The Job AMA Thread! - current AMA@ChickieD through 11/16 at 11:30 PM PST



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I am not sure how it selects topics to suggest or if we have control over it. I will research.


That’s not the problem. It’s the board going, “Um excuse me. You’re typing too much.”

It’s not the bossa me.


I have two friends who are clinical psychologists* and both recommend ACT as the “gold standard” (one used those words) for anxiety and depression these days and as a successor to CBT. How would you react to that idea? :slight_smile:

  • one quit clinical psych during his residency after having a fight with the administration of his facility on how they were teaching veterans (it was a veteran program and he’s a vet himself) that led to him ending the residency and, eventually, just quitting clinical psych to focus on his other career (successful) as a audiobook narrator.


ACT (Acceptance and Commitment Therapy) has a lot in common with DBT in that both modalities integrate mindfulness techniques with CBT. The evidence base for ACT is less definitive than for DBT, and outcomes for ACT don’t show a large difference from CBT. IIRC, ACT was developed in the 80s as a “one size fits all” modality and was being sold in trainings and seminars before it was the subject of any research (which is the inverse of DBT). My familiarity with “evidence-based” modalities is primarily from literature and seminars, but I don’t think ACT is very different from Mentalization Based Psychotherapy, MB-CBT (Mindfulness Based CBT), or MBSR (Mindfulness Based Stress Reduction). MBSR is kind of considered the go-to mindfulness program for anxiety. The actual interventions don’t vary very much between these modalities, so I think many therapists find a modality that speaks to them/speaks their language, and just use that. It’s not a matter of “what’s right” but of “what can I use effectively” and “does this make sense to me?” But just because something resonates with the therapist… that doesn’t mean that that modality can be used for everything.

It’s weird for me to be comparing “evidence-based” modalities because “evidence-based” is kind of a bullshit marketing term. It doesn’t indicate that the modality is more effective than any other modality, just that there is a body of research examining that modality. So, there are modalities that can be harmful (to certain people under certain circumstances) that are “evidence-based.” And the modalities with the largest evidence-base are psychdynamic (literally over 100 years of documentation), but they are not all RCT (random controlled trial) or follow the medical model (short-term results), so they “don’t count.” I have a bias against modalities that are developed in research settings or are purely theoretical. I prefer more organic and ecologically developed methods - that’s “my language.”


Yeah, I’ve participated in MBSR and similar and both of my clinical psychology friends are also Zen priests… I’m pretty up on the secular use of mindfulness practices as it is what I use for myself and as a Buddhist practitioner much of the time. My only issue with MBSR is that the somatic component doesn’t work well for some people (like me) that can’t do yoga poses for reasons of bodily injury do it is a little too one size fits all.

Of course, I also participated in 18 months of CBT for panic attacks about 17 years ago, which worked for me. I’m also a fan of Stoicism as a classical philosophy so I may be the right demographic for it


I’m glad you found something that worked so well for you!

And yet this is the perspective of many therapists and many modalities - that their way of doing things works for everything and if the patient struggles or doesn’t improve, the patient is at fault. I’ve found that in a lot of the “mindfulness-based” modalities lack compassion in practice, which feels icky to me.

People need to be empowered to find what works for them and I try really hard to help people figure out what that is, even if (especially if) it’s not me.


Also, CBT is absolutely indicated for panic disorder. So, in addition to being a good match for your personality, CBT was developed to deal with anxiety disorders and related symptoms and was the appropriate treatment for your problem!


Well, the problems then! I haven’t had panic attacks since though my college age daughter now has the same exact issues.

I saw an ACT person recently and was unimpressed. I’ve been dealing with chronic minor to moderate health injuries (spinal surgery!) for a few years now and having negative ideation, anxiety, etc about them. (This is not a request for therapy from you here!). I’ve thought about seeing someone about it. Perhaps I’ll go back to CBT. I just get so monofocused on day to day BS and minor pain. My wife is a saint. This was why I’ve investigated what people are using these days. I should probably do more Vipassana meditation to help though. :slight_smile:

I am glad to see more clinical practitioners using mindfulness though.


Have you used EMDR? What info can you provide on it? Also, tapping, EFT? Any thoughts on that?


That actually leads into another question I had.
I saw a therapist for a short while for panic attacks and anxiety disorder (again, assigned by my HMO) - who I remember as a balding guy wearing golf shirts – who would ask conversational questions about my work habits, my life, etc, along the lines of “how’s your work going?” or “do you like your apartment?”, and would just nod as I spoke. He’d occasionally point to me and state something like “You should be more open to praise,” or “You should be decisive.” But if I asked his thoughts on that he’d just shake his head and change the subject. After four or five sessions like this, he abruptly said “It’s clear we’re not making progress and I don’t want to waste your time, so this is our last session,” and that was that.

Was this poor therapy, or was his way of doing things just not good for me and he cut things short without explanation?


I think It’s all the things ypu mention and more. My opinion is that “poor therapy” varies by person. I have no doubt that I’ve been a poor therapist for some of my patients - but I do try to recognize it as it’s happening and talk about it with my patient: “I don’t think this going very well. What do you think? Yeah? What do you think it should be like? What is happening that’s keeping us from doing that?”

Without shitting all over another therapist (professional ethics - I got 'em!), I would say that he was a bad fit for you, but that he may have also been confined by the HMO (session length, number of sessions) and didn’t know how to best work within those boundaries. He may have been struggling with the same problem as you and felt unsure of how to give you guidance.

Personally, I do not understand therapists who make pronouncements and won’t respond to or work with patient questions. I don’t understand why therapists fire patients who come to sessions consistently (or inconsistently). I’ve “fired” one patient in six years, but that was a referral for more intensive treatment. I think terminating therapy due to “lack of progress” shows a lack of therapeutic skill and confidence. I think that it shows a lack of training regarding “self of therapist” issues (aka countertransference). It shows that they are shut off from their patients and self. And, even though the therapist may not be doing so intentionally, it makes the therapy about them rather than the patient.

Does this help clarify things?


This is likely extremely true. He may have simply looked at how many sessions I was allowed, decided that so far we’d basically made polite conversation for four sessions, and figured a clean ‘firing’ was better than changing his techniques up and then abruptly ending in a few more sessions anyhow. Which is totally fine. It just would’ve been cool to be told that rather than make it seem like the patient wasn’t succeeding at being helped, making it my fault, essentially. Thank you, that does help clarify things.


Okay, thank you @katherine for playing!!!

I’m a little late on this so let me know if we need to modify times so everyone gets to ask @Lucy_Gothro questions.

To get started:
What do you do?
What is one skill (other than the actual skill you get paid for) that is indispensable to your work?


What I do: I work at a discount crafts-&-floral supply store. I restock merchandise, create space for and stock new merchandise, make space for and put up overstock; I run a cash register, answer phones and transfer calls if need be; and I deal with customers and co-workers.

The indispensable-skill question…because I utilize all kinds of skills at work that are worth more than what I’m paid. (Did that sentence even make sense?)


Is crafting something that you’re personally into? Has that changed at all since you started working in the store?


Yes, to one degree or another, all my life. My older brother and I were encouraged to be creative for as long as I can remember. Dad did woodworking, and Mom was into crochet and knitting, making clothes (that interest faded eventually). My interest has waxed and waned as I’ve gotten older; but I must say, working in the store has activated it somewhat.


What do you look forward to on a daily basis? I’d also love to hear stories of some of the more memorable experiences - both positive and negative - that you’ve experienced.


What makes them “discount”?


I look forward to getting out of the house. I look forward to getting paid. I’ve only been there for two months, so the newness is beginning to fade. But I have friends there, and that’s a bonus.

The best experiences involve finding exactly what a customer wants, or little babies who smile and drool and ARE JUST SO CUTE ZOMG I WANT ONE…uh, er, sorry, where was I? Oh yes - and doing things right and being recognized for it.

The negatives: Customers who are rude, and who, if treated the way they treat others, would explode. Mothers who allow their young children to roam. Co-workers who have a resentment against everyone (well, at least they’re not restricted to a certain group). Supervisors who let power (hahahahaha!) go to their heads. DRAMA.


Well, as you may or may not know, just about everything that’s mass-produced costs less to make than the price for which it’s sold. Much of the added cost to the consumer is advertising and marketing. We don’t really do that. We have a very primitive website, and weekly specials are sent out by email. Plus, it’s a very warehousey-type atmosphere.

Given that, our sale prices are much lower than the wholesale cost, lower than even dollar stores. I suspect we get a lot of overstock from other stores; I see a lot of candles from the Mainstay brand, and those are sold at WalMart.

I’ve been DYING to correct the spacing, et al, so I rarely visit the site.