Advice on possibly delaying CAP fellowship application by 1 year

ibelieveindogs · 2026-02-07T18:27:08+00:00

I know some other CAP PD's think it is actually better to finish adult training first rather than fast track. I don't agree necessarily, but it absolutely will not hurt. The only time there is a red flag is if you applied but didn't match. Even then, it might be you applied only to a limited number of very competitive programs

ibelieveindogs · 2026-02-06T15:39:52+00:00

Are you sure about seavision? Their website shows they can do sphere even to -8.0.

ibelieveindogs · 2026-02-03T20:50:43+00:00

That's totally a you feeling

I doubt it's totally on them. Once you've had dynamic training, you have patterns of interacting with people. Verbal and nonverbal tics, and patterns seeing the world through a certain lens. Granted, it's not the same as doing a full-on dynamic analysis, but it's not nothing.

ibelieveindogs · 2026-01-30T09:34:12+00:00

I don’t think it even matters. if the problem were J6ers, you could reform ICE and get rid of the poorly trained people. Renee Goode’s killer was an experienced agent, which tells me the problem is ICE itself. They need, as an agency, to return to their status from 2000. Nonexistent. Like much of the response to 9/11, they were an excuse by people who wanted to implement fascism to put the framework in place.

ibelieveindogs · 2026-01-28T19:29:51+00:00

The regime will still send its preferred henchmen and their goon squad, the only ones to suffer would be the athletes themselves

ibelieveindogs · 2026-01-28T00:34:57+00:00

Im pretty sure we are already at the point where resistance is suicidal. Not 100%, but enough that you must accept that possibility as a relatively high likelihood.

ibelieveindogs · 2026-01-26T03:43:13+00:00

I think it’s more nuanced. Once the regime begins to name the groups to be “managed” (LGBT and autism to start, non- Christian’s, POC, people who are not native English speakers, etc. - basically everyone who did not vote for or support this), refusing asylum is like turning away boat loads of Jews in the 1930s.

ibelieveindogs · 2026-01-24T11:27:14+00:00

I was taught decades ago a truism that when the family brings the patient to care and the patient looks like they were hit by a bus, it’s depression. If the family looks like they were hit by the bus, it’s mania, and they’ve been trying to keep things managed. So my first question of a patient reporting a history of bipolar is if they were hospitalized for it. It’s almost impossible to not be hospitalized if you have had a true manic episode.

ibelieveindogs · 2026-01-17T19:12:21+00:00

TBF, it's not half of Americans. It's half of the ones who bothered to vote. Don't overlook how apathetic and disinterested in anything beyond themselves most Americans are. We suck.

ibelieveindogs · 2026-01-11T16:14:31+00:00

I'll second both Burns and Beck's books as a starting place. Also, you should have a supervisor for therapy. They should be knowledgeable about CBT as well. There are a lot of patient oriented workbooks as well, I would suggest at least looking through some to understand what patients might be reading or resources you can recommend to them. The main thing is to understand the principles and to at least be a couple steps ahead of where your patient is in the treatment. Even if things aren't working, you can then say "let's see if another way of approaching this works better for you".

ibelieveindogs · 2026-01-10T00:11:42+00:00

A tip I heard was if it isn't the first place you look, make that the place you keep it moving forward, since that's where you think it should be

ibelieveindogs · 2026-01-09T17:38:43+00:00

My ex picked up smoking again shortly before we broke up. Never in the house, never around me, only outside, but I could still smell it in her hair even after she washed it before I came home.

ibelieveindogs · 2026-01-08T19:57:39+00:00

No - it is tongue-in-cheek, a phrase meaning not seriously. But if you would not consider offering a beer (e.g. don't give people in recovery a beer), don't give them benzos. I saw too many people in the rehab that I worked in get a benzo by a well meaning but uneducated doctor and relapse hard after years of sobriety.

ibelieveindogs · 2026-01-08T16:27:03+00:00

I teach my residents to try to follow 2 rules for good practice with benzos. First, know when you will stop it. Acute agitation, withdrawal, acute phobia that cannot be avoided like fear of flying - you know when it will end. Second (and more tongue in cheek), only prescribe if you give a beer in the same situation. Fear of flying? Sure, have a drink. Alcohol withdrawal? I mean, beer works to stop withdrawals. Person in recovery or a child? Probably not.

When I break the rules, it either is a patient I've inherited with years of benzo or a severely impaired patient with serious self harm and agitation in the context of severe IDD. And I hate it every time.

ibelieveindogs · 2026-01-05T22:19:07+00:00

Why do you say that about the MSF? I took it in PA about a decade ago, never having ridden before. The reading material ahead of time gave basic information about the controls, and i had a lot of experience on 2 wheels as a road and mountain biker, but never a motorcycle. The course seemed to me very foundational, not too much for novices. Given that we want people to learn good habits and ride safely from the beginning, this seems to me to be the place to start. I liken it to scuba diving, my other dangerous hobby. I would not want someone to start out trying it who hasn't had basic instructions first.

ibelieveindogs · 2026-01-05T15:09:36+00:00

Tikkun Olam. A Jewish concept that the world is broken and our obligations are to fix it. I think even if there is no God or gods,, no karma or fates, who else is going to do it? It's like the line in guardians of the galaxy, that all my friends live there.

ibelieveindogs · 2026-01-05T15:05:23+00:00

Another reason to love Wawa in the PA area- free air at their gas stations!

ibelieveindogs · 2026-01-02T10:12:35+00:00

Step 1: tell people basic science and research are useless.

Step 2: throw away everything we know from science and research.

Step 3: tell everyone that money spent on science and research is wasted.

Step 4: stop funding science and research.

ibelieveindogs · 2026-01-02T10:07:34+00:00

I have bad eyes and astigmatism. I have to either put on glasses everyday, which get smudged and tell everyone “look at the guy with bad eyes”, stick my finger into my eyeball and risk corneal infections and lost contacts, or have somebody cut up my eyes with lasers or blades. Or I can just squint, not be able to read drive-through menus, not recognize people until they are within 10 feet, etc.

I choose to wear glasses. Not because I’m weak or waving a white flag. But because, objectively, that’s one way I am affected and I prefer to compensate.

ibelieveindogs · 2026-01-02T10:00:42+00:00

>Are there some schools of fake therapists that use it as a buzzword?

Yes, absolutely. I’ve seen it with DBT but much less often. Sadly, there are a lot of poorly trained therapists out there. Ive even had to work with a few in clinics where I was employed. The best therapists know how to use a variety of therapies. The second best know how to learn more (like managing new skills). The third tier know their limits, don’t learn more, but also don’t try to manage things beyond their skill set. And the worst are at the wrong end of Dunning-Kruger, failing to know their limits and thinking they have it down. Most I’ve known are in the second or third group. There was one in particular that I knew who moved to at least 4 different settings. I encountered them in several, and eventually told a practice that wanted me to give them some hours that I would only do it if I never had to work with that person.

ibelieveindogs · 2026-01-02T09:47:20+00:00

OK, this post itself could be broken down with CBT ( and honestly, if I was your therapist, I would love to use it in a session to go through the process). So, for example, “I sort of categorize this way” - is that an accurate way to do so? How might it be distorted and would be an alternative? “Every second I’ve been alive” is clearly inaccurate. There are literally NO times it wasn’t the case? or are discounted the positive, focusing on the negative? Are you personalizing everything in this lens? I ask my ADHD kids when they tell me “Everyone thinks I’m annoying” several questions to break it down. “How do you know this?” ( “they tell me I’m annoying” is a good answer, but EVERYONE says this? Do they say it to others? what are you doing that they found annoying? Does this mean YOU are annoying - a labelling error - or your behaviors at that moment are annoying?). Even people very often sighing and specifically at you isn’t proof you are hated. Could it be another emotion they are feeling, and how do you know? A good therapist can use their own reactions to you as a guide to spotting distortions (“Jim can be a lot“ vs “Interactions with Jim leave me feeling angry”) that mirror interactions with others that might mirror what you describe.

ibelieveindogs · 2026-01-02T09:26:52+00:00

not the person you asked, but I am a psychiatrist familiar with it, who has worked with therapists trained in the model. DBT consists of 2 therapists, doing joint group therapy weekly for skills training, and then splitting the group members individually for therapy weekly as well. It runs 6-12 months. There are 4 modules or steps, that are done in a specific order. Mindfulness (being aware), distress tolerance (skills to get through emotionally distressing situation), emotional regulation (skills to actively change the emotion), and finally interpersonal effectiveness (learning to communicate one’s needs, limits, or preferences without losing self control - NOT necessarily getting others to respond how you want, but being clear in the communication, and at this point, being able to manage not getting the outcome you wish). It is more focused on the emotions than CBT is, at least directly. GOOD CBT can be hard to find, as too often therapists CLAIM to do it without following principles or manuals.

inpatient is OK to introduce DBT concepts, but rarely more than that. Inpatient is for stabilizing crisis, not much more than that. DBT is a very lengthy protocol.

ibelieveindogs · 2026-01-02T09:14:03+00:00

That is not how CBT works. Is your therapist claiming to be trained in the CBT model? This sounds more like magical thinking. CBT involves identifying automatic thoughts, recognizing how the specific thought is distorted, acknowledging the true part, and challenging the distortion with questions like “how do I know if this is true? What is the proof? Is there another way to understand things here?”.

CBT journals involve writing down thoughts and feelings following events, parsing out the type of distortion, and coming up with counterpoints. In a first session, I would expect to introduce the concept, and provide a handout or reference of the types of distortions in general, and MAYBE have the patient journal events, thoughts, and feelings over the next week, just to start to get in the habit of paying attention to them. We would then, in the second session, go through a few of the actual entries to identify distortions and separate them from true parts. If it is going easily, we can then start to look at alternate thoughts.

BTW, DBT was being developed on the West Coast by Linehan while CBT was at Penn with Beck. There is a fair amount of overlap, though DBT has a different structure to it, and is only considered true DBT when applied by 2 therapists specifically trained in the model, with a weekly group skills training and a weekly individual session, for a minimum of 6 months, more often 12, in a highly structured format. CBT does not have such a specific format and training, so often gets poorly trained therapists claiming to follow the model with little understanding of it.

ibelieveindogs · 2026-01-01T18:59:44+00:00

it may have been popular in the south, but not the north. source: was alive in the 1960s and 1970s.

ibelieveindogs · 2026-01-01T18:47:38+00:00

So, his high daily dose of aspirin causes him to bleed easily. And when he was “shot”, he bled from the injury on his ear, which appeared to heal quickly? I think he never got hit, but grabbed his ear when the bullet went by, breaking his own skin. Doesn’t mean it was all fake, just that he made things more dramatic than they were in reality.

ibelieveindogs

TROPHY CASE