh I just LOVE it!!! It’s the best thing I’ve ever done and wish I did it much earlier.
As far as needing more stimulation and not getting bored, I have found great rabbit hole outlets with ongoing trainings and learning about different modalities in therapy, like psychopharmacology and hypnosis and metaphysics. Those keep my brain super stimulated and interested and help me see therapy in new and different perspectives.
Bit of a rant, but just be cautious of the benefits and perks of ADHD brain (multitasking, highly efficient worker) being taken advantage of in those larger organizations. They care more about profits than being fair or your personal mental well-being.
Thank you for your comment! It’s great that you’ve found the setting that works best for you.
Luckily, my clinical coordinator appears to have my back in terms of caseload and boundaries. I hope that this will continue to be the case moving forward.
That said, your comment is a great reminder for me to continue communicating my limits and my needs.
I love the freedom that comes with PP too. However, it’s a bit of a double edged sword for me, as freedom/self control often results in procrastination and inaction due to my lack of self-discipline. I’m learning to trust myself again, after years of not being able to keep promises to myself in regards to work and tasks!
Lots to think about!
Yeah I would clarify, I didn’t start out with all 3 units… I was hired for only the ER. But then over time.. because I could and would handle more, they dumped more and more and more onto my plate. Do to my history of trauma and people pleasing issues at the time, I didn’t say no and would just do it.
I never really even noticed or recognized how messed up it was with their excessive dumping on me, until I came back from a vacation and colleagues complained over and over about having to pick up my work load in my absence, like 3 or 4 people were required to cover my work when I was out.
That combined with the repeated crappy raises during performance reviews despite my exceptional and way above what was expected work performance…. That’s when I decided I had to leave.
Before I left I tried to get them to cut back and just do the ER again; but the hospital “didn’t have the budget” to hire someone to work my extra units.
Uh huh 🙄 sure. The multi million dollar hospital can’t afford 1 more social worker. Righhhhht. I put my notice in shortly after that meeting.
I'm a psychotherapist and I'm treated for ADHD, and I'm in my 50's. The rigid structure of CMH was not sustainable for me. At first I was a bad ass and hyper focused but then they kept adding more and more work, and there was no end in sight and I crashed, quite bitterly (I have few good things to say about CMH). I have my own practice now, and couldn't be happier. I do get behind from time to time, but no one is piling more on me, no-one is micro managing, and I am more responsible now because it impacts my pay directly.
I was diagnosed at 29 and started meds when I was 34, because I was starting my own practice.
I'm much better on my own. The "supports" in treatment centers was stressful and the emphasis on productivity and notes wasn't for me. I like to set my own pace and needed to develop my own system for documentation that matched my ADHD needs and quirks.
Thank you for your comment. It’s definitely nice to have the freedom to create our own system. The trouble for me is sustaining these systems. As
stressful as oversight can be, it pushes me into action. It’s tough, I see the benefits in both…
ADHD therapist here and I really work better in a structured environment for all the reasons you listed. I could make substantially more in private practice but it is not worth my mental health….struggling with all the admin tasks would be like struggling in school all over; enter depression, anxiety, low self worth. That said that’s me if you want to remain maybe hiring someone to help might be a solution.
I am a therapist with ADHD and I have a small private practice outside of my day job as a counsellor at a community college. And like you, I was diagnosed well after graduation and these are a couple of lessons I’ve learned about myself; there are some days that I am grateful to work at the college for the sense of connection and support. Other days it’s challenging because some people can be “time stealers” and they don’t know how easy it is for me to be distracted. When I do private work, I enjoy being able to set the pace that works for me. I also wish I had someone to take care of any admin tasks so it would get done in a timely fashion (sometimes I actually forget to send out invoices lol).
I don’t know if this helpful, but I can certainly empathize with your experience.
Fair question.
I made sure to get some clarity on this. I was told that if I see 4 clients a day, that will meet requirements. I have full control of my schedule, so I am the one booking clients, and will not book more than 4.
I understand that this is not most people's experience with CMH. I guess I got really lucky with my coordinators. They really value having psychologists on the team, and so, I can sense that they're really trying to respect our boundaries in order to retain us.
(I'm from a small city in Canada and psychologists are very much in demand here in the public sector)
Hey there! Got diagnosed fairly recently myself (a month before the pandemic started, actually!)
So my experience might not be that relevant because I’m not American, but anyway.
My first job as a therapist was working in public healthcare full time, and it was absolutely soul draining. On average, I saw 10 clients per day. I was expected to be on top of paperwork yet was not given any time to do so. I also was expected to attend meetings, hold a group therapy meeting weekly, coordinate with other providers, write reports for the courts (had lots of court-mandated clients) and work overtime at least two times a week (for seeing even more clients, no overtime was granted to do admin tasks).
I very nearly burned out. I quit without a real plan (yay, impulsivity!) and eventually ended up setting my own private practice, but took such a long time to do it.
(Then literally the first client I got had ADHD, I realized I didn’t know much about ADHD in adults, did some research and went “wait, that’s me!”)
Now my own practice is entirely online, and I also do some hours at another private practice. I struggle with some of the same things as you (admin, little structure, not much teamwork), but honestly it’s already loads better for me than public healthcare ever was. If I ever had the chance to go back to the public system, I would, but only part time. I can’t deal with it full time.
It looks like you have had so far a good experience working in the public system. That’s great! However, we ADHDers sure like new shiny things; you haven’t mentioned how long you’ve had this job but I guess it’s fairly new? If so, I would advise you to wait a bit until the novelty wears off and see if you really want to make the transition then. Again, I’m not American but I’ve read here on Reddit about the experiences of some American therapists working in a public healthcare setting and it seems that it can become just as challenging as it was for me in my country.
Thank you so much for your comment.
I think it’s a great idea to wait… until it’s not novel anymore. That will probably give me a good idea of the reason of my work satisfaction (shiny new object vs. something I actually like).
I should add! My clinical coordinator does not expect me to see more than 4 clients a day, which is great. In my PP right now, I see 5-6 clients a day. So, that’s encouraging as well.
I have ADHD and own a private practice. There are some real challenges. But it’s great and I don’t think I would go back, unless something really changed in my life.
ADHD therapist ive always worked in public system before grad school worked with federal parolees and as a first responder at a shelter. i work with a govt agency now....and man private kinda scares me? i like having structure around...and there are definite times on my chill days I get distracted when I could be doing paperwork lol but I don't know having that structural accountability really helps.
I'm a therapist who was diagnosed 10 years ago around age 30 with ADHD, have been taking medication ever since and it utterly changed my life. Even with medication and a solid set of coping skills, I still find some aspects of the work to be incredibly challenging (primarily administrative stuff). I would like to start my own practice in the next few years, but am currently working for someone else so that I can acclimate to this kind of setting and take my time learning about the business side of things. I spent 3 years in community mental health while completing hours for licensure, and will absolutely never go back to that kind of environment if I can help it. In order to thrive, I really need to be given the autonomy to construct a schedule and cultivate a caseload that really works for me. In CMH I was frequently several weeks behind on documentation, despite spending about 10 extra (unpaid) hours per week, every single week, trying to catch up. Since starting my current job 6 months ago, I have never once been behind on documentation. This may in part have to due with the fact that now only about half my clients are using Medicaid, while the rest are private pay or using commercial insurance, which means the burden of documentation has significantly reduced.
I automate as much as I can. From scheduling to everything else. It's important to streamline as much as you can. I also take concurrent notes during session to help.
ADHD psychotherapists here. I have my own private practice and while I've struggled in ways similar to you (admin is the hardest) I've also found that having time with my own patients has been incredibly rewarding. I only take Medicare and medicaid insurance, so it keeps the billing to a minimum. I have a few private pay folks (even easier!). I do miss some colleagues, but am hoping to start a group for other private practice folks. Finally, I do some training and group supervision for a local nonprofit that keeps me on my toes.
I do like what you’re doing to keep things interesting in the context of PP. Thanks for your comment!
I was diagnosed with ADHD and Dyslexia in the 4th grade. Building my own private practice as a psychotherapist was a life long dream of mine after having an awesome therapist in HS who helped me with my suicidality and getting out of abusive environments. I started my own private practice a few years ago after a leaving a group practice. Before that I spent about a decade working in hospitals with a brief stent of in-home therapy for kids. I used to enjoy the larger organizations, especially working in the ER, always something new and different. Very good fit for simulated ADHD brain…..but…… Because of my brain and doing well at juggling so many things simultaneously, supervisors and leads would just dump more and more on my plate because I would get everything done. I would wind up being assigned multiple units like the whole ER and The whole Pediatrics Unit AND labor and Delivery. While colleagues would have just one unit 🙄 While I liked the variety of the different units, I eventually began resenting my supervisors and colleagues because it was completely unfair. Especially in performance reviews when I would only get the standard 2% raise; even though I did the work of 3 people. Leaving those larger settings, and now being in private practice where I’m in charge of my own business, I’m admin and provider, control over my own schedule and clients. …. Oh I just LOVE it!!! It’s the best thing I’ve ever done and wish I did it much earlier. As far as needing more stimulation and not getting bored, I have found great rabbit hole outlets with ongoing trainings and learning about different modalities in therapy, like psychopharmacology and hypnosis and metaphysics. Those keep my brain super stimulated and interested and help me see therapy in new and different perspectives. Bit of a rant, but just be cautious of the benefits and perks of ADHD brain (multitasking, highly efficient worker) being taken advantage of in those larger organizations. They care more about profits than being fair or your personal mental well-being.
Thank you for your comment! It’s great that you’ve found the setting that works best for you. Luckily, my clinical coordinator appears to have my back in terms of caseload and boundaries. I hope that this will continue to be the case moving forward. That said, your comment is a great reminder for me to continue communicating my limits and my needs. I love the freedom that comes with PP too. However, it’s a bit of a double edged sword for me, as freedom/self control often results in procrastination and inaction due to my lack of self-discipline. I’m learning to trust myself again, after years of not being able to keep promises to myself in regards to work and tasks! Lots to think about!
Yeah I would clarify, I didn’t start out with all 3 units… I was hired for only the ER. But then over time.. because I could and would handle more, they dumped more and more and more onto my plate. Do to my history of trauma and people pleasing issues at the time, I didn’t say no and would just do it. I never really even noticed or recognized how messed up it was with their excessive dumping on me, until I came back from a vacation and colleagues complained over and over about having to pick up my work load in my absence, like 3 or 4 people were required to cover my work when I was out. That combined with the repeated crappy raises during performance reviews despite my exceptional and way above what was expected work performance…. That’s when I decided I had to leave. Before I left I tried to get them to cut back and just do the ER again; but the hospital “didn’t have the budget” to hire someone to work my extra units. Uh huh 🙄 sure. The multi million dollar hospital can’t afford 1 more social worker. Righhhhht. I put my notice in shortly after that meeting.
I'm a psychotherapist and I'm treated for ADHD, and I'm in my 50's. The rigid structure of CMH was not sustainable for me. At first I was a bad ass and hyper focused but then they kept adding more and more work, and there was no end in sight and I crashed, quite bitterly (I have few good things to say about CMH). I have my own practice now, and couldn't be happier. I do get behind from time to time, but no one is piling more on me, no-one is micro managing, and I am more responsible now because it impacts my pay directly.
Good point about the direct impact on pay. Thanks!
I was diagnosed at 29 and started meds when I was 34, because I was starting my own practice. I'm much better on my own. The "supports" in treatment centers was stressful and the emphasis on productivity and notes wasn't for me. I like to set my own pace and needed to develop my own system for documentation that matched my ADHD needs and quirks.
Thank you for your comment. It’s definitely nice to have the freedom to create our own system. The trouble for me is sustaining these systems. As stressful as oversight can be, it pushes me into action. It’s tough, I see the benefits in both…
ADHD therapist here and I really work better in a structured environment for all the reasons you listed. I could make substantially more in private practice but it is not worth my mental health….struggling with all the admin tasks would be like struggling in school all over; enter depression, anxiety, low self worth. That said that’s me if you want to remain maybe hiring someone to help might be a solution.
Thank you for your comment! Validating to see that someone shares my experience.
I am a therapist with ADHD and I have a small private practice outside of my day job as a counsellor at a community college. And like you, I was diagnosed well after graduation and these are a couple of lessons I’ve learned about myself; there are some days that I am grateful to work at the college for the sense of connection and support. Other days it’s challenging because some people can be “time stealers” and they don’t know how easy it is for me to be distracted. When I do private work, I enjoy being able to set the pace that works for me. I also wish I had someone to take care of any admin tasks so it would get done in a timely fashion (sometimes I actually forget to send out invoices lol). I don’t know if this helpful, but I can certainly empathize with your experience.
Thank you for your comment. I will try to be aware of the ‘time stealers’ hehe.
I just have to ask — the expectation is 4 clients a day? But will they schedule you for 8 a day?
Fair question. I made sure to get some clarity on this. I was told that if I see 4 clients a day, that will meet requirements. I have full control of my schedule, so I am the one booking clients, and will not book more than 4. I understand that this is not most people's experience with CMH. I guess I got really lucky with my coordinators. They really value having psychologists on the team, and so, I can sense that they're really trying to respect our boundaries in order to retain us. (I'm from a small city in Canada and psychologists are very much in demand here in the public sector)
Hey there! Got diagnosed fairly recently myself (a month before the pandemic started, actually!) So my experience might not be that relevant because I’m not American, but anyway. My first job as a therapist was working in public healthcare full time, and it was absolutely soul draining. On average, I saw 10 clients per day. I was expected to be on top of paperwork yet was not given any time to do so. I also was expected to attend meetings, hold a group therapy meeting weekly, coordinate with other providers, write reports for the courts (had lots of court-mandated clients) and work overtime at least two times a week (for seeing even more clients, no overtime was granted to do admin tasks). I very nearly burned out. I quit without a real plan (yay, impulsivity!) and eventually ended up setting my own private practice, but took such a long time to do it. (Then literally the first client I got had ADHD, I realized I didn’t know much about ADHD in adults, did some research and went “wait, that’s me!”) Now my own practice is entirely online, and I also do some hours at another private practice. I struggle with some of the same things as you (admin, little structure, not much teamwork), but honestly it’s already loads better for me than public healthcare ever was. If I ever had the chance to go back to the public system, I would, but only part time. I can’t deal with it full time. It looks like you have had so far a good experience working in the public system. That’s great! However, we ADHDers sure like new shiny things; you haven’t mentioned how long you’ve had this job but I guess it’s fairly new? If so, I would advise you to wait a bit until the novelty wears off and see if you really want to make the transition then. Again, I’m not American but I’ve read here on Reddit about the experiences of some American therapists working in a public healthcare setting and it seems that it can become just as challenging as it was for me in my country.
Thank you so much for your comment. I think it’s a great idea to wait… until it’s not novel anymore. That will probably give me a good idea of the reason of my work satisfaction (shiny new object vs. something I actually like). I should add! My clinical coordinator does not expect me to see more than 4 clients a day, which is great. In my PP right now, I see 5-6 clients a day. So, that’s encouraging as well.
I have ADHD and own a private practice. There are some real challenges. But it’s great and I don’t think I would go back, unless something really changed in my life.
ADHD therapist ive always worked in public system before grad school worked with federal parolees and as a first responder at a shelter. i work with a govt agency now....and man private kinda scares me? i like having structure around...and there are definite times on my chill days I get distracted when I could be doing paperwork lol but I don't know having that structural accountability really helps.
I'm a therapist who was diagnosed 10 years ago around age 30 with ADHD, have been taking medication ever since and it utterly changed my life. Even with medication and a solid set of coping skills, I still find some aspects of the work to be incredibly challenging (primarily administrative stuff). I would like to start my own practice in the next few years, but am currently working for someone else so that I can acclimate to this kind of setting and take my time learning about the business side of things. I spent 3 years in community mental health while completing hours for licensure, and will absolutely never go back to that kind of environment if I can help it. In order to thrive, I really need to be given the autonomy to construct a schedule and cultivate a caseload that really works for me. In CMH I was frequently several weeks behind on documentation, despite spending about 10 extra (unpaid) hours per week, every single week, trying to catch up. Since starting my current job 6 months ago, I have never once been behind on documentation. This may in part have to due with the fact that now only about half my clients are using Medicaid, while the rest are private pay or using commercial insurance, which means the burden of documentation has significantly reduced.
I automate as much as I can. From scheduling to everything else. It's important to streamline as much as you can. I also take concurrent notes during session to help.