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Predators and Roleplaying Communities
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@GF said in Predators and Roleplaying Communities:
I think it was a defense mechanism
One of my biggest personal battles is overcoming toxic behaviours that were originally sensible defence mechanisms from abusive relationships. It’s a hard road, because every fibre of your being is telling you that you need to do a thing or behave a way because it keeps you safe.
He/Him. Opinions and views are solely my own unless specifically stated otherwise.
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@Pavel said in Predators and Roleplaying Communities:
@GF said in Predators and Roleplaying Communities:
I think it was a defense mechanism
One of my biggest personal battles is overcoming toxic behaviours that were originally sensible defence mechanisms from abusive relationships. It’s a hard road, because every fibre of your being is telling you that you need to do a thing or behave a way because it keeps you safe.
I am 99% sure you’ve heard this from a supervisor (as the idea comes from one of my own supervisors), but in the small chance you haven’t: an important part in overcoming your pathogenic defenses is acknowledging their importance in your life. As you said, every fiber of your being was telling you that your behavior was appropriate to keep you safe. An insidious part of trauma is how often we are changed – including in a biological way in terms of hippocampal volume, amygdala function, prefrontal cingulate reactivity, etc. – by the nature of what we endured. So, two things: your brain responds to a biological change as a result of abuse suffered over time, and your behavior becomes habit due to its necessity in keeping you safe. Not easy stuff to overcome, so good on you for working towards a healthier holistic state of mind.
As a side note, my therapeutic tendency is more towards psychodynamic (TLDP) and internal family systems work, but I was also taught cognitive processing therapy and prolonged exposure in my training rotation at Veterans Affairs here in the States. The way I usually phrased it to that population is that we have two obligations to our defense mechanisms: one is to honor the work they did for us in keeping us safe, and the other is to gently put them to rest by recognizing our negative (pathogenic) defenses as cognitive distortions. We needed them once, we don’t need them now, but we can learn a lesson from why they developed and be aware of situations that may cause that to happen again.
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@somasatori Absolutely. I’ve worked with my trauma therapist for many a year. The only reason I say that it is still a battle is because I think it always will be, at least somewhat. There’s always going to be that temptation into reaction, I just get better and better at refusing it.
He/Him. Opinions and views are solely my own unless specifically stated otherwise.
BE AN ADULT -
@Pavel Word, and same. I have a struggle that I’m working through related to some pathogenic coping behavior.
Or in the immortal words of Tim Robinson: “I’m not a piece of shit! I used to be. People can change.”
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@somasatori I’m glad someone who’s less of a tourist in psychology brought this up, because I started writing and eventually deleted a post that touched on this (ask myself “what’s the function” of any given response, then ask myself if I think my response is likely to actually serve that function or if it will have unhappy consequences) because I didn’t want to sound like your one Facebook-using aunt who’s pretty sure she can diagnose you and prescribe correct therapies.
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@GF I appreciate the care! And not to derail the thread, but psychology is one of the few disciplines that have lay people butting in to say that they’re “basically therapists because they’re good listeners” or they can diagnose people because they have a copy of the DSM. I’m all but dissertation in my PhD (not to say that makes me an expert, but probably more knowledgeable than the Facebook aunt) and still would be unlikely to accurately diagnose and prescribe correct therapies to people I don’t know since it always depends on the individual. Also, the purpose I usually see in diagnosis is appeasing our insurance overlords who will say whether a patient will be able to be treated or not. Some people really like getting their diagnosis as it presents a quick explanation of symptomatology (“ah, so that’s why I’ve felt that way”) or can bring them some sense of togetherness (e.g., support groups for people with certain personality disorder diagnoses), but I think it’s more helpful when therapists follow the patient’s lead rather than stick by a prescribed treatment method. Whew, rant over!
they/them
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@somasatori said in Predators and Roleplaying Communities:
I’m all but dissertation in my PhD
So you’re also seeing a trauma therapist, right?
He/Him. Opinions and views are solely my own unless specifically stated otherwise.
BE AN ADULT -
@Pavel said in Predators and Roleplaying Communities:
@somasatori said in Predators and Roleplaying Communities:
I’m all but dissertation in my PhD
So you’re also seeing a trauma therapist, right?
Seeing someone who specializes in trauma while still having to meet with my advisor, so not a ton of progress on that front.
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Not to derail but where the fuck does everyone even get therapists, I had one through my insurance but she was so overbooked she was only available every 6 weeks or so and then I kept having to reschedule due to work until finally I just fell off completely and I STILL don’t have a replacement. Mental health is HARD.
I had an experience with an emotionally abusive person in MU** rp who used to threaten to kill herself at me when I was high school age. It’s been so long, though, that I don’t even remember how I separated myself. I think I just eventually drifted off that game and stopped interacting with her but not in any concrete, on purpose way.
let it be a challenge to you
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@sao Well, I was looking at a two years’ wait until I ended up finding one with only two months but in the other end of my country. Five hours of driving, thirty minutes of therapy, what’s not to love?
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@sao said in Predators and Roleplaying Communities:
Not to derail but where the fuck does everyone even get therapists,
Literally asked this question to my psychiatrist when he kept asking if I was in therapy yet during med checks, but also no one in his practice was taking patients. Like, I know I need therapy, dude, but HOW DO?!
The only reason I got to him was because they had a new psychologist willing to do my ADHD assessment. And now I’m not medicated because the adderall shortages made me realize it wasn’t quite right for me anyway, but he won’t try anything else, apparently, so I don’t even talk to him anymore, either.
Never mind that the whole system seems to be actively set up to be as inaccessible as possible. Don’t forget to make all these phone calls and set up more appointments and follow up with us because we will literally never follow up with you, person who has no short term memory and chronically dissociates rather than using the phone.
I’m fine.
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What bothers me is almost all therapists I can find are out of network. Like, they take no insurance at all. WHY?!
$200 for an initial consultation, $150 for every follow up appointment, probably just paying straight out of pocket with no hope of insurance covering anything because they’d like me to use someone “in network” who doesn’t do in-office hours and isn’t a good fit. Sigh.
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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.
