Joining Private Practice FB groups has me nauseous...letting off some steam

[FreudianSlippers]

So....i'm a recently licensed clinical psychologist who is dipping their toes in the private practice world (I also work part time at a university). I have joined several therapist groups for people in private practice (mostly for networking and insights on PP), and many of the posts have left me unsettled. The groups I am in consist of therapists of all different levels (e.g. LCSWs, Psychologists, MSWs, LPCCs, Ect). Maybe i've been living in a happy little bubble of science-based practice and the importance of empiricism, but far too many of the posts have to do with one of the following:

1. A therapist touting some of the more woo-woo treatments like Brainspotting, Tapping, energy yada yada bull****, etc
2. A therapist asking the group how to treat an incredibly basic diagnosis that already has a clear standard of care (e.g. phobias, panic attacks, OCD) and getting answers like "EMDR" and "brainspotting"
3. Therapists asking questions that anybody who passed a jurisprudence exam should know (remember, these are all people who are actively seeing clients). For instance "my client's husband called and asked about her treatment. What do I do?"
4. And then of course you get a host of posts with people CLEARLY practicing outside their scope of practice.

Anyways, I think I just wanted to vent a bit. I know this is a relatively small, biased sample, but It's also hard for my mind not to start coming up with reasons for the incompetence like the proliferation of online and for-profit clinical training that seems to be taking over. Sometimes I wonder if part of the mental health problem right now is that many practitioners just arent receiving good training. Or maybe i'm just in a pessimistic mood on this beautiful Saturday.

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[Mindfulpsych22]

I can relate a lot to your experience. I tried to join some local professional organizations but felt discouraged by many of the same things you discussed in your post.

Other than the proliferation of on-line training programs, other market forces seem to influence a lot of this. The market for mid-level therapists is saturated in many areas, thus many seek out training in unsupported or even emerging therapies to improve their ability to market themselves and distinguish themselves from their colleagues. You also have the average client who is fairly uneducated about therapy coming in and asking for EMDR, moonbeam therapy etc. because they read about it on the internet/heard about it from their sister and it sounds science-y and cutting edge. If you don’t offer it you will lose their business as they can find it elsewhere. It can be tough in a saturated market if you offer solid evidence-based approaches as a mid-level but all the clients savvy enough to know to look for these often seek out psychologists because of the very problem with the variance in quality of mid-levels.

Combine the above with the fact that mid-levels and psychologists trained in many FSPS or on-line programs have much less sophisticated understanding of research methods and statistics than the psychologist from the average PhD program and you get a big vulnerability to shifting into these woo-type therapies. I’ve also seen many social work and MA grad programs shift to a post-modern training orientation, which further weakens regard for the scientific method and fosters belief that if a clinician feels a therapy is helpful to a client or believes it is effective based on their experience using it, this is just as good as multiple rigorous trials showing a therapy to be effective.

You could take your discouragement and use what you can understand about why these therapists practice the way they do, form trusting relationships, and perhaps influence them to question some of these approaches and be more open-minded to evidence based ones.

 

[Sanman]

Welcome to the bursting of the bubble known as the real world. It happened for me the first week I was in PP as a post-doc.

I was asked to put together a screening measure to identify participants for a group. I researched it and came back to met with the director of the group. I gave him options of well researched measures that would identify the population. Turns out he just wanted a face valid measure to bring in referrals that was free. Not pay for a valid tool. That was the first of many times that I have run into this issue. At the end of the day, science and business often make poor bedfellows.

There is reason that evidenced based practices are not exclusively reimbursed by insurance. Ever ask yourself why that is?

 

[futureapppsy2]

I'm in a few ABA groups, and when I see questions that basically amount to "what is reinforcement?" from people in ABA graduate programs or with graduate degrees, it scares me a bit. Also, a huge number of people promote things like online and/or completely unfunded PhD programs from FSPS as being "wonderful."

 

[AbnormalPsych]

This was one of the most disheartening things to realize once I fully entered the field.

 

[AbnormalPsych]

I actually visited a colleagues PP website recently and saw that they were advertising for treatment with essential oils, other aromatherapy, sound meditation via crystal bowls, etc. It has taken a toll holding back and not starting a conversation about this with this person.

 

[deleted343839]

It's pretty unsettling to learn about what people in the community are doing. What surprised me most is the number of people trained in established, well regarded programs who still drift into peddling woo after they enter private practice.

Maybe find your city/regional psychological association and explore other networking options there?

 

[psych.meout]

Didn't Lilienfeld publish an article about how accepting providers are of science and evidence based treatments?

 

[MCParent]

Just for fun, try to correct one of them some time. You'll be met with the same sense of horror Meehl mentioned.

This has completely been my experience too. I had to drop off the HSP list serve. I dropped off another one when someone said that mistreatment of a pet was reportable to police "because they are the same as us."

Ever attend the "hot topics" ethics CE at APA? I've never been so horrified in all my professional life.

 

[BuckeyeLove]

This therapist on a group I'm on always and only talks about "bilateral stimulation." For everything. Any and all psychiatric syndromes. It's legit perseverative on his part.

 

[WisNeuro]

As long as people want to be fooled, this stuff will continue to flourish. It's nothing new, many people are happy in their blissful ignorance when they are paying lots of money for placebo treatments.

 

[Therapist4Chnge]

I loathe the “neuro therapists” (aka hacks) that put “neuro” in front of everything and pretend it means something. Between the EMDR charlatans and Brain Spotting dullards, it’s far more pervasive than many clinicians realize. Having Neurology groups refer to them bc they don’t know any better further legitimizes these hacks. I started adding what modalities to avoid in my recs bc there are now enough hacks out there siphoning off legit cases for their snake oil treatments.

 

[FreudianSlippers]

Thanks everyone for sharing!! And wow...these are some eye opening experiences. I feel both validated and saddened for the field. I remember in one of my very first classes in grad school, our professor showed us a video documentary about the farce that was Facilitated Communication for people with ASD (I THINK it was on ABC's 20/20). For those who havent seen it I highly recommend it. It's terrifying and really nails in the importance of evidence based practice and empiricism in general. I know FC is a whole different ball game, but Its crappy that so many similar things exist in different forms for different problems.

Edit: Also want to emphasize its not only the random, woo-woo interventions that are brought up, but the seemingly gross incompetence at times (e.g. ethics considerations, "what would you do" questions, etc). I mean, many clients I have seen have described previous therapy experiences that were absolute train-wrecks, but now i'm seeing that from the source! It's wild.

 

[FreudianSlippers]

Just for fun, try to correct one of them some time. You'll be met with the same sense of horror Meehl mentioned.

This has completely been my experience too. I had to drop off the HSP list serve. I dropped off another one when someone said that mistreatment of a pet was reportable to police "because they are the same as us."

Ever attend the "hot topics" ethics CE at APA? I've never been so horrified in all my professional life.

I love this. I also think I am at risk to developing Meehls snark as well! I kind of want to attend a hot topics talk now just to watch the trainwreck

 

[WisNeuro]

Thanks everyone for sharing!! And wow...these are some eye opening experiences. I feel both validated and saddened for the field. I remember in one of my very first classes in grad school, our professor showed us a video documentary about the farce that was Facilitated Communication for people with ASD (I THINK it was on ABC's 20/20). Its crappy that so many similar things exist in different forms for different problems.

Meh, happens in every field. Heck, look at that hack Dr. Oz. Selling junk like green coffee and the like. His show was on at the gym the other day and he was touting the "benefits" of the apple cider vinegar diet. Every field has their examples of people with zero integrity who will exploit people to make a buck.

 

[PsyDr]

IMO:

Much of the pseudoscience stuff is pure collusion. Dealing with unpleasant emotions is unpleasant. Maintaining that one is responsible for their own actions is unpleasant. Requiring patients to be active in their own treatment is unpleasant.

 

[erg923]

IMO:

Much of the pseudoscience stuff is pure collusion. Dealing with unpleasant emotions is unpleasant. Maintaining that one is responsible for their own actions is unpleasant. Requiring patients to be active in their own treatment is unpleasant.

Ha, Yea. One time at the VA, a patient asked me something to the effect of how we would handle it if they shot up a bunch of people "because of my PTSD." I told him he would go to jail. He really expected me to have a different answer.

 

[Sanman]

IMO:

Much of the pseudoscience stuff is pure collusion. Dealing with unpleasant emotions is unpleasant. Maintaining that one is responsible for their own actions is unpleasant. Requiring patients to be active in their own treatment is unpleasant.

Methinks P.T. Barnum would have done well for himself as a psychotherapist in PP.

 

[LadyHalcyon]

Social media has been weaponized. It's a sad state of affairs. Most of the people in those groups are B2B. Actually, you should look into the history of Facebook groups and when they were created. I suggest using the browser duck duck go.

 

[LadyHalcyon]

If anyone is interested, it's a good enough start

 

[LadyHalcyon]

Haha I don't know if it will let me share the link.

If anyone is interested, it's a good enough start

The Shadow Organizing of Facebook Groups
How political lies and conspiracies are spreading without detection

Jonathan Albright
Nov 4, 2018 · 10 min read
Photo: Thought Catalog/flickr/CC BY 2.0
This is the second installment of The Micro-Propaganda Machine, a three-part analysis critically examining the issues at the interface of platforms, propaganda, and politics.

That's the title.

 

[FreudianSlippers]

Shoot...I shouldn't have made this thread. I've been posting snarky comments on the social media groups over the past few days lol...and its not making me friends.

 

[psych.meout]

Shoot...I shouldn't have made this thread. I've been posting snarky comments on the social media groups over the past few days lol...and its not making me friends.

That's fine, we're your friends.

 

[Sanman]

Shoot...I shouldn't have made this thread. I've been posting snarky comments on the social media groups over the past few days lol...and its not making me friends.

Wait, snarky comments don't make you friends?!? That's what I have doing wrong all these years!

 

[FreudianSlippers]

I mean, WTF are you supposed to say to somebody who states that even though Brainspotting barely has outcome research, it's a totally legit, evidence based, gold-standard treatment because it is "perfectly in line" with current neuroscience understanding

 

[psych.meout]

Wait, snarky comments don't make you friends?!? That's what I have doing wrong all these years!

 

[MCParent]

Shoot...I shouldn't have made this thread. I've been posting snarky comments on the social media groups over the past few days lol...and its not making me friends.

If they try to get you to do brainspotting they aren’t really your friends. Go hang out with the kids who read articles after school.

 

[WisNeuro]

If they try to get you to do brainspotting they aren’t really your friends. Go hang out with the kids who read articles after school.

Science friends don't let friends engage in brainspotting. Also, this sounds gross. Someone really should have thought up a better name for marketing.

 

[cara susanna]

Ugh, brainspotting is the hot thing here and even some people in my (VA) clinic are fans of it.

 

[PsyDr]

Wait, snarky comments don't make you friends?!? That's what I have doing wrong all these years!

Might not work personally, but I literally got my AMC position because I made fun of a lecturer during his presentation. And a lot of legal work. And my most lucrative contract.

 

[KeikoTanaka]

I loathe the “neuro therapists” (aka hacks) that put “neuro” in front of everything and pretend it means something. Between the EMDR charlatans and Brain Spotting dullards, it’s far more pervasive than many clinicians realize. Having Neurology groups refer to them bc they don’t know any better further legitimizes these hacks. I started adding what modalities to avoid in my recs bc there are now enough hacks out there siphoning off legit cases for their snake oil treatments.

Chiropractors do this too. "Neuro Chiropractics" they'll say. As an Osteopath I learn (way more) than them, but I can already tell you the whole point of their training is meant to "align the nervous system" - So it's basically as redundant as the labels that say: "Peanut Butter - Warning: May contain peanuts"

 

[WisNeuro]

Chiropractors do this too. "Neuro Chiropractics" they'll say. As an Osteopath I learn (way more) than them, but I can already tell you the whole point of their training is meant to "align the nervous system" - So it's basically as redundant as the labels that say: "Peanut Butter - Warning: May contain peanuts"

Healthcare abounds with treatments that are at best placebos, with no additional benefit aside from "performing a procedure." Hospitals regularly have programs for acupuncture, or OMM, despite pretty clear evidence that they are no better than sham treatments. People like the woo.

 

[FreudianSlippers]

Let me say this..and perhaps it could help others who have to deal with the Brainspotting craze. I've done a lot of reading about Brainspotting lately (to help me counterpunch the proponents), and a very good friend of mine (who is a skeptical person and solid clinician) went to an intensive training a while back (their work had them go and payed for them), so i've picked their brain about it quite a bit and I feel like I have a good sense about what happens in the sessions.

There is a lot of sketchiness about Brainspotting, including the use of incredibly convoluted and unnecessary jargon, the research is totally overemphasized (basically all findings are anecdotal at this point), the mechanisms of action make 0 sense, it is "scammy" (i.e. a total cashcow), etc. That being said, I CAN see how clients may respond well to Brainspotting because it is literally a combination of: mindfulness of feelings, mindfulness of the body, and exposure. That's all. I can go into more detail about how Brainspotting specifically is packaged for this, but really that's what happens during sessions.

I want to make it clear (if it's not already) that I am absolutely, in no way, arguing FOR Brainspotting. I think its super unethical to tout brainspotting as a panacea (which it usually is) or use it above real EPB unless properly informing patients. While it makes sense how certain components would work, its a very round-about and nonsensical way to get there with clients. It's basically the same deal as EMDR working for trauma because it's exposure.

 

[Sanman]

Let me say this..and perhaps it could help others who have to deal with the Brainspotting craze. I've done a lot of reading about Brainspotting lately (to help me counterpunch the proponents), and a very good friend of mine (who is a skeptical person and solid clinician) went to an intensive training a while back (their work had them go and payed for them), so i've picked their brain about it quite a bit and I feel like I have a good sense about what happens in the sessions.

There is a lot of sketchiness about Brainspotting, including the use of incredibly convoluted and unnecessary jargon, the research is totally overemphasized (basically all findings are anecdotal at this point), the mechanisms of action make 0 sense, it is "scammy" (i.e. a total cashcow), etc. That being said, I CAN see how clients may respond well to Brainspotting because it is literally a combination of: mindfulness of feelings, mindfulness of the body, and exposure. That's all. I can go into more detail about how Brainspotting specifically is packaged for this, but really that's what happens during sessions.

I want to make it clear (if it's not already) that I am absolutely, in no way, arguing FOR Brainspotting. I think its super unethical to tout brainspotting as a panacea (which it usually is) or use it above real EPB unless properly informing patients. While it makes sense how certain components would work, its a very round-about and nonsensical way to get there with clients. It's basically the same deal as EMDR working for trauma because it's exposure.

I know very little about it, but I assume it is also a not approved by any insurance and a great way to get cash pay clients?

 

[PsyDr]

I know very little about it, but I assume it is also a not approved by any insurance and a great way to get cash pay clients?

It completely launched Ewan McGregor's career!

 

[MAClinician]

It completely launched Ewan McGregor's career!

That was Trainspotting

 

[PsyDr]

That was Trainspotting

About the same scientific rigor. Better acting.

 

[Sanman]

It completely launched Ewan McGregor's career!

So to paraphrase the great Mark Renton...Who needs research when you've got heroin?

 

[LadyHalcyon]

Yes. Step away from social media immediately! Don't panic though, that's what they want.

Shoot...I shouldn't have made this thread. I've been posting snarky comments on the social media groups over the past few days lol...and its not making me friends.

 

[LadyHalcyon]

Of course you did

Might not work personally, but I literally got my AMC position because I made fun of a lecturer during his presentation. And a lot of legal work. And my most lucrative contract.

 

[LadyHalcyon]

It has been promoted vehemently in adhd groups, along with MANY other medications.

Let me say this..and perhaps it could help others who have to deal with the Brainspotting craze. I've done a lot of reading about Brainspotting lately (to help me counterpunch the proponents), and a very good friend of mine (who is a skeptical person and solid clinician) went to an intensive training a while back (their work had them go and payed for them), so i've picked their brain about it quite a bit and I feel like I have a good sense about what happens in the sessions.

There is a lot of sketchiness about Brainspotting, including the use of incredibly convoluted and unnecessary jargon, the research is totally overemphasized (basically all findings are anecdotal at this point), the mechanisms of action make 0 sense, it is "scammy" (i.e. a total cashcow), etc. That being said, I CAN see how clients may respond well to Brainspotting because it is literally a combination of: mindfulness of feelings, mindfulness of the body, and exposure. That's all. I can go into more detail about how Brainspotting specifically is packaged for this, but really that's what happens during sessions.

I want to make it clear (if it's not already) that I am absolutely, in no way, arguing FOR Brainspotting. I think its super unethical to tout brainspotting as a panacea (which it usually is) or use it above real EPB unless properly informing patients. While it makes sense how certain components would work, its a very round-about and nonsensical way to get there with clients. It's basically the same deal as EMDR working for trauma because it's exposure.