How has that been working for you?

Perhaps even more than professional background, the therapist’s theoretical approach to clinical practice is a decisive facet in defining a psychotherapist’s identity, 6 and those theoretical approaches are also very diverse. In the clinical literature there appear to be literally hundreds of theoretical orientations, often closely related to one another, and with labels differing just by a word or two, sometimes prompted by therapists’ desires to have their own “brand” in the marketplace.

Orlinsky, David E.. How Psychotherapists Live (p. 15). Taylor and Francis. Kindle Edition. 

When people ask me what kind of psychotherapist I am I say, “I am a practical therapist. I talk with people about what might help with the problems they are trying to manage and when they return for their next session I ask, ‘How has that been working for you?”

People laugh, and I laugh, and it’s all good.

What happened to continuity of care in mental health?

 As has long been observed (e.g., Henry, Sims & Spray, 1972; Holt, 1971; Orlinsky, 2009) there is no single, inclusive and comprehensive profession of psychotherapy. 2 This differs markedly from other established professions such as medicine and law, engineering and accounting, nursing and ministry, and so on. Instead, psychotherapy is practiced as a sub-specialty within several different professions, each of which itself follows no single pattern of practice guided by a generally accepted theoretical framework.

Orlinsky, David E.. How Psychotherapists Live (p. 14). Taylor and Francis. Kindle Edition. 

Psychotherapy is a subspeciality of several professions such as Psychiatry, Psychology, Social Work, Counseling, Nursing, Art Therapy, Music Therapy, Marriage and Family Therapy, Substance Abuse counseling, Occupational therapy, Acupuncture, Naturopathic medicine, etc.

This use of psychotherapy in many mental health professions is called “role diffusion.” Each mental health profession also bring different knowledge bases and skills which is called “role differentiation”. In agencies and health care organizations, mental health services are often provided by a “team.” A mental health team is composed of individuals from different professional disciplines.

In agencies and health care organizations where teams are used to provide services there often is a “primary therapist” assigned who oversees the comprehensive treatment plan and assures continuity of care. In the last few decades with the increasing reliance on revenue from health insurance to pay members of a mental health treatment team, the emphasis by administrators is on the provision of reimbursable procedures rather than patient care and this management system has fractured treatment teams and corrupted the continuity of care leading to poor patient care and demoralization of staff.

Your provider will be with you shortly

 Clearly there must have been “something in the air” in the mid and late 1980s, some shift in the zeitgeist of psychotherapy, that made psychotherapists and their development more salient in the minds of researchers. Previously almost all scientific attention in the field had focused on therapeutic procedures, the “techniques” that therapists used (e.g., “interpretation” or “accurate empathy”), the processes that evolved in therapy from their use (e.g., “insight” or “self-acceptance”), and their impact on the patient’s mental and emotional condition (i.e., “outcome”). In many ways this model still largely persists, based on the assumption (imported from biological medicine) that the “curative effect” of psychotherapy derives from effective treatment procedures correctly applied to specific disorders. In this highly sanitized “laboratory” model, physician-therapists are viewed as well-trained administrators of the therapeutic procedure, with all other personal and professional characteristics an irrelevance; and they are essentially interchangeable. 8

Orlinsky, David E.. How Psychotherapists Live (p. 4). Taylor and Francis. Kindle Edition. 

The bolding has been added.

The commodification of psychotherapy based on medical “procedures” is inherently flawed and yet drives the reimbursement systems from health insurers. It has led to the corporatizing of “psychotherapy” in on-line schemes to provide psychological advice even via text messages for monthly service fees charged to a credit card.

What do you make of this?

Recently, at my last medical check-up the LPN took my weight, my temperature, my blood pressure, checked my medication list, and then got up to leave saying “Your provider will be with you shortly.” I was startled by the choice of the word “provider.” I wonder who had scripted her to say instead of “your doctor” or “Dr. Alweis”, “provider.”. And then it dawned on me that this is a large practice and she is “rooming” several patients all day long some of whom are seeing physicians, other P.A.s, some NPs, and some residents. “Provider” covers a lot of roles and professions and is a safe word to use when the discipline of the “provider” isn’t certain. They all to some extent are interchangeable. 

In my solo private practice of psychotherapy, there are no “providers.” There is only one Licensed Clinical Social Work Psychotherapist. I ask, “How did you get my name?”

 “Oh, my parents saw you twenty years ago. They told me you are good. You helped them.”

“You could go online and talk to someone like BetterHelp.”

“Oh I tried them for six visits. I decided I wanted to talk to a real person.”

“It’s nice to meet you.”

“Same here.’

What is the best age for legal adulthood: 18, 21?

 

There are historical and psychological reasons why the legal age for purchasing assault weapons does not make sense

theconversation.com/there-are-historical-and-psychological-reasons-why-the-legal-age-for-purchasing-assault-weapons-does-not-make-sense-184208

Ashwini Tambe

The Uvalde and Buffalo mass shootings in May 2022 had at least two things in common: The shooters were 18 years old, and they had both legally purchased their own assault rifles.

The shooters’ young age was not an aberration. The average age of school shooters is 18, when tracking incidents since 1966.

The relatively young age of most mass shooters has ignited conversations about the minimum legal age for purchasing firearms.

When it comes to gun laws, there is clearly a legal debate about how to define adulthood. But there is also a complex history of how societies determine adulthood, as I’ve examined in my work on the age of marriage and sexual consent.

Considering someone an adult once they turn 18 is a relatively recent trend, and it’s not clear that it can stand up to public scrutiny as a meaningful threshold for legally purchasing firearms.

A push for age limits

In the Parkland, Fla., school shooting in 2018, the shooter was 19. The Sandy Hook Elementary School shooter in Newtown, Conn., was 20 years old. And the shooters at the Columbine High School massacre in Littleton, Colo., in 1999 were 18 and 17.

Following the Uvalde massacre, Democratic Texas state senators called for an emergency legislative session to raise the minimum age to purchase firearms in the state from from 18 to 21, which Governor Greg Abbott has resisted.

The day after the Buffalo massacre, on May 15, 2022, New York Gov. Kathy Hochul called to raise the age to purchase assault rifles from 18 to 21. The New York State legislature then voted on June 2 to ban anyone under the age of 21 from buying assault weapon.

On June 2, President Joe Biden also called for a ban on assault rifles – or for raising the age when someone is allowed to purchase one.

On the other side of the issue, the National Rifle Association has challenged state laws in Florida and California that restrict people under 21 from buying rifles.

When adulthood begins

Several news outlets, including The Associated Press and The New York Times, called the mass shooters in Buffalo and Uvalde “men” and “gunmen” in their coverage. Some observers argued that these terms were accurate because the age of the shooters was 18.

But there is no single, cohesive legal answer to whether 18-year-olds are actually adults, in every respect.

In most U.S. states, 18 is the legal age of majority – this is the age when people are no longer entitled to parental support, can be emancipated from their parents or foster care, tried as adults for crimes, and enlist for military service. But not all states follow this age standard – in a few states, the age is 19 or 21.

Adulthood wasn’t always set at 18 in the U.S., either. The legal age of adulthood was 21 for several centuries in the U.S., a holdover from colonial rule reflecting a British feudal custom relating to when knighthood was possible.

In the early 1970s, following a congressional push to make the voting age consistent with the age of compulsory enlistment in the army, the 26th Amendment lowered the voting age from 21 to 18. In the following years, most states classified someone as an adult at the age of 18, aligning with the voting age.

This age does not rigidly define adulthood across every legal context, though.

Generally, at 18, a person can participate in activities that require a certain amount of cognitive independence, such as voting, consent to medical treatment and the right to sue someone.

Most states set the age of sexual consent between 16 to 18 years. The federal age of marriage is 18, but most states set a lower age for marriage with parental consent. Even in other parts of the globe, as I note in my book about the transnational history of marriage laws, parental consent determines the legal age standards for marriage.

A higher limit

On the other hand, some activities that can directly harm others and oneself have a higher age threshold.

The federal minimum legal drinking age is 21 because, after being dropped to 18 in the 1970s, an increase in drunken driving fatalities pushed states to raise it again to age 21 in the 1980s.

Government studies showed that states with the minimum drinking age of 18 had higher motor vehicle fatalities.

Drivers below the age of 25 also find it either difficult or more expensive to rent a car, given the higher risks of accidents for the car, the driver and others on the road.

The age threshold is also higher for activities involving financial risk.

For example, someone under the age of 21 needs a co-signer to get a credit card in their own name because of the Credit Card Accountability Responsibility and Disclosure Act, passed in 2009.

Phased-in adulthood

Researchers who study adolescent brain development argue that different types of maturity develop along distinct timelines. They offer nuanced distinctions between the ability to reason in a systematic way, which typically happens around age 16, and decision-making that involves emotion and risk assessment. This can take many more years to develop.

Such cognitive growth in fact continues until around age 25.

For these reasons, some legal scholars argue strongly against an absolute single standard for adulthood – one that holds across all activities.

The series of recent mass shootings by teenagers is challenging legal standards about when someone is an adult and can legally purchase firearms. Emotional maturity – the ability to recognize and process one’s fear, to control impulses – should ideally be a facet of gun ownership, if civilians are to have access to guns at all. The decision to pull a trigger requires exactly the kind of forethought that neuroscientists argue develops slowly.

In most legal contexts, activities that can put others at risk are not permissible at age 18. Adult status is actually granted in phases, depending on the activities in question. There is a strong case to be made on both historical and scientific grounds that 18-year-olds should not be allowed to purchase firearms.

Most schools in New York State have not implemented the required mental health training for staff

 

How did you get into Psychiatric Social Work?

I remember taking a vocational assessment in 8th or 9th grade and the question which has always stuck with me is something like "Do you prefer to work with people or things?" And I remember the quick and distinct answer I had, "People!" I remember this so well because I was so certain. 

As I grew older I did a lot of factory work while I was in college being a material handler at G & E and then a film tester at Kodak. My BA degree was in philosophy and then I found out if I got a job at a New York State Hospital they would allow me to go to graduate school on leave with pay. I got a job at Kings Park State Hospital at Kings Park New York on Long Island as a "Psychiatric Social Worker Trainee II." I applied to MSW programs and finally chose SUNY Albany where I attended from 1970 - 1972 and got my MSW in May of 1972 50 years ago.

It has been a wonderful career which I have enjoyed immensely although I have worked 3 jobs most of my career to support my large family.

Back in the 70s Social Work was called a "semi profession" along with nursing, and teaching. The three semi professions were female dominated, more poorly paid, and lower status than the professions of medicine, and law. Over the years the salaries and benefits of nursing and teaching have risen but Social Work has remained a lower paid, lower status, lower benefit semi profession. 

Nonetheless, I don't regret my decision to go into Social Work. The profession is a great fit for me and the satisfaction and fulfillment has been immense and more than offset the lower compensation, benefits, and social status. I have learned to use the low status to my benefit when requests and expectations are placed on me and I demure, saying, "Look, I'm just a Social Worker."

Just a Social Worker but truly yours,

Do you think of yourself as a victim?

Article Notes for "Why People Feel Like Victims by Mark McNamara

https://nautil.us/why-people-feel-like-victims-9728/

In a polarized nation, victimhood is a badge of honor. It gives people strength. “The victim has become among the most important identity positions in American politics,” wrote Robert B. Horwitz, a communications professor at the University of California, San Diego.

Horwitz published his study, “Politics as Victimhood, Victimhood as Politics,” in 2018.1 He focused on social currents that drove victimhood to the fore of American political life, arguing it “emerged from the contentious politics of the 1960s, specifically the civil rights movement and its aftermath.” What lodges victimhood in human psychology?

Snip

The study of TIV is built around four pillars. The first pillar is a relentless need for one’s victimhood to be clearly and unequivocally acknowledged by both the offender and the society at large. The second is “moral elitism,” the conviction that the victim has the moral high ground, an “immaculate morality,” while “the other” is inherently immoral. The third pillar is a lack of empathy, especially an inability to see life from another perspective, with the result that the victim feels entitled to act selfishly in response. The fourth pillar is Rumination—a tendency to dwell on the details of an assault on self-esteem.

Snip

You found a correlation between TIV and what you referred to as “anxious attachment style”, as opposed to “secure and avoidant” styles. What is the anxious style?

Snip

So victimhood is a learned behavior after a certain age?

Yes, normally children internalize the empathetic and soothing reactions of their parents, they learn not to need others from outside to soothe themselves. But people with high TIV cannot soothe themselves. This is partly why they experience perceived offenses for long-term periods. They tend to ruminate about the offense. They keep mentioning they are hurt, remembering and reflecting on what happened, and also they keep dwelling on the negative feelings associated with the offense: hopelessness, insult, anger, frustration.

Snip

Why is it so difficult for people with a high degree of TIV to recognize that they can hurt other people?

They don’t want to divide up the land of victimhood with other people. They see themselves as the ultimate victim. And when other people say, “OK, I know that I hurt you, but you also hurt me,” and want them to take responsibility for what they did, the person with TIV is unable to do it because it’s very hard to see themselves as an aggressor.

Snip

In one of your studies, you conclude that TIV is related to an unwillingness to forgive, even to an increased desire for revenge. How did you come to that?

Our study finds that not only do people with high TIV have a higher motivation for revenge, but have no wish to avoid their offenders.

Snip

How does the fourth pillar of TIV, Rumination, reinforce this tendency?

In the framework of TIV, we define rumination as a deep and lengthy emotional engagement in interpersonal offenses, including all kinds of images and emotions. And what’s interesting is that rumination may be related to the expectation of future offenses. Other studies have shown that rumination perpetuates distress and aggression caused in response to insults and threats to one’s self-esteem.

Snip

How debilitating is TIV for those with moderate TIV? Does it affect everyday functioning?

Yes. The higher the TIV, the more you feel victimized in all of your interpersonal relations. So if you are in the middle of the scale, you might feel yourself as a victim in one relationship but not another, like with your boss, but not with your wife and friends. But the more you feel like the victim, the more you extend those feelings to all of your interpersonal relationships. And then of course it can affect every aspect in your life

Snip

TIV aside, can there be a positive aspect of victimhood?

There could be, when victims gather together for some common purpose, like a social protest to raise the status of women. When I’m talking about victimhood, I’m talking about something that has aggression inside it, a lack of empathy and rumination. But when you express feelings of offense in an intimate relationship, it can be positive.

Snip

Do people high on a TIV scale tend to seek out lovers or friends who share the trait?

That’s a very smart assumption, but it’s not something I empirically investigated. Theoretically, yes. I think that people who are very low on TIV, if they have this romantic relationship with someone who is high on TIV, then they would not want to continue the relationship. For the relationship to continue, you need two people who are high on this trait or someone who is like this and someone who has very low self-esteem, which is not the same as low TIV, someone who feels they don’t deserve a better relationship.

Snip

Do people in most countries show this trait?

There are very big differences between countries. For example, when I traveled in Nepali I found that their tendency for victimhood is very low. They never show any anger and they don’t tend to blame each other. It’s childish for them to show anger.

Snip

Victimhood is also a matter of socialization.

Yes, and you see it when leaders behave like victims. People learn that it’s OK to be aggressive and it’s OK to blame others and not take responsibility for hurting others. This is just my hypothesis, but there are certain societies, particularly those with long histories of prolonged conflict, where the central narrative of the society is a victim-oriented narrative, which is the Jewish narrative. It’s called “perpetual victimhood.” Children in kindergarten learn to adopt beliefs that Israelis suffer more than Palestinians, that they always have to protect themselves and struggle for their existence. What’s interesting is the way in which this narrative enables people to internalize a nation’s history and to connect past and present suffering.

Snip

Can you extend this dynamic to groups that share this trait?

It’s a very interesting question, but unfortunately I can’t say much about it. What I can say is that the psychological components that form the tendency for interpersonal victimhood—moral elitism and lack of empathy—are also particularly relevant in describing the role of social power holders. Studies suggest that possessing power often decreases perspective-taking and reduces the accuracy in estimating the emotions of others, the interest of others and the thoughts of others. So not only does TIV decrease perspective, but power itself has the same effect. Additionally, power increases stereotyping and objectification of other individuals. So when you join TIV tendencies and the negative characteristics of the power holder together, it can be a disaster.

Snip

What can we do to overcome victimhood?

It begins with the way we educate our children. If people learn about the four components of victimhood, and are conscious of these behaviors, they can better understand their intentions and motivations. They can reduce these tendencies. But I hear people say that if they don’t use these feelings, if they don’t act like victims, they won’t achieve what they want to achieve. And that’s very sad.