Is Psychology a desk job?

[sockit]

IMO involving an OT only makes things worse. Best thing is to tell people that they are alright. If there are other issues, such as mood/psychiatric, then you refer to those services. If people erroneously believe their problems are due to a concussion that happened years ago instead of a real psychiatric issue currently, goo luck treating that successfully.

Many of my concussion cases are 4-10+ months post injury/accident....so the vast majority of cases wouldn't be appropriate OT / PT / SLP referrals, though on occasion there are still some things that can be done. Usually I recommend talk therapy and spend some time talking about what is involved, provide additional education about expectations of rehabilitation/recovery, address exercise, provide education and help with sleep hygiene, work with the PCP/referring physician on meds, etc.

Really? you don't feel there's a benefit to rehab or adjustment after the acute stage, once they're home and trying to figure out how to drive, shop, etc? i'm kind of surprised to hear this.

i know someone who suffered a stroke that blew out occipital areas (and a few others, i don't know for sure which) who 5 to 6 months afterwards, still needed help adjusting his life activities as aspects of his condition changed and different strengths and weaknesses were brought to light. boy howdee was it was tough on his wife. (he was not driving, obviously. but getting around the house, engaging in leisure activities - different story)

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[sockit]

(i'm pretty sure gabi giffords even still has rehab support.)

 

[sockit]

Again, I didn't get that from WisNeuro's post, but I could be wrong. In the end, I think we all agree that folks who may be misattributing their symptoms to the incorrect cause certainly aren't a waste of time. But if they're being significantly driven by compensation-seeking, then we need to keep that in mind, because this may then cause them to not respond to treatment (for a variety of reasons). Thus, at some point, we need to make the decision if further treatment attempts should be made, or if those limited resources are better spent elsewhere for the time being.

ah yes resources and time and the systems available, easy for us students who don't have to deal with those decisions to forget about those.

 

[Therapist4Chnge]

Really? you don't feel there's a benefit to rehab or adjustment after the acute stage, once they're home and trying to figure out how to drive, shop, etc? i'm kind of surprised to hear this.

i know someone who suffered a stroke that blew out occipital areas (and a few others, i don't know for sure which) who 5 to 6 months afterwards, still needed help adjusting his life activities as aspects of his condition changed and different strengths and weaknesses were brought to light. boy howdee was it was tough on his wife. (he was not driving, obviously. but getting around the house, engaging in leisure activities - different story)

It is important to clarify the distinct difference between an uncomplicated injury such as a concussion and a stroke (where there are positive neurologic findings/imaging). The former can actually be at more risk if education about the injury and expectations of recovery are not addressed up front. Rohling et al. (2012) did a nice job of addressing this concern. In regard to a stroke survivor, I'd expect to see possible gains in function for the first 12-18mon following injury, so completing a longer course of rehabilitation is often advised. However, this same course of treatment is not advised for the post-concussive syndrome (PCS) group, as it can reinforce an incorrect belief and/or take away from the more likely psychiatric etiology; Lee-Haley & Brown (1993) did some nice work in the area. Many symptoms associated with concussion are also commonly found in everyday life of non-injured persons, so they often are conflated with the long since resolved injury.

References:
Lee-Haley, P.R., Brown, R.S. (1993). Neuropsychological complaint base rates of 170 personal injury claimants. Archives of Clinical Neuropsychology, 8: 203-209.

Rohling, M.L., Larrabee, G.J., Millis, S.R. (2012). The “Miserable Minority” following mild traumatic brain injury: Who are they and do meta-analyses hide them? The Clinical Neuropsychologist. 26(2):197-213.

 

[AcronymAllergy]

T4C addressed the point I was going to make--WisNeuro was speaking specifically about folks with remote histories of mild head injuries. Things can be much different in the context of a severe/penetrating brain injury (such as the one sustained by Gabi Giffords) or a significant CVA. In the case of the former, as T4C pointed out, effective and pro-active psychoeducation about expected symptoms and course of recovery presented soon after the concussion is sustained is currently the most effective treatment.

 

[psych84]

I like how no matter what the original discussion is about, it always turns into a neuropsychology discussion.

 

[sockit]

Thank you TfC and AA for clarifying my confusion, and for the reading recommendations!

(I don't know why i derped there, my apologies.)

 

[psych84]

Do patients ever try to stupid **** like pay you off to give them a favorable report?

 

[PsyDr]

Do patients ever try to stupid **** like pay you off to give them a favorable report?

Bribe offers are rare. But stupid, stupid, stupid BS.... ALL....THE...TIME.

It gets insulting. Like somehow a google search and truly raspberry award lying is going to trump 20+ years of education and experience.

The non-forensic lies tend to vary between sad and hilarious.

 

[CheetahGirl]

Patients try to do ALL kinds of things...it is important for clinicians to establish boundaries & follow through with their ethical responsibilities. And for some types of interventions, it is important to therapeutically 'explore' the underlying nature of the initial request (i.e., potential transgression)....But hopefully, you discuss how to deal with these issues thoroughly in your ethics class(es) PRIOR (or concurrently) to their occurrence.

Do patients ever try to stupid **** like pay you off to give them a favorable report?

 

[Therapist4Chnge]

During the clinical interview I address the importance of making a good effort, the sensitivity of testing, etc. I can still guess w a pretty high degree of accuracy which patients are going to still bomb the assessment (because of poor effort). I try and have an honest discussion then bc an invalid profile (in most cases) isn't in the best interest of the patient.

 

[psych84]

I assume you guys (neuropsych's) are trained well in terms of pharmacology? Do you make drug reccomendations or is that left to the physician?

 

[erg923]

Not a npsych, but I can say that no, that's not part of their training. They do have better knowledge of neuroanatomy and are probably informally educated and exposed to psychotropic issues. Specific drug recommendations are generally outside the scope of any psychologists training.

 

[Therapist4Chnge]

I do, but I also got pharma trained (primarily for research use).

 

[oathkeeper]

I do, but I also got pharma trained (primarily for research use).

did you do a post doc MS in psychopharm?

 

[Therapist4Chnge]

Yes. I did it to help my research, as I'm not looking to prescribe.

 

[WisNeuro]

Really? you don't feel there's a benefit to rehab or adjustment after the acute stage, once they're home and trying to figure out how to drive, shop, etc? i'm kind of surprised to hear this.

i know someone who suffered a stroke that blew out occipital areas (and a few others, i don't know for sure which) who 5 to 6 months afterwards, still needed help adjusting his life activities as aspects of his condition changed and different strengths and weaknesses were brought to light. boy how was tough on his wife. (he was not driving, obviously. but getting around the house, engaging in leisure activities - different story)

If you look back, I specifically referred to mTBI. Yes, there is no benefit to it, the research would actually support that it makes things worse to give people services that they do not need and make them think they are more injured than they are.

 

[sockit]

Yes! Thank you for taking the time to reply - I am sorry I didn't reciprocate in my careless response, my apologies

 

[Goobernut]

This thread has been pretty much derailed, but I have a question related to the train that jumped the tracks. Is it just experience that helps you differentiate between the "misleading" patient and the non-standard presentation patient/client? I know everyone thinks they are a special snowflake, but some patients actually come in with weird side effects, rare side effects, rare disorders etc... So at what point do you call shenanigans? I mean statistically people are usually going to fit into that normal curve. But what about when they don't?

Like I said I have a feeling the answer is going to be experience hah. So do you just take it on a case by case basis or?

(Feel free to separate this out if I've gone too far into left field)

 

[AcronymAllergy]

This thread has been pretty much derailed, but I have a question related to the train that jumped the tracks. Is it just experience that helps you differentiate between the "misleading" patient and the non-standard presentation patient/client? I know everyone thinks they are a special snowflake, but some patients actually come in with weird side effects, rare side effects, rare disorders etc... So at what point do you call shenanigans? I mean statistically people are usually going to fit into that normal curve. But what about when they don't?

Like I said I have a feeling the answer is going to be experience hah. So do you just take it on a case by case basis or?

(Feel free to separate this out if I've gone too far into left field)

Discussion of the exact nature in which these sorts of things are determined and differentiated isn't particularly appropriate for an online forum, and is better left for a classroom/formal training setting. In general, experience can potentially help, but research suggests that clinical judgment alone isn't necessarily very helpful or accurate with these sorts of things.

 

[erg923]

Neurologic plausibility of symptoms/presentations. Some things are simply not possible.

 

[smalltownpsych]

Determining when a patient is being misleading or not also depends on what the gain would be. That can vary from setting to setting and in my current setting, if they have multiple vague medical complaints, I let the physicians treat them for that. I focus on any psychological symptoms they have and especially interpersonal stressors and often the physical complaints improve. Patients have different levels of insight into the connection between the mind and body. Some of the other settings have more potential for malingering which is a whole different animal than somaticizing.

 

[Goobernut]

Discussion of the exact nature in which these sorts of things are determined and differentiated isn't particularly appropriate for an online forum, and is better left for a classroom/formal training setting. In general, experience can potentially help, but research suggests that clinical judgment alone isn't necessarily very helpful or accurate with these sorts of things.

AA, your statement sounds to me as if I were soliciting online clinical supervision haha. Going back and re-reading my question, I can see why you thought my question might be inappropriate. I apologize for not being more clear. I was thinking of the ethics of the situation rather than asking for a flowchart of signs and symptoms. At first read of your answer I was really puzzled by your suggestion that my question was borderline inappropriate for an online forum. In my mind I wasn't asking for specific clinical telltale signs and symptoms. Smalltownpsych's and erg's answers were helpful and really in the ballpark of the type of answer I was looking for.

When I made my comment/question, I was just struck by the conundrum of having to be a patient's advocate and recognizing that patients are not always honest. In some areas of practice I can see how that might lead professionals to become frustrated in their practice if it is a frequently occurring thing. I was just wondering how people dealt with that.

 

[psych84]

AA, your statement sounds to me as if I were soliciting online clinical supervision haha.

With all these online schools, it's a distinct posibility.

 

[smalltownpsych]

AA, your statement sounds to me as if I were soliciting online clinical supervision haha. Going back and re-reading my question, I can see why you thought my question might be inappropriate. I apologize for not being more clear. I was thinking of the ethics of the situation rather than asking for a flowchart of signs and symptoms. At first read of your answer I was really puzzled by your suggestion that my question was borderline inappropriate for an online forum. In my mind I wasn't asking for specific clinical telltale signs and symptoms. Smalltownpsych's and erg's answers were helpful and really in the ballpark of the type of answer I was looking for.

When I made my comment/question, I was just struck by the conundrum of having to be a patient's advocate and recognizing that patients are not always honest. In some areas of practice I can see how that might lead professionals to become frustrated in their practice if it is a frequently occurring thing. I was just wondering how people dealt with that.

Actually, I am pretty sure that what AA was referring to was that the methods for detecting malingering should not be made readily available to the public.

 

[AcronymAllergy]

AA, your statement sounds to me as if I were soliciting online clinical supervision haha. Going back and re-reading my question, I can see why you thought my question might be inappropriate. I apologize for not being more clear. I was thinking of the ethics of the situation rather than asking for a flowchart of signs and symptoms. At first read of your answer I was really puzzled by your suggestion that my question was borderline inappropriate for an online forum. In my mind I wasn't asking for specific clinical telltale signs and symptoms. Smalltownpsych's and erg's answers were helpful and really in the ballpark of the type of answer I was looking for.

When I made my comment/question, I was just struck by the conundrum of having to be a patient's advocate and recognizing that patients are not always honest. In some areas of practice I can see how that might lead professionals to become frustrated in their practice if it is a frequently occurring thing. I was just wondering how people dealt with that.

No worries, I just tend to interpret and discuss these things in a very, very conservative manner in public settings. As was mentioned in another thread, this topic in particular (because of it's highly contentious nature) can lead to a lot of misinterpretation, even amongst/between clinicians.

Is it ethically and morally tough sometimes to work in settings that have a high degree of symptom invalidity? Short answer: yes, although we not only have to think about our responsibility to the patient at hand (and sometimes, hey, that responsibility involves calling it like it is), but to mental health/healthcare and society as a whole. This is one reason why psychologists functioning in settings with a high potential for this occurrence avoid true clinical/treatment relationships with the folks they're assessing, and instead have other parties (e.g., attorneys, judges, etc.) as their clients.

 

[Goobernut]

With all these online schools, it's a distinct posibility.

Truth. I'm surrounded by people with online degrees. They don't understand why I went to all the trouble to pursue my degree from a traditional brick and mortar.

Actually, I am pretty sure that what AA was referring to was that the methods for detecting malingering should not be made readily available to the public.

Yes, I figured this out, that's why I replied above making sure he knew that's not what I was looking for. I don't want anyone to think I was fishing for info to re-use. Or that I was asking innocently for methods that shouldn't be made public. I literally thought I was asking a "safe" generic question but I can see that it actually looks like a pretty specific question... my mistake

 

[Dr_lost]

Honestly I feel that a Psychology degree (especially an undergraduate degree) is a stepping stone. It can help you get into many other fields of work or other schools.

For example, on campus, I've met a couple of Graduate students that are in Business School, Law school and Engineering. All of them has a Bachelors of Arts/Science in Psychology. They didn't want to go the any higher in Psychology because "You can't do anything with an undergrad degree in psychology". The cost of a PhD/PsyD (and length of time) has made Medical school and Psychology programs unappealing to the masses.

At times I've been asked "Why are you studying Psychology, when you have an Associate degree in Graphic Design, Associates degree in Computer Technician and you own your own business?" Psychology is so unappealing and requires an advanced degree that you have to be insane to study it. It doesn't help that License Clinical Social Work has become a much cheaper and faster alternative to Psychology (no offense to any Sociology majors/professionals).

 

[CheetahGirl]

Psychology is so unappealing and requires an advanced degree that you have to be insane to study it.

Dr. lost, get out now...while you are ahead. No reason for you to suffer. Your entire post is counter-intuitive...rhetorically, why are you studying psychology if you find it so unappealing?!

 

[Dr_lost]

Dr. lost, get out now...while you are ahead. No reason for you to suffer. Your entire post is counter-intuitive...rhetorically, why are you studying psychology if you find it so unappealing?!

No I find it appealing.
Those at my university don't.
Also, just because I've made comments about what others have said to me, doesn't mean I'm disrespecting Psychology.

Many Football players love playing the quarterback position. But they are aware that they can suffer multiple concussions which can effect them down the road. That doesn't mean they'll stop playing just because of that. They are aware of the pro's and con's.

 

[CheetahGirl]

Ok, fine. If you reread your post, it says "you have to be insane to study it," which is quite the contrary (as another current thread discusses). Good luck then! And look into one of the excellent PsyD programs so you are not 'forced to earn a PhD' as your title suggests. Internal locus of control and volition are some keys to success.

No I find it appealing.
Those at my university don't.
Also, just because I've made comments about what others have said to me, doesn't mean I'm disrespecting Psychology.

Many Football players love playing the quarterback position. But they are aware that they can suffer multiple concussions which can effect them down the road. That doesn't mean they'll stop playing just because of that. They are aware of the pro's and con's.

 

[erg923]

Oyou are not 'forced to earn a PhD' as your title suggests

What does that poster's quote even mean?

 

[Dr_lost]

What does that poster's quote even mean?

My University doesn't offer a PsyD. I haven't been able to find a University in North Carolina that offers a PsyD. They all offer PhD in Clincal Psychology. That's why I posted that. I've done much reading about a PsyD and how it focuses more on Clinical applications than Research and teaching (which is what most PhD's focus on). That's why the quote under my avatar says "Forced to earn a PhD when I want a PsyD".

 

[WisNeuro]

Most PhD's are actually pretty balanced between clinical work, teaching, and research. The old "PhD's are all research thing" is just a misconception that has persisted for decades. Sure, there are still research powerhouse programs, mostly at R1's, but the balanced programs are probably more modal these days. And, geographical inflexibility is something of a huge roadblock heading forward, at several points.

 

[Dr_lost]

Most PhD's are actually pretty balanced between clinical work, teaching, and research. The old "PhD's are all research thing" is just a misconception that has persisted for decades. Sure, there are still research powerhouse programs, mostly at R1's, but the balanced programs are probably more modal these days. And, geographical inflexibility is something of a huge roadblock heading forward, at several points.

Thank you for informing me. I did find it strange that Schools in the in West and NorthEast of America offer a PsyD and PhD. I did wonder why not more schools in the "Bible belt" or MidWest offer a PhD and PsyD.

 

[WisNeuro]

There are plenty of PsyD places in the Midwest actually I can think of many in and around the states that I've lived in (MI, WI, MN, IL). They are generally just more likely to be in larger population centers.

 

[erg923]

My University doesn't offer a PsyD. I haven't been able to find a University in North Carolina that offers a PsyD. They all offer PhD in Clincal Psychology. That's why I posted that. I've done much reading about a PsyD and how it focuses more on Clinical applications than Research and teaching (which is what most PhD's focus on). That's why the quote under my avatar says "Forced to earn a PhD when I want a PsyD".

Well, that's kinda a dumb statement. No one forced you go to graduate school. And I doubt anyone one forced you to stay in NC. Research vs clinical work is also a completely false dichotomy. I never understand why people think that either. Ph.D programs are guided by a scientist-practitioner training philosophy. So obviously there is, and should be, substantial focus on scientific activities and production. There is also, obviously, a focus on clinical training. If there wasn't, it wouldn't be a ph.d in "clinical" psychology

 

[cara susanna]

My University doesn't offer a PsyD. I haven't been able to find a University in North Carolina that offers a PsyD. They all offer PhD in Clincal Psychology. That's why I posted that. I've done much reading about a PsyD and how it focuses more on Clinical applications than Research and teaching (which is what most PhD's focus on). That's why the quote under my avatar says "Forced to earn a PhD when I want a PsyD".

That's kind of a dangerous title to have around here. We have a lot of applicants who read this board and would be happy to be "forced" to earn a PhD.

 

[Dr_lost]

That's kind of a dangerous title to have around here. We have a lot of applicants who read this board and would be happy to be "forced" to earn a PhD.

Thanks for letting me know (I already removed it from my avatar). I've noticed that in this forum every word that appears on screen will be dissected thoroughly.

 

[erg923]

Thanks for letting me know (I already removed it from my avatar). I've noticed that in this forum every word that appears on screen will be dissected thoroughly.

I think it was simply a case of a statement that completely and totally inaccurate. One should probably expect statements like that to be corrected.