Hi! There is very little in the form of any sort of organized critical community psychology in my country, and I would like get some inspiration for readings that I could share with other libertarian/syndicalist professionals to try to get things going here. (I've heard some amazing stories of projects in the UK, what's the situation there at the moment, if someone is in the knows?)

Thank you

I'm a pre-licensed LPC who recently started reading A Clinical Introduction to Lacanian Psychoanalysis: Theory and Technique by Bruce Fink. I took an interest in psychoanalysis recently because I have a client who has been suffering from very consistent depression for a long time now and I've heard some people on this sub and r/therapists say that psychoanalysis can be really helpful for depression that doesn't seem to go away.

As I've been reading this book, though, I've noticed some terminology and theory that seems a little bit homophobic. For example, in one section he talks about a homosexual patient who said that his dad was behind him, and the author starts talking about the dad liking anal sex. And I've read at another part that they were implying someone saying that they were transgender was actually experiencing psychosis.

Am I misinterpreting something in this book? I find it fascinating but this is just kind of a hang up for me right now.

Just what it says in the title. I’m interested in clinician and client experiences with modalities that resulted in improvement in quality of life. If you have a “please for the love of god do not use xyz modality” experience I am interested in that too. For context, I am a pre licensed clinician who went to a non-CBT program, and I just took an online ERP (Exposure and Response Prevention) course that was ostensibly trauma-informed and inclusive of CBT-L and Relational Cultural Theory. I am having Complicated Feelings about using it in my practice, as I and my clients are from marginalized groups, with neurodivergent identities and trauma backgrounds, but often have OCD or OCD-like experiences (which makes sense—there’s statistically a lot of overlap there and it might all just be part of the neurodivergence umbrella). I’m asking here since y’all tend to have more of a liberatory lens, which is what I am going for. I recognize no matter what, I’d need additional training and supervision.

Disclaimer: I am a little hesitant posting here based on experiences in other leftist groups. I worry that someone is gonna fight me about something here, like my wording (which I am open to correcting), or for not being sufficiently or incorrectly leftist (I’m Indigenous. That is my political identity. My politics and the theory I rely on might be different than yours, but we are fighting for similar things). Please just hear me out that I am looking for additional trauma-informed/trauma-responsive ways to support my clients in improving their quality of life (by their definition, not mine), living values-congruent lives (again, their values, not mine), and increasing their autonomy and ability to trust themselves, rather than living a life constrained by self-doubt, intrusive thoughts, and/or compulsive behaviors. I know I’m part of a problematic system. I am doing what I can to change that, including asking questions like this., while supporting marginalized members of my own communities with the tools and systems I am permitted to use under colonialism. I am also someone with an OCD diagnosis who believes it is a real, legitimate, disabling experience, but I understand others have different relationships with the idea of OCD as a diagnosis (and the concept of diagnosis in general--my feelings there are complex as well).

There’s a post gaining traction in r/therapists asking about if people bill insurance 90837 for couples, and a lot of people are up in arms about it. Wondering what all y’all’s thoughts are. I don’t see couples so it’s not even applicable to me but imo private insurance is unethical and they can get bent

Really though

If you're not away, Headway, Alma, Grow (etc etc) are all venture capital backed companies. All VC projects have the same goal - get in and monopolize/corner the market, then fuck it up to reap in massive profits. That's why Headway is free. If Headway wins out against all the others, now they can decrease rates and everyone will be so dependent on Headway they won't quit, especially if insurance companies begin weird policies saying they won't panel with individuals anymore bc VCs are so much easier to work with. Or, Headway now starts incrementally charging fees. VCs and insurance companies are working together - with Blackstone, all the same goons. So.

---

Info here:
https://jayapal.house.gov/2024/07/26/representative-jayapal-senator-markey-introduce-health-over-wealth-act-setting-guardrails-for-private-equity-in-health-care/

Specifically, the Health Over Wealth Act would:  

·         Require that private equity-owned health care facilities publicly report on their debt and executive pay, lobbying and political spending, health care costs for patients and insurance plans, and any reductions in services, wages, or benefits 

·         Require that private equity-owned firms set up escrow accounts to cover five years of expenses to ensure continuation of care in the event of a hospital closure or service reduction 

·         Authorize the Department of Health and Human Services to revoke investment licenses from private equity firms that price gouge, understaff, or create access barriers to care 

·         Establish a task force to review the role of private equity and consolidation in health care, including how market trends create or exacerbate health care disparities  

·         Prohibit private equity firms from stripping assets from health care entities or undermining the quality, safety, or access to health care 

·         Close tax loopholes for real estate investors in order to disincentivize health care entities from selling their property and then paying exorbitant rents to these investors 

Lately I've been feeling cowardly for my lack of willingness to engage in direct action for Palestinian resistance. I believe it may be due to unprocessed trauma I've experienced in the face of ICE officers and a bus of detained people. I never bring the incident up to my therapists: for some reason, I've never trusted any of my therapists to engage with conversations of political resistance.

How do we process the violence and trauma inflicted upon us from these systems? How do we do so safely? I feel so alone but I know I shouldn't.

Read More About Evidence Based Practice and Research Psychology:

Lessons from the STAR*D Scandal 

The Corporatization of Healthcare

Incentives in Evidence Based Practice 

The Illusion of Progress

Psychotherapy is Indivisible form Philosophy and Anthropology

The Broken Incetives in Research and Clinical Practice

Healing The Modern Soul Series Part 1Part 2Part 3 Part 4 Healing the Modern Soul Appendix

Hey friends - we have another upcoming (online, free) seminar at Liberate Mental Health on November 5, 7pm BST. I've pasted some details below, but you can learn more and access our readings for the month (including a chapter of Lara and Stephen's book!) on the registration page.

Register here.

Event brief:

Join us for a dialogic seminar and open discussion on resistance towards and commitment to revolutionary praxis within (and without) the mental health sector. Our featured speaker is Lara Sheehi: psychoanalyst, activist, and co-author alongside Stephen Sheehi of Psychoanalysis Under Occupation: Practicing Resistance in Palestine.

• How can we channel our work towards revolutionary practice as mental health workers?
• How can we maintain militant clarity in the face of psychic intrusions and institutional obstinacy?
• How can we better resist and persist in bringing about a better world amidst complicit and complacent institutions?

Throwaway account for several good reasons. I'm a master's student in a mental health counseling program. The program is...fine. I applied and interviewed to several and, after this process, chose the least expensive. Again, the program itself is fine. However, as I get deeper into it, I realize there has been a turn in psychotherapy I was unaware of. It is being called "counseling," or "helping." It's being presented as this new field that orbits the Wellness Model. It feels diluted and less and less serious. I'd like to graduate and do serious psychodynamic/psychoanalytical work or, at least, explore those ideas. But these things seem far away from what's happening in my program or in the field in general.

Is this how it's going to be after school? Is this 'direction' the only direction, or...? I really appreciate your thoughts.

The firm level regards hospitals, clinics, group practices -- every place where there is an employer-employee dialectic happening. Class struggle in those arenas is primarily unionization whether in a more IWW fashion or a more NUHW fashion. (IWW doesn't care about appeasing the NLRB in the US, for example, and the NUHW cares very much about winning NLRB elections and going that way.)

There is potential for union movement building on the firm level. There is obviously the worker cooperative movement which is growing in our industry at the rate of a seriously injured snail.

But then there's a much broader class struggle, arguably, which gets every therapist that takes insurance reimbursements from the firm level to the independent practitioner level, to fight for higher rates from insurance companies. This fight can be a fight against venture capital -- against Headway, Alma, Grow, etc. It can also include fighting for single payer that includes high reimbursement rates for therapy (ie, 150 per 60m session from Medicare) and less bullshit (ie, therapists succeed in forcing Medicare admins to back off on soul-crushing documentation standards and clawback threats).

Curious what everyone here thinks about this.

Copy pasted from a link I don't think is allowed to be posted here?

Are Psychotherapy Group Practice Owners Exploiting Pre-licensed Therapists?

Within the mental health field, debates are being had amongst many clinicians on whether psychotherapy group practice owners are engaging in unethical labor exploitation when they pay their employees, licensed or pre-licensed, considerably less than what clients and insurance companies are paying for an hour of psychotherapy.

To illustrate the ethical dilemma outright, here's an example of a common group practice structure where the owner has 15 pre-licensed associates, pays 3 supervisors, and runs all the business operations of the practice. She has hired someone for billing and credentialing, a bookkeeper, and an accountant. Her job within the practice is mainly overseeing the people she pays to run the business, and as with most CEO or director positions, lots of high stakes issues arise that she and only she has to handle. 

She runs payroll, monitors productivity and documentation, does the hard work of recruiting, hiring and occasionally firing. While she handles some aspects of marketing, she expects associates to do their own marketing and pay for their own malpractice insurance. It's best for associates to learn the ins and outs of the business so they can launch into solo practice once licensed, if they wish.

She pays each associate $40 per client hour, and requires them to keep 20 clients per week as a full time caseload. Insurance pays somewhere near $100 per associate hour, which roughly means associates keep 40% and the owner keeps 60% to pay for expenses and profit. 

In this scenario, each of the 15 associates make $3200 per month, and $38,400 per year.

The owner is pulling in $18,000 per month and $216,000 per year in revenue *for the company.* 

Someone ignorant about business math might become infuriated to think the workers are pulling in barely enough to cover their own personal expenses while the owner is making 18k per month. It's important to understand that the 18k pays for all other business expenses, and in this case the 3 supervisors, the bookkeeper and accountant, the billing and credentialing person, and so on.

If expenses include office space (as opposed to a fully telehealth based practice), the owner will be pulling in considerably less profit to keep for herself.

There's a world in which the owner takes 50% of the monthly revenue for herself - in this case, $9,000 per month. There's one where she only takes 10% of the revenue, which would be $1,800 per month. Perhaps it could be as low as 5%, making her monthly income $900 per month.

So she may be making around 3x what her associates are making (a 3:1 pay ratio), and she may be making only 33% of what they’re making. We would only know for sure if group practice owners opened the books and showed us the business math, and any who are reading this are welcome to in the comments to help readers clarify!

Those who think capitalism as an economic-political system is mostly fair and good, one that promotes innovation and creativity and freedom, see no issue with any amount of wage gap between a worker and an owner, whether it’s 3:1 ratio or 100:1 ratio. She is the one who built this business from the ground up! She has created 15 jobs. She is helping 15 therapists accrue hours toward licensure. Once the associates are licensed they can open their own solo practice and, if they wish, grow into a group practice and run it however they want. She damn well earned whatever profit she keeps for herself, whether it's $20 a year or $20 million a year. Profits in a business are basically just a deserved reward for good, hard work in a business.

On the other hand, there are likely fervent anticapitalists who think that while there may be some tiny amount of exploitation going on in the microscopic little world of psychotherapy group practices, that this is not an interesting or strategic area of capitalism worth scrutinizing. We’re only able to buy cheap stuff on Amazon today because most workers in the global south are paid a penny a day— and Amazon warehouse workers are getting near minimum-wage all over the world. Shouldn’t we give a shit about real economic injustice?

Here are income disparities across S&P 500 companies that show what extreme income disparity can look like. In this graphic from the AFL-CIO “paywatch” website below you can see ratios not of 2:1 or 20:1 for bosses to workers, but disparities as wide as 10,377:1, 6076:1, 3769:1.

Most people likely feel there’s something wrong with a 10,000:1 pay ratio simply based on the sheer scale. Does anyone need to make 10,000 times more money than someone else? Should this even be allowed?

But for anyone who agrees that 10,000:1 is an unethical ratio and 2:1 is perfectly ethical, it’s important to wrestle with the why. Is it just the scale?

An easy picture to paint could be that in the 10,000:1 pay ratio situation, the average employee in the company is barely making rent and feeding their family, but the executives at the top are multi-millionaires. If the executives are millionaires specifically because they’re paying their workers so little, explaining why this is unethical is obvious. Labor exploitation as a concept is being defined before our eyes. Someone is benefitting by taking from someone else, and in a way that gives a great quality of life to the exploiter and a miserable one for the exploitee.

But even at a 2:1 ratio there is still an ethical dilemma to entangle, even if we agree that on paper a 2:1 ratio is numerically 5,000 times less terrible than a 10,000:1 ratio.

If an associate therapist is getting $3500 a month and the owner is making $7000 a month (or 42k/yr vs. 84k/yr, respectively), this could be a considerable difference in quality of life. If the associate is living in an expensive city with high rents, some medical expenses, and especially if they have children, $3500 a month may equate to relative poverty. Whereas, the differential in what the owner is making could be keeping them out of poverty and in a relatively comfortable place. There are plenty of other variables to consider in this hypothetical, but we can see from this that even a 2:1 ratio might be considered either unethical or at least worth our consideration.

A simpler way to think of the 2:1 ratio as ethically concerning, just for the sake of philosophical argument, would be to think of a family that lives in a house together. The father of the family built the house with his own hands, having paid for all the building materials with his own hard-earned money. The women in the family (mother, grandmother, aunt, two daughters) do all the cooking and cleaning, and the father gets a 2:1 ratio of certain allowances — because he built the house everyone labors in. He’s allowed to eat twice the amount of food, can have two pets (everyone else can only have one), and can spend twice the amount of time using the living room TV.

Some readers may just want me to stop philosophizing and say what I think about the situation — do I think a 2:1 ratio is unethical or not? Are group practice owners exploiting their therapists or not! 

What I think is that I really don’t know, but I don’t think therapists are wrestling with this enough. Lately I’ve begun agreeing with the sentiment that if all our cheap commodities are cheap due to dirt wages in poor countries, who cares about some 2:1 ratio in some highly educated, professional, middle class American situation. Really, who cares? 

But I also think there’s something significant about the 2:1 ratio because I think there’s an important relational dynamic to when someone gets twice as much money as someone. If that gap brings up resentments and anxieties for some, or defensiveness and ridicule by others, there’s something worth exploring more so we can get to the bottom of it.

So here I am wrestling with the issue, hopefully stoking emotion and thought from whoever has found this essay.

But zooming way out, what I find more interesting is that we aren’t trying to “conceptualize” the labor exploitation issue here with any coherent theoretical orientation. The obvious reason is we were only given theoretical orientations for understanding the human psyche in therapy school. How many of us know how to do case conceptualization of economic relationships and systems?

Case conceptualization of economic relationships and systems

We all love a good case conceptualization. Conceptualizing a new therapy case and doing it well is like trying to solve a puzzle in service of holistically understanding another human being in order to help them.

But conceptualization leans heavily on theoretical orientation, and not every theory is compatible with every other one. A strictly EMDR therapist doesn't necessarily think about “defense mechanisms.” An IFS therapist may not necessarily assess someone's “attachment style.” A psychoanalyst and a CBT therapist may not even speak the same language!

For all of us looking at a therapy group practice and asking what kinds of pay ratios are or are not ethical, how are we conceptualizing the case?

If we look beyond a therapy group practice at other businesses, industries — capitalism as a whole on the global scale! — what theoretical orientation are we using to understand this?

In the next part of this series I’m going to explore an unconscious theoretical orientation that I think most therapists are using to think about most matters of social issues, economics, and politics. It’s a concept written about by late British philosopher Mark Fisher and it’s called Capitalism Realism. After we thoroughly understand Capitalist Realism and how most of us are under its influence, we’ll explore other and arguably more helpful ways to conceptualize capitalism.

After we do that, we’ll have some theoretical bearings to understand whether psychotherapy group practice owners are exploiting their employees, and what can be done about this and similar issues within the field and beyond.

Hey folks,

I'm curious how other folks in clinical practice, who are forced to use (or at least report in their documentation) conventional treatment modalities (CBT, DBT, etc.) repackage the treatment. For example, if I run a CBT group, I take the basic CBT premise that "thoughts create emotions" to motivate critical investigation of what thoughts lead to suffering. Unsurprisingly, the discussion usually turns towards common thoughts that come from dominant capitalist ideology. This purported "CBT group" then becomes more of a critical analysis of dominant narratives, and I'm able to support the rationale for the group from CBT perspective in paperwork.

How have you found ways to repurpose or repackage other conventional treatment approaches so that they can be used, when they have to be?

Hi radical therapists! I wanted to hear your thoughts on the tv show couples therapy and Orna's therapeutic approach if anyone here has watched it.

This show has giving me a glimpse of what psychoanalysis looks like and I have really mixed feelings about the whole thing. Part of my feels like psychoanalysis makes my relational, systems, somatic, general counselling style look like a joke, but the other part of me questions the helpfulness of analyzing ourselves in this way. Particularly when it comes to the lack of tangible skills like nervous system regulation and addressing larger systemic issues.

Any thoughts?

Hi! I have just dropped out of law school and about to start studying to become a psychologist. I always dreamed about working for social justice and the most viable way always seemed to be by becoming a lawyer. Unfortunately, I struggled deeply in school due to badly managed adhd and I also might have given up too early. On one hand I worry that I have given up on a field I might be more needed in as a leftist, especially considering my former course mates views and values. On the other hand I might have some kind saviour/guilt complex and need to calm down + realise I can’t take a path that would lead to total burn out.

I worry that by becoming a psychologist I’ll always feel like I could have done more and that I’m only putting plasters on deep wounds. So many people struggle due the fact that structural change is needed and nothing that I as I psychologist do is ever going to change that. This mindset in it itself might make me lose motivation in my studies and even if I don’t fail, who would want such a negative psychologist?

Has anybody here ever been in a similar position? If so how did you deal with this?

New first year PhD student posting on my alt (hence the lower karma)

To TL;DR it, I'm kinda shocked at how liberal the field it and how rare leftists are in the field. I had much grander expectations to the degree of political wherewithal that would be in my colleagues. Beyond not hating marginalized groups, it's been a huge let down to see how uninformed a large degree of the profession is on things like foreign policy, workers' rights, or even how social safety nets should function.

I really want to stress that I don't want this to come of as me being on my high-horse or some shit, but instead that I'm legitimately finding myself let down in how little some of the above topics are discussed when they can have such a massive impact on our work. Especially when my colleagues truly are very intelligent people who ground themselves in evidence-based practice and sound science. I'm finding it, frankly, hilarious how many right-wingers say that academia is leftist, because holy fucking shit academia is by far one of the most aggressively liberal places I've work with far less true leftists than anticipated.

https://www.madinamerica.com/2024/09/right-wing-or-left-wing-who-really-owns-the-critique-of-over-medicalisation/

Research/Study

I hope this message finds you well! My name is E'lexis, and I’m currently conducting research on how interiors can support womxn impacted by generational trauma. I believe that the insights from this community could provide invaluable perspectives on this topic.

It aims to explore how interior design can address the needs of womxn impacted by intergenerational trauma. Research shows that trauma can be deeply embedded within families and communities, often affecting how individuals interact with their environments.

The goal of my project is to create a space that not only acknowledges these traumas but actively works to reduce stigma, foster healing, and provide a sense of safety and belonging. By gathering insights through this survey, I hope to better understand the specific elements that contribute to feelings of safety, support, and affirmation for women.

Your responses will directly inform the design principles and features incorporated into the project, ensuring that the space reflects the lived experiences and needs of women.

The survey will take approximately 5 minutes to complete, and I truly appreciate any contributions from the members of this group. Thank you for your participation!

Affiliation: Savannah College of Art and Design

Survey Link: https://forms.gle/npWgjBq9VVNBdxcy9

I am trying to decide between ACT boot camp and a Somatic trauma training (that looks like it includes some Hakomi, some IFS, some shadow work). They are around the same cost and I can only afford one.

Which one would you do?

I'd like to open up discussion for alternative to the word "termination" and also open us up to discussing the framing of ending therapeutic relationships.

Firstly the word it self feels very harsh and to me as a POC has a negative connotation. Termination is reminiscent of losing a job, being denied something, or being rejected. Does this ring true for anyone else?

In my culture we tend to frame things such as funerals as celebrations of life and I'm wondering if termination could be more useful to client and therapist if framed in a similar manner. When there is an opportunity for actually ending therapy is a non abrupt way, it should feel encompassing and reflective of the relationship between client and therapist. Full bodied, including rituals that feel important to the client, opportunity to express client concerns, explore loss of therapeutic relationship, and sharing maybe something unconventional like a meal, a song etc. Just something that feels authentic to the client and honors their journey.

This was not a fully thought out post, but a start to something feels kinda important and came up while reviewing the "termination" section of my consent forms.

I want to have enough money to support myself and hopefully some bunnies, its a hard world out there and most ppl are being overworked and underpaid. i want to try and get enough money to be comfortable in times like these. At the same time, i want to do work i feel ethically sound with. I don't want to just make my bag and not use the therapy skills for good.

How does one find jobs where they can do good for the world while still making good money? Is it like you get a job with some sort of non-proft?

Alternatively, would a better route be just giving up on making the world a better place through my job, and instead use the time I'm not working to do so (ie, doing volunteer work on the side)?