Kia Ora! As many of you already know, I’ve taken on the role of Clinical Director and Board Member at the ACFB Fund, a New Zealand charity that provides funding for mental health services to Kiwis who don’t have access to other funding.

Very recently, I received approval from the New Zealand Psychology Board and became a registered psychologist in New Zealand. You can learn more about my international practice on my clinical website. The first thing I did was request vetting from ACFB to be able to offer discounted ADHD and autism evaluations. The second thing I did was put together some information for anyone considering seeking an assessment.

If you’re a New Zealander who needs an evaluation and financial support to access this service, please email info@acfbfund.org.nz.

You Live in America. Why Do You Practice in New Zealand?

In March 2020, my husband and I had both accepted job offers in Auckland. We told our parents, I put in notice at my job at the time, and our veterinarian medically cleared our cats to fly. Then, I attempted to schedule my immigration physical and was told, “We’ve just had our first confirmed community transmission case of COVID and are closed for non-essential procedures. Please call back in two weeks.”

Let me tell you, that was a long two weeks.

In the meantime, I applied for licensure, thinking I would be able to move forward soon. Eventually, my new employer had to find someone who could commit to a start date, and the New Zealand immigration office was not processing applicants who were not physically in the country. I couldn’t just go to New Zealand with no income and no timeline on when I would be able to start working, so I had to give up the job. When I gave up the job, the board allowed me to set my licensure status to “active, non practising,” meaning that I was qualified as a psychologist in New Zealand but not actively providing clinical work.

I then met Ashley Cairns in a Facebook group for therapists practicing telehealth in a pandemic, and I loved her idea for a mental health organization that helped therapists make a living wage while simultaneously making mental health care affordable to our clients. Once she was able to secure funding for psychological assessments, I contacted the board to activate my license, and here we are!

Is That Legal?

Yes! I would never operate a practice that did not meet legal and ethical standards, and I would never collaborate with an organization that I felt was not meeting these standards. The Psychology Board approved me to practice, and my application clearly indicated my residential and business addresses, both in South Dakota. I also informed my malpractice insurance, and they stated that I can provide telehealth services from anywhere as long as I am licensed at the client’s location and the relevant licensing board granted approval.

Can Someone Get a Diagnosis Online?

We live in a time when anyone can create a website, so it is important to vet resources. There are organizations out there that offer fraudulent mental health services – I have personally reported several to the Better Business Bureau in an effort to get them taken down.

That being said, a wealth of studies have emerged in the last few years showing that telemental health (including psychological assessment) has comparable outcomes to in-person psychological services, as long as the provider is qualified to provide this service.

Are You Qualified to Provide This Service?

Short answer: Yes.

Long answer: I am a certified telehealth provider. In 2016, I helped my organization begin offering telehealth services in South Dakota, with an emphasis on legal, ethical, competent care. When the world went home in 2020, I saw hundreds of therapists panic about the transition. It’s actually why I first started this website – I found that it was not difficult to go online with my practice, and I wanted to help others do the same. I’ve taught a telehealth certification course and written two books on telemental health with kids.

When it comes to psychological assessment, I have specialized training in telehealth. In fact, I teach a continuing education course for other psychologists who want to learn how to provide assessments via telehealth.

Additionally, any psychologist who conducts ADHD and autism evaluations needs specialized training in these evaluations. I have this training and am in the process of creating trainings to ensure that other providers know how to provide neurodiversity-affirming care when providing ADHD and autism evaluations. I have written a book on mental health with autistic clients, which is coming out in 2024.

Is This An Official Diagnosis?

Yes, I am qualified to conduct psychological evaluations and grant official diagnoses when a client meets the diagnostic criteria. With appropriate release, I can forward your assessment to others on your treatment team (counsellors, prescribers, et cetera), and I am happy to answer any questions they have about my qualifications as well.

Do You Have Cultural Competency to Practice in New Zealand?

I believe cultural competency is a lifelong journey, not a finish line. The New Zealand Psychology Board requires all foreign psychologists to receive supervision on cultural competency, and I have supervision from Dr. Ember, who has experience training foreign psychologists in cultural competency with the Maori community.

Additionally, I have voluntarily sought secondary supervision from Jenny Manuera, Maori counsellor, to ensure I am learning from the community I serve.

I am also taking ongoing continuing education courses led by Maori individuals.

How Much Do Assessments Cost?

Typically, ADHD and autism assessments in New Zealand cost between $2,000 and $3,000NZD. I offer them for $1,500NZD. The ACFB Fund has funds to offset this cost for those who cannot afford it, so depending on financial need, your cost could be as low as $150. These prices include all tax, etc.

Why Do Your Assessments Cost Less?

I am efficient. Starting from my first clinical placement as a graduate student, I have consistently gotten feedback that my reports were high quality but took me less time to complete than my peers. That isn’t meant as a brag; it is simply a fact. I also run my business with minimal overhead. Instead of using these skills to increase profits, I pass the savings on to my clients.

Additionally, while I am also a human being with bills to pay, I prioritize giving back. Some of the funding for ACFB’s psychological evaluations comes from me volunteering my time to be able to offer this service.

How Can I Apply for Funding?

The application for funding is available here. You can indicate approximately how much funding you’ll need ($1500 – what you can afford to pay).

Why Is Your Hair Blue?

Because I like it. Why isn’t your hair blue?

The mental health field has only recently started to acknowledge the existence of autistic burnout, a phenomenon distinct from (but similar to) depressive episodes or other forms of burnout or exhaustion. Masking is one thing that can cause autistic burnout – essentially, pretending to be neurotypical and attempting to present with neurotypical communication, behavior, and sensory experiences when this is not how your brain works can wear a person down over time.

When masking exhausts you to the point of burnout, autistic traits can become more “obvious” to the people around you because you don’t have the energy to uphold the mask. That is why many providers used to think of burnout as a form of regression (skill loss). It is also why masking is not an appropriate therapeutic goal, and why so many autistic adults who were put through therapies to induce masking behavior (ABA) report that their experience was traumatic.

If you or your autistic loved one is in burnout, it is tempting to try and push for “back to normal” as quickly as possible. They may fall behind academically or miss work, leading to more stress. However, “back to normal” is not a healthy goal if “normal” is what caused the burnout in the first place.

These tips might help with managing the symptoms of burnout, fostering recovery, and preventing future burnout episodes.

Name It To Tame It.

This term is used in therapy to note how acknowledging our mental state can start to foster change even if no additional steps have been taken to alleviate symptoms. Simply by realizing you are experiencing burnout, you can feel a little better. You can start being gentler with yourself because you understand what is happening and be more aware of what you need during this time.

Rest, and Rest Some More.

There are not a lot of evidence-based treatments for autistic burnout at this time, in part because we have only recently acknowledged this as a distinct phenomenon from other mental health concerns. What we do know is that rest is imperative. Burnout is like a concussion, and the main way to help is to reduce stimulation and activity until you recover.

This is not always feasible – not everyone has the option to reduce work hours, take time off, or let go of responsibilities in their life so that they can recover from burnout. Know that making small adjustments where you can goes a long way.

Unmask.

Again, not everyone can safely unmask in their environment. However, as much as possible, reducing expectations around masking and presenting in neurotypical ways can go a long way in alleviating burnout. Remember, if masking contributed to your burnout, it might not be helpful to try and re-mask later on. You are redefining your needs.

You might not feel like you even know who you are without your mask if you have been doing it your entire life. Connect with the autistic community and learn more about the process of unmasking. Neuroclastic is a great resource for this information.

Create a Safe, Sensory-Friendly Environment.

As you unmask, you will likely start to notice more about your environment and its impact on your sensory experiences. Many autistic people are more sensitive to lights, noises, textures, visually busy areas, and temperature. Notice what kinds of sensory experiences give you calm feelings and what agitates you, and make changes to your environment to meet your sensory needs.

Learn To Say “No.”

We are all allowed to set boundaries around our time, energy, and relationships. Unfortunately, even though every person has this right, many are taught that they are not allowed to set or reinforce their boundaries. This is particularly true for autistic people, many of whom have experience being told that their needs are “too much,” that they are “overreacting,” or that they could do something that harms them if they just “tried harder.” This treatment, you guessed it, contributes to burnout.

It can be difficult to set boundaries if we are not used to having that option. But you have the right to have your needs met, and that includes saying “No” to requests that make you uncomfortable or cause you distress. Practice saying no to the things that burn you out.

Consider Therapy.

I want to start by acknowledging that many autistic people have experienced harm in the mental health system. Many “therapies” developed for autism focus on making the individual appear less autistic rather than centering the client’s needs and experiences. In fact, some of these therapies contribute to burnout!

At the same time, therapists can help with mental health episodes like autistic burnout. A therapist can create a safe space to process your emotions, help you problem solve coping skills, and build interoception and insight to be able to recognize your needs and get them met.

I recommend finding a therapist who identifies as neurodiversity-affirming, like the ones on ND Therapists, who recognize that neurodivergence is not a flaw to be fixed and commit to meeting clients where they are. It is okay to ask your therapist questions, like how they conceptualize autism and how they approach therapy with autistic clients, before you book with them. This can help you make sure that they are a safe person who understands how to support you in your burnout.

Get more mental health resources on my Patreon!

When I was in my undergraduate program, I had a second major in philosophy, and I did my capstone project on cognitive dissonance. I was fascinated by the way that we can twist facts and logic to justify our behaviors and thoughts. I have caught myself in cognitive dissonance, and I am sure I still have some beliefs based on my own misconstruction of what is “right.”

I think that this is something mental health professionals need to be aware of. While I truly believe that most of us are in this field with good intentions, clients still experience harm within the system. There may be providers out there who got into this field with the intent of hurting people, but I have seen many cases where a provider behaves in a way that harms the client, and the clinician truly believes they did nothing wrong.

It works like this: I believe I am a good person. Therefore, I strive to do good things. Therefore, the things that I do are good things. Therefore, I did not do a bad thing.

The fallacy here is that no one does good things every time. We all make mistakes, often because we did not realize that something was harmful until after the fact. Unfortunately, what happens often is that it then becomes distressing and even impossible to acknowledge a mistake. So, when it comes to light that a therapeutic intervention does more harm than good, many therapists who used this intervention will dig their heels in. I’m a good therapist! I would never harm my clients! Therefore, this intervention isn’t always harmful! It wasn’t harmful when I did it because I’m a good therapist who doesn’t do harmful things!

This is a dangerous mentality because that therapist is likely to continue using the intervention. Why stop when you do not recognize your behavior as harmful?

It is essential that we change our thinking. Instead of: “I believe I am a good person; therefore, the things I do are good things,” we need to shift to: “I try to make the right choices; therefore, I will strive to make the best decision with the information that I have. If I later learn new information, that does not make me a bad person, but it means I need to adjust my choices in the future.”

I had to un-learn a lot after I finished my graduate training, and I am still learning more every day. I used to recommend things I would never suggest today. Does that mean the choices I made years ago make me a bad person? I certainly hope not, but there are many I would do differently now. Because I strive to do my best, I regularly assess my clinical choices and note when I could have done something better.

Like Maya Angelou said, “Do the best you can until you know better. Then, when you know better, do better.”

Recently, California passed a law making it easier to force someone into treatment for substance dependence or other mental health issues. As with many things, I have opinions, mainly that mandating mental health treatment is not a good idea.

Yes, there are times when a person needs help but is not willing to seek it. Under the current system, when someone is actively suicidal, the options are death or involuntary commitment. I don’t have every answer, but it certainly is not “put more people in treatment against their will.” In fact, I believe if we fixed many of the barriers to getting support and resources, we could prevent people from getting to the crisis points that we use as justification for these holds.

Informed Consent

According to the APA Ethics Code, 3.10, Informed Consent:

When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code.

In other words, we must obtain informed consent before providing mental health services. That means the client understands and agrees to the treatment. Other ethics codes have similar requirements.

Is it really “consent” if someone agrees to treatment because they are mandated to do so? Are they agreeing to treatment, or are they trying to escape or avoid an involuntary hold? It would be impossible to know.

Effectiveness of Treatment

Much of my therapy practice is children and adolescents (so much so that I wrote an entire book on ethics and clinical documentation with this population), a group that often comes for services because someone else told them to. Usually, it is the parent who decides that a minor needs treatment, and the adults provide consent.

Side note, even though it is considered legally and ethically permissible for someone else to make the minor’s medical decisions on their behalf, I am still required to get assent (explain treatment at a developmentally appropriate level and ensure that the client agrees to participate).

When a client does not want therapy, they tend not to engage. When they don’t engage, treatment does not help them. When they are forced to continue treatment against their will, they learn that mental health treatment is unhelpful, awful, and harmful. It is unlikely to be helpful.

While writing this blog post, I spoke to a friend who has been mandated into treatment in the past. They asked to remain anonymous but said that I could share from their experience:

I lied to get discharged earlier than I should’ve been able to. I was still in crisis but figured I had better chances of getting the support I needed outpatient than I did staying there.

This is a common occurrence in involuntary inpatient treatment. This likely contributes to the high instance of suicide and self-harm following discharge from such programs.

Harm and Abuse

Not only is it unlikely that mandated treatment can benefit clients, many face harm and abuse in the system. There is already a power dynamic in place within the healthcare system, and when the client does not have the option to refuse support, that increases the risk for abuse.

Listen to testimonials from people who experience abuse when in an involuntary hold. And many share that, when they express anger, frustration, or disagreement with staff or providers, they are further pathologized.

Imagine you are forced into treatment against your will. Not only does it not help you, but you are harmed in the course of your involuntary treatment. Later, you are ready to seek support. How likely are you to return to that system? Forcing people into care makes them less likely to seek help.

When involuntary treatment is the only resource we have, it feels impossible to imagine anything else. But with these systems causing more harm, expanding them is not the answer.

Do you get requests for ESA letters, and you’re unsure how to respond? This course provides considerations every therapist should be aware of, as well as step-by-step guidelines and templates for determining when an ESA is appropriate and how to write these letters. Sigh up now!

Cost: $50 for the course and continuing education certificate. There are no additional fees for this course. The fee offers you lifetime access to the self-guided home study course. Because you maintain lifetime access to the learning materials, no refunds are offered for this course.

Presenter: Dr. Amy Marschall, PsyD, Licensed Clinical Psychologist, certified in Trauma-Focused Cognitive Behavioral Therapy, trained in trauma-informed care.

Bio: Dr. Amy Marschall is a clinical psychologist licensed in South Dakota, North Dakota, Montana, Florida, South Carolina, Wisconsin, and New York. She is certified in TF-CBT and has extensive education in trauma-informed care, and she teaches Trauma-Informed Cognitive Behavioral Therapy with Children and Adolescents with PESI. Dr. Marschall is an author and speaker, and she has a full-time private clinical practice, Resiliency Mental Health. She also created a website to distribute mental health and therapy resources to the public.

Resiliency Mental Health is approved by the American Psychological Association to sponsor continuing education for psychologists. Resiliency Mental Health maintains responsibility for this program and its content.

Description: Requests for Emotional Support Animal letters have increased exponentially in recent years, leaving many mental health professionals uncertain about their competency to provide this service. This course dives into legal definitions and considerations around ESAs as well as what national licensing bodies state about providing these letters. It also covers various aspects of determining if a client is eligible for an ESA, crafting a letter that meets requirements while protecting professionals from liability, and working with clients who make these requests. Upon completion of the course, students will be prepared to determine whether ESA letters are an appropriate service for their practice and provide ethical, competent service.

This 180-minute presentation is three continuing education credits. It is pre-recorded for home study, to be completed at your own pace.

Objectives:

1. Differentiate types of assistance animals, including ESAs and Service Animals, and the rights, protections, and requirements associated with each.
2. Assess client appropriateness for an ESA through objective evaluation and treatment planning.
3. Develop a template for responding to ESA requests from clients, both for submitting an ESA letter or recommendation and for indicating that an ESA is not appropriate.
4. Practice educating clients about their rights and responsibilities for their ESA.

Target Audience: This is an introductory-level continuing education course for psychologists, counselors, clinical social workers, and marriage and family therapists who want to understand best practices to provide ESA letters to clients.

Statement Regarding Conflict of Interest: Dr. Marschall and Resiliency Mental Health have no financial or non-financial conflicts of interest to disclose.

Quick Note: This post contains an analysis of a problematic advertising trend I have seen. The trend concerns me as a neurodivergent person and as a psychologist. The language and opinions about disability justice and support services reflects my experience and expertise but is not the end-all, definitive “right” way to approach this topic. Make sure you listen to a variety of voices in the community – we are not a monolith! If you’re neurodivergent and disagree with my takes, that’s okay too. My stance is not more important or valid than yours.

In recent months, I have noticed an influx of Facebook advertisements promoting lawsuits against various companies, including baby food, over-the-counter painkillers, and medical procedures for “causing” neurodivergence. Usually they blame these companies for autism, but sometimes the lawsuit is about ADHD or another form of neurodivergence. Since most of the claims seem to focus on autism, that is what I will discuss in this post, but the topic is applicable to other neurodivergences too.

The adds all follow the same template: A law firm asks if you or your child is autistic (usually they use the person-first language (PFL) of “has autism,” which a 2022 survey showed 80% of the autistic community rejects. If an individual prefers PFL, that is valid, but those outside the community should respect the majority preference), and if you or your child was ever exposed to some product. If they were, the add claims, you are entitled to compensation because this evil, horrible company has cursed your family with autism, and what could be worse than that?

Many of these lawsuits target the medical industry and products that have definitively been proven to not cause autism, so they spread dangerous misinformation by making these allegations. If a parent decides, for example, not to vaccinate their child because they were misinformed that vaccines cause autism, and their child contracts a fatal, preventable illness, the anti-vaxxers who perpetuated that myth are to blame for that child’s death.

Furthermore, many in the autistic community see their neurodivergence as an inherent part of who they are – essentially, if you somehow “removed” or “cured” my autism, I would no longer be me. The message that parents should forego medical procedures that could keep their child healthy and safe because that procedure might make their child autistic tells every autistic person, “It is better for children to die of preventable illnesses than to grow up and be like you.”

No wonder autistic people are at higher risk for suicide compared to the rest of the population. (You can read more about this here, here, and here.)

So, not only do these lawsuits promote information that has been proven false, but they make statements that actively harm the autistic community. I highly encourage you to report these adds for spam and misinformation, because that is what they are. Instead of assigning blame for what “made” someone neurodivergent, we can support our neurodivergent loved ones and listen to them about their needs and priorities for care.

It is true that autistic people can experience challenges, some of which are caused by living in a world not designed for them and some of which come from disability. Each person, regardless of neurotype or disability, deserves to have their support needs met. (This is actually the topic of my next book. Stay tuned!) If you or a loved one is autistic and is looking for support, the Autistic Self-Advocacy Network, Autistic Women and Nonbinary Network, and Neuroclastic offer free resources and education from an affirming standpoint.

I have written before about the challenges that come with accepting insurance as a therapist, especially as a therapist running my own private practice. We want mental health care to be affordable, and we need to pay our bills. In theory, health insurance is supposed to pay providers a living wage in exchange for services, making care affordable and allowing us to do things like eat and have shelter.

This is not how things tend to pan out in practice. Instead, insurance companies undercut us with “negotiated rates” that often are not enough to offset our business expenses, and then claim therapists are “greedy” when we refuse to accept it. Meanwhile their CEOs pull in seven-figure salaries.

When I credential with an insurance company, I sign a contract agreeing to accept their rates for the services I provide, which is lower than my stated rate for services. I also agree not to tell anyone what that rate is, so I actually do not know if a given insurance company pays me more or less than another provider who is also in their network. (This is actually one of the ways that Medicaid is ahead of the game – they publish their rates for various billing codes on their website, so I know exactly how much (how little) I will make for each service.)

When I opened my private practice, I had to re-apply for credentialing with each insurance company even though I was already in-network through my old job. Credentialing includes both the provider and the organization, so I was credentialed to bill as long as I was working through that organization. That meant that I had some idea of what my negotiated rates would be because I knew what they were paying me at that organization. I was able to credential with a few companies because their rates are sustainable, allowing me to run my business, help my clients, and continue to survive. I let several go, though.

Depending on your contract, you can regularly ask for a rate increase from the insurance company. You also have the option to de-credential if the rates are not sustainable.

When deciding whether or not to accept a contract position, consider what rates you can sustainably accept. In my practice, I gave myself a higher cutoff for insurance reimbursement because it is important to me to be able to see Medicare and Medicaid clients, and those rates are only sustainable when my private insurance contracts are high enough to offset the loss.

Fair Health Consumer is a free tool that lets you check the going rate for different services based on your zip code. Input the code, and see the average in-network pay per session. This can help you negotiate when trying to get a rate increase and let you know which payers are under-valuing your work. It can also give you a sense for how your private pay rates compare to the area – I learned that I am apparently under-charging for cash pay. (This is fine with me, as I am achieving my business’s income goals and want to make mental health care more affordable where I can!)

When figuring out reimbursement rates, make sure to ask about all codes that you bill. For instance, the company that pays me the most for individual therapy is not the company that pays me the most for a psychological evaluation. Some pay more for family therapy than individual, some pay the same for both, and others will not cover family therapy at all.

Before signing, find out what the negotiated rate is for each service you will bill, and don’t be afraid to ask questions or counter-offer. You should also re-assess your rates and financial needs on a regular basis. One company tried to lower my negotiated rate, so I left their network.

Use this information to figure out which insurances can sustain your business. And if you have the time, call your reps and demand healthcare reform that includes holding insurers accountable and requires sustainable reimbursement rates!

As you likely already know, Slipper the Penguin eBook and paperback are both available now, with hardcover coming soon.

I usually do not read reviews on my books because it brings up feelings of rejection sensitive dysphoria if they are negative. Is becoming a professional author a great career choice if you have trouble handling feedback on your writing? Probably not, but I am in too deep to turn back now.

But a few people commented on Facebook that they had left positive reviews, and I like when people say nice things to me, so I had a look.

You all. Thank you so much! These made me smile and tear up. I’m so glad Slipper is resonating with so many of you!! Some have also shared on social media that their kids have really enjoyed the book and gotten into the story, which just makes me so happy.

If you haven’t bought your copy yet, you are missing out! Unless you are holding off to get a hardcover – in which case, thank you for your patience. As soon as I can get the formatting to look right, that will be available. Thank you for your support!

And once again, don’t forget to check out Abby Lastowski, my illustrator because she is fantastic!

Since I have had revenue streams on my mind lately, I thought it would be helpful to share important considerations when partnering/contracting/otherwise working with companies. There are hundreds of mental health startups, all claiming to have the solution for mental health care, but their quality varies, with many openly violating the laws and ethics codes we are required to uphold. Some blatantly mistreat the therapists they hire or grossly underpay us.

What do you need to keep in mind when choosing your partnerships?

Ethics

Many therapy startups are run by people in the tech field, with little or no input from mental health providers. These individuals are not bound by the ethical codes that a licensed mental health provider must follow and, although I would argue that they have a responsibility to be aware of and follow these codes, they typically choose not to.

Your licensing board will not accept “But it wasn’t me, it was the company” if you cross an ethical or legal line when working for one of these companies. It is up to each provider to ensure that they are working with ethical companies. Your integrity is on the line with every partnership you make.

Not to mention, why would you want to work with an unethical company?

HIPAA Compliance

If you are engaging in any kind of clinical work with a company, you must ensure that the company’s product, platform, and policies are all HIPAA compliant. Again, the tech folks creating these platforms might not be bound by our legal and ethical requirements, but we must still uphold them in our work.

Earlier this year, BetterHelp was fined for illegally selling client information to third-party advertisers. BetterHelp has been under scrutiny for years for illegal practices, but therapists continue to accept jobs with them.

If you knowingly work with a company that is violating HIPAA, you are violating HIPAA. Any client receiving a payout from BetterHelp’s recent fines could potentially report their specific therapist for providing services through the platform. You might be able to document that you were not aware at the time (BetterHelp’s fine includes a reprimand for advertising themselves as HIPAA compliant when this was not true), but make sure you have done your diligence on this.

After the BetterHelp judgment went public, I contacted every company I work with. I sent them the article about BetterHelp’s fine and reminded them that I had asked if they were HIPAA compliant before I started working with them. I asked if this was still true, and I asked if they had any policies similar to BetterHelp. They all responded that they have never and will never sell client data, and they will always provide HIPAA-compliant services.

Now, I not only have reassurance, but I have documentation of their claims in writing.

Workload

I have heard horror stories from colleagues about telehealth companies requiring absurd time commitments and workloads. Some expect providers to see huge caseloads, and some require responses to any and all client messages within a certain timeframe (sometimes as few as six hours!) regardless of when the message comes through. That means, if a client emailed you at 3am on Christmas day (assume for this hypothetical scenario that you celebrate Christmas), you would be contractually obligated to reply to them by 9am that same day.

What is a reasonable workload for you? What are your boundaries around your work? Say no to companies that will not honor your needs.

Compensation

I often speak about how therapists are under-paid. Many telehealth companies are awful about paying a living wage, with some offering as little as $35 per session.

(Remember, this is for a job that requires a master’s degree and annual licensure/continuing education that can total in the thousands. Furthermore, $35 per session is not the same as $35 per hour. For every hour spent in session, we have about an hour of treatment planning, marketing, consultation, documentation, emails, phone calls, et cetera.)

You deserve to be compensated appropriately for your work and expertise. Do not settle.

Additional Opportunities

When I first started accepting EAP clients, I actually had very little availability in my practice. I said yes to the contract because the company also offered continuing education to therapists in their network, as well as other mental wellness products to their clients. I wanted those opportunities, and I learned that they chose their teachers and developers from their network of therapists.

So, I made myself available for one hour a week to get my foot in the door. Now, I do therapy, education, and other mental health products with this company.