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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by littleone on November 8, 2004, at 15:10:56
Hello there.
I noticed in another thread that you seemed a bit disillusioned with your training at the moment. The "Patch em up, folks" attitude of the system. I was really sorry to get that vibe from you. You often have such wonderful thoughts to share. I always thought you would make a wonderful T.
I know you recently set up your own ... I'm not sure what you call it ... consulting room? I guess I got a bit confused. I thought that by starting to see clients in your own room, you would see a whole range of clients and problems. Some of which would be helped with CBT, some with a psychodynamic orientation, some with these techniques, some with those techniques. A real mixed bag.
Is that not happening? Is it that they are only sending you clients that need CBT, or is it that they are telling you to treat everyone with CBT? Will this change as you get further along in your training?
Sorry to be so nosey. I'm just concerned for you.
Posted by gardenergirl on November 8, 2004, at 15:38:45
In reply to Hey, gardenergirl...., posted by littleone on November 8, 2004, at 15:10:56
Hi littleone,
I didn't mean to sound so negative. The room I set up is the office I use at the clinic where I am training. It's a health clinic, and we receive referrals from the physicians. My supervisor is a very problem-focused, CBT-oriented kind of therapist. He has tons of experience, so I am actually in a good place to learn to use CBT techniques. It's just not my favorite thing. I prefer long-term clients like I saw at a different training site last year. My supervisor has no patience for, and perhaps even disdains (I infer) self-psychology and dynamic therapies. That hurts, as it is how I think, and it is also the therapy that is working for me.Part of it that makes me a bit jaded is that I am dealing with insurance for the first time, and co-pays on the part of the clients. So, there is more than just the clinic's model which leads to shorter-term treatment. There is expense involved. And it's not really a "patch em up" mentality in the extreme, but wellness is not a focus for treatment. Insurance won't pay for that. Of course they also won't pay for "pre-existing" conditions for a period of one year. Just how is someone with a chronic and more severe disorder requring fairly consistent treatment supposed to get survive for a year without treatment or pay out of pocket somewhere? UGH. That aspect of the law needs to be changed. Mental Health Parity NOW! (okay, off of soapbox).
Sigh, I hate living in the real world sometimes. In my ideal fantasy therapy situation, everyone who wants it can have therapy for free for as long as they want/need it. All of the T's would be excellent. They would all be good fits between the client and the T. And the T's would be adequately paid by, er, somebody.
I also know that in the real world, long term therapy exists. I just feel like I went from one extreme to the other this year, and it's taking some adjustment for me to wrap my brain and my heart around this approach.
I realize I'm rambling, but am I making any sense?
Thanks for your concern and kind words. You are very sweet.
gg
Posted by Daisym on November 8, 2004, at 16:11:10
In reply to Re: Hey, gardenergirl...., posted by gardenergirl on November 8, 2004, at 15:38:45
GG,
I'll let you hold the success of my son close, to help you get your heart around it. He did biofeedback and CBT stuff to get past his anxiety. He was on paxil, and came off...he still gets anxious but he uses all the tools he learned to keep going and get through things. Sometimes I have to still go get him, but mostly he makes it. And he has a great relationship with his therapist, but it is nothing like the intimate one I have with mine. Which is fine with him. He is happy to see him when he does, but he is happier about being able to go to school consistently, etc.
So, not all bad. This approach IS good for some problems and some people. I wish we could all learn the lesson of one size does NOT fit all. I agree with your "perfect world wish" though it is my experience that when services are completely free, there is less investment from clients sometimes. Double-edge sword, I guess.
Posted by Susan47 on November 8, 2004, at 16:31:19
In reply to Re: Hey, gardenergirl...., posted by Daisym on November 8, 2004, at 16:11:10
What you said about the therapist being paid by, er, somebody ... was funny and accurate, wasn't it. Darn the system anyway.
Posted by gardenergirl on November 9, 2004, at 0:07:19
In reply to Re: Hey, gardenergirl...., posted by Daisym on November 8, 2004, at 16:11:10
Hi Daisy,
Thanks for the reminder. I knew when I was writing that post that I was leaving out all those who DO benefit from CBT. And I have faith that some of my clients will, too. :) It just feels foreign to me, still. But I'm having fun finding workbooks and resources and stuff. Making lots of copies of handouts. Now, hmmm, should probably share them with the clients, eh?Thanks,
gg
Posted by gardenergirl on November 9, 2004, at 0:08:29
In reply to Re: Hey, gardenergirl...., posted by Susan47 on November 8, 2004, at 16:31:19
Sigh, wouldn't it be nice??? Or maybe people could just bring us meals once in a while and make sure we don't get rained on? :-D
gg
Posted by Susan47 on November 9, 2004, at 1:06:55
In reply to Re: Hey, gardenergirl.... » Susan47, posted by gardenergirl on November 9, 2004, at 0:08:29
I had this image of you standing in the rain with your hair soaking wet stringily plastered to your face, giving street sessions.
Then I saw you with a shiny red raincoat on and a huge umbrella, dripping rain in massive rivulets, giving street sessions.
You moved up in life!!! :))
Posted by gardenergirl on November 9, 2004, at 1:27:22
In reply to Re: Hey, gardenergirl.... » gardenergirl, posted by Susan47 on November 9, 2004, at 1:06:55
Posted by alexandra_k on November 9, 2004, at 2:32:36
In reply to Re: Hey, gardenergirl.... » Susan47, posted by gardenergirl on November 9, 2004, at 0:08:29
Hey there gg, I do sympathise, I really really do. I studied a fair bit of psych, but all we can do (In NZ and at my Uni especially) with respect to abnormal is CBT with an emphasis on the behaviourist end. Psychodynamic and humanistic theories were caricatured and presented as straw men for ridicule. It made me so mad I stopped with psychology (well, that and the stats :-))
Got sick of assessing whether Chomsky the chicken preferred wheat to puffed wheat. And their idea of clinical psychology was altering reinforcement contingencies to prevent serious self injury in young severly intellectually handicapped individuals. It wasn't what I was interested in at all...
I remember all those good old CBT handouts.
I do not miss it. I do not miss it at all.In a bit longer you will be able to do more what you want - right?
Posted by Emily Elizabeth on November 9, 2004, at 9:59:58
In reply to Re: Hey, gardenergirl...., posted by alexandra_k on November 9, 2004, at 2:32:36
GG,
I wanted to say hi to you b/c we seem like we are in such similar positions in life. (I tried to figure out babblemail and I couldn't). I'm in my (sigh) 5th yr of a clinical PhD program. It has been a long hard road which has been complicated by clinical depression and a lot of bad stuff happening in my personal life. Sounds like you have made it to internship--which means one thing--you can see the light at the end of the tunnel!!
I also wanted to you let you know that you have served as a little hope for me. I figure, "GG can be depressed and make it through, so can I!!"
Best,
EE
Posted by sunny10 on November 9, 2004, at 11:20:26
In reply to Hey, gardenergirl Part II, posted by Emily Elizabeth on November 9, 2004, at 9:59:58
I wish the perfect world existed, too.... It basically used to- before the greedy people won.
Think about how nice it would be to exchange therapy for food and shelter; the old trade and barter way. Back then it was a lot simpler- then again, we probably needed less of you T's, too!
But people have always needed a helping hand and a shoulder to cry on from time to time... we just need you more now that we can't find a way to pay you !
-sigh- Don't let the economics of the world stop you from doing what you like and are good at! Your special gift is helping others AND feeling good about yourself for being able to do it!
You will make a GREAT T simply BECAUSE you understand that people ARE all different.
-sunny10
p.s. And those handouts??? When I go to a T because life feels so HARD to get through, day to day... the absolute LAST thing I want is someone to hand me "homework"....
Posted by Susan47 on November 9, 2004, at 12:50:13
In reply to Re: Hey, gardenergirl Part III, posted by sunny10 on November 9, 2004, at 11:20:26
You people are wonderful, and I love what alexandra-k had to say about her studies in psychology. I'm learning from you guys, thanks for being here.
Posted by gardenergirl on November 9, 2004, at 20:28:57
In reply to Re: Hey, gardenergirl...., posted by alexandra_k on November 9, 2004, at 2:32:36
Chomsky the Chicken???? LOL! I'm so so so glad I am not at a research school.
You know, there are also schools here that are pretty one-sided about what they teach. We get mostly CBT, but there are enough pscyhodynamic faculty that we get that,too. But no humanistic or existential training. Pooey.
Yeah, at some point in the future, I can do what I want, assuming somebody will pay me to do it.
Thanks!
gg
Posted by gardenergirl on November 9, 2004, at 20:41:14
In reply to Hey, gardenergirl Part II, posted by Emily Elizabeth on November 9, 2004, at 9:59:58
Hi Emily Elizabeth,
Yes, it is a long haul, isn't it. But you're getting there, too, I bet, if you are in your fifth year. It's nice to hear from you.If you ever want to babble mail, make sure you turned it on when you registered. You can go to registration again, where you can, for example, change your password, and choose to turn Babblemail on. You'll know it worked if the next time you open one of your posts your posting name is in blue like mine is. Then, all you have to do is click on the blue name of whoever you want to babblemail, and you should be directed to the webform that allows it.
I'd love to hear from you. If B-mail doesn't work, you can get me at gardenergirl 88 at yahoo dot com (spelled out to avoid web bots.)
Also, glad I can be an inspiration. My depression almost got me by the tail and made me lose out, but fortunately, I started seeing a wonderful T.
Take care,
gg
Posted by gardenergirl on November 9, 2004, at 20:44:36
In reply to Re: Hey, gardenergirl Part III, posted by sunny10 on November 9, 2004, at 11:20:26
Hi sunny 10,
Thanks for the encouragement. It made me smile. And your comment about the handouts made me laugh out loud! I'll have to be judicious in my use of them.Take care,
gg
Posted by alexandra_k on November 9, 2004, at 23:05:53
In reply to Re: Hey, gardenergirl.... » alexandra_k, posted by gardenergirl on November 9, 2004, at 20:28:57
> Chomsky the Chicken???? LOL! I'm so so so glad I am not at a research school.
Well I got to name her myself - it was my little dig at Skinner... We weren't allowed to call them McNugget or anything like that (on ethical grounds) and there were too many henrietta's. We get lots of research funding to teach cows how to milk themselves and figure out how to attract possums to certain frequencies of sound so that we can trap them etc etc. So the behaviourists thrive after all (whereas most psychologists just don't find behaviourism very reinforcing any more).
IMHO they should go join the biologists and leave psychology alone...
> Yeah, at some point in the future, I can do what I want, assuming somebody will pay me to do it.Yeah, thats the spirit :-)
Posted by Apperceptor on November 11, 2004, at 13:18:58
In reply to Re: Hey, gardenergirl.... » alexandra_k, posted by gardenergirl on November 9, 2004, at 20:28:57
I feel kinda fortunate, as in my program we're getting equal time in training for psychodynamic, CBT, strict behavioral, family, group, and phenomenological/existential/client-centered (we also do side trainings in Alderian and interpersonal). It's really helped, because it's allowed me to mix them into a conglomerate of methods that seem to work for my clients.
I think part of it may be that it is a Psy.D. - we still do as much (or more) research in comparison to many Ph.D. programs, but the priorities are on ensuring we can make an informed decision about theoretical orientation and practice. The "empirically validated treatment" perspective is highlighted, but we are also exposed to many faculty members who roll their eyes and share their pre-managed-care practices. It's nice :-).
If you want a list of some texts we've used, I'd be happy to share!
Posted by gardenergirl on November 11, 2004, at 19:47:31
In reply to Re: Hey, gardenergirl...., posted by Apperceptor on November 11, 2004, at 13:18:58
Hi Apperceptor,
Nice to hear from you again. My prog. is also a PsyD. I would hate all the research I would need to do in a PhD program.We get a few pre-managed care stories, but we also get much more doom and gloom..."If you think you are going to be able to survive in a private practice, think again!" Thanks for the encouragement.
I would love to hear about a good humanistic/existential/ or experiential text if you have one.
Thanks again,
gg
Posted by littleone on November 11, 2004, at 20:13:53
In reply to Re: Hey, gardenergirl.... » Apperceptor, posted by gardenergirl on November 11, 2004, at 19:47:31
> I would love to hear about a good humanistic/existential/ or experiential text if you have one.
I'm sure you would have already read this one, but "Existential Psychotherapy" by Irvin Yalom. Also, you may like "Interpersonal Process in Psychotherapy: A Relational Approach" by Edward Teyber.
PS I hope things improve for you.
Posted by Apperceptor on November 12, 2004, at 0:18:12
In reply to Re: Hey, gardenergirl.... » Apperceptor, posted by gardenergirl on November 11, 2004, at 19:47:31
GG-
Thanks for the welcome back! I had thought you were Ph.D., but I must admit I'm refreshed to hear you're also in a PsyD program! I do enjoy the relative switch of emphasis onto our clinical practice...there's still plenty of research, but it's nice to know that our priorities are embraced!
I agree with you that the general attitude is to avoid private practice, but I've been fortunate in having several of my practica with successful private practitioners...I think it's more a matter of learning the twisted art of making your interventions acceptable to insurance :-). I'm getting the impression that you're further along in your training than I am, so I'm certainly appreciating the insights you've been providing as you progress toward the doctorate.
The current text we're using in our Phenomenological class is "Neurosis and Treatment: A Holistic Theory" by Andras Angyal. I have to admit that I was fervently cognitive therapy oriented when I entered the program, but I am absolutely floored by the insights this book has provided. It has also been of great benefit to several clients. It is out of print right now (?!?!?!?) but my classmates and myself were able to find numerous copies on half.com, ebay, bookfinder, etc. Let me know what you think!
The bulk of our reading material is from our professor's privately compiled resource list. If you'd like, I'd be happy to discuss these further and share the articles I have. Just lemme know.
Thanks for the reply :-)
> Hi Apperceptor,
> Nice to hear from you again. My prog. is also a PsyD. I would hate all the research I would need to do in a PhD program.
>
> We get a few pre-managed care stories, but we also get much more doom and gloom..."If you think you are going to be able to survive in a private practice, think again!" Thanks for the encouragement.
>
> I would love to hear about a good humanistic/existential/ or experiential text if you have one.
>
> Thanks again,
> gg
Posted by alexandra_k on November 12, 2004, at 3:20:12
In reply to Re: Hey, gardenergirl...., posted by Apperceptor on November 12, 2004, at 0:18:12
Or of course one could keep a practice going seeing rich neurotics...
I suppose it is just getting the client base up to start with and it is easier if you are on the health insurance lists.
Posted by alexandra_k on November 13, 2004, at 3:19:20
In reply to Re: Hey, gardenergirl...., posted by alexandra_k on November 12, 2004, at 3:20:12
Bit too hammered. (Sorry)
Posted by gardenergirl on November 13, 2004, at 10:55:22
In reply to Sorry, ignore that » alexandra_k, posted by alexandra_k on November 13, 2004, at 3:19:20
No problem. I hope you had fun. :)
Actually, being on insurance lists does make it easier, but it's hard to get on them right away if ever. :(
gg
This is the end of the thread.
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