PhD/PsyD RANT: Arguing with therapists with no research background is like screaming at the ocean and begging the waves to subside

[R. Matey]

---

Members don't see this ad.

It's like people aren't taught (or they otherwise promptly forget) that the manualized nature of some modalities is part of the protocol. Just pulling out some cognitive reframing strategies from CBT and mixing them with whatever conceptually-muddled therapy smoothie you've concocted does not make you an eclectic therapist. It makes you unstructured and misguided, and overzealous attempts to try and appease every patient's particular whims about therapeutic methodologies can sometimes feed into that. Unfortunately these folks have also started to spread their ideas beyond the clinic and into the lay circles--some therapist influencer on TikTok may sat that CBT is just gaslighting and isn't okay for neurodivergent people and then patients and other laypersons just repeat those lines ad nauseam.

It comes from a very old (and discredited) belief that therapists can 'choose' their theoretical approach. Midlevels and lower tier professional doctorates are often taught the common factors approach as if it is the gospel not knowing that even the smarter among the common factors folks still agree that adherence to a evidenced-based theoretical approach is a necessary for component for change (i.e., Norcross). There are also not taught CBT adequately because it's usually presented quickly alongside a number of other theoretical approaches (viewed to be equally valid) so strawmen arguments abound.

I read an AMA with Stephen Faraone (probably the top expert in ADHD after Barkley) who was hassled for saying that CBT for Adult ADHD, is effective (which it is though not as effective as medication). It just seems like that's what you get with Reddit.

 

[AbnormalPsych]

Do you ever notice how many people in that same sub are always complaining about being broke and not able to make a living? One wonders if their general approach to the profession and their inability to make a living go hand in hand.

I am seeing mid-levels in my area move on from advertising EMDR in some online circles and listervs to "adjunctive brainspotting" to supplement the therapy they are getting from presumably other midlevels.

 

[psycho1391]

I think a lot of therapists, especially midlevel ones, have soaked up the "eclectic/mulitmodal" view of therapy to a point that goes far beyond what it originally was meant.

Right. I feel eclectic has become synonymous with jack of all trades, master of none. Then therapists wonder why they have clients who are not stable enough for discharge.

Folks are also so afraid of using directive techniques based in evidence that therapy becomes simply "supportive"

 

[EnPsychlopedia]

...even the smarter among the common factors folks still agree that adherence to a evidenced-based theoretical approach is a necessary for component for change (i.e., Norcross).

The other day, someone was trying to make the "just the therapeutic relationship alone is healing" argument on a thread about midlevels on r/ClinicalPsychology and the folks there were not having that ish. "You still need an EBT alongside the relationship," someone said, but that commenter was like "Nah, therapy is just a good relationship." This person was not, from what I could tell, a psychologist (many folks on that thread weren't because the thread was started by a midlevel complaining that midlevels don't get enough training in science and empirical methods), but it's still scary to know these folks exist.

 

[EnPsychlopedia]

Folks are also so afraid of using directive techniques based in evidence that therapy becomes simply "supportive"

Oh, I have directly witnessed some therapy that consisted of almost no therapeutic techniques beyond supportive listening. I've witnessed some "play therapy" that consisted of just watching the kid play and asking them some basic questions about how things are going. Maybe using dolls or board games to teach very basic moral lessons about sharing or being nice, but no real therapy. Now I'm no expert in play therapy, but I'm pretty sure that's not how it works lol.

Many folks in our field are also averse to the idea that not everyone needs therapy and that effective therapy should, in most cases, have an end date! Someone on another Reddit thread this morning was getting clowned for saying that lifetime/chronic therapy is (in most cases--certainly there are complex/severe enough pathologies to warrant ongoing therapy, such as in my own area of SMI) a sign that the therapy is not accomplishing any meaningful goal aside from being a friendly place to be. Several therapists were attacking that person and saying that anyone can benefit from therapy and keeping going in perpetuity is a good thing! (Never mind the idea that therapy can be iatrogenic in otherwise healthy people, I guess!)

 

[cara susanna]

When I was taking a CBT theory course in my M.A. program (research-based clinical psych program, not licensure-based), the professor drilled into us that "if the person in front of me doesn't want to do CBT or will not buy into it, it's my job to tell them I'm not the right therapist for them." I think a lot of therapists, especially midlevel ones, have soaked up the "eclectic/mulitmodal" view of therapy to a point that goes far beyond what it originally was meant to be. I have no issues with people pulling in ideas/concepts from other types of therapy as a way of supplementing the core method being used, but some folks are eclectic to such an extent that they are mixing and matching therapy components with no rhyme, reason, or theoretical basis for doing so. It's like people aren't taught (or they otherwise promptly forget) that the manualized nature of some modalities is part of the protocol. Just pulling out some cognitive reframing strategies from CBT and mixing them with whatever conceptually-muddled therapy smoothie you've concocted does not make you an eclectic therapist. It makes you unstructured and misguided, and overzealous attempts to try and appease every patient's particular whims about therapeutic methodologies can sometimes feed into that. Unfortunately these folks have also started to spread their ideas beyond the clinic and into the lay circles--some therapist influencer on TikTok may say that CBT is just gaslighting and isn't okay for neurodivergent people and then patients and other laypersons just repeat those lines ad nauseam.

Totally agree. I once ran a CPT group that I hadn't previously met (my co-facilitator had recruited them) and I started our first group off with session 1 (I will never do that again). Turns out they were not bought in. People got SO mad when I talked about the rationale and started arguing with me and overall didn't buy into it at all. My response? Well, you don't have to do this group.

 

[cara susanna]

Oh, I have directly witnessed some therapy that consisted of almost no therapeutic techniques beyond supportive listening. I've witnessed some "play therapy" that consisted of just watching the kid play and asking them some basic questions about how things are going. Maybe using dolls or board games to teach very basic moral lessons about sharing or being nice, but no real therapy. Now I'm no expert in play therapy, but I'm pretty sure that's not how it works lol.

Many folks in our field are also averse to the idea that not everyone needs therapy and that effective therapy should, in most cases, have an end date! Someone on another Reddit thread this morning was getting clowned for saying that lifetime/chronic therapy is (in most cases--certainly there are complex/severe enough pathologies to warrant ongoing therapy, such as in my own area of SMI) a sign that the therapy is not accomplishing any meaningful goal aside from being a friendly place to be. Several therapists were attacking that person and saying that anyone can benefit from therapy and keeping going in perpetuity is a good thing! (Never mind the idea that therapy can be iatrogenic in otherwise healthy people, I guess!)

I don't know how people have time and availability to see patients when they aren't discharging. If you have this approach in the VA, to phrase it dramatically, you will probably not survive. Heck, I know VA therapists who fall more on that side and they are drowning.

 

[WisNeuro]

Totally agree. I once ran a CPT group that I hadn't previously met (my co-facilitator had recruited them) and I started our first group off with session 1 (I will never do that again). Turns out they were not bought in. People got SO mad when I talked about the rationale and started arguing with me and overall didn't buy into it at all. My response? Well, you don't have to do this group.

Reminds me of a group I did in the VA for anxiety/panic. When discussing the exposure model and general psychoed, one especially cranky participant just wanted to argue. "So, you're saying that if I just sit there when I'm having a panic attack and don't do anything, I'm not going to have a heart attack or stroke!?! Bull****!" My response was just, "Sir, you've already told us that you've had hundreds of panic attacks in your life. Within those incidents, how many heart attacks and strokes have you suffered?" *Vet storms out of room*

 

[R. Matey]

it's still scary to know these folks exist.

Not only do they exist; they also likely comprise the majority of the psychotherapy provider workforce.

 

[EnPsychlopedia]

I don't know how people have time and availability to see patients when they aren't discharging. If you have this approach in the VA, to phrase it dramatically, you will probably not survive. Heck, I know VA therapists who fall more on that side and they are drowning.

I personally wonder how many of the folks who have this mindset are primarily working with the "worried well" population. We all know the type--generally economically stable/well-off, a tad anxious or some minor depressive symptoms, maybe some recurrent issues with minor acute adjustment problems, but overall very functional and not super symptomatic (perhaps even sub-threshold for any diagnosis). These folks provide a steady stream of low-stress income. They may not be getting objectively better with their supportive listening therapist, but they aren't necessarily getting worse, and the therapy gives them a nice sense of stability, routine, and validation (so they notice some subjective benefits). So they have no incentive to leave therapy, and the therapist has very little incentive to discharge them.

On the other hand, I wonder how many of the folks with this mindset are working with truly moderate-to-high needs individuals but doing therapy ineffectively, such that, again, there's no objective improvement, but the lack of decompensation makes the therapist assume they are essential to keeping the patient "stable." Not improving, but "stable." Or else they assume the subjective benefits reported by the patient are evidence of objective improvement but are self-aware enough to know that the person isn't yet well enough for termination, so they just think that therapy is inherently a slow, lifelong process.

Convoluted on my part, I know, but I wonder...

 

[MCParent]

It's such a concerning trend that the masses have begun scrutinizing legitimate evidence based practices and content experts as elitist, cold, and somehow incompetent while hailing midlevels as the people's hero/provider that knows the "truth."

People on Reddit aren’t normal people.

I once saw a post about a person who asked about their cat vomiting. The consensus was that you need to take your cat to the vet any time it throws up, immediately.

Another person asked for crate training tips for their dog. The consensus was that the person needs to quit their job and work from home.

 

[The Cinnabon]

People on Reddit aren’t normal people.

I once saw a post about a person who asked about their cat vomiting. The consensus was that you need to take your cat to the vet any time it throws up, immediately.

Another person asked for crate training tips for their dog. The consensus was that the person needs to quit their job and work from home.

This is true!

I'm also on reddit so this further backs your claims!

Just yesterday I forced my SO to call their vet because their dog ate 2 raisins. I mean, dogs have died this way and levels of toxicity aren't established, but the vet just told us the initial hypothesis of "if the dog starts puking take them in."

 

[AcronymAllergy]

People on Reddit aren’t normal people.

I once saw a post about a person who asked about their cat vomiting. The consensus was that you need to take your cat to the vet any time it throws up, immediately.

Another person asked for crate training tips for their dog. The consensus was that the person needs to quit their job and work from home.

Yep. And Facebook groups aren't much different.

I think it's mostly a problem with, like, people.

 

[smalltownpsych]

Do you ever notice how many people in that same sub are always complaining about being broke and not able to make a living? One wonders if their general approach to the profession and their inability to make a living go hand in hand.

I agree with this 100%. We just have to continue to make sure that as psychologists we stamp out this type of fuzzy thinking and poor practice as much as possible within our own ranks so that our brand maintains some substance and credibility. Let the LPCs and the like dilute their reputation, I’m fine with that. Meanwhile I’ll keep doing what a good psychologist does. Understand and use the scientific research to provide effective treatment and make a good living doing it.

 

[MCParent]

I agree with this 100%. We just have to continue to make sure that as psychologists we stamp out this type of fuzzy thinking and poor practice as much as possible within our own ranks so that our brand maintains some substance and credibility. Let the LPCs and the like dilute their reputation, I’m fine with that. Meanwhile I’ll keep doing what a good psychologist does. Understand and use the scientific research to provide effective treatment and make a good living doing it.

Someone I know asked me to rec a therapist in her area (Canada, smaller city of 50k people). Searched psych today. Not one doctoral level therapist. EVERY SINGLE mid level counselor listed brainspotting on their profile. I had to rec a psychiatric nurse practitioner who seemed to be the only person in the city doing empirically based treatment.

I agree that incompetence and lower PP income go hand in hand. Every person I’m friends with, who I know does good work, makes bank in PP.

 

[EnPsychlopedia]

Did anyone here see the very recent post on r/therapists asking whether clients having body odor could be a sign of trauma?

 

[WisNeuro]

Did anyone here see the very recent post on r/therapists asking whether clients having body odor could be a sign of trauma?

The people there are like Charlie from Sunny where he's got the corkboard with all the string going back and forth, but all of the strings just start and end with "trauma!"

 

[MCParent]

Did anyone here see the very recent post on r/therapists asking whether clients having body odor could be a sign of trauma?

Obviously due to toxin buildup from the trauma. I’d prescribe some essential oils, which I luckily have at the front desk.

 

[EnPsychlopedia]

The people there are like Charlie from Sunny where he's got the corkboard with all the string going back and forth, but all of the strings just start and end with "trauma!"

It's a horrible, horrible subreddit but I can't help browsing through it on occasion just to see what dumb stuff I will come across. It's also very fun to ridicule, so I have to keep current with what's going on in order to do so lol

 

[EnPsychlopedia]

I've also recently come across a self-described LPCC saying that OCD is traumatogenic, which is--as all of us here know--horrifically wrong.

 

[cara susanna]

I got downvoted for saying that there are studies showing distress related to pornography use is accounted for by religiosity.

 

[WisNeuro]

I got downvoted for saying that there are studies showing distress related to pornography use is accounted for by religiosity.

There is an inverse relationship between the empirical support of something in that sub, and downvotes. As mentioned earlier, the only research they seem to support is their misinterpretation of the common factors research.

 

[EnPsychlopedia]

I got downvoted for saying that there are studies showing distress related to pornography use is accounted for by religiosity.

We’re both in that thread!

 

[The Cinnabon]

I got downvoted for saying that there are studies showing distress related to pornography use is accounted for by religiosity.

This seems very Gen-Z "coded." I have to imagine this has reached its way to midlevels too, especially as us younger generations are finding ourselves in positions to practice. You'd honestly think talking to some Gen-Zs that pornography and smartphones will be the end of civilization as we know it.

 

[EnPsychlopedia]

This seems very Gen-Z "coded." I have to imagine this has reached its way to midlevels too, especially as us younger generations are finding ourselves in positions to practice. You'd honestly think talking to some Gen-Zs that pornography and smartphones will be the end of civilization as we know it.

The thread about porn was surprisingly not what one might think. Lots of folks there were pushing back on the idea. At least, the thread I’m thinking of. Not sure if it’s the same one cara susanna was on.

 

[psycho1391]

It's a horrible, horrible subreddit but I can't help browsing through it on occasion just to see what dumb stuff I will come across. It's also very fun to ridicule, so I have to keep current with what's going on in order to do so lol

Maybe we should have a separate thread of crazy stuff we find on there?

 

[WisNeuro]

Maybe we should have a separate thread of crazy stuff we find on there?

Does SDN have the server bandwidth to manage a discussion about all of the supremely stupid and crazy **** on that sub?

 

[cara susanna]

The thread about porn was surprisingly not what one might think. Lots of folks there were pushing back on the idea. At least, the thread I’m thinking of. Not sure if it’s the same one cara susanna was on.

This was a discussion on why people think porn addiction and sex addiction aren't a thing... er, things.