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[quote=Anonymous][quote=Anonymous]I'll play...out of network psychologist, additional training after, practice out of my home (virtual & in person), a bit under $200 per hour, patients range from those who started last month to my longest at 13 years, network of dc colleagues, in practice about 15 years.

1. It took many years to get here. Top of the line training, supervision and my own long (expensive) but deep psychotherapy. I estimate training and my  therapy at over 500 k during my lifetime. Since age 22 when I was a psych major and popped into therapy sporadically to ongoing, deep treatment into my midlife. 
2. You can take someone only as far as you yourself have gone. No shortcuts. You can't ask patients to do work you yourself have not done. They sense if you walk the walk and have the depth. That comes over time with experience and expensive training and supervision. 
2. People who pay out of pocket expect a lot and rightly so.  Deliver something of deep value, something meaningful to them, something helpful or they will go. Understandably. And that differs for each person and you have to work intellectually and emotionally to truly understand who they are and what they are saying on multiple levels. Then you must decide how to intervene, your technique, which takes years to explore and never ends. But the level of listening is active and at times, by the end of some days, exhausting.
3. It's demanding, gratifying, sometimes deeply sad, sometimes deeply enjoyable and everything in between, hour by hour, day by day, week by week. 
4. You learn to plunge the depths and love your patients and then you bear the goodbye. You work with loss, fear, pain,  suffering and existential dread. You do this with your own therapist too. You learn to bear pain and grief, personally and professionally. 
5. Whatever inner issue or family issue at play, you must show up for your patients. Which means keeping your personal life as stable as possible, to the best of your ability. Over years.

I love what I do, I'm grateful to have had this rewarding career and I hope I can continue to do it for several more years. But it was and is at times still a hard road and there are much, much easier ways to make money. [/quote]

I'm a social worker in private practice, and I echo most of this, particularly 2 and 5.

re #2 - I see 5-7 clients a day for 50-60 minute sessions. Some days, I don't get a break of more than a minute or two for hours. Today I have 6 clients and a supervision group (attending, not running, that's tomorrow). Realistically, by the end of the day, I will be carrying around the personal stories and likely intense pain of 7-10 people other than myself. At the end of the day, it can be hard to remember what happened at the beginning of the day, because you've lived 7-10 lives since then. I proactively schedule a yoga class for Wednesdays at 6:30 because I've learned from experience that I need that wind-down on days like this.

Re #5 - While I've been in private practice, I have had a baby and negotiated how to take maternity leave in this profession, which was nothing like when I took maternity leave in the first time when I worked admin in a nonprofit. My kids have had all the daycare illnesses and school events that everyone else's have had. I had to figure out how to be a therapist AND teach my older kid 4th grade AND parent my younger kid, who was 18 months old at the start of the pandemic. My dad died last summer on a Tuesday. I was at work Monday and Wednesday of week, and I didn't tell any of my clients anything about it because bringing that kind of intensity into the room would've made it hard for them to talk about their problems.

I have no desire to ever do anything different with my professional life. I might go back into some kind of agency work later if I want to get out of direct service, but I think that I make great money for the work that I do and the practice that I'm in/have built is stable enough that the biggest stressors are things like #2 and #5 plus occasional annoying billing related things.[/quote]

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