Training Therapists: We’re Doing It Wrong.

Becoming a therapist should not take two degrees. If we want to create a program to train therapists, it needs to be one degree that actually intends to make good counselors. We need a vocational school styled approach, explicitly focused on licensing in four years or less.

Getting a grab bag of undergraduate psych experience–which may or may not relate to counseling people, and a year of graduate school before you start interning (read: doing therapy with supervision) is useless. It’s expensive, it limits who can become a therapist in the wrong ways, and lets people who should not be practicing slip through the cracks and emerge with a license.

So We Can Stop Making Therapy a Wealthy Person’s Privilege

Look, the cost of an undergraduate degree is really high. The average public university costs per year is $15,918 [source]. So you go there for four years, and you have a degree in psychology. That’s great, except you can’t do therapy with that.

So you need a graduate degree. That’s $6,000-$15,000 [source] per year in tuition again for two years (assuming a Masters program). Of course, you also have living expenses–even assuming that you don’t have kids or a partner or a car accident or a major illness–the majority of therapists start out in debt. So what they charge for services matters. They can’t afford to spend time giving away therapy sessions, because they need food on their table. It’s harder to do sliding scale sessions if that’s not how your repayment plan works. (Sliding scale is a pay-as-you-can model.) Therapists want to be on an insurer’s list, so they can get a stream of clients.

So therapy costs money, and cheap(er) therapy requires insurance. See the problem here?

Burnout/Weeding Bad Therapists Out:

Premise: Some people who want to be therapists will actually make terrible therapists.

Arguments? No? Okay.

Undergraduate psych isn’t a lot about actually working in psych services. It’s “Look at this cool brain thing! And what about this one?!” “Stroop tasks!” “Neurons!”

And I like all of those things. I like them a lot. But they don’t tell you about how much paperwork comes from being a counselor. Or what the hours look like (hint: it’s not a 9-5). You don’t spend hours practicing how to listen and think and avoid asking “Why?” questions* all at the same time. Not everybody can do this, and that’s fine. But maybe we shouldn’t make everybody figure that out on their own. A program that mirrors the practice of mental health care lets those who can’t do it drop out early (before they get a an expensive set of degrees, hate it, feel obligated to use their education, irritate and harm clients, and then burn out.)

In undergrad, psychology is an ‘easy’ major. Being a counselor is not easy. Let’s match the training to the reality.

Intersectionality & Real Life.

I learned a lot of things about brains and people and microskills and heuristics and biases and writing a concise abstract in my major. I like all these things–I don’t like psychology just because I want to be a therapist. I love statistics and reading research and neuroscience.

You know what I didn’t learn about, beyond a passing mention that they exist?`

Gender & sexuality minorities

Why most people return to abusive situations.

Harm reduction

What systemic poverty looks like

Incest

Rape

Child abuse

What the foster system looks like in practice

Chronic illness as it relates to mental health

Bullying

Suicide prevention

Psychopharmocology (Psych medication)

Asexuality

How to ask for preferred pronouns/getting used to gender neutral pronouns

Polyamory

…or how any of these can intersect.

I would have liked to.
I want budding counselors to begin their education by learning about ALL kinds of people and systems. I want to stop assuming that living in the world gives you enough life experience to counsel anyone. Because you know who can afford to go to college for two degrees, who are encouraged and supported in doing so? Mostly privileged people. Do you know who we’re really bad at providing mental health services for? The underprivileged.

What Psych Services Jobs Can You Do With A Psych Undergrad Degree?

Seriously. Somebody.

You can work at a crisis center or hotline or be a research assistant or or or…yup, I’ve got nothing.

Tracked Classes Are Better Than Pick ‘N Choose

Psychology majors usually have a basket system for major completion. This isn’t a terrible idea, and it’s how most humanities majors work. You get some intro level classes, some intermediate classes, a handful of special seminars, and a few required things like statistics  and Writing a Paper a Specific Way That Will Be Quickly Outdated (aka Research Methods. Yes, I’m bitter). You don’t really have to get them in any order, except you might need Intro Psych first, and research seminars might need you to understand statistics and paper writing. Other than that, you take what you want, in whatever order works for you class schedule.

On the whole, this doesn’t seem unreasonable. You don’t really need to understand 200-level Social Psychology to understand 200-level Cognitive Psychology. I do, however, think you should take Developmental Psychology before you take Developmental Psychopathology. You should also take Psychopathology before you take Counseling, and you should know a little bit about neuroscience, developmental problems, and brain injuries before that too. You should definitely take more than one class about counseling people, and the second, third, and fourth classes should build on each other.

I want a program that plans classes, that puts them in the most useful order, that builds on knowledge to create a well rounded counselor by intention, not by accident.

Look, I’m going to get my two degrees and become a therapist. I would hope that I’ll be a good one. But we need to create a system that makes that the most common outcome, that doesn’t put potential therapists into debt, and that treats mental health work like a career with real requirements in terms of personality, skills, and devotion.

*With the exception of Rational Emotive Behavioral Therapy, therapists are highly discouraged from asking questions that begin with “Why…”, because they come across as implicitly judgmental, even if that’s not the intent. 

The Weight Requirement, and Other Ways We Diagnose Anorexia

This is a post that’s been a long time in coming. Unfortunately, every time I start it, I get upset and then have to leave it alone. So here we have it: what’s wrong with how we diagnose anorexia. Now with less ragequitting!

Anorexia has a weight requirement.

Refusal to maintain body weight at or above a minimally normal weight for age and height, for example, weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected.

PROBLEMATIC.

Please, someone define what a normal weight is. Because I know this totally isn’t controversial. Using BMI? It doesn’t account for muscle mass, so you’re leaving out  anyone who’s particularly athletic. Using clothing sizes? Ahahahahahahaha. 

Even supposing we had some accurate scale of normal height-to-weight ratios, should a diagnosis rest on a weight? If I’m restricting caloric intake, and I drop under 85%… Bingo, I have anorexia. Ding ding ding and all that. The next day, I enter treatment, or I eat a particularly large meal, or retain a little water, and suddenly I’m at 86%. Have I suddenly developed a disorder that is markedly distinguishable from what I had on Monday? I think not.

The emphasis on being excessively thin is also in the second criteria:

Intense fear of gaining weight or becoming fat, even though underweight.

Anorexia does not just happen one day, when you stop eating and magically, everyone can tell! This, like lots of the criteria, seem to be waiting to diagnose after the disease has progressed significantly.* That’s dangerous.

This is particularly true for people who start at an above-average weight. We fetishize the idea of heavy people losing weight through whatever means possible, up to and including unhealthy ones. (Biggest Loser, anyone?) It’s going to take an especially long time for family and friends to notice such severe weight loss–and of course, they’ll probably praise and reinforce it along the way–and all the while, the disorder will become more entrenched, wreaking havoc on the body it inhabits.

Amenhorrea

In postmenarcheal females, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycles. A woman having periods only while on hormone medication (e.g. estrogen) still qualifies as having amenorrhea.

Defined as non-menstruation for three cycles, this is competing with weight measurement for least helpful criteria. For one, it isn’t useful for anyone on hormonal birth control (withdrawal bleeding is not the same as getting your period). For two, it’s a fairly useless metric. Only cisgender women who can ovulate, are not pregnant, and who have reached puberty, but not menopause can use it. (Also, you qualify for this criteria automatically if you’re on birth control. Say what?) Further, there’s not a lot of research suggesting that amenhorrea occurs in a standardized way, or that it represents the severity of deprivation. Luckily, this is heading out with the publication of the DSM-5.

Waltzing between diagnoses.

In the span of six years, I met criteria for…

Anorexia nervosa (purging type)

Anorexia nervosa (non-purging type)

Binge Eating Disorder (BED)
Note: this is a proposed conditional diagnosis, given separate status from BN and AN. 

Bulimia Nervosa (non-purging type)

Eating Disorder Not Otherwise Specified (EDNOS)

…that would be all but two of the ways one can have an eating disorder. This suggests that we may just be quantifying eating disorders incorrectly. Those qualifying for anorexia diagnoses are automatically going to fall into EDNOS as they recover and gain weight (and consequently, no longer meet the first criteria for AN). Should we rename EDNOS as “Anorexia in Remission?” No, because then you leave out the others who were diagnosed as EDNOS for other reasons, such as not qualifying for a bulimia diagnosis. If EDNOS is made up of lots of people with very different manifestations of disordered eating, can we do any useful research about the diagnosis? Will we be able to draw any useful conclusions? Probably not.

And why does it all matter? After all, society recognizes that refusing to eat is bad, right? It matters because the research doesn’t look at “a population of women who have refused to eat at some point”. It looks at “300 female patients who had been diagnosed with anorexia in the last calendar year”. That means how we assess treatment, how we examine the genetic basis, how we study the disorder is a product of how we describe it.

And we’re doing it wrong.

*Also, the face of anorexia, besides being almost always a thin woman, is always white and upper class. Incorrect, and a scary myth to perpetuate.

Abusing ‘Normal’

Alternately titled: Yes, but isn’t EVERYBODY kinda mentally ill? What is mental illness anyways? Aren’t we just pathologizing being weird?! BUT SO MANY PEOPLE SEEM TO BE MENTALLY ILL NOW!

If you talk about mental health and mental illness long enough someone is going to pull one of these.

 You know, aren’t we all just different?

It seems like everyone has a mental illness. 

I mean, like, isn’t everyone sad/anxious/depressed/a little obsessive-compulsive?

Yes, but mental illness is just a social construct! We just decide what behaviors we don’t like and those are the ones we treat! 

I mean, it’s all just a bell curve!

I’ve always imagined myself shouting BECAUSE REASONS!!11!1, and then promptly brandishing a list at the offending questioner. This post is the internet equivalent to that word waving. Beware of snark.

1) The ‘Useful Heuristic’ Explanation

We, as humans, categorize things, then use shortcuts to understand what’s going on in our world. These can break down and aren’t always helpful (see every racist, sexist, heterosexist stereotype ever) but they do save cognitive time and space and increase processing speed. “Having X mental illness” or even “having a mental illness” is a useful heuristic that conveys specific information. I don’t have to tell you that I am statistically more likely to find food anxiety-provoking, while also having significant distorted bodily perception, obsessive behaviors related to food and drink consumption and discussion of the aforementioned–I can just tell you (or anyone else) that I have an eating disorder.

2) The ‘Special Snowflake’ Explanation

The experiences of those with mental illness are quantifiably different from those without mental illness. In fact, when people respond with “Oh, I get/understand/could imagine [whatever aspect of mental illness I was talking about].” I’m actually faintly uncomfortable. Because no you don’t.

By attempting to cheerfully shoehorn the experiences of the mentally ill into your Just Like Me box, you’re actually ignoring their experience–and also refusing to acknowledge that the ways in which they inhabit the world are fundamentally different from yours. You don’t understand it, and you can’t, and that’s fine. The solution is to get used to it, not to pretend you’re the same people with slightly different idiosyncracies. Mental illness not having a membership to a Special Club for the Quirky. It’s overwhelming, distressing, and the vast, vast majority of people with it spend their time wanting it to go away, now.

And for heaven’s sake, mental illness is not a cute little talent like juggling geese, rearing its head when convenient.

3) Dammit, It’s Hard to Do Research Without Diagnoses

Without some way of quantifying the clusters of symptoms that make up different mental illnesses, we’d have extraordinarily poor research. The anxiety surrounding food in anorexia is different from the anxiety of a phobia or the anxiety of PTSD. The You’re Ostracizing People Who Are Just Different crowd usually fail to consider that research lies almost entirely in developing and learning from divisions of differentness.

4) The Medical Model has Some Uses. 

Before I have a riot on my hands, this is not me throwing my support to the medical model of mental illness. (Medical model redux: Diagnose via a checking boxes on a list of symptoms, find appropriate fix.) I don’t particularly like it for any sort of understanding about actual illnesses. Go biopsychosocial!

But the model is useful for explaining why being neurodivergent is not the same as being neurotypical. By equating mental illness to physical illness, (Another note: I’m not endorsing mind-body dualism here either–or the excessive use of parenthetical notes.) we’ve benefitted greatly. You can say “someone with cancer has physical differences from someone without cancer!” and then substitute ‘depression’ for ‘cancer’, and people wil get it. Not only that, but they’ll understand why treatment is a necessity, why it should be covered under insurance, and why people with depression alter their lives around it. Pretty sure no claims office shelled out for “being a different kind of normal”.

So.
[Dusts off hands.]
Mental illness is A Thing.

How Girls Evolved To Shop

Rebecca Watson’s talk at Skepticon 5, which made my sides hurt from giggling.

So, back in the day, men were hunters and women were gatherers…and now, men like museums while women prefer shopping…And the researcher in question noticed this on a trip to Prague. He went with some friends, and all the men in the group wanted to see cultural attractions and the women wanted to go shopping. And he was like, whaaaaa? [audience giggles] So he has determined that visiting museums is just like hunting, and shopping is just like gathering…ergo, SCIENCE!

In all seriousness, this stuff is only funny when I’m not daling with people spouting it as evidence of gender roles.

[Content note: evo-psych about rape; sexism]

watch?v=r9SvQ29-gk8

Bad Psychic Gordon Smith

Alright, admittedly “bad psychic” is redundant, but this morning I got a comment on my old blog from a post I did about seeing a psychic where I used to work:

Ashley, people do not pretend its a gift. It is a gift. Because you do not have the gift is why you respond in this way. Its not a technique anyone can learn from a book. Its called altered consciousness. Do your research before writing about Gordon Smith in such a negative fashion. He is a top of the range medium. The real deal. Not the best of articles, very poor in fact. Go and see Gordon Smith live, you will not be disappointed. Then you will see his accuracy. Street names, names etc. – Mystic Kaz

Because the comment was clearly so traumatized by the idea of bad publicity for Gordon Smith, I thought I would share the story again, for a wider audience at FreethoughtBlogs.

I had the unique opportunity to see a psychic called Gordon Smith.  I hadn’t heard of him until today, but I took the liberty of google searching him before seeing him and learned a bit about him.  He’s not just a psychic, he’s also a medium, which means that in addition to seeing the future or reading your mind he can talk to dead people.  He is quick to reassure that this isn’t scary, because spirits are nice.

He once amazingly predicted that the body of someone last seen trying to cross a dangerous river would be found somewhere downstream, but his normal schtick is telling people that their recently deceased relatives love them and are happy on the other side.  Whether you find that to be taking advantage of people who are desperate and grieving or as comforting them is up to you.

But when I see things like he read about a dead kid in the newspaper and then used that information to do a hot reading on the parents and put it on TV to get publicity and money, I confess I get a little queasy.

It turned out to be a group reading for a crowd that was probably half hostile, half believers.  He started with a directive to be open and communicative with him if he talked to us, not to be afraid, and that it was all to do with love.  We were directed to try to make mental contact with a person who had passed.

He started by talking with an older woman I know who is well known for her love of all things woo — she likes to do astrological charts and thinks aliens built the pyramids — and who dresses that way as well.  I believe I saw her talking to him beforehand, but if not it would have been easy for him to get info on her or just guess it based on her looks.  She was an ideal target because she obviously wanted to believe.  Also, as much of the crowd was young, she was more likely to know people who’d died.

I won’t bore you with the cold reading details, suffice to say they were pretty standard.  ”An Older Man?  Your Father?  He loves you.  He had a nice smile.”  He went into histrionics and said that her father had had trouble breathing when he died.  How vague and necessarily true.  He said there were connections in Boston or NY, which really implies the whole northeast, which is how much of the population of the US?  She didn’t seem to know specifically what it was referring to nonetheless.

He said the name “Michael” was coming through, but this didn’t mean anything to her.  He insisted it would.  He started talking about wallets, photographs, and “the house”, all of which was incredibly vague.  He ended with “He’ll be with you in September.”  The entire thing was vague and banal, but she seemed happy with it.

Then he pointed to a group of three men standing together, and said he was sensing a man who’d had a heart attack and died and it was connected to “You, sir”, but he pointed so vaguely that it could have been any of the three.  Alas, it was not a hit with any of them.  He kept pressing and said someone had lost an older man, father perhaps.  A skeptical man in a mustache said, “Yes, about a year ago, but he didn’t die of a heart attack.”  Oh, snap.

Then Gordon proceeded to pretend that he’d heard about the one year thing from the ghostie, not from the guy, and the guy wasn’t buying any of it.  Gordon said that he had unfinished business, there was so much they never did.  There was a single rose, a symbol of love.  And the guy said, “I understand what you’re saying, but you’re way off the mark.”  Snickers.

GS: There are many unfinished things…
M: Like what?
GS: He’s telling me something about phone calls…
M: …
GS: He’s proud of you, he’s happy with your life.  Something about photos on a computer…
M: That doesn’t mean anything to me.
GS: There’s a dog with him?  He loved being with family.

I imagine had we been a less polite crowd, had we paid to see this, or had alcohol been involved, there would have been jeering and heckling at this point. Flop sweat is not a pretty thing, and as much as I wanted him to crash and burn, it was difficult to watch.

He obviously couldn’t end on that, so he pointed to a different trio of guys and said he was sensing an older woman. A guy I know pretty well took the bait.

GS: The last 18 months a lot as happened. Are we near some sort of anniversary?
M: … Yeah.
GS: She says you need to tidy your mess. Her hair is lovely, she got her hair done.
M: OK.
GS: Feeling something in my throat, she loved to sing?
M: Yeah
GS: She’s saying three’s company, two’s a crowd.
(What kind of embarrassingly trite bullshit is that, btw)
M: OK.
GS: She’s saying there are wires everywhere. You need to clean up the wires so there’s not a fire — that’s not a prediction, just a worry. There are too many phones.
M: OK, yeah.
GS: She’s saying the name “Anne” or “Annie”?
M: Yeah
GS: There’s a ring… she’s saying wear the ring so they’ll remember her
M: I don’t know of any ring.
GS: There’s a ring, look for it.
M: K.
GS: She had trouble with her legs, or her feet, difficulty walking in her old age
(Who doesn’t?)
M: She had a walker.
GS: She’s saying don’t worry about the money.
(Because like no one has money problems)
GS: She’s saying there’s a connection to Ireland?
M: … sure
GS: She’s saying get a passport to Europe, someone’s been talking about Europe
M: Italy
GS: That’s in Europe!
(killmenow)
GS: There’s something to do with the fourth of July, or near the fourth of July, not American Independence day, but something different
M: Yes.
GS: Complaining about a sore back?
(Everyone ever)
GS: There’s a spaniel, a little dog
M: … no
GS: You love animals
M: Yes
GS: There’s a watch?
M: Not that I know of.
GS: Maybe your grandfather’s. The name Tom, does that mean anything to you?
(Can’t they ever just use an interesting and uncommon name for shits and giggles?)
GS: Look for the watch. She’s saying that you’ve had two lives, that you’re very different now. The year 1981 does that mean anything?
M: No…
GS: She’s saying look to the early 80s. You’re a different person now than you were then.
(No shit, it’s been 30 fucking years)
GS: She says something about Rose? Not the flower, she’s with Rose?
M: Don’t know that…
GS: She says the best is yet to come.

At this point, he said no more spirits were coming to him but he’d take questions about what he did. There were a few questions and he told a lot of stories, including a particularly good one where he contacted someone named Jared and the lady said that was her husband, and he wasn’t dead, she’d just left him, and he said sometimes he made mistakes, but when she got home he was dead on the couch.

Then he said dead people were like angels, or light beings, and they were kind. Sometimes they’d apologize for abuse. All humans are spirits. Everyone has a sixth sense (I assume he means everyone has some sort of extra sense, because people have more than just five) but not everyone is a medium.  And then we were dismissed.

He was a perfectly pleasant man with a Scottish accent and a sense of humor, but I just don’t understand how people can do this and pretend it’s a gift not a technique anyone can learn from a book.

The Fallacy of Generalization from Fictional Evidence. (a.k.a. Harrison Bergeron)

A few days back, I cheerfully pointed out via a comment that when you say things like this:

I handle controversy really well; I do not break down in tears, jump to unreasonable conclusions about my safety, or have mental breakdowns.

…in the greater context of an article about how, in essence, those who can’t handle the heat should get out of the kitchen, (an idea which Stephanie excellently skewers here), that is ableism. Have breakdowns? Oh, it’s because you couldn’t handle controversy. You know, I’m just going to tell you (as someone who is neither your therapist or friend) that if you have mental health problems, you should just stay out of debate. Even if, y’know, it is about issues that involve you. Let us neurotypical people handle it.

I’m not going to tackle the resulting comments and blog post from the OP, because honestly, I’ve no interest.

What was interesting was the commenter who left one of those brief rhetorical comments (as you do):

Have you read Harrison Bergeron?

…with one of those faces of forced confusion and shock, O.o, the sort that always fail to convey their intended meaning by reminding me of these marsupials.

In brief, “Harrison Bergeron” is a dystopian short story by Vonnegut,  where ‘equality’ has become so inverted that those with talent are hamstrung and given handicaps to prevent them from expressing any ability better than anyone else. Those of intelligence wear earpieces that blast noise at intervals, the beautiful must wear masks, etc. In other words, the ‘equality laws’ have trampled the people. Harrison throws off the confinements, stands up against a world that wants him to conform to a normative idea of ability, and for a few brief moments, lives unconfined by society.

Now, to the actual question of my education: I have read it. In fact, due to a public school system that didn’t communicate required reading from grade to grade, it was part of my studies no less than three times.

Did I think the state of my high school literary education was actually the point of inquiry? No.

But, the “What about Harrison Bergeron?!11?!!” response is one I get often, and it’s still exams week(s) and I’m fed up.

You’re committing a logical fallacy. And it’s not even one of the fun ones. But, lest I fall into the trap of the Fallacy Fallacy, let me point out why, besides the obvious “this is a fictional short story”, “Harrison Bergeron” is not the appropriate response to actions to remove ableism.

Where exactly do you want me to draw the line? Do you think it’s utterly wrong to be saying sexist/homophobic/racist things, but when it’s fine to dismiss people on the basis of their mental health? Skin and gender and orientation aren’t up for mockery, but, hey, we gotta draw the line at being nice somewhere!

Then there’s this sticky situation:

Point 1: Ableism is treating a group of one type of able-ness as though everyone else should cope in their world, whether or not it serves them well.

Point 2: In ‘Harrison Bergeron’, less-preferred kinds of ability is forced to conform to the world, by use of handicaps, whether or not it serves them well, and leads to a heartbreaking climax…and THAT PROVES THAT DISCUSSING ABLEISM IS SILLY BECAUSE…..oh. errrr…….ooops?

If you’re upset with the way those we would call ‘normal’ are restrained to conform in Vonnegut’s tale, but not fussed by things like the Canadian government fighting to avoid updating their websites to work with screen readers for the visually impaired, you’re doing it wrong.

If you’re upset with the earpieces (which blare noise to disrupt intelligent thought) in the story, but think it’s fine to joke around about illnesses like OCD and schizophrenia, which often have invasive and uncontrollable thoughts that prevent concentration, you’re doing it wrong.

If you’re using “Harrison Bergeron” to tell me why I shouldn’t care about ableism and you don’t notice that it’s proving my point, you’re doing it wrong.

Intake Edition

This quarter at school, I’m enrolled in a number of classes geared towards a pre-professional student. Of course, I’m a psychology undergrad, and to be a counselor or therapist, graduate degrees and/or certifications are required. However, at this point my class load is centered around learning theoretical orientations, practicing micro-skills (don’t cross your arms at a client), writing up psychosocial histories of imaginary clients, looking at standardized tests of mental functionality.

Simultaneously with this, I’m restarting therapy at a new location. I write about the first interview with a new client…and then I go to my first interview. We talk about effective note-taking techniques….and I observe my therapist’s legal pad of blue scribbles and arrows and diagrams. I plan my first psychology internship…and then give permission for an intern to sit in on my session.

In discussions with peers and classmates and friends considering finding therapists, I notice a sort of mystery surrounds therapy. Everyone’s sure you sit around and talk about things eventually, but how do you get one? What about all the forms? How do you start with someone you’ve never met? And, in the case of friends applying for reduced or free sessions (at community or university health clinics, who have limited therapists, and often take only some of their possible clients), what are all the questions looking for?

I can’t tell you how every therapist works. I can’t tell you how to get taken on for free or reduced-fee treatment. I can’t tell you that the first therapist you see won’t be homophobic or transphobic or non-skeptical. There’s bad therapists and therapists that you just don’t like because they’re too loud or too boring or too patronizing or too unsure. But I can de-mystify the process a little. I can tell you what I know of each side. I can know that I felt safer, more relaxed, when I knew what would happen beforehand, and hope that I can offer you a little of that.

Not considering therapy* because brain-wise, you’re just peachy? That’s spectacular, but as I ranted to Facebook friends today, you aren’t handed an Always Mentally Heathy Certificate at birth. You aren’t the Okay side that gets to pity the Other. Life is messy, and those lines are blurry at best.

So. The Intake Interview. The dancer in me thinks of this as an audition: trying to figure out what treatment and whether or not the two of you can work together. It’s unethical for a therapist to take on a client for whom they aren’t qualified, so some of this is them feeling out what you need from them. Intake has other ethical obligations; the counselor tells you when they would have to break confidentiality (harm to self or others). They have to check for suicidal ideation, because your life trumps it all. They have to get a handle on what you might be dealing with.

This means a lot of questions. Direct, sometimes uncomfortable questions. Were you abused? Do you think of suicide? (In my case) How much food have you had today? Yesterday?

Then there’s my least favorite: Why are you here? I loathe it. How do you start? What do you say? I want to say how well I’m doing, how much I’ve improved…and that’s not what they want. They want all the bad, six years of eating disorder that morphed into disordered eating and out-of-control exercising. So I run through it. I’m never linear; I stop and go back, and gesture, and leave out names and clarify and repeat and confuse. I’m never satisfied with my explanation, and I trail off until they finish scratching out notes.

Intake is…unpleasant. It’s scooping out your guts along with your life story. You offer up this blobby mass of tears and feelings and facts and say, “This is me. Help, please?”.

And it’s worth it. You do it once, and you have this terribly unproductive session, but it’s over and there’s a file and you don’t have to retell it ever again. You can move forward. Therapy starts. You come back and there’s a plan.

Therapy doesn’t work for everyone. It’s not a cure-all, and I don’t want to represent it as that. A lovely friend reminded me after my Friend Manual posts that it’s important to talk about psychology’s bad side: the side that tried to “cure” and diagnose homosexuality, a side that still does problematic gatekeeping, that still has practitioners that treat their own clients with therapy that isn’t empirically based.
Furthermore, not everyone CAN access therapy. Transportation, the cost of insurance, cultural norms, inability to take time from work or life or caring for family are all problems we need to and should address. 

Video Dragon*Con 2011: Do Be a Dick

This is the talk I gave at Dragon*Con last year, which was itself an expansion on the talk I gave at TAM9.  It’s about how to use emotions to your advantage when trying to promote a cause.  I talk about Prop 8, the importance of social justice in getting people to like atheists, and how to be a dick in an effective way.

The powerpoint and notes for the presentation are here: http://freethoughtblogs.com/ashleymiller/2011/09/06/do-be-a-dick-sometimes-emotions-and-skeptics/

Goodbye Encyclopedia Brown: Thank you Donald J. Sobol

One of my first introductions to critical thinking was through the Encyclopedia Brown books.  They were more like riddles than mysteries, but they always taught you to pay close attention to the details and figure out which part was bullshit.

The author of these wonderful books, Donald J. Sobol, has passed away today.

If you have a few moments today, you can go read up on the ten most difficult cases or peruse the Encyclopedia of Encyclopedia Brown.

So long, and thanks for all the fun!

Everyone Needs to Read This: Pamela Gay is Awesome

“Dreaming is hard. It requires risks. It requires you to own the fact that you are capable of something great.”

“Imagine a world in which all the time, all the energy and and all the bandwidth that goes into cyber bullying and trolling instead goes into building good things.”

This is part of what it means to be a woman in science. With the creeps I generally hold my own and get them to back off like I would with any asshole in a bar. With the people in power… I commiserate with the other women as we share stories of what has been grabbed by whom. I know as I say this that it sounds unbelievable – and how can we report the unbelievable and expect to be believed?

This isn’t to say women shouldn’t go into astronomy. It is just to say that in the after hours events, you sometimes need to keep your butt to the wall and your arms crossed over your chest.

Some of you have to have power to stop discrimination and harassment. It pisses me off to know that as strong as I am, I know I’m not powerful enough to name names and be confident that I’ll still have a career.

But some of you are people with power who can change things.

http://www.starstryder.com/2012/07/15/make-the-world-better/