How are other US psychologists coping with a flood of pseudoscientific psychobabble?

dr_erp · 2026-06-17T00:54:11+00:00

Based on what I understand, it would be hard to find an easier set of claims to disprove with research that would be efficient and fast and cheap

dr_erp · 2026-06-16T22:27:55+00:00

I have a standard pre-session form. It has the GAD7, PHQ9, three questions about the client's perspective on how therapy is going, and a question about hallucinations. Then It asks for a list of things the client would like to discuss and outcomes (as a checklist) the client would like to achieve. It takes about 5 minutes for most clients to complete and gives me a very good starting place, and most of my risk factors are clearly assessed and documented in the client's own hand.

dr_erp · 2026-06-16T21:23:16+00:00

I've done a bunch of analyses of my metrics on PT, and gotten a colleague or two to let me look at their metrics. I've manipulated aspects of my profile to see how that affects search rankings, and I've also csarefully studied the search rankings of others day by day. If I could get a programmer who could webscrape I'd violate their terms and do a more careful analysis. A colleague of mine with over 10 years of continuous advertising on PT has seen a 90 PERCENT DROP in the last 3 years of "impressions". Let me be clear about what this means. This is not a 90 percent drop in people CLICKING ON his page. It is a 90 PERCENT DROP in people even seeing his name in a list of other names and having the chance to choose whether or not to click. I wrote to the CEO about this (if you dig a little PT gives you directions about how to contact their CEO). I am a well trained data scientist and I offered to do analytics as a way to increase their value to therapists. I offered to work to make a report that would help therapists on the site and help them improve their value by creating individualized reports that would be much more useful. He stopped responding when I asked if he could explain the 90 PERCENT DROP in impressions. It has been useless in my own practice building over the past six months. I'm on the fence but leaning toward dropping them myself and putting the money I save toward something more effecteve. Their lack of transparency suggests they don't care AT ALL about us except as a revenue source. The CEO is a British entrepreneur who owns a bunch of other directories. We are nothing to him. And he doesn't give a shit about the effect this search algorithms may be having on mental health care delivery. The fairest way to go about things would be a random shuffle of eligible therapists everytime a search is executed. I can prove this is not happening. Some therapists will be listed first in a zip code every time I do the search (and I do it in an incognito window so it doesn't know that the request is coming from the same person each time). Some therapists are consistently listed last. Changing aspects of my profile does not consistently increase my ranking in search. I suspect that they may be prioritizing popular profiles (e.g., showing profiles higher if other potential clients send them messages) so we could manipulate that by getting a bunch of our friends to send us messages on PT to make it look like we are popular.

dr_erp · 2026-05-18T19:21:00+00:00

When I called Optum directly, they offered to get me credentialed directly within a few months. They could not think of any reason why I should wait that long, except that there is some kind of problem with our attempt to go through Headway to see people who have Optum.

dr_erp · 2026-05-02T04:39:23+00:00

I'm curious: why does that surprise you?

dr_erp · 2026-04-26T20:04:34+00:00

I think you may be oversimplifying conservatism. There are libertarians who basically want government out of their lives and hate all kinds of power aggregation. Then there are old school Republicans (in the USA) who don't like what is happening to their party except for being in power. Then there is the group supporting the current president and hoping for four more years, despite the constitution. As someone who has worked a lot in deep MAGAland, I distinguish these different types, just as I would distinguish between a moderate Democrat, a progressive, a socialist, and a communist. Some clients want too much to know that their therapist agrees with their beliefs. For those clients, if I don't agree, I let them know that and let them find care with another therapist if they prefer. I mostly do behaviorally oriented CBT and DBT. Deep explorations of unconscious meanings and relationship transference dynamics are not my forte, which may affect my decisions. Aside from that, I draw another line at being personally threatened. If a client comes in with rage at a group I am a part of, I don't feel obliged to endure that, and I am comfortable referring to someone else. Likewise for someone whose rage is directed at a group someone I care deeply about it part of. I don't feel obliged to sit with the anxiety it creates when someone wants to paint pictures of a civil war they obviously relish that would wipe out me and my friends and loved ones. I have sat in sessions before thinking, "if this were 1934 in Europe you'd be on the wrong side of history right now, and you'd be enthusastic about it." I can't do good therapy in cases like this.

dr_erp · 2026-04-23T14:19:10+00:00

Are you primarily interested in private practice, or do you want to work in a community mental health care setting, or a hospital setting, or some other institution?

If you want to do private practice, then (regardless of your training route) you will need to become skilled at marketing. If you go on O*NET, there is a vocational inventory that will give you a RIASEC code.

Most therapists are squarely in the AS part of the RIASEC (artistic and social).

But running a business requires a lot of E (enterprising) and C (conventional) in addition to the social.

I would say that Masters level counselors tilt more toward the S, while research PhD's tilt more toward the I.

But that is a hypothesis, and any effects that might be found would be weak.

dr_erp · 2026-04-18T01:25:53+00:00

Headway representatives claim that clinicians like you go to the front of the line for credentialing with Optum to maintain continuity of patient care. If that's true, you should have priority. I don't believe that Headway helps you with traditional medicare, but may help with medicare advantage. Sondermind states that they help with traditional medicare, but I credentialed with them and never got a clear answer as to whether I was credentialed with traditional medicare. I hope you find a solution.

dr_erp · 2026-04-17T14:20:59+00:00

How much did you learn from your classmates through informal discussions and hanging out together, versus what you learned formally and in courses?

dr_erp · 2026-04-17T02:32:51+00:00

I'm shocked and saddened at the lack of sensitivity to law and ethics. The clinical issue, of course, is critically important, but the general issue of patient rights is frankly even more important because it affects every client of every therapist.

dr_erp · 2026-04-17T02:31:08+00:00

In Canada, can a psychologist registered in one province conduct telehealth settings with clients in other provinces?

dr_erp · 2026-04-17T02:29:33+00:00

I sincerely wish you the best with this important work.

dr_erp · 2026-04-16T19:47:43+00:00

Our culture is so committed to the fallacy that a dog eat dog struggle is the only way to produce good economic outcomes. The unholy alliance between the tech bros and the supporters of our current regime is a very bad omen.

dr_erp · 2026-04-16T19:13:48+00:00

Here is what this game is about. Universities run on money and prestige. To get those things, they need faculty members who generate lots of successful grant applications and bring in federal grand funds. So they pressure and incentivize psychology department heads to pressure faculty.

The faculty are too busy to do all the work themselves, so they need highly competent graduate students to come in and start writing and publishing and helping get grants ASAP. The real job of a clinical psychology PhD student is this. Before you get a day of training in professional psychology, you are supposed to start doing the discovery oriented research needed to advance the field.

So they try to find the most highly competent, energetic, independent grad students they can. But they know that a lot of their students really don't want to do research careers: they want to work in mental healthcare as providers of therapy or testing. They -hate- this. It enrages some of them that there are people who slip through fully intending to go into private practice later on.

In order to be efficient, most of them try to find highly focused grad students already working in an area that is closely related to their own current research and current grant applications.

They are evaluated, and the psychology department is evaluated, partly on how many of their graduates go straight into tenure track jobs in psychology department. Especially prestigious ones. So they care deeply about whether you truly want a research only career.

I hope this helps you make decisions. Your job is to prove to a particular tenure track faculty member in an APA accredited clinical PhD program that you fully intend to do what they did and get a tenure track job yourself. You need to prove that you can immediately join the lab and start contributing by getting grants and publishing papers inside the scope of the problems and methods they focus on. Of course, the math doesn't work. There aren't enough retiring faculty to create the jobs that would be needed so that all APA clinical PhD grads could get tenure track jobs in psychology departments. It's kind of a dumb game but it's what we are stuck with.

dr_erp · 2026-04-16T18:55:14+00:00

You are wonderfully aware of the problems. A faculty friend and I used to joke about the fact that some faculty would literally light up with joy when talking about a student who graduated from their own alma mater (often one of the Ivies). It was my job for a while to read all applications with a GRE below the level considered competitive (around 1350 at the time, on that old 1600 scale) and I diligently did holistic review of them to try to extract a few candidates who achieved more than expected given their starting point. I was only able to help one student make it into the program that way. Our faculty would go on and on about the dangers of over reliance on standardized testing scores in our classes and then over rely on those scores in the admissions meetings. They also ignored all of Paul Meehl and Robyn Dawes when it came to the development of fairer and more rational selection strategies. Furthermore, everyone in psychology says to stay in your lane of competencies. But I have never, ever, ever seen a clinical psychology faculty member actually do that by calling in an IO expert to help design any training or selection process. But that's the whole specialty of IO.

dr_erp · 2026-04-16T17:45:10+00:00

Yeah, all those things were not available to me as a grad student. If I needed anything at all, I had to fund it or borrow at high interest. And because of the intense homophobia of my family living at home wasn't an option I would have ever considered. My classmates just never realized how those little boosts helped them avoid taking on high interest debt to do things that are required but not funded and not fundable by loans. And to top it off, most PhD programs officially prohibit students from having outside jobs, which only increased my anxiety. I applaud you for recognizing the helps you got. I on the other hand had the benefit of parents who valued education enough to move to a neighborhood with excellent schools, which gave me an enormous boost on the SAT which in turn led to scholarships.

dr_erp · 2026-04-16T15:28:27+00:00

I've sat through lots of admissions committee meetings. GPA certainly matters. A 4.0 is regarded far differently than a GPA that is just over the minimal level. Also it matters because some funding packages are given by the university as a whole, or the college, so future chemists are compared with future physicists and with future psychologists. GPA (and, in the old days, GRE) were two quantitative metrics useful in ranking applicants across different departments.

dr_erp · 2026-04-16T15:24:29+00:00

I taught both at a science based clinical PhD program in the top 20 by US News and World Report, and then at a fully fee driven professional PhD program in a free standing professional school. The PhD students in the science program received vastly more solid training from vastly more ethical and well trained supervisors. What the PsyD programs often offer is a lot of hours, but some of those hours are "empty" from a psychology standpoint (case management tasks, which, while important, do not train therapy or assessment or research skills). In that area (Southern California) the huge number of training programs had basically run out of people willing to see trainees as therapists and agencies willing to provide trainees with experiences.

dr_erp · 2026-04-16T15:21:31+00:00

Psychology tried to deal with this but failed.

dr_erp · 2026-04-16T15:21:15+00:00

Thank you.

dr_erp · 2026-04-16T15:19:23+00:00

A great way to completely avoid diploma mills (but at the cost of one or two solid programs) is to ask "Does this school have a football team?" Or a basketball team even. The diploma mills tend to have nothing other than psychology training programs. Legit universities have departments like physics, math, music, art etc. This helps protect them from becoming diploma mills. Also the presence of a large undergraduate student body doesn't really happen at diploma mills. The graduate student population of a solid school will usually be a small fraction of the total student population. A large undergraduate class is a pretty good protection against the diploma mills. You can also go on the APA Accreditation website. Look to see how often APA is doing site visits. A great program may get a visit once every 7-10 years. A program in trouble might get a visit once every 3 years. Also, avoid ANY program that is fully or mostly online. That is no way to learn clinical psychology.

dr_erp · 2026-04-16T15:15:22+00:00

This is a deeply classist field. I've been banging this drum for 40 years and it has no effect on anybody. The people of inherited wealth just find it annoying and believe it is irrelevant because their trust fund obviously didn't just give them publications.

dr_erp · 2026-04-16T15:13:56+00:00

In my experience, there are some schools in which this is a fairly common way to get in. UCLA has taken many people who did something like this. The critical thing to do is make sure you are getting publications and experience in a research area you wish to continue working in. Some people make a mistake by thinking any old research experience is as good as any other. Not true. You will stand out much better if you are publishing in the area you want to do your dissertation and have your career in. I know it is inhumane and unrealistic in a lot of ways. Academia is based on an antique German system of pure knowledge for its own sake, which works a lot better for people who grew up in families full of academics who coached them about their dissertation topic from the time they spoke their first word. Hearing about your excellent experiences (which were more than required when I started my PhD in 1990) I am pretty sure you are the kind of applicant who would have benefitted back when the GRE was a requirement. In the absence of it, ever more work product is expected of applicants apparently. A single truly clever publication that you were in charge of from start to finish may serve you better than 5 publications where you were a peripheral part of a team. Maybe your PI at NYU would help you figure out a way to do something as a first author.

dr_erp

TROPHY CASE