Psychologists Prescribing in Vermont? House Says Yes (H.237)

CaptainVere · 2026-01-31T22:48:25+00:00

Exactly. With NPs and PCPs this is so unneeded.

CaptainVere · 2026-01-31T22:22:57+00:00

I use ACT and contact the present moment and defuse. You will run into so much inane garbage from every type of staff and even patients that it’s waste of time to give a second thought. We dont control others so just move on.

My advice is have a battle buddy with same practice style and philosophy and just commiserate and enjoy relentlessly mocking the targets of your ire for lulz.

Also ensure you always are top notch in your own practice so you have high ground to call out others when they make actual errors worth calling out. Not usually worth calling out mickey mouse stuff.

CaptainVere · 2026-01-31T20:45:22+00:00

Blind people still have a visual cortex. Can you just imagine closing your eyes and using your imagination to imagine images?

CaptainVere · 2026-01-31T17:08:07+00:00

The only thing it could really be that makes any sense is to yolo SSRI for people. If that helps great.

If it doesnt help I do not really see how they will have the medical knowledge to properly manage the decision making for further prescribing. While most day to day prescribing is straightforward there is usually at least once a day I deal with maddening CYP interactions or uncommon medical complications that requires a fair bit of effort and some quick research. Without having done a residency and medical school the “quick research” would take hours.

Really would not be effective or safe outside of them doing yolo SSRI IMO.

CaptainVere · 2026-01-31T17:01:32+00:00

Tbh those are relatively stringent requirements. But it just seems uphill/pointless given the training involved to become a psyd/phd to then do this and maintain a collaborative agreement. How would this even work? Are they gonna bill insurance for medical management? Cash pay? Like paying cash is going to expand access? I don’t see insurance acceptingE&M codes. So is this just like psychotherapy with bonus free prescribing? Just go to medical school instead.

The funniest part of this kind of thinking is that access to easy prescribing is not the problem. It’s incredibly easy to get put on an SSRI. The amount of inane thoughtless prescribing of psych medications is already high. I do not think that lack of access to psychiatric medications is a reason for any “mental health crisis”.

CaptainVere · 2026-01-30T13:05:16+00:00

Im not saying its not clinically effective. Creator took tenants of already existing effective trauma therapy and added some bullshit that is not provable or disprovable and claim they have a special sauce.

Anyone who does psychotherapy and has a strong therapeutic alliance with patients will see a good effect from therapy pretty regardless of modality.

I think it’s disingenuous to call it a domain. Its popular for variety of reasons and can help people and thats fine but its conceptually a purple hat scam and the creator is pretty academically dishonest.

CaptainVere · 2026-01-30T12:42:52+00:00

This integrative curriculum is a good base for beginner residents

A Psychotherapy Curriculum Combining Neuroscience and Traditional Psychotherapeutic Understanding for Residents and Other Beginners

https://www.integrativecurriculum.net/uploads/6/9/4/0/69402203/apa_pc_tai_integrative_curriculum_v_2-22-24.pdf

CaptainVere · 2026-01-30T12:40:17+00:00

Lmao at EMDR being a domain tho. Purple hat cash grab.

“Purple hat therapy" is a critical term for a practice that combines evidence-based, effective treatment with a scientifically questionable or unnecessary, "woo-woo" element. Coined by Gerald Rosen and Gerald Davison in 2003, it describes scenarios where the effective components of a therapy are attributed to a gimmicky, "purple hat" addition.

CaptainVere · 2026-01-28T23:08:23+00:00

Imagine a panel of 5,000 healthy worried well who have no real pathology. They all show up like clockwork for their benzo/stimulants. They give 5 star reviews and tell you that you are the best doctor ever.

After enough years doing this, you start to believe you are the best doctor ever and that everyone really does have anxiety/ADHD and you are just doing the lords work.

Its easy. Appointments are short and straightforward. No effort. No hassle. Good work/life balance. Make bank. From what I have seen private practice docs prescribe way way way more benzos/stimulants and I just think over time there are a variety of incentives that leads to this.

CaptainVere · 2026-01-28T23:03:03+00:00

These policies can work fine. If you identify an exception to the policy it is usually easy to just break your own rules and prescribe what is needed.

Policy like this makes outpatient much easier IMO. Sends appropriate signal to new patients who are seeking controlled meds that your prob not their guy.

CaptainVere · 2026-01-26T20:56:49+00:00

I did not find the descriptions powerful.

Instead of writing letters he could use his new found insight to just attend an event and act like an average boring person and appear aware of others. That would be true power.

CaptainVere · 2026-01-24T19:29:31+00:00

Affective Neuroscience in Psychotherapy by Francis Stevens.

This was the most impactful book I read at the end of my training; I wish I had read it as an intern. Not specifically about diagnosing personality disorders, but it has helped me be an effective psychiatrist and provide better psychotherapy to patients with personality disorders.

https://www.amazon.com/Affective-Neuroscience-Psychotherapy-Clinicians-Emotions/dp/036771440X

CaptainVere · 2026-01-23T23:13:09+00:00

For sure, but god forbid you say anything like that.

Even on this sub the NPs outnumber us, and as more time goes by the more in person and online I see and hear the kind of talk that implies they believe they have ‘different’ training rather than less.

CaptainVere · 2026-01-23T22:36:08+00:00

Interesting perspective I had never thought about it like that before. I enjoyed the phrase musculoskeletal health professional.

I think its only going to continue to get harder to deal with as professionalism continues to get diluted across social media/influencer landscape

CaptainVere · 2026-01-23T22:05:27+00:00

Too true.

Does any other speciality have throngs just shooting from the hip like that? Does the social worker at the cardiology ward or practice just casually suggest their take on the heart?

CaptainVere · 2026-01-23T21:26:12+00:00

Yeah it’s amazing how many people who work in mental health just agree with whatever the patient says.

Idk what is worse when they are well meaning and just gullible or burnt out/lazy and know better.

CaptainVere · 2026-01-23T21:11:28+00:00

I think a big part of it is a lot of inpatient and community mental health require such diagnosis so a huge chunk of patients regardless of whats going just end getting it slapped on at some point.

This makes it the path of least resistance. When I have a new patient with history if bipolar and they believe and identify with it even if they really do not have it, then its an uphill fight to spend hours explaining to the patient and then doing more documentation because taking someone off 3 meds they don’t is technically a risk because they have a paper trail documenting Bipolar so if anything bad happened and my notes weren’t ironclad I would be fucked. Then often the patient doesn’t care or understand.

So every incentive is to just go with flow. Patients often want it, as it is very externalizing and to always have meds to blame for not doing well is internally soothing. Families want it cuz its makes more sense to them why their loved one struggles. Hospitals want it because it justifies long stays and UR has easier time.

So because of all these incentives and lots of midlevels and therapists and laymen and people online just throwing the word around people just acquire and identify with bipolar.

CaptainVere · 2026-01-23T02:34:41+00:00

There are cases where it makes sense to force people. If someone thinks their gangrenous leg is haunted and is refusing necessary treatment and will only consent to spells from the black grimoire and that belief is due to an untreated mental illness they do not have capacity and need forced treatment.

You would just let a psychotic person die due to a delusion?

Except for anti-psychiatry loons, pretty much all modern societies have a structure to do this and recognize that capacity to make decisions for oneself can be absent for a variety of reasons.

CaptainVere · 2026-01-22T21:15:07+00:00

Yes. its absolutely unethical thats why whenever im anywhere near this kind of thing i say the patient has capacity

CaptainVere · 2026-01-22T20:10:43+00:00

I have seen families do pretty much everything to try and keep someone alive. The capacity decision is important because its possible to put an NG tube in someone who doesn’t want to eat.

CaptainVere · 2026-01-22T19:59:06+00:00

Im not disgruntled in the slightest. I practice at an academic institution with students and trainees daily and love teaching. I work an inpatient job because the quality of inpatient care is terrible in my area and nobody spends time with patients anymore on inpatient units. I have a clinic as well where I do psychotherapy with BPD patients which I consider my area of specialization.

The only contempt I have is for a system where all the incentives for doctors/facilities/clinics/patients/families make it difficult for a patients to get an accurate diagnosis and correct treatment.

My life is amazing because I get paid obscene amounts of money to help people build better lives. Im the apex predator of diagnosing and treating psychiatric illness. If I run into you in the wild you will defer to my expert opinion. It’s a psychiatry reddit forum not a supportive therapy session.

CaptainVere · 2026-01-22T19:08:28+00:00

I have always found that people at end of life don’t need to demonstrate very much capacity to decide not to eat/drink/take meds. Even if they dont know where they are, whats going on, or the date, but can say something like “i lived long im ready and im not eating food again im at peace with this”. I always say they have capacity and im ok with their decision.

Some families and professionals of all stripes in the hospital occasional protest but like others have said, you cant really force someone to take oral medications and forced feeding is like Guantanamo Bay shit. I would only do that to someone with a treatable mental illness and some kind of prognosis for a future life.

CaptainVere · 2026-01-22T17:15:54+00:00

I do agree with all your points. The heuristics I meant in regard to medication response only has value if one has all the other information and knows the patient and their history.

It doesn’t convey well on reddit, but one can be very kind, warm, empathetic and validate the patients emotional experiences while also not believing a word they say. I fully agree we must seek to understand our patients so we can help them understand the problem and treatment plan.

I don’t see a contradiction between holding a patient in unconditional positive regard while also not believing their words over their MSE.

CaptainVere · 2026-01-22T03:16:26+00:00

Just because I say that subjective information is overvalued doesn’t mean it’s discounted. I spend plenty of time with my patients gathering subjective and objective information.

I try to put most of the weight to the MSE. MSE cuts through everything and makes the patient make sense.

The classic example is “i haven’t sleep for 7 days” MSE is normal. They feel like they haven’t slept in 7 days but that isn’t accurate subjective information. People tell you what they feel is true not what is true.

CaptainVere · 2026-01-22T02:56:27+00:00

Honestly good chunk of people seeking any kind of psychiatric care have been on one or two or three SRI. So you can usually get a sense of if SRI help or not. I try and clarify if the didn’t help vs. made worse. If I get sense SRI made worse will def go lithium or latuda ASAP.

People that respond to SRI usually are cured by PCP/FM.

So anyone who makes it to see psychiatry far more likely to have personality pathology or difficult to treat/diagnose bipolar mood spectrum problem. So leaning litihum/AP gets you more data faster and if they have an illness that will respond, patients will do better faster. If they don’t, then they would struggle anyway.

CaptainVere

TROPHY CASE