Hacker News new | ask | show | jobs
by intralizee 2784 days ago
Key points from the video:

1) People mostly benefit from having someone to talk to about their problems. Drugs apparently aren't much help.

2) People with the most trauma are the ones that have the least finances to pay for treatments.

3) Most trauma is from early life.

4) The therapist has no support from colleagues and cannot talk openly. When someone mentions suicide its recommended to send the person straight to the hospital and to be medicated (Video author does not agree).

5) The responsibility is too much, hearing the horrors and being on the minds of the harmed person.

6 comments

I didn't watch the video yet but pt 2 and 3 is 100% correct.

I am in EU. We're supposed to have "amazing healthcare". Yeah, well, maybe if your face is in a ditch or you're dying alcohol poisoning? If you're one of those who managed somehow to function with insane levels of anxiety... you when you finally find the strength to reach out and heal.. you find out that you get a pityful 200 EUR a YEAR for psychotherapy (that's what my healthcare in Belgium pays).

Anyone healing significant trauma is going to do one year of therapy, probably more. At the very minimum twice a month, otherwise you lose the rhythm. Realistically, 5 times a month tapering down to 3-4 times a month, for a year or two or more. It's exhausting too. To heal and make real progress, you go to therapy like a beaten dog, keeping your heart open all the time, accepting to feel vulnerable all the time. You don't get to hold a mask, you have to undress and put it all out, every session... takes a lot of determination and courage. But who gives a shit. Here's 200 EUR for your troubles, good luck.

On top of that, in my case I have a 7 year gap in my career in IT. Doesn't help getting back into employment! Often times with trauma from early life, you don't grow in an environment surrounded by sane people. You're surrounded by dissociated parents / siblings. At school nobody gives a fuck or has the sensibility to ask questions. So in all likelyhood if you managed to function in adult life and hold a decent job, you're starting therapy much later, when it takes longer. So hopefully you got some savings otherwise well eat shit son.

I guess I have to be truly grateful that here in Belgium our "unemployment benefit" system is lax enough, that it allowed me to take the time to heal. But don't you go tell them that! I can only imagine what it was like for my parents, when they didn't have that kind of support.. because even with the unemployment benefits, I've had to fork out THOUSANDS of euros for my therapy.

Anyways just need to rant I guess.

In addition: there is a constant pressure to “upsell” the clients medication, i.e. refer them to psychiatrists. He felt frustrated at the institutionalised proclivity for medication, and had to fight hard when going against it.

(And one bit that struck me hard: he mentions suffering from vicarious trauma so much that at some point he was crying with patients every day. Makes the video worth watching, imo. It makes you think about the kind of therapist you’d hope to find yourself in a room with, if necessary, one day.)

>> he mentions suffering from vicarious trauma so much that at some point he was crying with patients every day.

Actually experiencing someones emotions is one of the most helpful things you can do for them. I say actually because it seems therapists train to pretend to understand. They train to hide their own feelings or let a client try to support them. It's ironic that they want people to become their authentic selves, but that's the one behavior they won't model. I have no doubt the guy in this video did wonders for his patients.

Regarding point #3 -- In the 80's, clinicians at Kaiser Permanente recognized that success in a weight-loss program was correlated to stresses experienced during childhood. This lead to the Adverse Childhood Experiences study, using a measure which scores people on a scale of 0-10. Those with scores of >3 (factors such as separated parents, child abuse, sexual abuse, food insecurity) have significantly worse outcomes in later life. https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_...
Thanks for the summary, as it’s the only way I’d have heard this person’s view. 1) paints a broad and inaccurate view unless there is more specificity about what kind of medication is being discussed. 4) & 5) are well taken, though; where do professionals with confidentiality restrictions get help, each other?
He didn't really discuss what kind of medication.

My interpretation is he feels medication is pushed too much and rarely solves the problem. He mentioned how people wanted to taper off and eventually stop taking prescription medication. He didn't like how he isn't allowed to help with that area.

Also he voiced how the cost difference for someone staying in the hospital as an impatient is very high compared to seeing him. Insurance will try to prevent patients from seeing him 3 days per week and only want once a week (even if 3 days is helpful). Insurance companies have every detail about a patient and demand it without respecting privacy.

Happy to see you clarified your take on point one. While summaries are helpful, it's playing the telephone game on interpretation. It's better to view the source material whenever possible.
A have a family member who is a marriage and family therapist (MFT). She and most of her peers themselves see therapists. This is partly because people who become (good) therapists have themselves had to struggle with issues in their lives and dealt with it by experiencing therapy.

It's also a way to be able to talk to someone else about their cases. The person they go to is themselves bound by confidentiality restrictions so they can talk about whatever they need to without worrying that patients' communications will be leaked.

Addressing your last point, at least in the UK, therapists usually/often have supervisors. I think it's a fairly peer-to-peer system, rather than hierarchical, once you get to a certain point of seniority.
In Australia it's a registration requirement for a psychologist to have another psychologist who supervises then in respect to the personal impact of caring for their patients.
the talk is from the US, where the american dream forces doctors into individual practice being the norm.
Therapists and psychologists in the U.S. are required to have supervisors in the latter stages of their training (2-5 years). Many of them continue to have a supervisor afterwards. Most therapists and psychologists are not doctors.
For people with so-called personality disorder (and that seems to be the group they're talking about: need for therapy; adverse childhood events) medication isn't recommended and treatment should be a long form talking therapy. "Meeting the Challenge, Making a Difference" has some useful information. https://www.crisiscareconcordat.org.uk/inspiration/meeting-t...

That's an important point because this group of people often find themselves medicated with a range of different drugs - valproate, quetiapine, lamotrigine, topiramate, carbamazepine, lithium, benzos, z drugs, SSRIs, etc etc, but there's little evidence that these meds provide any benefit for this group of people.

(I'm not anti-medication.)

I agree, that does seem to be what he is obliquely referencing.

I hope I don’t need to be on a stimulants forever, but at least the effect is quantifiable.

I wish all comment threads started with a summary. Thanks!
he also mentions that there are alternatives ways of dealing with the problems that only with medications, is he referring to psychedelics as one of them I am afraid, where you manage to lower your defenses in order to pain came out?