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

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So, as long as I'm DBT-trained, sleeping with patients is okay? (disclaimer: I'm obviously joking)

Ollie123 said:
Yeah...that's about what I thought.

I wonder if "Working with BPD without adequate training" have ever come up outside of cases where people sleep with patients....
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From what I've read and seen, I highly doubt it.
 
WisNeuro said:
At that point, just go into sexual surrogacy work
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But then you have to do it with all the patients that need it, not just when you feel like it. Back to to responsibilities...sigh. They made this job seem more fun on TV.
 
Latest issue I’m dealing with: figuring out who the patient is seeing for therapy - patient reports seeing a psychologist, I go look them up it says Christian Psychologist. Took me a while to figure out that they are not in fact a psychologist
 
tr said:
Er... Don't you work at the VA? Forgive me but the temptations there seemed... minimal
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I work for the VA and in geriatrics, so not really any temptations for me. However, that isn't really funny.
 
allantois said:
Latest issue I’m dealing with: figuring out who the patient is seeing for therapy - patient reports seeing a psychologist, I go look them up it says Christian Psychologist. Took me a while to figure out that they are not in fact a psychologist
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The term psychologist is protected in many states, if they are not a licensed psychologist, and use that term, they are likely open to legal action.
 
WisNeuro said:
The term psychologist is protected in many states, if they are not a licensed psychologist, and use that term, they are likely open to legal action.
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If someone is not a licensed psychologist, but calls themselves a psychologist, who will they get in trouble with? I can’t imagine the licensing board since they are not, in fact, licensed.

I have seen an influx of posts in my immigrant community of people coming here and advertising themselves as a “psychologist, therapist, numerologist, coach” (YES all of those terms listed at once!!)

When I ask them where they are licensed and for what, I get told to mind my own business because back in the homeland they practiced for years and were certified as so and so. Don’t have any intentions of being licensed here.

I am left wondering how to respond and why I bothered going to graduate school and going through the licensure process when I could have just been *all the things* without taking the pesky EPPP or crying over dissertation 😂
 
bluecolourskies said:
If someone is not a licensed psychologist, but calls themselves a psychologist, who will they get in trouble with? I can’t imagine the licensing board since they are not, in fact, licensed.

I have seen an influx of posts in my immigrant community of people coming here and advertising themselves as a “psychologist, therapist, numerologist, coach” (YES all of those terms listed at once!!)

When I ask them where they are licensed and for what, I get told to mind my own business because back in the homeland they practiced for years and were certified as so and so. Don’t have any intentions of being licensed here.

I am left wondering how to respond and why I bothered going to graduate school and going through the licensure process when I could have just been *all the things* without taking the pesky EPPP or crying over dissertation 😂
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Depends on your state statutes, could be your department of human/health services. Your state board will have the appropriate referring info. After reporting, generally they will get a cease and desist for practicing without a license/deception/public welfare/etc. After that they can be subject to fine and/or criminal prosecution.
 
bluecolourskies said:
If someone is not a licensed psychologist, but calls themselves a psychologist, who will they get in trouble with? I can’t imagine the licensing board since they are not, in fact, licensed.

I have seen an influx of posts in my immigrant community of people coming here and advertising themselves as a “psychologist, therapist, numerologist, coach” (YES all of those terms listed at once!!)

When I ask them where they are licensed and for what, I get told to mind my own business because back in the homeland they practiced for years and were certified as so and so. Don’t have any intentions of being licensed here.

I am left wondering how to respond and why I bothered going to graduate school and going through the licensure process when I could have just been *all the things* without taking the pesky EPPP or crying over dissertation 😂
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"As a licensed psychologist it is my business and I am deciding whether to report you to the state for practicing psychology without a license."
 
The individual in question is licensed as a counselor
 
The board protects the profession, meaning they may choose to go after people who are pretending to be in the profession.
 
AbnormalPsych said:
The boards I am familiar with make it clear they protect the public. They don't give a **** about the profession.
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I'd say that ours has its number one priority as protection of the public, but they also highly value integrity of the profession, as they have acted on ethical issues that have not involved any patient harm issues.
 
WisNeuro said:
Did you use your own, or the one (likely) included in your liability coverage?
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So, my work has in house council and pays for our liability coverage. They've done a ton of med and nursing board complaints, but never the psych board before. So they are paying for the lawyer I selected (up to 15k). I was willing to throw 5-10g's of my own cash for this one, so it feels good that my work has got my back. The lawyer selected seems to have the best outcomes and is licensed psych and JD. Now we're just in record releasing bureaucracy purgatory with our risk and compliance officers - who want the board to subpoena the records department for records. Apparently the medical boards usually want a records department to send in the records and can't believe the psych board is cool with my lawyer sending in the chart.

I've got a month to get all records and my response to them. But, I've drafted my response, which is being looked at right now, then it'll be a month or two before I go speak at the screening committee. My lawyer thinks the complaint is spurious and has a good chance of getting dismissed at the screening level and he's not very concerned. But, still it sucks. His demeanor changed to much more relaxed when he read the complaint.

Still - didn't think I'd be getting one this early in my career. I've only renewed my license twice. But anyone can make a complaint, and the bar for making one is very low. My lawyer has assured me, that in the type of work I do, assessing kiddos, this won't be my last.

I preemptively went down to .75 fte this month so I can exercise while the kids are at daycare, started with my therapist again, and started my old friend lexapro again. I'm not gonna let this ruin my ability to be a present parent, my health, my career, or my relationships. Or impact the meaning and purpose I get from this job.

What sucks is all the second guessing you do.
 
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borne_before said:
So, my work has council and pays for our liability coverage. They've done a ton of med and nursing board complaints, but never the psych board before. So they are basically paying for the lawyer I selected. I was willing to pay cash for this one. The one selected seems to have the best outcomes and is licensed psych and JD. Now we're just in record releasing bureaucracy purgatory with our risk and compliance officers. I've got a month to get all records and my response to them. But, I've drafted my response, which is being looked at right now, then it'll be a month or two before I go speak at the screening committee. My lawyer thinks the complaint is spurious and has a good chance of getting dismissed at the screening level and he's not very concerned. But, still it sucks. His demeanor changed to much more relaxed when he read the complaint.

Still - didn't think I'd be getting one this early in my career. I've only renewed my license twice. But anyone can make a complaint, and the bar for making one is very low. My lawyer has assured me, that in the type of work I do, assessing kiddos, this won't be my last.

I preemptively went down to .75 fte this month so I can exercise while the kids are at daycare, started with my therapist again, and started my old friend lexapro again. I'm not gonna let this ruin my ability to be a present parent, my health, my career, or my relationships. Or impact the meaning and purpose I get from this job.

What sucks is all the second guessing you do.
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As long as you're following a broadly defined standard of practice, no need to second guess.
 
WisNeuro said:
As long as you're following a broadly defined standard of practice, no need to second guess.
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Dude, they mailed me the notice on a Friday. I read it as I was gonna go get my kids at home. My heart sank, and I called this lawyer. But that was such a ****ty weekend. But, I got in early on monday, looked over everything and my heart just felt better. I def followed standards and best practices during this assessment.
 
borne_before said:
Dude, they mailed me the notice on a Friday. I read it as I was gonna go get my kids at home. My heart sank, and I called this lawyer. But that was such a ****ty weekend. But, I got in early on monday, looked over everything and my heart just felt better. I def followed standards and best practices during this assessment.
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All part of the game. This will be a good learning experience for next time as long as everything checks out.
 
EMDR=exposure therapy=eyeroll
Van der Kolk? Ugh

Masters trained. Not everyone drinks the kool aid.
 
psychma said:
I was gifted the book. It is still in the sealed plastic bag that it came in 2 years later.
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Similarly, I tried to read Francine Shapiro's EMDR book...once...couldn't make it past the first two pages of neurobabble.
 
I kind of wish we required psych students to take a pseudo-science class to talk about meta-theory and expose students to the direct stuff our clients use (required Tik Tok exposure to MH stuff, that crappy twitter therapist I hate who does 'trauma' everything, body keeps score, EMDR, etc). Clearly Lilianfeld is the required text. I think most of our students just dont know whats real to clients, or how to discuss with them

It would also probably make the fights between CBT and Humanistic (common v specific) far less robust if they just agreed 'lets get rid of trash'.
 
psycho1391 said:
Anytime someone asks me if I have read "The Body Keeps The Score", I die a little on the inside.
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I read this. It's not a scientific treatise. It's a distillation of the experiences of one clinician who specializes in trauma.

The underlying point that early life adversity has broad and lasting effects on multiple body systems, including endocrine, metabolic, cardiovascular, etc is very well scientifically established, but perhaps not widely appreciated among the lay public. TBKTS gets this across in a readable way.

The uncritical promotion of poorly established therapies is regrettable, but understandable in the context that we don't actually have any evidence based therapies that acknowledge or address this issue of somatic weathering/allostatic load, so it's unsurprising that woo should spring in to fill the gap.
 
I definitely think that PE and CPT need better social media presence, especially on TikTok.

I don't like van der Kolk, as you all know, but I do think that The Body Keeps the Score is overall a good and helpful book. It's the stuff he started saying later on that I find to be the issue.
 
cara susanna said:
I definitely think that PE and CPT need better social media presence, especially on TikTok.

I don't like van der Kolk, as you all know, but I do think that The Body Keeps the Score is overall a good and helpful book. It's the stuff he started saying later on that I find to be the issue.
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My impression of TBKTS from what I know of it is that it can be helpful for people with a good pre-existing knowledge of EBT for trauma but if you don’t have that, it’s easy to read the takeaway as “movement therapy is the only hope for PTSD.” 🤷‍♀️
 
tr said:
I read this. It's not a scientific treatise. It's a distillation of the experiences of one clinician who specializes in trauma.

The underlying point that early life adversity has broad and lasting effects on multiple body systems, including endocrine, metabolic, cardiovascular, etc is very well scientifically established, but perhaps not widely appreciated among the lay public. TBKTS gets this across in a readable way.

The uncritical promotion of poorly established therapies is regrettable, but understandable in the context that we don't actually have any evidence based therapies that acknowledge or address this issue of somatic weathering/allostatic load, so it's unsurprising that woo should spring in to fill the gap.
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It has generally been a net positive for my patients. It seems to me that their main takeaway is that traumatic experiences can affect them physically. My read on it was about the same as yours, although to be honest, I really just zipped through it and didn’t read very critically.
 
smalltownpsych said:
It has generally been a net positive for my patients. It seems to me that their main takeaway is that traumatic experiences can affect them physically. My read on it was about the same as yours, although to be honest, I really just zipped through it and didn’t read very critically.
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It makes sense that traumatic experiences (especially severe, especially repeated) would have a 'real' and enduring pathological impact on the central nervous system (and its functioning) over time. However, I believe than some authors in the 'trauma' field (which has become quite trendy and lucrative lately) tend to speculate wildly regarding the mechanisms involved with little anchoring in the medical/empirical literature and without much actual critical thinking applied to their own speculation. They like to weave an interesting/compelling verbal narrative and call it a day. As a therapist who sees PTSD patients all day long, I get a lot more out of reading, say, a serious medical text by Springer Press on the autonomic nervous system than I do reading Shapiro or Van der Kolk, although I admit I probably need to hold my nose a little more and try to make it through some of their work just to be more familiar with it because it's so 'popular' and 'trendy' these days.
 
Fan_of_Meehl said:
It makes sense that traumatic experiences (especially severe, especially repeated) would have a 'real' and enduring pathological impact on the central nervous system (and its functioning) over time.
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Not just the nervous system. Cardiovascular. Immune. Endocrine. Metabolic. Etc

Fan_of_Meehl said:
However, I believe than some authors in the 'trauma' field (which has become quite trendy and lucrative lately) tend to speculate wildly regarding the mechanisms involved with little anchoring in the medical/empirical literature and without much actual critical thinking applied to their own speculation. They like to weave an interesting/compelling verbal narrative and call it a day.
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Yes TBKTS is aimed at a popular audience, not the specialist reader.

Fan_of_Meehl said:
As a therapist who sees PTSD patients all day long, I get a lot more out of reading, say, a serious medical text by Springer Press on the autonomic nervous system than I do reading Shapiro or Van der Kolk, although I admit I probably need to hold my nose a little more and try to make it through some of their work just to be more familiar with it because it's so 'popular' and 'trendy' these days.
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OK so not a book for you then. I do think it's been helpful for a number of my patients who were starting from a very different knowledge base.
 
tr said:
Not just the nervous system. Cardiovascular. Immune. Endocrine. Metabolic. Etc


Yes TBKTS is aimed at a popular audience, not the specialist reader.


OK so not a book for you then. I do think it's been helpful for a number of my patients who were starting from a very different knowledge base.
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One of the bigger issues is that some of these authors tend to be quite evangelical in their unsubstantiated pet theories. And it draws teh lay person into their cult. It doesn't help that many of the, usually midlevels, who practice the pseudoscience that follows these books, also tend towards demagoguery and the denouncement of empirically supported trauma therapies as "dangerous." This has done far more damage than good in the field. I've also met very few people who have gone through these pseudoscience treatments and come out the better for it. Many people will report that they liked the treatment, but their objective functional status is still largely the same as before they started the therapies. The most successful outcomes are really only the incomes that people like Shapiro and workshop organizers secure.
 
My thought this morning is that the lack of understanding of basic principles of learning is also a part of why the less trained therapists are so quick to jump onto these types of bandwagons. Even when it comes to therapists who claim to do DBT, which is founded on behavioral principles, they don’t know how to use principles of reinforcement to shape behavior so instead they try to “fix” the patient instead. They devote a lot of attention to trying to stop patients from using maladaptive coping such as self-harm and get frustrated when patients keep doing it. Then they will throw out interventions to try and stop it. “Hmmm, have you had any EMDR or x,y,z treatment yet?”
 
Great thoughts in the two posts directly above this one. I'll only add that while it's probably true that trauma affects multiple body systems other than a person's psychological experience and/or just their brain, the mere presence of effects are right now far from being clinically actionable in a satisfying way. So, it's an interesting observation, sure, but interesting observations depart for planet grift when you start selling cures you can't reliably show to be actionable on said observations.
 
R. Matey said:
Great thoughts in the two posts directly above this one. I'll only add that while it's probably true that trauma affects multiple body systems other than a person's psychological experience and/or just their brain, the mere presence of effects are right now far from being clinically actionable in a satisfying way. So, it's an interesting observation, sure, but interesting observations depart for planet grift when you start selling cures you can't reliably show to be actionable on said observations.
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There are also innumerable possible reasons why people dx with PTSD may have any number of medical issues at a statistically higher rate when compared to non mental health involved populations or even other particular mental disordered patient populations. The first step is a careful examination of relevant covariates (e.g., heavy substance abuse, obstructive sleep apnea) so that you can at least attempt to move beyond a simple univariate analysis. Next, develop specific hypotheses with respect to the underlying mechanisms involved (or hypothesized to be involved) and critically examine those as well as competing alternative explanations. But, most critically and most often ignored, the PTSD research database is seriously compromised due to all the mis/over-diagnosis of the condition including failure to examine (or exclude) cases of severe elevation of validity indices (especially overreporting psychopathology). When 'PTSD (diagnosed) patients' constitutes the comparison group of interest, that is going the be a seriously heterogeneous group with at least two major subgroups: (a) bone fide trauma patients and (b) overreporting/malingering/misattrubutingpatients who are likely to have all sorts of comorbidities including personality disorders, poverty, homelessness, financial problems, unhealthy habits, etc. and this is likely at least a strong contributor to the frequently observed 'puzzling' and 'inconsistent' series of findings in this (heterogeneous) population. The broad literature on patients with PTSD can be useful in coming up with specific hypotheses about what may need to be assessed for and targeted (if present) in individual patients but characterizing things at a broad level of 'those with PTSD' is going to be fraught with imprecision for decades to come.

The notion that:

Traumatic event A directly caused and maintains specific physiological dysfunction B is not to be taken at face value due to associations/correlations being observed at the group level.
 
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