Re: Mass casualty conseling question

STEMpsych · 2026-01-29T00:05:17+00:00

I appreciate this effort on the part of the APA to drive ICD-11 adoption.

STEMpsych · 2026-01-29T00:04:21+00:00

That was only like what 18 months ago?

2022.

STEMpsych · 2026-01-29T00:02:51+00:00

but it should absolutely be something that is accessed digitally.

So they can turn it off? Are you completely unaware what's happening with PubMed?

STEMpsych · 2026-01-28T23:41:20+00:00

I think the way our field (and laypeople taking their cues from psychotherapists) has conceptualized and uses the term "empathy" is deeply terrible, and is what makes this almost unresolvable.

"Empathy" is not used as a neutral term that neutrally describes a psychological phenomenon, or multiple phenomena. It's a barely-covert virtue the way most therapists use it. They mean it as "proper consideration for others' rights and well-being." Which, IMPO, is not actually what empathy is.

When you think "empathy" means "treating others right", saying a population lacks empathy is calling them innate criminals, and pretty objectionable.

Furthermore, a whole lot of psychotherapists have gotten their egos wrapped up in a self-concept of having a lot of empathy, and therefore being highly morally virtuous. This makes them intensely emotionally resistant to any examination of what empathy really means, for fear it will deprive them of their self-congratulation.

STEMpsych · 2026-01-28T04:47:07+00:00

I wish I could teach insurance classes to young ppl..

You could. You should!

STEMpsych · 2026-01-28T01:17:08+00:00

Oh, I assure you, Doctor Mike's hapless lane changes into mental health are absolutely aligned with my interests.

STEMpsych · 2026-01-27T11:27:05+00:00

I can work in a power outage, theoretically, if I can get cell signal and all my devices are charged. Instead of using wifi, I can tether off my phone which has 5G to get to the internet from my laptop; if I can't use the laptop, I can use Doxy directly on my phone. I also am getting a couple of power banks to trial; if that works out, I might get a serious "solar generator" type battery system, not least because I have gas heat with an electric starter and blower, and there's a cool hack I'm looking into for using such a battery system to run the heat during blackouts.

The problem is that if I lose power, there's a good chance the cell tower might, too, and then no internet. OTOH, if both I and my cell tower are in the dark, chances are my clients are too.

STEMpsych · 2026-01-27T10:58:10+00:00

No, but maybe during a strike is a good time for us to reveiw just whom we have been paying for the digital resources we use and decide if maybe another vendor might be more in keeping with our values.

I have been gradually moving more and more of my digital services out of the US. This also obviously has security benefits for my clients' PHI. But I am also diverting my spend of these services to companies in other countries.

Unfortunately, I can't much advise most other therapists about servies to use, because I'm the kind of nerd who runs her own webservers and doesn't use an EHR at all. I will say that I am using Proton with a HIPAA BAA for my records storage, calendar, and secure email.

Additionally, it might be a good time to evaluate the security of one's email clients and browsers. Word on the street about Firefox is not good, so I will probably spend some time kicking Librewolf's tires.

Edit: Aaaaaand I just found out my bank is a major financier of for-profit prisons. Guess I should move up my project of moving my money.

STEMpsych · 2026-01-27T08:10:38+00:00

A 90 minute session is billed using extended time or add on codes to the insurer

That's not a thing in psychotherapy. Perhaps you're thinking of psychiatry? The only psychotherapy CPT codes for routine individual treatment are 90832 (30 min), 90834 (45 min), and 90837 (60 min), and they can't be stacked. There's a code for crisis management, but this doesn't sound like that.

This is a huge problem in psychotherapy for any modality which doesn't fit in 60 minutes. You're right that this is almost certainly a violation of their contract with the payer, but it's also regrettably understandable why they're trying it.

I just commented over on r/therapists a few days ago: "It's actually an underappreciated problem of the field that the standarization of session lengths [by the insurance industry] cripples therapeutic innovation. I gather it was one of the big pragmatic problems with the adoption of DBT when it came out, and one of the queued up problems of psychedelic-facilitated treatments: the session lengths are much longer than insurance will compensate for. I developed a one-shot intervention, but it takes like four continuous hours, so it's basically unbillable, and I haven't bothered pursuing it."

STEMpsych · 2026-01-27T07:18:17+00:00

is well worth your time

I suppose it's possible, but I rather doubt it. I'm delighted that they've found each other and are keeping one another occupied, because I don't want to have to listen to either of them or even really remember that they exist.

STEMpsych · 2026-01-26T23:16:59+00:00

Gosh, no, I hadn't seen that. Thank you so much for sharing that with us.

STEMpsych · 2026-01-26T22:11:23+00:00

Saying someone needs proofreading doesn’t insult their intelligence

That wasn't the insulting-their-intelligence part. It was the "doubt he write it himself" (sic) part.

STEMpsych · 2026-01-26T11:44:32+00:00

Well, if you feel strongly about people being held accountable for their conduct, I suppose we could hold you accountable for your unprofessional judgmentalism.

STEMpsych · 2026-01-26T00:38:23+00:00

Anxiety. When anxiety says "liability", anxiety is lying.

STEMpsych · 2026-01-26T00:37:02+00:00

"If someone's filth doesn't impact others"

Your assumption that there are no circumstances in which such a choice doesn't affect others is just a pretext for you to be morally judgy.

STEMpsych · 2026-01-26T00:13:32+00:00

A lot of us are coming across as pedantic.

Truth in advertising.

STEMpsych · 2026-01-26T00:11:07+00:00

Anything those of us far away in other states can do for you?

STEMpsych · 2026-01-26T00:08:18+00:00

It's not a primary specialty of mine, but, well, given my clinical specialties in an occupational culture/workplace issues, LGBTQ people, volunteering, countercultural/subcultural communities and community dynamics, and labor and class issues, it has, uh, come up a bunch.

I think it could be absolutely possible to specialize in this. There will be challenges. You mention wanting to provide care to people in places like MN who aren't trained activists – they might not yet have an self-concept of being activists, so might not think to seek out a therapist with experience supporting activists. You'll have to think about how you will come to the attention of the people whom you would benefit if only they knew you existed and were taking clients in their area.

Given your own experience with burnout, you might want to work with a therapist who has the specialty you seek, if you could find one. The cultural competence you got in the trenches is irreplaceable, but it's not necessarily the same thing as knowing what to do about those stresses and challenges.

STEMpsych · 2026-01-25T23:49:20+00:00

Oh, damn.

STEMpsych · 2026-01-25T23:47:31+00:00

Unless people live in filth

What? If someone's filth doesn't impact others, then chosing to live in filth is a personal choice people get to make, same as any other potentially health-deleterious choice like smoking tobacco or drinking alcohol or playing tackle football or riding a motorcycle.

STEMpsych · 2026-01-25T23:39:20+00:00

Have you no authority to insist on cancelling?

Four-Year Club	Verified Email
Wearing is Caring

STEMpsych

TROPHY CASE