A question about the day in, day out slog and happiness

[StellaB]

I personally love my day-in-day out "slog." I'm relatively early career still, full time job as a forensic evaluator, part-time private practice, teach several courses as an adjunct. I'm busy, but the work is extremely interesting. I think therapy services in general are extremely exhausting, so I only do assessment. The police reports can sometimes be fairly extreme of course, but I've found I can compartmentalize my work pretty well. I think a lot of the day-to-day stuff just comes down to finding your right niche. There are many, many different ways to be a psychologist, and more often than not what you think you want to do is not exactly what you end up enjoying, and that's okay.

As an aside, this is part of the reason this discussion board tends to be very negative about grad programs that will limit your career options, cause if you end up feeling really ground down by the daily slog but you need the job to pay off your loans, and you can't easily change jobs because your program has a bad reputation... that would be quite miserable.

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[Therapist4Chnge]

For me, it was mostly figuring out what I enjoyed v. what I didn't mind doing v. what I absolutely avoided. Most of my clinical/therapy training was in severe psych and polytrauma, which can grind you down if those types of cases aren't your thing. I didn't mind the severity, but my kryptonite has always been eyeore cases....the lack of engagement, woe is me, amotivated type, etc. As long as I avoid that type, I can work with most types of cases w/o issue. I refuse to see rapists or pedos, bit I've eval'd murderers and other violent felons w/o issue. I didn't want to hear about the various offenses during the clinical interview, as we already see/hear enough bad stuff.

I didn't enjoy doing chronic pain intervention the first time around bc we tended to see chronic pain patients who already had months/years of treatment and were basically set in their ways. The next time chronic pain work was on the table, I figured out that doing assessment only and referring to a counselor made it much better. The average patient is much earlier on in their treatment, and they are more amenable to putting in the work. They are probably 60%+ of my cases now....somewhat of an effect of doing mostly brain injury, IMEs, and car accidents.

I vastly enjoy assessment (duh, neuropsych), but I avoid dementia referrals bc I never enjoyed that niche. I still see a variety of cases, but I knew early on I didn't want to cover the lifespan (despite training in both peds and adults) and I definitely wanted to avoid ADHD eval.

I really enjoy legal work, which I avoided for most of my first 6+ yrs, but now I seek out. Preferences can change as you go through your career, but it's advisable to at least consider some of these questions when looking at day to day practice.

 

[AbnormalPsych]

I’ve always seemed to find that Barbara McMoneybags shows up with eye strain and I find out a few sessions later that she really is struggling with trauma from an assault that she never disclosed before. That’s more my reason for picking up admin/teaching, varying the program.

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[gohogwild]

For me, it was mostly figuring out what I enjoyed v. what I didn't mind doing v. what I absolutely avoided. Most of my clinical/therapy training was in severe psych and polytrauma, which can grind you down if those types of cases aren't your thing. I didn't mind the severity, but my kryptonite has always been eyeore cases....the lack of engagement, woe is me, amotivated type, etc. As long as I avoid that type, I can work with most types of cases w/o issue. I refuse to see rapists or pedos, bit I've eval'd murderers and other violent felons w/o issue. I didn't want to hear about the various offenses during the clinical interview, as we already see/hear enough bad stuff.

I didn't enjoy doing chronic pain intervention the first time around bc we tended to see chronic pain patients who already had months/years of treatment and were basically set in their ways. The next time chronic pain work was on the table, I figured out that doing assessment only and referring to a counselor made it much better. The average patient is much earlier on in their treatment, and they are more amenable to putting in the work. They are probably 60%+ of my cases now....somewhat of an effect of doing mostly brain injury, IMEs, and car accidents.

I vastly enjoy assessment (duh, neuropsych), but I avoid dementia referrals bc I never enjoyed that niche. I still see a variety of cases, but I knew early on I didn't want to cover the lifespan (despite training in both peds and adults) and I definitely wanted to avoid ADHD eval.

I really enjoy legal work, which I avoided for most of my first 6+ yrs, but now I seek out. Preferences can change as you go through your career, but it's advisable to at least consider some of these questions when looking at day to day practice.

Thank you for your advice. I'm kind of curious who your main crowd for your neuropsych evals are? I typically ONLY hear about ADHD and dementia referrals for that kind of thing.

 

[WisNeuro]

In the past year I've seen Parkinsons, TBI of different severity, CADASIL, several encephalitis, lots of brain tumor pre and post tx, MS, epilepsy, to name a few off the top if my head. While generalists will do a lot of dementia evals, patient presentations will vary greatly unless you are in a specific clinic.

 

[deleted106747]

Yes, but here's the deal with Barbara Susan (B.S.) McMoneyBags.

If I say anything perceived by this woman as remotely intrusive or confrontative or attempt any actual diagnostic interviewing or clinical intervention, my consumer satisfaction scores take a massive hit (mostly because the N is so low anyways and my patients that are doing amazing don't bother with this survey, just the ones that want to gripe).

This has a direct impact on everything. I am going to cross post (don't murder me moderators) in the VA thread, bc I am curious if the VA has this consumer satisfaction ranking after each MH visit these days.

I’ve never even heard of that. What a ridiculous idea. Our patients should be uncomfortable at times in order to grow. Although BSM there seems to have a pretty brittle personality and requires a high validation to push ratio! I guess I’m lucky in that I’ve never worked in an agency that takes those types of evaluations too seriously. At least that I ever knew about.

 

[gohogwild]

In the past year I've seen Parkinsons, TBI of different severity, CADASIL, several encephalitis, lots of brain tumor pre and post tx, MS, epilepsy, to name a few off the top if my head. While generalists will do a lot of dementia evals, patient presentations will vary greatly unless you are in a specific clinic.

Very interesting, thank you!

 

[ClinicalABA]

Thank you for your advice. I'm kind of curious who your main crowd for your neuropsych evals are? I typically ONLY hear about ADHD and dementia referrals for that kind of thing.

Actually, there's very little research support for neuropsych testing for ADHD, and insurance companies typically won't fund it.

 

[gohogwild]

Actually, there's very little research support for neuropsych testing for ADHD, and insurance companies typically won't fund it.

Interesting, it's possible I was clumping in psychiatric evaluations.

 

[AbnormalPsych]

I’ve never even heard of that. What a ridiculous idea. Our patients should be uncomfortable at times in order to grow. Although BSM there seems to have a pretty brittle personality and requires a high validation to push ratio! I guess I’m lucky in that I’ve never worked in an agency that takes those types of evaluations too seriously. At least that I ever knew about.

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[ClinicalABA]

Interesting, it's possible I was clumping in psychiatric evaluations.

You'd be surprised how many actual clinicians/pediatricians still make referrals for ADHD "testing", as well as how many psychologists still think its valid to diagnose symptoms of ADHD based on performance on things like cognitive/intelligence, achievement, or neuropsych tests.

 

[gohogwild]

You'd be surprised how many actual clinicians/pediatricians still make referrals for ADHD "testing", as well as how many psychologists still think its valid to diagnose symptoms of ADHD based on performance on things like cognitive/intelligence, achievement, or neuropsych tests.

I would know nothing about that, but it sounds sticky!

 

[niceman]

You'd be surprised how many actual clinicians/pediatricians still make referrals for ADHD "testing", as well as how many psychologists still think its valid to diagnose symptoms of ADHD based on performance on things like cognitive/intelligence, achievement, or neuropsych tests.

When there are parents who are willing to pay thousands of dollars for an ADHD diagnosis, there are clinicians who are willing to do a full battery to milk them and give that diagnosis.

 

[AcronymAllergy]

When there are parents who are willing to pay thousands of dollars for an ADHD diagnosis, there are clinicians who are willing to do a full battery to milk them and give that diagnosis.

To be fair, sometimes a full (psychoeducational) battery is well-warranted and usually won't be covered by insurance. But if it's just for diagnosis rather than accommodations, etc., and other conditions for which testing might be helpful (e.g., other neurodevelopmental disorders) aren't being strongly considered, then yeah, all you really need are some good patient and collateral interviews, school records (if you have them), and maybe a few rating scales. If it's a kiddo and you can actually do a classroom observation, bonus points.

 

[medium rare]

Ok... want your mind blown? Check this. When we are presented our numbers the next column over give the average scores for our peers within our clinical team, dept, clinic as whole, etc... (dependent on a few things like the kind of work you do, child vs. adult general, vs IOP vs. Beh Med, etc....). Cool way to create a positive atmosphere and teamwork, right?

I’d be looking for another job. Immediately. Another reason I prefer private practice.

 

[Sanman]

Ok... want your mind blown? Check this. When we are presented our numbers the next column over give the average scores for our peers within our clinical team, dept, clinic as whole, etc... (dependent on a few things like the kind of work you do, child vs. adult general, vs IOP vs. Beh Med, etc....). Cool way to create a positive atmosphere and teamwork, right?

Is this score tied to a bonus? If yes, a smart person might let their patients know that they get free coffee and cookies if you get a perfect five star review from everyone. Or just do it right before survey time, recency effects are awesome.

If there is no money, I might ask admin why I care about this score at all.

 

[AbnormalPsych]

Is this score tied to a bonus? If yes, a smart person might let their patients know that they get free coffee and cookies if you get a perfect five star review from everyone. Or just do it right before survey time, recency effects are awesome.

If there is no money, I might ask admin why I care this score at all.

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[Sanman]

Bonus, and higher ups perception of you and annual review (although I don't think they would formally put that in writing).

This ties into my academic work too. My student evals are taken too seriously as well. Basically in both my clinical practice and my academic teaching, I am now in the customer service industry. To make people happy and give them what they pay for... "A grades" or feeling better right now. It has noticeably impacted my happiness when I know the thing I do is the right thing to help students learn and to help treat patients, but it makes them uncomfortable, and they are not "satisfied" at the 5/5 star level or whatever. I had no idea this is what I would be dealing with when I was in grad school.

Yeah, I accepted that fact from the day I started working as a clinician. I have also accepted the fact that gold standard care requires gold standard payment and motivated clients. The rest of us make do in an imperfect system.

 

[deleted106747]

Ok... want your mind blown? Check this. When we are presented our numbers the next column over give the average scores for our peers within our clinical team, dept, clinic as whole, etc... (dependent on a few things like the kind of work you do, child vs. adult general, vs IOP vs. Beh Med, etc....). Cool way to create a positive atmosphere and teamwork, right?

Yikes. Who on earth came up with that idea??

 

[AbnormalPsych]

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[medium rare]

People who get paid to wear suits and come up with ideas that constantly change are unnecessary in any way other than to look busy and justify their jobs.

Maybe I’ve been practicing too long, but I have zero patience for this type of BS.