Something therapists never admit on Twitter: many don’t like treating Serious Mental Illness (SMI). The futility waters down perceived efficacy while increasing cognitive/emotional load.

It’s simply harder money for less return; economics 101.

A convenient way around this is going private practice & raising rates; weeds out the riff raff, eliminates paperwork, & avoids interpersonal headaches.

Human instinct is to then justify this morally questionable decision by hiding behind excuses like claiming private practice is financially required to make a living… which they then confirm vocally through each other & supportive clients “happy they don’t take insurance”.

Aka confirmation bias.

This allows therapists to sit neat & pretty on top legs crossed with all the socioeconomic benefits of helpful therapy & higher rates without drudging through the futile mental-mud uphill against impossible odds. Avoids “treatment resistant MI” to boot.

Everyone wins but patients.

Yet not one therapist ever tweets “these mentally ill patients are fucking exhausting. I prefer milder symptoms”. Not one.

Who wouldn’t prefer treating mild anxiety among rich housewives over schizophrenics mumbling nonsense? Can’t blame them. Or can we?


The psychology is simple: they can work with healthy folk & make $$$/hr 1:1, or they can work with SMI at $$/hr at 4 times the work. It’s not rocket science – we all like more money for less.

Where I get offended is the excuses evading this admission, which I believe they 100% believe.

It’s also the job. Mentally ill & loved ones need & deserve treatment.

What you find is a not-in-my-backyard (NIMBY) evasion common to humanity in general.

Tough noogies I say.

Sorry mental health providers, but it’s become my job to say the things you won’t.

Confirmation Bias: Confirmation bias is the tendency to search for, interpret, favor, and recall information in a way that confirms or supports one’s prior beliefs or values. CK Glossary

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