PhD/PsyD Psychiatrist "not providing therapy" on YouTube

haRtwin

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What do people think of this Harvard trained addiction psychiatrist? HealthyGamerGG

This psychiatrist began posting YouTube videos several months on mental health with persons from the Internet gaming community. One of his videos () features a conversation with a Twitch streamer about depression. There's news today that this streamer killed himself. The streamers most recent Tweets are pretty disturbing (https://twitter.com/Byron).

The YouTube channel seems to have been created against the advice of his colleagues in medicine and legal experts.
 
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beginner2011

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Yikes. On first pass it looks like this psychiatrist is taking the role of a professional psychotherapist and broadcasting sessions with popular internet personalities live via youtube/twitch. I'm not sure what sort of informed consent he's providing to the other parties, but that seems wildly unprofessional. I recognize the value of de-stigmatizing mental health services, but this seems like an approach that ignores the risk of harm to vulnerable patients and discounts the dignity and right to confidentiality of these folks (e.g., 'Reckful').

Edit: Poking around a bit more, it looks like psychiatrist had multiple "non-psychotherapeutic" sessions with this same non-pt. After one, the non-pt reports "after our last meeting ... I remember waking up and feeling sad and thinking to myself, 'Awww...I'm not fixed.'" That sounds a LOT like the non-pt believed these non-sessions to have had psychotherapeutic elements. Psychiatrist also considered meeting with this non-pt weekly. Unclear whether that happened.

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haRtwin

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Yes, I am very concerned about this channel. It seems like such negligent practice. At 1:10:48 of the video, the doctor talks to the streamer specifically about suicide and although he claims not to provide therapy he asks the streamer to contact him through a chat if he ever has thoughts of suicide. Seems like he should have referred at that point if he was really not providing therapy...
 
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Yes, I am very concerned about this channel. It seems like such negligent practice. At 1:10:48 of the video, the doctor talks to the streamer specifically about suicide and although he claims not to provide therapy he asks the streamer to contact him through a chat if he ever has thoughts of suicide. Seems like he should have referred at that point if he was really not providing therapy...

He has a private practice that purports to be specializing in gamers, whatever that means. Seems to look a lot like supportive therapy and therapeutic questioning for someone who's not doing "therapy." It's also clear to me that he's marketing his expertise to drive views. I think this is a person who hasn't thought very critically about the lines of demarcation between teaching, consultation, and therapeutic intervention. I'm suddenly grateful for my consultation class in graduate school.
 
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haRtwin

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Now that the streamer apparently has completed suicide, is there any possibility of legal action?

Edit: Watching it, this is DEFINITELY therapy.

My question is can this guy be reported to the medical board? Clearly his non patients and the viewers believe they are receiving treatment despite his claim that he is not providing treatment.
 
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futureapppsy2

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This was the main text for the class. It was pretty good. I can also copy the articles from the syllabus if people are interested.

Amazon product
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.
 
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futureapppsy2

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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....
 
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Wow. Reading his website is... I have no words. Admittedly I’m not up on the literature of video game addiction (is there much out there?) and I haven’t picked up a video game remote in 5+ years, but some of the info on his treatment program is questionable at best.
 
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He may have broken their ethics code. Maybe Section 7.3??? I don’t know how actionable this is though.

Here’s the link: https://www.psychiatry.org/File Library/Psychiatrists/Practice/Ethics/principles-medical-ethics.pdf

Hey, psychiatrists reading this thread. Care to comment?

Uh, what do you want us to say? I'm not going to watch a 2h youtube video but based on what I'm gleaning from this thread, yes, this is a grotesque violation of professional ethics that pretty obviously was not going to end well. Not sure what other insights you were hoping for.
 
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Uh, what do you want us to say? I'm not going to watch a 2h youtube video but based on what I'm gleaning from this thread, yes, this is a grotesque violation of professional ethics that pretty obviously was not going to end well. Not sure what other insights you were hoping for.

1. How do you folks interpret 7.3 of your ethics code and is this a violation of that standard?

2. Are violations of your psychiatry codes actionable offenses legally (e.g. can someone lose their physician’s license for violating a psychiatry code)?

3. I take it you agree with us that Heathy Gamer is providing therapy?

I don’t know how you guys interpret your ethics code. I feel like that was clear from my earlier post.
 
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futureapppsy2

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Looks like he is framing a lot of this as "gamer coaching." Interesting attempt to circumvent ethics and law, and approach to publish video evidence of his 'coaching' for everyone to judge.

I’ve seen other trained mental health professionals try to use “it’s coaching, not therapy!” to get around licensing laws, and it seems like a very, very hazy, flimsy distinction at best, especially when the “coach” has legitimate therapy training. Can anyone speak to that?

One PhD psychologist example:
 

R. Matey

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I’ve seen other trained mental health professionals try to use “it’s coaching, not therapy!” to get around licensing laws, and it seems like a very, very hazy, flimsy distinction at best, especially when the “coach” has legitimate therapy training. Can anyone speak to that?

One PhD psychologist example:

Took me a minute to find it, but there was just an article out about this that was shared over a listserv that I'm on. It's not that helpful for this specific situation, but it seems that people think of this as a thing.

Aboujaoude E. (2020). Where Life Coaching Ends and Therapy Begins: Toward a Less Confusing Treatment Landscape. Perspectives on psychological science : a journal of the Association for Psychological Science, 15(4), 973–977. SAGE Journals: Your gateway to world-class research journals

This is an ethical grey-area for sure. If psychologists/psychiatrists can market themselves as coaches, then what is their responsibility to their clients with severe mental health presentations? Do they refer or treat?

FWIW, this guy is screwed either way. If he's providing coaching service to a suicidal person and failed to make a referral, he's failed ICF's standards of practice, which are to refer to therapy when presentations dip into mental health concerns. If he's providing psychotherapy over the internet, that's even worse. And if he didn't refer, was he treating the patient or withholding treatment? Oh yeah, and whether it's coaching or psychotherapy, it's still confidential.
 
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Took me a minute to find it, but there was just an article out about this that was shared over a listserv that I'm on. It's not that helpful for this specific situation, but it seems that people think of this as a thing.

Aboujaoude E. (2020). Where Life Coaching Ends and Therapy Begins: Toward a Less Confusing Treatment Landscape. Perspectives on psychological science : a journal of the Association for Psychological Science, 15(4), 973–977. SAGE Journals: Your gateway to world-class research journals

This is an ethical grey-area for sure. If psychologists/psychiatrists can market themselves as coaches, then what is their responsibility to their clients with severe mental health presentations? Do they refer or treat?

FWIW, this guy is screwed either way. If he's providing coaching service to a suicidal person and failed to make a referral, he's failed ICF's standards of practice, which are to refer to therapy when presentations dip into mental health concerns. If he's providing psychotherapy over the internet, that's even worse. And if he didn't refer, was he treating the patient or withholding treatment? Oh yeah, and whether it's coaching or psychotherapy, it's still confidential.

Just to add on to the pile, because I am in the mood. Who knows where these two are located. Are they in different states? Different countries? That could be a big deal.
 
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1. How do you folks interpret 7.3 of your ethics code and is this a violation of that standard?

I don't speak for anyone but myself but I think Section 4 is more relevant here, in that it seems like an obviously harmful violation of privacy to post someone's individual therapy session in a public forum.

Section 7 seems more about the Goldwater rule, like not diagnosing public figures you haven't met or examined. I don't think that applies here.

2. Are violations of your psychiatry codes actionable offenses legally (e.g. can someone lose their physician’s license for violating a psychiatry code)?

Yes, someone would have to report him to his state medical board. It seems very likely that he could lose his license for this.

3. I take it you agree with us that Heathy Gamer is providing therapy?

Like I said I'm not going to watch a 2h YouTube video. Sorry not sorry

But also, a general question here, do people on this thread think it's realistic and actionable to designate techniques that separate therapy from life coaching, and to enforce them in some regulatory framework? It seems almost impossible to regulate what people say to each other in private sessions. There are tons of poorly trained therapists doing hogwash pseudoscientific interventions or offering mostly pointed advice with a side helping of judgement, and calling it therapy. You can regulate what kind of education and licensing people require to market themselves as therapists, but you really can't control what they finally choose to do in the room.

On the other hand if someone is an effective therapist but chooses to call what they're doing 'life coaching,' how would you propose to prevent them from using effective therapy techniques in their private interactions with clients?
 
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I’ve seen other trained mental health professionals try to use “it’s coaching, not therapy!” to get around licensing laws, and it seems like a very, very hazy, flimsy distinction at best, especially when the “coach” has legitimate therapy training. Can anyone speak to that?

One PhD psychologist example:

Granted, I just read through the About section, but he doesn’t say anything about holding a license despite his training. Hmm...
 

haRtwin

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But also, a general question here, do people on this thread think it's realistic and actionable to designate techniques that separate therapy from life coaching, and to enforce them in some regulatory framework? It seems almost impossible to regulate what people say to each other in private sessions. There are tons of poorly trained therapists doing hogwash pseudoscientific interventions or offering mostly pointed advice with a side helping of judgement, and calling it therapy. You can regulate what kind of education and licensing people require to market themselves as therapists, but you really can't control what they finally choose to do in the room.

On the other hand if someone is an effective therapist but chooses to call what they're doing 'life coaching,' how would you propose to prevent them from using effective therapy techniques in their private interactions with clients?

Maybe? There is some research gaining traction on the question of what to do with "low performing therapists" that may be relevant here. Although we cannot observe private interactions with clients, we may be able to use routinely monitored client outcomes within a clinic to designate therapists whose clients either do not achieve therapeutic benefits or become harmed.

Here is just one article on the topic of low performing therapists: Removing Very Low-Performing Therapists: A Simulation of Performance-Based Retention in Psychotherapy - PubMed
 
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I don't speak for anyone but myself but I think Section 4 is more relevant here, in that it seems like an obviously harmful violation of privacy to post someone's individual therapy session in a public forum.

I'm curious about this applying all around to any trained/liscensed therapist. There's a pretty popular podcast that has multiple psychologists delving into very intense psychodynamic oriented topics that is clearly intended to be therapy (in that there is a goal of developing insight and creating behavior change). Now of course dating and sexuality are lower risk topics than bipolar disorder but beyond that I'm not sure I see the difference.

 

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I'm curious about this applying all around to any trained/liscensed therapist. There's a pretty popular podcast that has multiple psychologists delving into very intense psychodynamic oriented topics that is clearly intended to be therapy (in that there is a goal of developing insight and creating behavior change). Now of course dating and sexuality are lower risk topics than bipolar disorder but beyond that I'm not sure I see the difference.


Is there a specific person this is being delivered to in the podcast, or just a general audience? I feel that is the difference. I remember an EPPP question that asks about a psychologist giving general advice as part of a seminar, and it wasn't thought to be unethical because it was just general advice and not an intervention delivered at one particular individual.

In the above videos, there is clearly an intervention being delivered to one individual. If we were asked to identify the "therapist" and the "patient," we could easily do so.

Also, in answer to the "when do we try to intervene" - If someone is doing bad therapy I'm probably not going to know about it, but this is on YT for the world to see.
 
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I'm curious about this applying all around to any trained/liscensed therapist. There's a pretty popular podcast that has multiple psychologists delving into very intense psychodynamic oriented topics that is clearly intended to be therapy (in that there is a goal of developing insight and creating behavior change). Now of course dating and sexuality are lower risk topics than bipolar disorder but beyond that I'm not sure I see the difference.


There's a big difference. Having a podcast where you discuss mental health topics and offer advice/solutions is no different than your local newscast that features a health reporter doing why you should get the flu shot or why you shouldn't skimp on eye exams type stories. It's different from someone actually doing therapy with an individual.

That said, I'm not sure what the difference is legally in advice what this psychiatrist did and in say someone like Dr. Phil. Now I would never do it because I dont' want to trash my reputation and be disrespected by my peers like Dr. Phil, but is there actual legal standing here? Because I feel like the law is murky around this and likely licensing is too.
 
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psych.meout

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I don't speak for anyone but myself but I think Section 4 is more relevant here, in that it seems like an obviously harmful violation of privacy to post someone's individual therapy session in a public forum.

Section 7 seems more about the Goldwater rule, like not diagnosing public figures you haven't met or examined. I don't think that applies here.



Yes, someone would have to report him to his state medical board. It seems very likely that he could lose his license for this.



Like I said I'm not going to watch a 2h YouTube video. Sorry not sorry

But also, a general question here, do people on this thread think it's realistic and actionable to designate techniques that separate therapy from life coaching, and to enforce them in some regulatory framework? It seems almost impossible to regulate what people say to each other in private sessions. There are tons of poorly trained therapists doing hogwash pseudoscientific interventions or offering mostly pointed advice with a side helping of judgement, and calling it therapy. You can regulate what kind of education and licensing people require to market themselves as therapists, but you really can't control what they finally choose to do in the room.

On the other hand if someone is an effective therapist but chooses to call what they're doing 'life coaching,' how would you propose to prevent them from using effective therapy techniques in their private interactions with clients?
I was mostly being snarky when I posted the screenshot earlier, but on his own website infographic he calls it "counseling." I think that lends itself to exposing how transparent his motives are in calling it "coaching" when he's really doing therapy.
 
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Merovinge

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There's a big difference. Having a podcast where you discuss mental health topics and offer advice/solutions is no different than your local newscast that features a health reporter doing why you should get the flu shot or why you shouldn't skimp on eye exams type stories. It's different from someone actually doing therapy with an individual.

That said, I'm not sure what the difference is legally in advice what this psychiatrist did and in say someone like Dr. Phil. Now I would never do it because I dont' want to trash my reputation and be disrespected by my peers like Dr. Phil, but is there actual legal standing here? Because I feel like the law is murky around this and likely licensing is too.

Is there a specific person this is being delivered to in the podcast, or just a general audience? I feel that is the difference. I remember an EPPP question that asks about a psychologist giving general advice as part of a seminar, and it wasn't thought to be unethical because it was just general advice and not an intervention delivered at one particular individual.

In the above videos, there is clearly an intervention being delivered to one individual. If we were asked to identify the "therapist" and the "patient," we could easily do so.

Also, in answer to the "when do we try to intervene" - If someone is doing bad therapy I'm probably not going to know about it, but this is on YT for the world to see.

I've listened to the entirety of this podcast and I suspect some of you may have not, this is NOT a discussion of general topics, it it literally a deep dive into childhood sexuality with a specific person with explicitly stated goals of being therapeutic. There is someone who is explicitly a named patient (literally their full name is known) and multiple different licensed PhD psychologists. It is explicitly an intervention being delivered to one individual (technically two, but one at a time).



.
 
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cara susanna

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I've listened to the entirety of this podcast and I suspect some of you may have not, this is NOT a discussion of general topics, it it literally a deep dive into childhood sexuality with a specific person with explicitly stated goals of being therapeutic. There is someone who is explicitly a named patient (literally their full name is known) and multiple different licensed PhD psychologists. It is explicitly an intervention being delivered to one individual (technically two, but one at a time).



.

Yeah, I didn't listen, which is why I asked. In that case, oof. I'm not really okay with that either. In terms of ethics and legality, though, that's probably more of a question for their licensing boards.
 

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But also, a general question here, do people on this thread think it's realistic and actionable to designate techniques that separate therapy from life coaching, and to enforce them in some regulatory framework? It seems almost impossible to regulate what people say to each other in private sessions. There are tons of poorly trained therapists doing hogwash pseudoscientific interventions or offering mostly pointed advice with a side helping of judgement, and calling it therapy. You can regulate what kind of education and licensing people require to market themselves as therapists, but you really can't control what they finally choose to do in the room.

On the other hand if someone is an effective therapist but chooses to call what they're doing 'life coaching,' how would you propose to prevent them from using effective therapy techniques in their private interactions with clients?

I think the goals of the treatment might be the difference. There are probably therapeutic elements of life-coaching, but the overall goal of the exercise is really to help an otherwise mentally healthy person achieve some kind of life goal. There are transferrable skills, sure. Goal setting shows up in treatments like Problem Solving Therapy, which can be helpful in treating mild to moderate depression, and building good rapport is probably necessary so people listen to you. In those ways, there's crossover. Like I article I linked mentioned, it becomes much more of an ethical sticking point when people are providing coaching to someone who probably needs therapy. Seems like a breach of ethics to me if a licensed mental health provider is providing coaching to someone who really needs therapy. I wonder if it would be akin to me discouraging a depressed client of mine to seek out medication, TMS, or something because I was feeling personally threatened by the fact my treatments weren't working.

That being said, I don't see anything wrong with restricting what uneducated people are able to do when they are peddling their skills as a life coach. The most ethical coaching I've seen restricts itself to some basic alliance building and solution focused interventions, which I don't consider therapy. I think if the techniques used by coaches were established by an accrediting body, then one would think they would be enforceable legally.

And I'm all for more accountability when it comes to bad therapists. I'd like to see these folks regulated as much as anyone else.
 
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I think the goals of the treatment might be the difference. There are probably therapeutic elements of life-coaching, but the overall goal of the exercise is really to help an otherwise mentally healthy person achieve some kind of life goal. There are transferrable skills, sure. Goal setting shows up in treatments like Problem Solving Therapy, which can be helpful in treating mild to moderate depression, and building good rapport is probably necessary so people listen to you. In those ways, there's crossover. Like I article I linked mentioned, it becomes much more of an ethical sticking point when people are providing coaching to someone who probably needs therapy. Seems like a breach of ethics to me if a licensed mental health provider is providing coaching to someone who really needs therapy. I wonder if it would be akin to me discouraging a depressed client of mine to seek out medication, TMS, or something because I was feeling personally threatened by the fact my treatments weren't working.

That being said, I don't see anything wrong with restricting what uneducated people are able to do when they are peddling their skills as a life coach. The most ethical coaching I've seen restricts itself to some basic alliance building and solution focused interventions, which I don't consider therapy. I think if the techniques used by coaches were established by an accrediting body, then one would think they would be enforceable legally.

And I'm all for more accountability when it comes to bad therapists. I'd like to see these folks regulated as much as anyone else.
That he advises the patient to contact him directly if he ever feels suicidal (see below) very clearly indicates that he's doing therapy and not some kind of life coaching. He can call it whatever he wants, but intervening on SI is quite manifestly within the domain of a professional therapeutic relationship.


Yes, I am very concerned about this channel. It seems like such negligent practice. At 1:10:48 of the video, the doctor talks to the streamer specifically about suicide and although he claims not to provide therapy he asks the streamer to contact him through a chat if he ever has thoughts of suicide. Seems like he should have referred at that point if he was really not providing therapy...
Also, I didn't watch the whole video, but tried to go to this section and right before it he explicitly says that his colleagues warned him not to do what he's doing here and he says that he hopes he doesn't get sued because he isn't providing medical care here.

It's difficult to tell whether he's just really ignorant and cavalier about the ethical and professional implications of what he's doing or if he's craven enough to understand them and just thinks he found some kind of loophole that allows him to do whatever he wants without any of the responsibility or liability.
 
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That he advises the patient to contact him directly if he ever feels suicidal (see below) very clearly indicates that he's doing therapy and not some kind of life coaching. He can call it whatever he wants, but intervening on SI is quite manifestly within the domain of a professional therapeutic relationship.

Right. In this situation, he's clearly using coaching as means to skirt the law. Telling is what you posted earlier about the terms "counseling" and "coaching" being interchangeable. As a counseling psychologist, I find this a bit annoying. Both practices are about giving guidance, but there are more legal protections for the term "counseling" than there are for "coaching." I was responding to a earlier comment about the differences at a more general level.
 
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He's currently streaming about support for suicide, grief, and loss. It is CRINGE, and I would argue potentially harmful.
 

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Bumped into this thread on the front page of reddit just now:

Dr.k breaks down talking about Reckful, you dont have to fight this alone

I do think that there is a lot of outreach value to what this psychiatrist was doing. Undoubtedly, mental health problems are endemic within the gaming community. I think the mistake he made when livestreaming was moving from interviewing someone about their mental health as something like a journalist to actually taking on the role of a psychotherapist. As others have pointed out in this thread already, this non-pt who is now dead would have been better served by a referral as soon as it became clear the non-pt was presenting with mental health issues, as opposed to continuing with "non-psychotherapeutic" livestreamed "coaching" or whatever.
 

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This whole thing is problematic. The thing is we don't know the types of contracts and releases that have been signed in the background. We also don't know what type of referrals were made. Did this guy give this gamer resources for therapy, med management, treatment programs etc.? We don't know. Regardless, I find it problematic and certainly something I would never do. I just don't know if its something that can result in loss of a license without a clear harm.

I think about things like Dr. Oz selling stuff that clearly doesn't work. Cringeworthy. Problematic. and he was even brought in front of boards and questioned, but dude still managed to walk a tightrope and still has his license.
 
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Bumped into this thread on the front page of reddit just now:

Dr.k breaks down talking about Reckful, you dont have to fight this alone

I do think that there is a lot of outreach value to what this psychiatrist was doing. Undoubtedly, mental health problems are endemic within the gaming community. I think the mistake he made when livestreaming was moving from interviewing someone about their mental health as something like a journalist to actually taking on the role of a psychotherapist. As others have pointed out in this thread already, this non-pt who is now dead would have been better served by a referral as soon as it became clear the non-pt was presenting with mental health issues, as opposed to continuing with "non-psychotherapeutic" livestreamed "coaching" or whatever.

Ugh, the community really worships him. I saw a few negative comments, but that was it. Some people also seem to think that he's a psychologist...
 
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Bumped into this thread on the front page of reddit just now:

Dr.k breaks down talking about Reckful, you dont have to fight this alone

I do think that there is a lot of outreach value to what this psychiatrist was doing. Undoubtedly, mental health problems are endemic within the gaming community. I think the mistake he made when livestreaming was moving from interviewing someone about their mental health as something like a journalist to actually taking on the role of a psychotherapist. As others have pointed out in this thread already, this non-pt who is now dead would have been better served by a referral as soon as it became clear the non-pt was presenting with mental health issues, as opposed to continuing with "non-psychotherapeutic" livestreamed "coaching" or whatever.
I don't think you're really understanding what people are saying here, which is that this person very much was a patient and was receiving psychotherapy. This wasn't a matter of something that was clearly non-therapy not being properly addressed once safety issues presented themselves. This was therapy from the get-go and the suicide was completed because the entire therapeutic situation was being handled unethically from the beginning. That there was a superficial veneer of being coaching or whatever is, at best, ignorance about the ethical ramifications and possibly intentional deception to avoid responsibility.

He even says in the video that he was warned by other professionals about doing this. That the perils of doing this were obvious to the community is evidence that this was problematic in general and not just in the specific case of this gentleman who unfortunately completed suicide.
 
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I don't think you're really understanding what people are saying here, which is that this person very much was a patient and was receiving psychotherapy. This wasn't a matter of something that was clearly non-therapy not being properly addressed once safety issues presented themselves. This was therapy from the get-go and the suicide was completed because the entire therapeutic situation was being handled unethically from the beginning. That there was a superficial veneer of being coaching or whatever is, at best, ignorance about the ethical ramifications and possibly intentional deception to avoid responsibility.

He even says in the video that he was warned by other professionals about doing this. That the perils of doing this were obvious to the community is evidence that this was problematic in general and not just in the specific case of this gentleman who unfortunately completed suicide.

I don't think I've misunderstood what people are saying. I described where I think boundaries were crossed, which was as soon as the psychiatrist took on the role of providing psychotherapy (which was right from the beginning). I think my facetious use of the term "non-pt" and "non-psychotherapy" may have confused you.

Edit: This is making me curious. Maybe I have misunderstood what people are saying. I wonder how you would define a patient? At what point does a conversation between two people become a conversation between a therapist and a patient?
 
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psych.meout

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I don't think I've misunderstood what people are saying. I described where I think boundaries were crossed, which was as soon as the psychiatrist took on the role of providing psychotherapy (which was right from the beginning). I think my facetious use of the term "non-pt" and "non-psychotherapy" may have confused you.

My bad. The tone doesn't really come through over text.

Edit: This is making me curious. Maybe I have misunderstood what people are saying. I wonder how you would define a patient? At what point does a conversation between two people become a conversation between a therapist and a patient?
When it's not just two people having a conversation, but rather thinly-veiled "coaching" that's actually therapy. And there are multiple times where he's either forgetting to keep up the facade or just not paying attention enough to keep up the narrative. E.g., telling the patient to contact him should he start having SI again. Is that something you do having a couple of beers with a stranger?
 

R. Matey

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Edit: This is making me curious. Maybe I have misunderstood what people are saying. I wonder how you would define a patient? At what point does a conversation between two people become a conversation between a therapist and a patient?

The fact that one of these "two people" is a trained psychiatrist and the "conversation" is about mental health concerns drastically changes the landscape of that conversation, IMHO. I mean...there's an obvious power dynamic there.
 
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