Predators and Roleplaying Communities
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@Floof I relate hard. My psych billed $500 for a noshow and I was paying out of pocket, no insurance. They waived the fee one time but then I no-showed again because I was off my meds. It took me an entire year to actually try and make another appointment, and then it took me two months to fill out the forms and send them back in. I’m on my second day of meds right now after 14 months+ of no meds. TOTAL DERAIL BUT ARRRRR it is ludicrous that this condition that is literally the ‘bad at phone calls and calendaring’ condition requires so much phone calls and calendaring in order to even get treatment and STAY treatment.
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@DrQuinn So a lot of this is because insurance is a headache to deal with as a therapist. Often insurance will require you to provide them with your progress notes as well as your intake summary. Some private practice folks I know who work with the bigger firms will also have a required “case consultation” with them (bogus term since case consultation is intended to be between mental health workers or physicians) where an underwriter will evaluate whether therapy is progressing properly. Insurance companies also pay less, from a materialistic perspective. As Marxist as I am, I still have $250,000 of student debt and that’s about the average these days.
Additionally, most outpatient therapists don’t use instruments to track progress. In inpatient (and at my current intensive outpatient place) we use various metrics – typically the GAD-7, PHQ-9 or BDI, and PCL-5 – to evaluate for anxiety, depression, or trauma symptoms respectively on a weekly basis. The return rate in inpatient and IOP is pretty low, probably natively around 40% at the VA, and we get about a 60-ish% return rate where I am now, so it’s a lot of hounding people “did you fill out the weekly form? Don’t forget to fill out the form” because it’s often a requirement by insurance companies.
In California, we have the mental health parity act, which is generally a good thing as it prevents therapists (or “coaches” in the worst case scenario) from practicing non-evidence based treatment. However, it also allows insurance companies to say “you’re going to use CBT for this patient.” Even if you’re working with, say, a person who has bipolar disorder and borderline personality disorder and would better serve them by using DBT or (maybe) acceptance and commitment therapy, the insurance companies know that CBT has a wife body of literature showing it to be effective insofar as it becomes a shotgun approach to treatment. CBT is effective for many things; CBT is also very ineffective for many things. CBT has an added benefit for the money people of having between 12-16 sessions for clinically significant change (with specific illnesses).
Research backs up the use of CBT as well. Depression and anxiety are also the most common mental illnesses in the US (probably the West in general), and usually receive the lion’s share of attention by researchers, who will typically use CBT because it’s quick to implement and fairly easy to learn, which means we have a research corpus that includes so much research on the effectiveness of CBT and a lot of papers that have to reiterate that ACT, DBT, CPT, TLDP, AEDP, other alphabet soup acronyms, etc. are as effective if not moreso than CBT in specific situations and within cultures. I didn’t touch on culture, but that’s just another big blind spot in the field.
None of this is intended to be an excuse, but a remonstration of the American medical and mental health system. All of this sucks and we’re aware.
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I was about to suggest we get back on topic, but really, is there a more on-topic discussion about predators than one that mentions health insurance companies and guidelines?
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@sao I’ve been hearing good things about https://www.betterhelp.com/ if you wanna try peeking at that (if you haven’t).
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I actually abandoned the therapy providers through my VERY good insurance because I NEEDED more than they could give. My anxiety, even medicated, was getting really bad. I finally signed up for BetterHelp and used a therapist for a few sessions and didnt click. Switched and used someone that fit me better for months. When summer came around I stalled out and canceled for a few months. The moment I started crying daily at school again I realized I needed it. For the last year I’ve met weekly/Bi-weekly with my therapist. 85% of the time I just talk, and other times she asks questions that make me think.
The flexibility to do video calls is a life saver. I can’t recommend it enough. (Also, it is more helpful now that I don’t have to take the time to drive or have the anxiety of being in-person either.)
And my pets can join me on the call. So if I’m feeling extra vulnerable I grab a kitty and snuggle it while we talk. Sometimes her dog jumps on camera. (Only allowed once I asked to see puppy and she saw how happy it made me). All around 100000% lovely.
Yes, I pay out of pocket, but it is worth it.
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@icanbeyourmuse I poked at this, but i was pretty turned off by the fact that I filled out some preferences when I signed up and they matched me with a therapist that fit none of the preferences I’d set.
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Before giving any data to BetterHelp, it’s important to know that they were recently fined something like 8 million dollars for selling patient data to companies like Facebook and SnapChat. They promised not to do it again… but they kinda promised not to do it when you sign up, so I’d take that with a whole shaker of salt.
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Cost benefit is always important to weigh. For me the fact that I can have almost weekly therapy is worth all the data they can sell on me. Is it a great cost? Nah. But this is AMERICA where health care is almost always choosing the lesser of shitty options.
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@sao Maybe it changed since you last tried (that sounds snarky in my head rreading it back but it isn’t meant to be). I don’t know how long it is since you did, obviously. Hopefully you can get what you need soon.
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I have a lot of complaints about BetterHelp, but most of them are related to their contracting practices and wouldn’t offer much insight into how they work from a consumer perspective. One positive thing I will say about BetterHelp is that has been useful is that there are many places in the US – and Canada, I would presume – that have no access to mental health resources whatsoever. When I lived in Oklahoma, for example, most mental health resources were available in the two major cities (OKC and Tulsa) but those cities are within about an hour and a half drive of each other with many small towns beyond that range. There are other services that could help you if you have bad luck with BetterHelp though. ReGain is one of them, there’s no matching algorithm that I recall with that.
TalkSpace has you do a short assessment with someone who will match you with a therapist, so it’s a little more hands-on. They also will work with insurance. I can’t remember if BetterHelp works with insurance or not. TimelyCare is something my university offers to undergrads through post-docs, but I think they have an alumni program, so if you went to college and still have your .edu email address, you might be able to find some resources through your alma mater. A lot of therapy apps are doing work with corporations as well, which gets a little dicey in terms of what you might feel comfortable sharing (technically in industrial psychology the company is the client and the workers are child clients of the company).
Anyway, all that to say that there is a lot of help out there. Despite that it is hard to find someone, especially someone with whom you really connect. And sometimes if you do, it’s often prohibitively expensive. In any case, I hope you find someone!
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@somasatori said in Predators and Roleplaying Communities:
technically in industrial psychology the company is the client and the workers are child clients of the company
The ethics organ in my brain (probably the amygdala) just squirmed at that…
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@Pavel said in Predators and Roleplaying Communities:
@somasatori said in Predators and Roleplaying Communities:
technically in industrial psychology the company is the client and the workers are child clients of the company
The ethics organ in my brain (probably the amygdala) just squirmed at that…
YEAH! I remember when I first learned that. Also, in forensic psychology the employer (prison or district) is the client, not the prisoner/parolee, so there is no ethical requirement to privacy for prisoners. It’s why I did a trauma emphasis instead of a forensic emphasis.
(Also I veered us wildly off topic, sorry about that!)
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Thank you for sharing this, Cobalt. LAMush was the first World of Darkness game I ever played, and the first MUSH. I was 17 when I first signed in. There were bad things that happened there which I have heard about over the years, including the infamous meetup. I experienced a few borderline things myself in pages and scenes. I thought it was just how things were, like hazing or I was just new to the MU* scene, and since I was too young and didn’t want people to know I was too young I made the mistake of not speaking up.
I’ve often had an overly rosy view of that place which I may have shared with you on occasion later on other games, and now that I realize how oblivious I was, I feel awful. I’ve been out of the hobby a long time, but I’ve always liked roleplaying with you when we’ve come across each other over the years. So, I felt compelled to say thank you for your courage and screw LAMush. And thanks for making the scene a safer place.
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A reminder to everyone:
Just because you’re an adult doesn’t mean you can’t be victimized. Just because you think you know better doesn’t mean you’ll always listen to the red flags. Just because you’ve handled shit before with grace doesn’t mean you always will. Just because everyone in a community says ‘oh man, so-and-so is such a good dude, you should ask him for advice/insight/resources/whatever’ doesn’t mean he can be trusted or he’s without flaws, or that if he sends you an unsolicited dick video that ‘you should be flattered’. It doesn’t mean you shouldn’t speak up or no one will believe you. And just because you flirted back because ‘really, everyone says he’s such a great guy/leader/whatever, the problem has to be me’, doesn’t mean you were not victimized, or that your feelings about being victimized are not valid.
I don’t know if this is the right place to put this, but I hope it reaches the people that need to see it. We have got to stop blaming ourselves for other people’s shitty behavior.
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@crawfish said in Predators and Roleplaying Communities:
Just because you think you know better doesn’t mean you’ll always listen to the red flags.
If I make a little light fun of the idea of listening to a flag, it’s only because your post made me feel things that I needed to find a way to laugh at. Thank you for these reminders, though, seriously.
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@GF I mean I get it. If we don’t laugh sometimes, we’d cry. Right?
I draw things! http://www.mahaldoodles.com
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@crawfish Or you can be an overachiever and do both!
Seriously though. Thank you for that reminder. It is very much appreciated.
