Are you adjusting your practice?

[thebalmofhurtminds]

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Yeah, I've only ever had a problem with patients completing worksheets at the VA.

 

[KillerDiller]

It has been literally years since I've been active on this site. Since pre-doc or post-doc maybe. Nice to see some old familiar faces (uh...usernames).

I'm in private practice full time and have been doing all sessions over video chat for almost two weeks. First time doing telemental health for me. Last week many of my clients were in crisis. Some had exacerbated anxiety or depression and some had logistical crises (being laid off, being kicked out of their dorms and having to move across the country, etc.)

This week there are fewer acute crises, but lots of clients are getting irritable with their quarantine-mates or the world at large. Anger stage of grief I suppose.

 

[Spydra]

Are you in the VA? That's the only setting I've ever had a problem getting patients to use worksheets in therapy. And, I have worked with some fairly low functioning people. Worksheets should never be the driving force of therapy, but they can be a pretty good demonstration of some skills, and also allow me to show them trends over time.

I have never been in a VA setting, but nope can't get anyone to get it together to use worksheets. I wouldn't even describe any of my current or former settings as having low functioning persons (I'm guessing you're referring to disability status). I just find clients can't get it together enough to complete and return a worksheet largely due to a mess of social and SES factors, yet I can get them to meditate or do breathing exercises. So I'll proceed with saving some trees. And no I can't get them to use apps either.

 

[WisNeuro]

I have never been in a VA setting, but nope can't get anyone to get it together to use worksheets. I wouldn't even describe any of my current or former settings as having low functioning persons (I'm guessing you're referring to disability status). I just find clients can't get it together enough to complete and return a worksheet largely due to a mess of social and SES factors, yet I can get them to meditate or do breathing exercises. So I'll proceed with saving some trees. And no I can't get them to use apps either.

More a variety of factors, disability, SES, cognitive ability, acute distress, etc. Never really been an issue with most. I'm curious now.

 

[R. Matey]

Admittedly I flat out despise CBT solely because of its worksheets.

Personally, I've found that worksheets give a good natural structure to therapy be them CBT or DBT worksheets. And, I've worked in community mental health primarily billing Medicaid.

 

[Spydra]

@WisNeuro @R. Matey Well I'm glad you and probably others have had success with worksheets. I have the same problem with DBT worksheets, but I dislike that treatment for completely different reasons. I certainly get the logic behind worksheets and I'm not sure the issue is entirely the patients or clients. It could also be partly me and the wretched training I've had, so the end result has been me teaching myself and hoping no one breaks.

 

[cara susanna]

@WisNeuro @R. Matey Well I'm glad you and probably others have had success with worksheets. I have the same problem with DBT worksheets, but I dislike that treatment for completely different reasons. I certainly get the logic behind worksheets and I'm not sure the issue is entirely the patients or clients. It could also be partly me and the wretched training I've had, so the end result has been me teaching myself and hoping no one breaks.

Can I ask why you dislike DBT? Just curious.

 

[erg923]

@WisNeuro @R. Matey Well I'm glad you and probably others have had success with worksheets. I have the same problem with DBT worksheets, but I dislike that treatment for completely different reasons. I certainly get the logic behind worksheets and I'm not sure the issue is entirely the patients or clients. It could also be partly me and the wretched training I've had, so the end result has been me teaching myself and hoping no one breaks.

I don't think its so much about "getting patients to do this or that." Its more about making it a natural flow of the therapy process, Exploring reasons for resistance is all "grist for the mill" within the therapy process/sessions. And, at a certain point, it may certainly be advisable to take another route entirely. But, I mean, its not like most patients who are appropriate for OP treatment actually can't do them. That's ridiculous. Most of our patients have jobs, children, homes, bills, and other responsibilities that they do manage to take care of on a regularity basis, despite doing them rather poorly, perhaps?

Just want to make sure we don't portray doing CBT= doing worksheets? Worksheets are just one means of practicing therapy/skills without the therapist. Facilitating self-efficacy and personal investment and responsibility for behavior change is a part of ALL psychotherapies. I would not really accept, "well, I forget" as a legitimate answer to worksheet noncompliance. Maybe its rapport. Maybe its investment in treatment. Maybe they are really wanting something else that you are not addressing in sessions or the treatment plan? Maybe even exploring the core or intermediary belief that underlies the resistance/excuses?

 

[Spydra]

Can I ask why you dislike DBT? Just curious.

I can't quite explain why, but when we learned about it in class something about it didn't sit well. Then I met Linehan and was thoroughly creeped out. So I wish to stay as far away from that as possible.

Just want to make sure we dont' portray CBT= worksheets. Worksheets are just one means of practicing therapy/skills without the therapist.

This is unfortunately the impression that is provided courtesy of my program. Our CBT training went like this "Here is a worksheet. Give it to the clients for homework and then ask them about it next session." When more than half of us couldn't get clients to do them and then wondered what we were supposed to spend sessions doing if the worksheets weren't done the response was "Just give them different ones until they do." I tired of that quickly and started experimenting with some of the mindfulness tools. I have never desired a therapy career, but training shouldn't be this poor in an APA accredited program.

 

[erg923]

This is unfortunately the impression that is provided courtesy of my program. Our CBT training went like this "Here is a worksheet. Give it to the clients for homework and then ask them about it next session." When more than half of us couldn't get clients to do them and then wondered what we were supposed to spend sessions doing if the worksheets weren't done the response was "Just give them different ones until they do." I tired of that quickly and started experimenting with some of the mindfulness tools. I have never desired a therapy career, but training shouldn't be this poor in an APA accredited program.

K. Yea. That's not CBT. Not at all. Thats all hard technique with no substance or frame. At that point its like, dont bother asking about rapport, because, congratulations, you have none.

I actually don't like therapy much either...at least not more than a couple days a week.

Learning Cognitive-Behavior Therapy: An... book by Monica Ramirez Basco

Jess Wright, MD is da man, yo! There is also a good one by Judith Beck (cant remember the name) that I used when I taught, and that I think was used to teach me?

 

[WisNeuro]

Ah, yeah, it looks like the patients are not the problem. Also, I agree with erg, it sounds like you weren't actually trained in CBT. Are you still in training at some level? If so, there may still be time to rectify getting proper training and supervision. Also, re: DBT, every competent clinician should be trained in DBT, at least at a basic level. You will use some of those techniques across a very wide variety of situations, including assessment contexts.

 

[Sanman]

I don't think its so much about "getting patients to do this or that." Its more about making it a natural flow of the therapy process, Exploring reasons for resistance is all "grist for the mill" within the therapy process/sessions. And, at a certain point, it may certainly be advisable to take another route entirely. But, I mean, its not like most patients who are appropriate for OP treatment actually can't do them. That's ridiculous. Most of our patients have jobs, children, homes, bills, and other responsibilities that they do manage to take care of on a regularity basis, despite doing them rather poorly, perhaps?

Just want to make sure we don't portray doing CBT= doing worksheets? Worksheets are just one means of practicing therapy/skills without the therapist. Facilitating self-efficacy and personal investment and responsibility for behavior change is a part of ALL psychotherapies. I would not really accept, "well, I forget" as a legitimate answer to worksheet noncompliance. Maybe its rapport. Maybe its investment in treatment. Maybe they are really wanting something else that you are not addressing in sessions or the treatment plan? Maybe even exploring the core or intermediary belief that underlies the resistance/excuses?

I really do find it to be a great litmus test for investment in therapy, especially at the the VA.

 

[ClinicalABA]

I've actually been doing ASD diagnostic assessments via telehealth. There's some research out there on it, and the researchers from Vanderbilt have done some free webinars and shared their materials. It's gone much better than I expected. The tech has worked well, and the families have been great about preparing ahead of time and following my instructions for doing some of the social presses that I would typically do in the office. There's actually some things that I'm more likely to see at home (eg some repetitive behaviors and routines) that I might see in my office. In no case did I feel that dx would've been different if I did assessment in person. One case I was not certain about cognitive level, so would want to measure that directly when I can, and think it would be good to get baseline formal language scores. However, these were pretty straightforward and relatively obvious cases, all of whom I've seen for in person intakes. It will be interesting when it's a less obvious dx and/or with a kiddo I haven't seen in person. I do miss actually being the one playing with the kiddo. I also do some sample teaching/ABA during live assessments, and that doesn't work as well remotely. I'm also doing much more talking than normal, and I'm getting sick of seeing my own face.

 

[erg923]

I can't quite explain why, but when we learned about it in class something about it didn't sit well. Then I met Linehan and was thoroughly creeped out. So I wish to stay as far away from that as possible.

By the way, with all due respect, I don't know nothin about Marsha, Marsha, Marsha (but I know there can be some hero-worship there...although not nearing people like Million, Reitan, Klopfer/Rorschach Inkblot, Beck, and Hay's ACT cult) but rejecting a very well studied and effective means of treatment for certain patients because you found the primary founder "creepy" is obviously just silly. This is like saying, "I don't like psychoanalysis because Siggy was a sexist piece of **** who used alot of blow at his intellectual peak." Well, yea, ok. But you are presumably a clinical scientist and practitioner who should be able to parse out peoples and personality from empirically supported treatments and explanatory models.

 

[futureapppsy2]

By the way, with all due respect, I don't know nothin about Marsha, Marsha, Marsha (but I know there can be some hero-worship there...although not nearing people like Million, Reitan, Klopfer/Rorschach Inkblot, Beck, and Hay's ACT cult) but rejecting a very well studied and effective means of treatment for certain patients because you found the primary founder "creepy" is obviously just silly. This is like saying, "I don't like psychoanalysis because Siggy was a sexist piece of **** who used alot of blow at his intellectual peak." Well, yea, ok. But you are presumably a clinical scientist and practitioner who should be able to piece out peoples and personality from empirically supported treatments and explanatory models.

I've heard ACT described as a cult other places. I really, really like ACT as therapy, but the hardcore ACT people treat Hayes like a literal messiah and it creeps me out to no end. It's really disturbing, ngl.

 

[R. Matey]

I've heard ACT described as a cult other places. I really, really like ACT as therapy, but the hardcore ACT people treat Hayes like a literal messiah and it creeps me out to no end. It's really disturbing, ngl.

For. Real.

 

[R. Matey]

K. Yea. That's not CBT. Not at all. Thats all hard technique with no substance or frame. At that point its like, dont bother asking about rapport, because, congratulations, you have none.

I actually don't like therapy much either...at least not more than a couple days a week.

Learning Cognitive-Behavior Therapy: An... book by Monica Ramirez Basco

Jess Wright, MD is da man, yo! There is also a good one by Judith Beck (cant remember the name) that I used when I taught, and that I think was used to teach me?

Are you thinking of Cognitive Behavior Therapy: Basics and Beyond? That one is really great.

Also, @Spydra check out Strategic Decision Making in Cognitive Behavioral Therapy by Amy Wenzel. It's fabulous.

 

[Sanman]

I've heard ACT described as a cult other places. I really, really like ACT as therapy, but the hardcore ACT people treat Hayes like a literal messiah and it creeps me out to no end. It's really disturbing, ngl.

Has that not been true of every school of therapy at one time or another. Go to a meeting at NY psychoanalytic. I did feel like I was sitting in a room with a cult.

 

[erg923]

I've heard ACT described as a cult other places. I really, really like ACT as therapy, but the hardcore ACT people treat Hayes like a literal messiah and it creeps me out to no end. It's really disturbing, ngl.

I do NOT like arrows that go in all direction. And I don't really give **** what a hexaplex is. More complicated than a "worksheet." They kinda lost me after the Chinese finger-cuffs analogy, which is actually very good clinically, but just makes me think of Kevin Smith and Ben Affleck and sex...ya know?

 

[Spydra]

Ah, yeah, it looks like the patients are not the problem. Also, I agree with erg, it sounds like you weren't actually trained in CBT. Are you still in training at some level? If so, there may still be time to rectify getting proper training and supervision. Also, re: DBT, every competent clinician should be trained in DBT, at least at a basic level. You will use some of those techniques across a very wide variety of situations, including assessment contexts.

That is no surprise to me, but that is the state of training in my program. There isn't any. And yes we've complained and the response is 'this is how we were taught.' None of the licensed faculty in my program have DBT training so our site doesn't accept anyone that treatment is aimed at. There are very few external options as there are few clinicians willing to take students that have pretty much no training. I can't say I blame them. I managed to land one intervention placement that focused on depression using a combination of mindfulness and behavioral activation so that's what I started using at my program's site. All of my other placements have been assessment-focused which happens to fit more with my interests, so no complaints there. And courtesy of COVID-19 the limited intervention external placements have dismissed students for the rest of the semester and will not be taking students in the summer. *sigh* I do understand. I'm just glad that despite the limited opportunities I have managed to get enough hours to apply for internship and all of the site directors I chatted with at APA in past years said they prefer students who have more to learn over those who appear (or claim) to have learned everything.

By the way, with all due respect, I don't know nothin about Marsha, Marsha, Marsha (but I know there can be some hero-worship there...although not nearing people like Million, Reitan, Klopfer/Rorschach Inkblot, Beck, and Hay's ACT cult) but rejecting a very well studied and effective means of treatment for certain patients because you found the primary founder "creepy" is obviously just silly. This is like saying, "I don't like psychoanalysis because Siggy was a sexist piece of **** who used alot of blow at his intellectual peak." Well, yea, ok. But you are presumably a clinical scientist and practitioner who should be able to parse out peoples and personality from empirically supported treatments and explanatory models.

Oh I'm not negating that it has value and there is research to support that. A different view of this may or may not appear on internship, we'll see, but my program isn't going to offer more then the pretty much nothing that has been offered. My thoughts regarding future professional me is a suspicion that my interest in assessments will lead to diagnoses that are best addressed with DBT at some point. So having appropriate referrals would be essential.

 

[AbnormalPsych]

Yeah, I've experienced less volume than usual. I guess cancellations and no shows are up a bunch at our facility so it isn't just me. Even for phone sessions, people don't seem to want to talk very long.

Not long at all. I feel like I am just bothering 75% of my caseload at this point when I call.

 

[medium rare]

I’ve been doing phone sessions only for the past 1.5 weeks. So far, everyone has kept their appointment. I have also noticed a modest uptick in demand in that time with several calls for new appointments as well as some previous patients calling to schedule again.

It’s been challenging doing everything over the phone but, so far, I’ve been somewhat surprised by how smoothly it’s going. We’ll see how things continue...

 

[Ollie123]

I have had good success so far getting people on the phone. Sessions are definitely shorter though, though in part because for insurance reasons we are supposed to be targeting 30 minutes. Only logistical issue has been hiccups in the EHR related to teletherapy appointments.

The bigger issue I am struggling with is what to DO with people I get on the phone. I was doing a lot of BA and agoraphobia work before. How the F does one treat agoraphobia when it is now not only adaptive, but also state-mandated? Same with BA given the restrictions in place.

I am fortunate my patients seem to "get it", realize this is a temporary state and have not internalized this (yet). As I noted elsewhere, symptoms have oddly enough seemed to have lessened in the face of this. So I am mostly just doing supportive therapy and validating what seem to be fairly normative responses while I figure out next steps. Almost feel bad billing for it....

 

[Sanman]

I have had good success so far getting people on the phone. Sessions are definitely shorter though, though in part because for insurance reasons we are supposed to be targeting 30 minutes. Only logistical issue has been hiccups in the EHR related to teletherapy appointments.

The bigger issue I am struggling with is what to DO with people I get on the phone. I was doing a lot of BA and agoraphobia work before. How the F does one treat agoraphobia when it is now not only adaptive, but also state-mandated? Same with BA given the restrictions in place.

I am fortunate my patients seem to "get it", realize this is a temporary state and have not internalized this (yet). As I noted elsewhere, symptoms have oddly enough seemed to have lessened in the face of this. So I am mostly just doing supportive therapy and validating what seem to be fairly normative responses while I figure out next steps. Almost feel bad billing for it....

I have had the same issue with what to do. The initial session of "catastrophe planning" is one thing. However, as this drags on, what are we calling for? There is only so much supportive phone therapy that is necessary for most people.

 

[cara susanna]

I have had the same issue with what to do. The initial session of "catastrophe planning" is one thing. However, as this drags on, what are we calling for? There is only so much supportive phone therapy that is necessary for most people.

Ditto. I usually do mostly PTSD therapies and even if it's not a formal EBT it involves exposure components. Behavioral activation work isn't exactly easy right now, either. I'm going to be doing DBT skills training over the phone, though - we'll see how that goes. Not exactly optimistic because that can come across dry even in person.

 

[SportsNeuroPsych]

Question for the neuropsych folks - how are you all going about billing?

We are trying to set this up at my hospital but admin is a bit confused since I am the only neuropsych in the entire system. I see that CMS has approved 96116 for telehealth services but how are you billing for the other codes that we typically use (e.g., 96132, etc)?

 

[PsyDWannabe]

By the way, with all due respect, I don't know nothin about Marsha, Marsha, Marsha (but I know there can be some hero-worship there...although not nearing people like Million, Reitan, Klopfer/Rorschach Inkblot, Beck, and Hay's ACT cult) but rejecting a very well studied and effective means of treatment for certain patients because you found the primary founder "creepy" is obviously just silly. This is like saying, "I don't like psychoanalysis because Siggy was a sexist piece of **** who used alot of blow at his intellectual peak." Well, yea, ok. But you are presumably a clinical scientist and practitioner who should be able to parse out peoples and personality from empirically supported treatments and explanatory models.

I did not interpret the poster as saying Marsha being creepy is WHY she doesn't subscribe to DBT. I heard (read) them say they did not like it because it did not sit well with them, AND Marsha was creepy. Both can be true yet unrelated - I personally did not consider the latter to be related to not liking it.

On a related note (not to you erg but in general), just because an approach is above and beyond empirically validated does not mean we are duty bound to practice it. There are myriad reasons for something to not 'sit well' with a practitioner, hence all the options we have. I think that is important to note.

 

[WisNeuro]

Question for the neuropsych folks - how are you all going about billing?

We are trying to set this up at my hospital but admin is a bit confused since I am the only neuropsych in the entire system. I see that CMS has approved 96116 for telehealth services but how are you billing for the other codes that we typically use (e.g., 96132, etc)?

I'm not doing telehealth yet, our leadership is something of a clueless disaster, so I am enjoying doing nothing from home and getting paid to do it. But, I'm following listserv stuff and engaging with state legislature as part of the state psych stuff. But, I think you can still bill your regular testing and report writing codes, as long as you are using multiple tests (e.g., 96132). However, more of my colleagues are triaging and doing some interviews and a brief eval over the phone, similar to what @AcronymAllergy described earlier, in which they are billing 96116 and however many units of 96121 they need.

 

[WisNeuro]

Though, a caveat is, you need to make sure you are using the right modifiers, and some insurance carriers are much more on the ball than others, so expect problems.

 

[AcronymAllergy]

Question for the neuropsych folks - how are you all going about billing?

We are trying to set this up at my hospital but admin is a bit confused since I am the only neuropsych in the entire system. I see that CMS has approved 96116 for telehealth services but how are you billing for the other codes that we typically use (e.g., 96132, etc)?

Like WisNeuro said, a lot of this may depend on the individual insurance and being sure you're using the appropriate modifer(s). Although as far as I've been hearing, most/all insurance companies are mirroring what CMS is doing.

As far as I know, 96116 and 96121 are both now covered by CMS for telehealth. 96132 might be, but I'm less sure of that. I don't think 96133 is as of yet.

 

[SportsNeuroPsych]

I'm not doing telehealth yet, our leadership is something of a clueless disaster, so I am enjoying doing nothing from home and getting paid to do it. But, I'm following listserv stuff and engaging with state legislature as part of the state psych stuff. But, I think you can still bill your regular testing and report writing codes, as long as you are using multiple tests (e.g., 96132). However, more of my colleagues are triaging and doing some interviews and a brief eval over the phone, similar to what @AcronymAllergy described earlier, in which they are billing 96116 and however many units of 96121 they need.

Like WisNeuro said, a lot of this may depend on the individual insurance and being sure you're using the appropriate modifer(s). Although as far as I've been hearing, most/all insurance companies are mirroring what CMS is doing.

As far as I know, 96116 and 96121 are both now covered by CMS for telehealth. 96132 might be, but I'm less sure of that. I don't think 96133 is as of yet.

Thank you both.

Per the CMS guidelines - it appears that only 96116 is an approved telemed code...not even the modifier (96121). I attached the file if anyone is interested. I know it will likely vary by insurance provider and I think time will tell what will/will-not be approved.

I am scheduled to have a call with my dept later today to see how we can make this work. We'll see...

 

[WisNeuro]

Thank you both.

Per the CMS guidelines - it appears that only 96116 is an approved telemed code...not even the modifier (96121). I attached the file if anyone is interested. I know it will likely vary by insurance provider and I think time will tell what will/will-not be approved.

I am scheduled to have a call with my dept later today to see how we can make this work. We'll see...

Check with your private insurers as well. Some of the insurers in our state have expressly opened up all neuropsych testing codes for billing.

 

[AcronymAllergy]

Thank you both.

Per the CMS guidelines - it appears that only 96116 is an approved telemed code...not even the modifier (96121). I attached the file if anyone is interested. I know it will likely vary by insurance provider and I think time will tell what will/will-not be approved.

I am scheduled to have a call with my dept later today to see how we can make this work. We'll see...

I've seen multiple emails that 96121 has since been added to the "approved" list by CMS. Unfortunately, I don't know if I've saved any of them that have first-hand info I could point you to.

 

[ClinicalABA]

I'm not doing telehealth yet, our leadership is something of a clueless disaster, so I am enjoying doing nothing from home and getting paid to do it. But, I'm following listserv stuff and engaging with state legislature as part of the state psych stuff. But, I think you can still bill your regular testing and report writing codes, as long as you are using multiple tests (e.g., 96132). However, more of my colleagues are triaging and doing some interviews and a brief eval over the phone, similar to what @AcronymAllergy described earlier, in which they are billing 96116 and however many units of 96121 they need.

Billing 96132, 96133, 96136, and 96137, with telehealth modifiers as appropriate.

 

[foreverbull]

I think this experience has really highlighted privilege or lack thereof amongst different groups.

Our services as psychologists are generally in demand, but those who are salaried at least have paid sick leave, vs. those working contract or hourly in places where telehealth isn't viable, but are still considered "essential." More broadly, the 10 days of sick leave that the government has agreed to provide have exceptions for companies with <50 or >500 employees, so a lot of folks in service industries and elsewhere are part of the exceptions and are just stuck feeling like they have no real choice in the matter (no pay + possibly lose job and stay at home, or go to work and risk exposure but still put food on the table?).

I am currently very privileged to be able to teach from home and practice telehealth; others, not so much. There is quite a disparity I'm seeing depending on the company/organization, specialty/role, and job status (salaried vs. contract/hourly). Crises also highlights how folks at the high end of SES get preferential treatment (several celebrities and athletes managed to get tested when people outside of high risk groups or with mild to moderate symptoms couldn't or can't hope to get tested at all because tests are in short supply). One teen in my state was turned away from urgent care with respiratory symptoms because he didn't have insurance and then died later from cardiac arrest (they initially reported it as a COVID-19 death but the CDC is investigating further). Just one anecdote, but it shouldn't have happened at all.

Having said that, CNAs, nurses, doctors, and related health staff (some of whom are salaried and make decent money) are also bearing the brunt of this as essential workers without adequate protection.

I can only hope that moving forward after this (in years to come), there will be a shift in policies that will protect our most vulnerable in the realm of healthcare, jobs, sick leave, maternity/paternity leave, etc. -- policies that are already in place in some other countries.

 

[Sanman]

I think this experience has really highlighted privilege or lack thereof amongst different groups.

Our services as psychologists are generally in demand, but those who are salaried at least have paid sick leave, vs. those working contract or hourly in places where telehealth isn't viable, but are still considered "essential." More broadly, the 10 days of sick leave that the government has agreed to provide have exceptions for companies with <50 or >500 employees, so a lot of folks in service industries and elsewhere are part of the exceptions and are just stuck feeling like they have no real choice in the matter (no pay + possibly lose job and stay at home, or go to work and risk exposure but still put food on the table?).

I am currently very privileged to be able to teach from home and practice telehealth; others, not so much. There is quite a disparity I'm seeing depending on the company/organization, specialty/role, and job status (salaried vs. contract/hourly). Crises also highlights how folks at the high end of SES get preferential treatment (several celebrities and athletes managed to get tested when people outside of high risk groups or with mild to moderate symptoms couldn't or can't hope to get tested at all because tests are in short supply). One teen in my state was turned away from urgent care with respiratory symptoms because he didn't have insurance and then died later from cardiac arrest (they initially reported it as a COVID-19 death but the CDC is investigating further). Just one anecdote, but it shouldn't have happened at all.

Having said that, CNAs, nurses, doctors, and related health staff (some of whom are salaried and make decent money) are also bearing the brunt of this as essential workers without adequate protection.

I can only hope that moving forward after this (in years to come), there will be a shift in policies that will protect our most vulnerable in the realm of healthcare, jobs, sick leave, maternity/paternity leave, etc. -- policies that are already in place in some other countries.

I appreciate where your head is at and am thankful for my safe government job in these times. That said, I doubt those changes will ever happen in this country.

 

[cara susanna]

I can only hope that moving forward after this (in years to come), there will be a shift in policies that will protect our most vulnerable in the realm of healthcare, jobs, sick leave, maternity/paternity leave, etc. -- policies that are already in place in some other countries.

I'm hopeful that, in the end, some good will come out of this and part of that will be people recognizing the importance of a social safety net and access to healthcare (among other things but I don't want to turn this into too political of a thread).

 

[Fan_of_Meehl]

I can't quite explain why, but when we learned about it in class something about it didn't sit well. Then I met Linehan and was thoroughly creeped out. So I wish to stay as far away from that as possible.



This is unfortunately the impression that is provided courtesy of my program. Our CBT training went like this "Here is a worksheet. Give it to the clients for homework and then ask them about it next session." When more than half of us couldn't get clients to do them and then wondered what we were supposed to spend sessions doing if the worksheets weren't done the response was "Just give them different ones until they do." I tired of that quickly and started experimenting with some of the mindfulness tools. I have never desired a therapy career, but training shouldn't be this poor in an APA accredited program.

For what it's worth, here's a link to some good CBT training vids with examples of doing CBT treatment that's definitely not just 'give em worksheets and ask about them next time.' I was trained in cognitive therapy by Jesse Wright in the 90s and he was always clear on the primary importance of thinngs like the therapeutic relationship, flexibility, humor, and many of the subtleties of working with deep schema-level content with clients.

If I was training grad students in CBT these days, I think I'd commit to having at least half of the curriculum/training material and readings come from the pre-2000 era--a time before the 'structure/worksheet fetish' crowd took over CBT. The writings of Beck, Mahoney, Meichenbaum, etc. tend to be theory rich and not emphasize technique/ worksheets nearly as much as the more recent stuff.

Link to vids:
www.appi.org/wright