PhD/PsyD Psychiatrist "not providing therapy" on livestream

[WisNeuro]

How does a lawyer not see these videos and just salivate at the potential settlements?

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[R. Matey]

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.

Here's a fun quote ~29 minutes in:

Dr. K: "So a lot of people think of BPD is uncurable, but there's some fascinating data that if you can in a stable relationship for two years and have someone not abandon you, then there's a fifty percent chance your BPD will like actually go away....I'm confident there's going to be someone around in your life who will be there for you most of the time hopefully for at least a period of two years....How I can be confident in that?...I'm counting on myself...I'm going to try to love you for two years at a minimum."

Reckful: *cries* "I really appreciate that."

 

[Sanman]

Here's a fun quote ~29 minutes in:

Dr. K: "So a lot of people think of BPD is uncurable, but there's some fascinating data that if you can in a stable relationship for two years and have someone not abandon you, then there's a fifty percent chance your BPD will like actually go away....I'm confident there's going to be someone around in your life who will be there for you most of the time hopefully for at least a period of two years....How I can be confident in that?...I'm counting on myself...I'm going to try to love you for two years at a minimum."

Reckful: *cries* "I really appreciate that."

Cool, this is "not" therapy, so poor boundaries and questionable science are okay. He tries to walk it back later, but never should have been said.

 

[psych.meout]

I'm hate-reading the comments because I'm a masochist:

I am a therapist in the field of addiction. It’s important to note, that in this profession, sometimes…you just lose one. It doesn’t make it your fault. It doesn’t mean you didn’t do a good enough job. If anything, you ideally gave them a safe space to contemplate their life and happenings in their final days that they would not have had otherwise. Sometimes you lose a client. Especially in my field. You do your best, but sometimes it’s just not up to you. We don’t blame doctors when their patients die. Don’t blame therapists when their clients commit suicide or overdose. I’m sure this man is having a hard enough time losing this man without you blaming him and not even having the courage to admit that it’s what you are doing.

I will be real pissed if Dr. K watches this video and starts to hold himself accountable, or holding himself back because of fear Really big mad. Opening up is always "risky", and trying to help someone like Byron is even riskyes because of blame... even if you have a 2 minute intro where you give some praise too

Something can be therapeutic and not be “therapy.” What Dr. K is providing in these talks is coaching. There are plenty of organizations that provide life coaching, akin to what Dr. K does, but with none of the credentials and mental health knowledge that he brings. If you notice, he often recommends that people talk to a therapist to further explore personal trauma after the topic comes up. While they do touch on the subject, this is not the main topic of conversation, and if it becomes such than it is referred out. Let’s not cancel something that provides support to people that live their lives on broadcast, and at the same time de-stigmatizes seeking support for mental health issues. Also, implying that Dr.K’s conversation resulted in Reckful completing suicide, indirectly or otherwise, is disgusting. This entire video is brutal down to the creepy music choice, clips taken out of full context, and glaring misconceptions from someone that is uneducated in mental health issues.

There might have been some bad timing with you reaching out because theres a chance that it was while he was on vacation.

If I remember correctly, Dr.K said once that what he does is not therapy, but only human conversations that should be considered normal, and how ****ed up the world is to think what he does is therapy.

my personal opinion is that byron's OVERALL mental health has much improved as a result of drK's interventions. sadly that day he jumped he was in a fragile state and made an impulse decision. it didnt have to do with getting better or getting worse. spur of the moment kind of thing.

hi, i'm watching this, and i think it is exceptionally possible for something to be simultaneously "dangerous" and "worth doing". Dr. K is the first of his kind. It will go bad. He is not the first mental health professional to have someone die on him, and he will not be the last. But he is filling a vital role: addressing a lot of people who do not have (or, given his audience of gamers, choose not to attend) therapy. People will learn from his mistakes, and do better next time.

As a therapist.. i underwent a huge existential crisis while getting my first grad degree (i have 3 psych related degrees).. i attempted death while in a dissociative state and had an NDE for 20 secs. Broke half my body, forced into treatment. Was officially diagnosed and began a new life with Borderline Personality with all its crap stigma on top of the actual symptoms i had with no meds available. I became so afraid to finish my degree bc i kept imagining this horrific scenario, that youre essentially triggering in me again. What if one of MY patients i tried so hard to help with my heart and knowledge, died. I was convinced the blame would make my self hatred eat me alive.

But thats wrong. I began helping others with BPD through Insta DMs on the side.. nothing hardcore bc thats unethical, but more like an experienced big sister. Btw this all began over 12 years ago.. so i had my clients, and like a handul of young girls who couldnt either afford a therapist, or couldnt find one they could connect with. I understand your points and ethically, i agree, but morally.... no i dont. Bc one of the IG girls, after 6 months told me i had saved her life.. all i had done was share my own experience and coping skills to reach self awareness.

Now i look at Dr K. A harvard psychiatrist. Like, thats not “pseudo therapy” you keep annoyingly say. Hes qualified. Id also argue this.. with Covid, how do you think im able to talk to my real clients? Zoom calls, face time. Hes looking at them and able to digest as much as i can through E devices. Hes most likely better bc hes ton more qualified than me. My point is.. ive seen his work, does he make me cringe at certain phrases id have said differently? Sure. But hes not a company assigned guy. He understands internet culture and influencers. Something i can tell you NONE of my past, current coworkers understand at all like me.

Hes a net positive. And i really hope he never had that crisis i had of nearly quitting my vocation i know i was meant for just bc one of his well documented “clients” fulfilled that fear. Bc i had to take a while to grasp and learn (WITH SIMULATENOUS BPD) that no, you cant save everyone.. but the number of those you CAN is grossly underreported. When do people in my occupation ever get press for having to essentially share the pain of our clients consistently.. saving some very directly from death? Never. And thats a very unfair weight to place on the mh work and stress we deal with already.

i do want to say that i think the way Dr. K handled Reckful in regards to his suicidal ideation has a lot to do with Dr. K's personal experience with suicidal patients, including those who have killed themselves. he's mentioned that people who are suicidal are perfectly logical, and that while it can be seen as a mental health issue, it's also something anyone can go through. the point that i took away from the conversation (and that resonated with me heavy actually) was that people who are determined to commit suicide or have some kind of plan or desire to go through with it are typically not swayed by conventional approaches to dealing with mental illness. suicidal ideation is a severe crisis, and the person in question is very often perfectly logical in their desire to die.

i should say that he didn't say that in the terms i used, and maybe i just totally misinterpreted his point, but i think ultimately he believes that people who are suicidal can only be swayed by reforming the way they think, and in such a crisis radical intervention is necessary beyond what most therapists are trained to offer. i think when it comes to reckful in particular he saw a lot of his former patient, but he was positively reinforced to continue down the radical interventionist path (which involves some, let's say... nonstandard psychiatric advice) because reckful insisted that he was helping and talked often about how useful he found it. plus i think Dr. K just genuinely cared about reckful and liked talking to him. i think this gets to the essence of the ethical violations in this case. maybe the best solution has to do with suicidal people or people with a history of suicidal ideation or tendencies: terminate the interview as soon as possible and do your best to urge the person to get help.

what sucks is that this approach, at least in my experience, never helps. suicidal people AREN'T swayed by being told to get help, that's all they're ever told. it's also very rare that they're ever so excited to speak to someone, and to kill that momentum by telling them you can't talk to them can be more harmful than helpful, so i'm not sure there is a truly good solution to the problem

 

[R. Matey]

Cool, this is "not" therapy, so poor boundaries and questionable science are okay. He tries to walk it back later, but never should have been said.

I'm not exactly Otto Kernberg but I do wonder how walking back a promise of love to a borderllne patient does for their fear of abandonment.

 

[WisNeuro]

I'm not exactly Otto Kernberg but I do wonder how walking back a promise of love to a borderllne patient does for their fear of abandonment.

I wonder what Dr. K's liability insurance would say?

 

[R. Matey]

I wonder what Dr. K's liability insurance would say?

Considering he has little arrows that point to him saying 'therapist' or 'psychiatrist' on his YouTube video icons, I'd hope they'd ask for another zero or two

 

[WisNeuro]

Considering he has little arrows that point to him saying 'therapist' or 'psychiatrist' on his YouTube video icons, I'd hope they'd ask for another zero or two

I'm more wondering if he is technically breaking terms of his insurance contract and they can throw him under the bus when/if he gets sued.

 

[R. Matey]

I'm more wondering if he is technically breaking terms of his insurance contract and they can throw him under the bus when/if he gets sued.

I suppose it depends on how bulletproof his argument about 'not doing therapy' is.

 

[WisNeuro]

I suppose it depends on how bulletproof his argument about 'not doing therapy' is.

Based on what I see, not at all bulletproof.

 

[Sanman]

I wonder what Dr. K's liability insurance would say?

"We're dropping your liability coverage effective immediately"

 

[psych.meout]

"We're dropping your liability coverage effective immediately"

"Wait, wait, wait I actually was doing therapy wink wink, so you have to cover my malpractice and wrongful death lawsuits."

 

[WisNeuro]

"Wait, wait, wait I actually was doing therapy wink wink, so you have to cover my malpractice and wrongful death lawsuits."

Some of these policies have gross incompetence clauses that indemnify the carrier in some cases. So, depending on the contract, he can be thrown under the bus either way. And, Dr. K has been conveniently recording all instances of his potential malfeasance along the way.

 

[cara susanna]

Here's a fun quote ~29 minutes in:

Dr. K: "So a lot of people think of BPD is uncurable, but there's some fascinating data that if you can in a stable relationship for two years and have someone not abandon you, then there's a fifty percent chance your BPD will like actually go away....I'm confident there's going to be someone around in your life who will be there for you most of the time hopefully for at least a period of two years....How I can be confident in that?...I'm counting on myself...I'm going to try to love you for two years at a minimum."

Reckful: *cries* "I really appreciate that."

(screaming internally)

A lot of my BPD patients are married or in stable, long-term relationships. I guess they're just in that unlucky other 50%?

 

[PsyDr]

For me, the take away point from all this:

This is an unmet need, and people want it.

 

[cara susanna]

How does a lawyer not see these videos and just salivate at the potential settlements?

Curious what you and others (PsyDr especially!) think about this comment. Would this actually be a solid legal argument?

Let's approach this like a lawyer. Dr. K: 1) Gets agreement that what he is doing is 'not therapy' 2) Gets permission to stream what he is calling 'mental health coaching' I will grant that Dr. K is medically trained, and did/does/may have patients. But all of the Dr. K accusations in his dealings with Reckful seen as 'mistakes', are assuming that what he is doing 'is therapy'. If it is 'not therapy', those things positive or negative do not have the same connotation as if they were. Things that are 'not therapy', cannot be graded on the same assumptions as if it is. If he clarifies, and Reckful by the act of taking the stream agrees to the terms that it 'isn't therapy', even if in his head it is, then from all legal purposes there was an agreement it wasn't by both parties involved. By agreeing to do the stream, any person seeking such coaching is willfully giving up their anomality, so they do so knowingly. Generally, Dr. K explains what he does in these streams, as something between mental health coaching, religion, and medical advise. As far as I know, he does all of this without charging anyone anything. Thus, there is no 'payment' for 'services', (an important legal distinction). Once you start stepping into the religion pathway of conversations, you are choosing a 'belief' over science. In the US, there is a freedom of religion, so basically no legal system will really touch it here, as long as consent was received. (I am unsure of the exact process Dr. K has, but most streams I have watched he does touch about it being 'not therapy'.)

 

[WisNeuro]

Curious what you and others (PsyDr especially!) think about this comment. Would this actually be a solid legal argument?

Whether or not he says he is or is not doing therapy is somewhat irrelevant here. Additionally, doing this pro bono does not indemnify him from potential damages either. You still need liability insurance for pro bono work. But, as to the first point, if I can find other MH providers who say that he is using therapy techniques that are indistinguishable from therapy, there is a potential case.

 

[psych.meout]

For me, the take away point from all this:

This is an unmet need, and people want it.

But what proportion of people who "want this" actually want therapy for gaming addiction, are career streamers who want a therapist who understand where they are coming from (as opposed to older or less tech savvy therapists who aren't familiar with current trends), etc. vs people who just want to be voyeurs and watch live streaming therapy sessions, especially if they involve their favorite streamers?

I.e., what proportion are people who want to be patients like this vs. those who just want to be the next gen of Dr. Phil viewers?

I'd posit that the former is tiny compared to the latter and the YouTube comments seem to bear this out.

 

[cara susanna]

Isn't it also sketchy that he gives his credentials, so it's like he's having his cake and eating it too?

Like, if it's just a conversation and not therapy, why invoke your expertise?

 

[cara susanna]

I'm watching the video and omg they mentioned us. R. Matey, you're famous!

 

[PsyDr]

@psych.meout

Good points, which demonstrate my ignorance about the platform.

@cara susanna

The "I'm not touching you" thing didn't work in grade school. It wouldn't work here. The legal standard is if a reasonable person would agree with the premise. I doubt an entire jury would agree that a reasonable person would think this was "not therapy".

It doesn't really matter, because malpractice requires a treating relationship, some negligence in what is being done, some injury caused by the negligent care, and identifiable damages. It would be easy to say that this is a treating relationship, and that having subscribers deviates from the standard of care. However, it would be difficult to say that this caused an injury that is quantifiable.

What would matter, is practicing in a location where you are not licensed.

Where in the video do they mention R. Matey?

 

[WisNeuro]

Good points, which demonstrate my ignorance about the platform.

GD Twitch streaming kids need to stay off our lawns!

 

[cara susanna]

As I'm getting deeper into that 45 min video (can someone just write an essay in the future?), I'm struck by the gross neglience of how Dr. K handled suicidality. The patient was making overt suicidal statements that he did not further assess (if he is doing therapy) or encourage connecting to resources or actual mental health treatment (if he is not doing therapy). He also was framing suicide in a philosophical way, like even talking about the right to suicide. As those of you this board know, I have a lot conflict about how our field handles suicide and is expected to always prevent it. However, I would never, ever voice these personal thoughts in a clinical session with a patient who expressing SI.

Clinically it's also not a great way to manage suicide via psychotherapy--I wonder how much psychotherapy training Dr. K had outside of residency.

The YouTube comments seem pretty defensive and ignoring the fact that he interviewed several professionals (also, our board is not just students! A lot of us are licensed psychologists!) They also confuse the ideas of responsibiltiy and blame. I wonder if it would help if a professional weighed in on the specific therapy techniques they have observed in Dr. K's videos, like cognitive restructuring.

I also agree that the danger of this pseudo-therapy is the person thinking it's treatment. Then deciding, hey, I'm doing treatment and I'm not doing better. It's like the danger of doing an EBP where the patient isn't engaging, they are going to come away thinking this doesn't work and feel even more hopeless.

Edit: I just got to a clip where he literally diagnoses him.

 

[R. Matey]

I'm watching the video and omg they mentioned us. R. Matey, you're famous!

@PsyDr like ~12-13 minutes in. A comment I posted splashes across the screen. I'm using my cut to buy shares in Wis's brewery

 

[R. Matey]

Clinically it's also not a great way to manage suicide via psychotherapy--I wonder how much psychotherapy training Dr. K had outside of residency

I wondered the same, also if he started waxing philosophically there because the clinical instinct is to do a suicide assessment when someone makes comments like that and he's in the corner because he's "not doing therapy."

 

[Sanman]

@psych.meout

Good points, which demonstrate my ignorance about the platform.

@cara susanna

The "I'm not touching you" thing didn't work in grade school. It wouldn't work here. The legal standard is if a reasonable person would agree with the premise. I doubt an entire jury would agree that a reasonable person would think this was "not therapy".

It doesn't really matter, because malpractice requires a treating relationship, some negligence in what is being done, some injury caused by the negligent care, and identifiable damages. It would be easy to say that this is a treating relationship, and that having subscribers deviates from the standard of care. However, it would be difficult to say that this caused an injury that is quantifiable.

What would matter, is practicing in a location where you are not licensed.

Where in the video do they mention R. Matey?

Video from post #100 at the 15 minute mark screenshots this thread.

 

[haRtwin]

New video on the Harvard psychiatrist who is "not providing therapy" via Twitch. This video highlights clips, quotes the AMA ethics code, and provides expert opinion.



Apparently the video creator placed a formal complaint at the Massachusetts State Ethics Commission and was told to send a "jpg" of the psychiatrists streamed "interviews."



The psychiatrist responded to the new video with his own on ethics.


Edit for formatting

 

[R. Matey]

https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Ethics/APA-Recent-Ethics-Opinions.pdf

B.6 is probably the most germane to our discussion and seems to be most in line with his thinking on the issue. Still, I think experts in psychotherapy here and elsewhere have agreed that he crossed a line in the service he provided Reckful was strikingly similar to psychotherapy given the symptom presentation and his responses. Regardless of what he may say (by his own admission), the opinion of the committee makes clear he bears responsibility for his own actions.

 

[psych.meout]

New video on the Harvard psychiatrist who is "not providing therapy" via Twitch. This video highlights clips, quotes the AMA ethics code, and provides expert opinion.



Apparently the video creator placed a formal complaint at the Massachusetts State Ethics Commission and was told to send a "jpg" of the psychiatrists streamed "interviews."



The psychiatrist responded to the new video with his own on ethics.


Edit for formatting

The second video is honestly pretty disconcerting. No wonder licensing boards don't really go after providers for much besides sleeping with patients and open fraud.

 

[AbnormalPsych]

His thoughts on ethics were interesting to hear. I actually think it is a good video for the public to understand what therapy is more than what they are getting from betterhelp or cerebral ads and Tik Tok.

It is interesting that he has a producer do an informed consent off camera with people before they stream, I wonder if anything is in writing.

I also found it hilarious that he admitted on video that he consulted with peers and lawyers about doing this and everyone said not to do it. LOL.

At the end of the day, although his arguments about his choices and views on ethics seem sound at times I think he misses what everything looks like from the outside (gamer/public) perspective, especially if someone is suffering and vulnerable. He is in a way targeting those people too.

 

[R. Matey]

The second video is honestly pretty disconcerting. No wonder licensing boards don't really go after providers for much besides sleeping with patients and open fraud.

That's state government for you. When I was getting licensed in State A, I had to demonstrate that my LPC license in State B was in good standing. State A's board would not accept a website link to the online credentialing system even though that State B's board said the website was their primary method of verifying credentials. Instead, I had to pay State B for the privilege of mailing them State A's form to complete and then mailing to State A.

 

[WisNeuro]

That's state government for you. When I was getting licensed in State A, I had to demonstrate that my LPC license in State B was in good standing. State A's board would not accept a website link to the online credentialing system even though that State B's board said the website was their primary method of verifying credentials. Instead, I had to pay State B for the privilege of mailing them State A's form to complete and then mailing to State A.

For some states, it depends if that online credentialing system lists the original date of license conferral. If it doesn't, you would also need a mailed direct confirmation for something like CPQ/IPC/PSYPACT credentialing.

 

[R. Matey]

For some states, it depends if that online credentialing system lists the original date of license conferral. If it doesn't, you would also need a mailed direct confirmation for something like CPQ/IPC/PSYPACT credentialing.

In my case it did as well as lapses, disciplinary actions etc... There was literally nothing on the form that the board's website did not also list. Ironically, the boards of both States A and B now direct people to their website for license verifications.

 

[WisNeuro]

In my case it did as well as lapses, disciplinary actions etc... There was literally nothing on the form that the board's website did not also list. Ironically, the boards of both States A and B now direct people to their website for license verifications.

Yeah, that sucks, then. If they can get the info straight from the source. Though that's not as much state government as much as it is the board itself. Board has to abide by the statutes of state government, but then they have their own P&P. Mine is particularly onerous. Another state I license in isn't rigorous, but grossly understaffed and borderline incompetent.

 

[R. Matey]

Yeah, that sucks, then. If they can get the info straight from the source. Though that's not as much state government as much as it is the board itself. Board has to abide by the statutes of state government, but then they have their own P&P. Mine is particularly onerous. Another state I license in isn't rigorous, but grossly understaffed and borderline incompetent.

Yeah, the other half of this story is that State B's board lost the form so I called State A and, after some haggling, they agreed to accept an email from a board official from State B. What did that board official email? A .pdf copy of the print out from their online licensing credential system.

Your point is well-taken though and thought about editing my earlier post. The state statues here haven't changed, but the board here just recently overhauled their entire system so people don't have to mail in things anymore.

 

[smalltownpsych]

Just skimmed through everything. I would testify that in my opinion he was providing psychotherapy and had established a treatment relationship. The only way to dodge liability for that in my opinion would be if someone else was providing that treatment. That way when the client is suicidal, they have someone to treat that. If that someone is you, then you are treating them. This guy should probably be sued for not providing standard of care. To me the best way these video treatment types could protect themselves and be able to argue that they are not providing the treatment is by making sure that the person does have an existing and adequate care team in place that is.

 

[neurotic_cow]

I can also dig up some consultation references if people are interested! Do a lot of programs not require this course? Mine did, and I found it very helpful.

Our program had a class focused on a combo of both supervision and consultation, which I definitely found to be helpful.

 

[cara susanna]

I'm glad that someone lodged a complaint, but wouldn't it be easier to go to the licensing board? Or is the ethics commission the same thing?

Edit: Also, man, I wish people would write articles instead of making videos about this stuff. The video's over an hour? Ain't nobody got time for that.

Editing to add comments as I watch. I'm skipping forward and listening to parts as I do some administrative work.
- Oh man, as a trauma person the clip with the pink-haired girl (Yvonne?) makes me VERY uncomfortable.
- He also mentions her "goals" which... ding ding ding.
- That one streamer literally called him her therapist. Oof.
- I think the board was being ridiculous and clearly not up to date on technology, but I also get why they didn't want to watch hours upon hours of videos. Happy medium maybe?
- Dr. K's response is making me quite angry. I don't think he's understanding (or purposefully ignoring?) the point or issue at hand. You can't assume that the public knows everything that you do, the fact that people referred to you as their "therapist" shows that you have failed to make the distinction to them.

 

[smalltownpsych]

I'm glad that someone lodged a complaint, but wouldn't it be easier to go to the licensing board? Or is the ethics commission the same thing?

Edit: Also, man, I wish people would write articles instead of making videos about this stuff. The video's over an hour? Ain't nobody got time for that.

Editing to add comments as I watch. I'm skipping forward and listening to parts as I do some administrative work.
- Oh man, as a trauma person the clip with the pink-haired girl (Yvonne?) makes me VERY uncomfortable.
- He also mentions her "goals" which... ding ding ding.
- That one streamer literally called him her therapist. Oof.
- I think the board was being ridiculous and clearly not up to date on technology, but I also get why they didn't want to watch hours upon hours of videos. Happy medium maybe?
- Dr. K's response is making me quite angry. I don't think he's understanding (or purposefully ignoring?) the point or issue at hand. You can't assume that the public knows everything that you do, the fact that people referred to you as their "therapist" shows that you have failed to make the distinction to them.

Watching video too. First thing that I noticed was, "tell me what you said last time I can't remember I was drunk." I use a lot of humor myself, but it didn't seem warranted or appropriate. Then my next thought was this guy is not a good therapist anyway, he doesn't even listen to the client. Client: "I thought I had gotten over it, then it came back."
Dr. K "so you thought you were improving and then it got worse again?"
Client reiterates: "No, I thought I had gotten over it."
We all miss stuff, but this just seemed like he wasn't really paying attention at all or maybe he is just drunk again? Maybe really really crappy therapy is an excuse that he wasn't doing therapy.

 

[cara susanna]

Watching video too. First thing that I noticed was, "tell me what you said last time I can't remember I was drunk." I use a lot of humor myself, but it didn't seem warranted or appropriate. Then my next thought was this guy is not a good therapist anyway, he doesn't even listen to the client. Client: "I thought I had gotten over it, then it came back."
Dr. K "so you thought you were improving and then it got worse again?"
Client reiterates: "No, I thought I had gotten over it."
We all miss stuff, but this just seemed like he wasn't really paying attention at all or maybe he is just drunk again? Maybe really really crappy therapy is an excuse that he wasn't doing therapy.

Honestly, to me he seemed to be acting more like how people imagine a therapist to act than how an actual therapist acts. Granted, we may also have very different styles and theoretical orientations.

 

[smalltownpsych]

Honestly, to me he seemed to be acting more like how people imagine a therapist to act than how an actual therapist acts. Granted, we may also have very different styles and theoretical orientations.

I wonder if it would be better to discuss the distinctions between effective therapy as opposed to amateur therapeutic interventions. As I watch Dr. K trying to do therapy with someone with what he called Borderline PD, I see a clinician way over their head and not having a solid framework for how to treat this. Media often portrays the development of rapport and opening up emotional material and developing insight as what is curative. Therapy can look like this for relatively high functioning individuals, but for the more fragile, opening them up and having a few insights will make them worse. At that point, the clinician, teacher, friend, etc. tends to blame the patient and refer/abandon them. Many of my patients have experienced this dynamic time and time again.
If Dr. K had known about this dynamic and doubled up his "therapy" when the client was "getting better", might have been a different outcome. Interestingly enough, it seems that Dr. K's intuition was telling him that when he talked about being there for the guy for at least two years, but the format he was in and lack of clear clinical framework caused him to back away from it. I personally don't put a time limit on it, but I do broach what life will be like after our relationship changes. A client like this who had a brother die when he was a child I would leave the door open to some form of contact for perpetuity. I have probably ten clients who I have done that for and they shoot me an email or card every couple of years or so to let me know how they are doing.

 

[smalltownpsych]

For me, the take away point from all this:

This is an unmet need, and people want it.

When I hear how much compensation can be obtained through streaming, it makes me wonder about how to go about meeting that need.

 

[cara susanna]

I wonder if it would be better to discuss the distinctions between effective therapy as opposed to amateur therapeutic interventions. As I watch Dr. K trying to do therapy with someone with what he called Borderline PD, I see a clinician way over their head and not having a solid framework for how to treat this. Media often portrays the development of rapport and opening up emotional material and developing insight as what is curative. Therapy can look like this for relatively high functioning individuals, but for the more fragile, opening them up and having a few insights will make them worse. At that point, the clinician, teacher, friend, etc. tends to blame the patient and refer/abandon them. Many of my patients have experienced this dynamic time and time again.
If Dr. K had known about this dynamic and doubled up his "therapy" when the client was "getting better", might have been a different outcome. Interestingly enough, it seems that Dr. K's intuition was telling him that when he talked about being there for the guy for at least two years, but the format he was in and lack of clear clinical framework caused him to back away from it. I personally don't put a time limit on it, but I do broach what life will be like after our relationship changes. A client like this who had a brother die when he was a child I would leave the door open to some form of contact for perpetuity. I have probably ten clients who I have done that for and they shoot me an email or card every couple of years or so to let me know how they are doing.

Absolutely - for BPD, you need to approach therapy differently.

 

[psych.meout]

Watching video too. First thing that I noticed was, "tell me what you said last time I can't remember I was drunk." I use a lot of humor myself, but it didn't seem warranted or appropriate. Then my next thought was this guy is not a good therapist anyway, he doesn't even listen to the client. Client: "I thought I had gotten over it, then it came back."
Dr. K "so you thought you were improving and then it got worse again?"
Client reiterates: "No, I thought I had gotten over it."
We all miss stuff, but this just seemed like he wasn't really paying attention at all or maybe he is just drunk again? Maybe really really crappy therapy is an excuse that he wasn't doing therapy.

The "drunk" thing seems like a really amateurish and transparently false way of getting around not remembering stuff from the previous session. He just seems bad at therapy and conversation in general (wouldn't you be pissed off at a friend who didn't remember details from when you poured out your heart to them?) and lacks specific skills and training that would avoid a lot of these issues.

When I hear how much compensation can be obtained through streaming, it makes me wonder about how to go about meeting that need.

Exactly, and whose needs are being met here with the way Dr. K is going about this, the other person or his own (e.g., clout, streaming income, etc)?

There are plenty of therapists who specialize in niche populations (e.g., athletes, corporate executives) but what they do falls more into a more traditional therapy context and isn't really monetizable or a way to get the kind of clout Dr. K is chasing.

 

[cara susanna]

I just reread this entire thread and realized that every single comment of mine is complaining about how I don't want to watch these long videos and would prefer a written article. Sorry to be so repetitive, guys!

Also, this feels like it'd be a good article for, say, Kotaku or something.

 

[erg923]

The "drunk" thing seems like a really amateurish and transparently false way of getting around not remembering stuff from the previous session. He just seems bad at therapy and conversation in general (wouldn't you be pissed off at a friend who didn't remember details from when you poured out your heart to them?) and lacks specific skills and training that would avoid a lot of these issues.


Exactly, and whose needs are being met here with the way Dr. K is going about this, the other person or his own (e.g., clout, streaming income, etc)?

There are plenty of therapists who specialize in niche populations (e.g., athletes, corporate executives) but what they do falls more into a more traditional therapy context and isn't really monetizable or a way to get the kind of clout Dr. K is chasing.

Yea. So...you don't tell someone that you may have some a meaningful relationship with that you were intoxicated at last conversation and
"dont remember"...unless you were telling the truth or telling them....something? This is frat bro stuff. What is even the function of this comment?

Yes, this person should be reported to boards. But also, I think this probably happens multiple times per day on "YouTube" that we don't see and isn't "trending."

 

[haRtwin]

I just reread this entire thread and realized that every single comment of mine is complaining about how I don't want to watch these long videos and would prefer a written article. Sorry to be so repetitive, guys!

Also, this feels like it'd be a good article for, say, Kotaku or something.

Kotaku has covered Dr K before (Psychiatrist Brings Streamer To Tears During Confessional Stream). Most stories covering what goes on in these "not therapy interviews" frames the stream as Dr K doing a "net good" that draws awareness about mental health.

 

[psych.meout]

Yea. So...you don't tell someone that you may have some a meaningful relationship with that you were intoxicated at last conversation and
"dont remember"...unless you were telling the truth or telling them....something? This is frat bro stuff. What is even the function of this?

Yes, this person should be reported to boards. But also, I think this probably happens multiple times per day on "YouTube" that we don't see and isn't "trending."

No, I'm saying that if someone close to you didn't recall those very personal, meaningful things you told them while they were sober you'd be pissed at them.

I'm saying that this stuff about him being "drunk" is transparent BS because he's bad at therapy. He's lying about it because he realizes that it's a bigger fracture to admit that he forgot what happened, didn't take notes, didn't review the previous video session beforehand, etc. than to blame it on being "drunk."

It's the equivalent of lying to someone you don't want to talk to that you have bad cell reception and the call is cutting out before you hang up on them. It's transparent that you don't want to talk to them, but you don't want a direct confrontation of just ending the call and there's enough plausible deniability if the parties involved want to believe it's true.

 

[haRtwin]

The "drunk" thing seems like a really amateurish and transparently false way of getting around not remembering stuff from the previous session. He just seems bad at therapy and conversation in general (wouldn't you be pissed off at a friend who didn't remember details from when you poured out your heart to them?) and lacks specific skills and training that would avoid a lot of these issues.


Exactly, and whose needs are being met here with the way Dr. K is going about this, the other person or his own (e.g., clout, streaming income, etc)?

There are plenty of therapists who specialize in niche populations (e.g., athletes, corporate executives) but what they do falls more into a more traditional therapy context and isn't really monetizable or a way to get the kind of clout Dr. K is chasing.

I have followed this guy's videos from the inception and my impression has been that he's a psychiatrist playing what he thinks a psychologist does. I think he believes that psychologists or people practicing therapy are charismatic and drop knowledge on patients.

Dr K claims that he is meeting a need for mental health education among the gamer community. For example, he said from the outset that he would do things like release a mental health guide for free (that guide now costs money on his website).

What I find the most disturbing is that any criticism of him within the community is met with major backlash from his audience. They support this guy through anything. I can only imagine how that puts more fuel on the fire for him to keep going. It's kind of like a cult...

 

[erg923]

I have followed this guy's videos from the inception and my impression has been that he's a psychiatrist playing what he thinks a psychologist does. I think he believes that psychologists or people practicing therapy are charismatic and drop knowledge on patients.

Dr K claims that he is meeting a need for mental health education among the gamer community. For example, he said from the outset that he would do things like release a mental health guide for free (that guide now costs money on his website).

What I find the most disturbing is that any criticism of him within the community is met with major backlash from his audience. They support this guy through anything. I can only imagine how that puts more fuel on the fire for him to keep going. It's kind of like a cult...

Self Selection Bias. But, yes.

"Meeting a need for mental health education among the gamer community" is obvious self-serving nonsense. What is the "need" exactly? That people who (likely have robust coverages such as State Medicaid or select insurances) won't help themselves unless you poke and prod them? How paternalist is that??? Kinda thought that's what we are going ageist here in recent years?