101 Reasons Being a Psychotherapist Sucks


1. Often overworked

2. Independent contractors feast or famine

3. Frequently forced to market and self-promote

4. Unconsciously create client dependencies

5. Client – therapist interests are frequently misaligned

6. Motivated reasoning drives direction

7. HMO’s

8. Interactions are “all about them”

9. Licensing requirements

10. Liability insurance requirements

11. Dealing with lawyers

12. Potential suicides

13. Continuing Education Expenses

14. Subjecting clients to the Actor-Observer Bias

15. Confronted with problems all day

16. One dissatisfaction after another

17. Clients pay reluctantly

18. Below average annual income

19. Ever-increasing overhead costs

20. Uncertain work hours

21. Scheduling requirements

22. Occasional homicide threats

23. Unconventional work hours

25. Little constructive feedback

26. Infrequent long term assessment

27. No accurate results measurement

28. Clients can be emotionally manipulative

29. Unintentionally end up with pro bono clients

30. Clients want fee reductions

31. Inherent conflict of interest

32. Client-therapist conflicts

33. Increasing competition from incompetent practitioners

34. Competing with non-professionals

35. Thankless job

36. Most you can expect is 1% improvement

37. Requirement for keeping case notes

38. Too much paperwork

39. Work / Play imbalance

40. Too much work sitting down

41. Crushing school loan debt

42. Vulnerable to self-medication

43. No retirement plan

44. No paid vacation

45. Big burnout potential

46. Supplemental work often necessary

47. Challenging to stay current in the field

48. Second class citizen vis a vis the AMA

49. Clients no-show

50. Clients delinquent payers

51. Being an informed consumer limits help for you

52. Trauma reenactment without resolution

53. Regularly victimized by the Overconfidence Effect

54. Work in an unintegrated field

55. Handcuffed by confidentiality

56. Limited by own self-development

57. Sanity fluctuations

58. Negative transference

59. Unconscious countertransference

60. Ever-changing government regulations

61. Being victimized by information bias

62. Reality of practice is different than imagined

63. Challenges of really skillful listening

64. Limits for advancement/promotion

65. Social isolation

66. Requirement to be on-call

67. Unexpected client decompensation

68. Requirement to respond during non work hours

69. Blindness to the Outcome Bias

70. Susceptibility to the illusion of control

71. Too much work; not enough help

72. Self-imposed or client-imposed elevated stress levels

73. Getting booted off the positive transference pedestal

74. Succumbing to Trait Ascription Bias

75. The inevitable “Black Swan” client

76. No paid sick-leave

77. Few tools for addressing Unthought Known

78. Client perception distortion

79. Focus on emotionally traumatic experience

80. Frequent struggle with Backfire Effect

81. Belonging to the 95% cohort who think they’re above average

82. Thinking yourself less biased than your clients

83. Challenge of changing perspective when new info comes to light

84. Oblivious to the Curse of Knowledge

85. Too wide an Empathy gap

86. Functional fixedness in treatment approach

87. Taking patients home emotionally

88. Little income predictability

89. Irrational escalation due to too many sunk costs

90. Inherent negativity bias in many modalities

91. Susceptibility to the observer-expectancy effect

92. Expectation to reciprocate for referrals

93. No accurate measure of Hippocratic Oath adherence

94. Little reality-based, in situ experience of clients

95. Few tools to combat the Pro-Innovation Bias

96. Unwittingly subjecting clients to the Texas Sharpshooter Fallacy

97. Therapeutic structure demands making the Fundamental Attribution Error

98. Unconscious promotion of the Illusion of Transparency

99. Clients who literally drive us temporarily insane

100. Working a profession where the Dunning-Kruger Effect runs rampant

101. Tendency to subject this list to the Semmelweis Reflex