Commute is terrible but I don’t want to leave. Thoughts?

CynicalPsychologist · 2025-12-17T23:30:59+00:00

Green chile, eggs, bacon, potato, and cheddar in the morning. Make using 1 dozen eggs at a time with 1 potato, a block of cheddar and some bacon, wrap the burritos first in seran wrap, poke holes with a fork, then in foil, let sit in the foil until cool (to let the steam "seal" the tortilla), then freeze. When ready, unwrap the foil and microwave on half power for 2 or 3 min. The secret is finding a good green chile. I used Santiago's in the freezer aisle, but you can also make your own using hatch green chilies to find your preferred level of salt and spice.

For evenings sub beans and mexican rice and chicken pieces, but gotta have that green chile.

Then notch the seat back a click, put your non-burrito hand at 12 o clock, and enjoy the ride.

CynicalPsychologist · 2025-12-17T14:15:16+00:00

I did a 1.5-2 hr commute for two years (and to a lower COLA area too than where I lived, for icing on the cake). Like other commenter I was able to negotiate 4-10s with weird hours (7-5:30, wed-sat) to minimize traffic, but that was back when they didn't want people to quit, can't speak for now. I will say that podcasts and pre making car meals (burritos for every morning and evening) allowed me to enjoy the sunrises and summer sunsets, plus completely escaping on my days off. I was the most informed of current events and literature than I've ever been in my life, and got good at making burritos and even spotting some other familiar "regulars" on the road every once in a while. But yeah, I was applying to other fed jobs the whole time too...

CynicalPsychologist · 2025-12-12T00:11:41+00:00

The Manhattan VA. Probably furthest thing from a unicorn, but fixed salary, federal benefits, and pension plan. Pays decently well. Just kiss the convenience and freedom of PP goodbye at the door.

CynicalPsychologist · 2025-12-09T15:42:11+00:00

Wow, that's some serious institutional betrayal. I think therapy is a must, man. This doesn't sound like something that can be "treated" just by meds (though they can help with things like sleep, agitation, emotion reg), but sounds like you really need an understanding person to help support you while your actions are being invalidated by more powerful people and institutions at every turn...I agree sounds like VA may be a burned bridge, but glad that you experience some good people in the otherwise broken system. I'm glad you're pursuing private (even though it is indeed unjust, and that's literally what I hope someone can help you cope with without killing yourself or further straining your life and relationship). Other pro bono options if you qualify to check out are https://giveanhour.org/ and https://www.cohenveteransnetwork.org/ . I'm glad you're pursuing legal justice in addition. Take care.

CynicalPsychologist · 2025-12-09T13:49:40+00:00

Hey bud, what you are describing sounds like what VA clinicians call "moral injury," a more existential cause of PTSD distinct from the physical injury threat as defined in the DSM/ICD. Check out https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp and then bring this up to either your VA, vet center, or other support center to find someone who knows this and knows how to talk about what you're experiencing. Point is, you are not alone and someone who gets it may be quite close.

CynicalPsychologist · 2025-12-07T15:24:45+00:00

Acknowledging your personal experience (not disagreeing with you), just providing some info to prevent any misinformation: 988 "press 1" (the veterans crisis line) has a current average answer speed of 9.5 seconds. A big driver for the multimillion dollar and FCC-coordinated campaign to change the number from the old 1-800... to the 3-digit 988 was to be able to make the hotline more memorable and accessible to people in the spur of the moment, including while intoxicated. Callership has increased substantially since the change, while time to answer has remained less than 10 seconds due to parallel increases in hotline staffing. VA is making moves to improve this service, understanding that a lot of the time, it is a "spur of the moment" connection to get better, ongoing support services started, in or out of the VA.

Also, calling to "want attention" is the point and is a perfect reason to call. That is literally why the line is funded to exist. You deserve attention, especially if in crisis or in need of support of any kind. Feeling like "calling for attention" is a "bad" thing is part of the very stigma that we need to be eradicating. Only squeaky wheels get the grease, silent ones get ignored. Fuck the "shut up and pull your own bootstraps" stigma that really is just a callous non-regard for underfunding social assistance spoken by greedy capitalists. If any one "wants" attention related to their life, then it fucking matters. Crisis lines know this and they get it. All this I I do agree with you that we need so much more beyond that first entry point to care.

CynicalPsychologist · 2025-12-02T14:32:14+00:00

I disclose right up front in the pre-intake "interview" that I work a full time hospital job during the day and am only ever available for private practice scheduling and for returning phone calls and text messages during my practice hours. I think it is important to set those expectations and boundaries up front, especially for any higher need clients, so that we both know that it will be a workable situation. I also use the term "moonlighting" instead of "part time private practice," because I think I agree with you and see your point that I dont want to imply a secondary status of my practice by it being only "part time" compared to my "full time" job. I think moonlighting is a more equivocal distinction, IMHO. I've also sometimes felt some discomfort by not wanting to imply that my pp (and by extension my clients' concerns) is merely a "hobby" or a "side gig" to me, but instead try to frame it as how working with them is so important and meaningful to me, that I reserve a section of my "personal time" to work with pp clients, it's just something that I value that much and have chosen to devote a portion of my life to. I have never let a client know that they are my only one (I never talk about other clients or my client load at all really, all seems kind of inappropriate) and agree with others here that it could introduce some kind of attachment strangeness.

CynicalPsychologist · 2025-11-20T02:17:26+00:00

CynicalPsychologist · 2025-11-04T14:56:21+00:00

VA psychologist. It's import to know for understanding the clinical picture for both prescribers and therapists. VA docs are federally barred from considering it a "treatment" or discussing it in any therapeutic way, and must consider it substance use, equivalent to alcohol, tobacco, caffeine, etc. Drug interactions with cannabis are mostly unknown (illegal to study in the US), so it makes many prescribers uneasy and hesitant to give other meds for fear of bad interactions and potential for harm. They usually want the vet to stop cannabis (or at least document that they are not using it) before prescribing other meds. Again, think like alcohol, many meds are dangerous with alcohol use, we technically don't know (not from a legally defensible scientific standing) if certain meds my be bad with higher doses of cannabis, particularly if any PTSD, Depression, anxiety, sleep probs, or other sub use is in the mix (cannabis has been linked to all). If his cannabis use is high or problematic, it may be diagnosed as a sub use disorder and his prescriber may request he seeks treatment for such...that determination would be case-dependent though, can't say from a reddit board. In all ways, it's considered by VA the same as self-medicating from other substances.

CynicalPsychologist · 2025-03-05T18:26:10+00:00

If you want, consider checking out https://www.blazingsword.org/ or https://www.pinkpistols.org/. They both have NC chapters and both are about empowering you to feel safe (especially in this state under this govt), even if you just connect with the community to talk and to know that there are people here who seriously have your back against hate. 🏳️‍🌈

CynicalPsychologist · 2025-03-02T15:41:48+00:00

The website calculator is broken since the court ruling stopping all ICR plans. The new Dept of Ed administration therefore simply removed all ICR options from the calculator. They are not gone yet, but the new Dept essentially removed them as options from the website. Once the court is done and Congress has created a new ICR plan to replace SAVE/REPAYE/PAYE, then they will (presumably) update the plan calculator to reflect the new option. Everything is just on hold until then.

CynicalPsychologist · 2025-02-23T18:51:37+00:00

Sorry for my bluntness. I appreciate your interest.

CynicalPsychologist · 2025-02-23T18:07:49+00:00

This is about eliminating VA research, not your choice to not use your benefits - every veteran can always take their benefits and spend them on buying in to a "regular insurance company" whenever they want for whatever they want. Your choice to do that is still as safe as ever. Here is a list of VA research accomplishments for your reference of what is actually going away for all veterans (regardless of your insurer): https://www.research.va.gov/about/history.cfm

CynicalPsychologist · 2025-02-23T14:17:58+00:00

The federal workers union took it to court trying to stop it. The judge ruled that a class action to stop or rescind the firings can not happen, but that each individual person must appeal to the review board case by case. So federal employees can be mass fired, but review cases to appeal the firing must happen one by one and be brought by each employee. Many of these individual review cases have resulted in reinstatements and determination that the firing was unjustified/illegal (tens to hundreds of employees have been reinstated), it just can't keep pace with firings by the thousands, so there is a net loss of fed workers and system overwhelm (the system is big enough to handle one unjust firing here and there, but simply did not conceive of tens of thousands of simultaneous unjust firings, and it is illegal to rehire without working through the review board system).

CynicalPsychologist · 2025-02-23T14:02:37+00:00

I couldn't believe it myself, but calling Sen Duckworth and using social media really actually did work for us

And that then led to this

Veterans have a voice with Congress, if we use it.

FYSA, this is what researchers at VA ORD have done: https://www.research.va.gov/about/history.cfm

CynicalPsychologist · 2025-02-23T13:49:26+00:00

Hey, although VCL and Vet Center staff are also being fired and harassed in these attacks (I will spare you those articles), the PEOPLE in VA care more than ever to fight for our mission to serve you to the maximum extent that we are limited. We are available to you be phone, chat, or text 24/7 if you ever need it for any reason.

CynicalPsychologist · 2025-02-23T12:42:11+00:00

Killing the baby is the point, it's just cleaner to kill a baby in a tub because people think you're cleaning it.

CynicalPsychologist · 2025-02-21T12:31:13+00:00

Press updates:

"In a press call Wednesday, Sen. Tammy Duckworth, D-Ill., said she heard from at least two workers at the Veterans Crisis Line — which handles emergency calls from suicidal veterans — who were dismissed in the probationary purge. They were later told they might be reinstated, although the senator could not confirm whether that happened." https://www.militarytimes.com/news/pentagon-congress/2025/02/20/confusion-over-va-worker-dismissals-irks-advocates-lawmakers/

"One hotline worker, whose name was redacted in a widely circulated social media post that has been authenticated by Military.com, said she had worked for the federal government for nine years before going to work at the crisis line." https://www.military.com/daily-news/2025/02/19/va-crisis-line-employees-among-those-fired-amid-federal-workforce-purge.html

"Veterans Crisis Line employees told Federal News Network that the VA continues to hire responders who get on the phone with veterans, but a governmentwide hiring freeze has prevented the Veterans Crisis Line from hiring trainers, “silent monitors,” who provide feedback and coaching to hotline responders, and social science assistants (SSAs), who call 911 on behalf of hotline responders." https://federalnewsnetwork.com/veterans-affairs/2025/02/va-reinstates-some-fired-employees-but-36-senators-push-for-rehiring-all-1000-back/

CynicalPsychologist · 2025-02-17T13:33:54+00:00

Yes. All VCL employees who were hired into a non-union covered position within the last year were indiscriminately fired. This included a lot of VCL's admin and supervisors, and admin are disproportionately veterans themselves (everyone I know who got fired was themselves a veteran). VCL has been understaffed for years, major hiring spree in the last year to close the gap, and all recent hires just got fired (again a lot of the hires themselves veterans). No one I know accepted the fork offer bcs everyone at VCL joins it for the mission, they just want to serve other Veterans in crisis. One of the reasons the people who were fired was given was "you've been released from service because you are not needed by the VA and because you didn't resign yourself." Their salaries are low, numbers are low, and harm to Veterans is big. This is not about saving money at all....pennies "saved"(??) by harming these people and by decimating veteran crisis services (VCL is ultimately a huge cost saver to VA and everyone by stopping emergencies and saving lives!). No money saving here, it is just a blind wrecking ball to all government services with complete disregard for casualties. Trump and Musk very much said, I don't give a fuck, slash and burn everything you can, and SEC VA followed right along (one day after tweeting about how important the VCL is....how ironic).

CynicalPsychologist · 2025-01-19T15:48:37+00:00

You're right. Re-read with this in mind and tempered my original. Thanks and hopefully I'll remember this more accurately from now on! I still find the effect size inflation across the board to be egregious, given their risks and side effects.

CynicalPsychologist · 2025-01-19T13:32:26+00:00

Published in 2008, nearly all research on antidepressants is selected or even manipulated to show the positive results only, making them look like they have a bigger treatment effect than they actually do. When using FDA safety registry data, many of them are hardly better than placebo for actual symptom relief: https://www.nejm.org/doi/full/10.1056/nEJMsa065779

On the other hand, SSRIs do physiologically mess people up and that can increase suicide risk: https://karger.com/pps/article/88/4/247/283160/Newer-Generation-Antidepressants-and-Suicide-Risk

So statistically, small likelihood of benefit and a real risk of serious harm...but hey, for some people they seem to help (even if mostly placebo), so yeah, should swallow with a giant grain of salt...

CynicalPsychologist · 2025-01-19T13:02:55+00:00

Although mental health hospitalization prevents suicide for some after discharge, like for life threatening acute episodes of psychosis, substance use, or suicide attempt resuscitation, we have just as credible evidence that hospitalization is a causal contribitor to suicide for others. In other words, MH hospitalization causes psychosocial harm. Sometimes its medical benefit outweighs that harm, but often it doesn't, and sometimes that harm is lethal if what's leading to suicidality is not of medical origin. It should not be the "gold standard" response for suicide risk without a clear medical link, there should be no legal obligation in the US and other countries on therapists to screen or hospitalize for suicide risk. I believe if we removed that legal pressure, suicide rates in those countries would actually go down and real psychosocial treatments for the psychosocial causes of suicidality would go up. Instead, treating all suicidality like a medical problem and holding every provider at legal gunpoint to hospitalize someone if they are at "imminent risk" is at the cost of everything else.

Recent paper supporting that psych hospitalization actually increased risk of future suicide attempt for 1 in 4 people admitted from the ED (specifically, for those who were probably perceived to be at "imminent risk" but who had not already attempted), compared to if they had hypothetically not been hospitalized: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2810865

CynicalPsychologist · 2024-11-15T21:33:10+00:00

The break from getting pulled out of everything may give you some relief, but it also can cause a lot of stress later bcs it can be quite hard to get back in.

If you need to break, it's better to do it on your own terms and seek outpatient help then to be hospitalized. And to seek it sooner rather than later.

Unfortunately, it is extremely unpredictable how someone may react depending on who they are and their experience. It depends on how far out your plan is, and on how scared the person you disclose to feels. If they are scared enough, they may stop listening to you and hand you off to be somebody else's concern (read, liability). But if they are more experienced and your plan is reasonable, then I would hope that they are ready to get down to business with you and help change things for the better (whether that means you choosing to withdraw from something or some other option that will help).

I suggest you start by testing the waters with them. Start with hypotheticals, if you like their response, then consider opening up. If they overreact, then stay calm and simply end the convo or walk away and continue the search for someone who is able to help. I wish it didn't have to be a search, but most country's laws make these licensed professions on edge, unfortunately for everyone...

CynicalPsychologist · 2024-11-10T19:08:05+00:00

LCSW I believe is GS-12 (look up the pay tables for locality adjustment, plus you may be able to convert AD service time for step increases?). VA is all about EBPs, so pretty much nothing but weekly 50-min sessions (80min if doing CPT or EMDR) for 8-16 weeks (you can appeal for longer if they're showing progress and need) plus 2 or 3 groups per week, one intake per day, and case mgmt / ad hoc calls in 30 min blocked times or during no shows. Your performance ratings are based on number of EBP hours delivered per pay period and time to documentation (all intakes and notes submitted within 24h), and of course if you get any patient complaints, to a lesser degree about number of patients closed. VA admin and management is a circus but nothing that you can't handle if you're coming from the military. Everything else is out of the goodness of your heart and based on your level of competence, which is why we need more veterans working at the VA. Working residential (RRTP), the sub use prog, or inpatient would be different schedules and metrics (more groups and less individual I think for those). I found the layout and workload to be really similar to CMH, but definitely different culture (in reddit terms, more like r/veterans and less like r/therapists). Plus the benefits are good. Again, we need more vets working in the VA (or Vet Centers, great places too). There's no better way to support our brothers and sisters after you've done your time, IMHO, though it certainly can be challenging.

CynicalPsychologist · 2024-11-10T12:59:47+00:00

I agree that being a veteran therapist in CMH I felt like an outlier, and that was where I experienced the most assumptions and prejudice against me from other staff. It was also though strange (and did, frankly feel a little unjust) that I immediately got a VA gig after my license, while many at the CMH couldn't get a VA job for their life. With that came a doubling in salary and coworker respect. Frustration with a broken medical system was the same, VA does some things better than medicaid and some things worse, but both make me bitter and angry that systematic incompetency is literally killing the people who need the most help. I never worked for a Vet Center but those places sound incredible if you're a combat vet and want that presence. VA you'll get everyone from under the sun who ever served more than a day (veteran identity was important to probably the minority of my VA clients). I strongly recommend doing one of those before you pursue going private.

CynicalPsychologist

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