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

[clausewitz2]

I saw someone on Reddit recently talk about how they created and operate a "trauma-focused" martial arts course designed to release trauma stored in the body. I may also have managed to read their company website and apparently flinching or other behavioral signs of recoil while sparring with other students is possible evidence of a history of trauma that has not been remembered. This person is, according to their comments, a licensed psychotherapist, and is evidently a 100% true-believer in these methods.

It's a well known fact that unless you have at least 5 ACEs you don't mind being punched in the head.

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[R. Matey]

People really seem to like equine therapy.

I'm sure there's an overcoming fear component to this that is probably beneficial, but because most people's relationships and places of work contain very few, if not, dare I say no horses, I tend to side-eye this approach.

 

[EnPsychlopedia]

The newest r/therapists thread on trauma has people recommending so many things except PE, CPT, or CBT-TF.

 

[chicandtoughness]

The newest r/therapists thread on trauma has people recommending so many things except PE, CPT, or CBT-TF.

Wait I need to know what else they’re recommending 😂 Gotta stay on top of what is up and coming since EMDR is now mainstream.

 

[EnPsychlopedia]

Wait I need to know what else they’re recommending 😂 Gotta stay on top of what is up and coming since EMDR is now mainstream.

Well, EMDR is among them...also, predictably, IFS, somatic therapies (including something called Hakomi), and a couple of recommendations for this scammy thing called "deep brain reorienting therapy." I also saw a recommendation or two for accelerated resolution therapy, psychodynamic therapy (with the ever-ubiquitous recommendation to read McWilliams), some weird *&^% called "Reconciliation of Traumatic Memories," "instinctual trauma response," and ego states therapy. To be fair to this thread, the comments after I first looked at it appear to have somewhat improved and moved much more in the direction of CPT, PE, and CBT-TF.

 

[Sanman]

You guys missed the best one. There was a great discussion there about how to bill for a session when a client takes an extended bathroom break. Great reading.

 

[EnPsychlopedia]

You guys missed the best one. There was a great discussion there about how to bill for a session when a client takes an extended bathroom break. Great reading.

I’ve seen multiple posts there about flatulence during session. Totally gripping and engaging stuff.

 

[MCParent]

I’ve seen multiple posts there about flatulence during session. Totally gripping and engaging stuff.

Yeah that’s detoxification happening. Mind body connection wow I can’t believe you didn’t learn that in grad school.




(/s, just to make sure)

 

[EnPsychlopedia]

I’ve also recently been absolutely enthralled by the amazing and intellectually rich discussions about how to sign off on emails (“Best, [Name]?” “Kind Regards, [Name]?” “Catch ya on the flip side, home slice, [Name]?”). I mean, the options are endless!

 

[RxPsych]

I’ve also recently been absolutely enthralled by the amazing and intellectually rich discussions about how to sign off on emails (“Best, [Name]?” “Kind Regards, [Name]?” “Catch ya on the flip side, home slice, [Name]?”). I mean, the options are endless!

I'm partial to:

Pistols at dawn, old boy.
RxPsych

 

[EnPsychlopedia]

I'm partial to:

Pistols at dawn, old boy.
RxPsych

Meanwhile, we’re all letting this noise distract us from the fact that Al Bundy once scored four touchdowns in one game.

 

[Sanman]

Meanwhile, we’re all letting this noise distract us from the fact that Al Bundy once scored four touchdowns in one game.

The man is beloved everywhere but the village of Lower Uncton.

 

[EnPsychlopedia]

The man is beloved everywhere but the village of Lower Uncton.

And the D’Arcy household.

 

[Sanman]

And the D’Arcy household.

Jefferson liked him well enough. So did Steve for that matter.

 

[R. Matey]

I’ve also recently been absolutely enthralled by the amazing and intellectually rich discussions about how to sign off on emails (“Best, [Name]?” “Kind Regards, [Name]?” “Catch ya on the flip side, home slice, [Name]?”). I mean, the options are endless!

One pet peeve I see on signatures: Dr. First Name Last Name, Ph.D.


Wait, are you telling me you have a doctorate?

 

[EnPsychlopedia]

In other news not related to Al Bundy, why is it that so many folks on r/therapists never seem to want to refer patients to more appropriate services? I understand that certain places don’t have the resources and availability to have reliable access to referral pipelines (I’m originally from the rural South and worked in a private practice briefly after undergrad, so I know the struggle); but it can’t be so common of a limitation as to explain all the things I see in that sub. I see folks asking for advice on how to treat OCD when it’s not their specialty, or how to treat chronic pain symptoms when they don’t have a background in that area, or (I saw this once a long time ago and it stuck with me since it’s an area of specialty for me) how to assess for potential prodromal psychosis. Bruh, refer out!

 

[chicandtoughness]

One pet peeve I see on signatures: Dr. First Name Last Name, Ph.D.


Wait, are you telling me you have a doctorate?

My other pet peeve is John Smith, MA, LPC/LMFT. Or even worse, John Smith, MSW, LCSW.

I’m just being petty, I know. But the masters is a prerequisite to the license so once you have the license no need to put the masters.

The only thing worse is John Smith, MA, BS, LMFT. Let the bachelors go when you have your masters 😭

 

[EnPsychlopedia]

My other pet peeve is John Smith, MA, LPC/LMFT. Or even worse, John Smith, MSW, LCSW.

I’m just being petty, I know. But the masters is a prerequisite to the license so once you have the license no need to put the masters.

The only thing worse is John Smith, MA, BS, LMFT. Let the bachelors go when you have your masters 😭

NPs (not all of them!) are the worst offenders in this realm. “Dr. First Last, BSN, RN, MSN, APRN, FNP, PMHNP, DNP.”

 

[AcronymAllergy]

One pet peeve I see on signatures: Dr. First Name Last Name, Ph.D.


Wait, are you telling me you have a doctorate?

The clinic I used to work at had this format for a few of the doctors' office door nameplates (psychologists and physicians). Luckily, mine was just AcronymAllergy, Ph.D.

 

[R. Matey]

NPs (not all of them!) are the worst offenders in this realm. “Dr. First Last, BSN, RN, MSN, APRN, FNP, PMHNP, DNP.”

Alphabet soup is super common with the mids too (e.g., First Last, M.A., LPC, NCC, CDAC, CCMHC). In their defense though, I think it might be actually encouraged by orgs looking to make a buck.

 

[chicandtoughness]

Alphabet soup is super common with the mids too (e.g., First Last, M.A., LPC, NCC, CDAC, CCMHC). In their defense though, I think it might be actually encouraged by orgs looking to make a buck.

It absolutely is, and it’s disgusting. The NCC credential is literally just throwing money to the wind because no one cares what it is, or it carries negative implications in some areas. It’s also ridiculously expensive for a piece of paper that just says you did the bare minimum to graduate lol.

 

[R. Matey]

It absolutely is, and it’s disgusting. The NCC credential is literally just throwing money to the wind because no one cares what it is, or it carries negative implications in some areas. It’s also ridiculously expensive for a piece of paper that just says you did the bare minimum to graduate lol.

A nice way to exploit anxious people who are rightly worried about their competence.

 

[EnPsychlopedia]

Every day, almost, I see master’s-level folks on r/therapists asking for recommendations for “assessments” (by which they largely just mean screeners) for different things. I don’t understand why they don’t stop and think “If I am not sufficiently aware of the available tools and their respective strengths/limitations/validity, should I really be conducting any screeners at all?”

 

[chicandtoughness]

Screeners are also easily google-able so if you can't even do that...

 

[AcronymAllergy]

Anyone have recommendations for a quick assessment to assess the utility of other assessments? Asking for a friend.

 

[EnPsychlopedia]

Does anyone know if it’s appropriate to diagnose BP1 in a patient who has never had a manic (or even hypomanic) episode?

/s, in case that isn’t clear

 

[chicandtoughness]

The amount of times I see this in clinic is disgusting 😥 “Oh the patient has mood swings they must have BP I right?”

No, Susan. Use the damn DSM you paid for.

Fun story: I had a patient come in with a BP I dx with no mania, tried bringing it up to them, and they flipped out at me because HOW DARE I imply this. An hour later, that BP I dx was now a BPD dx 🤪

 

[AcronymAllergy]

Does anyone know if it’s appropriate to diagnose BP1 in a patient who has never had a manic (or even hypomanic) episode?

/s, in case that isn’t clear

In my experience, the fastest way to get diagnosed with bipolar = say you aren't sleeping and that you're irritable. No follow-up questions needed.

 

[WisNeuro]

Does anyone know if it’s appropriate to diagnose BP1 in a patient who has never had a manic (or even hypomanic) episode?

/s, in case that isn’t clear

Only if you are a psychiatrist or a midlevel who doesn't want to talk to the patient about their accurate diagnosis of Borderline PD.

 

[Sanman]

In my experience, the fastest way to get diagnosed with bipolar = say you aren't sleeping and that you're irritable. No follow-up questions needed.

Had one that was acting pretty manic in session once with those complaints. Turned out he was doing cocaine.

 

[EnPsychlopedia]

Only if you are a psychiatrist or a midlevel who doesn't want to talk to the patient about their accurate diagnosis of Borderline PD.

I am snarking on a recent post in r/therapists where the therapist mentioned having “plenty of justification” (paraphrased) for a dx of BP1 or BPD based on “moods observed in session” (paraphrased), and wanted input on how to do differential. No mention of any behaviors that meet criteria for (hypo)mania. Thankfully they were called out in the comments, but it’s still scary that there are folks approaching dx in this way.

 

[WisNeuro]

I am snarking on a recent post in r/therapists where the therapist mentioned having “plenty of justification” (paraphrased) for a dx of BP1 or BPD based on “moods observed in session” (paraphrased), and wanted input on how to do differential. No mention of any behaviors that meet criteria for (hypo)mania. Thankfully they were called out in the comments, but it’s still scary that there are folks approaching dx in this way.

Definitely a reason why people not well trained in diagnosis should not be able to diagnose someone one in the record. These people are actively harmful to patients.

 

[R. Matey]

I am snarking on a recent post in r/therapists where the therapist mentioned having “plenty of justification” (paraphrased) for a dx of BP1 or BPD based on “moods observed in session” (paraphrased), and wanted input on how to do differential. No mention of any behaviors that meet criteria for (hypo)mania. Thankfully they were called out in the comments, but it’s still scary that there are folks approaching dx in this way.

I'm surprised the Reddit consensus wasn't ADHD and cPTSD with the recommendation to immediately start stimulants and psychedelic-assisted therapy.

 

[WisNeuro]

I'm surprised the Reddit consensus wasn't ADHD and cPTSD with the recommendation to immediately start stimulants and psychedelic-assisted therapy.

You're obviously not trauma informed. This person clearly needs EMDR and IFS.

 

[R. Matey]

You're obviously not trauma informed. This person clearly needs EMDR and IFS.

And somatic experiencing because the trauma is in the body.

 

[WisNeuro]

And somatic experiencing because the trauma is in the body.

It's in our genes! Passed down from anyone who has ever been related to us!

 

[EnPsychlopedia]

It's in our genes! Passed down from anyone who has ever been related to us!

Petition to make “Do you ever get the sense that your DNA is carrying the lived experiences of your ancestors?” a question on the SCID (but I’m not saying for which section)! (/sarcasm, if not clear.)

Although it’s pretty clear that some of these diagnosticians don’t even use the SCID…

 

[WisNeuro]

Petition to make “Do you ever get the sense that your DNA is carrying the lived experiences of your ancestors?” a question on the SCID (but I’m not saying for which section)! (/sarcasm, if not clear.)

Although it’s pretty clear that some of these diagnosticians don’t even use the SCID…

Or even basic reasoning skills

 

[AcronymAllergy]

Petition to make “Do you ever get the sense that your DNA is carrying the lived experiences of your ancestors?” a question on the SCID (but I’m not saying for which section)! (/sarcasm, if not clear.)

Although it’s pretty clear that some of these diagnosticians don’t even use the SCID…

To be fair, I don't think I know anyone who uses the SCID in their day-to-day clinical practice. I don't know many people who use it forensically, either, but I've seen it here and there. I had interns train with it so they could get experience with it (and the idea of adhering to diagnostic criteria in general), but even I never used it much.

But yeah, it'd be nice if they actually knew the diagnostic criteria, let alone used them.

Slight tangent--if I had $1 for every provider I've seen misuse/misunderstand the word "flashback".........

 

[Shiori]

I have noticed an uptick both on TikTok and in session of partners weaponizing each other's perceived attachment styles. Avoidant and disorganized attachment styles are the new narcissistic personality disorder.

 

[chicandtoughness]

I have noticed an uptick both on TikTok and in session of partners weaponizing each other's perceived attachment styles. Avoidant and disorganized attachment styles are the new narcissistic personality disorder.

Indeed. And anxious is the new BPD.

 

[WPMO]

Had one that was acting pretty manic in session once with those complaints. Turned out he was doing cocaine.

It is also amazing to me how often people forget that the sleep disturbance in Bipolar is marked by not sleeping (much) AND THEN not being tired.

 

[WPMO]

Every day, almost, I see master’s-level folks on r/therapists asking for recommendations for “assessments” (by which they largely just mean screeners) for different things. I don’t understand why they don’t stop and think “If I am not sufficiently aware of the available tools and their respective strengths/limitations/validity, should I really be conducting any screeners at all?”

I'll defend them on this at least some. They may be aware of screeners, but want to learn of more or which ones might be superior to others in the opinion of their peers. It does seem like an effort to learn. Sometimes there are a lot of different evidence-based assessments for the same thing, but if you talk to people in the field there are various reasons for preferring one or another. For example, I am very unimpressed with the MDQ screener for Bipolar, but I really like the Hypomania Checklist-32. Both of these could be administered by people at the Master's-level, but with the HCL-32 you need to do some background research to determine cutoff points that you want to use diagnostically, in the context of your interview and any other assessment.

 

[cara susanna]

I'm pretty sure TikTok is helping to push my nephew's anxiety into full blown OCD.

 

[AcronymAllergy]

I'm pretty sure TikTok is helping to push my nephew's anxiety into full blown OCD.

I, for one, would not be at all disappointed if TikTok ends up banned (which I don't see happening, but still).

 

[Shiori]

I, for one, would not be at all disappointed if TikTok ends up banned (which I don't see happening, but still).

I still have a soft spot for TikTok. The algorithm is probably (definitely) showing me the more evidence-based stuff, but I see quite a few therapists gently steering their audiences away from the stuff mentioned in this thread and giving tips to help people find high quality providers rather than a professional friend.

If you end up on the therapy side of TikTok, you'll see A LOT of different styles and approaches. It's a different vibe than some of the subreddits I've seen too. People are also more likely to see someone critique their favorite internet therapist, so there is a higher chance to see differing opinions. Engagement does interesting and weird things to your FYP.

 

[EnPsychlopedia]

I'll defend them on this at least some. They may be aware of screeners, but want to learn of more or which ones might be superior to others in the opinion of their peers. It does seem like an effort to learn. Sometimes there are a lot of different evidence-based assessments for the same thing, but if you talk to people in the field there are various reasons for preferring one or another. For example, I am very unimpressed with the MDQ screener for Bipolar, but I really like the Hypomania Checklist-32. Both of these could be administered by people at the Master's-level, but with the HCL-32 you need to do some background research to determine cutoff points that you want to use diagnostically, in the context of your interview and any other assessment.

Eh, maybe. I think it’s admirable to give the benefit of the doubt, but my reading of most such posts is that the OP has no experience with screeners or “assessment” at all but still wants to proceed with using them to make clinical conclusions. For instance, some folks on r/therapists were reacting to a state surgeon general (or some other such public health figure who isn’t an expert in mental health) mentioning that all doctors should start screening/assessing every patient for psychological trauma by asking what assessments to use for this purpose—literally NO exposure to extant measures or the appropriate ways of using them (e.g., not using high screener scores as diagnostically specific). But it’s totally possible that I’m just being too cynical.

 

[EnPsychlopedia]

The folks on r/therapists have hit a new low. They are now encouraging the behavior of charging $1.99/min. to run a phone line that is essentially a general venting service. This is apparently totally okay to do as a side hustle and doesn’t at all encroach on the ethical constraints of their therapy license.

 

[WisNeuro]

The folks on r/therapists have hit a new low. They are now encouraging the behavior of charging $1.99/min. to run a phone line that is essentially a general venting service. This is apparently totally okay to do as a side hustle and doesn’t at all encroach on the ethical constraints of their therapy license.

Why are people still surprised at the level of ethical and intellectual bankruptcy on that sub?

 

[AcronymAllergy]

The folks on r/therapists have hit a new low. They are now encouraging the behavior of charging $1.99/min. to run a phone line that is essentially a general venting service. This is apparently totally okay to do as a side hustle and doesn’t at all encroach on the ethical constraints of their therapy license.

Please, please, please let people start making late night television commercials on local channels for these phone lines...