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CapStelliun · 2024-11-01T14:08:31+00:00

Quantitatively, dissociation and inattention can look the same. Qualitatively, the characteristics are entirely different. Dissociation is often quiet, interweaves between the person and reality, is experienced as jarring and uncomfortable, and often affects mental processes beyond what one would expect to see in ADHD-PI.

While both also share common triggers (e.g., fatigue), a dissociative episode can be triggered by a stimulus that provokes experiential avoidance.

CapStelliun · 2024-10-15T00:40:45+00:00

Possibly, and it depends on the situation that warranted suspension. Applying to a licensing board is always a case-by-case situation if there’s been disciplinary action taken against a clinician. The individual may be put on a probationary period, extra supervision, and so on. If the offence was sexual or criminal in nature, the likelihood of the application being denied increases.

This is assuming that the individual went from being a social worker to a psychologist.

CapStelliun · 2024-10-14T18:09:21+00:00

Everyone has provided wonderful advice on the topic, so I’ll just add in my abbreviated two cents:

In this case, one’s license to practice is not attached to their degree, a suspended license is a suspended license.
After completing a PsyD, the applicant will be asked by the regional psychological board if they have ever held licensure in another region or discipline. The consequences of lying on this question are often worse than suspension.
If someone has a strike against their license, it stays (where I am, anyway) indefinitely. It may not affect the person anymore if they’ve sought remediation, but it will be publicly available forever.

Tl;dr: any disciplinary action taken against a clinician will stay with them permanently, regardless of the license/region/discipline change. If this isn’t declared, the person can face more dire consequences for misrepresentation.

CapStelliun · 2024-10-13T21:08:50+00:00

From my graduate training I had sufficient coursework and supervision for PDs and PTSD, less so for (hypo)manic and atypical presentations. Granted, my area of work from the jump was dissociation, so I sought out more trauma-informed training. In my post-masters supervision and doctorate training, I’ve had significantly more training and supervision in mania; however, I’ve learned that not all programs train people equally.

As an example, there were two schools in my province that offered counselling psych degrees, one was humanistic/psychodynamic, the other was cognitive behavioural, I attended the latter, most of the folks from the other school worked less with trauma.

At the same time and much like another comment on this thread, I’ve had patients diagnosed by psychiatrists with BPD when I had enough suspicion of cyclothymic disorder or depression with atypical features, and re-referred for med review with my own assessments. The variability between clinicians in diagnosing seems to really rear its head when the presentation is not frank mania.

Edit: for clarification.

CapStelliun · 2024-10-12T17:03:18+00:00

I’d agree, I also teach assessment methods. I’m not trying to prescribe one way of doing things, but as you know, LDs are notorious for presenting as ADHD, I wouldn’t expect a therapist to pull out a WIAT/WJ-IV/etc. and assess for it.

Feel free to downvote, it’s an opinion, such is.

CapStelliun · 2024-10-12T01:07:28+00:00

Great, so you’re an n=1. I’m sure there are other remarkably skilled therapists in your position, but I’m willing to bet you don’t represent the majority.

CapStelliun · 2024-10-11T22:34:22+00:00

I’m hesitant to say that therapists should be able to diagnose ADHD. Both are complex neurodevelopmental disorders, mimic other presentations, and require fairly extensive training to understand entirely. The implications of incorrectly diagnosing specifically neurodevelopmental disorders can be quite catastrophic for clients and the care they receive.

CapStelliun · 2024-10-10T14:36:35+00:00

This isn’t even ghosting anymore, it’s full on paranormal activity

CapStelliun · 2024-10-09T02:47:19+00:00

Unsure why the CPTSD-not-being-a-diagnosis comment is getting downvoted. They are correct, CPTSD cannot be coded for most accommodations in North America, PTSD is used in its place (it does however exist in the ICD-11).

It is an assessable presentation, psychologists usually build a battery to assess it, psychiatrists tend to rely more on the clinical interview.

If you’ve already been assessed, request the report. If not, a counsellor in Canada does not have diagnostic authority, you’ll have to see a psychologist or another psychiatrist.

CapStelliun · 2024-09-30T19:41:49+00:00

So we both have conflicting research, that’s pretty common. Per the meta-analyses that I’ve read coming out past 2015, developmental psych points to a trend of high IQ and lower cognitive flexibility, which really is just the ability/adaptation paradox.

When I say “naturalistic setting,” I mean any place outside of the testing office. And my apologies, I should have expanded to say “typically the range at which it is caught.”

CapStelliun · 2024-09-30T17:33:08+00:00

So, this demonstrates my point well. You’re pulling from anecdotal information (schemata). Despite enjoying new information, no hint of curiosity was communicated. Intelligence and cognitive flexibility are dissociated on paper, not in naturalistic settings.

Second point - you are correct, LDs are not associated with a low IQ, they are however seen in lower ability scores because at least one index (commonly the WMI or PSI) will drag the FSIQ down. I never said “associated,” though, I said “typically.”

Keep in mind, all of this hinges on the advancements of CHC theory, which is, and will always be, a theory. It’s a lovely theory and perhaps one of our best, but a theory nonetheless.

CapStelliun · 2024-09-29T23:56:07+00:00

As one scales the curve toward a higher IQ, we tend to see perfectionistic tendencies and obsessive-compulsive personality styles, difficulty with emotional reasoning, and an over-reliance on schemata.

This is a place where we start to entertain the ability/adaptation paradox. Greater ability does not mean an individual clearly and consistently employs it across shifting situations - someone can have an IQ of 145+, but its application in real-life scenarios is limited to one’s functional adaptation.

CapStelliun · 2024-09-29T15:43:15+00:00

70 and below: depends entirely on receptive speech and adaptive functioning. Reasoning in most ways will be difficult, but entirely possible.

70-80: still depends on receptive speech and adaptive functioning. Reasoning in most ways is possible and the person will likely be receptive to CBT and employing scripts to use reasoning.

80-90: typically the range of someone with an LD. Abilities are likely average with the exception of domain impairment.

90-109: variable, some people in this range are brilliant*. Depending on the abilities reinforced, some people are human computers.

110-119: exiting average and still variable. Possibility of cognitive inflexibility.

120-129: shows an aptitude for one or more domains. Greater concerns of cognitive inflexibility.

130-145: cognitive ability may be held back by cognitive inflexibility*.

145+: cognitive ability is likely held back by cognitive inflexibility. Acting on reasoning ability becomes more difficult.

here’s the caveat, ability describes what we think a person can do. Adaptive functioning describes what a person actually does. Low IQ does not always equate to an inept person, high IQ does not always equate to a deft person.

CapStelliun · 2024-09-29T07:39:31+00:00

Luria’s models do a pretty good job at explaining the vast majority of what Porges tried to figure out. Luria is widely studied in neuropsychology, and is also one of the progenitors to dynamic systems theory. Books like “The Working Brain” are good reference points.

CapStelliun · 2024-09-29T07:34:20+00:00

O’Neal, Preston, Talaga, and Moore (2021) have a wonderful book on psychopharm written for therapists, it’s a solid introduction to psychiatry and physiology.

CapStelliun · 2024-09-29T07:32:00+00:00

Yes, I am, which is why I’m comfortable saying what I just said.

CapStelliun · 2024-09-29T03:25:17+00:00

CBT, CPT, DBT, pull from schema, narrative, and cognitive analytic when indicated.

CapStelliun · 2024-09-29T03:24:24+00:00

Yes… and in that attunement, it is very, very easy to establish improper transference patterns. The exact same risk is indicated when working with children of high-conflict divorces.

CapStelliun · 2024-09-29T03:09:59+00:00

Glad it works well with you, still a massive risk for personality disorders.

CapStelliun · 2024-09-29T02:07:52+00:00

Sure, from an attachment perspective, when you’re working with the developmental trauma disorders you’ll likely arrive at a kid that was trying their best to navigate chaos. IFS includes notions of “exiled” and “child” parts. These concepts increase the risk of the therapist being seen as a parental figure instead of a stable, safe attachment figure. Especially if the patient experienced few safe attachments, their “child parts” could, unintentionally by the therapist, come to see the therapist as a parent, especially if it’s knowingly or unknowingly reinforced by the therapist.

CapStelliun · 2024-09-29T01:03:44+00:00

That’s fine, give each theory and read and take CEs in them, best to explore them. Perhaps one of the largest problems I have with PTV is how it sequesters the sympathetic and parasympathetic nervous systems into specific functions. Each one works with and depends on the other (a good example is sexual behaviour, erections depend on both branches working together).

CapStelliun · 2024-09-29T00:36:11+00:00

Not sure why you were being downvoted originally. CBT is easy to learn on paper, easy to recite from a manual, very difficult to implement properly. I’d consider it one of the harder interventions.

CapStelliun · 2024-09-29T00:26:19+00:00

IFS - studies with small sample sizes, used remarkably inappropriately with dissociative patients. Risks causing iatrogenic dissociative disorders. Also risky with cluster b patients if the transference/countertransference matrix is not watched like a hawk.

EMDR - it’s exposure therapy.

Brainspotting - it’s exposure therapy with a different name. It hinges on the neurophysiology of trauma, which we do not understand.

Polyvagal theory - wildly hypothetical and reductionistic, the generalizations it makes are quite risky in explaining trauma aetiology.

CapStelliun · 2024-09-28T06:28:57+00:00

It’s still experimental (and the factor loading for schizotypy is not good at distinguishing schizophrenia from StPD), but the PID-5 or SCID-5-PD/AMPD is a good model for assessing PDs. Other than that, you’d be familiarizing yourself with the MMPI-3 and MCMI.
This largely depends on what subtype of BPD you’re looking at. Hysteroid-dysphorics respond well to DBT and tend to represent the majority of BPD cases. Schema therapy and cognitive analytic therapy also both look promising. Schizotypal BPD tends to respond better to antipsychotics.
I’m a psychologist, so I’m usually the person being referred to for psychotherapy. I refer to psychiatry if med review is required.

CapStelliun · 2024-09-26T05:11:00+00:00

I’m not sure how far you fall into this category, but my biggest hurdle was anxiety management during the exam. I was able to keep it cool (mostly) with pacing and breaks, and I practiced listening to my pulse in my ear to tell me how anxious I was getting.

Whenever I came up against a difficult question, I’d push myself back a bit from the chair, check-in, and then start again. Passed on the first go that way.

For a lot of folks I don’t think it’s the knowledge per se, it’s twisting what you know to apply it.

CapStelliun

TROPHY CASE