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

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EnPsychlopedia said:
In case people are interested, Lilienfeld et al.'s (2015) Science and Pseudoscience in Clinical Psychology is currently available for free in digital format.

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Great book. I have the hard copy and a pdf. I give it to interns any chance I get.
 
There's a thread in the therapist sub about harmful misconceptions about the field in pop culture/mainstream media and it's a dumpster fire.
 
Our state is trying to crack down on ESA letters. It will be interesting if it passes.
 
WisNeuro said:
I literally just read a "Neuropsychological Consultation" report where a provider just diagnosed a neurocognitive disorder based purely on self-report and MMSE of 29/30. I wish I were making this up.
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I really wonder what the missed item was...

"Do you know the year?"
"Yep, 1987!"
 
R. Matey said:
It's more likely this person took the diy path to board certification. I've seen a few of these in the wild with mixed results.
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Went to a real PhD program, but unfortunately with a famous PVT/SVT denier (35 on the TOMM is a "near miss"). Would explain why, in a later actual neuropsych eval, they ignored some pretty clear PVT failures as well.
 
Fan_of_Meehl said:
'Modern' psychotherapist: "So, what is your goal for therapy?"

Client: "I want absolutely nothing to change."

'Modern' psychotherapist: "I think I can manage that."
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I just can't wrap my mind around charging clients for the sole purpose of letting them vent with no intent to make actionable changes. Or to promote unstructured "self-discovery" as the sole purpose of the service. At that point, you're no longer providing a clinical service and are operating more like a spiritual leader.
 
EnPsychlopedia said:
I just can't wrap my mind around charging clients for the sole purpose of letting them vent with no intent to make actionable changes. Or to promote unstructured "self-discovery" as the sole purpose of the service. At that point, you're no longer providing a clinical service and are operating more like a spiritual leader.
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Yeah, a lot of them really haven't thought through the humanistic assumptions of their training and are not in a position to evaluate them scientifically.
 
WisNeuro said:
It was the recall portion, provider said it "demonstrated impairment in memory processes."
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Who needs normative comparisons or empirically-supported cut scores when you can just make up your own interpretations on the fly!
 
cara susanna said:
It's weird they hate the medical model so much. I mean, it's called mental HEALTHCARE.
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It's almost always just a straw/boogeyman that they can point to to justify why they are doing something with little to no empirical support. For many of these people, their business model relies on people in never ending therapy.
 
cara susanna said:
It's weird they hate the medical model so much. I mean, it's called mental HEALTHCARE.
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Folks are arguing that it’s fine if someone's only goal for therapy is "self-discovery..." Let's just say that my priorities are very different from these folks'.
 
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WisNeuro said:
It's almost always just a straw/boogeyman that they can point to to justify why they are doing something with little to no empirical support. For many of these people, their business model relies on people in never ending therapy.
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Also, the medical model implies accountability for treating something.
 
EnPsychlopedia said:
Folks are arguing that it’s fine if someone's only goal for therapy is "self-discovery..." Let's just say that my priorities are very different from these folks'.
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I don't have a problem with that being someone's goal for therapy, but they shouldn't be expecting their health insurance to pay for it.
 
AcronymAllergy said:
I don't have a problem with that being someone's goal for therapy, but they shouldn't be expecting their health insurance to pay for it.
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I guess this is fair. I suppose I just have a hard time with this because it's never clear to me what these folks mean when they talk about "self-discovery" being the motivating factor for therapy. Often it seems like the term is commensurate with "finding some profound wisdom that will change my life in some pseudospiritual way." Perhaps if what they mean is "using psychoeducation and intervention principles to maximize psychological wellbeing even though I have no clinical need," then I might be less persnickety.

Maybe I'm too rigid (and I'm open to someone convincing me of that), but I just don't know that I am being trained to aid in nebulous "self-discovery." I'm being trained to help folks identify, articulate, and manage problems which are impacting QOL and functioning. I don't know how I can ethically justify my services as beneficial (Standard 10.10 in the Ethics Code) when the benefits are not rooted in anything I can measurably demonstrate. Maybe I'm too much of a hardliner, but my perspective is that I feel no more justified in providing ongoing therapy sans a clinical need than I would expect a physical therapist to feel ethically justified in providing ongoing physical rehabilitation to someone with no physical need. Sure, we could argue that a client may be happy to pay for these services, but that wouldn't make me feel any less ethically questionable. (Just to be clear, these are my ethical holdups and my understanding of the spirit of the Code, and I believe reasonable actors can disagree on my perhaps very individual take here. I am not saying that folks who disagree are unethical.)
 
EnPsychlopedia said:
Maybe I'm too rigid (and I'm open to someone convincing me of that), but I just don't know that I am being trained to aid in nebulous "self-discovery." I'm being trained to help folks identify, articulate, and manage problems which are impacting QOL and functioning. I don't know how I can ethically justify my services as beneficial (Standard 10.10 in the Ethics Code) when the benefits are not rooted in anything I can measurably demonstrate. Maybe I'm too much of a hardliner, but my perspective is that I feel no more justified in providing ongoing therapy sans a clinical need than I would expect a physical therapist to feel ethically justified in providing ongoing physical rehabilitation to someone with no physical need. Sure, we could argue that a client may be happy to pay for these services, but that wouldn't make me feel any less ethically questionable. (Just to be clear, these are my ethical holdups and my understanding of the spirit of the Code, and I believe reasonable actors can disagree on my perhaps very individual take here. I am not saying that folks who disagree are unethical.)
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You may be conflating self-discovery with aimlessness in psychotherapy. Take perfectionism as an example. It's not a clinical diagnosis, but is associated with many, many psychological problems. Off the top of my head, I can think of half a dozen or so students that came to me with GAD or something similar but stayed to deal with perfectionism (for which there are many resources in cognitive therapy) when I was at the UCC. Discovering that you have perfectionist traits (that can be measured) and how to deal with them in arguably self-discovery in a sense, but not rudderless "how-was-your-week" psychotherapy.
 
EnPsychlopedia said:
I guess this is fair. I suppose I just have a hard time with this because it's never clear to me what these folks mean when they talk about "self-discovery" being the motivating factor for therapy. Often it seems like the term is commensurate with "finding some profound wisdom that will change my life in some pseudospiritual way." Perhaps if what they mean is "using psychoeducation and intervention principles to maximize psychological wellbeing even though I have no clinical need," then I might be less persnickety.

Maybe I'm too rigid (and I'm open to someone convincing me of that), but I just don't know that I am being trained to aid in nebulous "self-discovery." I'm being trained to help folks identify, articulate, and manage problems which are impacting QOL and functioning. I don't know how I can ethically justify my services as beneficial (Standard 10.10 in the Ethics Code) when the benefits are not rooted in anything I can measurably demonstrate. Maybe I'm too much of a hardliner, but my perspective is that I feel no more justified in providing ongoing therapy sans a clinical need than I would expect a physical therapist to feel ethically justified in providing ongoing physical rehabilitation to someone with no physical need. Sure, we could argue that a client may be happy to pay for these services, but that wouldn't make me feel any less ethically questionable. (Just to be clear, these are my ethical holdups and my understanding of the spirit of the Code, and I believe reasonable actors can disagree on my perhaps very individual take here. I am not saying that folks who disagree are unethical.)
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My "counter" (sort of) would be that the ethical principles also ask us to respect the autonomy of our clients (side note: I typically use the term patients, but if you're not treating a disorder, then IMO, client is probably more appropriate).

I entirely agree that the client needs to enter into the therapeutic relationship with fully-informed consent, which includes understanding what it's going to cost, what the therapy will generally look like, and what expected benefits there are. I also agree that there should be some clearly-articulable goals, and that if the psychologist doesn't feel comfortable helping the individual work toward those goals for whatever reason (e.g., they don't feel trained to do so, they want to reserve their services for individuals with MH disorders), they shouldn't initiate therapy.

But if a client goes into therapy aware of all these things, IMO, it's their right to seek those services, and it's a psychologist's option to provide them.

Using the PT example: a person may not have an injury/condition that requires treatment. But that doesn't mean principles of physical therapy couldn't be helpful for, say, preventing future injury. Or as R. Matey said, from trying to prevent a more minor, non-diagnosable/subclinical condition from progressing to something more significant. Or heck, maybe the person just wants to learn some effective stretches and proper form on some different types of exercises. As long as the physical therapist is up front about the services they're providing and the potential associated benefits, my take is: have at it.
 
I completely agree with both of these takes.
R. Matey said:
You may be conflating self-discovery with aimlessness in psychotherapy. Take perfectionism as an example. It's not a clinical diagnosis, but is associated with many, many psychological problems. Off the top of my head, I can think of half a dozen or so students that came to me with GAD or something similar but stayed to deal with perfectionism (for which there are many resources in cognitive therapy) when I was at the UCC. Discovering that you have perfectionist traits (that can be measured) and how to deal with them in arguably self-discovery in a sense, but not rudderless "how-was-your-week" psychotherapy.
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AcronymAllergy said:
My "counter" (sort of) would be that the ethical principles also ask us to respect the autonomy of our clients (side note: I typically use the term patients, but if you're not treating a disorder, then IMO, client is probably more appropriate).

I entirely agree that the client needs to enter into the therapeutic relationship with fully-informed consent, which includes understanding what it's going to cost, what the therapy will generally look like, and what expected benefits there are. I also agree that there should be some clearly-articulable goals, and that if the psychologist doesn't feel comfortable helping the individual work toward those goals for whatever reason (e.g., they don't feel trained to do so, they want to reserve their services for individuals with MH disorders), they shouldn't initiate therapy.

But if a client goes into therapy aware of all these things, IMO, it's their right to seek those services, and it's a psychologist's option to provide them.

Using the PT example: a person may not have an injury/condition that requires treatment. But that doesn't mean principles of physical therapy couldn't be helpful for, say, preventing future injury. Or as R. Matey said, from trying to prevent a more minor, non-diagnosable/subclinical condition from progressing to something more significant. Or heck, maybe the person just wants to learn some effective stretches and proper form on some different types of exercises. As long as the physical therapist is up front about the services they're providing and the potential associated benefits, my take is: have at it.
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I don't disagree with either of these takes. In both of these instances, I would argue that there are clear goals for how therapy is supposed to look and what it's meant to achieve. In both cases, there are measurable outcomes. If this is what is meant by "self-discovery," then I'm all in favor. But it seems like (and maybe I am wrong) the folks I've seen using this term on Reddit are using it more along the lines of "trying to discover who I am and what my purpose is in life." Questions that are not so much goal oriented but instead are vague quests for some kind of pseudospiritual or existential knowledge. I say this because they are directly referencing "self-discovery without the need to change." Reaching any kind of goal implies change. If the client isn't changing (even if it means exercising less rigid perfectionism), then what are they doing and how is it therapy?

And, to be clear, I am not saying that existential questions cannot be discussed in therapy, e.g., "Now that my spouse has died, I am having trouble managing my grief because being a good spouse was my purpose of living." I am saying that such a thing is very different from "I am really just here to discover the secrets of who I am" in a pop-psych, "Let's do pseudoscientific stuff like MBTI or Enneagram and construct a narrative about who you are with no other goals" kind of way.

I don't know if I'm properly articulating my point.
 
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EnPsychlopedia said:
But it seems like (and maybe I am wrong) the folks I've seen using this term on Reddit are using it more along the lines of "trying to discover who I am and what my purpose is in life." Questions that are not so much goal oriented but instead are vague quests for some kind of pseudospiritual or existential knowledge.
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There are two things happening here: (1) a patient is stating an open ended problem and (2) a therapist could be mishandling it. From the perspective of cognitive therapy (@Fan_of_Meehl, get in on this!), questions about life's meaning are questions about a patient's personal values, which can be addressed via Socratic Questioning and behavioral experiments.

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

FTR, I'm not saying this is true of all master's level training everywhere nor am I saying that a master's level clinician cannot rise above some ****ty classes they got in graduate school via self-study and/or supervision. This is my experience as a former LPC who has worked with many LPCs/LCSW.
 
cara susanna said:
I refuse to say "client." Just absolutely refuse.
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I'll use it when I do evals for administrative purposed (e.g., FAA or the like), but it sounds gross when using it instead of patients. Also, have literally never had a patient remark on it in any way.
 
The push a number of years back by some mid-levels to blur the lines kept pushing "consumer" and other BS terms to avoid saying "patient". They are patients if they are receiving clinical care. If it is a legal case, there are other terms. There really isn't a gray area outside of these two areas, but some still want to push their overly PC terms. The majority of patients don't want to be called something else, and there is research to support this too.
 
Therapist4Chnge said:
The push a number of years back by some mid-levels to blur the lines kept pushing "consumer" and other BS terms to avoid saying "patient". They are patients if they are receiving clinical care. If it is a legal case, there are other terms. There really isn't a gray area outside of these two areas, but some still want to push their overly PC terms. The majority of patients don't want to be called something else, and there is research to support this too.
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Patient, client, consumer, survivor or other alternatives? A scoping review of preferred terms for labelling individuals who access healthcare across settings - PMC

Use of the term ‘patient’ has been recently debated, compared with alternatives including ‘consumer’ and ‘client’. This scoping study aimed to provide an integrated view of preferred labels across healthcare contexts and countries to clarify ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

"Overall, healthcare recipients appear to prefer the term ‘patient’"
 
cara susanna said:
It's weird they hate the medical model so much. I mean, it's called mental HEALTHCARE.
Click to expand...
I have my own problems with the medical model (metaphor) for psychotherapy, especially when it's taken too far and ignores the fact that it is, indeed, more of a metaphor. 'Protocol-for-syndrome (diagnosis)' has its uses but is not the 'be-all-and-end-all' of effective (even 'evidence-based') psychotherapy treatment planning, case formulation, and intervention.
 
R. Matey said:
There are two things happening here: (1) a patient is stating an open ended problem and (2) a therapist could be mishandling it. From the perspective of cognitive therapy (@Fan_of_Meehl, get in on this!), questions about life's meaning are questions about a patient's personal values, which can be addressed via Socratic Questioning and behavioral experiments.

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

FTR, I'm not saying this is true of all master's level training everywhere nor am I saying that a master's level clinician cannot rise above some ****ty classes they got in graduate school via self-study and/or supervision. This is my experience as a former LPC who has worked with many LPCs/LCSW.
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There are 'acceptance vs. change' strategies/ dynamics that ebb and flow during the course of ANY effective course of psychotherapy. For certain patients, the 'acceptance,' relationship building, motivation enhancement, and even 'acceptance-based' tasks are 'front-loaded' to the first phases of case formulation / intervention. However, they are always ultimately in service to change-oriented strategies. If the patient doesn't want to change, they don't need the help of a professional therapist to accomplish this...inertia is enough...and it's free. I've seen what I would consider a 'rookie mistake' of some therapists who think that every single patient should come to the first session knowing exactly what they want to change, or exactly what their detailed 'goals for therapy' are, etc. I mean, sometimes they do, but many times they don't and it's our job to help them explore through Socratic questioning, reflections/ summaries ('empathic reflections') and pros/cons analyses, etc. what their goals for therapy might be. You know, the whole motivational interviewing thing of eliciting and helping them to resolve their ambivalence toward behavior change. From a Beckian (cognitive therapy) perspective, these things (including the therapeutic relationship) are essential and Beck and them really didn't have to write too much about them because they were kind of taken for granted at the time. Nowadays, you can spot someone who isn't really all that well trained in cognitive (behavioral) therapy because they think it's all technique/worksheet-driven and/or fixed, manualized, session-by-session completely mapped out from start to end 'protocol-for-syndrome' work. Beck was the 'granddaddy' of manualized treatment, in a way (his first 12-20 (?) session CBT for Depression protocol as spelled out in his famous book) but I think he'd be appalled by how much of 'CBT' is conceptualized and practiced these days (or caricatured by some). The vital importance of (a) the working therapeutic relationship, (b) a flexible, Socratic approach to questioning, and (c) a 'case formulation'-driven customized, individualized approach (e.g., with key appreciation for a patient's particular cognitive structures in terms of patterns of negative automatic thoughts, intermediate beliefs (rules, attitudes, assumptions) and core schema(s) is not often appreciated nowadays. Beck had an overall structure to his therapies, but he knew how to be flexible and targeted with his approach.
 
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R. Matey said:
There are two things happening here: (1) a patient is stating an open ended problem and (2) a therapist could be mishandling it. From the perspective of cognitive therapy (@Fan_of_Meehl, get in on this!), questions about life's meaning are questions about a patient's personal values, which can be addressed via Socratic Questioning and behavioral experiments.

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

FTR, I'm not saying this is true of all master's level training everywhere nor am I saying that a master's level clinician cannot rise above some ****ty classes they got in graduate school via self-study and/or supervision. This is my experience as a former LPC who has worked with many LPCs/LCSW.
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'questions about a patient's personal values, which can be addressed via Socratic questioning and behavioral experiments' - absolutely, 100%!

And the 'downward arrow' technique of trying to uncover the personal values/ beliefs/ schemas underlying why someone is getting upset over political events or news is my standard 'go to' in order to bring things back into a therapeutic frame these days.
 
WisNeuro said:

Patient, client, consumer, survivor or other alternatives? A scoping review of preferred terms for labelling individuals who access healthcare across settings - PMC

Use of the term ‘patient’ has been recently debated, compared with alternatives including ‘consumer’ and ‘client’. This scoping study aimed to provide an integrated view of preferred labels across healthcare contexts and countries to clarify ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

"Overall, healthcare recipients appear to prefer the term ‘patient’"
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Yup, that was the one I was remembering! I knew it was from the last 5-6 years, though the push has been since I was in fellowship bc our primary social worker used to push that and called everyone by their first name.
 
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