Mom of Six needing Career Advice

[Rain Sova]

Do you have an advanced copy of the DSM 5-TR?

Why would you ask this?

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[PsyDr]

Why would you ask this?

How would you know if the DSM has been updated, if you don't have an advanced copy?

 

[Rain Sova]

How would you know if the DSM has been updated, if you don't have an advanced copy?

It has in the past.....

 

[foreverbull]

PPrison transgender science

Isn't transgender science ever-evolving? Isn't it true that some professionals disagree with the whole concept of transitioning? Isn't it true that the DSM has been updated to change the definition of transgender?

Past DSMs went from diagnosing “gender identity disorder” to “gender dysphoria” since the gender identity isn’t the problem, the dysphoria is. That is the current language used in the DSm-5.

On a related note, homosexuality was also a diagnosis in past DSMs until the 1970s. But it was updated when the board of trustees of the DSM finally came to understand that gay identity was not a problem or pathology—homophobia/society’s judgment was the problem. They had a big push from LGBT advocates to make the change. Several decades lager, this removal isn’t controversial in the least and is seen as a necessary change by mainstream psychology to practice ethically.

 

[psych.meout]

Do you have an advanced copy of the DSM 5-TR?

I thought they were going to do updates as 5.1, 5.2, etc., which is why they switched from Roman to Arabic numerals.

 

[borne_before]

I thought they were going to do updates as 5.1, 5.2, etc., which is why they switched from Roman to Arabic numerals.

I too thought this. But, the DSM is a camel (a horse designed by a committee). I have an issue with that phrase because camels are remarkable creatures, but the DSM definite has the smell of bureaucracy.

 

[PsychSupreme]

I am definitely open to being further educated. I once didn't believe in white privilege but I took a course in college that showed me that I was totally ignorant on the topic and did not know what I was talking about! My faith is my compass, however, and I know I'm not alone in that. (White privilege doesn't contradict my faith either way)

And if the science continues to determine, as it already has, that being transgender itself is not a mental health problem (but rather dysphoria and mental health difficulties resulting from societal barriers and prejudice), and that transitioning and identity support are the most effective means of reducing dysphoria and improving mental health outcomes for transgender individuals, would you accept these findings and then treat your clients accordingly? The issue here isn't your faith. The issue is whether, as a science-minded clinician, you would put aside your personal biases regarding gender identity and support your clients' decisions to transition, support them during and after doing so, and help foster a system of support from families and other social networks. You are welcome to have whatever spiritual and faith-related beliefs you would like to have, but mental health treatment must be evidence-based. When the evidence is in favor of transitioning as the most effective way of treating dysphoria, you have an ethical duty to follow that evidence. Peoples' lives and general well-being depend upon it.

 

[PsyDr]

It has in the past.....

Then the answer to your misleading question is: no.

 

[ClinicalABA]

Then the answer to your misleading question is: no.

So helpful!

 

[deleted106747]

And if the science continues to determine, as it already has, that being transgender itself is not a mental health problem (but rather dysphoria and mental health difficulties resulting from societal barriers and prejudice), and that transitioning and identity support are the most effective means of reducing dysphoria and improving mental health outcomes for transgender individuals, would you accept these findings and then treat your clients accordingly? The issue here isn't your faith. The issue is whether, as a science-minded clinician, you would put aside your personal biases regarding gender identity and support your clients' decisions to transition, support them during and after doing so, and help foster a system of support from families and other social networks. You are welcome to have whatever spiritual and faith-related beliefs you would like to have, but mental health treatment must be evidence-based. When the evidence is in favor of transitioning as the most effective way of treating dysphoria, you have an ethical duty to follow that evidence. Peoples' lives and general well-being depend upon it.

If I could love this post I would. I think it speaks to the ideas people have about psychology being opinion, or about what you anecdotally think, vs. about what the evidence and the science demonstrate. Just as people think they can shortcut the education component: "I want to become a psychologist but make no changes in my life, I can just do it on the side." It's frustrating. No one would support a physician not providing life-saving treatment because they personally thought it was wrong. Can you imagine? "No, I'm not going to prescribe you the evidence-based chemotherapy for your type of cancer because I'm against chemotherapy." Yet the same standard is applied to this field and its science. I will say that I appreciate the OP's relative non-defensiveness with the feedback she has gotten, but I also understand why some of the responses might reflect frustration.

 

[Rain Sova]

If I could love this post I would. I think it speaks to the ideas people have about psychology being opinion, or about what you anecdotally think, vs. about what the evidence and the science demonstrate. Just as people think they can shortcut the education component: "I want to become a psychologist but make no changes in my life, I can just do it on the side." It's frustrating. No one would support a physician not providing life-saving treatment because they personally thought it was wrong. Can you imagine? "No, I'm not going to prescribe you the evidence-based chemotherapy for your type of cancer because I'm against chemotherapy." Yet the same standard is applied to this field and its science. I will say that I appreciate the OP's relative non-defensiveness with the feedback she has gotten, but I also understand why some of the responses might reflect frustration.

I absolutely understand that psychology is a time consuming and massive undertaking, a study, a lifestyle, something that cannot be done "on the side". I also know and admire Christian clinicians and should probably approach them with my questions. Most have dual theology degrees as well.

 

[PsychSupreme]

I absolutely understand that psychology is a time consuming and massive undertaking, a study, a lifestyle, something that cannot be done "on the side". I also know and admire Christian clinicians and should probably approach them with my questions. Most have dual theology degrees as well.

I don't think Psycycle was referring to you with that part of the comment. Also, respectfully, I cannot help but feel as though you are dodging the meat of the comments here. Would you follow the scientific evidence regarding best practices for gender dysphoria if/given the evidence in question were to/does contradict your perspective on the issue?

 

[CheetahGirl]

I absolutely understand that psychology is a time consuming and massive undertaking, a study, a lifestyle, something that cannot be done "on the side". I also know and admire Christian clinicians and should probably approach them with my questions. Most have dual theology degrees as well.

Rain Sova,

I'm Hindu (born & raised for as far as my generations can see; hence, I feel my religion makes my clinical life more broad, and dig the world making mindfulness a priority. Everyone should be trained in DBT...). I was also raised in rural Southern U.S. (my grandpa/Dadaji became Catholic before his death, *God bless his soul*), so what you're firm about when it comes to Christianity is perplexing to me.

Just sayin.'

You can be you, but again, our field is evidence-based (otherwise, we'd all be life coaches...). We're firm about that.

Graduate studies/even specialized-trade schools are like funnels. We're all tossed in, churned around, and are popped out, differently with expanding worldviews. It's a must to know your lane, in science. We take an Oath...repeatedly.

 

[albatross_at_crossroads]

If I could love this post I would. I think it speaks to the ideas people have about psychology being opinion, or about what you anecdotally think, vs. about what the evidence and the science demonstrate. Just as people think they can shortcut the education component: "I want to become a psychologist but make no changes in my life, I can just do it on the side." It's frustrating. No one would support a physician not providing life-saving treatment because they personally thought it was wrong. Can you imagine? "No, I'm not going to prescribe you the evidence-based chemotherapy for your type of cancer because I'm against chemotherapy." Yet the same standard is applied to this field and its science. I will say that I appreciate the OP's relative non-defensiveness with the feedback she has gotten, but I also understand why some of the responses might reflect frustration.

I hope I won't derail this thread and I generally agree with your point. However, from my experience, there are physicians that fall into this trap as well. In several countries in Europe some physicians refuse to perform abortions even if the mother's life is in danger, based on their beliefs. You could argue that well, it's their belief and you can find someone else - but if there are too many of these physicians in an area, even if it's a legal procedure in that country, they still endanger the life of their patients by refusing. One of my friends found this out the hard way - she was married, wanted the child, but found out the fetus had no heartbeat. And even in this scenario she had to travel hundreds of km to find someone to do the procedure because she kept getting refused (in a really large city) based on personal/religious beliefs. In multiple countries entire hospitals refuse based on being "conscientious objectors".

Moreover, the same thing happens with physicians who refuse to provide contraception options to non-married people due to their beliefs. An acquittance with a genetic blood clotting issue (who would literally be in danger of dying if she got pregnant) ran into this problem as well.

I don't think Psycycle was referring to you with that part of the comment. Also, respectfully, I cannot help but feel as though you are dodging the meat of the comments here. Would you follow the scientific evidence regarding best practices for gender dysphoria if/given the evidence in question were to/does contradict your perspective on the issue?

This is way the above point is so important. As healthcare providers, in any shape or form, we have to insist on everyone following the scientific evidence regarding best available practices. I may be wrong, but I don't see how there is room for other types of beliefs in here. Being lenient with "personal beliefs" that contradict this just leaves room for the situations above that threaten the physical and mental well-being of our patients and clients.

 

[borne_before]

A couple of things:

Personally, I do think we need to be careful treating science as static state with a finite end, communicating it a final declaration, or invocating it as a diety without backing up by data. Science is first and foremost a process by which truth is uncovered via observation and experiment. In psychology, the goals are the same as another scientifically informed field: to explain, to predict, and to influence outcomes. Of course there are values, politics, and other constructs involved in where we point our tools. When some says "this is what the science says, accept it" that's not exactly a correct statement. I realize I am being a little pedantic, but I feel that public trust in science has been severely undermined by the pandemic and people making finite statements about the "the science" and then turning out pretty darn wrong. I think we, as messengers, should do a better job of couching our language about science. When we need to make summary statements, we should also say or imply "this is what the evidence is trending towards currently."

Bringing this back to the student aspect of the forum there is worry that OP is not displaying a strong commitment to the openness needed to make a doctoral program one of the best things you can do for yourself and others. Put another way, we all enter the program a certain way and leave it with a different perspective. We learn things about ourselves and the world that change you over the course of the program. If OP enters a program in a disagreeable or closed off manner, I could see them really struggling to reap the benefits of the program and really not have a good time.

Do you guys think that one must enter the program with a certain openness? Or do you think the process of the program can lead to more openness? Is it a chicken or an egg insofar that open people choose to become psychologists or that only open people are successful at getting into programs and being successful?

I also think OP has a bit of an open flame by posting here and staying involved in the debate. OP might not say they are open, but I think their behavior is showing a little bit of a flame in a box that is starting to burn it's way out.

 

[iheartbacon]

I have but it does seem more terminal if that makes sense? Also, they don't make me uncomfortable, I just don't agree with transitioning minors (and I have read literature from clinical psychologists that also argue against it) whearas it seems to be embraced in sw. ETA I am in Chicagoland where I am told internships abound. Our kids range from 17 to 5 months

I am unsure what you mean about terminal, because the ultimate goal is a terminal degree with which you can practice. Know that regardless of the degree you get, you will be spending a number of hours each licensing period gaining additional knowledge through continuing education, so there are always opportunities to continue to expand your knowledge and gain new skills to move your career in different directions.

About the programs... yes, I would say PhD programs are more stats heavy. And this involves advanced math classes to understand conceptually why you are running the statistics you are - by hand or with a calculator - before attempting to run them on a computer program. It also involves thorough training in research design so you know what statistics to use in your research and why. I can't speak for how many credits are required in each program - you would have to check brochures for programs you are interested in.

Also, FWIW... there is only a possibility that you could match for internship in the Chicago area - or even the entire midwest. There is no guarantee, and programs are pretty good about weeding out people that aren't prepared for or want the experiences there and are simply applying because of the geographical convenience. Internship is required, so if your family would not be able to move with you or if you would not be willing or able to leave them for a year, I would not even consider pursuing a doctorate in psychology at this time for that reason alone. Especially at the high cost of a PsyD degree - you don't want to take out $100k+ in loans and then not even be able to finish the program or pay those loans back. I have known moms who applied for internship to a number of internships locally, did not match, and ended up matching in Phase II or PMVS and moved across the country for a year - some with their families, some without. It is doable, but the bigger question is what is doable for you? And what are you willing to do in general to get this degree? There is a huge amount of sacrifice involved - even more so if you are a mom or have similar responsibilities.

Continuing with the last paragraph... before even getting to the internship phase, both types of doctoral programs (PhD and PsyD) are a HUGE time commitment - even if you are in a program that can be done part-time (keeping in mind, there is a 10 year time limit to complete your degree - which sounds like a lot, but if you are going part-time would get eaten up quickly). In both types of programs, expect around three hours per class on campus, and for each hour of time spent in class another 1-3 hours per week of reading, assignments, writing papers, preparing presentations, etc. For assessment courses, expect additional time to practice - especially if you have no prior experience with testing. After your first year, expect up to 25 hours per week engaged in clinical work (on top of coursework). In addition to this, dissertation is a huge time commitment in itself. If you are in a PhD program, you would likely have additional commitments as a teaching assistant or research assistant. I am not trying to paint a bleak picture, but as a mom of four myself, I guarantee there are things you would miss. I missed most of last summer with my kids while I was preparing my dissertation proposal so I could defend in time to apply for internship. Assuming I match this round, I will be gone for 50-60 hours per week (between internship and travel time), so I will be working hard to try to finish my dissertation before I start; otherwise, I probably would not see my kids at all until it is done. The best advice on that I can give is plan for the important stuff (birthdays, holidays, etc.) well in advance so most of the sacrificing happens during the everyday stuff (which is still not easy to miss) instead of disappointing your kids (and being disappointed yourself) by having to miss their soccer game, spring concert, etc. because of important deadlines.

I cannot give much advice with your posed question about working with transgender individuals. I have extremely limited experience with this population (one biofeedback session with one; and only a few minutes with another who was a research participant), and have no training in specialized issues like transitioning. If you have developed no competence in this area, I am not sure why you would take such a case on and be involved in this type of decision making process. Outside of being closely supervised or consulting extensively with professionals who do have competence in this area, it would be unethical, especially if you know you have a bias already. In the Chicagoland area, I would bet that there are professionals with expertise in this area that would better serve an individual discerning transitioning, and would hope you would refer them to someone else rather than tackle this yourself alone. Part of ethical practice is being aware of our own biases, prejudices, etc. and actively working on ourselves to keep from doing harm - intentionally or unintentionally - to those we serve.

 

[iheartbacon]

A couple of things:

Personally, I do think we need to be careful treating science as static state with a finite end, communicating it a final declaration, or invocating it as a diety without backing up by data. Science is first and foremost a process by which truth is uncovered via observation and experiment. In psychology, the goals are the same as another scientifically informed field: to explain, to predict, and to influence outcomes. Of course there are values, politics, and other constructs involved in where we point our tools. When some says "this is what the science says, accept it" that's not exactly a correct statement. I realize I am being a little pedantic, but I feel that public trust in science has been severely undermined by the pandemic and people making finite statements about the "the science" and then turning out pretty darn wrong. I think we, as messengers, should do a better job of couching our language about science. When we need to make summary statements, we should also say or imply "this is what the evidence is trending towards currently."

Bringing this back to the student aspect of the forum there is worry that OP is not displaying a strong commitment to the openness needed to make a doctoral program one of the best things you can do for yourself and others. Put another way, we all enter the program a certain way and leave it with a different perspective. We learn things about ourselves and the world that change you over the course of the program. If OP enters a program in a disagreeable or closed off manner, I could see them really struggling to reap the benefits of the program and really not have a good time.

Do you guys think that one must enter the program with a certain openness? Or do you think the process of the program can lead to more openness? Is it a chicken or an egg insofar that open people choose to become psychologists or that only open people are successful at getting into programs and being successful?

I also think OP has a bit of an open flame by posting here and staying involved in the debate. OP might not say they are open, but I think their behavior is showing a little bit of a flame in a box that is starting to burn it's way out.

I think your point about openness in the profession is extremely important. If we expect our clients to be open to looking at themselves, trying new things, etc., I think we need to expect the same of ourselves. To answer your question about openness when entering a program... I think it is important to have some degree of openness, but also that your program (assuming you have good mentors and supervisors that encourage self-awareness, curiosity, and exploration) will continue to help you develop more openness. At least, that is what I like to believe.

 

[iheartbacon]

Thank you for sharing this @foreverbull! I feel really uninformed and had little training and experience in this area, and I appreciated your really thorough posts. They have been very helpful!

 

[ClinicalABA]

As you pursue a carreer in mental health care, I think it is important to ask yourself what type of evidence would it take for you to act incongruous with your pre-existing beliefs, including faith-based beliefs. If the empirical evidence indicated that a procedure or practice you were "against" actually led to reduced suffering, lower rates of suicide, increased well-being, and higher rates of "life-success" (e.g., more stable work and relationships; higher income), would you still be "against" it? If so, then acting on your pre-existing beliefs would harm your clients, and you should consider another field. I don't know if this is the specific case with gender reassignment in minors, but what if it is?

I used to work in a catholic facility which was ultimately under the auspices of a group fo sisters. There were pastoral counselors (nuns) involved in the treatment. We had a case were we were unable (both ethically and clinically) to prevent some of the patients from having sex. It was one of the nuns who first brought up the issue of contraception, basically aknowledging that the individuals in question would not want to have a child, and would not be able to take care of it if they did (it was a long-term care/psychiatric facility). Further, she acknowledged that most certain way to prevent such a harmful (and unwanted by all) outcome was contraception. She commented that her beliefs, while worthy of some brief discussion, were not relevant in that in this case they ran counter to the overall mission of caring and compassion. In more general discussions with her, she pointed out that she lived her own life guided by her beliefs, but if those in her care chose not too, she was still obligated to express her beliefs but then act in accordance with the mission of caring and compassion and then let her god sort it out in the end. As an atheist, i was suprised to find that the most rational voice on the matter belonged to her.

Ultimately, my own personal belief regarding treatment of issues related to transgender, gender dysphoria, etc. are irrelevant, as I don't have the appropriate post-doctoral supervised clinical training and experience to offer any clinical guidance other than "let me help you with a referral to someone qualified to assist you with this issue."

 

[tr]

If I could love this post I would. I think it speaks to the ideas people have about psychology being opinion, or about what you anecdotally think, vs. about what the evidence and the science demonstrate. Just as people think they can shortcut the education component: "I want to become a psychologist but make no changes in my life, I can just do it on the side." It's frustrating. No one would support a physician not providing life-saving treatment because they personally thought it was wrong. Can you imagine? "No, I'm not going to prescribe you the evidence-based chemotherapy for your type of cancer because I'm against chemotherapy." Yet the same standard is applied to this field and its science. I will say that I appreciate the OP's relative non-defensiveness with the feedback she has gotten, but I also understand why some of the responses might reflect frustration.

Say what? Obstetricians can and do choose not to provide therapeutic pregnancy terminations but refer out to someone who does these often lifesaving procedures -- someone who may well be hundreds of miles away across state lines -- despite the mountain of objective evidence documenting better psychological, economic, and physical health among women who received elective abortions vs those who were denied them. Similarly, pharmacists can refuse to dispense Plan B based on their personal religious beliefs. Personally I think it's a travesty of justice, but this is in no way unique to psychology.

 

[iheartbacon]

As you pursue a carreer in mental health care, I think it is important to ask yourself what type of evidence would it take for you to act incongruous with your pre-existing beliefs, including faith-based beliefs. If the empirical evidence indicated that a procedure or practice you were "against" actually led to reduced suffering, lower rates of suicide, increased well-being, and higher rates of "life-success" (e.g., more stable work and relationships; higher income), would you still be "against" it? If so, then acting on your pre-existing beliefs would harm your clients, and you should consider another field. I don't know if this is the specific case with gender reassignment in minors, but what if it is?

I used to work in a catholic facility which was ultimately under the auspices of a group fo sisters. There were pastoral counselors (nuns) involved in the treatment. We had a case were we were unable (both ethically and clinically) to prevent some of the patients from having sex. It was one of the nuns who first brought up the issue of contraception, basically aknowledging that the individuals in question would not want to have a child, and would not be able to take care of it if they did (it was a long-term care/psychiatric facility). Further, she acknowledged that most certain way to prevent such a harmful (and unwanted by all) outcome was contraception. She commented that her beliefs, while worthy of some brief discussion, were not relevant in that in this case they ran counter to the overall mission of caring and compassion. In more general discussions with her, she pointed out that she lived her own life guided by her beliefs, but if those in her care chose not too, she was still obligated to express her beliefs but then act in accordance with the mission of caring and compassion and then let her god sort it out in the end. As an atheist, i was suprised to find that the most rational voice on the matter belonged to her.

Ultimately, my own personal belief regarding treatment of issues related to transgender, gender dysphoria, etc. are irrelevant, as I don't have the appropriate post-doctoral supervised clinical training and experience to offer any clinical guidance other than "let me help you with a referral to someone qualified to assist you with this issue."

I have worked in Catholic agencies before too, and despite any personally held beliefs of any individual or doctrines of the church, it was more important to provide compassionate care and act in a way that ministered rather than evangelized (if that makes sense).

 

[deleted106747]

Say what? Obstetricians can and do choose not to provide therapeutic pregnancy terminations but refer out to someone who does these often lifesaving procedures -- someone who may well be hundreds of miles away across state lines -- despite the mountain of objective evidence documenting better psychological, economic, and physical health among women who received elective abortions vs those who were denied them. Similarly, pharmacists can refuse to dispense Plan B based on their personal religious beliefs. Personally I think it's a travesty of justice, but this is in no way unique to psychology.

Fair enough. I was once part of an Ethics seminar where two male pharmacy residents said they would never give someone plan B. I indeed went off point when I said the part you kindly bolded for emphasis of where exactly I went off the point. However, the target I was going for was to compare signal to signal without getting caught in the noise; evidence based care to evidence based care.

 

[borne_before]

I have worked in Catholic agencies before too, and despite any personally held beliefs of any individual or doctrines of the church, it was more important to provide compassionate care and act in a way that ministered rather than evangelized (if that makes sense).

Catholics don't even believe in Catholicism...

 

[futureapppsy2]

I think it's worth noting that, for all we preach and aspire to openness, we all have many things that we aren't really open to ourselves, even clinically/. For example, a growing body of literature shows that "masking" is potentially quite iatrogenic in autistic people over time, but many (probably most?) behavior analysts continue to teach autistic clients to mask, and many still uphold the treatment goal of making autistic people "indistinguishable" from non-autistic people, as articulated by Lovaas, because that's a part of the "founding doctrine" of ABA as applied to autism. Openness is easier to preach than practice in many ways.

 

[R. Matey]

Do you guys think that one must enter the program with a certain openness? Or do you think the process of the program can lead to more openness? Is it a chicken or an egg insofar that open people choose to become psychologists or that only open people are successful at getting into programs and being successful?

I know the correlation between openness to experience and investigative, artistic career subtypes (psych type is ISA) is fairly strong in the I/O literature.

 

[ClinicalABA]

I think it's worth noting that, for all we preach and aspire to openness, we all have many things that we aren't really open to ourselves, even clinically/. For example, a growing body of literature shows that "masking" is potentially quite iatrogenic in autistic people over time, but many (probably most?) behavior analysts continue to teach autistic clients to mask, and many still uphold the treatment goal of making autistic people "indistinguishable" from non-autistic people, as articulated by Lovaas, because that's a part of the "founding doctrine" of ABA as applied to autism. Openness is easier to preach than practice in many ways.

What a surprise- turns out being forced to and trying to be something you are not, don't want to, or can't be often doesn't turn out so well.

 

[Rain Sova]

I guess

I don't think Psycycle was referring to you with that part of the comment. Also, respectfully, I cannot help but feel as though you are dodging the meat of the comments here. Would you follow the scientific evidence regarding best practices for gender dysphoria if/given the evidence in question were to/does contradict your perspective on the issue?

I don't feel qualified to respond to that. I would want to study and see for myself what IS the science, how do faith based clinicians integrate the science, how much can science know beyond a shadow of a doubt, etc. My faith doesn't tell me to exclude or discriminate, but going a step further, signing off on a minor undergoing transitional surgery as mentioned previously, I don't think I could do that.

 

[Rain Sova]

Rain Sova,

I'm Hindu (born & raised for as far as my generations can see; hence, I feel my religion makes my clinical life more broad, and dig the world making mindfulness a priority. Everyone should be trained in DBT...). I was also raised in rural Southern U.S. (my grandpa/Dadaji became Catholic before his death, *God bless his soul*), so what you're firm about when it comes to Christianity is perplexing to me.

Just sayin.'

You can be you, but again, our field is evidence-based (otherwise, we'd all be life coaches...). We're firm about that.

Graduate studies/even specialized-trade schools are like funnels. We're all tossed in, churned around, and are popped out, differently with expanding worldviews. It's a must to know your lane, in science. We take an Oath...repeatedly.

I have some knowledge of Catholicism but very little knowledge of Hinduism so it would be difficult for me to compare/contrast my beliefs with yours but I do appreciate your perspective. I've been learning about the NASW code of ethics for a decade, I'm sure psychologists have their own

 

[Rain Sova]

I hope I won't derail this thread and I generally agree with your point. However, from my experience, there are physicians that fall into this trap as well. In several countries in Europe some physicians refuse to perform abortions even if the mother's life is in danger, based on their beliefs. You could argue that well, it's their belief and you can find someone else - but if there are too many of these physicians in an area, even if it's a legal procedure in that country, they still endanger the life of their patients by refusing. One of my friends found this out the hard way - she was married, wanted the child, but found out the fetus had no heartbeat. And even in this scenario she had to travel hundreds of km to find someone to do the procedure because she kept getting refused (in a really large city) based on personal/religious beliefs. In multiple countries entire hospitals refuse based on being "conscientious objectors".

Moreover, the same thing happens with physicians who refuse to provide contraception options to non-married people due to their beliefs. An acquittance with a genetic blood clotting issue (who would literally be in danger of dying if she got pregnant) ran into this problem as well.



This is way the above point is so important. As healthcare providers, in any shape or form, we have to insist on everyone following the scientific evidence regarding best available practices. I may be wrong, but I don't see how there is room for other types of beliefs in here. Being lenient with "personal beliefs" that contradict this just leaves room for the situations above that threaten the physical and mental well-being of our patients and clients.

Everything in life is a belief or opinion. Even science. You gave extreme and rare examples about abortion, but let's say a woman finds out her baby has DS. She wants an abortion. The doctor should absolutely be able to refuse the procedure. She should go elsewhere.

 

[Rain Sova]

A couple of things:

Personally, I do think we need to be careful treating science as static state with a finite end, communicating it a final declaration, or invocating it as a diety without backing up by data. Science is first and foremost a process by which truth is uncovered via observation and experiment. In psychology, the goals are the same as another scientifically informed field: to explain, to predict, and to influence outcomes. Of course there are values, politics, and other constructs involved in where we point our tools. When some says "this is what the science says, accept it" that's not exactly a correct statement. I realize I am being a little pedantic, but I feel that public trust in science has been severely undermined by the pandemic and people making finite statements about the "the science" and then turning out pretty darn wrong. I think we, as messengers, should do a better job of couching our language about science. When we need to make summary statements, we should also say or imply "this is what the evidence is trending towards currently."

Bringing this back to the student aspect of the forum there is worry that OP is not displaying a strong commitment to the openness needed to make a doctoral program one of the best things you can do for yourself and others. Put another way, we all enter the program a certain way and leave it with a different perspective. We learn things about ourselves and the world that change you over the course of the program. If OP enters a program in a disagreeable or closed off manner, I could see them really struggling to reap the benefits of the program and really not have a good time.

Do you guys think that one must enter the program with a certain openness? Or do you think the process of the program can lead to more openness? Is it a chicken or an egg insofar that open people choose to become psychologists or that only open people are successful at getting into programs and being successful?

I also think OP has a bit of an open flame by posting here and staying involved in the debate. OP might not say they are open, but I think their behavior is showing a little bit of a flame in a box that is starting to burn it's way out.

I agree with a lot of what you're saying although I'm afraid I don't understand the flame in a box concept.
I am extremely curious and compassionate and open-minded, but a few things are non-negotiable to me, this is true. My politics have evolved, many of my beliefs have evolved through educational or life experiences. I would say everything is handled in a "how does this line up with the word of God as I know it? Do I know it well enough to address this?" Sort of analysis. Many topics don't apply at all.

 

[Rain Sova]

I am unsure what you mean about terminal, because the ultimate goal is a terminal degree with which you can practice. Know that regardless of the degree you get, you will be spending a number of hours each licensing period gaining additional knowledge through continuing education, so there are always opportunities to continue to expand your knowledge and gain new skills to move your career in different directions.

About the programs... yes, I would say PhD programs are more stats heavy. And this involves advanced math classes to understand conceptually why you are running the statistics you are - by hand or with a calculator - before attempting to run them on a computer program. It also involves thorough training in research design so you know what statistics to use in your research and why. I can't speak for how many credits are required in each program - you would have to check brochures for programs you are interested in.

Also, FWIW... there is only a possibility that you could match for internship in the Chicago area - or even the entire midwest. There is no guarantee, and programs are pretty good about weeding out people that aren't prepared for or want the experiences there and are simply applying because of the geographical convenience. Internship is required, so if your family would not be able to move with you or if you would not be willing or able to leave them for a year, I would not even consider pursuing a doctorate in psychology at this time for that reason alone. Especially at the high cost of a PsyD degree - you don't want to take out $100k+ in loans and then not even be able to finish the program or pay those loans back. I have known moms who applied for internship to a number of internships locally, did not match, and ended up matching in Phase II or PMVS and moved across the country for a year - some with their families, some without. It is doable, but the bigger question is what is doable for you? And what are you willing to do in general to get this degree? There is a huge amount of sacrifice involved - even more so if you are a mom or have similar responsibilities.

Continuing with the last paragraph... before even getting to the internship phase, both types of doctoral programs (PhD and PsyD) are a HUGE time commitment - even if you are in a program that can be done part-time (keeping in mind, there is a 10 year time limit to complete your degree - which sounds like a lot, but if you are going part-time would get eaten up quickly). In both types of programs, expect around three hours per class on campus, and for each hour of time spent in class another 1-3 hours per week of reading, assignments, writing papers, preparing presentations, etc. For assessment courses, expect additional time to practice - especially if you have no prior experience with testing. After your first year, expect up to 25 hours per week engaged in clinical work (on top of coursework). In addition to this, dissertation is a huge time commitment in itself. If you are in a PhD program, you would likely have additional commitments as a teaching assistant or research assistant. I am not trying to paint a bleak picture, but as a mom of four myself, I guarantee there are things you would miss. I missed most of last summer with my kids while I was preparing my dissertation proposal so I could defend in time to apply for internship. Assuming I match this round, I will be gone for 50-60 hours per week (between internship and travel time), so I will be working hard to try to finish my dissertation before I start; otherwise, I probably would not see my kids at all until it is done. The best advice on that I can give is plan for the important stuff (birthdays, holidays, etc.) well in advance so most of the sacrificing happens during the everyday stuff (which is still not easy to miss) instead of disappointing your kids (and being disappointed yourself) by having to miss their soccer game, spring concert, etc. because of important deadlines.

I cannot give much advice with your posed question about working with transgender individuals. I have extremely limited experience with this population (one biofeedback session with one; and only a few minutes with another who was a research participant), and have no training in specialized issues like transitioning. If you have developed no competence in this area, I am not sure why you would take such a case on and be involved in this type of decision making process. Outside of being closely supervised or consulting extensively with professionals who do have competence in this area, it would be unethical, especially if you know you have a bias already. In the Chicagoland area, I would bet that there are professionals with expertise in this area that would better serve an individual discerning transitioning, and would hope you would refer them to someone else rather than tackle this yourself alone. Part of ethical practice is being aware of our own biases, prejudices, etc. and actively working on ourselves to keep from doing harm - intentionally or unintentionally - to those we serve.

I absolutely appreciate this very thorough response- possibly a heartbreaking reality check about my dream but gratefully appreciate it. A lot to consider here. Relocation is not off the table but whether in Illinois or elsewhere, I don't have a "village" with my kids, I am that village.

 

[Rain Sova]

As you pursue a carreer in mental health care, I think it is important to ask yourself what type of evidence would it take for you to act incongruous with your pre-existing beliefs, including faith-based beliefs. If the empirical evidence indicated that a procedure or practice you were "against" actually led to reduced suffering, lower rates of suicide, increased well-being, and higher rates of "life-success" (e.g., more stable work and relationships; higher income), would you still be "against" it? If so, then acting on your pre-existing beliefs would harm your clients, and you should consider another field. I don't know if this is the specific case with gender reassignment in minors, but what if it is?

I used to work in a catholic facility which was ultimately under the auspices of a group fo sisters. There were pastoral counselors (nuns) involved in the treatment. We had a case were we were unable (both ethically and clinically) to prevent some of the patients from having sex. It was one of the nuns who first brought up the issue of contraception, basically aknowledging that the individuals in question would not want to have a child, and would not be able to take care of it if they did (it was a long-term care/psychiatric facility). Further, she acknowledged that most certain way to prevent such a harmful (and unwanted by all) outcome was contraception. She commented that her beliefs, while worthy of some brief discussion, were not relevant in that in this case they ran counter to the overall mission of caring and compassion. In more general discussions with her, she pointed out that she lived her own life guided by her beliefs, but if those in her care chose not too, she was still obligated to express her beliefs but then act in accordance with the mission of caring and compassion and then let her god sort it out in the end. As an atheist, i was suprised to find that the most rational voice on the matter belonged to her.

Ultimately, my own personal belief regarding treatment of issues related to transgender, gender dysphoria, etc. are irrelevant, as I don't have the appropriate post-doctoral supervised clinical training and experience to offer any clinical guidance other than "let me help you with a referral to someone qualified to assist you with this issue."

Wow, that's a very interesting story. That had to be a difficult situation. I have known this to happen in secular inpatient. Thank you for sharing

 

[tr]

For example, a growing body of literature shows that "masking" is potentially quite iatrogenic in autistic people over time,

I apologize for being the grammar jerk, but could you please stop misusing the word 'iatrogenic'? It is an adjective that modifies an adverse outcome (usually "harm" or "disease", etc.). By itself it just means 'generated by the doctor.' Masking can be said to be a cause of iatrogenic harm, but saying the masking is iatrogenic would imply the masking is itself an adverse outcome resulting from a doctor's intervention, which is nonsensical.

 

[futureapppsy2]

I apologize for being the grammar jerk, but could you please stop misusing the word 'iatrogenic'? It is an adjective that modifies an adverse outcome (usually "harm" or "disease", etc.). By itself it just means 'generated by the doctor.' Masking can be said to be a cause of iatrogenic harm, but saying the masking is iatrogenic would imply the masking is itself an adverse outcome resulting from a doctor's intervention, which is nonsensical.

Point noted--thanks (although I do know people who would argue that masking in and of itself is an adverse outcome--I wouldn't, personally)

 

[deleted106747]

Everything in life is a belief or opinion. Even science. You gave extreme and rare examples about abortion, but let's say a woman finds out her baby has DS. She wants an abortion. The doctor should absolutely be able to refuse the procedure. She should go elsewhere.

Science is not an opinion; it wasn’t opinion that provided my mother with lifesaving medication when she developed a work related bloodborne viral infection. It was methodological research, virology, and facts.

 

[WisNeuro]

Science is not an opinion; it wasn’t opinion that provided my mother with lifesaving medication when she developed a work related bloodborne viral infection. It was methodological research, virology, and facts.

Pssh, we all know that "infection" was a demonic infestation. Damn Pasteur for filling your head with that heretical germ theory nonsense!

 

[ClinicalABA]

Science is not an opinion...

No, but the belief that science should be the dominant epistemology of clinical psychology is an opinion (It's a well informed and the appropriate opinion as far as I'm concerned, but it is an opinion nonetheless).

 

[deleted106747]

No, but the belief that science should be the dominant epistemology of clinical psychology is an opinion (It's a well informed and the appropriate opinion as far as I'm concerned, but it is an opinion nonetheless).

Yeah I’m going back and forth on what I think about this. Is it an opinion if it’s backed by evidence that it works? Going back to my mother’s situation, is it an opinion that one should believe in the science that generated the medication, or is it a fact?

 

[ClinicalABA]

I think it's worth noting that, for all we preach and aspire to openness, we all have many things that we aren't really open to ourselves, even clinically/. For example, a growing body of literature shows that "masking" is potentially quite iatrogenic in autistic people over time, but many (probably most?) behavior analysts continue to teach autistic clients to mask, and many still uphold the treatment goal of making autistic people "indistinguishable" from non-autistic people, as articulated by Lovaas, because that's a part of the "founding doctrine" of ABA as applied to autism. Openness is easier to preach than practice in many ways.

This example emphasizes the importance of good, science-based clinical training. Not only should practitioners be able to identify from the origninal research article Lovaas' operational definition of "indistinguishable" (i.e., scoring similar to non-autism diagnosed first graders on measure of IQ and public school performance), but also understand the relevant context of the literature, the evolving social validity of the outcome measures- for example, when the options are participate in a standard elementary school classroom or be wharehoused in substantially separate and decidely not equal "educational" program are the only options, the former is perhaps more desirable, even though we now know that there are a multitude of better options for all students- and the evolving body of literature (including from fields other than education, ABA, or psychology) on the topic. This is why a lot of us stick to our guns about there being no shortcuts in clinical training. Learning somtehing is one thing, but understanding how what you learned came to be is another.

 

[ClinicalABA]

Yeah I’m going back and forth on what I think about this. Is it an opinion if it’s backed by evidence that it works? Going back to my mother’s situation, is it an opinion that one should believe in the science that generated the medication, or is it a fact?

What you choose as "evidence" is at the heart of the matter. Many (most?) people will default to appeal to authority (over empiricism) in many cases. We could go further down the rabbit hole and argue wether or not we actually have the free will to make the choice as to our own opinions, but discussion of superdeterminism quickly becomes complicated and boring (in my opinion)

 

[deleted106747]

What you choose as "evidence" is at the heart of the matter. Many (most?) people will default to appeal to authority (over empiricism) in many cases. We could go further down the rabbit hole and argue wether or not we actually have the free will to make the choice as to our own opinions, but discussion of superdeterminism quickly becomes complicated and boring (in my opinion)

I suppose, but is it fact or opinion of the evidence is empirical and it demonstrates efficacy? So you go with the example above, I could have prayed that the virus would leave my mother, or she could take the med. Or both, but the med killed the virus. So is there any choice but to believe in it and the factual nature of it? I think I have a lot of empathy for providers who work tirelessly to save a patient’s life using EBTs and everyone credits god!

 

[borne_before]

I think it's worth noting that, for all we preach and aspire to openness, we all have many things that we aren't really open to ourselves, even clinically/. For example, a growing body of literature shows that "masking" is potentially quite iatrogenic in autistic people over time, but many (probably most?) behavior analysts continue to teach autistic clients to mask, and many still uphold the treatment goal of making autistic people "indistinguishable" from non-autistic people, as articulated by Lovaas, because that's a part of the "founding doctrine" of ABA as applied to autism. Openness is easier to preach than practice in many ways.

Can you expand and unpack this a little more for me?

BTW - you are using iatrogenic correctly.

 

[borne_before]

No, but the belief that science should be the dominant epistemology of clinical psychology is an opinion (It's a well informed and the appropriate opinion as far as I'm concerned, but it is an opinion nonetheless).

There we go talking like science is an object! It's a method for observing, describing, and using experiments/studies to generate evidence to explain, predict, and influence outcomes. I view it as a flashlight or truth bazooka.

BTW - these discussions are FUN and a major reason I keep coming back to the salon that is SDF.

 

[deleted106747]

There we go talking like science is an object! It's a method for observing, describing, and using experiments/studies to generate evidence to explain, predict, and influence outcomes. I view it as a flashlight or truth bazooka.

BTW - these discussions are FUN and a major reason I keep coming back to the salon that is SDF.

Haha right? I love these discussions, even my moments of annoyance!

 

[PsychSupreme]

I guess

I don't feel qualified to respond to that. I would want to study and see for myself what IS the science, how do faith based clinicians integrate the science, how much can science know beyond a shadow of a doubt, etc. My faith doesn't tell me to exclude or discriminate, but going a step further, signing off on a minor undergoing transitional surgery as mentioned previously, I don't think I could do that.

I think you are intentionally choosing an extreme, extreme minority type of case to justify not answering the question. People advocating for minors to undergo transitional surgery are very few and exceptionally far between. Let's entertain a much more likely hypothetical situation. If someone came to you experiencing gender dysphoria related to experiences of outside prejudice and stigma resulting from their non-cisgender identity, would you, given that the evidence is in favor of supporting that identity to improve mental health outcomes, call them by their preferred pronouns, work with them to bring their family on board to supporting this identity, and, if they are not a minor, be willing and open to the idea of recommending transitional surgery? If you would not take these steps, would you at least recognize your own bias and refer them to another professional whom you know would take these evidence-based steps? Or would you attempt to counsel them away from their identity, fall short of being affirming of their reality, and fail to advocate for meaningful changes in their social network? If you cannot honestly say you would choose to be affirming or to refer them to someone who is, then that is an ethical, humanitarian, and epistemological problem. It simply is. We know that affirmative support saves the lives of transgender individuals and non-affirmative forces exacerbate suicidality on one end of the mental health spectrum and simple poor QOL on the other end. Therefore, we have a duty to do what is known to work (until such time as further evidence demonstrates that something else, or some other iteration of the same thing, works better).

 

[tr]

Can you expand and unpack this a little more for me?

BTW - you are using iatrogenic correctly.

My goodness, is this some pervasive psychology thing? It's not right, please don't perpetuate it. 'Iatrogenic' describes the result, not the intervention.

Definition of IATROGENIC

induced unintentionally by a physician or surgeon or by medical treatment or diagnostic procedures… See the full definition

www.merriam-webster.com

Medical Definition of Iatrogenic

Read medical definition of Iatrogenic

www.medicinenet.com

 

[ClinicalABA]

I suppose, but is it fact or opinion of the evidence is empirical and it demonstrates efficacy? So you go with the example above, I could have prayed that the virus would leave my mother, or she could take the med. Or both, but the med killed the virus. So is there any choice but to believe in it and the factual nature of it? I think I have a lot of empathy for providers who work tirelessly to save a patient’s life using EBTs and everyone credits god!

Yes, the empirical evidence demonstrates efficacy (and we'll assume an objective, reliable/valid measure of efficacy). However, people can (and do) choose a different course of action based on what some authority figure says, anecdotal evidence, representative heuristic, etc. There's a large fancy building (Church of Christ, Scientist - Wikipedia) in my state capital that supports this position. It's their opinion- and one that empirical evidence would contradict- but it's supported by what they think is evidence.

Even in your mother's case, the specific example is post hoc ergo propter hoc reasoning. There is likely a large n, placebo controlled study somewhere that supports the medication as the mechanism of action, but in individual instances it's not possible to say that it wasn't the "thoughts and prayers" that really the virus go away. That's why it's so tough to argue with/change opinions of those who subscribe to a different doninant epistemology-they just don't follow the same rules.

In deference to the OP- sorry about the slight drift in topic. It's nice to see that you are still hanging around this thread, even when you may have heard some things that are uncomfortable or don't jell with your beliefs (and despite some obvious bullying from others!)

 

[R. Matey]

What you choose as "evidence" is at the heart of the matter. Many (most?) people will default to appeal to authority (over empiricism) in many cases. We could go further down the rabbit hole and argue wether or not we actually have the free will to make the choice as to our own opinions, but discussion of superdeterminism quickly becomes complicated and boring (in my opinion)

Let's do it!! My brain is making me want to pursue this discussion further. I tried to stop it, but I'm afraid I'm helpless to do so.

I suppose, but is it fact or opinion of the evidence is empirical and it demonstrates efficacy? So you go with the example above, I could have prayed that the virus would leave my mother, or she could take the med. Or both, but the med killed the virus. So is there any choice but to believe in it and the factual nature of it? I think I have a lot of empathy for providers who work tirelessly to save a patient’s life using EBTs and everyone credits god!

But empiricism is roughly a material viewpoint where causes are accepted to be attributed to observable phenomena. If you make allocations for unobservable actors on a given cause (e.g., a miracle), then the origin of said cause is brought into question. It's a sticky wicket, I know, but important in a conversation like this. The higher brow version of the OP's argument is that the philosophical viewpoint of evidenced based practices is at epistemological odds with her personal faith because it isn't limited to material intervention. FWIW, I think that's actually right, but the question at hand is how an intellectually honest clinician negotiates two competing philosophical frames without compromising on either. Like I told the OP already, there are extensive writings on this topic from people who share her faith background. From what I remember in previous conversations I've had, it turns on accepting a certain degree of pragmatism and deference to a community standard.

 

[ClinicalABA]

Let's do it!! My brain is making me want to pursue this discussion further. I tried to stop it, but I'm afraid I'm helpless to do so.

You cannot accurately predict both the location and momentum of a sub-atomic particle when given its initial position, therefore it follows that I had a free choice to eat leftover pizza for both breakfast and lunch today (as opposed to it being already determined at the point of the Big Bang that I would eat leftover pizza for breakfast and luch today, and if we just knew the conditions at the point of the Big Bang we would have been able to predict my meal choices today, yesterday, and tomorrow). Discuss

Interestingly, the original "experiement" by Heisenberg regarding this sub-atomic uncertainty took place soley in his mind (or in his private verbal behavior, as us ABA guys like to call it)!

 

[PsyDr]

But empiricism is roughly a material viewpoint where causes are accepted to be attributed to observable phenomena. If you make allocations for unobservable actors on a given cause (e.g., a miracle), then the origin of said cause is brought into question. It's a sticky wicket, I know, but important in a conversation like this. The higher brow version of the OP's argument is that the philosophical viewpoint of evidenced based practices is at epistemological odds with her personal faith because it isn't limited to material intervention. FWIW, I think that's actually right, but the question at hand is how an intellectually honest clinician negotiates two competing philosophical frames without compromising on either.

Science and the Catholic Church - Wikipedia

en.wikipedia.org