PhD/PsyD Just a thread to post the weirdest/whackiest/dumbest mental health-related stuff you come across in the (social) media...

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R. Matey said:
There are two things happening here: (1) a patient is stating an open ended problem and (2) a therapist could be mishandling it. From the perspective of cognitive therapy (@Fan_of_Meehl, get in on this!), questions about life's meaning are questions about a patient's personal values, which can be addressed via Socratic Questioning and behavioral experiments.

As far as therapist mishandling it, again, this comes back to how many masters level clinicians are trained. They are taught the humanistic model of counseling as the "basic skills" of psychotherapeutic intervention. Implicit in that model is Rogers's idea that the goals of counseling are to remove barriers to a client's (using his term) self-actualizing tendencies. By providing unconditional positive regard, empathy, and open-ended care, therapists facilitate growth. It was a good idea in the sense that not being an absolute d*ck to your patients mean they will keep talking to you. It's a bad idea in another sense because patients often do not know how to treat their own problems, which is why they are talking to you. If you couple that foundational instruction with a deemphasis in EPB that is often due to time constraints in master's level training, lack of knowledge among master's level clinicians (they often are teaching each other), and lack of training in general psychological knowledge, it can be easy to see why a therapist would take this perspective.

FTR, I'm not saying this is true of all master's level training everywhere nor am I saying that a master's level clinician cannot rise above some ****ty classes they got in graduate school via self-study and/or supervision. This is my experience as a former LPC who has worked with many LPCs/LCSW.
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I'm making no claims about the role of educational level in this, just clarifying the thing I'm arguing against when saying therapy should not be solely about self-discovery with no desire to change. I am okay with people wanting to work on issues that are not necessarily traditionally clinical in nature, but I do think change is a necessary part of any successful psychotherapy, and I do think it outside the psychotherapist's scope to give someone meaning or purpose outside of giving them strategies to discover such a thing on their own. I tend to think that people wanting such a thing are better off finding a spiritual community or a friend to have dinner with once per week. It's probably equally as (or more effective), and probably much less expensive than therapy without health insurance.
 
futureapppsy2 said:
I really wish people would stop using “hyper fixation” to mean “thing I have any interest in whatsoever l.”
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"hyperfocus" is one that really grinds my gears: "Oh, you mean perseverate?" No, that does not mean you have ADHD."
 
EnPsychlopedia said:
I'm making no claims about the role of educational level in this, just clarifying the thing I'm arguing against when saying therapy should not be solely about self-discovery with no desire to change. I am okay with people wanting to work on issues that are not necessarily traditionally clinical in nature, but I do think change is a necessary part of any successful psychotherapy, and I do think it outside the psychotherapist's scope to give someone meaning or purpose outside of giving them strategies to discover such a thing on their own. I tend to think that people wanting such a thing are better off finding a spiritual community or a friend to have dinner with once per week. It's probably equally as (or more effective), and probably much less expensive than therapy without health insurance.
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The bolded is the most important operator in your argument. Mutually agreed upon goals that are tracked and reviewed for progress are necessary for any successful psychotherapeutic intervention.
 
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futureapppsy2 said:
I really wish people would stop using “hyper fixation” to mean “thing I have any interest in whatsoever.”
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or...'hypervigilance' for...like...normal vigilance. Like paying attention to your surroundings late at night when stopped at a gas station in a bad part of town.
 
In many years of clinical practice, I have never had a patient present with wanting psychotherapy for self-discovery. Self-discovery is a side benefit of psychotherapy. Identifying unproductive behaviors and irrational thought patterns and interpersonal problems is what my patients always want to do. Typically these problems rise to the level of a diagnosable disorder, but sometimes not quite. That’s what an Adjustment Disorder is about. If they don’t improve rapidly and move onto more productive ways to spend their time than hanging out with me once a week, then there probably is a disorder that these clinicians are just not astute enough to diagnose and are likely colluding with a defensive/avoidant narrative.
 
R. Matey said:
Mutually agreed upon goals that are tracked and reviewed for progress are necessary for any successful psychotherapeutic intervention.
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Very much agree, hence my frustration with the folks literally arguing that therapy is perfectly appropriate for folks who "just want to discover themselves with no need to change."
 
EnPsychlopedia said:
Very much agree, hence my frustration with the folks literally arguing that therapy is perfectly appropriate for folks who "just want to discover themselves with no need to change."
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Understandable. Although I guess if I had to choose, "it's fine to get therapy even if you don't need it or know what you want it for" is a better societal mindset overall than, "therapy is for the weak!"
 
My bottom line, if people want some self-discovery therapy without any diagnosable MH condition, more power to them. But also, if insurance does not want to pay for this type of therapy, I'm fine with that too.
 
I have never heard of 'pathological demand avoidance' until today...but I'm fascinated by the term/concept.

Google says that "individuals with PDA may go to great lengths to avoid perceived demands, which can manifest in various ways, including refusal, distraction, and even aggression."

Can you get service-connection for that?
 
cara susanna said:
I feel like I've asked this before, but what's the empirical support for pathological demand avoidance? Is it actually a thing, or is this another situation like rejection sensitivity dysphoria?
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Both lack discriminate validity from anxiety disorders that are commonly comorbid with neurodevelopmental disorders. Here's a semi-recent review for PDA specifically.
 
R. Matey said:
Both lack discriminate validity from anxiety disorders that are commonly comorbid with neurodevelopmental disorders. Here's a semi-recent review for PDA specifically.
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See also this one. It’s one of those terms that has really picked up steam when linked to autism, and in social media circles, particularly those sort of “self-diagnosed autism” spaces. You might see people in those communities refer to themselves as “PDAers.”

The only difference I can really tell between reactance and PDA is that PDA is supposed to explicitly linked to anxiety and overwhelm as opposed to pushback against threats to autonomy. Functionally they probably look exactly the same.
 
EnPsychlopedia said:
Very much agree, hence my frustration with the folks literally arguing that therapy is perfectly appropriate for folks who "just want to discover themselves with no need to change."
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Self-discovery implies change, at least in theory. Even when people seek out years-long psychoanalysis, it's often with the expectation that they will act differently or view themselves differently (to a behaviorist, thinking differently is technically behavior). In clinical terms, framing self-discovery as enacting personal values makes it intervenable to reduce any perceived subclinical impairment (i.e., the motive for seeking out intervention). As flawed as they were in terms of interrater reliability, I think GAF scores captured dimensionality of functional impairment pretty well. If someone wanted to move from 69 to 81, that's a good goal. But, I do agree that it's something that they shouldn't necessarily expect insurance to cover.
 
R. Matey said:
Both lack discriminate validity from anxiety disorders that are commonly comorbid with neurodevelopmental disorders. Here's a semi-recent review for PDA specifically.
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So PDA is something that could also be found in anxiety disorders without comorbid autism? That would make sense to me. My question was, is this something specific to autism? I would think it could apply to a lot of people.
 
cara susanna said:
So PDA is something that could also be found in anxiety disorders without comorbid autism? That would make sense to me. My question was, is this something specific to autism? I would think it could apply to a lot of people.
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In theory, PDA is specific to neurodevelopmental conditions and is used to differentiate reactance in a manner that's not consistent with "typical higher functioning autism." The initial effort came from a good place, they were trying to develop a category that wasn't PDD NOS to differentiate in Asperger's syndrome back in the 1970s. But since then, our understanding of the role of emotion dysregulation in many neurodevelopmental conditions and the amount of shared variance between them has evolved so much that it raises real questions about how this classification of behavior is fundamentally different from how people with neurodevelopmental conditions express problematic anxiety or anxious distress. I suppose it is possible for people without neurodevelopmental disorders to display similar types of behavior, but it didn't originate in that manner theoretically. In my mind, this is a bug, not a feature of the category.
 
Does PDA improve with a stimulant and is there a coercive parent child interaction loop?
 
cara susanna said:
I refuse to say "client." Just absolutely refuse.
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That's one of the things I miss about the VA

Everyone was able to to default to "veteran" and nobody got their pants in a bundle
 
It is evidently hard for folks to understand that someone can maintain traits of a disorder while still being in partial remission. Some folks on r/psychology are arguing that maturation processes don’t affect ADHD since most still show symptoms going into adulthood. Like, yes, most still show some symptoms, but a not insignificant portion of those folks do meet criteria for partial remission and notable functional improvement. That someone maintains some traits into adulthood does not mean maturation has no effect symptom severity.
 
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EnPsychlopedia said:
It is evidently hard for folks to understand that someone can maintain traits of a disorder while still being in partial remission. Some folks on r/psychology are arguing that maturation processes don’t affect ADHD since most still show symptoms going into adulthood. Like, yes, most still show some symptoms, but a not insignificant portion of those folks do meet criteria for partial remission and notable functional improvement. That someone maintains some traits into adulthood does not meet maturation has no effect symptom severity.
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This brings up an interesting aspect of disability, and I will use my own ADHD as an example (and I suspect this is one reason why like 40% of undergrads at the Ivy League schools) receive accommodations:
  • Once diagnosed, are they always disabled? For most of my life young life, I grew up thinking I just had dysgraphia and that's why school was hard. But guess what? Dysgraphia is a side effect of untreated ADHD. Once my ADHD got treated (I think I was 24 when I was rx a stimulant). It was life changing, and my wife immediately saw my writing output improve. She would help me edit everything.
  • During the day, is someone with ADHD not disabled when their stimulant is working, and then when it's out of their system, are they magically impaired again?
  • I am in the top ten percent of income earners in America, I have a wonderful house, a beautiful family. I yell at my kids sometimes and can be quick to temper. I haven't had a speeding ticket in about 20 years. It's hard to make the case for functional impairment here aside from the normal trials of life. Am I disabled?
  • Is someone medically treated for ADHD and having a perfect response in remission?
  • If you look hard enough, at anyone, will there be functional impairment somewhere?
 
borne_before said:
This brings up an interesting aspect of disability, and I will use my own ADHD as an example (and I suspect this is one reason why like 40% of undergrads at the Ivy League schools) receive accommodations:
  • Once diagnosed, are they always disabled? For most of my life young life, I grew up thinking I just had dysgraphia and that's why school was hard. But guess what? Dysgraphia is a side effect of untreated ADHD. Once my ADHD got treated (I think I was 24 when I was rx a stimulant). It was life changing, and my wife immediately saw my writing output improve. She would help me edit everything.
  • During the day, is someone with ADHD not disabled when their stimulant is working, and then when it's out of their system, are they magically impaired again?
  • I am in the top ten percent of income earners in America, I have a wonderful house, a beautiful family. I yell at my kids sometimes and can be quick to temper. I haven't had a speeding ticket in about 20 years. It's hard to make the case for functional impairment here aside from the normal trials of life. Am I disabled?
  • Is someone medically treated for ADHD and having a perfect response in remission?
  • If you look hard enough, at anyone, will there be functional impairment somewhere?
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Just wanted to quickly add that there is a specifier for in partial remission in the DSM-5-TR, for ADHD. I figure most people are unaware of it's existence, so I always try to remind people that a diagnosis can certainly be changed to it, just no one does...
 
Not social media, but closest I can think of: the DBT listserv has erupted into yet another argument over Israel and Palestine
 
psy.d. 2021 said:
Seems like the DBT listserv community needs to learn about setting boundaries
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In another twist of irony, in the first several months of the Gaza War, the Peace Psych listserv was a dumpster fire of personal insults and arguments over Israel and Palestine. It got so bad they closed the listserv, and, to my knowledge, it hasn't been re-opened yet.
 
cara susanna said:
Not social media, but closest I can think of: the DBT listserv has erupted into yet another argument over Israel and Palestine
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This has inspired the dad joke I’ve been trotting out lately (my wife does not find it funny, but it’s been a surprisingly good way to identify chill people).

Background: My kids’ birthdays are only two days apart. People inevitably ask what they want as gifts. After getting tired of saying, “They have enough stuff,”

I now say: “Nothing political, please. Things have been pretty tense lately. My son supports Israel, and my daughter supports Palestine.”

I find it funny because my four- and seven-year-olds have about the same chance of fully understanding the situation as the DBT listserv.
 
Just met with a pt that said he has been working with a "doctor of therapy" for 13 years. I got their name and the person of interest is an LPC advertising themselves as "Dr. Xyz" and their website url is "Dr. Xyz.com." They DO have a doctorate.... in Psychology, General Research, and Evaluation from Walden. They also sell an online course and drive a van with their name on it.
 
RxPsych said:
Just met with a pt that said he has been working with a "doctor of therapy" for 13 years. I got their name and the person of interest is an LPC advertising themselves as "Dr. Xyz" and their website url is "Dr. Xyz.com." They DO have a doctorate.... in Psychology, General Research, and Evaluation from Walden. They also sell an online course and drive a van with their name on it.
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Grifters gonna grift. And grifter programs produce grifter "providers."
 
WisNeuro said:
Grifters gonna grift. And grifter programs produce grifter "providers."
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One of our neurology providers told me yesterday that the parent of child kept telling the provider that they were a social worker and "had conducted an extensive neuropsychological test" for determining their child's Tourette's syndrome. I couldn't stop myself from laughing at all the absurdities within that statement when the provider told me lol 😆
 
Therapist sub has a discussion of why so many therapists don't practice based on scientific evidence. Cue all of the "EBPs are culturally biased and capitalist/Tolin criteria are flawed/EBPs only lead to short term improvement/only CBT research gets funded" BS
 
cara susanna said:
Therapist sub has a discussion of why so many therapists don't practice based on scientific evidence. Cue all of the "EBPs are culturally biased and capitalist/Tolin criteria are flawed/EBPs only lead to short term improvement/only CBT research gets funded" BS
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Always Sunny Reaction GIF
 
cara susanna said:
Therapist sub has a discussion of why so many therapists don't practice based on scientific evidence. Cue all of the "EBPs are culturally biased and capitalist/Tolin criteria are flawed/EBPs only lead to short term improvement/only CBT research gets funded" BS
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What always loses me here is never legitimate critiques of CBT, I enjoy the skepticism.

What gets me is how so many clinicians will voice these critiques then run to the least empirically investigated/validated modalities of treatment. Just because a physician may recognize that wearing a surgical mask to reduce transmission of a respiratory illness may not be a perfect fix all doesn't mean that physician should start telling their patients to walk around naked to reduce said transmission rate because masks are only mostly effective.

I realize I'm preaching to the choir now
 
cara susanna said:
Therapist sub has a discussion of why so many therapists don't practice based on scientific evidence. Cue all of the "EBPs are culturally biased and capitalist/Tolin criteria are flawed/EBPs only lead to short term improvement/only CBT research gets funded" BS
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Thread got nuked by the mods
 
EnPsychlopedia said:
There is currently a thread where OP is wondering if their clients having some childhood amensia means all these clients have extensive childhood trauma. Comments are predictably bad.
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The way I RAN to this thread 😂🍿

EDIT: Peter Levine, avoidant attachment, little-t, AuDHD, aphantasia, “everything is trauma”… this is a whole bingo card 😍
 
I honestly have no idea why we even require midlevels to be "trained" at all at this point. They're all essentially caricatures of what they think therapy should be, based off media portrayals and social media.
 
WisNeuro said:
I honestly have no idea why we even require midlevels to be "trained" at all at this point. They're all essentially caricatures of what they think therapy should be, based off media portrayals and social media.
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Unfortunately their training programs seem to agree, given that 1) supervision is trash during provisional licensing, it's the blind leading the blind, and 2) masters programs are doing bare minimums.

In some states you can start supervising after 2 years of being independently licensed. No therapist 2 years out from being a supervisee themself should be supervising!!!
 
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WisNeuro said:
I honestly have no idea why we even require midlevels to be "trained" at all at this point. They're all essentially caricatures of what they think therapy should be, based off media portrayals and social media.
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Same for most psychologists and psychiatrists.
 
Dr. Mike evidently has posted a video conversation with Daniel Amen, and I'm hearing that Mike does a brutal takedown.
 
cara susanna said:
Therapist sub has a discussion of why so many therapists don't practice based on scientific evidence. Cue all of the "EBPs are culturally biased and capitalist/Tolin criteria are flawed/EBPs only lead to short term improvement/only CBT research gets funded" BS
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We had a younger professor in our doctoral program who taught the history of psychology and focused exclusively on criticism of the field. Legitimate critiques, but it missed the point. It’s like a big ad hominem attack and not very helpful. We should have been more concerned as that type of thinking seems to have overtaken much of the field. What is interesting is how the degree of denial or misuse of science seems to be correlated with how far people are from the political center. In undergrad, I went to a very liberal college in a liberal state, so I mainly saw it on that side, but one doesn’t have to look too far to see it on the other side either.
 
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