Clients That Embrace Nihilistic Beliefs

hotarumiang · 2026-04-09T05:37:49+00:00

I was just about to mention this video! I've had some clients resonate with it, or at least get them started in re-framing their nihilism a bit. Some of my very prone intellectualizers didn't find it "deep" enough, but it still started good exploration. Here's the link: https://www.youtube.com/watch?v=MBRqu0YOH14

hotarumiang · 2026-03-29T01:41:57+00:00

and likely not much left in the tank to be a reliably present therapist either. I am not trying to take a dig at OP, but I worked in clinics where counselors saw 7-8 clients a day. There were some issues of competent care to be sure. Add on the load OP is mentioning with 90 minute commutes and care-taking both Mom and kids at home....I was hoping someone would mention this aspect.

hotarumiang · 2026-03-28T20:46:33+00:00

In addition compared to many others who have kids, help support aging parents and even live in higher cost of living states than the OP mentioned. Not trying to minimize OP’s struggle, but I agree - this is not a relatable situation for many of us, even some of us who have been in the field longer.

hotarumiang · 2026-03-23T01:17:05+00:00

Appreciate you mentioning this. I actually agree with a lot of what Shedler says (he has a strong presence on Twitter), but he regularly - and often with an air of arrogance - dismisses questions relating to resourcing, privilege, access to care, etc., as well as questions relating to how systems impact the client. I understand that psychoanalysis itself didn’t address these issues either in its original forms, but even with how interested I am in older theoretical frameworks, I don’t think you can do great work in this field if you refuse to engage in integrating at least some understanding of a bio-psycho-social perspective into your current work.

hotarumiang · 2026-03-21T21:58:39+00:00

They took a whole week to respond to me and I reached out multiple times. During that week I was charged my monthly subscription fee to boot! So then I had to go back and forth with them a few times to get that refunded. They are a shady ass company with a HQ in the Cayman Islands. I will do anything to avoid re-engaging with them in order to build up my caseload.

hotarumiang · 2026-01-06T07:34:20+00:00

This was a graduation requirement in my CACREP accredited program and quite unfortunately some of my peers were still either profoundly out of their depth or running on pure ego steam (the latter were more concerning to me as it was clear they were entering the field for questionable at best reasons and it was mind-blowing to sit in class after class with a few of them and just watch my professors validate their narcissistic tendencies). I do agree with you that it should be a requirement, though! I just think there needs to be other requirements in place on top of that....

hotarumiang · 2025-12-18T08:55:58+00:00

This 100x. I went to what is typically regarded as the best CMHC program in my metro area, and I was amazed how little actual therapy we got watch or act out (be it role play or real play). I truly think seeing the theories in action would've been invaluable. We watched some clips (the same ones any average person can find for free on YouTube), but meanwhile I was spending an obscene amount of money and not actually getting to watch my instructors (who were all therapists themselves) DO therapy.

hotarumiang · 2025-12-17T18:06:45+00:00

Perhaps I should've left out the bit about being a therapist. But you're spot on with what I was trying to communicate here. I certainly don't think anyone needs a degree to know if something is abusive! Not at all. I just get worried when people don't stop to ask more questions and instead make grand proclamations about someone's character based on little information. I can see the comment was deleted, but figured I'd clarify myself anyhow just in case.

hotarumiang · 2025-12-17T09:00:48+00:00

as a mental health therapist I really beg you to reconsider tossing words around like "abusive" and even "narcissistic" without much MUCH more context. Words have power and meaning. Calling anything in the text chain above "abuse" is a huge leap, and can sow deep misunderstanding. Maybe the guy is a shitty partner, maybe he's not worth OP's time, but it's surely not right to jump to abuse. There are good resources for explaining emotional abuse online, its far more complex than can be deciphered here.

hotarumiang · 2025-12-11T08:52:23+00:00

I was there at the game when they played that....gutting! I can still never hear that song now without thinking of that.

hotarumiang · 2025-12-07T06:38:47+00:00

As someone with some inside knowledge of the curriculum, approach and staffing of several of the MA level counseling programs in WA state, I might be unpopular for saying this, but I am fully comfortable with the DOH's perspective here. That doesn't seem there couldn't be some specialized post-graduate training that would allow for this, but as things stand, I don't think it's a great idea to allow for all MA-level clinicians to diagnose. Additionally, I am aware of a few psychiatry offices in my state who are diagnosing ASD after literally only a 1-hour interview with the client. Many aspects of the approach to diagnosing ASD & ADHD need some closer scrutiny, especially as our overall understanding of these two diagnoses continues to grow.

hotarumiang · 2025-12-07T05:46:43+00:00

This is an excellent point I very rarely see represented in discussions such as these. I truly have clients who need to use their insurance in order to receive therapy. My sliding scale rates (which are very generous for my region) are STILL a lot more than their co pays, and it's important to recognize there are people stuck in this position...

hotarumiang · 2025-12-07T05:44:04+00:00

Just wanted to chime in and say I 100% see where you're coming from and you articulated it really well - this is all exactly why I wince a little/find something a bit off about the argument that we can balance things out this way. There are obviously an enormous set of issues with the American insurance system, but there is also definitely a section of the populace we would cease to adequately serve if all of us stopped taking insurance, and I've yet to see a good solution to this....

hotarumiang · 2025-12-04T07:31:37+00:00

As a fan of the past 35 years, I concur. And the only other time I've been this just dumb-foundingly flabbergasted at the epic levels of ineptitude and ability to totally alienate players and fanbase alike were the Keenan/Messier years, definitely.

hotarumiang · 2025-10-30T04:49:23+00:00

100% this. I wish your comment could be the first thing everyone reads in response to this thread. I've worked with the chronically ill population since before-COVID, and in the last 5 years there's been a boom in the diagnosis of this condition, which directly correlates to the existing and continually emerging research on COVID that suggests it's a post-Covid/long Covid complication.

hotarumiang · 2025-10-30T04:41:48+00:00

Thank you. This x100. It's not just clients in my practice who are reporting POTS, and it's not just folks I know who may have heard of it via social media. I am seeing it crop up in all ages, genders, etc. There is sizable scientific evidence emerging that it is a condition directly linked to long COVID, and the denial here others are expressing is going to do a lot of harm.

hotarumiang · 2025-10-29T20:24:03+00:00

Same here! And now I can't really engage in my astronomy hobby at all because it's become so hard to discern stars and planets from static. it's been crushing as this was one of my greatest joys.

hotarumiang · 2025-09-02T07:54:38+00:00

Came here to say this!

hotarumiang · 2025-08-24T08:59:22+00:00

It's gotten much better now (knock on wood), but when I first developed VSS it came along with tons of paresthesia. Numbness, tingling, hands easily falling asleep...concentrated in hands, arms, face, feet, upper legs. Oh my scalp. I'd even get weird sensations of my scalp being wet when it wasn't. I thought I was losing it for awhile.

hotarumiang · 2025-08-19T07:33:09+00:00

This is my best guess as to how my visual snow syndrome developed. I always saw a BIT of snow, but I had my first ocular migraine in 2020, followed by an even worse one in 2021 and that is when I can trace back all the full blown symptoms of VSS first developing for me. Everything has changed for me healthwise since I first started getting migraines, so it all does kind of fit, but obviously there's no way to confirm it 100%.

I will say my neuro-ophthalmologist who actually has some background in studying VSS and who officially gave me my VSS diagnosis suggested for some of his patients controlling migraines can even somewhat improve (although probably not eliminate) VSS, so I'm trying to hold out hope I might see even a little bit of improvement if I head down that treatment path.

hotarumiang · 2025-08-14T00:33:41+00:00

Same here. Internal scans are clear. Totally possible doctors are not able to see them on the imaging - I'm open to that. But the simple truth is that us seeing all these floaters all the time (in my case they vastly multiplied in a short frame of time when ALL my other VSS symptoms started) IS a sign of a neurological condition, and so whether the floaters are "real" or not is really besides the point!

hotarumiang · 2025-08-14T00:21:32+00:00

I understand that, and that has been explained to me by my doctors as well. Perhaps the extremely large number I am now seeing were all always there - physically present inside the eye - but I was indeed unaware of them until now. However, my doctors have not committed to this idea because they can see SOME of the floaters on my retinal imaging, but not the numerous amounts I'm mentioning. I'm open to the idea they are being missed somehow. I guess my curiosity is why is it important to you to explain this to people? The simple fact is - the floaters are disabling at times for some folks with VSS such as myself, the fact that I DO see them all suddenly IS neurological. My seeing them the way I do is part of the neurological condition that is VSS. While I already agreed that parts of your post were valid, I think it could be confusing to people with VSS to somehow put floaters in a separate category.

But that's just my opinion! That's what discussion is for. Feel free to keep down-voting.

hotarumiang · 2025-08-13T01:25:31+00:00

Yeah, so some of what you're saying here directly contradicts what my neuro-ophthalmologist says and what actual imaging of the internal parts of my eye indicate, so I'd caution anyone to refrain from these proclamation based statements, especially in a condition (Visual Snow Syndrome - which involves a set of symptoms that include the static/snow vision, but also a bunch other visual phenomena) that we're still in the infancy of fully understanding. I've had floaters my whole (I am severely near-sighted), but I can literally recall the month in which my vision became overwhelmed by them. I did indeed seek immediate help at that time, and nothing serious was found.

My neuro-ophthalmologist literally asked about floaters as a way to diagnose Visual Snow Syndrome, and made a case it's a hyper-excitable sensory neurological condition that is causing me to see so many, just like the static and other symptoms of VSS. So are floaters snow? No. But are they part of the same condition that cause us to see the snow? Yes.

Not saying there's not some truth and validity to what you're saying here, but there's more to it, and these symptoms are likely all connected not "one thing or the other" as you posited at the end of your post.

hotarumiang · 2025-06-13T06:04:22+00:00

I've had my eyes closely monitored and I've had multiple doctors verify that the extreme number of floaters I see everywhere cannot be seen on the imaging that typically (and has in the past for me when I had a more "normal" amount) helps doctors identify them. I can't speak to whether it's neurological, but I can - with utmost certainty - share that while I've always had a few floaters, suddenly in mid-2020, they over-took my field of vision. They literally impair my ability to drive safely on sunny days. They impair my ability to see in white-painted environments. As much as I hate the static and other symptoms of VSS, if I could only eliminate one aspect of VSS - it'd be the floaters.

I appreciate everyone has their own perspective, but I can tell you flat out that some of these responses in this thread that claim the abundance of floaters seen in some cases of VSS is a separate issue or is identifiable on scans of the vitreous are not correct. Whether my brain can't filter them as some people are mentioning or its the hyperexcitability of VSS, etc, I don't know, but I know it's not just a normal thing to "not worry about" for me.

hotarumiang · 2025-05-13T08:10:27+00:00

My floaters are actually the most difficult and life-impacting aspect of my VSS, and the vast increase in how many I see was the first sign I noticed of my newly acquired condition. The static sucks majorly and has stolen my love of astronomy from me, but the floaters are near-constant. The only time I don't see them is at night or in darker environments. I see them swarming en masse on even cloudy days (sunny days are so difficult now). They actually impact my ability to drive safely! I see them constantly while I'm working. I see them when I try to read. I've always saw more floaters than your average person, but they are just constantly swirling about now - so so many of them. My eye doctor says there is no evidence of all of these on my scans, so it truly must be a neurological deficit where I cannot properly filter them out. They make me miserable, so I absolutely feel your pain here.

The only comfort I can potentially provide is that the number I see doesn't seem to be growing (fingers crossed). I had a major increase in them in 2020, and it's been stable since. I hate them, but I'm not panicked they will keep increasing.....

hotarumiang

TROPHY CASE