I meet with groups of therapists every single week, which gives me a bird's eye view of what's going on in our field. And lately I keep hearing the same thing, in different words, from clinicians at every career stage:
“Is it just me, or is this field getting harder?”
“I'm not sure I can keep doing this work.”
It is not just you.
The strain you're feeling is a reasonable response to a genuinely difficult season in our field. So let's name what's actually happening, because we can't address what we won't look at.
The courtroom we've all been watching
Many of us have followed the Lindsay Clancy trial. A mother, a nurse, a person who was in treatment, and three children who are gone. It is unbearable on every level, and we hold that grief first. The system failed her.
But underneath the grief, I hear something additional from clinicians: fear. Part of what played out in that courtroom was a detailed dissection of her care. What was prescribed, what was documented, what was asked and not asked. Every clinician watching has had the same quiet thought: that could be my chart on that screen.
If you've been second-guessing your risk assessments lately, or lying awake reviewing a session in your head, you are not being paranoid. You are responding to something real.
The headlines that blame us
This summer, a national publication asked whether therapists are to blame for adult children cutting off their parents. In one survey, about a third of estranged parents believed their child's therapist influenced the cutoff.
A third of those parents believe WE did that.
You and I know what actually happens in our offices. Ethical therapists don't hand out estrangement like a prescription. We help clients understand their relationships and their options, then we support their autonomy, sometimes through decisions we wouldn't have chosen for them. But that nuance doesn't make it into a headline. So we're practicing under a cultural narrative that paints us as family-wreckers, and that is exhausting in a way that's hard to explain to anyone outside our field.
The insurance grind
Then there's the piece nobody outside the medical profession sees. Claims denied by algorithms no human ever reviewed. Reimbursement rates flat or shrinking while every cost of running a practice goes up. Hours spent appealing sessions you already provided in good faith.
I want to say this plainly: fighting an AI-generated denial after a full clinical day is not a personal failure of efficiency. It is an unreasonable burden being placed on you.
The values question in the room
On top of all of this, a new wave of national coverage is questioning whether therapists steer clients with our own values and politics. It's a fair question to sit with. But the timing is brutal. Clients are bringing the political divide into session more than ever, and we're being asked to hold all of it with perfect neutrality while headlines suggest we can't be trusted to.
That is a lot to carry. And most of us are carrying it alone, in a home office, with no colleague down the hall to turn to and say “did you see that article?”
So what do we do about it?
Here's the part where I tell you that naming it matters, AND we need to act. Both things are true.
Get your consultation in place before you need it. This is the single most protective thing you can do right now, clinically and legally. Regular, documented peer consultation is how you catch blind spots in risk assessment and think through a values-loaded case before it becomes a problem. “I consulted regularly and documented it” is a very different position than “I decided alone.”
Tighten your documentation. Not out of fear. Out of self-respect. Document your risk assessments, your clinical reasoning on hard calls, and your consultations. Future you will be grateful.
Fight the denials, and report the pattern. Appeal AI-generated denials; a share of appealed claims get overturned. Then file complaints with your state insurance commissioner and report patterns to your professional association. Individual appeals fix your Tuesday. Reported patterns are how regulation eventually changes.
Add your voice. NASW, ACA, AAMFT and APA all have active advocacy efforts around reimbursement, AI in claims review, and mental health parity. Twenty minutes of participation is a genuine antidote to helplessness.
Check your own tank. Your own therapy. Your news limits. Your caseload honesty. You already know this. Consider this your permission slip to actually do it. IT IS OK to protect yourself first so you can keep doing this work.
And stop carrying it alone. Every hardship I've named gets heavier in isolation and lighter in trusted company. The clinicians who are weathering this season best are not the ones with the fewest hard cases. They're the ones with colleagues who know their work, hear their doubts, and remind them of who they are.
