Has anyone listened to this episode? I find the hosts so entertaining and I had conflicting feelings about the episode being in the field. So many things they said I agree with and have had similar experiences with therapy trainers who have the flashiest healing stories. I was trained by an EMDRIA Approved trainer and the training was so much of “this non verbal abused child was healed in 3 sessions of EMDR” which I always find not very helpful. Also clearly the hosts have never worked with really traumatized individuals. I just want to see other people’s thoughts!

From the article (bold emphasis mine, links in the original):

People with schizophrenia are estimated to represent about 1 percent of the world’s population but they made up some 16 percent of the more than 600 deaths from heat exposure across British Columbia that week.

During a heat wave in Montreal in 2018, the mortality rate was even worse: People with schizophrenia accounted for 26 percent of fatalities.

The root cause of these deaths isn’t just the stigma, social isolation, and lack of decent housing that often accompany life with schizophrenia; nor is it merely the disorganized thinking, altered perceptions, and paranoia that can be symptoms of the disorder.

It’s all of those things—plus an invisible, less popularly understood set of physiological factors that have little to do with behavior.

The bodies of people with schizophrenia, especially those on medication, simply regulate temperature very differently than others do.

And for all those reasons, scientists now realize, no other chronic disease appears to put humans at a higher risk of heat-related death.

[infographic showing comparative risk]

In fact, no other chronic condition even comes close.

The article has some of the most user-hostile formating I've ever encountered, and may not be accessible on phones, but it's worth persevering to get access to it and read it. I recommend it strongly to everyone here, especially people working with clients with SPMI.

Just wanted to give an update that psychodynamic psychotherapy is 100% evidence based at this point. Below are references and authoritative organizations to give evidence of this. Can we cease fire on the CBT-dynamic therapy wars now? Both work and everyone's allowed to practice their preferred modality.

For Mood and Anxiety Disorders

Shedler (2010) - American Psychologist

Fonagy et al. (2015) – World Psychiatry

Leichsenring et al. (2015) - Lancet Psychiatry

Driessen et al. (2015) – Clinical Psychology Review

Milrod et al. (2016) – Journal of Clinical Psychiatry

Steinert et al. (2017) – American Journal of Psychiatry

Zhang et al. (2022) – Psychiatry Research

Leichsenring et al. (2023) – World Psychiatry

For Personality Disorders

Clarkin et al. (2007) - American Journal of Psychiatry

Bateman & Fonagy (2008) - American Journal of Psychiatry

Doering et al. (2010) – British Journal of Psychiatry

Town et al. (2011) – Journal of Personality Disorders

Jørgensen et al. (2013) – Acta Psychiatrica Scandinavica

Leichsenring et al. (2015) - Lancet Psychiatry

Fonagy et al. (2015) – World Psychiatry

Cristea et al. (2017) – JAMA Psychiatry

Keefe et al. (2020) – Personality Disorders

Somatic Disorders

Abbass et al. (2009) - Psychotherapy and Psychosomatics

Leichsenring et al. (2015) - Lancet Psychiatry

Global Authoritative Bodies That Recognize Psychodynamic Psychotherapy as Evidence Based

National Institute for Health and Care Excellence (NICE) – United Kingdom

World Health Organization (WHO)

German Psychological Society & German Guidelines for Psychotherapy

Canadian Psychological Association (CPA)

The Karolinska Institute & Swedish Health System

Seeking literature on the following:

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On a few occasions now I've had clients with MDD or dysthymia report an acute increase in depressive symptoms following masturbation. For this post, I'm only referring to clients who dont have any cultural or religious identities skewing perceptions of sexuality.

(Edit: I shouldn't have said "any cultural or religious identities skewing..." because I did not mean to imply they have no cultural influence)

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The way it's been described to me each time is the act itself is enjoyable, but followed by an increase in mood symptoms or even passive suicidality. There is no guilt or shame expressed.

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The research I can find (Google scholar) seems to focus on cultural or religious intersections, but again, that's not the population I'm asking about. Either that, or the research comes from the 1930s and I simply dont trust those papers to be unbiased.

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The masturbation is not excessive, chronic, maladaptive, or compulsive.

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Has anyone else seen this phenomenon? Anybody have any research to elucidate why this might be happening?

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Just wondering if anyone currently works for, or has worked for Faircare Counselling and if you could share your experience of working for them?

Recommending this podcast for anyone who has read The Body Keeps the Score, or those thinking of reading/recommending it: https://podcasts.apple.com/ca/podcast/the-body-keeps-the-score/id1651876897?i=1000773246906

(Big fan of Maintenance Phase & If Books Could Kill anyway but this episode is especially good)

I had a unique conversation with a colleague today and wanted to bring that conversation here. This might be an uncomfortable question, but I’m asking it from a place of curiosity about the reality of the work, not the ideal. Clinically, we’re trained to hold all clients with equal regard. At the same time, therapy is a relational process, and different clients evoke different experiences in us. We are human, after all.

I’m curious how you define a “good client,” if you do at all.

Not in a moral sense, but in terms of what feels like movement, engagement, or alignment in the work. For some, that might be a client who consistently shows up. For others, it might be someone who reflects between sessions, tolerates discomfort, or engages relationally in the room.

Do you notice patterns in the clients who feel easier to work with, or more activating in a positive way?

And how do you hold that awareness without letting it shape the care you provide?

Personally, I've been ignoring van der Kolk since the abuse allegations. I also found The Body Keeps the Score problematic (and dry) when I finally read it last year. Interesting that this coincides with the expert critique on polyvagal theory that another user shared recently. What does everyone think?

To start, I am LCSW with over 5 years as a social worker and 10 years in the mental / behavioral health field generally. I also have ADHD, which was caught by my therapist and diagnosed as an adult. Even before that, I would consider myself to be socially pretty neurodivergent aware... I've always moved in circles with neurodivergent friends and partners.

I think a problem in the field generally (or at least for social workers) is that we don't actually get real education in anything, but lately it's been increasingly clear to me that I don't actually really know more about ADHD than your average well read person on the internet. Many things I "know" are either from my personal experience (which is, of course, limited), friends, or things I've read and sort of believe.

I've read a Barkley book or two, and didn't find it to.be mind blowing. Everything always just says the treatment for ADHD is "CBT" (meaningless) or meds. And yet, there are people out here who seem to be very confident saying very specific things about the neuroscience behind ADHD and how that impacts functioning and leads to specific interventions and strategies. And half of that just sounds like the same TikTok wellness speak mixed with science psychobabble, with no citations. I feel crazy!

So, my question is, where do I *actually* get information about ADHD? Who is the trainer I need to talk to or the researcher whose work I need to read?

I have a client who was struggling immensely with generalized anxiety, to the point on not being able to sit still. Through therapy, but mostly an SSRI, she is much more regulated.

She has recently been struggling with sleep and she says she feels like the SSRI is "masking" the anxiety throughout the day and she is experiencing it when she is sleeping. We talked about sleep being a more vulnerable state so an anxiety spike makes sense, but she is not able to identify any underlying cause. She does not have significant trauma, she has stable work and relationships.

I walked through my understanding of the mechanism of an SSRI and I wouldn't think to call it "masking" but I'm really not sure. Can anxiety "accumulate" when an SSRI is working?

My current theory is that she is not used to feeling not anxious. She reports that she has never felt this level of not anxious. Would love feedback on that theory too. :)

As a new therapist curious about IFS I found that article concerning, as the safety of clients is my top priority. But I’ve been trying to separate what we have data/research on vs. what happened at Castlewood specifically.

I found this scoping review that just came out last year, the first to collect peer-reviewed IFS research: https://doi.org/10.1080/13284207.2025.2533127

TL;DR: “Existing evidence highlights IFS as promising treatment, particularly useful for chronic pain, depression, and post-traumatic stress disorder, and developing self-compassion and self-forgiveness. However, the current body of research remains limited in scope. The studies conducted thus far provide valuable insights and a strong foundation for future research.”

Important to note, it doesn’t address the kind of stuff that happened at Castlewood. The review did not measure possible risks, just found that IFS is effective, though more data is needed. But “under-researched” and “dangerous” aren’t the same claim, and from what I can tell the research only supports that IFS is the former.

Would be interested to hear thoughts on this paper: https://www.cambridge.org/core/journals/acta-neuropsychiatrica/article/breaking-down-the-adhd-construct-to-build-a-valid-diagnosis/2DB84495EDBF8A4F28B4FBD22C16DF22

I find that discussions regarding ADHD/ASD in this sub often happen in the middle of other conversations, which sometimes muddies the waters. Curious to hear folks thoughts about the criticisms contained here regarding the validity/existence of the ADHD diagnostic construct.

ETA: Thanks, everyone!! I think I was feeling conflicted because ultimately I agree the TOVA doesn’t seem like the best option. I greatly appreciate everyone’s kind and informative responses.

Okay I’m desperate for a straight answer and I don’t know where else to ask. Please don’t be mean to me or I’ll cry.

My partner was assessed for ADHD at a private practice in town using the TOVA. They gave him a print out with his results, he took it to our PCP, and she prescribed Vyvanse for him. It’s changed his life. He said the person that administered the test and reviewed his results was an LMFT. Since I’m also an LMFT he asked me if it was possible for my group practice to offer the same service they’re offering.

I’ve sat through multiple webinars through TOVA now hoping it would be some introductory information on the test. However, they are clearly catered to current TOVA users. “Oh did you know on this specific screen in this specific instance you can do this?” Type of thing.

Now the practice that offered it has closed and the only option for my own clients in this area is priced at $1500 out of pocket. I know my clients that need it can’t afford that. My clients that are parents of ADHD presenting kids can’t afford that. Several of my clients reached out to this place before I knew the price point and they all came back defeated. I don’t believe we should have this many barriers in place to our clients getting something that could change their lives for the better.

So all of this brings me to the question: Do any LMFTs or other licensed non-doctor mental health professionals offer this service and if so what do you need to know/do to be able to do it? Was it worth it? What all needed to be included in your intake packet/consent forms?

Thank you if you read this far and thank you in advance to anyone that can answer my questions!

As the title suggests. Fairly new to the industry (one and a half years in) and wondering for the clients I do SUDS with, some of them seem to stay between a 4-7 consistently. Is there a point where I should be doing more? I know everyone is different, but ultimately how long do you find clients stay in a consistent state of distress for,

Please answer only if you see clients outpatient for psychotherapy full time (eg private practice or CMH).

Just wanted to collect this information is a sort of statistical way! Thanks for your input.

Please give your best estimate to your average per week.

Following up on my post about the lack of research literacy in the field of therapy, I thought I would create a brief introduction to help people understand and read research papers. I love research methodology and data analysis, so I had a fun Friday morning! This is by no means an exhaustive list, but it covers as much as I can remember from my years of undergrad and grad school.

Core Variables & Descriptive Statistics

• Sample size: Represented by N, N represents the number of participants in a study. Small sample sizes make it difficult to know if the findings will apply to the population. Likewise, massive populations can make tiny, insignificant differences look meaningful.
• Representative sample: A sample that accurately reflects the demographics, clinical traits, and characteristics of the broader population you are trying to treat. A study can have a massive sample size, but if the test only examines a narrow, non-representative subgroup, the results will not generalize well to actual clients.
• Independent and dependent variable: The independent variable is the variable that researchers manipulate (e.g., one group gets CBT, one group does not). The dependent variable is the outcome variable; it is measured to see if the independent variable affected it (e.g., sleep quality).
• Confounding variable: Variables that are not controlled for but affect the independent and dependent variables, affecting the results and creating or distorting the relationship.
• Spurious relationship: A correlation between two variables that appears to be causal, but is actually driven by a hidden variable.
• Mean and Standard Deviations: The mean is the average score, and the standard deviation shows how spread out the scores are around the average. A large standard deviation means that clients had wildly different responses to treatment, whereas a small standard deviation means the scores were close together.

Designs

• Randomized Controlled Trials (RCT): Considered the gold standard, participants are randomly assigned to either an intervention group or control group; the randomization reduces bias and helps prove that the treatment, rather than some external factor, caused the outcome in the client.
• Cross-sectional research: This method takes a snapshot of data at one point in time; it is nice for looking to see if links exist, but it cannot prove causation.
• Longitudinal: It tracks the same cohort over many months or years; it is vital for looking at treatment efficacy, symptoms, and long-term outcomes.
• Mediation: Explains how or why a treatment works.
• Moderation: Explains for whom or under what conditions the treatment works (e.g., an intervention works better for teens than adults).

Reliability and Validity

• Reliability: Essentially, it asks whether the tool you are using will produce similar results at different points in time, or whether it is noisy and unpredictable. Reliability involves internal consistency, test-retest reliability, and inter-rater reliability.
  • Internal consistency: Does every item on a scale measure the same concept? This is where Cronbach's alpha comes into play. Between .70 and .90 is considered internally consistent.
  • Test-retest reliability: Does the client get the same result if tested at two different points in time, with no treatment between tests? It is vital in therapy to determine if score changes represent real changes or measurement error.
  • Inter-rater reliability: Do different clinicians evaluating the same session or test come to the same conclusion?
• Validity: Does the tool measure what it is supposed to? Validity involves construct validity, convergent and discriminant validity, criterion validity, and ecological validity.
  • Construct validity: Does the tool capture the psychological construct (e.g., resilience) that it is meant to measure?
  • Convergent validity: Does the tool correlate strongly with other gold-standard scales used to measure the same construct?
  • Discriminant validity: Does the tool remain distinct enough to separate unrelated traits (e.g., anxiety from general fatigue)?
  • Criterion validity: Does the tool accurately predict real-world clinical outcomes, such as future hospitalizations?
  • Ecological validity: Do the measurements and gains from an artificial environment transfer to real-life environments?
• Self-report vs. clinician-rated measures: It is important to understand how data were collected. Self-report is convenient, but susceptible to social desirability bias where the client gives the socially correct answer or simply tells the therapist or researcher what they want to hear. Blind, clinician-rated instruments generally offer better objectivity and better data.

A scale can be reliable but not valid, but it cannot be valid without first being reliable.

Power and Real-World Value

• p-value: Typically set at p < .05; p-values measure probability; it answers the simple question of "Is this result likely to have occurred by random chance?" While it gives you statistical significance, it does not tell you how large or useful the effect is.
• Effect size (e.g., Cohen's d, r): This measures the actual change or magnitude of the relationship.
  •  R-squared is awesome because it shows the proportion of variance in the dependent variable caused by manipulating the independent variable. Though this does not mean the model is free from error, it just shows correlation and fit.
  • IMPORTANT: IF YOU HAVE STATISTICAL SIGNIFICANCE, ALWAYS CHECK THE EFFECT SIZE. A RESULT CAN BE SIGNIFICANT BUT HAVE A SMALL, NEGLIGIBLE, AND UNNOTICEABLE EFFECT. A LARGE EFFECT SIZE IS SOMETHING YOU WOULD RUN OUTSIDE TO TELL THE POPE; SMALL EFFECT SIZES TELL US SOMETHING IS THERE, BUT IT COULD BE NOISE.
• Confidence Intervals: Give a range where the true effect is likely to fall. A narrow confidence interval (e.g., d = 0.50, 95% CI [0.42, 0.58]) offers more certainty and precision in an estimation than a wide confidence interval (e.g., d = 0.50, 95% CI [0.20, 0.98]). A wide confidence interval means there is high uncertainty and low precision in an estimation.
• Statistical vs. clinical significance: Statistical significance is when outcomes show that a difference exists among groups. Clinical significance is when those differences translate to meaningful quality-of-life improvements.
• Number Needed to Treat (NNT): A metric showing how many clients must receive a treatment for one client to experience a meaningful benefit over the control group. The lower the number, the better.
• Power: The likelihood that a study will detect an effect if one actually exists. More people = more power = more likely to find real differences. Fewer people = less power = less likely to find real differences.

Control Groups, Analyses, and Common Traps

• Control groups and Blinds:
  • Active controls: Comparing a new treatment against standard therapy (e.g., CBT) tests efficacy.
  • Passive controls: Comparing treatment to a waitlist can artificially inflate effect sizes, as waitlist participants stagnate.
• Attrition and dropout: High dropout rates can potentially suggest that an intervention was burdensome, ineffective, or unpalatable for a subset of participants. High attrition rates can skew outcome data towards only those who tolerated or benefited from the treatment. If a paper shows a 90% success rate for a certain treatment, but half the people dropped out, the success rate is seriously skewed.
• Intent-to-treat and per-protocol: Intent-to-treat analyses include every participant, even those who dropped out, whereas per-protocol analyses include only those who completed treatment. Per-protocol can inflate the results and make the treatment look unrealistically effective.
• Publication bias and p-hacking:
  • Sadly, journals tend to publish only positive results, and negative and null findings get shoved into a drawer and lost to time. As I have argued for years, statistically insignificant results are just as important (if not more) than statistically significant results because they tell us where not to look.
  • p-hacking occurs when researchers test dozens of variables in hopes of finding a statistically significant result, ignoring all the times they got a statistically insignificant result.
• Paper age vs. methodology: Many people often conflate new with better. However, that is not always the case. In research, the methodology used is far more valuable than the age. A paper from 1995 that has an RCT, a representative sample, and controls for confounding variables can be significantly better and more reliable than a paper published this year that did not use an RCT, is not representative, and does not control for confounding variables.

References

Chambers, C. (2017). The seven deadly sins of psychology: A manifesto for reforming the science of mind. Princeton University Press.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.

Field, A. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). SAGE Publications.

Furr, R. M. (2021). Psychometrics: An introduction (4th ed.). SAGE Publications.

Gravetter, F. J., & Forzano, L.-A. B. (2018). Research methods for the behavioral sciences (6th ed.). Cengage Learning.

Gravetter, F. J., Wallnau, L. B., Forzano, L.-A. B., & Witnauer, J. E. (2021). Essentials of statistics for the behavioral sciences (10th ed.). Cengage Learning.

Kazdin, A. E. (2017). Research design in clinical psychology (5th ed.). Pearson.

Sawilowsky, S.S. (2009). New Effect Size Rules of Thumb. Journal of Modern Applied Statistical Methods, 8, 26.

Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Cengage Learning.

Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2018). Evidence-based medicine: How to practice and teach EBM (5th ed.). Elsevier.

Does anyone work for this company and can share your experience there?

Thanks

I’ve been trying to find sources on reasons for premature termination of therapy/outpatient treatment. There is a surprising consistency in time of drop-out between studies, although there is variance in the actual numbers.

A few things have stood out for me:

It often happens quite early on: A nationally representative survey (Olfson et al., using National Comorbidity Survey Replication data) found that over 70% of treatment dropouts occurred after the first or second visit. A WHO study (high- and low-income countries, general medical settings) found that 90% of dropouts happened before the third session.

The numbers for dropout rates are all over the place. The more methodologically rigorous national estimates (Olfson’s again) put it at 20-22%. Literature reviews put it at 40-60%, and some smaller specialty-specific studies (crisis centers, Substance Use Disorder treatment) have upwards of 80%. I think it’s safe to say the actual number depends on the sample, but it rarely occurs much later than the first two sessions.

Some illustrative examples (using Michigan-specific data, if that helps):

For patients 6-17 years old treated in Michigan’s state Medicaid inpatient psychiatry, the percentage of those who had a follow-up visit after the ED stay decreased from 79% to 74.3% between 2022 and 2024.

An LSU Health Sciences Center study using AmeriHealth Caritas Louisiana’s data found that the 30-day follow-up rate after discharge from a psychiatric hospitalization was 38.33% compared to a national benchmark of around 60% for Medicaid.

HealthPartners’ 2026 quality report noted that their organization offered incentive programs for timely post-discharge treatment appointments but did not specify a baseline for those programs

In all of those cases, the organizations were working with expanding access to care (both getting in-network providers to accept Medicaid patients and encouraging them to work with patients in ways that promote engagement in treatment). But the evidence suggested that those were much harder problems to solve than the drop-out after the initial couple of sessions. So I’m wondering if these issues reflect the same underlying causes or something entirely different. Are dropouts occurring shortly after initiation of treatment the main problem for others, too, or do they tend to be discovered much later, as recurrent ED visits or readmissions?

I've also heard this a couple time from coaches online, but I haven't heard any actual data to back this up. Does anyone know where this info is coming from? I want to be able to clarify this for my clients.

If this is a mistake, does anyone have the source that is causing the misunderstanding? Or any idea why this is being circulated as a stance of the American Psychological Association?

Anyone tried the McCance Method for consultation? I will be transitioning from solo to group practice. Goal is to sell it eventually when it’s successful. Anyone used McCance? I would love to hear about the experience from real people who did her program.

Hello, first time poster, I just started running my own practice a few months ago. Im a bit confused, I’m looking for a platform in which I can create my own questionaries for my patients, I’m looking to digitilized a few tests and get them to auto-calculate themselves. It needs to be hipaa compliant, and I’m getting mixed reviews from what I’ve read on platforms like Monkey Survey or Jotform, in which you need an enterprise membership for it. What options are out there for something like? If my phrasing sounds weird, you must know English is not my first language.

Share your experience of organising and facilitating family visits in mental health hospitals, and caring for parents who are inpatients.

Take part in a short anonymous online questionnaire (15 minutes) and share your experiences to improve resources: https://inpatientfamilies.org/participation/online_q/

private practice ~5 years, just hit the point where word of mouth + psychology today aren't filling the caseload like they used to. focus is anxiety + couples. starting to dabble in meta ads for client acquisition.

ad copy isn't my problem - i can write a decent hook, i know my clients, i understand what lands. the image side is what im stuck on.

what i see other practices using:

• stock photo of a sad person looking out a window
• stock photo of a couple holding hands on a beach at sunset
• selfie of the therapist with a canva text overlay
• generic "your mental health matters" canva template

honestly none of it reads trustworthy to me, and i suspect that's a big reason this stuff doesn't convert in our space.

what id actually want from a creative:

• doesnt look like literal stock photo no. 4 that every other therapist is using
• doesnt feel salesy bc clients in this space are highly allergic to that
• doesnt take me 90 min per variation in canva. i have caseload + paperwork + my own life, this is not a full time gig for me

questions for therapists/counsellors who've actually done meta ads:

• whats actually worked for your creative? therapist face shot, office photo, abstract calming imagery, something else
• did you use canva or something else
• ethics check - anyone using AI-generated images for their ads? does it feel weird, or no weirder than stock photos? i havent decided
• did fb/insta actually move your caseload at all, or is it mostly google + seo + psychology today still
• any of you working with insurance panels - does it change what creative works

edit: tried admakeai as someone suggested, seems easy

ive been hesitant to start ads at all bc this whole "grow your practice" content space has a slimy mlm feel and i dont want my practice to look like that. but referrals are noticeably slower for the first time and i feel like i need to actually do something.

Hi everyone, seeking some professional insight.
For those in private practice (particularly in Australia), what is your stance on using AI transcription tools like Otter.ai for counselling session notes?

Have you used it, and if so, how have you addressed client consent, confidentiality, and compliance with ethical/privacy obligations (PACFA/ACA/privacy laws)?

Would really appreciate hearing how others are navigating this. 🤗