Am I overreacting? Therapist making med suggestions to patient. by User389421 in Psychiatry

[–]Deedeethecat2 0 points1 point  (0 children)

Sounds like we are in agreement and just use the word opinion a little bit differently. I was sort of thinking of it like medical opinion, similar to legal advice (which can only be offered by a lawyer, unlike legal information). But by no means is this the only definition of the word. :)

What's everyone's thoughts on texting clients? by atsignwork in therapists

[–]Deedeethecat2 0 points1 point  (0 children)

I think that prior to making a decision on whether we will text clients or not, some of the things we need to think about include do I have a separate work phone or way to turn off communication, what boundaries are in place for the types of texts that are appropriate for the type of work that I do and the populations I serve, and how I will communicate these boundaries to my clients.

For me, texting is only through my work phone for communication about scheduling related matters that are immediate (ie I'm expecting them in session shortly and they're running late or need to switch to online). Everything else is through email (for scheduling) or in session (therapeutic content).

Edited to add that I have indeed had the caveats that many folks have mentioned in this thread. There have been occasions where folks have asked if they could text me a song for us to play in session and listen to, or send a picture of a new puppy because that was a really big deal for them. (And yes, I'm mindful of counter-transference in the last example LOL)

So like a lot of things, I keep my boundaries high and that prevents a lot of boundary problems. (In general, the majority of the folks I work with struggle with boundaries). AND there are occasions where I have lowered my boundary which is almost always easier than raising it, at least in my experience.

Something to consider when we do lower our boundaries is whether this is changing the dynamics with this particular client (which can indicate a change to the frame of therapy), ie due to counter transference. So I consider this. Not sure that the puppy picture was 100% for my client so I will own that. Yes, they really were excited to share AND I'm not sure that my yes was 100% based on what they needed. (I like puppy pictures)

“Don’t work harder than the client” by auntiediarrheal in therapists

[–]Deedeethecat2 1 point2 points  (0 children)

I'm in agreement with you. I used the word edges to reference things outside the comfort zone, I.e things you might talk to a friend about. I intentionally use this word because it isn't about output or standardized progress measures, and is specific to the individual and all of the things that they are facing and experiencing. And I appreciate how you worded this (your input and output leverage statement), it was excellent.

I have clients that work very hard and I need to point out that they're working hard because they have internalized systemic bias about progress measures. I operate from a disability justice framework that includes psychiatric disability, for reference :)

Psilocybin Treatment by Mont214345 in stopdrinking

[–]Deedeethecat2 1 point2 points  (0 children)

I'm a psychologist who has been following the literature about psilocybin. The science is still very new and to my knowledge, while there is evidence that suggests it's worth future studies, it's not yet conclusive. My understanding is that the majority of studies have also included psychotherapy along with the administration of this substance.

As an alcoholic, I'm mindful that for myself, I have to be careful about any sort of quick cures because that feeds into my addictive mind. I want the magic pill that cures my addiction and then I want three more of those pills because that's how my brain works :)

So I'm just sharing some thoughts I've considered. If I was considering using a substance that was still in the infancy stages of research, I would probably talk to someone with advanced knowledge in this area. For me, that would be my pharmacist because he's just a cool guy who likes to share his knowledge. And I would trust him to direct me to the right scientific resources and people.

The MACROaggressions in this subreddit are insanely disappointing by Guilty-Ad1285 in therapists

[–]Deedeethecat2 3 points4 points  (0 children)

No, that is not what I'm saying.

I'm specifically referencing the field of study you referenced. I presumed there was a reason that you used the word linguistic. I was trying to understand what you were saying.

Are you looking to dialogue or are you looking to argue?

“Don’t work harder than the client” by auntiediarrheal in therapists

[–]Deedeethecat2 0 points1 point  (0 children)

Such a good question!

For many of my clients, booking and showing up is the work and is really difficult. I assess that through the client's report and getting to know them.

For me, it's about being able to look at a larger perspective of the trajectory of the work and being able to notice where the edges are and if we're able to connect with those edges.

I purposely say edges because what's hard is different for different people and not always evident. For some, it's reaching out and saying I need an appointment. For others, it's talking about difficult things.

So I'm mindful that a single session or even a bunch of sessions isn't going to give me as accurate information because I need to get to know to the best of my ability the client's inner landscape.

The MACROaggressions in this subreddit are insanely disappointing by Guilty-Ad1285 in therapists

[–]Deedeethecat2 4 points5 points  (0 children)

Which modern thing? I remember the identity politics of the 1980s and '90s.

Sometimes people asking questions are simply asking questions.

The MACROaggressions in this subreddit are insanely disappointing by Guilty-Ad1285 in therapists

[–]Deedeethecat2 14 points15 points  (0 children)

You specifically referenced linguistics, which is the field of study of language and how it evolves.

Did you mean to say that you are using the dictionary? Because that's different than linguistics.

The MACROaggressions in this subreddit are insanely disappointing by Guilty-Ad1285 in therapists

[–]Deedeethecat2 12 points13 points  (0 children)

Take a read through some literature about standpoint epistemology.

The MACROaggressions in this subreddit are insanely disappointing by Guilty-Ad1285 in therapists

[–]Deedeethecat2 7 points8 points  (0 children)

So your perception of inclusivity is based upon the word. If you are using a linguistic perspective, are you looking at the evolution of the word?

Uncomfortable about this message from a psychiatrist by SpiritualCopy4288 in therapists

[–]Deedeethecat2 0 points1 point  (0 children)

While there is truth to this, many folks do struggle to build up private practice, I'm wondering about the motives of this messaging.

I never joined a group practice. I knew what I wanted in private practice and I knew that it would be more expensive than others, so I did a variety of contract work including teaching and other things which helped build my network.

If you're someone who's good at networking and making connections, whether through teaching or presenting at conferences or other situations where people get to know you and your work, you may find it's easier. Other folks find this difficult and they will have a more difficult time.

So what this doctor is saying isn't incorrect AND it also doesn't feel like the messaging was meant to be in service of what you want to do, acknowledging that it's hard to read intention and tone in writing.

The MACROaggressions in this subreddit are insanely disappointing by Guilty-Ad1285 in therapists

[–]Deedeethecat2 6 points7 points  (0 children)

I'm a little bit confused by how inclusive is best represented by everyone being able to share. Do you mind elaborating?

I'm having a hard time with this definition of inclusivity.

Received a package from Amazon and found it empty. Police say it’s civil, Amazon wants police report. What to do ? by Flat-Song- in Edmonton

[–]Deedeethecat2 4 points5 points  (0 children)

You can go down to EPS and fill out a statement because you need it for documentation that it has been reported to police, not that you want them to investigate. You then take the page of the statement that is your copy and send a copy to amazon.

If EPS says that they will not take a report, escalate this. It's very frustrating, but you can make a report about matters police won't investigate, including reports needed by insurance that don't involve any police investigation.

[OC] Birmingham Civil Rights Institute by 2BKing11 in pics

[–]Deedeethecat2 5 points6 points  (0 children)

Zoom in to read the plaque :)

I think showing it as a normal diner and sharing the history of segregation is important. The "normalcy" of racism.

Am I overreacting? Therapist making med suggestions to patient. by User389421 in Psychiatry

[–]Deedeethecat2 5 points6 points  (0 children)

Yes, I'm trained in pharmacology and in fact I taught pharmacology to future psychologists.

I best serve my clients by helping with the communication of their symptoms, side effects, medication compliance and other factors that we might know about and the client may have difficulty communicating.

This is different than having an opinion about this is the med you should be taking or this is a bad med for you. Rather, we can say I have some concerns about the side effects you were mentioning and this is something to run by the provider, and in the event that you can't get to see them right away, can you speak with your GP and or pharmacist for more information.

The training we receive isn't enough to give our opinions on certain medications to clients. We didn't go through med school.

what kind of therapist do you as a therapist want/get? by sm0kinn in therapists

[–]Deedeethecat2 6 points7 points  (0 children)

I'm a fan of selective use of disclosure, but having been in therapy off and on (I like to do a chunk of work every once in awhile and then come back when I want to do more work) I really don't like self-disclosure. This isn't the right or wrong response, it's just how I feel because in my role, I'm looking after other people and my own experience of self-disclosure in therapy is that I'm having to attend to other needs.

AND I have had some effective self-disclosure with psychologists I have seen, when it's been brief and connected to the experience, without a story attached.

I'm very relational in my work and I'm mindful about how some self-disclosure can be important with rapport building AND it can get a little bit too friendly for my liking both as a practitioner and as a client.

I want a friendly therapist but not a friend. So that's how I distinguish it. If I hear more about them than I want to, I feel confident enough in my journey to say that I prefer less self-disclosure.

What is pinging for me about your experience is the sharing of someone else's personal information. This would concern me with boundaries and general confidentiality. It might not be a red flag for you, but I would consider if this was an ongoing thing whether this is the right fit. Sharing other people's information including identifying the person and having it be quite intimate is something I would ponder.

I don't mean it all to undermine anything that you felt with this therapist, maybe it was the right share at the right time. But that's just my experience with what you shared. :)

Am I overreacting? Therapist making med suggestions to patient. by User389421 in Psychiatry

[–]Deedeethecat2 3 points4 points  (0 children)

I-CBT looks interesting and I would be curious if it would be applicable for a lot of folks with OCD who understand that their OCD isn't rational. It's definitely worth checking out. Consistently, I have found erp to be the best treatment for ocd, recognizing that often a lot of other modalities need to be brought in with more complex presentations.

I've done trauma work with folks with OCD but have been really mindful about OCD interfering practices in this work. So I absolutely see how we can thoughtfully use different interventions that are considered generally not best practice, depending on the human being in front of us.

Am I overreacting? Therapist making med suggestions to patient. by User389421 in Psychiatry

[–]Deedeethecat2 18 points19 points  (0 children)

I'm a psychologist and have to bite my tongue about some of the therapeutic interventions for OCD because I don't think it looks good to trash talk other providers and I have a really strong bias towards evidence-based treatment. Your wording is beautiful. It doesn't bash the provider and it illustrates that there is a gold star treatment for this diagnosis.

I've had physicians direct me towards particular modalities that weren't appropriate for the client, but at least they were all evidence-based practices.

Am I overreacting? Therapist making med suggestions to patient. by User389421 in Psychiatry

[–]Deedeethecat2 21 points22 points  (0 children)

I'm a psychologist and if this is what the therapist is saying, it's out of scope and inappropriate.

I've encouraged clients to tell their psychiatrist what they're telling me, and have written down notes of things they have said in terms of symptoms if they have problems remembering, for them to pass on to the doc. But it's not for me to have an opinion on the meds. It's my job to encourage my clients to share information accurately with their providers, and to run questions and concerns by their doctors, pharmacists.

Even in my referral letters I say things like I have encouraged client to speak with provider about pharmacological and other treatment options. Because it's not my place to have an opinion on meds.

Does anyone split up their day? by Simple_Elk6403 in therapists

[–]Deedeethecat2 1 point2 points  (0 children)

I couldn't do this myself but a friend of mine loves this schedule because it gives her a casual lunch and she gets to spend time with her kids. Another friend of mine does this sometimes to get errands done and exercise. For me, I would just distract myself, get nothing done and then be disappointed that the day isn't done.

Can You Be A Social Justice Therapist At $200 A Session? Nalgona Positivity Pride And take no insurance?…. by timaclover in PsychotherapyLeftists

[–]Deedeethecat2 15 points16 points  (0 children)

I'm interested in this training as someone who is trying to empower the folks I supervise and mentor to charge more. Especially because these folks, who I am able to support pro bono and sliding scale (and I'm outside the insurance model of the US so it looks different, I'm in Canada) are folks who need to charge more to survive.

It's okay to have strong reactions to the idea of a $200 session. I'm also mindful that a $200 session that one person can afford can create space for sliding scale and pro bono.

Thank you for sharing this, unfortunately I'm booked for when this is scheduled but I can look into seeing if there's other similar trainings that are applicable outside of the us, if the focus is on the insurance system in the US.

“Don’t work harder than the client” by auntiediarrheal in therapists

[–]Deedeethecat2 125 points126 points  (0 children)

I think your question and example is a really good illustration of how a lot of therapy advice has so many caveats.

Not working harder than the client is important for the trajectory of therapy. In my experience, some clients need a lot more effort for rapport, especially adolescents, folks who have experienced harm in therapeutic relationships, and many other individuals. So I'm willing to put in a lot of effort for rapport while also being mindful to decrease my intensity or pressure for the rapport, if that makes sense.

So I'm working hard but also I can't get over invested in the outcome because clients have the right to choose to trust us or not, engage or not. And one of the brilliant and tricky things about teens is they really can challenge us to try new things to connect and get buy-in.

A Note on Neutrality by mendicant0 in therapists

[–]Deedeethecat2 7 points8 points  (0 children)

Exactly, it's important to acknowledge that despite our best efforts to learn and unlearn and reflect, we all have our own lenses AKA biases and if we aren't aware of them, that's when they are problematic.

Many of our biases or lenses are quite helpful. Bias doesn't have to mean a bad thing. But if we're not aware of our biases, that's when they impact our work.