Non-scientific, pseudoscientific, nonsensical, or seemingly cashing-in-on-a-popular-treatment CE examples

[R. Matey]

If people haven't had specific training and supervision in PE/CPT protocols, my opinion is that they should not be delivering those treatments. Having done a lot of trauma and PTSD work over the years, I'd say that the "straightforward" cases are the exception and not the rule, and many cases that seem straightforward, turn out to be fairly complicated. And, for liability reasons, I would not treat eating disorder cases without specific training as there is a higher overlap with medical complications as a result of the disorder(s).

Where did I say that people with no training and supervision should practice these modalities? And from what I can gather, it seems like your experience has been predominately in the VA, where you would expect more severe and complex presentations. A fictionalized version of what I perceive to be a "straightforward case" is someone with no MH prior history who experienced a car accident and having trouble getting back behind the wheel. This fictional person might respond well to a few sessions of PE or WET in combination with imaginal or in-vivo exposure, which is all in the wheelhouse of a competent CBT clinician who has had the appropriate training. Same goes for EDs. Maybe we disagree on what counts as expertise?

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[WisNeuro]

Where did I say that people with no training and supervision should practice these modalities? And from what I can gather, it seems like your experience has been predominately in the VA, where you would expect more severe and complex presentations. A fictionalized version of what I perceive to be a "straightforward case" is someone with no MH prior history who experienced a car accident and having trouble getting back behind the wheel. This fictional person might respond well to a few sessions of PE or WET in combination with imaginal or in-vivo exposure, which is all in the wheelhouse of a competent CBT clinician who has had the appropriate training. Same goes for EDs. Maybe we disagree on what counts as expertise?

It sounded as you were implying that as my comment discussed someone who had been trained in a broad modality doing those specific treatments. As for my trauma work, most of that actually has occurred outside of the VA. I have done a god amount of work with sexual assault victims. If anything, my non-VA patients have been much more severe than the VA patients, in general. The VA patients are just less likely to engage in meaningful MH treatment, but that's a systemic issue rather than a disorder specific one. I have had the "straightforward" accident patients before, and I would agree that they are easy to treat. They are, however, the clear minority of patients presenting for trauma treatment in my experience.

As for EDs, my initial clinical supervisor was an ED specialist, so I got a good deal of experience in that. From a personal liability standpoint, I wouldn't see those patients unless I was either being supervised or got some more extensive training.

We could be disagreeing on expertise. Maybe it's due to working with a foot in the legal world and past involvement with state associations and licensing boards, as I am fairly protective of my professional liability.

 

[Sanman]

If people haven't had specific training and supervision in PE/CPT protocols, my opinion is that they should not be delivering those treatments. Having done a lot of trauma and PTSD work over the years, I'd say that the "straightforward" cases are the exception and not the rule, and many cases that seem straightforward, turn out to be fairly complicated. And, for liability reasons, I would not treat eating disorder cases without specific training as there is a higher overlap with medical complications as a result of the disorder(s).

I can't disagree with the logic. However, Outside the VA it is hard to find well-trained folks what are willing to see these patients. Even in the VA, I often have the option of treating a PTSD patient myself or sending them to a group, often run by an intern. I had not done a ton of PTSD treatment between leaving the VA system on internship and returning. However, I am often the most competent option most of my folks have regardless of my actual competence in an area of practice.

Then the question becomes one of do you treat the patient with your limited knowledge-base or leave them to someone less ethical or to receive no treatment at all. Personally, I won't take on much in PP because it is not worth it and there is easier money to be made treating less serious issues, but there is not always a simple answer.

 

[R. Matey]

My concern with this is that it can be applied very broadly and can actually result in a net negative. For example, I may have been trained in MET for alcohol use, but that was 5+ years ago and I have not been immersed in that field/literature since even with that foundation. Sure, I might do better than the diploma mill student next door, but there's also a possibility that this is a more complicated case, I'm not up to date on the nuances of the treatment/population beyond didactic, etc. A big danger then, if I don't do any obvious harm, is that treatment doesn't work. And now Mr. Joe doesn't believe therapy works and won't try anything again for 10 years.

That's valid. If anything the generalists' life is a difficult one because there would be a lot to keep on. There is also, of course, overlap in interventions between the various modalities especially in CBT, but it's on the clinician to keep up. However, the opposite extreme is I think what we actually see in clinical practice where ethical psychologists have 1-3 niche areas and the void remaining is filled with diploma mill grads and master's level clinicians where your net negative is realized on the daily.

 

[WisNeuro]

I can't disagree with the logic. However, Outside the VA it is hard to find well-trained folks what are willing to see these patients. Even in the VA, I pften have the option of treating a PTSD patient myself or sending them to a group, often run by an intern. I had not done a ton of PTSD treatment between leaving the VA system on internship and returning. However, I am often the most competent option most of my folks have regardless of my actual competence in an area of practice.

Then the question becomes one of do you treat the patient with your limited knowledge-base or leave them to someone less ethical or to receive no treatment at all. Personally, I won't take on much in PP because it is not worth it and there is easier money to be made treating less serious issues, but there is not always a simple answer.

There is definitely a philosophical side to this debate. Yes, there are plenty of people hanging their EMDR snakeoil shingles out there. And I, personally, would rather see a competent CBT person with an understanding of PE, than a SW who has "extensive" training in flashing lights and pseudoneuro jargon. But, from a liability standpoint, I'm good seeing a narrower subset of people under which I can clearly and objectively demonstrate competence in were I to be brought up in front of the board or for a lawsuit. May be an uncommon thing, but happens often enough for me to "let them eat cake," in a sense.

 

[Sanman]

There is definitely a philosophical side to this debate. Yes, there are plenty of people hanging their EMDR snakeoil shingles out there. And I, personally, would rather see a competent CBT person with an understanding of PE, than a SW who has "extensive" training in flashing lights and pseudoneuro jargon. But, from a liability standpoint, I'm good seeing a narrower subset of people under which I can clearly and objectively demonstrate competence in were I to be brought up in front of the board or for a lawsuit. May be an uncommon thing, but happens often enough for me to "let them eat cake," in a sense.

I don't disagree on a personal level. I learned these lessons early on in my career. Frankly, there is no money in treating the complex therapy stuff due to the flat payment structure. It was much easier for me to make my money seeing only mild anxiety and depression cases and referring out the rest. I ended up with a few more severe cases and headache was not worth it. I am now in a financial position to be even choosier and have a narrower range of practice. The problem with that is the most severe cases end up at the bottom of the barrel.

 

[WisNeuro]

I don't disagree on a personal level. I learned these lessons early on in my career. Frankly, there is no money in treating the complex therapy stuff due to the flat payment structure. It was much easier for my to make my money seeing only mild anxiety and depression cases and referring out the rest. I ended up with a few more severe cases and headache was not worth it. I am now in a financial position to be even choosier. The problem with that is the most severe cases end up at the bottom of the barrel.

As a somewhat related aside, this is really why we need a code/billing structure with meaningful complexity anchors and increasing reimbursement, more skin to certain types of medical visits. Beyond that stupid "interactive complexity" code that payers decline all of the time.

 

[R. Matey]

It sounded as you were implying that as my comment discussed someone who had been trained in a broad modality doing those specific treatments. As for my trauma work, most of that actually has occurred outside of the VA. I have done a god amount of work with sexual assault victims. If anything, my non-VA patients have been much more severe than the VA patients, in general. The VA patients are just less likely to engage in meaningful MH treatment, but that's a systemic issue rather than a disorder specific one. I have had the "straightforward" accident patients before, and I would agree that they are easy to treat. They are, however, the clear minority of patients presenting for trauma treatment in my experience.

As for EDs, my initial clinical supervisor was an ED specialist, so I got a good deal of experience in that. From a personal liability standpoint, I wouldn't see those patients unless I was either being supervised or got some more extensive training.

We could be disagreeing on expertise. Maybe it's due to working with a foot in the legal world and past involvement with state associations and licensing boards, as I am fairly protective of my professional liability.

Ah, I see. I think I'm viewing it not just as supervision and training, but also as amount of cases seen and severity of the presenting concern. To your point, it would depend on the severity of the concern on whether I could trust myself to treat the case. I could see the accident case with some confidence, but would probably enlist a consultant on anything more complex practicing on my own.

It sounds like we have a similar level of ED experience and I would agree that I would enlist a consultant in cases of ARED and mild bulimia also, but I don't know if I'd turn them away if there isn't anywhere else for them to go. I don't think I could ethically take anything more than that on at all.

 

[Sanman]

As a somewhat related aside, this is really why we need a code/billing structure with meaningful complexity anchors and increasing reimbursement, more skin to certain types of medical visits. Beyond that stupid "interactive complexity" code that payers decline all of the time.

Agreed, even if insurance did pay it, I think it was worth all of $4 dollars and likely increased your chances for an audit if used too frequently.

 

[R. Matey]

I don't disagree on a personal level. I learned these lessons early on in my career. Frankly, there is no money in treating the complex therapy stuff due to the flat payment structure. It was much easier for me to make my money seeing only mild anxiety and depression cases and referring out the rest. I ended up with a few more severe cases and headache was not worth it. I am now in a financial position to be even choosier and have a narrower range of practice. The problem with that is the most severe cases end up at the bottom of the barrel.

This is a key issue, but reluctantly have to agree that it's systemic and beyond a single provider. It still raises the question: what would one consider the boundaries of generalist practice.

 

[thebalmofhurtminds]

That's valid. If anything the generalists' life is a difficult one because there would be a lot to keep on. There is also, of course, overlap in interventions between the various modalities especially in CBT, but it's on the clinician to keep up. However, the opposite extreme is I think what we actually see in clinical practice where ethical psychologists have 1-3 niche areas and the void remaining is filled with diploma mill grads and master's level clinicians where your net negative is realized on the daily.

I agree with that and it's definitely a personal struggle for me, but I also try to recognize that I can't change an entire system by overextending the reach of my clinic (e.g. people love to say chronic pain -> trauma, please treat both) in a borderline ethical way to save people from potentially terrible midlevels.

 

[WisNeuro]

Agreed, even if insurance did pay it, I think it was worth all of $4 dollars and likely increased your chances for an audit if used too frequently.

Yeah, I think it's .33 RVUs.

 

[R. Matey]

I agree with that and it's definitely a personal struggle for me, but I also try to recognize that I can't change an entire system by overextending the reach of my clinic (e.g. people love to say chronic pain -> trauma, please treat both) in a borderline ethical way to save people from potentially terrible midlevels.

Sure, agree that the problem is bigger than providers, but my understanding of the ethics code is that you can make a good faith effort to seek out support in cases where you feel you aren't competent and still be engaging in ethical practice. That seems to imply to me that it's understood that we are sometimes asked to do things beyond what we have experience with. Maybe we're talking more about incentives than ethics?

This discussion is really just highlighting class inequalities in psychotherapy as I imagine generalists are more a function of more affordable insurance companies and hospital systems that tend to employ midlevels.

 

[Sanman]

Sure, agree that the problem is bigger than providers, but my understanding of the ethics code is that you can make a good faith effort to seek out support in cases where you feel you aren't competent and still be engaging in ethical practice. That seems to imply to me that it's understood that we are sometimes asked to do things beyond what we have experience with. Maybe we're talking more about incentives than ethics?

This discussion is really just highlighting class inequalities in psychotherapy as I imagine generalists are more a function of more affordable insurance companies and hospital systems that tend to employ midlevels.

Absolutely. However, I think this is easier said than done in reality. I am part of a large medical system. If I opt to treat a patient with PTSD following a PE/WET or CPT protocol, I can discuss it with the Trauma team if they are unable to see the person. Whether I want to do so and leave the comfort of the things I know how to do is a different question.

Will a person in PP want to pay for this consultation/supervision on a case that they will then be making no money on? Unlikely, which brings us back to PESI and the the handy dandy certification that will be CYA for many not willing or unable to get the real thing.

 

[Sanman]

This is a key issue, but reluctantly have to agree that it's systemic and beyond a single provider. It still raises the question: what would one consider the boundaries of generalist practice.

I think that depends on the case and knowing the limits of your expertise. I work with a number of PTSD folks, for example, that have declined to participate in trauma services protocols and are unwilling to discuss traumatic memories. They have been educated by me about the science, the best interventions, and the need to devote 10-12 weeks for a protocol without missing sessions otherwise they may experience an exacerbation of symptoms. As they are unwilling to do that, I work with them to improve coping skills/problem-solving, manage decompensation, and reduce hospitalizations and suicidality with the goal to improve functioning and get them to the point where they may engage in PTSD treatment with trauma services. There is a role for the generalist in treatment. It needs to not be in the area of providing specialty care badly. It comes down to proper treatment planning and honesty.

 

[thebalmofhurtminds]

Sure, agree that the problem is bigger than providers, but my understanding of the ethics code is that you can make a good faith effort to seek out support in cases where you feel you aren't competent and still be engaging in ethical practice. That seems to imply to me that it's understood that we are sometimes asked to do things beyond what we have experience with. Maybe we're talking more about incentives than ethics?

This discussion is really just highlighting class inequalities in psychotherapy as I imagine generalists are more a function of more affordable insurance companies and hospital systems that tend to employ midlevels.

While you're correct overall about the inequalities sentence, I actually am in an affordable hospital system (my payor percentage is heavily Medicare/Medicaid), albeit with very few MH providers - midlevels or above. So unfortunately, taking on cases outside of my scope means taking away from the only affordable option for my actual expertise in the area. If that makes sense. It's a difficult ethical decision for me frequently.

 

[R. Matey]

Absolutely. However, I think this is easier said than done in reality. I am part of a large medical system. If I opt to treat a patient with PTSD following a PE/WET or CPT protocol, I can discuss it with the Trauma team if they are unable to see the person. Whether I want to do so and leave the comfort of the things I know how to do is a different question.

Will a person in PP want to pay for this consultation/supervision on a case that they will then be making no money on? Unlikely, which brings us back to PESI and the the handy dandy certification that will be CYA for many not willing or unable to get the real thing.

Yeah, more and more this seems like a resource/"don't sue me" issue rather than a question of how to gain competence to a novel clinical presentation.

I think that depends on the case and knowing the limits of your expertise. I work with a number of PTSD folks, for example, that have declined to participate in trauma services protocols and are unwilling to discuss traumatic memories. They have been educated by me about the science, the best interventions, and the need to devote 10-12 weeks for a protocol without missing sessions otherwise they may experience an exacerbation of symptoms. As they are unwilling to do that, I work with them to improve coping skills/problem-solving, manage decompensation, and reduce hospitalizations and suicidality with the goal to improve functioning and get them to the point where they may engage in PTSD treatment with trauma services. There is a role for the generalist in treatment. It needs to not be in the area of providing specialty care badly. It comes down to proper treatment planning and honesty.

Maybe I don't know what qualifies as expertise. For instance, I'm more well read and practiced on cognitive therapy for depression than most people I've encountered. My experience as a CT clinician is that most people referred to me for depression have never actually tried CT beyond a basic categorizing of one's automatic negative thoughts, which really an app can do for you. It's rare that I meet someone who knows how to select a technique that intervenes on the right level of dysfunction according to the cognitive model. That training made CPT pretty easy to digest when I was introduced to it even though the assumptions aren't exactly the same, but I haven't had as much practice with it as I've had with CT for depression. So does that make me an expert in CT, but not CPT? Or am I an expert in both because of the overlap?

While you're correct overall about the inequalities sentence, I actually am in an affordable hospital system (my payor percentage is heavily Medicare/Medicaid), albeit with very few MH providers - midlevels or above. So unfortunately, taking on cases outside of my scope means taking away from the only affordable option for my actual expertise in the area. If that makes sense. It's a difficult ethical decision for me frequently.

I guess I shouldn't generalize as you're probably not the only doctoral provider in that situation. That would be a tough place to be and I could see why speciality care makes more sense there.

 

[WisNeuro]

While you're correct overall about the inequalities sentence, I actually am in an affordable hospital system (my payor percentage is heavily Medicare/Medicaid), albeit with very few MH providers - midlevels or above. So unfortunately, taking on cases outside of my scope means taking away from the only affordable option for my actual expertise in the area. If that makes sense. It's a difficult ethical decision for me frequently.

Yeah, it's a different ballgame when it comes to lack of providers, especially in rural areas. I'm in a medium sized metro, so we have pretty good access to specialists. But, if you are more remote, then there is a separate pressure of the patient receiving care from someone who may not be an "expert" but is familiar vs. not getting the care at all. It's also easier to CYA from an ethics standards point of view here.

 

[Sanman]

Yeah, more and more this seems like a resource/"don't sue me" issue rather than a question of how to gain competence to a novel clinical presentation.



Maybe I don't know what qualifies as expertise. For instance, I'm more well read and practiced on cognitive therapy for depression than most people I've encountered. My experience as a CT clinician is that most people referred to me for depression have never actually tried CT beyond a basic categorizing of one's automatic negative thoughts, which really an app can do for you. It's rare that I meet someone who knows how to select a technique that intervenes on the right level of dysfunction according to the cognitive model. That training made CPT pretty easy to digest when I was introduced to it even though the assumptions aren't exactly the same, but I haven't had as much practice with it as I've had with CT for depression. So does that make me an expert in CT, but not CPT? Or am I an expert in both because of the overlap?

I think we need to get away from this binary of expert/non-expert and into the realm of "adequately able to ethically treat" the condition in front of you. This becomes more clear over time. Fast forward 10 years to where I am. You have continued to treat thousands of patients with depression via CT and have not completed a CPT case since training. What is your comfort level with each now? Do you feel adequately able to do something you have not in 10 years? Are you more or less competent now than 10 years prior? Expertise is not a static thing, but an ongoing evaluation of your skills and those around you. A trauma fellow is likely more competent in PTSD treatment than I. On the flip side, you won't encounter many people more familiar with late life depression than yours truly. Are my cog assessment skills up to par with those that exclusively practice neuropsych? No. Do I feel competent to handle an uncomplicated dementia assessment? Yes, particularly when the question is related to functional assessment and not an A vs B diagnostic clarification. A patient with a history of a brain injury, previous CVA, and a family history of Alz is definitely getting a referral.

 

[R. Matey]

I think we need to get away from this binary of expert/non-expert and into the realm of "adequately able to ethically treat" the condition in front of you. This becomes more clear over time. Fast forward 10 years to where I am. You have continued to treat thousands of patients with depression via CT and have not completed a CPT case since training. What is your comfort level with each now? Do you feel adequately able to do something you have not in 10 years? Are you more or less competent now than 10 years prior? Expertise is not a static thing, but an ongoing evaluation of your skills and those around you. A trauma fellow is likely more competent in PTSD treatment than I. On the flip side, you won't encounter many people more familiar with late life depression than yours truly. Are my cog assessment skills up to par with those that exclusively practice neuropsych? No. Do I feel competent to handle an uncomplicated dementia assessment? Yes, particularly when the question is related to functional assessment and not an A vs B diagnostic clarification. A patient with a history of a brain injury, previous CVA, and a family history of Alz is definitely getting a referral.

That's a helpful perspective, very much appreciated.

 

[AcronymAllergy]

I think we need to get away from this binary of expert/non-expert and into the realm of "adequately able to ethically treat" the condition in front of you. This becomes more clear over time. Fast forward 10 years to where I am. You have continued to treat thousands of patients with depression via CT and have not completed a CPT case since training. What is your comfort level with each now? Do you feel adequately able to do something you have not in 10 years? Are you more or less competent now than 10 years prior? Expertise is not a static thing, but an ongoing evaluation of your skills and those around you. A trauma fellow is likely more competent in PTSD treatment than I. On the flip side, you won't encounter many people more familiar with late life depression than yours truly. Are my cog assessment skills up to par with those that exclusively practice neuropsych? No. Do I feel competent to handle an uncomplicated dementia assessment? Yes, particularly when the question is related to functional assessment and not an A vs B diagnostic clarification. A patient with a history of a brain injury, previous CVA, and a family history of Alz is definitely getting a referral.

I see these cases as well and definitely don't mind, but particularly if the ultimate need is just to figure out whether or not the person has dementia or can take care of themselves (regardless of etiology), there are plenty of folks other than me who could help figure that out.

Just please don't then say their recently-identified dementia is due to the uncomplicated concussion they may or may not have had 40 years ago. And pretty please don't imply or directly state that to the patient. (This obviously isn't directed at you personally).

As for your first and more substantial point--I agree, expertise is most definitely fluid over one's career, and the minimum bar should be more akin to what you've mentioned, "adequately able to ethically treat." And your past experiences likely affect your ability to attain or re-attain this competence. So I could probably get to the point of adequately completing a Wada evaluation more easily than someone who'd never had that type of training before, for example, but there's no way I'd try to fly solo on one tomorrow.

The limitation of access is also a sticky issue. Would I want someone with PTSD to ideally see an expert in that area? Yes. But if no experts are available to them, would I prefer they see a psychologist who's had training in PE/CPT years ago vs. a less-well-trained individual who's never seen a trauma patient or relies solely on "supportive therapy?" Yep.

 

[Sanman]

I see these cases as well and definitely don't mind, but particularly if the ultimate need is just to figure out whether or not the person has dementia or can take care of themselves (regardless of etiology), there are plenty of folks other than me who could help figure that out.

Just please don't then say their recently-identified dementia is due to the uncomplicated concussion they may or may not have had 40 years ago. And pretty please don't imply or directly state that to the patient. (This obviously isn't directed at you personally).

As for your first and more substantial point--I agree, expertise is most definitely fluid over one's career, and the minimum bar should be more akin to what you've mentioned, "adequately able to ethically treat." And your past experiences likely affect your ability to attain or re-attain this competence. So I could probably get to the point of adequately completing a Wada evaluation more easily than someone who'd never had that type of training before, for example, but there's no way I'd try to fly solo on one tomorrow.

The limitation of access is also a sticky issue. Would I want someone with PTSD to ideally see an expert in that area? Yes. But if no experts are available to them, would I prefer they see a psychologist who's had training in PE/CPT years ago vs. a less-well-trained individual who's never seen a trauma patient or relies solely on "supportive therapy?" Yep.

Nah, I just tell them it was due to them stubbing their toe last week. Seems equally likely.

 

[futureapppsy2]

Interesting discussion... the question of what qualifies as "expertise" is something I've been mulling over recently, as I'm newly eligible for fellow in my main professional org (5 years post-PhD) and mulling over/seeking mentor input on whether I'm enough of an expert in the field to apply.

 

[WisNeuro]

Interesting discussion... the question of what qualifies as "expertise" is something I've been mulling over recently, as I'm newly eligible for fellow in my main professional org (5 years post-PhD) and mulling over/seeking mentor input on whether I'm enough of an expert in the field to apply.

This is all definitely contextual. For example, having gone through a formal APPCN neuropsych fellowship, being ABPPd in clinical neuropsychology, and having worked and published in the field of neuropsychology, I would have no problem claiming expertise in the field of neuropsychology. I would maintain that I could claim this clinically as well as in an IME forensic context. But, there may be specializations within the field (e.g., MS, Parkinson's, etc) of which I have a good deal of knowledge on and can assess, but I may not go as far as to say I am an expert on. Somewhat relatedly, I have a background in trauma/PTSD, in both clinical work and publishing, but that's an area I generally stay away from and defer those legal cases to others, who work more exclusively in the area.

 

[futureapppsy2]

This is all definitely contextual. For example, having gone through a formal APPCN neuropsych fellowship, being ABPPd in clinical neuropsychology, and having worked and published in the field of neuropsychology, I would have no problem claiming expertise in the field of neuropsychology. I would maintain that I could claim this clinically as well as in an IME forensic context. But, there may be specializations within the field (e.g., MS, Parkinson's, etc) of which I have a good deal of knowledge on and can assess, but I may not go as far as to say I am an expert on. Somewhat relatedly, I have a background in trauma/PTSD, in both clinical work and publishing, but that's an area I generally stay away from and defer those legal cases to others, who work more exclusively in the area.

Yeah, it's definitely a contextual situation... wrt to fellow designation, it feels tricky, because I think I'm well-known in the field for making unique and significant contributions to some areas, but it also feels a bit uncouth to apply for essentially the specialty's highest designation while still technically an ECP.

 

[WisNeuro]

Yeah, it's definitely a contextual situation... wrt to fellow designation, it feels tricky, because I think I'm well-known in the field for making unique and significant contributions to some areas, but it also feels a bit uncouth to apply for essentially the specialty's highest designation while still technically an ECP.

I imagine the fellow academicians can comment more accurately, but I'd think that if the ECPs production and contributions are actually at a level that matches most mid to later career folks, it'd be ok. Also, is there any downside to spplying for it and being turned down? Like, could you do this now, and if turned down, wait X amount of years and reapply with whatever additional contributions you've made in that interval?

 

[AcronymAllergy]

I imagine the fellow academicians can comment more accurately, but I'd think that if the ECPs production and contributions are actually at a level that matches most mid to later career folks, it'd be ok. Also, is there any downside to spplying for it and being turned down? Like, could you do this now, and if turned down, wait X amount of years and reapply with whatever additional contributions you've made in that interval?

Agreed. And isn't ECP sometimes considered into the 10-year post-degree range? There's a LOT that can be done and accomplished in ten (and, as you've evidenced futureapppsy2, five) years.

I also think expertise has a relative component. To add to WisNeuro's point, do I think I'm an "expert" on movement disorders compared to the general public or most (non-neuro) psychologists? Yeah, probably. Do I think I'm one compared to a neuropsychologist or neurologist working in a movement disorders clinic? Nope.

 

[WisNeuro]

Somewhat related to the original topic of the thread, providers in my area are now asking for referrals for EMDR for long-covid sufferers. What in the actual **** is going on in our field?

 

[Sanman]

Somewhat related to the original topic of the thread, providers in my area are now asking for referrals for EMDR for long-covid sufferers. What in the actual **** is going on in our field?

I recognize all those words, but huh?

 

[thebalmofhurtminds]

Somewhat related to the original topic of the thread, providers in my area are now asking for referrals for EMDR for long-covid sufferers. What in the actual **** is going on in our field?

 

[AcronymAllergy]

Somewhat related to the original topic of the thread, providers in my area are now asking for referrals for EMDR for long-covid sufferers. What in the actual **** is going on in our field?

I suspect the requests for referrals to hyperbaric oxygen for long-covid (ala PTSD in the past) will be coming shortly.

 

[R. Matey]

Somewhat related to the original topic of the thread, providers in my area are now asking for referrals for EMDR for long-covid sufferers. What in the actual **** is going on in our field?

And relating it to another active thread: while PCSAS tries to build their gated community with the hopes that everyone will listen to "the real psychologists," people flock towards pseudoscientific treatments. Seems like psychology's efforts could be better spent elsewhere.

 

[Sanman]

And relating it to another active thread: while PCSAS tries to build their gated community with the hopes that everyone will listen to "the real psychologists," people flock towards pseudoscientific treatments. Seems like psychology's efforts could be better spent elsewhere.

Honestly, no one cares what "real psychologists" have to say if they can't be paid for it. If supportive therapy, EMDR, rainbow and sunshine therapy are all reimbursed the same or better as real interventions, that is what people will do. I used to make less money on CBT than basic supportive therapy due to money lost prepping for sessions.

 

[AbnormalPsych]

I've come to the realization that in my area, it is just customer service at this point. People are looking for either:

1) a very specific thing (e.g., EMDR for X, Y, or Z), "somatic therapy for trauma") or
2) an outcome (e.g., legalized stimulants / benzos; ESA letter; fix my spouse or kid).

I really value to patients I see come in and are open to doing the work

 

[R. Matey]

Honestly, no one cares what "real psychologists" have to say if they can't be paid for it. If supportive therapy, EMDR, rainbow and sunshine therapy are all reimbursed the same or better as real interventions, that is what people will do. I used to make less money on CBT than basic supportive therapy due to money lost prepping for sessions.

Yeah, I hear ya. It's pretty automated for CT/IPT for me, but anxiety/panic requires a lot of prep time and it's frustrating that we can't bill for it. The issue that I run into more than that, in anxiety anyways, is compliance. MI ad infinitum and people would still rather take a benzo or decide they have trauma that needs to be dealt with first and want a referral for EMDR.

 

[Sanman]

Yeah, I hear ya. It's pretty automated for CT/IPT for me, but anxiety/panic requires a lot of prep time and it's frustrating that we can't bill for it. The issue that I run into more than that, in anxiety anyways, is compliance. MI ad infinitum and people would still rather take a benzo or decide they have trauma that needs to be dealt with first and want a referral for EMDR.

If we have learned anything from COVID, it is that the U.S. population has a low tolerance for discomfort. That is something which is required for the psychotherapeutic treatment of anxiety.

 

[cara susanna]

More advertisements sent to my house.

PESI offering Hypnosis for Trauma & PTSD with buzzwords like mind/body and neuroscience.

A different one to become a certified clinical trauma professional, whatever that means.

I guess I'm not a certified clinical trauma professional even though I completed a 2 year fellowship in a trauma specialty clinic.

While we're dunking on hypnosis, is anyone aware of any high quality studies on PTSD and hypnosis? Everything that I can find seems to suggest it works, but the studies don't seem very rigorous.

 

[AbnormalPsych]

[FREE WORKSHEETS] Hollywood’s guide to disordered personalities​

How often does this happen to you?

You’re watching a movie and a character is such a clear example of Narcissistic behavior that you make a mental note to use this clip as a reference in future sessions.

Or a character in a TV show gets diagnosed as Borderline for the sake of the plot, when they actually fit almost ZERO of the criteria.

Whatever the personality disorder, Hollywood is full of examples.

Although some portrayals are less than accurate (I’m looking at you, Girl, Interrupted!), it can be helpful to have a “character case study” as a benchmark when working with challenging clients.

That’s why I’ve compiled a robust list of personality disorders represented by characters from famous movies and TV shows.

This list illustrates the differences between “normal” personality and Disordered Personality. Once you understand the personality disorders affecting these characters, you’ll never see them the same way again!

 

[cara susanna]

Actually, what's really been bothering me lately is when characters clearly have personality disorders but aren't diagnosed in the show. For instance, there's a character in You're the Worst who's almost textbook BPD, but the show only ever acknowledges her as having depression. Ditto Bojack Horseman.

It's almost like depression isn't "interesting" enough so they make the character display personality disorder symptoms.

 

[Sanman]

Actually, what's really been bothering me lately is when characters clearly have personality disorders but aren't diagnosed in the show. For instance, there's a character in You're the Worst who's almost textbook BPD, but the show only ever acknowledges her as having depression. Ditto Bojack Horseman.

It's almost like depression isn't "interesting" enough so they make the character display personality disorder symptoms.

Depression is not that interesting unless they want to shoot someone not getting out of bed, being unkempt, crying, etc.

Relatedly, Can the DSM-6 please include "willingness to be cast in a reality tv show or become an Instagram celebrity" as diagnostic criteria for all Cluster B personality disorders?

 

[Dazen]

Not a CE, but I just got a 30 minute lecture on resistance stretching and the 16 genetic personality types while waiting for a flight (Resistance Stretching by Bob Cooley - The Genius of Flexibility). Was genuinely entertained by the complete and utter confidence he displayed in these unproven methods, his own intelligence, and his inevitability of winning golf masters within the next two years.

 

[foreverbull]

@Dazen I see that confidence a lot with people who think they have the secret to life and success. There are so many people who think this way in our field and also many outside of it who think they’re experts IN our field because therapy is advice-giving, you know?!

Different question: has anyone doing CE’s noticed how little of the lecture is devoted to clinical utility tips/practical information for actually working with clients?

In the presentations I’ve attended virtually AND in person, about 10 minutes at the very ended is reserved for practice, whereas the entire rest of it is theory, research background, sometimes assessment of the issue, and a very long introduction with technical issues discussed. I attended many lectures with topics that I was excited to learn more about but ended up getting no practical info I could use with clients. Hence why I’ve become very disappointed in CEs overall. I almost never walk away with practical info, and the one day-long in-person training I attended where I had practical info to use, it didn’t end up working well with my clients. Speakers are far more jazzed about some of their own methods and confident in them being successful with the general therapy population than is actually probably warranted at times. One speaker said he got a lot of success out of just educating his clients about the brain and how anxiety works in the brain (he said it was life-changing for many of them). Most clients with chronic anxiety hear the psychoeducation piece about the brain and say “uh huh. Got it.” I’ve never once had a client who went through psychoeducation about anxiety and thought it was groundbreaking or life changing, although of course I agree with sharing knowledge and empowering clients in that way, and it is one piece of the overall puzzle of treatment.

 

[MiniLop]

Different question: has anyone doing CE’s noticed how little of the lecture is devoted to clinical utility tips/practical information for actually working with clients?

This is pretty much always my experience too and it drives me batty.

I’ve never once had a client who went through psychoeducation about anxiety and thought it was groundbreaking or life changing, although of course I agree with sharing knowledge and empowering clients in that way, and it is one piece of the overall puzzle of treatment.

Once in a while, I'll get a panic disorder case (with no comorbidities) where psychoed alone on the cycle of panic and avoidance leads to an improvement in functioning, but that's probably the only time it's an effective intervention on its own.

 

[clausewitz2]

Once in a while, I'll get a panic disorder case (with no comorbidities) where psychoed alone on the cycle of panic and avoidance leads to an improvement in functioning, but that's probably the only time it's an effective intervention on its own.

I had one patient with insomnia who had had a lot of distress about his sleep for years and years who came to see me. I did a careful sleep history and had him do a sleep diary and figured out he slept about 7 hours per night but spent 9-10 hours in bed trying to sleep. He scored 2 on ESS, hadn't napped as an adult and could not remember a time he fell asleep without meaning to or a time he had missed anything important or really suffered any consequence as a result of not waking up in a timely fashion.

After we established all that was true, I asked him "So in what sense has your trouble with sleep caused problems for you?" He paused and didn't say anything for long enough to make me worry his connection had dropped and then said "I never thought about it like that." We talked about normal variation in human sleep need and sleep drive. He never complained about any sleep problem again.

If he wasn't so earnest most of the time I would never have been able to shake the sense he was trolling me.

 

[Ollie123]

Primary insomnia is probably the only area where I see massive gains from psychoed.

"Actually, sleeping 6-7 hours a night is normal for some people. If you aren't tired, I wouldn't worry about it"

"I know you think that night cap helps you sleep, but for most people it makes things worse."

"I promise you the TV is not helping you sleep and you can go to sleep without it."

These statements alone could get me to like....maybe a 10% cure rate?

 

[cara susanna]

Primary insomnia is probably the only area where I see massive gains from psychoed.

"Actually, sleeping 6-7 hours a night is normal for some people. If you aren't tired, I wouldn't worry about it"

"I know you think that night cap helps you sleep, but for most people it makes things worse."

"I promise you the TV is not helping you sleep and you can go to sleep without it."

These statements alone could get me to like....maybe a 10% cure rate?

Adam Ruins Everything did an episode on sleep where he presented a LOT of the research and information on common misconceptions about sleep, including alcohol. I wish that we could show it to everyone, like, in the entire country.

Fun fact: I actually had a patient show up in PCMHI who told me that they had seen that episode and then changed some of their sleep habits as a result.

 

[AbnormalPsych]

Adam Ruins Everything did an episode on sleep where he presented a LOT of the research and information on common misconceptions about sleep, including alcohol. I wish that we could show it to everyone, like, in the entire country.

Fun fact: I actually had a patient show up in PCMHI who told me that they had seen that episode and then changed some of their sleep habits as a result.

I like that show. Didn't he do on on the Meyers Briggs?

 

[WisNeuro]

I like that show. Didn't he do on on the Meyers Briggs?

I think so, while I generally like it, he suffers from the Gladwell problem in that he doesn't really understand the science behind things and misses a lot, or flagrantly ignores large bodies of research that don't fit the show's narrative. He did an IQ piece at one point that raised some good criticisms, but never explored the very well supported answers to those criticisms or other dis-confirming sets of research.

 

[cara susanna]

I think so, while I generally like it, he suffers from the Gladwell problem in that he doesn't really understand the science behind things and misses a lot, or flagrantly ignores large bodies of research that don't fit the show's narrative. He did an IQ piece at one point that raised some good criticisms, but never explored the very well supported answers to those criticisms or other dis-confirming sets of research.

Yeah, his IQ episode disappointed me.

 

[DynamicDidactic]

He did an IQ piece at one point that raised some good criticisms, but never explored the very well supported answers to those criticisms or other dis-confirming sets of research.

This is the case with almost every podcast I have tried listening to on the subject. A big misconception seems too be that the IQ mostly represents ones ability to take standardized tests. They also mention all the harmful ways IQ testing has been used. While a fair point, it really does not mean that the concept, and the testing, are invalid or unreliable. It really seems like no one in the popular media actually cares about the psychometrics and science behind intelligence (including many psychologists). But this may be a thread jack, sorry.