Difficulty collaborating with Psychologists

[AcronymAllergy]

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This, to me, is really interesting. Partially because its new information but also because you imply that its a standard. I'm in california and I work in an a sort of community/UC academic environment and private practice. The private practice psychologists are terrible although I should generally say therapists because the majority aren't psychologists. I had assumed they were being lazy or dumping. Some of the psychologists got their training in prisons and they are proud of it. I am sure they have seen SMI, but the quality of work is subpar.

The psychologists I work with at the govt job are top notch, which I had always attributed to having a working relationship. The difference is remarkable when I think about it. I get annoying calls from the PP psychologists telling me I need to increase meds on a borderline patient while we regularly discuss how not to enable a similar borderline and give more structure/boundaries in the pseudo-academic setting.

It seems to be the case in CA in particular that psychologists who attended...less-than-stellar (i.e., diploma mill) grad schools, which are unfortunately highly over-represented in CA, often go the PP route. Conversely, jobs in the VA are significantly more competitive for psychologists; thus, many of the more highly-credentialed folks end up there (as well as in academic medical centers). Given the academic roots of clinical psychology, I'd imagine this goes back a long way, in part due to the affiliations at AMCs and VAs and subsequent increased ability to conduct/participate in collaborative research. Also, VAs and AMCs typically require that folks attend AP(sychology)A-accredited predoctoral internships, which folks from diploma mill-type programs often have a hard time securing (or perhaps don't even apply for to begin with).

It's been said a few times on the psychology forums here--some/many folks feel that our field needs the equivalent of medicine's Flexner Report ASAP. The current variability in training quality almost necessitates that not only should patients and other providers ensure that the psychologist is licensed, but they should also find out where the person attended grad school and internship.

 

[Ceke2002]

To get back to the original topic as this has digressed a bit. I am wondering why the OP would be surprised to find inept practitioners. I have worked with quite a few psychiatrists where I question their competency. My biased perspective has always been that they are not as competent as the average physician. Participating in this board has changed my perspective on that, my fear is that you guys are the exception. Of course, one of my supervisors pointed out that I didn't trust my colleagues in psychology very much and she was right because I hear too many stories of incompetence. I could give example after example from both professions. Psychologist who told my sister-in-law that she was likely a victim of satanic ritual abuse because she had difficulty remembering childhood, psychiatrist who prescribes stimulants to kid with anxiety due to sexual abuse and testifying against the perp, psychologists and psychiatrists who work with kids but have no ability to develop rapport and just have painful awkward sessions (this happens all the time, especially with adolescents), psychiatrists who prescribe benzos to substance abusers, team of psychiatrists who agreed ECT was best treatment for Borderline. Psychologists and psychiatrists who take sides with their patients and begin doling out advice about how to deal with people they have never met. I would think disagreement over diagnosis ranks pretty low down the list.

As a patient I can really relate to what you've written here. Aside from my current Psychiatrist (who really has turned out to be just an absolute godsend for me), in the 20+ years I've been in and out of the mental health system in South Australia I've had maybe 2 Psychologists and 1 basic Therapist who I can honestly say provided me with a good level of care and even then that was only for one specific issue, Borderline PD. Credit where credit's due those Psychologists and Therapist did provide me with enough of a solid treatment basis that the Borderline PD diagnosis was eventually able to be taken off the table, but in terms of my other issues/symptomology up until recently I've pretty much just stumbled from one treatment disaster to another. There was the Psychiatrist who diagnosed me with Schizophrenia after just 45 minutes, when the majority of that time was spent on taking my history not discussing the current symptom presentation (at one point I mentioned a childhood diagnosis of ADD, which I described as being like having a filing cabinet in my head with everything just thrown in at random, and when I managed to sneak a quick look at my notes while she was out of the room she had seriously written down, "Patient has delusions of filing cabinet in head" - Um hellooo, I was using a metaphor! ); the Psychiatrist who snoozed his way through the majority of my first session whilst sporting an exceedingly noticeable erection; the Psychiatrist who, not even 15 minutes into the session, suddenly turned around and said "you're full of ****, get the f*** out of my office" (his exact words, and to this day I still have no idea what I said or did to have triggered such a response); the Psychiatrist who over turned a diagnosis of Anorexia Nervosa, previously given to me by one of the Professors at the state's main out patient eating disorders hospital treatment unit, and despite my presenting as clinically emaciated at the time, based solely on the fact that I buttered my half slice of toast in the morning and sugared my tea and coffee; the radical separatist feminist Psychologist who blamed everything on men and the patriarchal system of oppression; the Psychiatrist who basically turned out to be a sexual predator with a medical license and very graciously left me with a nice little package of trauma and trust issues that I'm still working through more than several years after the fact (yeah, thanks for nothing, a-hole )...

But then having said all that I see my Psychiatrist now, or I come on here and read some of the posts by awesome treatment providers/researchers like yourself, Whopper, Fonzie, OldPsychDoc, Billypilgrim, Nitemagi, Erg923, and so many others, and suddenly I'm seeing a vastly different side to mental health care - one that I honestly thought just barely even existed, and it makes me wonder 'well where the hell ARE all the good Doctors/Therapists out there, what is so wrong with mental health overall that coming across even a handful of (more than) decent practitioners feels tantamount to wandering outside and finding a Unicorn just randomly standing there?' And more to the point, what can be done to fix it? Not just in terms of better liaisons between different groups of practitioners (Psychiatrists, Psychologists, etc), but with everything.

 

[Ceke2002]

1. You are in CA, no? Psychologist is the PP market in that area are likely to have attended rather subpar professional schools. Psychologist who graduated from rigorous university bsased programs there (Berkley, UCLA, etc) are generally in academia or hold academically affiliated clinical positions rather than PP.

It's been said a few times on the psychology forums here--some/many folks feel that our field needs the equivalent of medicine's Flexner Report ASAP. The current variability in training quality almost necessitates that not only should patients and other providers ensure that the psychologist is licensed, but they should also find out where the person attended grad school and internship.

I'm really surprised to read stuff like this. Here in South Australia (and this is going back a while so it may be even more rigorous now) if someone wants to practice as a Psychologist they have to complete a 3 year Bachelor's degree majoring in Psychology, and then go on to do another one year of post graduate honours, two years of post grad masters, plus finish a further two years of supervised work experience, before they can be registered. Anyone who hasn't completed those requirements can only call themselves or practice as a therapist or counsellor. I guess I assumed the same, or at least similar standards would have applied in the US as well. Again, very surprising.

 

[erg923]

Well, same here. Bachelors degree plus 5-6 years for a doctorate, then post-doc in many states (but not all states). But when you have low admission standards and subpar supervision, doesnt matter how long you are in training, right?

 

[Ceke2002]

Well, same here. Bachelors degree plus 5-6 years for a doctorate, then post-doc in many states (but not all states). But when you have low admission standards and subpar supervision, doesnt matter how long you are in training, right?

Good point, thanks for the insight. 👍 So it sounds like more of a quality control issue then?

 

[AcronymAllergy]

Good point, thanks for the insight. 👍 So it sounds like more of a quality control issue then?

Yes, it's more an issue of quality control regarding the grad programs than it is a lack of standardization of the training process itself. And relatedly, the nationally-developed "gold standard" currently (i.e., APA accreditation) leaves a lot to be desired, and was initially intended to be a bare minimum rather than something to which programs aspire as a high point...although in my opinion, given some of the accredited programs out there, it's not really doing a good job of ensuring minimal standards, either.

State licensing boards are all fairly similar in what they require in terms of education/training, with the exception that erg mentioned of some requiring one year of supervised postdoctoral practice while others do not.

 

[whopper]

Wow, I'm actually semi-agreeing with Vistaril.

While I can't speak for him, I can say I've noticed what he's talking about.

Several people here don't like EMDR and think it's bullocks but have a well educated view on it. AcronymAllergy's post is an example of this.

But there's also another group that just doesn't buy it without really reviewing the data on it. That's what at least I'm talking about. If you don't see this, I can bring in several parallels, for example doctors who don't buy that SAM-E, fish oil, walking a few miles a day, etc could also work without actually reviewing the data. Outside our field there's accupuncture, ginseng, red bean extract, all with data supporting it could work. (Emphasis on could, not definitely so).

While I was a resident, the first emerging data was coming out on fish oil and depression so I started giving fish oil in addition to an antidepressant, not instead of one (unless the patient didn't want an antidepressant, and I told them the fish oil was not intended to be a substitute). I got the snarky "Oh you're one of those" from some attendings--none of whom reviewed the data.

Way I saw it, even if I was wrong, that stuff does have health benefits and it's cheap. Add that this was right before the emergence of $4 antidepressants, where Celexa was going to cost a lot of money.

 

[vistaril]

It seems to be the case in CA in particular that psychologists who attended...less-than-stellar (i.e., diploma mill) grad schools, which are unfortunately highly over-represented in CA, often go the PP route. Conversely, jobs in the VA are significantly more competitive for psychologists; thus, many of the more highly-credentialed folks end up there (as well as in academic medical centers). Given the academic roots of clinical psychology, I'd imagine this goes back a long way, in part due to the affiliations at AMCs and VAs and subsequent increased ability to conduct/participate in collaborative research. Also, VAs and AMCs typically require that folks attend AP(sychology)A-accredited predoctoral internships, which folks from diploma mill-type programs often have a hard time securing (or perhaps don't even apply for to begin with).

It's been said a few times on the psychology forums here--some/many folks feel that our field needs the equivalent of medicine's Flexner Report ASAP. The current variability in training quality almost necessitates that not only should patients and other providers ensure that the psychologist is licensed, but they should also find out where the person attended grad school and internship.

Look it doesn't take a brain surgeon to figure out why VA's attract quality psychologists and the VA is seen as a desirous place for psychologists to work, whereas for psychiatrists the VA is generally not seen that way. VA's easily recruit very good/well trained psychologists, but sometimes have difficulty recruiting psychiatrists with even good english skills.

VA psychologists generally have a nice income after a few years(around 100k or more in some cases on a gs-13 or 14 after a years), obviously great benefits, a nice schedule, not worrying about getting patients or billing, etc....that's obviously a desirable job for psychologists.

 

[MacDonaldTriad]

I think what psychology lacks is adequate control of accreditation process. It seems like you can go through a much wider variety of educational programs and still call yourself a psychologist. There are non-accredited schools, non-accredited internships, non-accredited post-doctoral fellowships. There are also bachelor, master and doctoral levels, all of which can find jobs in mental health. I’m not saying there aren’t good and bad psychiatrists, or good and bad psychiatric training, but there are more hurdles that cull out some of the incompetent. Weak students can generally find some kind of psychology program that will take their money. You might say this is somewhat true of medicine, but it is much less true. At least medical schools that lose accreditation tend to die off and graduates of unaccredited medical schools do hit a dead end usually. I’m not an expert in state licensing requirements for psychologists, but they do seem to be somewhat variable state to state or maybe variably necessary to find work. Medical licensing requirements also vary state to state, but there seems to be more of a standard floor that all states require, and some add other things to this floor.
Psychologists from universities with quality training have good job opportunities, but lots of people who fancy themselves as psychologists have trouble finding work. There isn’t a board eligible/board certified psychiatrist who can’t find employment somewhere, well all but a small handful. Medicine has a better flow restrictor at the front end of the pipeline; psychology’s biggest flow restrictor is more at the employment seeking end. Law is closer to the psychology model; medicine is more like one of those highly coveted highly paid union jobs that are passed from one generation to the next.
“You’re a psychologist, hay, so am I”.
“No, you really aren’t, not really”.

 

[vistaril]

I think what psychology lacks is adequate control of accreditation process. It seems like you can go through a much wider variety of educational programs and still call yourself a psychologist. There are non-accredited schools, non-accredited internships, non-accredited post-doctoral fellowships. There are also bachelor, master and doctoral levels, all of which can find jobs in mental health. I’m not saying there aren’t good and bad psychiatrists, or good and bad psychiatric training, but there are more hurdles that cull out some of the incompetent. Weak students can generally find some kind of psychology program that will take their money. You might say this is somewhat true of medicine, but it is much less true. At least medical schools that lose accreditation tend to die off and graduates of unaccredited medical schools do hit a dead end usually. .

well i think this is true in some fields requiring an MD/DO....psychiatry less so. Simply because psychiatry has such a high number of imgs(both american and not). So what is essentially a neccessary hurdle in 96% of cases(and the 2% that arent were extraordinary anyways) in a field like ent(being accepted into an american allopathic school) doesn't exist in our field. You can say that the usmle steps are a hurdle, but that's dubious I think.

What I will grant is that incompetent people wanting to do psychiatry are likely going to have to make some tough choices and sacrifice a bit more than incompetent people wanting to do psychology(for example leaving the country to go to school for a couple years)

 

[erg923]

I think what psychology lacks is adequate control of accreditation process. It seems like you can go through a much wider variety of educational programs and still call yourself a psychologist. There are non-accredited schools, non-accredited internships, non-accredited post-doctoral fellowships. There are also bachelor, master and doctoral levels, all of which can find jobs in mental health. I’m not saying there aren’t good and bad psychiatrists, or good and bad psychiatric training, but there are more hurdles that cull out some of the incompetent. Weak students can generally find some kind of psychology program that will take their money. You might say this is somewhat true of medicine, but it is much less true. At least medical schools that lose accreditation tend to die off and graduates of unaccredited medical schools do hit a dead end usually. I’m not an expert in state licensing requirements for psychologists, but they do seem to be somewhat variable state to state or maybe variably necessary to find work. Medical licensing requirements also vary state to state, but there seems to be more of a standard floor that all states require, and some add other things to this floor.
Psychologists from universities with quality training have good job opportunities, but lots of people who fancy themselves as psychologists have trouble finding work. There isn’t a board eligible/board certified psychiatrist who can’t find employment somewhere, well all but a small handful. Medicine has a better flow restrictor at the front end of the pipeline; psychology’s biggest flow restrictor is more at the employment seeking end. Law is closer to the psychology model; medicine is more like one of those highly coveted highly paid union jobs that are passed from one generation to the next.
“You’re a psychologist, hay, so am I”.
“No, you really aren’t, not really”.

This is very accurate. The doctorate is still what allows someone to be a "psychologist" (masters level folkds are only therapists of some type or another), but some of the doctoral training out there is basically nothing more than a subpar masters degree plus some work experience- as opposed rigorous, scientifically based training in psychology and mental health assessment, intervention, and dissemination. Its bad for the field. Its bad for patients. Its bad for science.

 

[AcronymAllergy]

I think what psychology lacks is adequate control of accreditation process. It seems like you can go through a much wider variety of educational programs and still call yourself a psychologist. There are non-accredited schools, non-accredited internships, non-accredited post-doctoral fellowships. There are also bachelor, master and doctoral levels, all of which can find jobs in mental health. I’m not saying there aren’t good and bad psychiatrists, or good and bad psychiatric training, but there are more hurdles that cull out some of the incompetent. Weak students can generally find some kind of psychology program that will take their money. You might say this is somewhat true of medicine, but it is much less true. At least medical schools that lose accreditation tend to die off and graduates of unaccredited medical schools do hit a dead end usually. I’m not an expert in state licensing requirements for psychologists, but they do seem to be somewhat variable state to state or maybe variably necessary to find work. Medical licensing requirements also vary state to state, but there seems to be more of a standard floor that all states require, and some add other things to this floor.
Psychologists from universities with quality training have good job opportunities, but lots of people who fancy themselves as psychologists have trouble finding work. There isn’t a board eligible/board certified psychiatrist who can’t find employment somewhere, well all but a small handful. Medicine has a better flow restrictor at the front end of the pipeline; psychology’s biggest flow restrictor is more at the employment seeking end. Law is closer to the psychology model; medicine is more like one of those highly coveted highly paid union jobs that are passed from one generation to the next.
“You’re a psychologist, hay, so am I”.
“No, you really aren’t, not really”.

Agreed with erg; the above is very accurate re: the current professional and training problems in psychology. And because there are a larger number of poorly trained psychologists out there (and because the professional organization is doing little to curb this), it brings down the market value of psychology as a whole, given that there's a fairly stark contrast between the services provided by well-trained versus poorly-trained psychologists. So you then have poorly-trained folks coming out who are unable to find jobs and end up feeling fortunate when taking $40k/year positions that are listed for "MFT/MSW/PhD/PsyD."

Certain sub-specialties are trying to take some of the accrediting process/power into their own hands by embracing board certification, which is starting to gain traction in psychology as a whole (although it's nowhere near as ubiquitous as in medicine). And the predoctoral internship process tends to cull out some of the more degree mill-type applicants (at least with respect to obtaining accredited vs. non-accredited internships). But unfortunately, as was mentioned, there just aren't a lot of checks-and-balances along the way. In rigorous doctoral programs, there are plenty of opportunities for folks to be dismissed if that's appropriate (e.g., pre- and post-masters/generals, pre- and post-comps, pre-dissertation); but if the program itself is the problem, those culling points are inconsequential. And beyond that, the national licensing exam is a bit of a long-running joke.

So I'm unfortunately not at all surprised when other providers tell me they've had issues with psychologists in the past.

 

[MacDonaldTriad]

Maybe we can leave the psychology training system as it is. We will just pass a new law that says: “If your professional school wasn’t at a University, you have to use air quotes when introducing yourself as a doctor”.
On a more serious note, I probably would not be very good at guessing the quality of my psychology colleagues’ doctoral programs. It is all about training, lifelong learning, who mentors you and how passionate you are about learning. I probably could make a good guess if I work with them in a research setting. At the end of the day, some psychologists are very impressive and have awesome skills, and some are far from that. Psychiatrists are not much different. The tighter monopoly on medicine does make a world of difference on the job market however.

 

[Therapist4Chnge]

Maybe we can leave the psychology training system as it is. We will just pass a new law that says: “If your professional school wasn’t at a University, you have to use air quotes when introducing yourself as a doctor”.

I agree with the prior posts about psychology training…there are too many loopholes and fly-by-night kind of programs. We are about 20+ years overdue for a Flexner-type review.

 

[hamstergang]

But there's also another group that just doesn't buy it without really reviewing the data on it. That's what at least I'm talking about. If you don't see this, I can bring in several parallels

Was anyone disagreeing with this, because if so I didn't see it?

Here's a run-down of how I remember the conversation:
1) Vistaril: I believe EMDR works.
2) others/me: Sure, but it's just exposure therapy plus black magic.
3) Vistaril: Psychiatrists just dismiss things that won't make them money without looking at the evidence.

Do you see the problem here? Firstly, he's assuming that those of us in this thread haven't looked at the evidence, and secondly he's not willing to look at the evidence to see that what we're saying is correct. He's dismissing out views about EMDR because he's guessing they're not well-reasoned while at the same time refusing to challenge his own un-evidenced based view on EMDR.

 

[vistaril]

Was anyone disagreeing with this, because if so I didn't see it?

Here's a run-down of how I remember the conversation:
1) Vistaril: I believe EMDR works.
2) others/me: Sure, but it's just exposure therapy plus black magic.
3) Vistaril: Psychiatrists just dismiss things that won't make them money without looking at the evidence.

Do you see the problem here? Firstly, he's assuming that those of us in this thread haven't looked at the evidence, and secondly he's not willing to look at the evidence to see that what we're saying is correct. He's dismissing out views about EMDR because he's guessing they're not well-reasoned while at the same time refusing to challenge his own un-evidenced based view on EMDR.

lmao....you remember the conversation wrong.

My view on emdr can be summed up as follows:

1) I have no idea if the eye movements actually produce any benefit. I'm pretty sure that >95% of the people who comment on them(including you) don't either. I've said as much.
2) The patients I know of who have done emdr have had success with it
3) Most psychiatrists who slam emdr with their black magic/magic sprinkles/whatever snarks are doing so because they got their feelings hurt other providers in mental health have had some success with something that they aren't(for the most part) a big part of. Nevermind that most of these same people also don't do trauma focused cbt regularly either(and arent competent in it), so I'm a little puzzled why they would go in that direction but whatever...
4) Most psychiatrists who talk about the 'literature' about the eye movements in emdr actually haven't read it, aren't familar with it, and are just bozos parroting what someone else told them.

The difference between me and you(and others) on this matter is I can admit points #1,3,4. I will openly admit to not knowing what the right answer is.

So those are my views on emdr.

 

[vistaril]

want to add one more thing:

part of my reason to call out the psych snarkiness on this matter(which literally extends from 1st year med students interested in psych to longtime attendings...and amazingly it always takes the same exact form) is that the people I've seen making these remarks aren't even in the game......

If some psychiatrist who actually had a large practice devoted to individual cbt with trauma patients wanted to speak up......fine. That person has some cred.

But 100% of the people I've seen making these remarks in the real world(from my hospital to multiple moonlighting gigs to our faculty/residents) are psychs who are not doing either.

So imagine how you would look at that if you were a psychologist who specializes in trauma work and spent a good deal of time learning emdr(after you have already worked with hundreds of patients in cbt, exposure therapy, etc) and some psychiatrist takes a quick break from shoving Seroquel down a pt's mouth to make a snarky comment about something they aren't doing and have never done. I mean really......

 

[hamstergang]

lmao....you remember the conversation wrong.

Great assertion. Can you back that up?

1) I have no idea if the eye movements actually produce any benefit. I'm pretty sure that >95% of the people who comment on them(including you) don't either. I've said as much.
2) The patients I know of who have done emdr have had success with it
3) Most psychiatrists who slam emdr with their black magic/magic sprinkles/whatever snarks are doing so because they got their feelings hurt other providers in mental health have had some success with something that they aren't(for the most part) a big part of. Nevermind that most of these same people also don't do trauma focused cbt regularly either(and arent competent in it), so I'm a little puzzled why they would go in that direction but whatever...
4) Most psychiatrists who talk about the 'literature' about the eye movements in emdr actually haven't read it, aren't familar with it, and are just bozos parroting what someone else told them.

Again, you make great assertions that you really just made up on the spot. I don't know if 3 or 4 are true are not, but you don't either.

No one has disagreed with #2. That is not at all in contention. So why are you bringing it up?

And then there's #1. You are not sure, but you admit to not having looked at the easily accessible evidence. I am sure. I have looked at the evidence. Are you calling me a liar?

So what we have here is that you don't know if the eye movements are anything real and refuse to look at the evidence, yet you support the therapy. And then you tell those of us who have actually looked at the evidence and told you the conclusions that we are lying to you and are just acting like hurt little babies. Really wonderful from you, reaching a new low.

 

[vistaril]

Great assertion. Can you back that up?


Again, you make great assertions that you really just made up on the spot. I don't know if 3 or 4 are true are not, but you don't either.

No one has disagreed with #2. That is not at all in contention. So why are you bringing it up?

And then there's #1. You are not sure, but you admit to not having looked at the easily accessible evidence. I am sure. I have looked at the evidence. Are you calling me a liar?

So what we have here is that you don't know if the eye movements are anything real and refuse to look at the evidence, yet you support the therapy. And then you tell those of us who have actually looked at the evidence and told you the conclusions that we are lying to you and are just acting like hurt little babies. Really wonderful from you, reaching a new low.

Once again, I don't neccessarily 'support the theory'. I don't know. I've said that multiple times now....

So hamster, where is the evidence you allude to that 'the eye movements are not real'? Now that I've looked into this issue more thanks to this thread I see an older meta analysis(before it became real popular) which didn't show much difference between trauma focused cbt(which again is harder to find in some locales than a good burrito in storrs)....I certainly don't see a lot to answer this question in the affirmative in any direction frankly.

And as for you? yeah I'm pretty confident you are lying to me. Which is ok and everything.

 

[hamstergang]

yeah I'm pretty confident you are lying to me.

Then we're done here. If you don't believe me when I tell you something about myself, then there's no point in talking to you.

If you're interested in becoming a better, more well-informed doctor, someone else already posted links to the literature in this thread. I shouldn't need to post them again for you to be able to find them.

 

[vistaril]

Then we're done here. .

excellent...bye now.

 

[AcronymAllergy]

To be fair, the links I posted earlier weren't all trauma-specific, and as I mentioned back then, perhaps there's something unique regarding the eye movements with trauma specifically. I personally doubt it other than through the eye movements perhaps making the treatment less intimidating, and thereby possibly improving adherence and completion (as would the therapist's exhibited passion about the therapy), but hey, anything is possible. I can certainly say that there are some folks who respond better to CPT or PE based largely on them buying into one paradigm more than the other, so the same could of course apply to EMDR.

There is literature to support the unique contributions of the eye movements, although it's all conducted mostly by the same group of folks and much of it consists of case reports that may or may not include actual single-case research methodology rather than just qualitative statements.

 

[whopper]

I probably would not be very good at guessing the quality of my psychology colleagues’ doctoral programs.

I've also seen some good people come from bad programs because that specific individual gave a damn. They were able to be a good clinician in spite of their programs.

 

[Ceke2002]

Wow, I'm actually semi-agreeing with Vistaril.

While I can't speak for him, I can say I've noticed what he's talking about.

Several people here don't like EMDR and think it's bullocks but have a well educated view on it. AcronymAllergy's post is an example of this.

But there's also another group that just doesn't buy it without really reviewing the data on it. That's what at least I'm talking about. If you don't see this, I can bring in several parallels, for example doctors who don't buy that SAM-E, fish oil, walking a few miles a day, etc could also work without actually reviewing the data. Outside our field there's accupuncture, ginseng, red bean extract, all with data supporting it could work. (Emphasis on could, not definitely so).

While I was a resident, the first emerging data was coming out on fish oil and depression so I started giving fish oil in addition to an antidepressant, not instead of one (unless the patient didn't want an antidepressant, and I told them the fish oil was not intended to be a substitute). I got the snarky "Oh you're one of those" from some attendings--none of whom reviewed the data.

Way I saw it, even if I was wrong, that stuff does have health benefits and it's cheap. Add that this was right before the emergence of $4 antidepressants, where Celexa was going to cost a lot of money.

My Psychiatrist would probably be considered one of 'those' as well. There's plenty of stuff he's either presented to me or been supportive of me engaging in, as an adjunct to traditional talk therapy and/or medication, that probably either wouldn't stand up to, or hasn't yet been exposed to rigorous scientific testing. To my way of thinking if something isn't going to cause any further harm, and might prove beneficial (even if it is just in the manner of a placebo effect), then I'm happy enough to give it a go - if it's something I don't find particular helpful then no harm no foul, and if it is is then it's one more thing I can add to my treatment arsenal. I don't know enough about EMDR to make any sort of real judgement call on it, and as a patient I certainly wouldn't dismiss trying it for myself at some stage if the opportunity arose, the main drawback for me is more in how it's marketed or presented (too much hype, too many buzzwords, and so on). I'm not saying all websites etc on EMDR are like that, there are some good sites out there that are more down to earth, matter of fact, 'here's the research, this is how EMDR might be applicable to you', and so on, just that there are a number where it is being presented more along the lines of 'powerful new technique, vibrant images arising to transcend and free energy, unlock the hidden trauma in your mind...it slices, it dices, but wait there's more!'

 

[erg923]

My Psychiatrist would probably be considered one of 'those' as well. There's plenty of stuff he's either presented to me or been supportive of me engaging in, as an adjunct to traditional talk therapy and/or medication, that probably either wouldn't stand up to, or hasn't yet been exposed to rigorous scientific testing. To my way of thinking if something isn't going to cause any further harm, and might prove beneficial (even if it is just in the manner of a placebo effect), then I'm happy enough to give it a go - if it's something I don't find particular helpful then no harm no foul, and if it is is then it's one more thing I can add to my treatment arsenal.

I think the obvious problem with that logic is that one really cant rely on their intuition about what may or may not be harmful. That's an empirical question. The results of which sometimes defy common sense. Take "stress debriefings" following traumatic events, for example. Sounds like a good idea. But...survey says? Counterproductive.

I posted a link to Scott Lilenfeld's article in that goofy thread about dance therapy. If you'll notice, none of those therapies happen to be "hit patient with hammer" therapy. That is to say, none, on the surface, would really seem to be counterproductive...yet "rigorous scientific testing" has show that they indeed are. So, actually, if a adjunctive treatment has not been studiied, I dont "recommend" it and I dont comment on whether or not it could be harmful.

 

[AcronymAllergy]

Wow, I'm actually semi-agreeing with Vistaril.

While I can't speak for him, I can say I've noticed what he's talking about.

Several people here don't like EMDR and think it's bullocks but have a well educated view on it. AcronymAllergy's post is an example of this.

But there's also another group that just doesn't buy it without really reviewing the data on it. That's what at least I'm talking about. If you don't see this, I can bring in several parallels, for example doctors who don't buy that SAM-E, fish oil, walking a few miles a day, etc could also work without actually reviewing the data. Outside our field there's accupuncture, ginseng, red bean extract, all with data supporting it could work. (Emphasis on could, not definitely so).

While I was a resident, the first emerging data was coming out on fish oil and depression so I started giving fish oil in addition to an antidepressant, not instead of one (unless the patient didn't want an antidepressant, and I told them the fish oil was not intended to be a substitute). I got the snarky "Oh you're one of those" from some attendings--none of whom reviewed the data.

Way I saw it, even if I was wrong, that stuff does have health benefits and it's cheap. Add that this was right before the emergence of $4 antidepressants, where Celexa was going to cost a lot of money.

I whole-heartedly agree; a treatment, theory, measure, etc. shouldn't be dismissed outright (unless it causes obvious harm, such as erg's "hit patient with hammer" therapy example) without a review of the current evidence. CTE is another example of this. Do I think repeated "low impact" and/or mild head injuries might lead to real neuropathological changes? Sure, but as things currently stand, there's essentially no viable data supporting the idea that mild head injuries lead to any semblance of sustained cognitive problems once controlling for other factors (e.g., substance abuse, premorbid characteristics, effort, emotional factors, etc.), and the existing CTE literature (including the "diagnostic" criteria themselves) are rampant with problems. But I'm certainly open to changing my view if something comes out and proves my current stance incorrect.

EMDR is the same way, and I agree with whopper that this really should be the approach to pretty much everything we do in mental health. Now don't get me wrong, none of us has the time to thoroughly review the literature on every single thing out there, but if we're going to take a stance that "XXX doesn't work" rather than "I'm just not sure if it works," then we certainly should be able to back that stance up.

 

[Ceke2002]

I think the obvious problem with that logic is that one really cant rely on their intuition about what may or may not be harmful. That's an empirical question. The results of which sometimes defy common sense. Take "stress debriefings" following traumatic events, for example. Sounds like a good idea. But...survey says? Counterproductive.

I posted a link to Scott Lilenfeld's article in that goofy thread about dance therapy. If you'll notice, none of those therapies happen to be "hit patient with hammer" therapy. That is to say, none, on the surface, would really seem to be counterproductive...yet "rigorous scientific testing" has show that they indeed are. So, actually, if a adjunctive treatment has not been studiied, I dont "recommend" it and I dont comment on whether or not it could be harmful.

That's a really good point, and I realise now my previous words were perhaps a bit too much of a blanket statement. I suppose I meant it more along the lines of my Psychiatrist has gotten to know me over the past few years, he knows what sort of interests I have, and the sorts of things I've found helpful in the past, so he's supportive of me engaging in those activities, or he'll suggest certain things I might be interested in trying because they have proved helpful to me on an individual level and we can both see evidence of that.