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

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad.
AcronymAllergy said:
Yeah, it can be an easy out. Although to be fair, cardiovascular disease, and cardiovascular risk factors, are pretty common, especially in VA, so it's almost always on the differential at least to start. Probably 80+% of the folks I saw in VA who were over 50 had at least two, and often all three, of: hypertension, hyperlipidemia, and type 2 diabetes.

Or writing "microangiopathic" in reports made him feel smarter. Could be both.
Click to expand...

Wait, HTN/HLD/T2DM aren't just all one word?
 
Shiori said:
I had a client call in to the front desk to ask what their appointment was for. The MSA told them. Instead of just canceling when they found out, they no-showed.
Click to expand...

My favorite part of this thread is the constant validation that leaving the VA was absolutely the right choice, in every way imaginable way, for me.
 
WisNeuro said:
My favorite part of this thread is the constant validation that leaving the VA was absolutely the right choice, in every way imaginable way, for me.
Click to expand...
I joke with the clerk every time I have to go, physically, lay eyes on the waiting room at the appointment time and then at various intervals after the appointment time (but prior to the 15 after session mark when I can call a no show) that, no...I don't need anything, I am just rolling through the waiting room because I am on 'No-Show Patrol.' You know...because we can't actually hold veterans responsible for formally checking in for their appointments nor can we necessarily place the responsibility on the clerk to notify us when our patient arrives (say, 4 mins after the appointment start time) because the clerk might be busy doing other things and it's not necessarily their job to notify us when our patient arrives (or to ensure that they check in). So, we have the electronic system that allows us to see IF a patient has checked in...but there is no guarantee that a patient will, you know, actually check in after they arrive. So there's plenty of 'false negatives.'

I wish I was kidding.

I also wish this was the only example of "screw what the provider wants/needs" game at the VA.

I also wish I was kidding when I say that I actually formally requested that they help providers out with a closed circuit TV feed to continuously monitor the waiting room so that we could see our patients arriving late without continually patrolling the waiting room.

Also not kidding when I say there was this day several weeks back when I was feeling so fed up with the BS games and way providers are treated that I just spent several minutes physically hanging out in the waiting room giddily greeting everyone like a damn Walmart greeter because, you know, why not?
 
Last edited:
Fan_of_Meehl said:
They just...disappear from the schedule...forever.
Click to expand...
You can actually see this on Vista and some Vista scheduling programs. There's also a way to set your CPRS default settings to display patients for your clinics for an upcoming period. I set mine to 3 months out so I have a better idea of my availability.
 
IloveCBT said:
You can actually see this on Vista and some Vista scheduling programs. There's also a way to set your CPRS default settings to display patients for your clinics for an upcoming period. I set mine to 3 months out so I have a better idea of my availability.
Click to expand...
Yeah, there's a way for some scheduling folks/people with the right access keys to see it, but I was never able to; I'd always have to ask a clerk if I needed to know who canceled (e.g., because they were a feedback appointment that wouldn't be automatically rescheduled).

It was also easier for me to look ahead and mentally keep track because I typically only had 1 or 2 patients/day.
 
AcronymAllergy said:
Yeah, there's a way for some scheduling folks/people with the right access keys to see it, but I was never able to; I'd always have to ask a clerk if I needed to know who canceled (e.g., because they were a feedback appointment that wouldn't be automatically rescheduled).

It was also easier for me to look ahead and mentally keep track because I typically only had 1 or 2 patients/day.
Click to expand...
I've never really understood why it would be too much to ask to either (a) have the system automatically send us an alert/notification when one of our patients canceled and/or...(take a deep breath with this one) (b) expect the clerks to let us know.

Every day I am amazed at how elevated the clerks (secretaries) are in the VA hospital system and how downtrodden the doctoral-level clinicians providers are and are treated (even by our 'own' [psychologist supervisors]).

The latest issue I'm dealing with is having the clerk fail to schedule weekly appointments for CPT protocols all of a sudden. I see a client and plan a course of CPT. I enter the RTC for 12 weeks, all appointments separated by 7 days. Veteran goes to front desk to schedule (I impress on him the importance of scheduling these sessions weekly even if they are not on the same day of the week (e.g., they do NOT all have to be on Mondays...one could be...on...(deep breath) a Tuesday if necessary). He comes back to my office saying the clerk would only schedule him on Mondays and that since I am off 1.5 weeks for Christmas and because of a Monday Federal holiday next year, we had to 'skip' certain weeks.

Knowing that my status is about 10 levels beneath the clerk (secretary) in the office, I just let it go in the moment. Later, I look at the scheduled sessions. There is a massive gap of 3 weeks between sessions 8 and 9 and then another 2 week gap between sessions 9 and 10. For no good reason. So I write this really polite email to the clinic manager (psychologist) asking how I can diplomatically address the issue (I proposed simply me entering two additional RTC orders asking for appointments to 'fill the gaps.'

Program manager writes me back that it is probably because she was asking the clerk to do this for her patients (scheduling for her protocol sessions) because she only sees patients certain days of the week. She says that if I 'really want' to insist that my CPT patients are actually scheduled weekly (implying this is somehow asking too much of the clerk...like it's so friggin difficult to schedule someone on a Tuesday rather than a Monday), then I need to include in my RTC additional text insisting that it actually be scheduled weekly (even though the damn RTC clearly stipulates every session separated by 7 days). She goes on to lament how 'difficult' it is to schedule multibooks (guilt trip me into not asking 'too much' of the clerk). I simply emailed back that I will be entering the RTC's for the 'extra' sessions in order to preserve the integrity of the medical treatment (CPT protocol) and will be daring, I suppose, to ask the clerk to do this 'extra work.'

I will never get over how much clerks (secretaries) are treated like gods in the VA system while providers are treated like peasants. Maybe that's why everyone is leaving and there are so many vacancies in psychology positions around here.

On another (similar) note, we've been having tons of complaints (justified) by veterans of trying to call the clinic back to schedule/reschedule appointments and never having anyone pick up the phone, even though the clerks are supposed to have some sort of 'rollover' system to cover for one another to make sure phones are picked up. For a while, when I say EVERY veteran was complaining all the time, I mean EVERY veteran was complaining all the time. Did admin/supervisors respond by handling the situation. Nah. Know what they did? They came up with this (according to them) brilliant 'solution.' Program manager said that she was printing out blank 'Report of Contact' forms. We were directed to get veterans' statements (that they called and no one picked up) recorded on Report of Contact forms and submit them. They refuse to act to address the problem without this pile of 'evidence' already gift-wrapped and delivered to them. (not that they would act to hold clerks accountable even if I completed 1000 of said forms). So, at a meeting lately, we were smugly 'confronted' that not one single provider had spent the time to fill out Report of Contact forms for this issue. The providers were just dumbfounded. So......EVERYONE is complaining that the clerks aren't answering the phones and your 'solution' is to put more paperwork / responsibility on your providers and when we don't do it you smugly confront us about it almost as if to say (a) this isn't actually a problem, all of you and your veterans are just making this up and/or (b) 'providers are lazy' (for not filling out a whole bunch of Report of Contact forms in addition to the three million other tasks we have during the therapy hour.

I GUARANTEE YOU, that if *I* (as a psychologist) was having EVERYONE complaining about my behavior ALL THE TIME...it would not take the submission of piles of written affadavit 'evidence' for my administrative line to confront me about it and take proactive steps to hold me accountable. The double standards are really frustrating.
 
Last edited:
Fan_of_Meehl said:
I've never really understood why it would be too much to ask to either (a) have the system automatically send us an alert/notification when one of our patient's canceled and/or...(take a deep breath with this one) (b) expect the clerks to let us know.

Every day I am amazed at how elevated the clerks (secretaries) are in the VA hospital system and how downtrodden the doctoral-level clinicians providers are and are treated (even by our 'own' [psychologist supervisors]).

The latest issue I'm dealing with is having the clerk fail to schedule weekly appointments for CPT protocols all of a sudden. I see a client and plan a course of CPT. I enter the RTC for 12 weeks, all appointments separated by 7 days. Veteran goes to front desk to schedule (I impress on him the importance of scheduling these sessions weekly even if they are not on the same day of the week (e.g., they do NOT all have to be on Mondays...one could be...on...(deep breath) a Tuesday if necessary). He comes back to my office saying the clerk would only schedule him on Mondays and that since I am off 1.5 weeks for Christmas and because of a Monday Federal holiday next year, we had to 'skip' certain weeks.

Knowing that my status is about 10 levels beneath the clerk (secretary) in the office, I just let it go in the moment. Later, I look at the scheduled sessions. There is a massive gap of 3 weeks between sessions 8 and 9 and then another 2 week gap between sessions 9 and 10. For no good reason. So I write this really polite email to the clinic manager (psychologist) asking how I can diplomatically address the issue (I proposed simply me entering two additional RTC orders asking for appointments to 'fill the gaps.'

Program manager writes me back that it is probably because she was asking the clerk to do this for her patients (scheduling for her protocol sessions) because she only sees patients certain days of the week. She says that if I 'really want' to insist that my CPT patients are actually scheduled weekly (implying this is somehow asking too much of the clerk...like it's so friggin difficult to schedule someone on a Tuesday rather than a Monday), then I need to include in my RTC additional text insisting that it actually be scheduled weekly (even though the damn RTC clearly stipulates every session separated by 7 days). She goes on to lament how 'difficult' it is to schedule multibooks (guilt trip me into not asking 'too much' of the clerk). I simply emailed back that I will be entering the RTC's for the 'extra' sessions in order to preserve the integrity of the medical treatment (CPT protocol) and will be daring, I suppose, to ask the clerk to do this 'extra work.'

I will never get over how much clerks (secretaries) are treated like gods in the VA system while providers are treated like peasants. Maybe that's why everyone is leaving and there are so many vacancies in psychology positions around here.
Click to expand...
Asking anyone, other than providers, to do any amount of extra (or even standard) work does seem to often be met with resistance. Although to be fair, IME, even when I've had program managers that routinely went to bat for providers with MSA staff and their leadership, they were typically shot down by upper-level management. A lot of the issues seemed to stem from MSA being their own, separate service line. So even though clerks were embedded in MH/primary care/wherever, those services couldn't often dictate what their assigned MSA did. This was infinitely frustrating for my old boss. Anything perceived as outside normal job duties was forwarded up the chain for review. And this was in a setting where we actually had good MH MSA staff.
 
AcronymAllergy said:
Asking anyone, other than providers, to do any amount of extra (or even standard) work does seem to often be met with resistance. Although to be fair, IME, even when I've had program managers that routinely went to bat for providers with MSA staff and their leadership, they were typically shot down by upper-level management. A lot of the issues seemed to stem from MSA being their own, separate service line. So even though clerks were embedded in MH/primary care/wherever, those services couldn't often dictate what their assigned MSA did. This was infinitely frustrating for my old boss. Anything perceived as outside normal job duties was forwarded up the chain for review. And this was in a setting where we actually had good MH MSA staff.
Click to expand...
Well, the real dynamic we're dealing with in our clinic is this:

- to be fair, clerks are underpaid and understaffed (this is a management failure), when I go to my local dentist/MD/optometrist office, there are always more clerks/support staff than providers. At VA, there are typically like 2 MSAs for 6+ providers or 1 MSA for 4+ providers
- so, you get very low quality people in those positions and they don't stay long
- so, when a program manager gets a half-decent one (say, a 42 out of 100 in quality), they will fight tooth and nail (against their own peers, even) to defend everything they want to the death because they are terrified of 'losing' that MSA and having them replaced by a 5 or a 17 out of 100 (quality) one
 
The PTSD national folks admit that the VA's scheduling system is designed for primary care and not mental health episodes of care. EBP scheduling is always kind of a nightmare, and word on the street is that they're gonna issue official guidance for how to do it most effectively.
 
cara susanna said:
The PTSD national folks admit that the VA's scheduling system is designed for primary care and not mental health episodes of care. EBP scheduling is always kind of a nightmare, and word on the street is that they're gonna issue official guidance for how to do it most effectively.
Click to expand...

Wait until you get to Cerner 😉
 
cara susanna said:
The PTSD national folks admit that the VA's scheduling system is designed for primary care and not mental health episodes of care. EBP scheduling is always kind of a nightmare, and word on the street is that they're gonna issue official guidance for how to do it most effectively.
Click to expand...
How about *I* get to decide how to do it most effectively and they figure out how to make that happen?

So tired of non-providers running everything (into the ground).
 
Fan_of_Meehl said:
How about *I* get to decide how to do it most effectively and they figure out how to make that happen?

So tired of non-providers running everything (into the ground).
Click to expand...

I dunno, this nation runs on non-experts dictating how experts do things. 😉
 
This might sound morbid, but is there a way to be notified if a client dies? I get notified for EVERYTHING else. I had a regular client who ended up no-showing me a couple of times a while back. I pulled them off my schedule and figured they'd reconnect later. I didn't think anything of it. I was going back and closing things out for the month and found out they died.
 
Shiori said:
This might sound morbid, but is there a way to be notified if a client dies? I get notified for EVERYTHING else. I had a regular client who ended up no-showing me a couple of times a while back. I pulled them off my schedule and figured they'd reconnect later. I didn't think anything of it. I was going back and closing things out for the month and found out they died.
Click to expand...
I've had this happen multiple times (natural causes & suicide) and no, I'm pretty sure there isn't anything built into the system beyond the "This patient is deceased. Are you sure you want to enter the medical record?" CPRS alert.

I imagine suicide prevention coordinators and people in other specialized roles might have dashboards or specific alert systems and then we rely on them to pass the word around if needed.
 
Shiori said:
This might sound morbid, but is there a way to be notified if a client dies? I get notified for EVERYTHING else. I had a regular client who ended up no-showing me a couple of times a while back. I pulled them off my schedule and figured they'd reconnect later. I didn't think anything of it. I was going back and closing things out for the month and found out they died.
Click to expand...
I have always found out just from opening their chart (either the pop up or just in other notes). I've been told that you're supposed to be notified by the chaplain, but I've never had the privilege of actually being notified of it before getting to the chart and getting that surprise.
 
Shiori said:
This might sound morbid, but is there a way to be notified if a client dies? I get notified for EVERYTHING else. I had a regular client who ended up no-showing me a couple of times a while back. I pulled them off my schedule and figured they'd reconnect later. I didn't think anything of it. I was going back and closing things out for the month and found out they died.
Click to expand...
Also, I'm really sorry.
 
PsychPhDone said:
Also, I'm really sorry.
Click to expand...
I appreciate you! It was my first loss of an active client, so I definitely had some emotions around it. I have some wonderful colleagues and a supportive supervisor, so I got to process things with them. It was just such a surreal experience seeing that they were gone and there being no information in the chart other than the death occurring. I reached out to my supervisor who must have reached out to SP. It's such a weird system to work in.
 
Shiori said:
I appreciate you! It was my first loss of an active client, so I definitely had some emotions around it. I have some wonderful colleagues and a supportive supervisor, so I got to process things with them. It was just such a surreal experience seeing that they were gone and there being no information in the chart other than the death occurring. I reached out to my supervisor who must have reached out to SP. It's such a weird system to work in.
Click to expand...
Is there another provider on your team who also worked with this veteran?

I had a similar scenario where the psychiatrist found out and proactively messaged me and we ended up having a long and good chat, reminisced about that patient, did some joint mourning and that was super helpful in that we were able to put into the world some genuine shared experiences, like one would for a friend or family member.
 
That is a good idea. I shared the veteran with the psychiatrist on my BHIP team.
 
Shiori said:
This might sound morbid, but is there a way to be notified if a client dies? I get notified for EVERYTHING else. I had a regular client who ended up no-showing me a couple of times a while back. I pulled them off my schedule and figured they'd reconnect later. I didn't think anything of it. I was going back and closing things out for the month and found out they died.
Click to expand...

Primary Care gets notified and then they may or may not alert you as a cosigner. I had the same thing happen, and it was really awful. I felt so upset that I didn't know sooner, especially because I had many notes in this person's chart. I even complained to my supervisor about it. I only checked on the chart because I hadn't seen the patient in a while and it wasn't like them to stop seeing me. It had been months since the patient died and I had no idea.
 
Shiori said:
This might sound morbid, but is there a way to be notified if a client dies? I get notified for EVERYTHING else. I had a regular client who ended up no-showing me a couple of times a while back. I pulled them off my schedule and figured they'd reconnect later. I didn't think anything of it. I was going back and closing things out for the month and found out they died.
Click to expand...
Recently had a client death. I was alerted because spouse called to inform VA, and I was listed as MHTC despite not actively treating them. I guess if I wasn't MHTC, they might’ve never alerted me. I ended up adding additional staff who were actually treating the patient (groups, prescriber, etc) because they weren’t originally alerted.

EDIT: I alerted my supervisor because I’d never had that happen before. I felt very strange especially because I had just spoken to them a few weeks prior. Supervisor added an addendum saying myself or SPC needed to call the family to discern cause of death. I was shocked that that was my job. Luckily SPC did it and it was natural causes.
 
One of my patients spent about 5 minutes ranting about how he used to get long appointment reminder letters that used lots of ink. He said that he once told a provider that the VA would save "millions of dollars that they could spend a lot more wisely" if they reduced these letters to a line or two. And now he's convinced that he's responsible for some VA-wide policy and procedure change because his appointment reminder letters aren't as long. 🙄

Most of our sessions are just various iterations of this interaction and him airing grievances related to the VA. I have tried multiple times to discontinue therapy or space sessions out because I really don't do supportive therapy with no clear goals, but he then suddenly can't handle the lack of support and we are back to where we started. It's exhausting some days.
 
VintageRed said:
One of my patients spent about 5 minutes ranting about how he used to get long appointment reminder letters that used lots of ink. He said that he once told a provider that the VA would save "millions of dollars that they could spend a lot more wisely" if they reduced these letters to a line or two. And now he's convinced that he's responsible for some VA-wide policy and procedure change because his appointment reminder letters aren't as long. 🙄

Most of our sessions are just various iterations of this interaction and him airing grievances related to the VA. I have tried multiple times to discontinue therapy or space sessions out because I really don't do supportive therapy with no clear goals, but he then suddenly can't handle the lack of support and we are back to where we started. It's exhausting some days.
Click to expand...
You did an excellent job of promoting an internal locus of control.
 
VintageRed said:
One of my patients spent about 5 minutes ranting about how he used to get long appointment reminder letters that used lots of ink. He said that he once told a provider that the VA would save "millions of dollars that they could spend a lot more wisely" if they reduced these letters to a line or two. And now he's convinced that he's responsible for some VA-wide policy and procedure change because his appointment reminder letters aren't as long. 🙄

Most of our sessions are just various iterations of this interaction and him airing grievances related to the VA. I have tried multiple times to discontinue therapy or space sessions out because I really don't do supportive therapy with no clear goals, but he then suddenly can't handle the lack of support and we are back to where we started. It's exhausting some days.
Click to expand...
Sounds like he needs an appointment with the local patient advocate or his state or Federal senator or congressperson.

'Sir, I'm a therapist...if other people (or organizations) are the problem, then you need to talk to (insert blank)...if you're in need of assessing and changing your patterns of thinking, feeling, or behaving...I'm your man.'

There is no need to necessarily schedule a followup psychotherapy appointment with someone who is utterly committed to being stuck in pre-contemplation. Do a couple of genuine attempts at motivational interviewing and psychoeducation about what therapy is/isn't and patient and therapist roles in psychotherapy, document it, and call it a day.

I think trying to space sessions out with these types of patients---though TOTALLY understandible (I've done it too)---is a mistake. If at all possible, INCREASE frequency of sessions and intensively address their lack of engagement. That has been my approach for more than a year and--predictably--most of these patients end of dropping out of therapy over the long haul (of course they cancel/ no-show their way there). Make sure to increase response effort on their part in these sessions. Hell, Amazon has a decent Motivational Interviewing workbook you can direct him to complete between sessions. He reads the chapters and fills in the blanks and you review with him in session.
 
cara susanna said:
Did you guys hear about the new BHIP Coordinator role yet? Great, ANOTHER administrative position!

Although I am excited to no longer be a MHTC
Click to expand...
I know absolutely nothing about it but...let me guess...

1) they won't have their own caseload of patients to treat or grids to schedule treatment sessions of their own in

2) they will get to be the 'deciders' slash 'coordinators' slash 'champions of equitable distribution of patients among the plebian classes' and will get to decide who has to take which cases...right?

So the people who they hang out with after work, eat lunch with, and socialize with will get all the sweet assignments and lopsided workloads will be apportioned according to favoritism?

Did I leave anything out?
 
VintageRed said:
One of my patients spent about 5 minutes ranting about how he used to get long appointment reminder letters that used lots of ink. He said that he once told a provider that the VA would save "millions of dollars that they could spend a lot more wisely" if they reduced these letters to a line or two. And now he's convinced that he's responsible for some VA-wide policy and procedure change because his appointment reminder letters aren't as long. 🙄

Most of our sessions are just various iterations of this interaction and him airing grievances related to the VA. I have tried multiple times to discontinue therapy or space sessions out because I really don't do supportive therapy with no clear goals, but he then suddenly can't handle the lack of support and we are back to where we started. It's exhausting some days.
Click to expand...
Sounds like he is holding you hostage to being his friend because no empirical based therapy is happening? That sounds predatory.
 
Fan_of_Meehl said:
Sounds like he needs an appointment with the local patient advocate or his state or Federal senator or congressperson.

'Sir, I'm a therapist...if other people (or organizations) are the problem, then you need to talk to (insert blank)...if you're in need of assessing and changing your patterns of thinking, feeling, or behaving...I'm your man.'

There is no need to necessarily schedule a followup psychotherapy appointment with someone who is utterly committed to being stuck in pre-contemplation. Do a couple of genuine attempts at motivational interviewing and psychoeducation about what therapy is/isn't and patient and therapist roles in psychotherapy, document it, and call it a day.

I think trying to space sessions out with these types of patients---though TOTALLY understandible (I've done it too)---is a mistake. If at all possible, INCREASE frequency of sessions and intensively address their lack of engagement. That has been my approach for more than a year and--predictably--most of these patients end of dropping out of therapy over the long haul (of course they cancel/ no-show their way there). Make sure to increase response effort on their part in these sessions. Hell, Amazon has a decent Motivational Interviewing workbook you can direct him to complete between sessions. He reads the chapters and fills in the blanks and you review with him in session.
Click to expand...
@VintageRed then you can document his inevitably failed attempts at completing homework, participating, etc., which will give you actual documented reasons for discontinuing therapy with him, in case he tries to punish you for doing so by running his grievances up your chain of command
 
Fan_of_Meehl said:
I know absolutely nothing about it but...let me guess...

1) they won't have their own caseload of patients to treat or grids to schedule treatment sessions of their own in

2) they will get to be the 'deciders' slash 'coordinators' slash 'champions of equitable distribution of patients among the plebian classes' and will get to decide who has to take which cases...right?

So the people who they hang out with after work, eat lunch with, and socialize with will get all the sweet assignments and lopsided workloads will be apportioned according to favoritism?

Did I leave anything out?
Click to expand...

One of the things I have learned about being a VA psychologist who is doing the work is that we are going to come into conflict with middle management. As long as your leadership is semi-competent and does not have personality pathology, you still get to have a successful career in VA psychology.
 
IloveCBT said:
One of the things I have learned about being a VA psychologist who is doing the work is that we are going to come into conflict with middle management. As long as your leadership is semi-competent and does not have personality pathology, you still get to have a successful career in VA psychology.
Click to expand...
I just get tired of tolerating BS. Whether it's from patients, from co-workers (creating unnecessary drama)...I'm just tired...I'm just done at this point. I don't get rude, I don't get nasty, I don't lose control...but I also don't back down when I have done nothing wrong and the facts/truth are on my side. I'm not kissing anyone's butt, I'll admit when I'm wrong (and I'm wrong plenty) but I just cannot and will not play the 'butt kissing' and accepting lies as truth anymore. It's been freeing and my God has it been successful in getting patients to either (1) participate in active attempts at psychotherapy (in or out of a formal protocol) or (2) decide that therapy isn't actually what they're asking for.

So far I haven't had any formal complaints (that I'm aware of). I'm actually amazed. I'm sure, at some point, someone will complain but--you know what--I'm not doing anything wrong...like...at all. I'm just trying to actually provide them effective psychotherapy, politely, and accurately documenting my efforts and their responses.
 
Fan_of_Meehl said:
I just get tired of tolerating BS. Whether it's from patients, from co-workers (creating unnecessary drama)...I'm just tired...I'm just done at this point. I don't get rude, I don't get nasty, I don't lose control...but I also don't back down when I have done nothing wrong and the facts/truth are on my side. I'm not kissing anyone's butt, I'll admit when I'm wrong (and I'm wrong plenty) but I just cannot and will not play the 'butt kissing' and accepting lies as truth anymore. It's been freeing and my God has it been successful in getting patients to either (1) participate in active attempts at psychotherapy (in or out of a formal protocol) or (2) decide that therapy isn't actually what they're asking for.

So far I haven't had any formal complaints (that I'm aware of). I'm actually amazed. I'm sure, at some point, someone will complain but--you know what--I'm not doing anything wrong...like...at all. I'm just trying to actually provide them effective psychotherapy, politely, and accurately documenting my efforts and their responses.
Click to expand...
You have the right ideas and clinical practice @Fan_of_Meehl.

Anyone else interested in turning this forum into a virtual meeting like once or twice a month for an hour? I'm picturing a quasi-AA type deal for being a current/former VA mental health professional.
 
IloveCBT said:
You have the right ideas and clinical practice @Fan_of_Meehl.

Anyone else interested in turning this forum into a virtual meeting like once or twice a month for an hour? I'm picturing a quasi-AA type deal for being a current/former VA mental health professional.
Click to expand...
I am (potentially)...but I'd have to think about it. I'm pretty concerned about anonymity and I am not convinced that there wouldn't potentially be people dropping in who would may be motivated to 'report back' to the powers-that-be in some way. It's rough out there and there's a reason why people don't already do this with their local colleagues. I have always (half)joked that the mental health providers (who see patients) at VA really do need to form their own separate (from AFGE) union or something, so I'm torn.
 
Fan_of_Meehl said:
I just get tired of tolerating BS. Whether it's from patients, from co-workers (creating unnecessary drama)...I'm just tired...I'm just done at this point. I don't get rude, I don't get nasty, I don't lose control...but I also don't back down when I have done nothing wrong and the facts/truth are on my side. I'm not kissing anyone's butt, I'll admit when I'm wrong (and I'm wrong plenty) but I just cannot and will not play the 'butt kissing' and accepting lies as truth anymore. It's been freeing and my God has it been successful in getting patients to either (1) participate in active attempts at psychotherapy (in or out of a formal protocol) or (2) decide that therapy isn't actually what they're asking for.

So far I haven't had any formal complaints (that I'm aware of). I'm actually amazed. I'm sure, at some point, someone will complain but--you know what--I'm not doing anything wrong...like...at all. I'm just trying to actually provide them effective psychotherapy, politely, and accurately documenting my efforts and their responses.
Click to expand...

Just go into PP and be done with it.
 
IloveCBT said:
You have the right ideas and clinical practice @Fan_of_Meehl.

Anyone else interested in turning this forum into a virtual meeting like once or twice a month for an hour? I'm picturing a quasi-AA type deal for being a current/former VA mental health professional.
Click to expand...
If the focus could be on psychotherapists in the system openly discussing issues (that are never discussed) and sharing positive strategies to proactively address these problems (and reduce burnout), it might be something I could agree to do. There are realities that are never openly discussed (and that never will be) that--once acknowledged and openly discussed--actually can lead to really effective changes in perspective/approaches of a therapist trying to survive and stay sane in the system. There are realities that just simply aren't ALLOWED to be true by the system and those who administer over it. Case in point, once I re-conceptualized my job as mainly one of accurately addressing the manifold species of active lack of engagement in the psychotherapy process that about 80% of my caseload was throwing at me and responding accordingly, I kind of made a breakthrough of sorts and developed my own developmental model of engagement and that has been really personally helpful. I've tried to share this model (and its success) but, so far, I haven't gotten any traction because I don't think that it is consistent with the lie (from the 'system') that almost no (if any) veterans have any issues with engagement in the therapy process, all the providers must just suck or be lazy, lol--which is a set of preconceived notions that just pervade the VA system (and even the journal articles on 'rolling out' the EBP's). Most of those articles just assess/examine things like therapist attitudes and institutional factors but completely ignore/downplay what I refer to as 'client-side' barriers to EBP uptake/engagement. I sit there in my office with my mouth open reading paragraphs of the experts talk about how there really aren't any client variables that relate to lack of EBP agreement/engagement and I just...can't...believe what I just read. I wish I could have a camera crew follow me around and record everything. My experience is that 99-100% of 'lack of engagement' in EBP protocols (that are, literally, offered to everyone in my caseload...multiple times per year, at least) is coming from the 'client-side' barriers. Meanwhile, in meeting after meeting, supervisors bemoan the low percentages of people doing EBP protocols in clinics, frowning and wagging fingers at us like we are misbehaving children who simply refuse to do our chores...and they either don't have a clue or are pretending not to.

It was a real moment of clarity recently when I was asking myself, 'why isn't my supervisor enthusiastic about these data that I just shared with them that--over the past year--I have 'handled' around 100 cases in my outpatient clinics (successfully) and maintained 100% weekly/biweekly sessions in my clinic and haven't gotten 'backed up' or 'behind' on cases? And the answer became so clear. They aren't actually interested in solving the access issues. They are just interested in maintaining the status quo, frowning/wagging fingers at us in meetings of how we fail to do our jobs, and going about their business. A real bummer...but strangely liberating at the same time.

So, even though they aren't going to say, 'wow...good work...maybe we could teach this to others and try to structure people's clinics to help enable them to see people weekly (episodes of care),' they also aren't fighting me on what I am doing in my clinics to reconceptualize/ evolve my approach to dealing with the issues of lack of engagement, either. They're not promoting my ideas/innovations...but they aren't (yet) 'fighting' me on them, either.

In the days before the American Revolution, people submitted papers to the local newspapers under pseudonyms (e.g., 'Seneca') rather than using their real names--that's how we got The Federalist and Anti-Federalist Papers. Maybe we could start an anonymous journal or something. Call it "Dr. StrangeHate: How I Learned to Stop Worrying and Love the No-Show." Make it really funny and lighthearted (some articles) but also full of very practical tips that actually work (even if they aren't consistent with VA schemas about therapists that the system harbors) and make our jobs easier as therapists.
 
Last edited:
Fan_of_Meehl said:
I hear ya...the idea gets more and more tempting every day.
Click to expand...

Well....3 years with the VA, this last year was a kick in the balls every day I clock into work and it was motivation for me to do the hard work building my practice from scratch. Every day was motivation as I knew the kind of job I wanted....wasn't really out there, and is something I had to create myself.
 
Fan_of_Meehl said:
If the focus could be on psychotherapists in the system openly discussing issues (that are never discussed) and sharing positive strategies to proactively address these problems (and reduce burnout), it might be something I could agree to do. There are realities that are never openly discussed (and that never will be) that--once acknowledged and openly discussed--actually can lead to really effective changes in perspective/approaches of a therapist trying to survive and stay sane in the system. There are realities that just simply aren't ALLOWED to be true by the system and those who administer over it. Case in point, once I re-conceptualized my job as mainly one of accurately addressing the manifold species of active lack of engagement in the psychotherapy process that about 80% of my caseload was throwing at me and responding accordingly, I kind of made a breakthrough of sorts and developed my own developmental model of engagement and that has been really personally helpful. I've tried to share this model (and its success) but, so far, I haven't gotten any traction because I don't think that it is consistent with the lie (from the 'system') that almost no (if any) veterans have any issues with engagement in the therapy process, all the providers must just suck or be lazy, lol--which is a set of preconceived notions that just pervade the VA system (and even the journal articles on 'rolling out' the EBP's). Most of those articles just assess/examine things like therapist attitudes and institutional factors but completely ignore/downplay what I refer to as 'client-side' barriers to EBP uptake/engagement. I sit there in my office with my mouth open reading paragraphs of the experts talk about how there really aren't any client variables that relate to lack of EBP agreement/engagement and I just...can't...believe what I just read. I wish I could have a camera crew follow me around and record everything. My experience is that 99-100% of 'lack of engagement' in EBP protocols (that are, literally, offered to everyone in my caseload...multiple times per year, at least) is coming from the 'client-side' barriers. Meanwhile, in meeting after meeting, supervisors bemoan the low percentages of people doing EBP protocols in clinics, frowning and wagging fingers at us like we are misbehaving children who simply refuse to do our chores...and they either don't have a clue or are pretending not to.

It was a real moment of clarity recently when I was asking myself, 'why isn't my supervisor enthusiastic about these data that I just shared with them that--over the past year--I have 'handled' around 100 cases in my outpatient clinics (successfully) and maintained 100% weekly/biweekly sessions in my clinic and haven't gotten 'backed up' or 'behind' on cases? And the answer became so clear. They aren't actually interested in solving the access issues. They are just interested in maintaining the status quo, frowning/wagging fingers at us in meetings of how we fail to do our jobs, and going about their business. A real bummer...but strangely liberating at the same time.

So, even though they aren't going to say, 'wow...good work...maybe we could teach this to others and try to structure people's clinics to help enable them to see people weekly (episodes of care),' they also aren't fighting me on what I am doing in my clinics to reconceptualize/ evolve my approach to dealing with the issues of lack of engagement, either. They're not promoting my ideas/innovations...but they aren't (yet) 'fighting' me on them, either.

In the days before the American Revolution, people submitted papers to the local newspapers under pseudonyms (e.g., 'Seneca') rather than using their real names--that's how we got The Federalist and Anti-Federalist Papers. Maybe we could start an anonymous journal or something. Call it "Dr. StrangeHate: How I Learned to Stop Worrying and Love the No-Show." Make it really funny and lighthearted (some articles) but also full of very practical tips that actually work (even if they aren't consistent with VA schemas about therapists that the system harbors) and make our jobs easier as therapists.
Click to expand...
I love these ideas, especially writing under pseudonyms. I proposed that idea to a former colleague and joked that we could write under the names Locke and Demosthenes (as a cutesy nod to Enders Game and OSC) and start a blog called Psychologist Problems. I would be interested in making this a thing.

I also understand the anxiety about things getting back to your supervisors that could get you in trouble. A phone conference call could be another good option.
 
Fan_of_Meehl said:
Hell, Amazon has a decent Motivational Interviewing workbook you can direct him to complete between sessions. He reads the chapters and fills in the blanks and you review with him in session.
Click to expand...

Is this the one by Angela Wood? I'm always looking for more good worksheets!
 
I found out that there is going to be even MORE of a push to increase VA access (it's called sprint). Apparently primary care is first, with eventual plans for mental health. Yes, that's what we all think MH needs more of...
 
You must log in or register to reply here.

Similar threads

N
  • Poll Poll
Health Psychology: support and vent thread
Replies
39
Views
4K
oliversacks4thewin
oliversacks4thewin
N
Health Psychology Support Thread/Discord
Replies
5
Views
2K
nicolascagephd
N
Sanman
ProPublica Article on Mental Health
Replies
16
Views
2K
Therapist4Chnge
T
pinkbromeliad
Help from Non-VA Health System Providers: salary and negotiation
Replies
25
Views
3K
R. Matey
R. Matey
quickpsych
Education Department stops $1 billion in funding for school mental health
Replies
6
Views
1K
Shiori
Shiori
Top