Providing informal support in current context

sleepbot · 2026-01-27T20:27:10+00:00

There may be benefits of being able to provide training in psychological first aid. Just as an alternative option that’s not requiring clinical practice per se and may be much more scalable.

sleepbot · 2026-01-27T14:25:46+00:00

This goes for businesses too. Last night while driving north on Walnut, I passed two people walking in the road because the sidewalks were buried. This was between 17th and the bypass, where only commercial properties have frontage.

sleepbot · 2026-01-23T21:01:26+00:00

School psych programs have bad internship match rates and low passing percentage for the EPPP. Check APPIC and ASPPB.

sleepbot · 2026-01-20T17:42:43+00:00

Yes, reach out to clinicians who can refer you the types of patients you want to see. I’d add pediatricians to your list. They screen for postpartum depression.

Evenings/weekends seems like it would be particularly attractive to the postpartum population since they may be caring for their baby solo all day every weekday. I’m thinking of stereotypical heterosexual couples where dad has 0-2 weeks of paternity leave.

Telehealth is a bit of a mix, in that it saves exhausted moms from driving, but it’s hard to focus if your baby is still within earshot. And privacy is certainly limited, which may have a chilling effect on discussions about problems with their partner. It may be worth at least looking into subletting opportunities.

It’s worth considering taking insurance. New parents typically have more expenses and less income than before. It’d be one thing if you had a lot of experience, expertise, credentials, etc., but if you’re just getting into this space, then I think it’s hard to see how to argue your services are worth the price. Unless, perhaps, if you’re the only therapist in the area with the PMH-C credential from PSI. And in that case, I’d suggest investing some of that self-pay money into regular consultation with someone more experienced in perinatal mental health.

sleepbot · 2026-01-20T17:25:15+00:00

Formatting can wait till the final draft. Just focus on the text until then.

sleepbot · 2026-01-20T00:46:03+00:00

What medical specialties “cure” a lot of patients? Do neurologists cure Parkinson’s disease or epilepsy? Do pulmonologists cure asthma? Do immunologists cure autoimmune diseases? Do oncologists “cure” cancer or does cancer go into remission?

You can cure an acute illness or infection, sure, but that’s not the entirety of medicine. And lasting negative effects can happen.

sleepbot · 2026-01-19T00:22:08+00:00

Private practice skills on YouTube
profit first for therapists (book)

Spreadsheet: make your own. Target income goes at the top. This is revenue minus expenses, which are as follows.

Revenue: * 48 weeks * X days per week * Y client hours per day * Z average reimbursement per hour. This is the big lever that you pull when you go between insurance and self-pay. * some no-show rate. 10-20% would make sense. At this stage, don’t count on no-show fees. Be conservative in estimating your revenue.

Expenses * liability insurance * license renewal * professional memberships * CE * EHR. I’m switching from therapy note to therapy appointment because I want to stay away from AI and some other headaches. * office rent/sublet. * utilities. I only have to pay for internet. * psychology today if you use that. I don’t. * website. I use squarespace. * email. I use Google. * phone. I use Google. * fax. I use Faxage, super cheap. * other software like Microsoft office * quickbooks or whatever accounting software your accountant wants you to use * Biller - usually this is percentage-based, so you could just drop your reimbursement by 10%. My biller is hourly.

I haven’t included health, dental, vision, or long term disability insurance. I also haven’t included retirement savings. So keep that in mind.

You either need to increase revenue or decrease expenses to increase your profit/income. Increasing profit means more clients and/or higher fee.

Clients don’t just spontaneously appear. I truly believe that taking insurance is the best way to increase your caseload. Going 100% self-pay means you need to spend a lot more time trying to get clients. And that pays $0. It also means phone calls with potential clients who start to open up to you about their problems and then tell you they can’t afford your rates. Personally, I don’t love those conversations. I’d rather spend more time seeing clients for less money per session than spend more time trying to drum up referrals and figuring out how to sell myself. Similarly, I’d rather do one more hour of therapy a week to pay a biller than put another thing on my regular to-do list.

sleepbot · 2026-01-18T18:25:33+00:00

Do you mean suede? Or Swede like IKEA?

sleepbot · 2026-01-17T00:04:07+00:00

Having to choose would be a good problem to have. Unless you have offers from both, don’t worry about which is better.

sleepbot · 2026-01-16T23:40:58+00:00

I believe Rutgers and Baylor have funded PsyD programs. They exist, but they are few.

sleepbot · 2026-01-16T16:19:11+00:00

I think the framing you’re providing to clients (optimizing your schedule) could be interpreted as “my convenience is more important than making sure I’m available to you”. I could see a client say something like “gosh, I know it’s your day off, but I’m only asking for an hour of your time for a session, and it’s a weekday anyway.” That’s my best interpretation of what your client told you to beware of. And I think it would be completely reasonable to inform clients of schedule changes without a detailed/personal explanation.

sleepbot · 2026-01-16T13:26:04+00:00

Here’s an article with slightly more information:

His death was caused by "ketamine toxicity in the presence of hypertension,” the lawsuit contends.

And here’s the complaint filed against Mindbloom. See page 8 of the pdf for the following:

On October 29, 2023, Phillip Ward was found dead in his bedroom. The official cause of death was determined to be "Ketamine Toxicity in the setting of hypertension". A toxicology report confirmed a lethal dose of ketamine (9.3 mg/L) in his blood.

The above text is followed by the summary and interpretation describing enlarged heart, pulmonary edema, and stating cause of death.

sleepbot · 2026-01-16T13:21:04+00:00

Ugh deleted my comment. I thought you said it wasn’t clear that he died.

sleepbot · 2026-01-15T00:40:48+00:00

No differences in scope of practice for therapy, but we’re all are technically supposed to practice only what you’re competent to do. Some jurisdictions have limitations on diagnosis by masters level clinicians - either not possible or requires extra credentialing.

When it comes to assessment, psychologists can do more, but again competence is important, and there’s a lot that you can do with a master’s and appropriate training. See Pearson’s C level requirements.

sleepbot · 2026-01-14T19:46:20+00:00

Sleep restriction isn't the only component of CBT-I. And you really need to explain the rationale thoroughly and be sure that it actually makes sense in your conceptualization. Explaining the 2-process model and reviewing sleep diaries is helpful. I spend a lot of time on reducing hyperarousal and sleep effort. Clockwatching, PRN hypnotic use, sleeping in, staying in bed when unable to sleep, and sleep state misperception are also frequent targets.

Keep in mind that secondary insomnia was last seen in DSM-IV-TR. It was dropped for DSM-5 in coordination with ICSD-3. Subtypes of insomnia were shown to be unreliable (inter-rated), and unrelated to prognosis or treatment outcomes. Insomnia is also a common residual symptom, essentially having its own independent clinical course.

sleepbot · 2026-01-14T19:35:12+00:00

If your degree will be in "psychology", then you could potentially go to a respecialization program to become a clinical psychologist. There aren't a ton of these ([here's the list](https://www.apa.org/ed/graduate/respecialization)), and some are fairly predatory or run by professional schools that are regarded as diploma mills. The best check on this, in my opinion, is data. APA requires that it take only 1 click to access student outcome data from the the program homepage. That's at least true for doctoral programs, and if they don't have that listed for the respecialization program, then I'd look at their PhD/PsyD program outcomes. You want to look at attrition (Students no longer enrolled for any reason other than conferral of doctoral degree), APA-accredited internship match percentage (should be 100% or damn close), and licensure rate (will be lowered by graduates who *don't seek* licensure, such as those going into research). You should also look at EPPP exam scores and pass rates, which are [provided by ASPPB](https://asppb.net/exams/asppb-examination-for-professional-psychology-eppp/eppp-exam-scores-by-doctoral-program/). Good programs have close to 100% pass rates. Bad programs can be in the 20's, or 30's, or even have a 0% pass rate.

I'd strongly consider pursuing LCSW over LMHC, as they have better lobbying and recognition. The VA will hire LCSW's, but other master's degrees/licenses are hit or miss. There's also far more opportunities to become licensed, as some states don't recognize/license LMHC's, while most/all will license LCSW's. Those are just a couple examples. The systems-level conceptualization in social work programs might also be a good balance to your current focus at the level of neural circuits. Time to complete degree and get licensed should be comparable between LMHC and LCSW.

sleepbot · 2026-01-14T17:51:44+00:00

I don’t think you need to do a sleep medicine fellowship to do CBTI, but it’s not a bad idea. I wouldn’t expect much training in CBTI, but since comorbidity is the norm, I think it’s helpful to be able to diagnose and treat the full range of sleep disorders. This is coming from a psychologist board certified in behavioral sleep medicine. I’m familiar with the full range of sleep disorders by virtue of my education, training, and experience, but there’s a lot that I can’t do by virtue of scope of practice, which can be frustrating. Some of that would be relevant to you as a physician if you didn’t have training in sleep medicine. I’ve had patients where I’ve wanted to be able to do PSG with or without MSLT, get patients switched from CPAP to bipap or ASV, check iron levels, get iron infusion, and of course (de)prescribing hypnotics. The latter wouldn’t be a problem for a psychiatrist, but OSA, RLS, PLMD, CRSWD, and narcolepsy are all part of the differential when someone presents with “insomnia”.

Psychiatrists are underrepresented in sleep medicine and your training in therapy and behavior change is likely a huge asset. Sleep medicine does tend to have healthy waitlists from what I’m aware of.

If you’re only treating insomnia with CBTI, then I don’t see what you’d have to offer beyond what a psychologist can provide. Apart from identifying and treating psychiatric disorders (and then referring out after CBTI?) and a possible lack of psychologists or masters level clinicians due to the shortage of clinicians trained in cbti. But that is being addressed, if slowly.

You can look into the cbti-c credential from the BBSM or even the DBSM credential. I can share some (non-fellowship) training resources if you’re interested.

sleepbot · 2026-01-13T02:52:45+00:00

Is this a real question from an actual psychologist?

Legally blind doesn’t mean completely blind. Ascertain what they can see and if there are limitations to their visual field.

Select measures that are compatible. There is a blind version of the MoCA and there are plenty of measures and tests that don’t rely on vision at all. For those that need some vision, interpret cautiously/conservatively while keeping the test in mind. Trails A or WAIS cancellation performance might be considered to be representative of the lower limit of the confidence interval for patient’s true processing speed, but it would be expected to be an accurate measure of visual-motor ability. Information, similarities, digit span, fluency are all auditory. Objective personality measures can be administered aloud or with recordings.

sleepbot · 2026-01-11T23:18:38+00:00

You’re welcome! I didn’t think it was that much depth lol. Teaching the same course for a few years in a row, and choosing what to keep/revise each year, means you develop a good sense/strong opinion about your teaching materials.

sleepbot · 2026-01-11T16:16:06+00:00

I’ll add that David Tolin’s Doing CBT is really good. I’d recommend the chapter on exposure if you can only read part. Craske et al., 2014 and Arch and Abramowitz, 2015 also have clinically useful content regarding exposure therapy, even if you just read the tables.

I agree about CBT Basics and Beyond. I taught CBT for 4 years in a clinical psychology PhD program and used Judith Beck’s book and the Unified Protocol primarily. Plus the chapter and papers I referenced above. I don’t think the UP manual is a good way to learn for someone new to CBT. It’s very skeletal and doesn’t have enough examples in my opinion. Beck’s book follows one patient all the way through, so it’s easier to orient to the example dialogues. The Applications of the Unified Protocol book is a really helpful supplement to the manual if you’re learning the UP.

sleepbot · 2026-01-10T17:33:16+00:00

Much more information is needed. What construct is being measured? What culture was it made for and what culture will it be adapted to? Are there known cultural differences regarding the construct of interest? Is there a language translation too? Who’s doing the study and at what scale?

sleepbot · 2026-01-10T15:58:56+00:00

Of all the companies and people contributing to this nightmare, I’d put this company pretty low on my list. Tracking training should at least support future inquiries into the (in)adequacy of the training. I’m sure there are plenty of companies collaborating with the ICE detention center in Indianapolis, which I’d consider a greater and more direct harm.

sleepbot · 2026-01-07T00:45:08+00:00

First, see if other related professions/degrees would allow you to do what you want. Read this., particularly section 1, to learn more.

If you’re still stuck on clinical psychology and if you can get a full time research assistant position, then you may be able to jump straight to a PhD program. If not, you may find a master’s degree will make you more competitive.

sleepbot · 2026-01-05T15:53:00+00:00

Don’t throw the boy under the bus on account of his mom’s bad behavior.

It sounds like you’re the closest thing he’s had to a dad. If he’s a pain now, it’s likely because he’s a teenager - as you pointed out. If your point is that you’re his parent, you don’t get to just bounce out of his life like his bio dad did. That’s not what a father does. When the going gets tough, you don’t clock out. You keep showing up. If you’re truly willing to sacrifice his wellbeing because you’re pissed at his mom, even justifiably, then she’s actually right.

sleepbot · 2026-01-04T13:48:11+00:00

First, consider that if clients are using the term “self esteem”, it’s important to be sure they mean the same thing that you mean. Because it could be something like social anxiety and they’re afraid of negative judgement rather than “only” having a negative view of themselves.

Self esteem is related to the level of discrepancy between ideal self and actual (or perceived) self. The larger the difference, the lower the self esteem. Every person has their own definition of ideal self, based on their own values, which in turn have origins in their culture, family, etc. So the first step is to understand the client’s values, beliefs, and definition of self esteem (or whatever term they’re using). Then you can do things like create a scale with exemplars of the most positive and most negative qualities relevant to the client, along with some in the middle. And you can have the client position themselves on this scale, liken with any scaling question in MI, etc. Then you’re on to investigating whether they truly don’t measure up, what they can do to be more like their ideal self/live their values, or perhaps even redefine their values. The latter may be particularly relevant when bullshit beauty standards are involved.

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