A referral for someone who has no actual interest in therapy and some other provider just thought they’d benefit despite the patient stating they really weren’t all that interested and then the patient is wondering why they’re meeting with you? That’s been happening to me more lately.
Sorry to jump on, but this happened a lot in community health. And then also having to keep contacting people to get them to re-engage in therapy, I almost felt like I was harassing them and I'm not sure the same requirements happen in private practice. If someone doesn't want to come in, they don't want to come in.
You are correct. Administrative mandates/pressure to 'aggressively pursue' patients while they are passively (or sometimes actively) avoiding therapy is a symptom of a dysfunctional organization with such latent schemas as: 1) we know what is best for everyone; 2) providers are lazy and 3) if we weren't on top of hounding our providers to hound patients back into therapy, then the world would fall apart and everyone would kill themselves.
This might be a good time for me to restate my example of once VA patient (circa 2017) who threated to kill people if not helped. We went thru all the usual stuff at the session. He said if it didn't work he might "kill some people? He asked what would happen then. I told him he would go to jail, likely for the rest of his life. So, maybe he should shut the **** up with that kind of stuff before it gets him in serious trouble.
Had a veteran with service-connected PTSD I was doing therapy with (anger management workbook). He starts talking (half-serious, half-joking) about how if he killed someone that, because of his PTSD diagnosis, he would just claim 'insanity' and he believed that...I dunno...he wouldn't be prosecuted or something? I made a psychoeducational / reality-orienting comment to the effect of how difficult the 'insanity defense' is to utilize in cases of prosecution for killing someone and that PTSD wasn't really a diagnosis that was among those where people used that defense. He stuck to his guns claiming superior knowledge in the area at which point I essentially declined the offer to get in a debate with him by redirecting him to the therapy tasks/agenda at hand (after ensuring that he was, indeed, just 'kidding' and testing boundaries). Of course he backed off of it and said he was just joking (and this was almost certainly the case, given his clinical history, the context, the non-verbals, the high level of functioning and behavioral control, etc.). But I really do believe that veterans like this really do believe that they could 'kill someone and get away with it' and claim the 'blackout' PTSD defense and that, somehow, they'll get off Scot free.
I try to imagine how I would feel if I got a call from a behavioral health provider out of the blue that was like "So your doctor had some concerns about you, how about making a therapy appointment?" That's kind of really freaking weird and I don't think I would go back to that doctor or schedule an appointment with that therapist.
That's a sad one.
These are difficult/precarious cases to treat...and they're fairly frequent in VA outpatient. Vet with PTSD and severe alcohol use disorder (and other comorbidities). Frequent heavy alcohol use, 'blackouts,' anger outbursts. Clearly a volatile situation with significant long-term risks for something tragic happening at some point but veteran doesn't meet legal criteria for involuntary hospitalization acutely (which would probably destroy the therapeutic alliance at that point anyway). You just try to do the best treatment you can (when they show up for therapy), maintain/deepen the therapeutic relationship and try to leverage it to help them move forward...maybe sneak in a little practical risk-reduction efforts.
not specifically trauma therapy, but many send veterans over for "anger management"; upon interview these veterans have been court mandated to take anger management and are seeking a "certificate of completion" to show to a judge. i cringe at these referrals.
I do too. Haven't gotten many, but such a referral almost always means the veteran will be entering into 'therapy' only because they are being compelled and will, therefore, likely be stuck in pre-contemplation and be minimally invested in the therapy. However, for those who might be willing to work, I can offer them a CBT workbook on conceptualizing and dealing with anger in order to put some structure in place and have an objective body of therapeutic work that they can either actively engage (or not) and this can be documented.
Fully agree.
It’s not a WN post if he/she doesn’t mention their exorbitantly lucrative IME gig lol but my question is, based on your experience on both private and VA sides, are you saying this is a good time to open up a non-forensic private practice in Neuropsychology?
I would like to lay hands on the person who created that idea.
Definitely, money matters are embarrassingly underdiscussed in our field. And great response, thank you! I am in the process of making the switch, and I keep having doubts about my ability to build a steady and profitable caseload. Then you reminded us of the outrageous community waitlists and I feel empowered again, since I am accepting insurance. Thanks!
Good one! In addition to actually having a passion for the work I do, I'm so excited and ready for greener pastures! My big boy britches are beyond ready to hit the networking trail. Thank you again, these tips from seasoned pros are invaluable. I hope I am not derailing this thread but please keep them coming in other threads, I have bookmarked some of your other tips as well so I promise they are helping at least 1 person on here haha.
That lines up with what I know, although I’m unaware if it can be submitted before or not.
Thank you, AcronymAllergy! Yes! It will be a grade change. That makes sense now. I can see it gets auto rejected if the dates don't line up. So, I will be patient and wait until next month to remind my supervisor again 🙂
Thank you, summerbabe! Luckily, the HR people at my current VA facility are very responsive and stay on top of things. Hopefully, it will be processed pretty quickly here 🙂
Wait what… I don’t think I’ve ever seen VA HR and “responsive” and “on top of it” in the same sentence 🤯
You need to heap all possible praise on these people so they don't leave for other positions (which is almost inevitable). Buy them coffee, give them gift cards, bring them donuts. That, or see if you can somehow forward-date all HR-related paperwork you ever foresee yourself needing now so they'll go ahead and complete it for you.
Those pre-covid world tricks don't work. Most of these people went virtual, so you can never bother them again.
An AI algorithm with a VISTA interface would be preferable to the status quo
God bless you. Seriously...the stories I've heard/read about it are atrocious.
There are some 'employees' / departments at the VA whom you have to, literally, 'lay siege' to in order to finally get through to them and/or get them to help you (by doing their job).
When I started my current position I harassed HR nearly every day so they would file my FEHB on time so my benefits could start at the earliest possible moment. Some folks who started around the same time as me didn’t have their paperwork processed for months. I know folks whose grade increases were delayed several months and they had to resort to emailing every single day. Seems like the next step to get their attention is cold calling via Teams.
Sounds like a 'High Reliability Organization.' Checks out. I mean, I've been getting emails several times a week touting the VA as a 'High Reliability Organization' and I think one of them even asked that I make a pledge to do everything I can to ensure that we 'remain' such a 'High Reliability Organization.' LOL.
Has your direct supervisor/leadership in your new hiring dept been of any help? I imagine they would need to initiate some behind the scenes things to get something like a start date changed. Good luck!
That’s a good idea, I hadn’t thought to reach out because the start date thing was a new hiccup, and I had other questions for HR that don’t have anything to do w/new supervisor’s duties. Thank you for the suggestion!
I'm in a fully virtual VA role and love the flexibility to work in my own spaces and take my breaks as I see fit (laundry, pets, making food, etc). A VA iphone with Teams synced being a game changer to not always being tied to a desk. And shortening my morning and post-work routine, which I don't miss one bit.
I'm not in the VA system, but I can speak to running a virtual practice.
I like having control over my workspace, especially in terms of ergonomics and comfort. I like having easy access to my fridge and snacks and food delivery. I like being home to be able to sign for packages or take them in as they're delivered. I do not miss the commute at all.
