VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

Started by Fan_of_Meehl
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Speaking of bureaucracy, it was better for the clinic for me to call out today rather than allow me to telework. I only had virtual clients today.
 
Shiori said:
Speaking of bureaucracy, it was better for the clinic for me to call out today rather than allow me to telework. I only had virtual clients today.
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It Doesnt Add Up Amazon Studios GIF by Amazon Prime Video
 
DoubtfulDoc said:
I had supervision with a student who didn’t like behavioral and cognitive therapies because it doesn’t get to the “root” of things like…you guessed it…trauma. I asked him to explain what is the “root”of trauma and how you can treat something that happened months, years, or decades ago. He didn’t have an answer but I think I got him to agree that we can only treat the consequences of trauma like specific thoughts and behaviors that are a product of learning. Slowly I got him to admit that changing how you think about yourself and the world can be a “root cause” treatment and eventually I even got him to admit that doing things you’re afraid of doing or thought you couldn’t do or handle was another great way to change how you think about yourself and the world that was once heavily influenced by their trauma.

I’m so tired of students, established professionals, etc just not having a basic understanding of the clinical application of cognitive, behavioral, learning and social science. Or even how to articulate a treatment plan for something like PTSD, let alone identify what maintains most psychiatric problems in the long run. It’s all woo woo stuff about “depth” and going “deep” and “exploring” but there is no real substance to their approach, nothing to ground these poor patients that are unmoored. I feel like 2/3 of all Our students and licensed psychologists are like this smh. This year was rough, I’m not sure I want to supervise anymore but it kills me that if I leave then that’s one less person who isn’t teaching “keep your patient forever therapy and never expect anything to change for you or them” therapy.
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Oh, that is one of my BIGGEST pet peeves. Please tell me how improving PTSD symptoms through processing the trauma is not actually "addressing the root cause."

What really kills me are people who claim that PTSD EBPs are "atheoretical." Just because you don't agree with the theory doesn't mean that it doesn't have one.
 
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smalltownpsych said:
Behavioral and cognitive therapy does go directly at the root of the problem. Classical conditioning, learning, and the fear response are some of the most basic aspects of our science. There is no magical way to treat it other than exposure. People naturally want to avoid that, as that is an adaptive aspect of the fear response to avoid scary things, but avoidance can increase the response so by intentionally exposing in a careful and systematic way we decrease the response. As far as the cognitive therapy part, I tend to think that it is most effective when it is done with some thinking. I would even argue that the ability to think about our difficult and come up with rational strategies to address them might even be a good goal for all humans.

Anyone who is criticizing from the stance of behaviorism and CBT is not helpful for x, y, and z doesn’t even realize that it is the core of all that we do. This is coming from someone who conceptually is a psychodynamic and object relations kind of guy which interestingly enough doesn’t have to be separated from or replace basic science.
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“…someone who conceptually is psychodynamic and object relations kind of guy…” yes, that’s him. You nailed it! I reviewed some Goldfried (2019) with him to try and demonstrate how he could easily move from behavioral and cognitive scientific understanding of things.
 
Fan_of_Meehl said:
It isn't the whole story but I have, over my decades in psychology, noticed that there appears to be a direct correlation between what you're describing (attraction to the 'woo woo') and lack of competence/knowledge + Cluster B type personality traits (especially Narcissistic and/or Histrionic traits).

I have also found that it is pretty damn futile to attempt to engage these types (once they get their degree/license) in any serious conversations aimed at influencing them toward the mainstream scientist-practitioner perspective.

Hopefully, you may be able to positively influence a student/intern, though, if you can catch them after these types have tried to 'wow' them with their confidence and showmanship.
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Well they at least said things that made me think he is challenging some deeply held beliefs…but I doubt I made much traction by discussing clinical science, common sense, both emic and etic applications of it seems more cluster C intropunitive, neurotic, melancholic, etc. but I’ve 100% seen the cluster B phenomenon you’ve described too
 
Shiori said:
Is there a therapeutic way to say "I think you're the villain in this story"?
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If you work as a VA clinician, you should just agree with whatever their perspective is on the matter. It is your duty, as a VA therapist to agree with 'the veteran' at all times (even if you don't). Otherwise, you risk a 'complaint' that may be career/advancement-ending and be accused of the worst crime imaginable: not being "an advocate" for 'your' veteran.
 
Fan_of_Meehl said:
If you work as a VA clinician, you should just agree with whatever their perspective is on the matter. It is your duty, as a VA therapist to agree with 'the veteran' at all times (even if you don't). Otherwise, you risk a 'complaint' that may be career/advancement-ending and be accused of the worst crime imaginable: not being "an advocate" for 'your' veteran.
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There is career advancement at the VA?
 
Fan_of_Meehl said:
If you work as a VA clinician, you should just agree with whatever their perspective is on the matter. It is your duty, as a VA therapist to agree with 'the veteran' at all times (even if you don't). Otherwise, you risk a 'complaint' that may be career/advancement-ending and be accused of the worst crime imaginable: not being "an advocate" for 'your' veteran.
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Not every clinic or program manager operates like this (thankfully)
 
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cara susanna said:
Gotta love PACT giving cognitive screeners to people in their 20s and 30s
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Doubly so if it's the MoCA and they aren't using age-appropriate norms (paging @PsyDr). Although even then, a "perfect" score doesn't necessarily tell you a whole lot.

But in our case, our service required that one be given before a neuropsych referral could be placed, so I didn't really mind them that much. And if you've got a 25-year-old giving you a 20 on the MMSE, you know something is up.
 
cara susanna said:
Gotta love PACT giving cognitive screeners to people in their 20s and 30s
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I mean, hell, Cara Susanna, that is the PRIME age range for onset of that scourge of the veteran community: "idiopathic super-duper early-onset dementia with service-connection and caregiver-support deficiency syndrome."
 
AcronymAllergy said:
Doubly so if it's the MoCA and they aren't using age-appropriate norms (paging @PsyDr). Although even then, a "perfect" score doesn't necessarily tell you a whole lot.

But in our case, our service required that one be given before a neuropsych referral could be placed, so I didn't really mind them that much. And if you've got a 25-year-old giving you a 20 on the MMSE, you know something is up.
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THE AGE RANGE IS ON THE F'ING FRONT PAGE OF THE WEBSITE AND THE MANUAL! Have I been transported to bizarro land where adults take the WISC?
 
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Sanman said:
So that's what they pay you the big bucks for. Does the judge require you sing it?
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This month, my mortgages were paid by reciting the DSM criteria, nothing that competent people own said book, documenting how long it took to open the book to the relevant diagnostic criteria, and saying that their expert literally didn’t exert that many seconds to diagnose.

It’s a stupid career.
 
PsyDr said:
This month, my mortgages were paid by reciting the DSM criteria, nothing that competent people own said book, documenting how long it took to open the book to the relevant diagnostic criteria, and saying that their expert literally didn’t exert that many seconds to diagnose.

It’s a stupid career.
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Mine was paid refuting an opposing expert using his own article citations which do not, in fact support his assertions. I am also pretty sure, as I have been able to recreate it, that they are simply searching for certain terms in google scholar, finding the first publicly available article, reading the abstract only, and citing it as support for their position, which has no real empirical support.
 
cara susanna said:
I've never even heard of CoreCivic, what are they?
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Per their website, "we provide a broad range of solutions to government partners that serve the public good through high-quality corrections and detention management, innovative and cost-saving real estate solutions, and a growing network of residential and non-residential alternatives to incarceration to help address America's recidivism crisis."

My guess would be they're a recruiter cold-calling psychologists for corrections positions.

I haven't heard from them that I can remember, but there are a handful of recruiters covering my area that are always emailing about positions at jails and military/VA facilities. Guess it's good to know there are always options.
 
AcronymAllergy said:
Per their website, "we provide a broad range of solutions to government partners that serve the public good through high-quality corrections and detention management, innovative and cost-saving real estate solutions, and a growing network of residential and non-residential alternatives to incarceration to help address America's recidivism crisis."

My guess would be they're a recruiter cold-calling psychologists for corrections positions.

I haven't heard from them that I can remember, but there are a handful of recruiters covering my area that are always emailing about positions at jails and military/VA facilities. Guess it's good to know there are always options.
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There's always money in the banana stand.
 
AcronymAllergy said:
Per their website, "we provide a broad range of solutions to government partners that serve the public good through high-quality corrections and detention management, innovative and cost-saving real estate solutions, and a growing network of residential and non-residential alternatives to incarceration to help address America's recidivism crisis."

My guess would be they're a recruiter cold-calling psychologists for corrections positions.

I haven't heard from them that I can remember, but there are a handful of recruiters covering my area that are always emailing about positions at jails and military/VA facilities. Guess it's good to know there are always options.
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I believe they also have many of the contracts for the new immigrant detention centers.
 
Sanman said:
I believe they also have many of the contracts for the new immigrant detention centers.
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That's what they have been trying to recruit for at the moment. CoreCivic is also known for not providing safe conditions for staff. There have been multiple assaults and facilities closing down. Even if you could get behind the mission, the conditions are terrible. It must be why all their pitches have included that they're paying $175,000 and up.
 
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I get occasional stuff from the state prisons, but it's nothing like this. I chatted with some of the local psychologists here and everyone has been getting recruitment outreach. I guess they need to spend all that money they got.
 
PsynofTimes said:
I'm about ready to leave... any thoughts on how much notice one needs to give? I feel like the 2-week standard for other types of work doesn't apply as much to clinical jobs.
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I would definitely give it more than 2 weeks. Probably more like 2 months. But it also depends on how much longer you can stand it, and when your next job would start.

In my last VA job, someone quit the same day, but it was not looked upon well and I don't think the VA would hire this person ever again.
 
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