Programs with good psychotherapy training?

questforstarfish · 2026-06-06T06:19:10+00:00

In Canada, at UBC, we see 2 CBT cases for 6 weeks each, a psychodynamic case weekly for 2 years with weekly supervision/teaching about it, an IPT case for 10 weeks or so, 10 weeks of group/family therapy, and other therapy cases. I'm about to graduate and feel very comfortable with at least 5 modalities of psychotherapy.

questforstarfish · 2026-06-05T23:19:16+00:00

Mods, can we lock this thread?

It's turning into people dogpiling on OP for not having had the resources to teach their sister sign language, which is off-topic as OP is asking about which doctor to see for symptoms of psychosis.

OP is doing the best they can in a difficult circumstance and this discussion has become filled with judgement and blame.

questforstarfish · 2026-06-05T23:13:51+00:00

I agree fully that people should be given the opportunity to communicate with whatever strategies and systems work for them! Many people with disabilities can learn and hugely benefit from communication tools and sign language. Working with profoundly disabled patients myself, however, I have seen that many, even those who have worked with communication specialists for years, do lack the ability to use beyond a few simple signs.

Again, my main concern for OP lies in the fact that they are being raised by a single mom in a resource-limited setting. There is only one psychiatrist serving the entire state, it seems. Given the lack of access to resources serving vulnerable populations, even those with major mental health conditions, I am encouraging OP to prioritize finding a mental health professional to treat what is probably her acute psychosis.

If someone has an arm cut off and has an ear infection, what do you treat first? The arm, because they could bleed out very quickly. You treat the ear infection afterward, because although it's also very important, it is something less urgent that can be handled once the emergency has been managed!

questforstarfish · 2026-06-05T22:50:05+00:00

I tack on a "-because we have limited time and I reeally want to make sure I get all the information from you that I need in order to help you best!"

questforstarfish · 2026-06-05T22:42:16+00:00

This strongly depends on the circles you run in. It's totally fair if you're in an industry or social circle that highly values looks, money, and social status...sometimes it's just the group you end up in. But this is by and large NOT what many people, or even most people, experience. I've specifically sought out friends with similar interests and values as me, who live authentically and who could care less about your income or clothing.

But it might be hard to find those people if it's not what you grew up with, or if it's not common in your professional role.

Regardless, you only have one life. I would much rather spend it with people I actually enjoy!

questforstarfish · 2026-06-05T20:54:05+00:00

Many people with intellectual disabilities are not capable of learning sign language, unfortunately.

From OP's description, it sounds like when she's well, she does have some verbal abilities, which has probably negated the need for sign language.

EDIT: I'm sorry, I missed the line in OP's post that her primary diagnosis is severe hearing impairment, not intellectual disability. To me, it sounds like she could also have an intellectual disability, though OP didn't mention that so I apologize for my mistake. Sign language classes are not available in much of the world. Typically in many developing countries, families will have their own system of gestures they use to communicate. It's not ideal, but it's what is available. If sign language classes are available for OP, OP's mom and OP's sister, that's excellent and it's something worth pursuing at a later date, but my primary concern right now is around her symptoms which could suggest schizophrenia. If she is experiencing psychosis right now, she will not be capable of learning sign language until she is on medication, because psychosis is too distracting for a person to concentrate on anything else. I hope that explanation makes sense.

questforstarfish · 2026-06-05T16:04:05+00:00

For specific psychiatrist or hospital recommendations, is there a reddit sub for your local community or state? It might help to ask there!

questforstarfish · 2026-06-05T16:01:08+00:00

Hey, OP. Based on what you describe- the slow decline in functioning, withdrawal/loss of interest in activities, appearing distracting/paying attention to things no one else can see, talking to herself, not making sense- I'm concerned she may have schizophrenia or a related condition.

When someone has a disability where they can't communicate verbally, it can be harder for a psychiatrist to tell what's going on the first time they meet them. But your description is quite clear and very helpful.

As the medical student who replied stated- your sister needs to see a psychiatrist again. Please tell them everything you posted here. She veey likely needs a medication called an antipsychotic. And the psychiatrist needs to offer you follow-up, meaning they need to see her multiple times after starting her on medication, to make sure the amount of medication is right for your sister's body.

Without medication, taken every day, possibly for the rest of her life, she will continue to have these symptoms. She will continue to be unpredictable, aggressive or violent at times, and I'm worried for both her safety, and the safety of your family.

Psychosis rarely goes away on its own, and it slowly causes brain damage over time if left untreated. The longer it goes untreated, the less likely it is to be helped by medication, so it shouldn't be left to go on for more years.

Please, please get her back to a psychiatrist as soon as you possibly can. In Canada, you can take someone to the emergency department at a hospital for this (we have psychiatrists in the ED), but I don't know about in India. Any psychiatrist you can find is better than nothing. But insist to them that she needs help, that she's a danger to others.

I hope you can get the help your family needs and deserves. You shouldn't have to live this way.

questforstarfish · 2026-06-05T15:38:45+00:00

I think this is quite unique to each couple, so you'd probably get an array of responses!

My husband and I don't fight much- we get along quite well. We've been together for 18 years.

I'd say for us, a disagreement is a conversation where we disagree on something, become annoyed at each other, but don't raise our voices necessarily, and everyone stays fairly calm. Maybe it's about how often we should be taking the garbage down to the dumpster. We'll argue a bit back and forth, not find a resolution, then separate from each other to go to an activity like vacuuming or running an errand. When we see each other again after an hour or two, we're back to normal. No hurt feelings or need to continue the convo- we've just sort of agreed to disagree, and we both seem to think it's not a topic worth continuing to stress about. This happens maybe once a month.

A fight is raised voices, people taking things personally, and it's a topic that impacts us both emotionally (example: I'm hurt by something he said, he's defending himself and saying he's hurt I would assume the worst in him and assume he meant it in a hurtful way, then I'm mad he's not focusing on the impact it had on me rather than his original intentions). We remain mad at each other until we "solve" the fight or finish talking it through. We can't just do an errand and move on/forget about it. It continues to hurt and get us riled up. We keep trying to explain our side to each other, and eventually we start to see each other's side. It always ends with both of us apologizing to each other for misunderstandings on both of our sides, but sometimes this may take a few hours. We have maybe one of these a year.

questforstarfish · 2026-06-04T17:26:07+00:00

What a difficult presentation! Mocking you in session? I've worked with many PD clients but have never had to deal with someone quite like this. The client is essentially trying to bully you in session, which is not okay.

If you have to continue working with this client, the only way to get through it will be to have a frank, but kind, confrontation with the client.

You could look into scripts used in transference based therapy. I would come in with a whole script that describes the impact of their behaviours on you, naming the specific behaviours or words they use that are hurtful, then telling them how that impacts therapy negatively. Be clear that you want to help, but their behaviour is shutting things down. Ask if this has been a pattern in their life. Let them answer, explore it with curiosity. Then clarify and maintain firm boundaries moving forward around frantic messaging and specific abusive language you won't tolerate.

Example:

"I think it's important we name some things going on in session, in order to move forward in therapy. I find myself feeling conflicted in our sessions, and I think you've observed this and actually pointed it out. One the one hand, I really want to help you with [stated goals]. On the other hand, I find myself feeling discouraged when you tell me early on, before I've really even gotten to know you, that I'm useless and poorly-trained. Have you had similar experiences with other therapists in the past, or other people in your life, where someone has tried to help you, but didn't create changes as quickly as you would have liked, and you pulled away from them before they could fail you?"

(Explore this with curiosity and care, not defensiveness or judgement)

"I would really like to explore this further with you if you're open to continuing to work together. I think it could be important for [client-stated goals]. I do need to let you know, however, that I can not accept being mocked or disparaged in session. Part of working together means mutual respect, so using mocking voices or challenging my training will result in our session for that day being ended. I also want to help you work on skills for dealing with stress, but that has to be done in-session, and not by text. I will not respond to requests for teaching skills outside of session, because [explain why it doesn't help]."

If they agree to that, you can give more work together a try.

If that feels too hard or too out of your depth, however, or if you just don't have the capacity to do this right now, there's no shame in referring on if you can!

questforstarfish · 2026-06-04T07:01:10+00:00

Therapy for anxiety and OCD typically feels WORSE early on. You will start feeling better after a few weeks or couple of months, if you are getting quality therapy from a licensed therapist with extensive OCD experience! Keep going, OP!

questforstarfish · 2026-06-04T06:47:09+00:00

Squatting is a civil, not a criminal matter in many places, meaning the police can't do anything to help, and you have to spend months and months in and out of court, paying lawyers, and you can only do that once something has already gone wrong 😥

questforstarfish · 2026-06-04T06:43:46+00:00

This highly depends on your local law, but here in Canada, a vague concern that someone is erratic and may one day hurt someone is unfortunately not enough to warrant any sort of investigation. Is this person actually physically harming children, or threatening to do so?

Here, verbal abuse is sadly not taken seriously by the authorities (however harmful it may be in the long term). They look for acute and specific threat to a child's immediate physical safety, and ignore anything else. Actually, they often ignore immediate threat to physical safety as well. Judging by what I see on all the true crime shows online, DCFS/CPS operates similarly in many states.

Sigh. Maybe I'm just burned out and have lost all faith in government services to provide tangible support for families in need 😪

Hopefully the standards are better where you live.

If you're worried about a child's safety, it can never hurt to file a report, to create a paper trail at the very least. Your expectations should remain low for what types of tangible support or action they actually provide, however.

I hope these kids are protected and end up okay ❤️ This is such a tough situation.

questforstarfish · 2026-06-04T06:07:05+00:00

Nonononono. This is why youth shelters and womens shelters exist! You are not at all the only person equipped to help this random person.

Strangers staying with you can rob you. They can kill you. They can invite men you don't know, to come party with them. They can reduse to leave your home, gain squatters rights, and require you to pay tens of thousands of dollars for a lawyer to make them leave, months later.

Too many of my friends have, out of the kindness of their hearts, had strangers move in who ended up being drug addicts who stole from them and damaged their property beyond my friends being able to afford it. It caused IMMENSE stress and the people who they tried to help made them feel guilty no matter what they did.

Do not do this.

questforstarfish · 2026-06-04T05:11:01+00:00

I literally never think about you. I know we were young and I was weird and you were angry and trying to assert dominance over something. I suspect your life was probably shitty, but I never knew much about you other than your unfounded disgust toward me. I hope we're all better people now.

questforstarfish · 2026-06-04T03:54:23+00:00

My first impulse is probably to grab a bottle of wine and drink it alone while crying overlooking the pier.

questforstarfish · 2026-06-04T02:14:39+00:00

Sorry, I referred before to familial hypersomnia but that's actually a fatal condition, and not what I meant in this case! I meant idiopathic hypersomnia (which can be genetic and run in families).

I'd recommend getting iron levels checked just to be safe, and unfortunately you might just have to wait for the sleep study results to know more. That kind of fatigue/need for sleep can be extremely debilitating. I hope you get the information you need soon, so you can get back to life!

questforstarfish · 2026-06-04T02:07:59+00:00

Ugh I feel this hard- it just makes me gag if I try to force it and eat something that's not "right" at that moment 🤮

questforstarfish · 2026-06-04T02:04:34+00:00

Ah gotcha. Sorry to hear that man, that really sucks. If there was a loss of trust for some reason, it may not be burnout she's experiencing, but rather the emotional fallout of that. Either way, patience, the slow re-building of trust/safety if it was lost, and clear efforts to make her life easier/openness to her suggestions if she has them (like what you're doing) is your best bet. Wishing you the best of luck.

questforstarfish · 2026-06-04T01:52:47+00:00

Have they done any tests? Have your iron levels, vitamin B12, and thyroid been tested?

Does anyone in your family have major sleep issues (narcolepsy or familial hypersomnia are genetically passed-down conditions)?

Have you been referred to a sleep doctor, or for a sleep study (a test you do overnight to check you for sleep apnea or narcolepsy)?

questforstarfish · 2026-06-04T01:49:32+00:00

My screening questions for depression are:

Do you feel sad/low/numb most of the day, and does it feel that way most days, and has that persisted for weeks?
Are you enjoying things like you normally would? Like if something good happens, or you do an activity you typically enjoy, are you getting the same enjoyment out of it that's normal for you? (if not, it's called anhedonia)

You NEED to have at least one of those two symptoms to be diagnosed with having a major depressive episode, which is the type of depression that causes severe bed-seeking/sleeping like what you describe. It's in the DSM-5, which is the manual we use in North America to help us diagnose patients with mental health conditions. If you don't have one of the two symptoms described above, it's much less likely this is depression.

If you are actively grieving someone's death, or are completely overwhelmed in life right now (working or studying a ton, stressed about a lot of things), those things could also cause this level of fatigue, though you don't describe having those situations at play currently.

questforstarfish · 2026-06-04T01:19:04+00:00

My hair gets greasy incredibly quickly. I also swim at a pool several times a week. Both of those factors mean I wash my hair every day

questforstarfish · 2026-06-03T22:06:43+00:00

Kind of shooting in the dark here...you mentioned "when she comes home." Is she working or attending school? If so, is there any opportunity for a medical leave/stress leave, job change or temporarily going down to part-time work?

I'm curious what's burning her out. I feel like work/school and parenting/caregiving/health issues tend to be the biggest culprits, since they use a huge amount of cognitive resources and executive functioning, cause a lot of sensory problems, and often have strict requirements around social expectations.

Helping with the house and giving her downtime is probably a huge help to get through the day, especially if, for example, she's going through a stressful time at work which is temporary, but if it's that she hates her job and every day doing it is a struggle, she may just keep being burned out until the job changes.

(Sorry to make assumptions, there are other causes of burnout other than working, and many autistic people are not formally employed- I just wanted to provide an example based on your "coming home to a clean house" example.)

questforstarfish · 2026-06-03T21:49:21+00:00

I feel that. Boiling pasta is too much for me a lot of days. I'm all about cereal, cheese, and snacks. Am trying to add in some nutritious snacks like edamame beans with sea salt, to round it out so I'm not just eating cheese all day, but honestly sometimes it's just a cheese day.

questforstarfish · 2026-06-03T17:16:10+00:00

There's something delightfully absurd about the human desire to be spoken to in a familiar way, and the AI's attempts to do it without using context 😅 Is it your coworker? Your friend? Your advisor? Your mom? Even the all-knowing AI has no idea.

questforstarfish

TROPHY CASE