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I work as a mental health therapist. My focus is on cognitive development, and most of my clients are children on the autism spectrum, have an educational disability, a traumatic brain injury, or some other form of cognitive abnormality. However, I have had experience treating clients within the range of anxious about their upcoming exam to pervasive mental illnesses like schizophrenia. In the past I have worked as a crisis interventionist, prevention researcher, and academic counselor. The environments I have worked in are non-profit agencies, schools, and universities. I'm not personally familiar with private practice, but I have many friends who do private practice. "Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change and overcome problems in desired ways." There are several popular approaches to therapy, most I am familiar with. Ask me questions about life, therapist education, or seeking therapy.
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Oct 18, 2016 05:32
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This should be an awesome thread. I've been a psych patient of various sorts for...good god, tomorrow marks 17 years of continuing psych care at some level, and 20 years intermittent. Inpatient, outpatient, intensive outpatient (not necessarily in that order). Considering I'm 32, yeah, I've been in the psych milieu for longer than I'd ordinarily admit. So I will probably have tons of questions, someone please slap me if I seem to dominate things - I don't want to, one of the awesome things about A/T threads is that there's usually a diversity of perspectives. First off, the usual standard starter questions: 1. What got you into mental health therapy as a career? 2. PhD, PsyD, LCSW, what kinda mental health therapist are you?  3. What the hell makes CBT so popular as the "miracle pill" approach to psychotherapy? (Personally, I prefer my current psychologist (who I've seen continuously for nearly 16 years, Jesus Christ self) and his more humanistic/freestyle approach (he fully admits he kind of doesn't pay attention to the theoretical boundaries between approaches), but I know because he's older I've been keeping an eye out for possible other shrinks for when he retires...and going by websites, it seems like everybody does CBT nowadays, which never worked for me.  )And a question on a personal note: 4. I'm disabled as gently caress, both in obvious ways (blind in one eye, practically blind in the other (10 degrees central visual field, 20/80 corrected vision at distance...At least my closeup vision doesn't suck?) and not-obvious ways (have a light case of cerebral palsy, and other stuff besides) - and my psychologist admits that I was one of his first disabled patients, and still rare in the sense of being disabled. I can guess why in his case - if it weren't for really good insurance gotten through my dad and the government, no way I could ever afford it. But it seems like even newer therapists, even the ones who take medicaid (rare as hell I know), have very little exposure to live patients with disabilities, if talking to other disabled folks is any guide. What's with that?
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Oct 18, 2016 13:53
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1. During high school I had a difficult time with anxiety and coping with a neurological disorder (cluster headaches), and went through my own therapy for two years before college. At university I originally started out in early childhood and elementary education following in what is a family education legacy. Most of my relatives are in the education field. I noticed I enjoyed working one on one with students far more than in a classroom setting, and focused a lot of my time in special education, but found there was more going on with some students and their family life. This resonated with me, having my own struggles before impact my education. I switched directions and focused on developmental psychology. A lot of the influence comes from family and my own personal journey, but mostly the fact that I really enjoy working with kids and young adults because the changes I see when they learn new ways of being in the world are quicker, stick better, and allows me to give a gift that I was given at a time in my own development. 2. I'm a Clinical Psychology Ph.D student. My masters is in Counseling Psychology, so I'm considered a QMHP and LPC. I'm not licensed to diagnose, so I practice under my supervisors license and they do the legal diagnosis for clients I see based on my reports. The difference between Clinical and Counseling psychology isn't huge, but basically clinical deals with psychopathology more and counseling deals with declining mental health or life stress, but not to the point of mental illness yet. 3. CBT is extremely popular for a few reasons. First, it is shorter than most treatments and therefor it has been studied more, so is more 'evidence based'. More proof that it works and fewer sessions means that insurance is likely to cover it because it saves them from billable hours. Therapists like it because it's easy to work with insurance and almost any of their clients can qualify to get 10 or so sessions covered. Think of CBT as aspirin. If you call your doc and say you're in pain, it's going to cost a lot less for him to tell you to take two aspirin and call back tomorrow, and it's not going to cause much harm to try that first. If it doesn't work, you can always increase treatment. Healthcare providers can actually be charged criminally and lose a license for waste, fraud, and abuse if we provide unnecessary or excessive treatments to line our pocket books or increase prestige. Most therapists are eclectic, pragmatic, and integrative. It's not surprising to me that if you are a long-term client your therapist utilizes many approaches, and that's a good sign. 4. That's good that your psychologist admitted to having little experience with disability, it shows quality and attests to his humanistic approach. I'm going to throw out an idea about the problem of disability inexperienced therapists, and let's see if it sticks. Disabled folks face a variety of oppression because our society values some bodies over others (i.e. race, gender, ect...), and because of this they are more likely to face accessibility issues. This leads to lower formal education achievement, lower income, and unfortunately in this case higher rates of mental illness -- on a population level. Therapy is seen by many to be a luxury health care expense. If you're already spending a ton of money on healthcare because of your disability, have a low income in the first place, and on top of that are just dealing with life the best you can with your disability - mental health may be low on your priority list. In terms of Maslow's Hierarchy of Needs, most disabled folks are focused on adapting their basic needs to a society that is set up for people with a different set of basic needs (i.e. stairs), there isn't much energy left over for deep emotional exploration -- in a sense 'don't fix what seems to be working' and even more so if you spent your life figuring out how your 'working' works. So less disabled folks access therapy services, most who do go to specialists, so those who aren't specialized don't have much face time with disabled clients. This leads to them being inexperienced. However, I don't think inexperience is an excuse for ignorance. Therapists are responsible for understanding the dynamics of living with a disability as it is part of the human experience. clam the FUCK down fucked around with this message at 04:55 on Oct 19, 2016 |
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Oct 18, 2016 21:59
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How much does the SA Forums remind you of your patient population?
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Oct 18, 2016 22:43
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What are your thoughts on EMDR?
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Oct 18, 2016 23:30
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I have a question that probably gets a little too close to 'Requesting Medical Advice Over The Internet™', but... I have this problem, and have had it for at least a couple years now, where I often am kept up at night thinking about 'stuff'. 'Stuff' in this case is anything from somewhat rational to totally irrational. Rational things include like: 'I haven't been to a dentist in at 6 years. The Dentist visit I have scheduled in the next few weeks is going to be very expensive and probably painful and this sucks' or 'I feel like I could be doing more for my career but cannot motivate myself to do start something that might not pay off ever, and if it does, it'd be at least a couple years down the road. I like my current position as well, so it's that much harder to motivate myself and this sucks.' To the totally irrational: 'It'd really suck if a Black Hole just hits Earth tomorrow. That'd suck!' and 'What if a way to live significantly longer is developed in my lifetime and I take this therapy and it ends up being a terrible existence!' Really it doesn't matter what I think about, it generally is something that causes me a lot of anxiety in the moment - so much so that I literally cannot sleep. When I'm 'awake', these things do not trouble me at all and I rarely even think about them, or at least think about them more productively. My favorite method to get me to sleep is to put on a random TV show with a lot of dialogue. As long as my head is preoccupied with something else, in this case, half-listening to dialogue, I can dodge that anxiety, but if it's quiet, or even if there is white-noise, those thoughts tend to creep up. So my question then is, 'Is this something a person should see a psychologist about? Am I inviting some long-term mental problems by just 'dodging' this issue?'
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Oct 19, 2016 01:26
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OP, you might want to take your answer out of the quote attributed to me (awesome answers though, thanks!). Canine...A quick rule of thumb I use as a patient: Is this impairing my social, occupational, academic, etc functioning in any significant degree (and avoiding medical/dental care is definitely impairment)? If yes, then by God see a professional. If there's even a chance it's something serious, a copay for an outpatient visit to a therapist or psychologist or psychiatrist (presuming you can find one who takes insurance which is a separate issue) or even paying cash for a visit...Is fuckloads cheaper than letting it fester. Because if it is a mental illness, one key thing to remember about mental illness is that almost all of them are progressive when untreated. Meaning they get worse. And get worse is not-infrequently code for "Can make you end up institutionalized or dead". And treating it later in the progression means you spend much more time and money treating it. (Yes I am an unabashed promoter of psychiatry. It works better than pretty much every alternative in its space.)
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Oct 19, 2016 02:35
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Trillian posted:How much does the SA Forums remind you of your patient population? I can't tell much from reading text. The only times I've had red flags go up is when reading E/N posts about situations or environments goons are living in that are likely to gently caress up their mental health. TCC is an entirely different area, and unsurprisingly most fall into some substance abuse categories -- also drugs / addiction can gently caress up your mental health like no other. It's really frustrating to me to deal with substance abuse disorders, and there's reason I didn't go into addiction counseling. It's hard to tell if someone is acting one way because of drugs or a mental illness. For example, a lot of meth users run around with improper diagnoses of schizophrenia when if they would just detox from meth they would probably be fine. Shoren posted:What are your thoughts on EMDR? Good, but tricky question. A problem exists in the researching of new approaches to therapy. It's difficult to distinguish if the new therapy is just a re-branding of old tried-and-true methods (relaxation, psychoeducation, therapeutic environment and relationships, placebo) or if the new therapy is really adding something to what we already know. This determination is done using statistics and literature reviews. EMDR is currently trying to solve this problem. It's more effective for some things (such as trauma) in the numbers, but why it works isn't apparent. None of the proposed theories hold much salt scientifically. So while it does 'work', we don't know why it does. For me that means it's probably just a strong placebo. However, a placebo effect is still an effect, especially in psychology. There are thousands of 'therapies' so it's important to be skeptical of anyone claiming they have anything new to offer. The work of psychotherapy has been around in one way or another for most of history (see inquisition, shamanism, confession, oracles). What I'm reading seems like anxiety. If left to spiral, anxiety can definitely cause problems. This is an extreme example, but look at 'Shell Shock' from WWI veterans to see what months of holding the thought of 'I could die at any moment' in your head can do. It's extremely stressful on the brain(see: PTSD). Unfortunately, anxiety can spiral. Sleepless nights turn into a lack of sleep, which turns into fatigue, not eating well, not exercising, limiting social interactions. All of this worsens anxiety. The fear of God has been put into me when it comes to talking about medication My internet stranger advice is you probably don't need to see a psychologist (PhD). If you are comfortable taking medications, your general practitioner could prescribe something, but keep in mind one possible medication option is benzos (super addictive -- so stay clear if you know yourself to struggle with that). A licensed professional counselor is probably the level of therapist you would want to see, they commonly deal with anxiety. You could also integrate some anxiety reducing behaviors into your daily life https://www.adaa.org/tips-manage-anxiety-and-stress. So full-on treatment plan wise, go see a GP and tell them about your anxiety issues. Request medication for anxiety reduction or sleep if you're comfortable with trying medication . Get a referral to an LPC. They will probably see you for 10 sessions depending on insurance. Try and include some mental health behaviors into your daily living habits. clam the FUCK down fucked around with this message at 05:49 on Oct 19, 2016 |
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Oct 19, 2016 05:41
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Can you tell me how you tailor your approach for working with a lower functioning population? Can you give us a summary of what a regular visit with a client would look like?
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Oct 20, 2016 17:03
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I've got a question that doesn't involve describing symptoms over the internet, OP. What do you think of what this guy says?
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Oct 20, 2016 18:35
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JohnsonsJohnson posted:Can you tell me how you tailor your approach for working with a lower functioning population? The phrase "meet them where they are at" gets passed around a lot between therapists. We are usually at a higher level of education, wealth, and social status than the clients we treat. We have advanced training in how to manipulate conversations and encourage certain thinking and behavior over others. It's a lot of power, and a major need in therapy is to be able to join together with your client. That's not going to work if you act like you have that 7-10 years of higher education, a brand new espresso machine, and the admiration of clergy, school principals, local politicians, and most of all the legal system. Sometimes my signature can land someone back in jail, in the hospital, or to not go back to work. It's important to understand that power and how easy it is to come off as an authority figure. It's also important not to rush someone just because you as a person trained in psychology have a more robust coping strategy. A typical first session will be an information exchange and building rapport with the client. This is when insurance is setup, history is discussed, and the plan is laid down. Nothing very therapeutic occurs here aside from trying to get the client motivated to engage in treatment and feel like they had a part in designing the plan. This session will often be longer (1-2 hours), I'll do risk assessments if I feel they are necessary (i.e. client uses phrases like "I just can't take it anymore"), get other providers names (doctors, past therapists), emergency contacts and insurance, get to know the client's demographics and day-to-day life. Usually 50% of that time will be discussing the issue, but without going too deep. I'll talk a bit about what I think would be a good plan and see if they agree or want to change things. If it's a high risk client we may meet three times a week. If it's just some light test anxiety issues we may meet once a month between testing with a lot of home exercises. I can only really say how the typical first session is because every session after varies a lot. Often I'll start with a type of therapy I think may work like Motivational Interviewing, but need to quickly change to Dialectical Behavioral Therapy if they aren't responding. It's extremely dynamic. ALL-PRO SEXMAN posted:I've got a question that doesn't involve describing symptoms over the internet, OP. What do you think of what this guy says? The difficulty with many aspects of psychoanalysis is they are not falsifiable, and therefor not 'evidence based' because no research with valid scientific methods can back it up. However, Freud never claimed to be doing rigorous science, and many psychoanalysts don't. Most therapists are trained as scientist-practitioners now, and gain skills that allows them to create their eclectic own approach from the literature. One thing I enjoy about the profession is it gives a lot of flexibility to developing your own style. Those who do the more 'artistic' thing and do psychoanalysis are not going to get a lot of insurance coverage and possibly be much more expensive to go to. I'm not saying psychoanalysis doesn't work, it can, but the way it's set up doesn't lend itself to easily discovering why it works when it does. Some would call it a psuedoscience, but it doesn't claim to be a psuedoscience in the same way that a good movie doesn't claim to be science but can still have a very real impact in the world.
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Oct 23, 2016 09:15
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What do you think of the efficacy of mindfulness meditation and techniques for tackling anxiety? These seem to be increasingly popular from what I can tell. I've given meditation a try (guided by a proffesional shrink) and it's kind of nice and all but with it originating as a religious practice it's hard not to be sceptical
Surprise Giraffe fucked around with this message at 15:26 on Nov 15, 2016 |
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Nov 14, 2016 13:36
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How often do you have patients whom you feel unable to help after several sessions? How do you deal with that?
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Nov 15, 2016 02:00
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This is sort of a dumb question, but if I've gotten a list of therapists in the area from my insurance company, should I just call them direct? Or do you need a referral?
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Nov 15, 2016 09:00
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Surprise Giraffe posted:What do you think of the efficacy of mindfulness meditation and techniques for tackling anxiety? These seem to be increasingly popular from what I can tell. I've given meditation a try (guided by a proffesional shrink) and it's kind of nice and all but with it originating as a religious practice it's hard not to be sceptical Maybe the mindfulness and meditation worked and religious practices grew around them...
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Nov 15, 2016 16:35
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I guess this ties into Kuiperdolin's question, but how often do you change your approach to a patient if you feel what you are doing isn't working? Can you tell if you have patients that are too reticent or unwilling to ask for something else if they feel they want to try something different? I ask because I've been seeing a therapist for a few months to help with my depression and every session seems to be the same: The therapist sits in near silence and I just talk. Occasionally he will make a remark about something but it doesn't feel like we're getting to anything or making progress. I'm too unfamiliar with the process to tell if this is something that is supposed to happen or if he's just taking my money and that is slightly worrisome.
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Nov 15, 2016 17:39
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Chip McFuck posted:I guess this ties into Kuiperdolin's question, but how often do you change your approach to a patient if you feel what you are doing isn't working? Can you tell if you have patients that are too reticent or unwilling to ask for something else if they feel they want to try something different? If your therapist isn't doing it for you find another therapist.
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Nov 16, 2016 05:23
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Do you prefer patients with some knowledge of psychology or would you rather have people with none? It was my impression that whenever I used psychological terms or showed some insight it wasn't very welcome, so eventually played naive with later therapists.
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Nov 16, 2016 09:54
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It's been a while since Clam was active in this thread, and I'd like to fill in. I'm a post-doc therapist at a university counseling center, so most of my clients are 18 to early-20's. I've also worked with adolescents in a few different settings, alcohol intervention, and disability accommodation.Surprise Giraffe posted:What do you think of the efficacy of mindfulness meditation and techniques for tackling anxiety? These seem to be increasingly popular from what I can tell. I've given meditation a try (guided by a proffesional shrink) and it's kind of nice and all but with it originating as a religious practice it's hard not to be sceptical I think that mindfulness can be a very useful tool. A lot of the time people aren't really aware of their thoughts, and so miss a lot of what's going on under the surface. Since a lot of therapy involves understanding ourselves better, developing that awareness is really useful. Whether it's framed with religion/spirituality or as "metacognition," you're enacting similar principles. Kuiperdolin posted:How often do you have patients whom you feel unable to help after several sessions? How do you deal with that? Something I try to always be aware of is if what I have to offer is working, or if some other intervention or venue is more appropriate. If for whatever reason there's someone else who can help more effectively, I'm going to make a referral. It's also worth keeping a long view in mind; I figure if a person's concerns were easy to resolve, they would have solved them without help. Sometimes the work takes a while. the JJ posted:This is sort of a dumb question, but if I've gotten a list of therapists in the area from my insurance company, should I just call them direct? Or do you need a referral? Give them a call! A lot of therapists have their information publicly available (for example), and I personally don't know any who demand referrals. Chip McFuck posted:I guess this ties into Kuiperdolin's question, but how often do you change your approach to a patient if you feel what you are doing isn't working? Can you tell if you have patients that are too reticent or unwilling to ask for something else if they feel they want to try something different? I believe that flexibility (within the range of your competence) is necessary. I can definitely feel when sessions have us chasing our tails or rehashing the same topics over and over again, and from my perspective that's usually a sign that we're focusing on the external facts as opposed to the internal perceptions (content as opposed to process). I can't comment on your therapist's style; I know there are some theories that direct the therapist to hang back from the discussion and only offer occasional direction. You're noticing something that's not working for you, though, and I think it could be helpful to mention it directly. ToxicSlurpee posted:If your therapist isn't doing it for you find another therapist. Seriously. A lot of the effectiveness of therapy comes from the rapport between the client and therapist and if you're not clicking, it's going to be harder. lllllllllllllllllll posted:Do you prefer patients with some knowledge of psychology or would you rather have people with none? It was my impression that whenever I used psychological terms or showed some insight it wasn't very welcome, so eventually played naive with later therapists. Personally, either works for me. Clam mentioned "meeting clients where they're at," and I agree with that sentiment. I want to understand how a client views the world, because that's going to influence how we approach the work; that's more important to me than fitting the client into a particular box. I'd hope other therapists would agree, though this isn't always the case.
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Nov 18, 2016 05:05
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Bizarre Echo posted:Seriously. A lot of the effectiveness of therapy comes from the rapport between the client and therapist and if you're not clicking, it's going to be harder. Is it also true that pretty much every therapist doesn't take it personally if a patient moves on to somebody else? That's what I always got told. Granted I also got lucky and got somebody that clicked and did well for me on the first shot. I've had to have that discussion with a few people that have gone to therapy; it's totally, absolutely fine if you have to switch. In physical medicine if one approach doesn't work you try a different one so why would it be wrong to have that attitude with mental medicine?
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Nov 19, 2016 19:10
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ToxicSlurpee posted:Is it also true that pretty much every therapist doesn't take it personally if a patient moves on to somebody else? That's what I always got told. Granted I also got lucky and got somebody that clicked and did well for me on the first shot. I've had to have that discussion with a few people that have gone to therapy; it's totally, absolutely fine if you have to switch. In physical medicine if one approach doesn't work you try a different one so why would it be wrong to have that attitude with mental medicine? Every supervisor I've had has stressed the importance of not taking a client switching personally. There's a bunch of ways that a switch may have nothing to do with us, and even if it does then getting the client to a better match is a win. I would say that if a client is thinking of transferring to a different therapist, it can be really useful to talk about it with the therapist (and the new therapist, for that matter). Sometimes there's good information that comes out of why the client wants to switch. If a guy is coming to therapy because he's worried about not being able to make deep friendships and later decides that he wants a different therapist because he feels the therapy is shallow, that's important. Whatever relationship patterns he's acting out with his friends is probably happening between him and the therapist, and being able to illuminate that and challenge it in the room is really helpful.
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Nov 20, 2016 06:53
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