PhD/PsyD Psychiatrist "not providing therapy" on livestream

[beginner2011]

Not disagreeing with you at all. My impression is that the psychiatrist did not believe he was working with a patient, and perhaps the streamer did believe he was receiving some form of care from the psychiatrist.

I'm just curious if our field has clear guidelines about what criteria need to be met for someone to become a patient. Everyone knows about the elements of "attorney-client privilege" from the media, but it's unclear to me what the standards are for psychotherapy. If others know more please share.

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[R. Matey]

Not disagreeing with you at all. My impression is that the psychiatrist did not believe he was working with a patient, and perhaps the streamer did believe he was receiving some form of care from the psychiatrist.

I'm just curious if our field has clear guidelines about what criteria need to be met for someone to become a patient. Everyone knows about the elements of "attorney-client privilege" from the media, but it's unclear to me what the standards are for psychotherapy. If others know more please share.

My impression is that the psychiatrist had a clear idea what he was doing, got in too deep at the expense of a human’s life, and is now back peddling hard. He was advised by his colleagues that this was a bad idea and didn’t heed that advice. From my perspective, this constitutes a failure to meet a community standard which is 100% considered malpractice. The fact that reddit loves this guy shows how easy it is to gather a cult following on the internet.

Take a look at the article I linked in advances in psychological science. It kinda provides a bit of framework to your question.

 

[psych.meout]

Not disagreeing with you at all. My impression is that the psychiatrist did not believe he was working with a patient, and perhaps the streamer did believe he was receiving some form of care from the psychiatrist.

I'm just curious if our field has clear guidelines about what criteria need to be met for someone to become a patient. Everyone knows about the elements of "attorney-client privilege" from the media, but it's unclear to me what the standards are for psychotherapy. If others know more please share.

He literally says "all my colleagues told me not to do this" immediately before this patient talks about his SI history and the doc tells him to contact him if he has SI or is unsafe again.

It's stupidity, willful ignorance, or craven self-promotion.

 

[beginner2011]

My impression is that the psychiatrist had a clear idea what he was doing, got in too deep at the expense of a human’s life, and is now back peddling hard. He was advised by his colleagues that this was a bad idea and didn’t heed that advice. From my perspective, this constitutes a failure to meet a community standard which is 100% considered malpractice. The fact that reddit loves this guy shows how easy it is to gather a cult following on the internet.

Take a look at the article I linked in advances in psychological science. It kinda provides a bit of framework to your question.

Useful article:

Several features are often highlighted in trying to distinguish coaching from psychotherapy ... it is intended for a psychopathology-free clientele who are not seeking help for mental illness or psychoeducation.

By that definition it's very clear that what was happening here was not coaching.

The argument that life coaches work with healthy individuals to increase their capacity and that therapists treat mentally ill individuals carries a serious assumption— that nonclinician life coaches can diagnose mental illness and rule it out or refer elsewhere before deciding to initiate coaching. Given that the majority of coaches have not received formal mental health training and are not trained or licensed to identify mental illness, it is conceivable that serious psychiatric conditions may be missed. Rather than a theoretical concern, research suggests that 25% to 50% of recipients of life coaching appear to meet criteria for significant mental health issues (Green, Oades, & Grant, 2006; Spence, Cavanagh, & Grant, 2008).

I'd be curious to hear what the psychiatrist's rationale is/has been for his decision to provide therapy live on stream to vulnerable individuals with mental illness who are seeking mental health services. Someone without a license could possibly claim they just didn't realize the person they were working with had a mental illness. The psychiatrist, however, clearly couldn't make this claim.

What on earth was he thinking? Yikes.

 

[futureapppsy2]

Can we also talk about how incredibly exploitative this is of the psychiatrist, first exploiting Reckful's mental illness for views and then exploiting his death by suicide for views?

Also, I wonder if Reckful did Discord the psychiatrist before he attempted suicide--as the psychiatrist specifically told him to--as that would open up even more liability.

 

[psych.meout]

I'd be curious to hear what the psychiatrist's rationale is/has been for his decision to provide therapy live on stream to vulnerable individuals with mental illness who are seeking mental health services.

$$$$$$$

 

[haRtwin]

From what I can gather from his Twitter, the psychiatrist is now living in Austin, TX (seems like he intends for that location to become his permanent residence). His license is in Massachusetts.

 

[cara susanna]

From what I can gather from his Twitter, the psychiatrist is now living in Austin, TX (seems like he intends for that location to become his permanent residence). His license is in Massachusetts.

Oh, really? His website says he still works at McLean.

 

[haRtwin]

Oh, really? His website says he still works at McLean.

I wonder why he hasn't changed the location. It's confirmed that he's now living in Texas.

 

[BuckeyeLove]

A) That’s definitely therapy.
B) Don’t tell someone to IM you on Discord if they’re suicidal. Tell them to seek medical or professional mental health help, including going to the hospital if they’re imminently suicidal.
C) His ex-GF mentioned on Twitter (TwitLonger — When you talk too much for Twitter )that he previously had a really really bad experience with the police being called for suicidality. IMO, getting the police involved in suicide intervention was a terrible move as a society that’s done a lot more harm than good.
D) Do that many people really watch 2 hours of someone else’s therapy? I guess I can’t talk because I watched a 90 minute literary analysis of Sonic Adventure 2 that was so thorough and well-presented that I’d have little problem counting it as a dissertation but....

I LOVE Sonic Adventure 2! That soundtrack is still solid AF!

 

[psych.meout]

I LOVE Sonic Adventure 2! That soundtrack is still solid AF!

 

[futureapppsy2]

I LOVE Sonic Adventure 2! That soundtrack is still solid AF!

Live and Learn is forever a jam.

 

[futureapppsy2]

I admire speedrunners because they literally memorize the coding of the game.

 

[futureapppsy2]

I LOVE Sonic Adventure 2! That soundtrack is still solid AF!

Also, City Escape is one of the best opening levels out there, imo:

 

[Dazen]

What an awesome video. I've always enjoyed watching speedruns of games after I play them to understand what mastery looks like compared to my beginner attempts. It's cool that they emphasize the community, as it does seem to be really collaborative.

 

[futureapppsy2]

From what I can gather from his Twitter, the psychiatrist is now living in Austin, TX (seems like he intends for that location to become his permanent residence). His license is in Massachusetts.

That’s interesting, as it places him and Reckful in the same city!

 

[R. Matey]

Look who showed up for a sympathetic piece on NPR today.

 

[cara susanna]

Is there a transcript so I don't have to spend 5 min of my life (and especially my precious lunch break) listening to this? Lol

 

[R. Matey]

I wasn't able to find one

 

[WisNeuro]

I found it pretty fair. They explicitly discuss the "hazy" ethical area that this exists in. Particularly for a quick piece. A better format would be a longer piece with multiple interviews, but that would have to be a non Morning Edition piece

 

[R. Matey]

"Hazy" seemed like a generous term when it's apparent to me, at least, that he is delivering therapeutic interventions while purportedly "not doing therapy" (e.g.: diagnosis, mindfulness interventions).

Agree that the format wasn't the best for interacting with the issue.

 

[beginner2011]

"Hazy" seemed like a generous term when it's apparent to me, at least, that he is delivering therapeutic interventions while purportedly "not doing therapy" (e.g.: diagnosis, mindfulness interventions).

Agree that the format wasn't the best for interacting with the issue.

The piece includes a quote from the interaction where Dr. K says, after Reckful tells him he's been diagnosed with depression and bipolar, "You may have clinical depression, but I think what you're describing here is not clinical depression." Then, the reporter states that Dr. K told him, "I chose my words very carefully, in order to not contradict [Reckful]'s diagnosis."

It appears that is Dr. K's defense or justification for why he wasn't engaging in professional practice, at least from this piece. I totally agree with your assessment, @R. Matey. As far as the APA Code of Ethics, this seems to me like an area that is less grey and more just straight up not appropriate professional behavior. I'm very curious to hear from anyone who thinks there might be a better explanation or defense here.

 

[WisNeuro]

The piece includes a quote from the interaction where Dr. K says, after Reckful tells him he's been diagnosed with depression and bipolar, "You may have clinical depression, but I think what you're describing here is not clinical depression." Then, the reporter states that Dr. K told him, "I chose my words very carefully, in order to not contradict [Reckful]'s diagnosis."

It appears that is Dr. K's defense or justification for why he wasn't engaging in professional practice, at least from this piece. I totally agree with your assessment, @R. Matey. As far as the APA Code of Ethics, this seems to me like an area that is less grey and more just straight up not appropriate professional behavior. I'm very curious to hear from anyone who thinks there might be a better explanation or defense here.

Point of reference. Dr. Konojia is not subject to the ethics code of the Psychology APA.

 

[beginner2011]

Point of reference. Dr. Konojia is not subject to the ethics code of the Psychology APA.

Yep! Trying to practice good professional ethics here by focusing on my own profession.

 

[WisNeuro]

Yep! Trying to practice good professional ethics here by focusing on my own profession.

Fair, just wanted to make sure that people were citing relevant statutes. If we wanted a more analogous example, we could go with Dr. Phil.

 

[R. Matey]

Point of reference. Dr. Konojia is not subject to the ethics code of the Psychology APA.

And posts from his peers above suggest that it's possible that he committed an ethics violation according to their code.

 

[WisNeuro]

And posts from his peers above suggest that it's possible that he committed an ethics violation according to their code.

Possible yes, though I only saw one that had actually listened/watch a segment, but I didn't see any references to actual codes, nor a discussion on what is permissible in the context of public media figures delivering what they call education vs therapy. Not saying I agree with it, but that legally and ethically, I don't think it's as cut and dry as some have made it out to be.

 

[beginner2011]

Possible yes, though I only saw one that had actually listened/watch a segment, but I didn't see any references to actual codes, nor a discussion on what is permissible in the context of public media figures delivering what they call education vs therapy. Not saying I agree with it, but that legally and ethically, I don't think it's as cut and dry as some have made it out to be.

Out of curiosity, do you think it would be ethical for a psychologist to behave in the way Dr. K has?

 

[WisNeuro]

Out of curiosity, do you think it would be ethical for a psychologist to behave in the way Dr. K has?

Personally, no, but I'd say my bar is set at a different level than our own APA ethics on many issues. As an aside, I do think that the APA will need to look long and hard at it's code in the new world of social media and different walls of privacy with younger generations.

 

[R. Matey]

Possible yes, though I only saw one that had actually listened/watch a segment, but I didn't see any references to actual codes, nor a discussion on what is permissible in the context of public media figures delivering what they call education vs therapy. Not saying I agree with it, but that legally and ethically, I don't think it's as cut and dry as some have made it out to be.

This is like the first one:

1.1: A psychiatrist shall not gratify his or her own needs by exploiting the patient. The psychiatrist shall be ever vigilant about the impact that his or her conduct has upon the boundaries of the doctor–patient relationship, and thus upon the well-being of the patient. These requirements become particularly important because of the essentially private, highly personal, and sometimes intensely emotional nature of the relationship established with the psychiatrist.

idk really, but I would think there's a solid case to be made that this person is exploiting his so called non-patients for his own gain. Saying something isn't what it actually is, is fallacious. He is failing to protect their privacy and using his credentials to present himself as an expert to make a professional judgement that he claims he's not making. To me that's fishy.

I know the comeback is: "Well, these aren't my patients." But if they're aren't, what is the nature of the relationship?

Out of curiosity, do you think it would be ethical for a psychologist to behave in the way Dr. K has?

I wonder if this standard applies:

5.04: "When psychologists provide public advice or comment via print, Internet, or other electronic transmission, they take precautions to ensure that statements (1) are based on their professional knowledge, training, or experience in accord with appropriate psychological literature and practice; (2) are otherwise consistent with this Ethics Code; and (3) do not indicate that a professional relationship has been established with the recipient."


Admittedly though, I'm a huge fan of Fraiser, so F*** me.

 

[WisNeuro]

This is like the first one:

1.1: A psychiatrist shall not gratify his or her own needs by exploiting the patient. The psychiatrist shall be ever vigilant about the impact that his or her conduct has upon the boundaries of the doctor–patient relationship, and thus upon the well-being of the patient. These requirements become particularly important because of the essentially private, highly personal, and sometimes intensely emotional nature of the relationship established with the psychiatrist.

idk really, but I would think there's a solid case to be made that this person is exploiting his so called non-patients for his own gain. Saying something isn't what it actually is, is fallacious. He is failing to protect their privacy and using his credentials to present himself as an expert to make a professional judgement that he claims he's not making. To me that's fishy.

I know the comeback is: "Well, these aren't my patients." But if they're aren't, what is the nature of the relationship?

I would imagine he and his lawyer would claim that this is not a doctor-pateint relationship as outlined in the informed consent that they had signed, and that the psychiatrist is commenting more broadly on an issue vs. a certain level of specificity of individual patient characteristics.

Again, not my personal position, just have enough knowledge of board actions and the legal system to know more about the actual process.

 

[R. Matey]

I would imagine he and his lawyer would claim that this is not a doctor-pateint relationship as outlined in the informed consent that they had signed, and that the psychiatrist is commenting more broadly on an issue vs. a certain level of specificity of individual patient characteristics.

Again, not my personal position, just have enough knowledge of board actions and the legal system to know more about the actual process.

How is "I don't think you have depression" commenting broadly on an issue? And I know it's not, I'm just more academically curious at this point.

Edit: Are informed consent forms really that bulletproof legally? Like if I was running encounter groups in my basement, it's totally fine because I have obtained informed consent?

 

[WisNeuro]

How is "I don't think you have depression" commenting broadly on an issue? And I know it's not, I'm just more academically curious at this point.

If you talk more broadly about the symptoms and requirements for a diagnosis of depression in that context, you can talk about what it would take to get a diagnosis of depression. All word play. May not mean anything practically in a clinical sense, but it's the world in a legal sense.

 

[R. Matey]

If you talk more broadly about the symptoms and requirements for a diagnosis of depression in that context, you can talk about what it would take to get a diagnosis of depression. All word play. May not mean anything practically in a clinical sense, but it's the world in a legal sense.

I guess then where do community standards fall into play here? Because if a group of experts reviewed his sessions and said: "this appears to be psychotherapy" that carries no weight because he has decided it isn't?

 

[WisNeuro]

I guess then where do community standards fall into play here? Because if a group of experts reviewed his sessions and said: "this appears to be psychotherapy" that carries no weight because he has decided it isn't?

Well, a group of experts can review it, in some cases this may be a board, but he may be able to appeal in the legal arena. Those experts can testify as to what they think, but in the end it can come down to a legal decision in many cases. I would assume he's consulted an attorney at some point, if he hadn't, that's on him.

 

[R. Matey]

 

[cara susanna]

I'd really love input from any of the psychiatrists who read our subforum.

I dunno, yes he could argue he's commenting more broadly on issues but if you watch the video that is not in line with what he's actually doing. It's very much targeted towards a specific individual and that person's specific issues.

 

[WisNeuro]

I'd really love input from any of the psychiatrists who read our subforum.

I dunno, yes he could argue he's commenting more broadly on issues but if you watch the video that is not in line with what he's actually doing. It's very much targeted towards a specific individual and that person's specific issues.

I definitely agree, personally, but I do believe there is more to it in a legal sense. Heck, look at what Dr. Phil used to do before he stopped renewing his license.

Also, Albert Ellis used to do public sessions for educational purposes using real people and real examples. I personally saw several of them. They were definitely therapy.

 

[psych.meout]

Well, a group of experts can review it, in some cases this may be a board, but he may be able to appeal in the legal arena. Those experts can testify as to what they think, but in the end it can come down to a legal decision in many cases. I would assume he's consulted an attorney at some point, if he hadn't, that's on him.

As I mentioned in an earlier comment a while back, he explicitly said during that session that several of his peers told him to not do this. If he was given this advice prospectively that would seem to be a very different situation than if it was only after the fact when reviewed by the board or by an expert hired by opposing counsel. I.e., He can't really say he didn't realize what he was doing was wrong or that he was really doing therapy and having a doctor-patient relationship when he thought it was only coaching.

Moreover, I think that the inconsistent phrasing he uses in his own marketing materials is also going to make things difficult for him. Yes, he does describe it as "coaching" at times, but he's also discussing treating "video game addiction" and describes what he and the coaches are doing as "counseling," "addiction interventions," etc. The boards and courts aren't (that) dumb when it comes to these linguistic gymnastics, especially when it's apparent that a lay audience would see this as therapy.

As you and others have said here, looking at the sessions, he's not really speaking generally. It's pretty apparent even to a layperson that it's really just an individual therapy session. I'm not sure if this is intentional (i.e., that it's all just actual therapy and he's trying to weasel out of professional responsibility with linguistic gymnastics) or if he intends on it being general discussion and he doesn't realize or can't help himself but to turn it into individual therapy.

 

[WisNeuro]

As I mentioned in an earlier comment a while back, he explicitly said during that session that several of his peers told him to not do this. If he was given this advice prospectively that would seem to be a very different situation than if it was only after the fact when reviewed by the board or by an expert hired by opposing counsel. I.e., He can't really say he didn't realize what he was doing was wrong or that he was really doing therapy and having a doctor-patient relationship when he thought it was only coaching.

Moreover, I think that the inconsistent phrasing he uses in his own marketing materials is also going to make things difficult for him. Yes, he does describe it as "coaching" at times, but he's also discussing treating "video game addiction" and describes what he and the coaches are doing as "counseling," "addiction interventions," etc. The boards and courts aren't (that) dumb when it comes to these linguistic gymnastics, especially when it's apparent that a lay audience would see this as therapy.

As you and others have said here, looking at the sessions, he's not really speaking generally. It's pretty apparent even to a layperson that it's really just an individual therapy session. I'm not sure if this is intentional (i.e., that it's all just actual therapy and he's trying to weasel out of professional responsibility with linguistic gymnastics) or if he intends on it being general discussion and he doesn't realize or can't help himself but to turn it into individual therapy.

Once again, I personally think what he is doing is wrong. Also, you vastly underestimate the stupidity and lack of empiricism contained within boards, and especially the legal system.

 

[R. Matey]

Yes, he does describe it as "coaching" at times, but he's also discussing treating "video game addiction" and describes what he and the coaches are doing as "counseling," "addiction interventions," etc.

Plus, counseling is now mostly a protected term. One usually needs a license in order to provide counseling.

 

[PsyDr]

I guess then where do community standards fall into play here? Because if a group of experts reviewed his sessions and said: "this appears to be psychotherapy" that carries no weight because he has decided it isn't?

It doesn't.

A. The general prerequisites for a med mal action are:

1) The existence of a treating dr-pt relationship (i.e., can't sue someone who isn't treating you, aka "standing").
2) The treatment provider had a duty of care for the specific circumstances (e.g., would be hard to sue a psychologist for a respiratory condition, because that is grossly outside the expected scope of practice).
AFTERWARDS
3) the treating provider did not act in a reasonable manner (i.e., negligent). Often this is defined by a departure from the community standard of care. HOWEVER, the legal exemption to such a departure is the "reasonable minority". Basically, if you can find ONE person in your profession to say that your actions were reasonable, even in the face of a community standard of care, you're good.
4) that the actions in #3 resulted in an injury/damages.


B. The way to defend this is:

1) to say that there was no dr-pt relationship (e.g., we were not doing psychotherapy). Then the prerequisites are not met.
2) To say that this was life coaching , which has no professional standards or licensure. Or it was entertainment. Or it was educational. Then there are no standards.
3) To find a fellow online psych to back you up. Then you're a part of a reasonable minority in your profession.
4) To claim that any events are unrelated to you.

 

[R. Matey]

1) The existence of a treating dr-pt relationship (i.e., can't sue someone who isn't treating you, aka "standing").

I'm not a lawyer, but I would think this is the legal question at hand because there is a relationship between the service receiver and the service provider based on the provider's expertise.

 

[WisNeuro]

I'm not a lawyer, but I would think this is the legal question at hand because there is a relationship between the service receiver and the service provider based on the provider's expertise.

Not so cut and dry in the legal sense as to what exactly constitutes the clear establishment of a treating Dr/patient relationship. Providers deliver services very similar to clinical services all the time without establishing such a relationship. For example, it's the basis of IMEs. Also, the "education" loophole is fairly forgiving in the context being discussed.

 

[psych.meout]

Not so cut and dry in the legal sense as to what exactly constitutes the clear establishment of a treating Dr/patient relationship. Providers deliver services very similar to clinical services all the time without establishing such a relationship. For example, it's the basis of IMEs. Also, the "education" loophole is fairly forgiving in the context being discussed.

That's a very good point, though in Reckful's case, he seemed like he was fairly clearly establishing a doctor-patient relationship, especially when he told Reckful to contact him if he starts having SI again. I mean, would you tell the audience or another participant in an educational presentation to contact you if they have SI? What about in an IME situation?

 

[WisNeuro]

That's a very good point, though in Reckful's case, he seemed like he was fairly clearly establishing a doctor-patient relationship, especially when he told Reckful to contact him if he starts having SI again. I mean, would you tell the audience or another participant in an educational presentation to contact you if they have SI? What about in an IME situation?

I don't even tell my clinical evals to call me if they are having SI. What I would do is irrrelevant in this specific case. As for the hypothetical, I wouldn't even venture near that line. As I stated before, I believe this practitioner has crossed that line, but this a much more gray matter when it actually comes to board actions or legal issues.

 

[R. Matey]

I don't even tell my clinical evals to call me if they are having SI. What I would do is irrrelevant in this specific case. As for the hypothetical, I wouldn't even venture near that line. As I stated before, I believe this practitioner has crossed that line, but this a much more gray matter when it actually comes to board actions or legal issues.

I know you're playing devil's advocate, but I think @psych.meout has a good point: This person conflates their clinical role with auspicious educational or coaching role in a haphazard fashion at times claiming clinical responsibility and at other times, not.

 

[WisNeuro]

I know you're playing devil's advocate, but I think @psych.meout has a good point: This person conflates their clinical role with auspicious educational or coaching role in a haphazard fashion at times claiming clinical responsibility and at other times, not.

I'm not really playing devil's advocate. I don't condone what he is doing. I'm just bringing up the reality of how board and legal actions actually exist. What we think is wrong, and what the legal system thinks is wrong are not perfectly overlapping circles.

 

[beginner2011]

There's something oddly tragic about a psychiatrist rising to internet fame by streaming individual psychotherapy sessions with popular streamers who often seem to be distressed primarily by the pressure and demands associated with streaming all day and constantly being watched.

 

[haRtwin]

Recent video that questioned the ethics of Dr. K's practice that even mentions this thread. Lots of information that discussed in this thread is highlighted around 11 minutes.