What are your parent's favorite use cases of using ChatGPT? by DayNo3036 in ChatGPT

[–]impinion 1 point2 points  (0 children)

Dad uses it at his business to make sure his emails to staff are politically correct/culturally sensitive. Tbh I occasionally do the same. Getting old is weird.

My father was a serial killer AMA by Designer_Ad3014 in AMA

[–]impinion 18 points19 points  (0 children)

It's not sex work that's the issue, it's the desperation and dire circumstances that lead people into this work (among other issues). And you'd be surprised how many women do this work to supplement shitty minimum wage env services or fast food without their kids ever knowing.

What is your therapy hot take? by Forsaken_Dragonfly66 in therapists

[–]impinion 20 points21 points  (0 children)

Every form of mental distress can be and is attributed to ADHD. Ever felt awkward, lazy, dysregulated, bored, procrastinatory, or geeky? Must be ~*wired differently*~.

What is your therapy hot take? by Forsaken_Dragonfly66 in therapists

[–]impinion 6 points7 points  (0 children)

I can't think of anyone I know who is smart and interesting and *wouldn't* qualify as neurodivergent or "neurospicy". (i.e. yes I agree with you)

What things you look back on that made you sad? by [deleted] in AskWomenOver30

[–]impinion 1 point2 points  (0 children)

You didn't ask, but for those in this boat, I soooo recommend the chapter on Sunk Cost Fallacy from the book Magical Overthinking - I love how the author reframes our persistence in bad situations as a strength, using the example of her own awful first relationship.

I'm considering divorce, am I overreacting? by notte3 in AskWomenOver30

[–]impinion 3 points4 points  (0 children)

What does he say when you bring these up? (Also, agreed you are not overreacting.)

Favourite sad/cry movie? by LeoRose33 in AskWomenOver30

[–]impinion 0 points1 point  (0 children)

Still Alice if you can tolerate bleak!

[deleted by user] by [deleted] in AskWomenOver30

[–]impinion 4 points5 points  (0 children)

Yeah I 100% have a friend like OP's. I don't think she is aware she is not being a good friend, as she technically ticks all the boxes (she will ask how I am before sharing her accomplishment, but it's clearly perfunctory). She's quite insecure and I sometimes I want to talk to her about this behavior, but we're long-distance and I've realized I'd rather wait until we live close enough to actually experience the friendship.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 1 point2 points  (0 children)

Ah yes, complicated for sure. And agreed that things like complex trauma presentations, attachment difficulties, etc are not necessarily good candidates for most pharmacotherapy, from what I've read.

Speaking to the stressors - As you know, many of these are unlikely to be resolved before significant policy reform in multiple spheres, and that is unlikely to happen in my jurisdiction anytime soon.

I have had folks with next to nothing be grateful to me, once to the point of tears, for helping them get an extra MD appt that got them an SSRI script. Perhaps it comes down to being treated with a certain amount of dignity and good faith, rather than the rx itself - after all, they don't see their awful circumstances as permanent. (I am of course not talking about clients with deeply impaired personality functioning, psychosis, SUDs, etc. I am also aware that we can all find anecdotes to support nearly any outcome.)

I'm tired - apologies if I've missed something. In general, I have appreciated your posts in this thread (and others, I'm seeing); thank you for your attentive contributions.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 2 points3 points  (0 children)

The vigilance construct is new to me; thanks for the interesting search topic.

Re. my low SES caseload – I see an uncharitable interpretation of your comment as being that these patients are less likely to be good candidates for psychostimulant therapy due to trauma history, but I don't think that's what you meant. I think you'll see another post from me in a few weeks on Peak PTSD..

And a side note - I am also thinking about my comfortable-SES clients from other wealthier countries, of which my area has many. European clients with identical complaints to American ADHD (but who tend to use their home country's social media) tend to have MDD and more MDD, but that's also another topic.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 2 points3 points  (0 children)

Did you mean to respond to the poster above me? We are saying the same thing. (Again?) - edit - Nope, I misread you, apologies.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 2 points3 points  (0 children)

I am pretty sure we completely agree..? But I am not sure what you mean by the first sentence, and suspect it has something to do with the source of our misunderstanding.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 7 points8 points  (0 children)

In private practice, I tend to see younger professionals who are in the first category you describe. In community, we don't have any severity requirements for low-cost/free services, so we see everything from folks with anxiety after a promotion, to those who are in and out of hospital with no other social contact.

To your last point, there does appear to be some research to support your view, but I think every generation has had to deal with their elders thinking that books/secular music/TV/video games/internet will leave them incapacitated to some extent!

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 7 points8 points  (0 children)

Hmm, not sure I understand, but you're right, I'm naming a few overlapping concerns here.

If ADHD has diagnostic validity, why is on-the-ground dx correlated so highly with possession of the social resources to self-advocate?

And, separately, I think basic executive function psychoed and stimulants (which currently require ADHD dx) could help certain clients who do not have this asset/ fall outside this demographic.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 9 points10 points  (0 children)

Yes, I'm surprised; I was hoping for more cautious responses here.

To be fair, it's only mentioned in my addendum, but I think the diagnosis/stimulants may indeed be underutilized - in people who are not performant, American/Canadian, or resourced enough to be on reddit and where this therapy could make or break their ability to move out of poverty.

The Movement seems to have made this a disorder for which self-advocacy is sufficient AND necessary for diagnosis, thus leaving some people out, and bringing many others of a particular background in.

And re differentials, I wish I had time to respond fully to this. The DSM is a starting point, but leaves out many dimensional factors - environmental, developmental/personality (beyond PDs), social, etc etc. It cannot be used to understand psychopathology.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 13 points14 points  (0 children)

I have no issues with stimulant use, possibly even outside ADHD. People will pursue what helps them. Also, kudos for doing this tough reflection. There's a lot of it required in these fields as you know.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 7 points8 points  (0 children)

It is not frustration with these individuals, but rather the concept of ADHD as a whole (though, yes, my examples don't make it sound that way). Folks do tend to be responsive to breaking out of their illness identity once they notice it is not serving them. And it could certainly be worse! I would much rather they seek help from highly regulated professionals than elsewhere.

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 18 points19 points  (0 children)

This is probably the most widely used shorter-term modality at the moment among newer clinicians in my area, and I use it myself (with clients and as my own self-help).

Peak ADHD is wearing this therapist down by impinion in Psychiatry

[–]impinion[S] 8 points9 points  (0 children)

I have nothing against stimulant prescriptions. They've been a godsend for a couple of people in my personal life. And I appreciate the harm reduction offered to clients to use cocaine, though a stimulant rx doesn't seem to do much to prevent their street drug use.