What Does It Take To Become A Celebrity Psychologist?

[smalltownpsych]

Many court clinics use the Rorschach, and the courts are sticklers for objective data. The Rorschach is also used at many major teaching hospitals. Insurance companies sometimes do, sometimes don't pay for projectives.

I don't think this is a black and white issue.

Was the black and white issue intended to be a bit of a pun? If so, pretty good. I always preferred the cards without colors myself. I know that one of my professors who was a respected forensic psychologist used the Exner system and never had a problem with courts. Any instrument can be challenged but in court it is about your own personal credibility as much as anything else. I don't use the Rorschach myself and have serious doubts about it's clinical utility, but I don't think it is all hocus pocus either. From my perspective, all measures require knowledge of the psychometrics in order to interpret and there is some evidence that our mental state affects our perceptions so the possibility does exist that a projective could have some utility.

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[Peacemaker36]

Yes, Smalltown, thanks for appreciating my off-color response

WisNeuro, I agree that the use of something is not evidence of its effectiveness (i.e., EMDR). I'm just saying that some experts who practice evidence-based interventions use the Rorschach. Schools are still teaching the inkblot for a reason. There's room for disagreement on this issue.

Personally, my last assessments occurred on internship, and I've hung up my blots for good. But when I refer a patient for psychological testing, I have to admit that I enjoy reading the Rorschach interpretation. Maybe it's a guilty pleasure.

 

[WisNeuro]

Evidence based interventions are awesome, I just want to see the evidence that matches up with the purported usage. Lot's of medical and psychological things persist against empirical reasoning. It still being taught is also not evidence of it's reliability/validity for these purported uses.

 

[LAPsyGuy]

When people assert that Rorschach can mean zilch to one clinician whereas it can mean something very insightful to another is actually a great argument for the invalidity of the tool...at least if we stuck to the same definition of psychological test (vs interesting parlor game).

 

[erg923]

Did you read the rest of this thread after that post?

 

[crazypsychstudent]

Imagine they actually do become a celebrity psychologist? Who will be laughing then? lol

 

[473912]

Imagine they actually do become a celebrity psychologist? Who will be laughing then? lol

I think we will still be laughing, they'll just be at the bank in their 2021 Bugatti when we do laugh at them. lol.

 

[erg923]

Imagine they actually do become a celebrity psychologist? Who will be laughing then? lol

No one.

 

[LAPsyGuy]

I'm in LA and know a few psychologists that see celebrities and lesser known people in the industry. It's possible, but I don't think their lives are any better or that they're making any more money. There's a documentary about Metallica that includes some footage of their concierge psychologist. Watch and enjoy.

 

[deleted656923]

No one.

^What he said

 

[Estee Lauder]

I don't want to be Dr. Drew nor Dr. Phil...I just want to move to Los Angeles after graduation and be a Personal Psychologist to a Celebrity. I know this is a bit unusual, but this is where my heart is at. Any suggestions?

I know this is an old post from 2015, but I think this is an awesome idea. I have thought of doing this myself as well. I am wondering if you acted upon this and have made some good forward progress.

 

[Estee Lauder]

I'm in LA and know a few psychologists that see celebrities and lesser known people in the industry. It's possible, but I don't think their lives are any better or that they're making any more money. There's a documentary about Metallica that includes some footage of their concierge psychologist. Watch and enjoy.

Concierge psychologist... that has a interesting ring to it.

 

[Estee Lauder]

Your heart needs a new place to go. Seriously. The work needs to be about the work, and not about being famous for treating famous people. Most "famous" clinicians are hacks, jerks, or a combination of the two.

Most psychologists have some level of aspirations, but it gets much dicier when you are in a treatment setting. There are a ton of ethical land mines around promoting yourself, using patient testimony, etc.

FWIW...celebrity types can be a nightmare to treat. I've treated/assessed various "famous" ppl/athletes, and it is more hassle than anything else. They are often out of touch with what is "normal", are resistant to feedback, and are non-compliant w treatment recommendations. Not all, but far more than the Average Joe/Jane.

**I also love my auto-correct bc my iPhone kept changing "treat" to "test"...which is actually far more accurate to my day to day work. Touché auto-correct! **

Is that the reason why they need treatment, i.e. out of touch with reality. Isn't that the undertone of why there are psychologist. Anyone can be a nightmare. I have met a few.

 

[Estee Lauder]

Ellen? You mean the person that danced with candidate Obama? She's so last presidency. I'd suggest getting down with reality TV. Get on Hoarders or Ru Paul's Drag Race. See if you can intern on SVU/CSI. Profit.

Hoarders is a good idea. it is depressing to see the depressed and this disorder play out.

 

[Rick4001s]

Show me the efficacy data. Show me where it improves treatment outcomes. I always ask for this data and no one can produce anything. I don't want opinion, I want empirical data.

From your moniker, I'm guessing that you use the WAIS-IV. Can you point me to the empirical data indicating that it "improves treatment outcomes"?

It's simply scientifically dishonest to claim that there are no validity data for the Rorschach. E.g.:

http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1999-11130-005

My favorite part of that interchange is in the followups from Woods and Garb trying to lecture Robert Rosenthal on conducting meta-analyses....dudes, he literally wrote the book.

Despite their obvious slant, even Woods and Garb acknowledge the validity of the Rorschach for certain purposes:

http://www.srmhp.org/0202/focus.html

So, if you're a neuropsychologist, certainly thought disorder would on occasion be a critical differential diagnosis. What thought disorder assessment do you recommend based upon "empirical data"? The Rorschach has extensive research support for this purpose, as acknowledged by Garb and Woods. What has more?

 

[WisNeuro]

Whoah, resurrecting this zombie, and starting off with a strawman to boot! There are two things that the Rorschach purports to be able to do, measure depression and thought disorder. I generally don't need to waste 3 hours finding out if someone is depressed. And, generally, don't need to waste that time finding hints of thought disorder given a thorough background interview with additional collateral information. In teh few times I've seen this dying instrument used, people make wild claims that have zero support from anything in the patient history. It's more a projective test for the examiner than it is for the examinee. If you want to use this, by all means, move to the East coast or NY, no one will stop you from reading your tea leaves, my man.

 

[erg923]

From your moniker, I'm guessing that you use the WAIS-IV. Can you point me to the empirical data indicating that it "improves treatment outcomes"?

It's simply scientifically dishonest to claim that there are no validity data for the Rorschach. E.g.:

http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1999-11130-005

My favorite part of that interchange is in the followups from Woods and Garb trying to lecture Robert Rosenthal on conducting meta-analyses....dudes, he literally wrote the book.

Despite their obvious slant, even Woods and Garb acknowledge the validity of the Rorschach for certain purposes:

http://www.srmhp.org/0202/focus.html

So, if you're a neuropsychologist, certainly thought disorder would on occasion be a critical differential diagnosis. What thought disorder assessment do you recommend based upon "empirical data"? The Rorschach has extensive research support for this purpose, as acknowledged by Garb and Woods. What has more?

Who pays for the Rorschach? Most major carriers utilize interqual these days for determining medical necessity and appropriateness.

 

[Rick4001s]

Whoah, resurrecting this zombie, and starting off with a strawman to boot!

It does seem to be an old thread but the issues remain, namely the need to be better informed about what is an "empirically supported assessment". If you say "I want empirical data", providing the empirical data is hardly a straw man argument.

The question still remains about finding a better validated standardized indicator of thought disorder. You can say:

And, generally, don't need to waste that time finding hints of thought disorder given a thorough background interview with additional collateral information.

In other words, you believe that your clinical judgment suffices in that assessment, but I probably don't need to remind you of the literature on the limitations in that approach. A number of experienced clinicians can probably estimate FSIQ within a reasonable margin after a background interview with collateral information, but that doesn't mean we should rely on that in a high stakes situation in order to save the 2.5 hours of the WAIS.

 

[WisNeuro]

No, the WAIS question was the strawman. It is entirely irrelevant to the question at hand. Regarding the though disorder component, what does the Rorschach use as a gold standard from which to judge its own validity?

 

[Rick4001s]

No, the WAIS question was the strawman. It is entirely irrelevant to the question at hand. Regarding the though disorder component, what does the Rorschach use as a gold standard from which to judge its own validity?

With respect to "gold standards", I'll refer you to Cronbach and Meehl, and I'll fight the impulse to pose the same question about the WAIS:

http://psychcentral.com/classics/Cronbach/construct.htm

With respect to sensitivity to thought disorder, the Woods and Garb summary cited earlier provided a number of citations, even though they are highly skeptical of the instrument. This is from their summary:

There is abundant evidence that two kinds of Rorschach scores are related to psychotic disorders. First, as Hermann Rorschach (1921/1964) noted, the inkblot responses of patients with schizophrenia often exhibit poor form quality (Rieman, 1953; Sherman, 1952; see reviews by Frank, 1990; Goldfried, Stricker, & Weiner, 1971). That is, the images reported by these patients often do not “fit” the shape of the blots. Form quality is also poor among many patients with bipolar disorder (Frank, 1990).

Second, as David Rapaport and his colleagues (1946) first noted in their famous book Diagnostic Psychological Testing, the Rorschach can be used to identify thought disorder, the disorganized cognition and peculiarities of language exhibited by many patients with schizophrenia. Several scoring methods have been developed to measure thought disorder on the Rorschach (for reviews, see Aronow & Reznikoff, 1976; Goldfried et al., 1971; Kleiger, 1999), the most prominent being the Thought Disorder Index (Johnston & Holzman, 1979; Solovay et al., 1986), the TETRAUT of the Logical Rorschach (Wagner, 2001), and the Weighted Sum (WSum6) of the Comprehensive System for the Rorschach (Exner, 2003). The Comprehensive System’s Schizophrenia Index (revised recently as the Perceptual Thinking Index) combines scores for thought disorder and form quality (Exner, 2003).

Research has shown that all these scores are related to schizophrenia (Greaves, 2000; Johnston & Holzman, 1979; Jorgensen, Andersen, & Dam, 2000; Kleiger, 1999; Wagner, 1998; 2001). Many patients with schizotypal personality disorder and bipolar disorder in the manic phase also apparently exhibit thought disorder on the Rorschach (Coleman, Levy, Lenzenweger, & Holzman, 1996; Singer & Brabender, 1993).

The Rorschach—particularly the Thought Disorder Index—has proven useful to researchers who examine genetic and familial patterns of schizophrenia (e.g., Knight & Silverstein, 1998; Lenzenweger, 1998).

There is no doubt in my mind that certain Rorschach users presume validity for purposes for which it has little if any empirical support. But equally irksome to me are others that presume it has no validity for anything, in the face of considerable evidence to the contrary. If I'm designing an intervention to reduce thought disorder, I'd want to measure it with something a lot better evidenced than raw clinical judgment.

 

[WisNeuro]

Side stepping the question. The studies purporting the "validity" of this garbage instrument used whether or not it differentiates normal people from those hospitalized with schizophrenia. Information easily accessible from chart review and interview. No need for 3 hours of useless examination. Your presumption of the "validity" of the Rorschach is built solely on pre-existing diagnoses and raw clinical judgment.

Seriously, keep using if you want. No one will stop you. Just like no one will stop the ensuing professional scorn from its use. Although, as erg said, you may have problems getting reimbursed for it seeing as insurance companies sometimes give a damn about evidence base.

 

[BuckeyeLove]

Words can't describe how excited I am that this thread got bumped again.

 

[WisNeuro]

Words can't describe how excited I am that this thread got bumped again.

I'm just hoping a MBTI apologist jumps into the mix.

 

[Therapist4Chnge]

I'm just hoping a MBTI apologist jumps into the mix.

I'm years out of practice to argue about projective measures, but I'm always up for a good MBTI discussion.

 

[smalltownpsych]

If I was going to be a psychologist for celebrities, maybe I would need to have a Rorschach in my assessment closet. Maybe do a little bit of profiling and some hypnotic regression to free up repressed memories too. I mean after all, that's how they do it on tv.

In other words, aside from the lack of clinical utility, I also don't like the way that it feeds into inaccurate and often unhelpful stereotypes.

 

[WisNeuro]

I'm years out of practice to argue about projective measures, but I'm always up for a good MBTI discussion.

ZOMG!!! You must be an INTJ too!

 

[Rick4001s]

....insurance companies sometimes give a damn about evidence base.

So far, the only "evidence" I've seen in this discussion involves peer-reviewed articles that I've cited. But, whatever.

 

[WisNeuro]

Meh, this has been argued ad infinitum in other threads, I don't care enough to dig it up. I have more important things to do to waste my free time at work today, like evaluating off-season trade targets for my favorite MLB team. Do a search if you want. At this point, it's like debating a creationist. It just gives them a false sense of credence.

 

[Rick4001s]

Do a search if you want. At this point, it's like debating a creationist. It just gives them a false sense of credence.

I don't think a creationist would do something like cite a meta-analysis on Rorschach validity by Robert Rosenthal, who won the Gold Medal for Life Achievement in Science from APA, is a member of the American Academy of Arts and Sciences and the winner of their prize for Behavioral Science Research, and who was one of the most cited psychologists of the past century. But, heck, all that recognition probably gives him a false sense of credence.

The data are out there, and supposedly our profession trains people to evaluate it in an objective way.

 

[erg923]

So far, the only "evidence" I've seen in this discussion involves peer-reviewed articles that I've cited. But, whatever.

Who pays for the Rorschach? I dont work for free.

 

[WisNeuro]

The data are indeed out there, and the validity criticisms still stand. Citing one meta-analysis, that contains flawed studies does nothing to combat that. Appealing to authority is meaningless as well, considering the opposing side has luminaries that are just as decorated, just a logical fallacy. On top of that, no one has addressed the obvious problems of it being a time consuming test that only purports to do two things kind of well, of which we can measure by cheaper, easier, and more valid ways. Simple, really.

 

[erg923]

I don't think a creationist would do something like cite a meta-analysis on Rorschach validity by Robert Rosenthal, who won the Gold Medal for Life Achievement in Science from APA, is a member of the American Academy of Arts and Sciences and the winner of their prize for Behavioral Science Research, and who was one of the most cited psychologists of the past century. But, heck, all that recognition probably gives him a false sense of credence.

The data are out there, and supposedly our profession trains people to evaluate it in an objective way.

And why do rorschachers always seem to have the idol worship thing going on. As if these people could do know wrong in their rorschachery just because APA gave them a medal, or they "wrote the book" on this thing or that thing. L Ron Hubbard wrote a book too.

 

[WisNeuro]

Meh, if the data don't support you, might as well throw out some luminaries who are biased towards the instrument.

 

[BuckeyeLove]

I'd be worried utilizing any instrument that you can access the stimuli as well as popular responses on Wikipedia...but that's just me.

 

[WisNeuro]

I'd be worried utilizing any instrument that you can access the stimuli as well as popular responses on Wikipedia...but that's just me.

Nah, I'm sure it has stellar performance/symptom validity indicators...

 

[Rick4001s]

And why do rorschachers always seem to have the idol worship thing going on. As if these people could do know wrong in their rorschachery just because APA gave them a medal, or they "wrote the book" on this thing or that thing. L Ron Hubbard wrote a book too.

No idol worship, just citing peer-reviewed research from credible sources that are hardly "creationists", let alone "biased towards the instrument" (I'd be curious to see the evidence for that claim in regards to Rosenthal). If people around here are going to spout off about "empirically supported", they should know the literature before making pronouncements about "garbage". If the Rorschach is a "garbage" assessment of thought disorder, then cite the relevant literature supporting that claim. If you can't, then don't offer claims outside of your area of expertise. If you can't evaluate the difference between peer reviewed research and L. Ron Hubbard, you should be waiting for a spaceship somewhere, not practicing psychology.

 

[WisNeuro]

Coupe things, this has been debated before, feel free to search. Second, most of us don't care enough to go do a lit review and write a mini review paper. We've already done this in the past as students. We're grown ups now, people pay us to do this **** at this point. I'm not going to spend hours redoing research to kick a dying instrument. There are no stakes in it for us at this point. Especially in my practice. I've lived and worked in 4 different states in 3 geographical regions. I've never seen it used in a paid clinical evaluation. It's right where it should be, on the trash heap of history, relegated to the parlor game it was meant to be.

 

[Rick4001s]

Coupe things, this has been debated before, feel free to search. Second, most of us don't care enough to go do a lit review and write a mini review paper. We've already done this in the past as students. We're grown ups now, people pay us to do this **** at this point. I'm not going to spend hours redoing research to kick a dying instrument. There are no stakes in it for us at this point. Especially in my practice. I've lived and worked in 4 different states in 3 geographical regions. I've never seen it used in a paid clinical evaluation. It's right where it should be, on the trash heap of history, relegated to the parlor game it was meant to be.

If I wanted to learn the details about these issues, I don't think a search of internet forums is the best place to start. As for the claim that it is a dying instrument, it's still being examined in recent meta-analyses, e.g. Mihura et al (2013) Psych Bull 139, 548-605. And the notorious anti-Rorschach crowd Wood, Garb, Lilienfeld et al (2015 Psych Bull 141, 236-249) wrote in response: "First, we agree there is compelling evidence that 4 categories of cognitive scores-the "Rorschach cognitive quartet"-are related to cognitive ability/impairment and thought disorder. We now feel comfortable endorsing the use of these scores in some applied and research settings." If that group can accept that conclusion, it's unclear what it would take for you to do so.

Regarding anecdotes about usage, there are other issues involved in assessment use, selection, and research besides what approach pays the best. Do whatever strikes you as the best balance of efficiency and validity; I understand the constraints, but other people do different work than you do. Regardless, describing the technique as "trash" and "garbage" is endorsing a studied ignorance of the research database--hardly consistent with the "empirically supported" concept.

 

[smalltownpsych]

Just figured I needed to point out that this conversation has really gone far afield from the incredibly important original thread topic.
(I really just wanted a chance to use that emoticon)

 

[WisNeuro]

Report back in 10 years about the resurgence of this crippled dinosaur. Good luck in the crusade. But, I ultimately agree with STP, we've gone far astray. Now I'm wondering if what's her face that started this thread ever became bff's with a Kardashian.

 

[erg923]

No idol worship, just citing peer-reviewed research from credible sources that are hardly "creationists", let alone "biased towards the instrument" (I'd be curious to see the evidence for that claim in regards to Rosenthal). If people around here are going to spout off about "empirically supported", they should know the literature before making pronouncements about "garbage". If the Rorschach is a "garbage" assessment of thought disorder, then cite the relevant literature supporting that claim. If you can't, then don't offer claims outside of your area of expertise. If you can't evaluate the difference between peer reviewed research and L. Ron Hubbard, you should be waiting for a spaceship somewhere, not practicing psychology.

I don't care about any of this. I want to know who pays for the administration, scoring and interpretation of this instrument because I want to make money when I work, not lose it.

 

[Rick4001s]

I don't care about any of this. I want to know who pays for the administration, scoring and interpretation of this instrument because I want to make money when I work, not lose it.

Seems to me we should ALL care. The discipline and individual practitioners should be pressing to use the best validated approaches for what we seek to accomplish. Insurance companies strive to make a profit, and prioritize cost-efficiency. If we let insurance companies lead fully in this dance, then in Wis's 10-year update we'll discover that the field is a bunch of bachelor's level people doing heavily manualized CBT after administering a 10 item symptom checklist. If a practitioner feels, based upon the research documented in the aforementioned citations in the flagship journals of APA, that a Rorschach might help clarify issues of thought disorder prior to engaging the patient in a long-term treatment with potentially serious side effect profiles (such as many antipsychotics), I hold the perhaps naive hope that the discipline would support that decision and that our health care system would pay for the assessment as readily as they would pay for the pharmaceuticals.

 

[smalltownpsych]

Report back in 10 years about the resurgence of this crippled dinosaur. Good luck in the crusade. But, I ultimately agree with STP, we've gone far astray. Now I'm wondering if what's her face that started this thread ever became bff's with a Kardashian.

I have worked with celebrities myself. They are just like my other patients except they have an entourage. People might describe the celebs as having an exaggerated sense of entitlement, but the truth is that many of my patients can be even more entitled with perhaps even less reason. Any work with "disabled" substance users will give you a good flavor for that.

 

[WisNeuro]

Dude, no one gets a thorough evaluation before being given anti-psychotics. Have you worked in any SMI settings? That person is lucky to get a 30 minute psychiatry consultation before getting the script, let along a 3 hour long lame albatross of an evaluation.

 

[WisNeuro]

I have worked with celebrities myself. They are just like my other patients except they have an entourage. People might describe the celebs as having an exaggerated sense of entitlement, but the truth is that many of my patients can be even more entitled with perhaps even less reason. Any work with "disabled" substance users will give you a good flavor for that.

Don't need celebrity to get entitlement, just work with a mTBI population.

 

[smalltownpsych]

Dude, no one gets a thorough evaluation before being given anti-psychotics. Have you worked in any SMI settings? That person is lucky to get a 30 minute psychiatry consultation before getting the script, let along a 3 hour long lame albatross of an evaluation.

Patient is brought to our ED by local police because they were shouting jibberish at local business. After ten minutes of spouting conspiracies and responding to unseen others, I tell the EM physician, "yep they are psychotic.". The EM doc prescribes IM halperidol or seroquel or geodon depending on their preference and I come back in the a.m. to see if we can begin figuring out discharge plan. No inkblots are needed.

To be fair, I did administer a Rorschach during a practicum that did reveal psychotic thought processes as the patient completely decompensated during the administration. Scary how quickly it happened and amazing how he had hidden it on the unit and during superficial diagnostic interviews. Subsequent to that, however, I have found that a bit of key probing in diagnostic interviews can achieve similar results.

 

[WisNeuro]

Patient is brought to our ED by local police because they were shouting jibberish at local business. After ten minutes of spouting conspiracies and responding to unseen others, I tell the EM physician, "yep they are psychotic.". The EM doc prescribes IM halperidol or seroquel or geodon depending on their preference and I come back in the a.m. to see if we can begin figuring out discharge plan. No inkblots are needed.

Are you sure it was florid psychosis? How could you tell without a 3 hour evaluation?

 

[erg923]

Seems to me we should ALL care. The discipline and individual practitioners should be pressing to use the best validated approaches for what we seek to accomplish. Insurance companies strive to make a profit, and prioritize cost-efficiency. If we let insurance companies lead fully in this dance, then in Wis's 10-year update we'll discover that the field is a bunch of bachelor's level people doing heavily manualized CBT after administering a 10 item symptom checklist. If a practitioner feels, based upon the research documented in the aforementioned citations in the flagship journals of APA, that a Rorschach might help clarify issues of thought disorder prior to engaging the patient in a long-term treatment with potentially serious side effect profiles (such as many antipsychotics), I hold the perhaps naive hope that the discipline would support that decision and that our health care system would pay for the assessment as readily as they would pay for the pharmaceuticals.

That ship sailed...like 15-20 years ago. nYou want to spend your (unpaid) time writing appeal letters to BCBS, be my guest. I, however, am more than happy to evolve my practice and my approach to doing business.

The force is strong in you, I get it. But, unless you have been working under a rock for the last decade, you know that quetiapine is handed-out like candy. There is little (although not nothing) you can do about it. Proposing a Rorschach administration on all your peeps will not help you in this endeavor. I would highly suggest your adapt your approach.

 

[Therapist4Chnge]

That ship sailed...like 15-20 years ago.

You want to spend your (unpaid) time writing appeal letters to BCBS, be my guest.

Yup.

Off to cash pay land or figure out how to survive in a system bc taking insurance and being in PP is a rough existence going forward.

I'm looking cash pay + admin/non-clinic for the future. No sense fighting over a shrinking pie.

 

[Sanman]

Yup.

Off to cash pay land or figure out how to survive in a system bc taking insurance and being in PP is a rough existence going forward.

I'm looking cash pay + admin/non-clinic for the future. No sense fighting over a shrinking pie.

Agreed on the cash pay move, playing with cash pay models myself. As much as people see socialized medicine as poor care, we are already there. My medicare/insurance clients end up with largely supportive care due to the lack of support, time, and money for proper ebt therapies. Those that can afford to pay out of pocket in PP will get proper ebt offerings. Most others get a watered down version due to lack of proper prep time. At least in my experience. I am getting tired of watered down.