A Leadership Fetish

[erg923]

Maybe I'm nuts or something, but does anyone else notice that this is a thing now days? It's not just psychology and Org Psych people either. This all over the interwebs and out in the community and in our CE community now too.

I also have 2 friends from gradate school (clinical psychs) where this seems to be a big, big, big thing....and a surrounding corporate linked-in community that is all about "balance" but also somehow ALL about non-stop work, "self-improvement/reflection" and leadership development/worship. Like, seriously, nonstop. Have no training? No problem. Listen to us/me and become a "leader" (whatever that means). Need some help? Here's a 3-day seminar that will teach you to be present and listen and be a "servant leader" and generally make you impossible to be around to any other normal person on the planet.

Want to a be a leader this and want to be a leader that. What the F is this all about? This is too much damn excitment about "work" for me. Much of this seems like nonsense, or at least vast overkill to me. Work is called work for a reason. I "lead" people too, but geez people! There is very much a limit on how exciting that is or even the skills needed to do it!

And, I swear to Jesus, if someone else says "Thought Leader" to me again, I will smack them square in de nuts!

---

Members don't see this ad.

 

[Temperance]

One of the conferences I used to attend regularly started having "thought leader sessions" where they would invite certain speakers to talk about their ideas. I thought the term was silly then, and I still think it's silly now.

 

[Fan_of_Meehl]

Maybe I'm nuts or something, but does anyone else notice that this is a thing now days? It's not just psychology and Org Psych people either. This all over the interwebs and out in the community and CE community now too.

I also have 2 friends from gradate school (clinical psychs) where this seems to be a big, big, big thing....and a surrounding corporate linked-in community that is all about "balance" but also somehow ALL about non-stop work, "self-improvement/reflection" and leadership development/worship. Like, seriously, nonstop. Have no training? No problem. Listen to us/me and become a "leader" (whatever that means). Need some help? Here's a 3-day seminar that will teach you to be present and listen, and to be a "servant leader" and generally make you impossible to be around to any other normal person on the planet?

Want a be a leader this and want to be a leader that. What the F is this all about? This is too much damn exictment about "work" for me. Much of this seems like nonsense, or at least vast overkill to me. Work is called work for a reason, right? I "lead" people too, but geez! There is very much a limit on how exciting that is.

And, I swear to Jesus, if someone says "Thought Leader" to me again, I will smack them in the square in de nuts!

It's so annoying and it's an epidemic.

Everybody wants to be 'a leader' or 'a champion' or a 'program manager' but nobody wants a caseload.

It creates rather 'sado-masochistic' dynamics in a lot of work environments as well. 'Fetish' is a good word for it.

It is, by the way, often co-morbid with a 'numbers/measurement fetish.'

And don't get me started on the 'continuous improvement' trope.

Yeah...'continuous improvement.' Take a team of Olympic weight lifters and drone on to them about their need for 'continuous improvement.' 'But, coach, I'm already benching like 500lbs...' 'Oh c'mon now, Johnny, you know how important continuous improvement is to me and to this organization now, don't cha?' Sounds like a recipe for injury and burnout.

Somewhere in the past 20 years or so in mental health, we went from aspiring to provide standard of care treatment to people to aspiring to 'end suicide' or achieve '100% customer satisfaction.'

I understand that there's nothing wrong with a sane take on 'continuous improvement' like 'keep your foot in the relevant literature,' or 'get some consultation from a colleague on difficult cases,' or 'learn a new EBP protocol once every couple of years.'

I'm not talking about that. I'm talking about the slathering on of layer after layer after layer of documentation, double-documentation, triple-documentation, documentation checkers for the documentation checkers all in the name of 'continuous improvement' meanwhile, as a clinician, I can barely spare like 5% of my cognitive and emotional resources to expend toward the patient and the actual clinical duties I'm trying to perform.

Amazon product

 

[Sanman]

@erg923 , someone is noticing trends and analyzing them....sounds like an emerging thought leader to me!

 

[Sanman]

It's so annoying and it's an epidemic.

Everybody wants to be 'a leader' or 'a champion' or a 'program manager' but nobody wants a caseload.

It creates rather 'sado-masochistic' dynamics in a lot of work environments as well. 'Fetish' is a good word for it.

It is, by the way, often co-morbid with a 'numbers/measurement fetish.'

And don't get me started on the 'continuous improvement' trope.

Yeah...'continuous improvement.' Take a team of Olympic weight lifters and drone on to them about their need for 'continuous improvement.' 'But, coach, I'm already benching like 500lbs...' 'Oh c'mon now, Johnny, you know how important continuous improvement is to me and to this organization now, don't cha?' Sounds like a recipe for injury and burnout.

Somewhere in the past 20 years or so in mental health, we went from aspiring to provide standard of care treatment to people to aspiring to 'end suicide' or achieve '100% customer satisfaction.'

I understand that there's nothing wrong with a sane take on 'continuous improvement' like 'keep your foot in the relevant literature,' or 'get some consultation from a colleague on difficult cases,' or 'learn a new EBP protocol once every couple of years.'

I'm not talking about that. I'm talking about the slathering on of layer after layer after layer of documentation, double-documentation, triple-documentation, documentation checkers for the documentation checkers all in the name of 'continuous improvement' meanwhile, as a clinician, I can barely spare like 5% of my cognitive and emotional resources to expend toward the patient and the actual clinical duties I'm trying to perform.

Amazon product

You need continuous improvement to maximize your high efficiency lifestyle and ensure that your productivity quotient is on an exponential growth trajectory. For example, I sent 3 emails this morning on my phone while still asleep. You won't believe what I can get done when I'm awake!

 

[erg923]

Everybody wants to be 'a leader' or 'a champion' or a 'program manager' but nobody wants a caseload.

This is a fetish

 

[erg923]

@erg923 , someone is noticing trends and analyzing them....sounds like an emerging thought leader to me!

I know where you live, MFer.

 

[erg923]

It's so annoying and it's an epidemic.

Everybody wants to be 'a leader' or 'a champion' or a 'program manager' but nobody wants a caseload.

It creates rather 'sado-masochistic' dynamics in a lot of work environments as well. 'Fetish' is a good word for it.

It is, by the way, often co-morbid with a 'numbers/measurement fetish.'

And don't get me started on the 'continuous improvement' trope.

Yeah...'continuous improvement.' Take a team of Olympic weight lifters and drone on to them about their need for 'continuous improvement.' 'But, coach, I'm already benching like 500lbs...' 'Oh c'mon now, Johnny, you know how important continuous improvement is to me and to this organization now, don't cha?' Sounds like a recipe for injury and burnout.

Somewhere in the past 20 years or so in mental health, we went from aspiring to provide standard of care treatment to people to aspiring to 'end suicide' or achieve '100% customer satisfaction.'

I understand that there's nothing wrong with a sane take on 'continuous improvement' like 'keep your foot in the relevant literature,' or 'get some consultation from a colleague on difficult cases,' or 'learn a new EBP protocol once every couple of years.'

I'm not talking about that. I'm talking about the slathering on of layer after layer after layer of documentation, double-documentation, triple-documentation, documentation checkers for the documentation checkers all in the name of 'continuous improvement' meanwhile, as a clinician, I can barely spare like 5% of my cognitive and emotional resources to expend toward the patient and the actual clinical duties I'm trying to perform.

Amazon product

I can say that I love my wife fully and would do most anything for her. However, "slathering" anything might be where I draw the line. Yuck!

 

[Sanman]

I know where you live, MFer.

In your head...rent free. Have a happy Thanksgiving

 

[texanpsychdoc]

So...I used to work in corporate America as I put myself through school. I can confidently say that between those experiences and my recent/current experiences within the VA system, I have perfected the art of doing the absolute minimum to appear as tho I am productive in my role(s). Even then, I find ways around certain things so I don't have to do them.

 

[Fan_of_Meehl]

So...I used to work in corporate America as I put myself through school. I can confidently say that between those experiences and my recent/current experiences within the VA system, I have perfected the art of doing the absolute minimum to appear as tho I am productive in my role(s). Even then, I find ways around certain things so I don't have to do them.

There's a reason that my avatar is Milton from Office Space.

 

[WisNeuro]

I agree on the front of "thought leader" bs and the explosion of poorly organized trainings. Less so when it comes to psychology leadership in some areas. Many state organizations have a hard time getting people to step up to leadership. You sometimes see the same people in some of the positions, not because people "fetishize" leadership or want to stay in "power," but because they tried to recruit other people to run for things and couldn't find anyone, so many people stay on out of duty/obligation.

 

[PsyDr]

I don’t take leadership advice from people from non-leaders, I don’t go to bald barbers, and I don’t take career advice from people with average careers.

 

[Sanman]

I don’t take leadership advice from people from non-leaders, I don’t go to bald barbers, and I don’t take career advice from people with average careers.

I mostly take leadership advice from circus performers because they are never average!

Though, I do know a pretty good bald barber and pretty bad leaders.

 

[Sanman]

I agree on the front of "thought leader" bs and the explosion of poorly organized trainings. Less so when it comes to psychology leadership in some areas. Many state organizations have a hard time getting people to step up to leadership. You sometimes see the same people in some of the positions, not because people "fetishize" leadership or want to stay in "power," but because they tried to recruit other people to run for things and couldn't find anyone, so many people stay on out of duty/obligation.

This is certainly true in many psychologist leadership positions. However, it may just be my experience, but I find this to be related to the loss of income and power in jobs. I see relatively few academics among the young looking for service compared to the older legacy folks because tenure is rare. Even in the VA, there are so few mid level leadership positions that no one cares. Many of the leaders, I find, are leaving for greener pastures (such as telehealth, corporate, etc).

 

[ClinicalABA]

I've held some true leadership positions. I did a decent job, objectively and subjectively, but it WAY too hard to maintain what I considered an acceptable level of performance with unacceptable effects on the non-work stuff. Now I get to be a leader with no followers, and it's the best of both worlds.

 

[WisNeuro]

This is certainly true in many psychologist leadership positions. However, it may just be my experience, but I find this to be related to the loss of income and power in jobs. I see relatively few academics among the young looking for service compared to the older legacy folks because tenure is rare. Even in the VA, there are so few mid level leadership positions that no one cares. Many of the leaders, I find, are leaving for greener pastures (such as telehealth, corporate, etc).

It's hard to find people who want to juggle a family and work willing to donate thousands, or tens of thousands of dollars of time for service. Particularly given the changing nature of the constituency these days.

 

[bluecolourskies]

I work for a state agency that has been making a lot (positive) changes with how we do things in the prison but then there was a big meeting to also unveil our new *state agency motto!!* to reflect our new values, blah blah and please change all marketing and email signatures to the new logo, and I just thought about how long they took to come up with it and is that really going to solve issues?
But at least they were implementing other changes that actually mattered so there’s that.

 

[AbnormalPsych]

And, I swear to Jesus, if someone else says "Thought Leader" to me again, I will smack them square in de nuts!

I've heard of "change makers" used alongside "thought leaders". I almost barf'ed.

 

[albatross_at_crossroads]

Maybe I'm nuts or something, but does anyone else notice that this is a thing now days? It's not just psychology and Org Psych people either. This all over the interwebs and out in the community and in our CE community now too.

I also have 2 friends from gradate school (clinical psychs) where this seems to be a big, big, big thing....and a surrounding corporate linked-in community that is all about "balance" but also somehow ALL about non-stop work, "self-improvement/reflection" and leadership development/worship. Like, seriously, nonstop. Have no training? No problem. Listen to us/me and become a "leader" (whatever that means). Need some help? Here's a 3-day seminar that will teach you to be present and listen and be a "servant leader" and generally make you impossible to be around to any other normal person on the planet.

Want to a be a leader this and want to be a leader that. What the F is this all about? This is too much damn excitment about "work" for me. Much of this seems like nonsense, or at least vast overkill to me. Work is called work for a reason. I "lead" people too, but geez people! There is very much a limit on how exciting that is or even the skills needed to do it!

And, I swear to Jesus, if someone else says "Thought Leader" to me again, I will smack them square in de nuts!

So this nonsense has been going on for quite some time. In my part of Europe it seemed to reach its peak somewhere around 2018/2019, then the pandemic put a damper on it. I was working as a consultant at the time and my boss was obsessed with pushing most of our consultancy towards the "leadership" sphere because every company big and small requested it and it was quite profitable.

In some ways, I liked the humility/ servant leader aspect being pushed towards dark-triad C-suite types (and their followers) because it helped to tone down some of the toxicity. But overall, my guess is that it got so big because the ones who want to have leadership roles/ want to be seen as leaders pay the big bucks for this type of training/development/ rebranding, instead of doing the actual work of managing people and supporting them in their work. The less knowledge and expertise they have, the more they want to cover up their incompetence with leadership buzz words. What I did notice is that they spent huge budgets on the top "leadership" individualized programs, but barely scraped by for group training for the people who actually needed it, like first time managers.

In any case, I see that people mentioned thought leaders, but the one that really makes me cringe is the "evangelist" role. Usually in tech companies and sometimes it's an actual job title in start-ups. Like they couldn't just call it sales/marketing, you need to proselytize the work as well. In the famous words of Carlin, it's all bull****, folks and it's bad for ya.

 

[Fan_of_Meehl]

So this nonsense has been going on for quite some time. In my part of Europe it seemed to reach its peak somewhere around 2018/2019, then the pandemic put a damper on it. I was working as a consultant at the time and my boss was obsessed with pushing most of our consultancy towards the "leadership" sphere because every company big and small requested it and it was quite profitable.

In some ways, I liked the humility/ servant leader aspect being pushed towards dark-triad C-suite types (and their followers) because it helped to tone down some of the toxicity. But overall, my guess is that it got so big because the ones who want to have leadership roles/ want to be seen as leaders pay the big bucks for this type of training/development/ rebranding, instead of doing the actual work of managing people and supporting them in their work. The less knowledge and expertise they have, the more they want to cover up their incompetence with leadership buzz words. What I did notice is that they spent huge budgets on the top "leadership" individualized programs, but barely scraped by for group training for the people who actually needed it, like first time managers.

In any case, I see that people mentioned thought leaders, but the one that really makes me cringe is the "evangelist" role. Usually in tech companies and sometimes it's an actual job title in start-ups. Like they couldn't just call it sales/marketing, you need to proselytize the work as well. In the famous words of Carlin, it's all bull****, folks and it's bad for ya.

The true leader archetype leads with courage and competence from the front and by example. Historically, at least.

The 'new' brand of 'leader' 'coaches' and shouts slogans from the rear and endlessly criticizes (or have others do it for them) while they do nothing themselves.

 

[WisNeuro]

The true leader archetype leads with courage and competence from the front and by example. Historically, at least.

The 'new' brand of 'leader' 'coaches' and shouts slogans from the rear and endlessly criticizes (or have others do it for them) while they do nothing themselves.

In terms of today it's definitely an "every country has the leader it deserves" situation.

 

[texanpsychdoc]

I work for a state agency that has been making a lot (positive) changes with how we do things in the prison but then there was a big meeting to also unveil our new *state agency motto!!* to reflect our new values, blah blah and please change all marketing and email signatures to the new logo, and I just thought about how long they took to come up with it and is that really going to solve issues?
But at least they were implementing other changes that actually mattered so there’s that.

GASP.....so you mean to say that simply changing a name, re-branding, or re-framing something doesn't really change much?

 

[Fan_of_Meehl]

GASP.....so you mean to say that simply changing a name, re-branding, or re-framing something doesn't really change much?

One thing it does accomplish is this: The more I see people in charge engaging in buzzwords, sloganeering, and rampant use of the current 'cool' corporate terms, it serves as an effective screening mechanism for who's serious/credible in their communications vs. who's just trying to 'play their audience.'

 

[Peacemaker36]

One thing it does accomplish is this: The more I see people in charge engaging in buzzwords, sloganeering, and rampant use of the current 'cool' corporate terms, it serves as an effective screening mechanism for who's serious/credible in their communications vs. who's just trying to 'play their audience.'

Pledging allegiance to DEI, without actually doing anything to affect systems or people's lives, is an example of this trend.

 

[texanpsychdoc]

Yeah....I didn't even know what DEI was until about a month or so ago when it gained popular media/social media attention. Evidently someone recently told me they plan to stick a "J" at the end of DEI for "justice." Again....changing up them terms will absolutely lead to those changes they so badly want to appear to be doing.

 

[PikminOC]

One thing it does accomplish is this: The more I see people in charge engaging in buzzwords, sloganeering, and rampant use of the current 'cool' corporate terms, it serves as an effective screening mechanism for who's serious/credible in their communications vs. who's just trying to 'play their audience.'

Yes I just saw that on shark tank. They don't like that either

 

[Fan_of_Meehl]

Yeah....I didn't even know what DEI was until about a month or so ago when it gained popular media/social media attention. Evidently someone recently told me they plan to stick a "J" at the end of DEI for "justice." Again....changing up them terms will absolutely lead to those changes they so badly want to appear to be doing.

"Justice" is such a loaded concept and notoriously difficult to operationally define. Society has been trying to do so for thousands of years already.

 

[texanpsychdoc]

"Justice" is such a loaded concept and notoriously difficult to operationally define. Society has been trying to do so for thousands of years already.

Well...circa 2020 - present I've seen just how folks are wanting to operationalize and implement [social] "justice" initiatives. It's like jumping from the frying pan into the fire.

 

[Mr.Smile12]

I think we have had at least a decade of "career coaches...".

 

[futureapppsy2]

This is nothing new. In the competitive college admissions fandom (yeah, that's a thing), everyone has to be a "leader" of every activity, which begs the question of who they are ever going to be leading,

 

[Mojito_15]

Speaking for myself- I'm relatively new to the job market- currently working where I did my residency in community health- I want to make more money with a limited increase in work- I'm not particularly interested in running my own practice- at least not full time- I probably am not a good fit for a VA position- already worked in academia and that was less money and more work- I could work for someone else's private practice, join a group practice- or take on one of these leadership management positions- managing counselors or consulting w/ big companies. So- I've been applying for management positions. In my current job, I manage 3 MA counselors already- and I don't get the title or the pay for that. I've applied to a few positions already.

 

[erg923]

Maybe I'm nuts or something, but does anyone else notice that this is a thing now days? It's not just psychology and Org Psych people either. This all over the interwebs and out in the community and in our CE community now too.

I also have 2 friends from gradate school (clinical psychs) where this seems to be a big, big, big thing....and a surrounding corporate linked-in community that is all about "balance" but also somehow ALL about non-stop work, "self-improvement/reflection" and leadership development/worship. Like, seriously, nonstop. Have no training? No problem. Listen to us/me and become a "leader" (whatever that means). Need some help? Here's a 3-day seminar that will teach you to be present and listen and be a "servant leader" and generally make you impossible to be around to any other normal person on the planet.

Want to a be a leader this and want to be a leader that. What the F is this all about? This is too much damn excitement about "work" for me. Much of this seems like nonsense, or at least vast overkill to me. Work is called work for a reason. I "lead" people too, but geez people! There is very much a limit on how exciting that is or even the skills needed to do it!

And, I swear to Jesus, if someone else says "Thought Leader" to me again, I will smack them square in de nuts!

This came up again today. But....Goodness. Can people stop this ****. It is soooo annoying. Yes, yes. Org psychology is "great." Marketing with psychology and mental health and wellness in mind is "great." Can we settle down a bit? I actually bowed out of co-hosting/giving a state psych org CE that had mostly nothing to do with this due to this 'trend."

 

[Fan_of_Meehl]

This came up again today. But....Goodness. Can people stop this ****. It is soooo annoying. Yes, yes. Org psychology is "great." Marketing with psychology and mental health and wellness in mind is "great." Can we settle down a bit? I actually bowed out of co-hosting/giving a state psych org CE that had mostly nothing to do with this due to this 'trend."

Unrestrained compensatory narcissism is what fuels this trend. It's also a form of circular reasoning or 'begging the question' (or outright fraud).

I'm going to 'be' a 'great leader' by...I know...simply declaring myself a great leader. Not by leading by example; not by quietly honing my skills, working my butt off, demonstrating 'great leadership,' taking a clinic filled with uncooperative personality-disordered providers and actually turning it into an actual efficient, competent functioning team...no...I'm going to just flat out say that I am one of the elect few in the field who is a 'great leader.' I'm going to get a t-shirt that says, 'world's greatest leader' in big bright letters/colors so everyone can see me display publicly what a great leader I am. Screw the PhD/PsyD. I'm going for the 'Exp.D. ['professional expertologist'] or the Exc.D. ['professional excellentologist'] degree. I am an 'expert' at 'being an expert.' I am 'excellent' because I say so. I am an E.W.o.C. (an Expert Without a Caseload). Those storm troopers better watch out. This is my planet.

If you're a 'great leader' (in practice, in reality), you don't need to call yourself that or announce it to the world...others consider you that by default due to your proven track record of accomplishment, integrity, etc.

 

[Ollie123]

Nothing about this is surprising to me. Its just marketing aimed at stroking people's egos. Everyone wants to be a "leader" just like everyone wants to be "rich" (scammy-financial seminars), "thin" (diet industry), etc. The people drawn to these things are unlikely to become true leaders, just like the typical person paying to attend a "Make a thousand dollars a day from the comfort of your home!" seminar is unlikely to become rich.

I think its just because we're in psychology the leadership thing bugs us (it does me too), but lots of fields have their version of this crap. People will pay money for it because leadership is synonymous with professional success and high income. Corporations will pay for it for the same reason.

I'd take a leadership workshop run by the ghosts of Winston Churchill and Mahatma Gandhi if anyone finds one. Most seem to be run by "soulpreneurs" who previously relied on their spouse to subsidize their multilevel marketing schemes.

 

[Fan_of_Meehl]

Everybody these days seems to want to maximize their authority while simultaneously minimizing their responsibility at work. This practice is actually 'anti-leadership' but it is so often the observed behavior of those who refer to themselves publicly as 'leaders.' Healthcare is so shot through with this utter pathology that it is extremely dysfunctional, inefficient, redundant, and petty on a daily basis. Everything is about 'metrics' or 'rule-following', 'gotcha-driven,' 'tattle-tale code enforcement' rather than implementation of reasonable, articulable standards of care/practice and the exercise of prudent 'evidence-based' (and logically defensible) clinical judgment by those (providers) who are actually medico-legally responsible for the care itself.

Another disturbing trend involves labeling tyrannical behavior as 'leadership.' Most often, these 'leaders' continually engage in an organizational process that constantly creates new and more 'priorities' where everything is 'top priority' to the point that there literally are no 'priorities.' If EVERYTHING is a 'top priority' (and non-negotiable) then NOTHING is a 'priority.' By definition, there has to be a hierarchy of 'priorities' (some above others) in order for the term or concept to even make any sense.

 

[Sanman]

I'd take a leadership workshop run by the ghosts of Winston Churchill and Mahatma Gandhi if anyone finds one. Most seem to be run by "soulpreneurs" who previously relied on their spouse to subsidize their multilevel marketing schemes.

The problem with that class is that the type of leadership you are discussing usually requires the type of instict and fortitude of character that cannot be taught ahead of time. Similar to Thomas Edison or Jeff Bezos, how can someone teach you to believe in something no one has accomplished before you. Closest you may get now is a class taught by Malala Yousafzai and Greta Thunberg.

 

[Ollie123]

The problem with that class is that the type of leadership you are discussing usually requires the type of instict and fortitude of character that cannot be taught ahead of time.

You are the inaugural winner of the newly-created SDN "Most likely to take a reference to ghost lecturers seriously" award

 

[Sanman]

You are the inaugural winner of the newly-created SDN "Most likely to take a reference to ghost lecturers seriously" award

Thank you, Thank you! I would like to thank god for making this ghost lecture series possible, without him I couldn't have won this award.

Also, in a way, I have taken part of your dream lecture series. So I do take it seriously. It is important to have though leaders.

 

[smalltownpsych]

A former friend of mine from high school is one of these self-appointed leaders. He has done absolutely nothing tangible and is not a clinician, but is a mental health leader promoting awareness and access and equity and advocacy and just about any other buzzword. He attends lots of meetings with other thought leaders and is on boards of organizations that promote these same buzzwords. Last time I talked with him he was head of patient advocacy for LA county mental health before he left this for more nebulous pastures. He wasn’t a bad guy in high school, but he is now the worlds most insufferable ass who has adopted lots of idiosyncrasies that make him a horrible dinner guest. Funny thing is that his sister is a grounded ER doc who is normal and down to earth. Kind of reminds me of that saying about those who can, do and those who can’t teach, just not sure how these types fit in because I actually like a lot of teachers.

 

[AcronymAllergy]

A former friend of mine from high school is one of these self-appointed leaders. He has done absolutely nothing tangible and is not a clinician, but is a mental health leader promoting awareness and access and equity and advocacy and just about any other buzzword. He attends lots of meetings with other thought leaders and is on boards of organizations that promote these same buzzwords. Last time I talked with him he was head of patient advocacy for LA county mental health before he left this for more nebulous pastures. He wasn’t a bad guy in high school, but he is now the worlds most insufferable ass who has adopted lots of idiosyncrasies that make him a horrible dinner guest. Funny thing is that his sister is a grounded ER doc who is normal and down to earth. Kind of reminds me of that saying about those who can, do and those who can’t teach, just not sure how these types fit in because I actually like a lot of teachers.

Those who can, do. Those who can't, take fuzzy leadership workshops to try and tell the doers that what they're doing is wrong while offering no constructive solutions and having little to no relevant training or experience.

In other news, it may be my cynical day of the week.

 

[Fan_of_Meehl]

A former friend of mine from high school is one of these self-appointed leaders. He has done absolutely nothing tangible and is not a clinician, but is a mental health leader promoting awareness and access and equity and advocacy and just about any other buzzword. He attends lots of meetings with other thought leaders and is on boards of organizations that promote these same buzzwords. Last time I talked with him he was head of patient advocacy for LA county mental health before he left this for more nebulous pastures. He wasn’t a bad guy in high school, but he is now the worlds most insufferable ass who has adopted lots of idiosyncrasies that make him a horrible dinner guest. Funny thing is that his sister is a grounded ER doc who is normal and down to earth. Kind of reminds me of that saying about those who can, do and those who can’t teach, just not sure how these types fit in because I actually like a lot of teachers.

Actually having to try to IMPLEMENT therapy with ACTUAL patients on a daily basis does wonders for your humility and keeps you fairly grounded regarding the nature of your limitations to "change the world" as a thought leader or "eliminate the scourge of suicide" (c.f. the "War on Suicide"). Absent daily contact with patients, I can see how you might be able to engage in significant flights of ideation on such topics.

"I'm gonna change the world! End despair! I'm wearing a 'War on Despair' T-shirt today for my 'March to End Veteran Suicide!'

"Yeah...but can you successfully collaborate with this particular depressed client to cut his BDI-II by 50% over the next 12 weeks? Let's try to walk before we sprint there Aaron T. m'boy..."

VA has WAY too many 'activists' and marchers and way too few clinicians treating patients.

VA is trying to build the Pyramid of Cheops with 10,000 administrative personnel and priests commanding an army of like 50 builders.

 

[R. Matey]

VA has WAY too many 'activists' and marchers and way too few clinicians treating patients.

When I was on internship, a common refrain was that "we can't hire our way" out of our access issues (i.e., hiring more clinicians) yet this didn't seem to stop the same folks from hiring "mental health advocates" that tried to address the problem programmatically through outreach, which I always felt is the Tylenol of mental health interventions for college students. I think the idea is this will save money by reducing demand for individual therapy (I remember one training with these folks trying to roll out a chatbot with a very creepy looking avatar), but yet the patients still keep on coming. I always wonder how much money they're actually saving vs. losing on failed initiatives where the obvious answers, at least to me, are better outcome monitoring and a stronger commitment to evidenced based practice in addition to hiring more clinicians.

 

[Fan_of_Meehl]

When I was on internship, a common refrain was that "we can't hire our way" out of our access issues (i.e., hiring more clinicians) yet this didn't seem to stop the same folks from hiring "mental health advocates" that tried to address the problem programmatically through outreach, which I always felt is the Tylenol of mental health interventions for college students. I think the idea is this will save money by reducing demand for individual therapy (I remember one training with these folks trying to roll out a chatbot with a very creepy looking avatar), but yet the patients still keep on coming. I always wonder how much money they're actually saving vs. losing on failed initiatives where the obvious answers, at least to me, are better outcome monitoring and a stronger commitment to evidenced based practice in addition to hiring more clinicians.

Yeah. Some of the low intensity 'telephone coaching' and smartphone apps interventions have their place/utility in therapy but they will never replace actual therapists for our population for MANY reasons.

"You can't hire your way out of access issues."

Yeah...just like we can't eat our way out of starvation or fight our way out of a corner. I know...maybe we can 'slogan' our way out of access issues or perhaps 'email' or 'drum circle our way out of access issues since hiring more clinicians is such a rotten idea. VA 'leadership.'

 

[Sanman]

When I was on internship, a common refrain was that "we can't hire our way" out of our access issues (i.e., hiring more clinicians) yet this didn't seem to stop the same folks from hiring "mental health advocates" that tried to address the problem programmatically through outreach, which I always felt is the Tylenol of mental health interventions for college students. I think the idea is this will save money by reducing demand for individual therapy (I remember one training with these folks trying to roll out a chatbot with a very creepy looking avatar), but yet the patients still keep on coming. I always wonder how much money they're actually saving vs. losing on failed initiatives where the obvious answers, at least to me, are better outcome monitoring and a stronger commitment to evidenced based practice in addition to hiring more clinicians.

There is a bigger issues that none of these advocates can ever handle. I do agree that the VA cannot just hire their way out of access issues. The bigger problem is setting consistent limits on patient usage. However, that is politically unpalatable. Alternatively, fire the mental health advocate and hire a paraprofessional to screen out all the garbage consults.

 

[R. Matey]

There is a bigger issues that none of these advocates can ever handle. I do agree that the VA cannot just hire their way out of access issues. The bigger problem is setting consistent limits on patient usage. However, that is politically unpalatable. Alternatively, fire the mental health advocate and hire a paraprofessional to screen out all the garbage consults.

I've never set foot in a VA so I'll take your word for it, but I have definitely seen waste in individual therapy at the places I've worked as well and I do wonder if a stronger commitment to EPBs would limit this. That said, I think people want supportive therapy even after acute symptom remission and it's hard to figure out who's going to pay for it.

 

[Sanman]

I've never set foot in a VA so I'll take your word for it, but I have definitely seen waste in individual therapy at the places I've worked as well and I do wonder if a stronger commitment to EPBs would limit this. That said, I think people want supportive therapy even after acute symptom remission and it's hard to figure out who's going to pay for it.

Not only that, there are plenty of physicians that want that as well because there is nowhere to send someone that needs support and soft skills. Many people need/want a friend and case manager, not a psychologist that provides an EBP. Often, they want to bend the physician's ear.

 

[Shiori]

I would love if we had case managers. I have several people vaguely on my caseload who I just shoot them a secure message to see how they're doing and if they need anything. They're managing okay, but just need to know someone is getting their consults moving and to answer basic questions about navigating the system. A lot of my false start intakes are those kinds of patients. I also think it allows burnout to creep in when we're constantly churning patients. It makes all those leadership opportunities look appealing. I don't have to justify all of my "wasted" time if I can point to some sort of leadership task. It's messy over here.

 

[Sanman]

I would love if we had case managers. I have several people vaguely on my caseload who I just shoot them a secure message to see how they're doing and if they need anything. They're managing okay, but just need to know someone is getting their consults moving and to answer basic questions about navigating the system. A lot of my false start intakes are those kinds of patients. I also think it allows burnout to creep in when we're constantly churning patients. It makes all those leadership opportunities look appealing. I don't have to justify all of my "wasted" time if I can point to some sort of leadership task. It's messy over here.

Just tell them you were showing people where to go and checking in...you know committing to those ICARE values that we have to recertify annually but that no one in leadership actually cares about.

 

[cara susanna]

I agree that the VA's access issues will never be solved until we can actually set limits on psychotherapy and not be accused of "denying care." It would help if we didn't have to chase down patients through multiple NS calls, responses to VCL calls, etc. Also, we definitely need better consult triage. In my ideal world, Primary Care wouldn't be able to place outpatient mental health consults and everything would go through PCMHI (obviously PCMHI doesn't love this idea, lol).