4 ms·

Been using Lifestance for my therapist/psychiatrist since it was one of the few places that took Medicaid. Calling it a digital pill-mill seems inaccurate base

Been using Lifestance for my therapist/psychiatrist since it was one of the few places that took Medicaid. Calling it a digital pill-mill seems inaccurate based on my experiences, but maybe other providers within the system are shadier than the ones I've interacted with. My main complaint is that I've met with multiple therapists and none of them are really academic like I want my therapists to be. Good vibes does not work for me, show me some data.

rideontime 3y ago
That's exactly the "therapist vs. psychiatrist" divide mentioned in the article. If you want "academic," you aren't going to get it from people paid the same as “'mani-pedi or salon haircut' workers."
- jeffreyrogers 3y ago
  Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills. I don't really see any reason why a psychiatrist would be any better than a therapist (unless you need to be prescribed psychiatric drugs) once you control for general intelligence and experience. Very little of the med school education is relevant to what a therapist does.
  - ImPostingOnHN 3y ago
    >Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. Correct on the important points here: - They are trained as a medical doctor - They went though an additional 4 years of training during residency as a medical doctor. - Due to that additional training beyond PhDs, they are granted prescription privileges. >You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills. You can, but: - You usually won't, if we were to pick an example at random from "therapists". - That isn't the sort of therapist we're discussing here, as the article points out. - A PhD can be in anything, not just psychiatric disorders. - A PhD requires significantly less training in treating patients than an MD. >I don't really see any reason why a psychiatrist would be any better than a therapist For the above reasons. The vast majority of self-labeled "therapists" don't go through as much training, and most of them are glorified life coaches. I don't intend to besmirch all therapists, but it should be clear to everyone that literally anyone can wake up one day and declare themselves a "therapist", and they magically become one, equal to every other "therapist", as far as legally required qualifications go. Due to this, they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.
    - hirvi74 3y ago
      > * they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.* I believe too much credit and merit is given to psychiatrists. I'm not arguing that an average psychiatrist is less knowledgeable than an average psychologist, therapist, or licensed councilor/social-worker. I, as well as much of society, benefit from the existence of both fields. However, despite psychiatrists going through a more academically and scientifically rigorous training program, I often find the work of psychiatrists to be anything but scientific. If anything, psychiatry is more of an art than a science. I try to have clemency for the field psychiatry, but it can be difficult at times. We are talking about a field that has to work with the nebulous black-box that is the human mind, which is no easy feat. To my understanding, we treat mental disorders as if they are organic diseases, and many of the said disorders, if not all, have consistently failed to demonstrate any reliable evidence of an organic etiology or biomarker for diagnostic purposes beyond a reasonable doubt. The field also relies on completely arbitrary heuristics based on vague symptoms to diagnose conditions many of which have significant overlap. I have read plenty of peer reviewed psychiatric papers and journals. While it is not my field of expertise, I have noticed that in much of the academic and scientific literature there seems to be a better attempt at making a quantitative assessments in terms of the efficacy of various treatments. Obviously, nothing is perfect, but that is neither here nor there. Speaking of treatments, we also have countless medications used to treat psychiatric conditions with little more than hypotheses as to how or why many of the commonly used medications actually provide relief. I have been diagnosed with ADHD, and I had to go through many rounds of psychometric testing and questionnaires in order to receive a diagnosis (administered and proctored by a Psy.D). After I received the diagnosis, the treatment from psychiatrists have been nothing more than throwing pills at a wall and seeing what sticks. After over a decade of treatment from a multitude of medical professionals, there has yet to be a single attempt to quantifiably measure whether or not the medications I have trialed actually provide relief. During the whole entire decade long ordeal, I have never once had blood drawn, thyroid checked, a sleep study, neurological evaluation, etc.. If I quack like a duck, waddle like a duck, then I am a duck, right? Anyway, while psychometric testing practices are not without subjection to plenty of scrutiny and criticism, such testing still seems to have been the only attempt at some sort of empirical analysis in my entire treatment process. Everything else has been nothing more than a series of brute-forced attempts. If the success of treatments are predominately measured by the greatest reduction in symptoms with the least amount of adverse side-effects, then I sometimes wonder if a pharmacists with training in various mental conditions could almost entirely replace psychiatrists?

rideontime 3y ago

That's exactly the "therapist vs. psychiatrist" divide mentioned in the article. If you want "academic," you aren't going to get it from people paid the same as “'mani-pedi or salon haircut' workers."

jeffreyrogers 3y ago
Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills. I don't really see any reason why a psychiatrist would be any better than a therapist (unless you need to be prescribed psychiatric drugs) once you control for general intelligence and experience. Very little of the med school education is relevant to what a therapist does.
- ImPostingOnHN 3y ago
  >Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. Correct on the important points here: - They are trained as a medical doctor - They went though an additional 4 years of training during residency as a medical doctor. - Due to that additional training beyond PhDs, they are granted prescription privileges. >You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills. You can, but: - You usually won't, if we were to pick an example at random from "therapists". - That isn't the sort of therapist we're discussing here, as the article points out. - A PhD can be in anything, not just psychiatric disorders. - A PhD requires significantly less training in treating patients than an MD. >I don't really see any reason why a psychiatrist would be any better than a therapist For the above reasons. The vast majority of self-labeled "therapists" don't go through as much training, and most of them are glorified life coaches. I don't intend to besmirch all therapists, but it should be clear to everyone that literally anyone can wake up one day and declare themselves a "therapist", and they magically become one, equal to every other "therapist", as far as legally required qualifications go. Due to this, they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.
  - hirvi74 3y ago
    > * they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.* I believe too much credit and merit is given to psychiatrists. I'm not arguing that an average psychiatrist is less knowledgeable than an average psychologist, therapist, or licensed councilor/social-worker. I, as well as much of society, benefit from the existence of both fields. However, despite psychiatrists going through a more academically and scientifically rigorous training program, I often find the work of psychiatrists to be anything but scientific. If anything, psychiatry is more of an art than a science. I try to have clemency for the field psychiatry, but it can be difficult at times. We are talking about a field that has to work with the nebulous black-box that is the human mind, which is no easy feat. To my understanding, we treat mental disorders as if they are organic diseases, and many of the said disorders, if not all, have consistently failed to demonstrate any reliable evidence of an organic etiology or biomarker for diagnostic purposes beyond a reasonable doubt. The field also relies on completely arbitrary heuristics based on vague symptoms to diagnose conditions many of which have significant overlap. I have read plenty of peer reviewed psychiatric papers and journals. While it is not my field of expertise, I have noticed that in much of the academic and scientific literature there seems to be a better attempt at making a quantitative assessments in terms of the efficacy of various treatments. Obviously, nothing is perfect, but that is neither here nor there. Speaking of treatments, we also have countless medications used to treat psychiatric conditions with little more than hypotheses as to how or why many of the commonly used medications actually provide relief. I have been diagnosed with ADHD, and I had to go through many rounds of psychometric testing and questionnaires in order to receive a diagnosis (administered and proctored by a Psy.D). After I received the diagnosis, the treatment from psychiatrists have been nothing more than throwing pills at a wall and seeing what sticks. After over a decade of treatment from a multitude of medical professionals, there has yet to be a single attempt to quantifiably measure whether or not the medications I have trialed actually provide relief. During the whole entire decade long ordeal, I have never once had blood drawn, thyroid checked, a sleep study, neurological evaluation, etc.. If I quack like a duck, waddle like a duck, then I am a duck, right? Anyway, while psychometric testing practices are not without subjection to plenty of scrutiny and criticism, such testing still seems to have been the only attempt at some sort of empirical analysis in my entire treatment process. Everything else has been nothing more than a series of brute-forced attempts. If the success of treatments are predominately measured by the greatest reduction in symptoms with the least amount of adverse side-effects, then I sometimes wonder if a pharmacists with training in various mental conditions could almost entirely replace psychiatrists?