Having appreciated Get Out—though not caring for his other directed, written, or produced movies—I recently watched Jordan Peele’s film Nope. I walked away thinking, “You know what, that’s not for me.”
While there will be no spoilers contained herein, I reflect upon my psychotherapy practice and what one critic stated of Nope, regarding the “movie’s theme of turning tragic events into a spectacle.” I think of tragedy and how some people view it.
In specific, I ponder how people perceive their experiences; how they think I may help them; and I wonder about what services they actually seek versus what assistance they claim to need. Increasingly, I’ve grown aware of people seeking help while veiling expectations, also known as secondary gain.
This relates to a number of events I’ve experienced as a professional in the field of mental, emotional, behavioral, and social health—collectively, mental health—which may benefit prospective clients. As such, when receiving future inquiries, I will provide a link to this blog entry.
Before I address client-specific issues, it may be useful to understand how Nope ties into the content of this blog entry. It involves the marketing technique of, “Get them to yes.”
When collaborating with a mental health professional a number of years ago, I was surprised to learn how some private practice psychotherapists select clients when determining appropriate fit for services. Here’s how the conversation with the person unfolded (**not verbatim**):
Boss: What do you say if a client calls and asks, “Do you specialize in treating alcoholism?”
Me: I would say that I have some education, training, and experience in working with individuals who have addictions. I don’t specialize though.
Boss: Wrong! All they’ll remember is hearing you say you don’t. Get them to yes!
Me: People can die when going into alcohol withdrawal. I’m uncomfortable with the idea of performing outpatient services for what may best be done through inpatient care.
Boss: Get them to yes! If you need to assist them with inpatient scheduling, first get them to yes. Now, how about if someone calls and says, “Do you treat Alzheimer’s?”
Me: Well, I have no clinical background in this—
Boss: No! All they heard was “no.” Say someone calls and askes, “I have a young child who has intellectual and developmental disabilities, are you an expert in treating this condition?”
Me: Wait, I don’t treat minors and I definitely am not the right fit for—
Boss: Wrong! They’ll hang on to “don’t.” You may have only one phone call to get them to yes. You understand what I’m saying?
Me: I understand, yes. I’m not sure that ethically this aligns with—
Boss: Forget ethics! This is about business. You have to get them to yes every time. Here, now I’ll play the clinician and you play the prospective client.
Me: Umm, ok. Do you treat trichotillomania?
Boss: Yes! We can schedule an appointment to discuss the details.
Me: Wait, do you actually treat it?
Boss: It doesn’t matter. We get them to yes and you can always look up how to treat it later.
Me: That…that doesn’t seem…not only is it unethical, is it legal?
Boss: I value risk-takers. Are you a risk-taker? I need someone who can get them to yes! Go, give me another one.
Me: Uhh, do you treat pica?
Boss: Absolutely! We can schedule an appointment to discuss details.
Me: Do you treat major depression with psychotic features?
Boss: Yes! Let’s schedule an appointment. You see? You get them to yes every time. Schedule the appointment. As a client, what am I going to do with a “no”? I stop listening at that point and I’m on to the next person I’ve lined up to call. You have to get them to yes!
Imagine, reader, you’re experiencing one of the darkest moments of your life. It took all the courage you could muster just to admit you need help, let alone to execute the steps it takes to reach out.
Given the “get them to yes” marketing strategy, would you want to see a therapist whose primary focus is money? Do you prefer a flashy clinical practice more than a clinician who will truthfully tell you whether or not you’d be an appropriate fit for services?
Mental health treatment is often uncomfortable as is, so would you want the added discomfort of knowing your therapist may have zero competencies in treating your specific needs? Perhaps you are emphatically saying to yourself, “Yes! Sign me up!”
For the rest of the audience, I suspect the answer is resoundingly, “Nope!”
Get Them to Nope
No longer employed by the aforementioned individual, and having practiced independently for quite some time, I have the ability to serve the ethical, moral, legal, and common decency principle of denying mental health services if and when appropriate. Get them to nope when necessary.
If a prospective client is an inappropriate fit for services, I can provide resources for clients to seek services elsewhere. To me, this is a healthier strategy than a “get them to yes” approach to mental health care.
Rather than waste the time of prospective clients, I will instead get them to nope. The following examples serve as preemptive nope question and answer criteria, as these situations may not be an appropriate fit for the services I offer:
Question: Do you provide emotional support animal (ESA) letters?
Answer: To my understanding, as one source indicates, “While Emotional Support Animals or Comfort Animals are often used as part of a medical treatment plan as therapy animals, they are not considered service animals under the ADA [Americans with Disabilities Act of 1990].”
Per a separate source, candidates seeking ESA letters need:
· Proof that you suffer from a mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders, edition 4 or 5
· Confirmation that this condition prevents you from undertaking a significant life activity, such as going to work, socializing or being in public spaces
· A statement from the professional that they deem your Emotional Support Animal to be a necessary part of your treatment and mental health support
It is largely that final bullet point which sums up why I may not be an appropriate fit for this sort of service. This isn’t to say that no one qualifies for an ESA, because I couldn’t possibly make such a claim.
Per one source, “To qualify for an ESA a licensed medical health professional must attest in an ESA letter that their patient benefits from having an ESA. A Licensed Clinical Social Worker (LCSW) can indeed make this decision and write an ESA letter.”
While I can appreciate how people may receive some benefit from ESAs, I practice Rational Emotive Behavior Therapy (REBT) and wonder about what message I would relay to an individual by affirming a proposed need for something other than self-reliance.
Per one source, “According to REBT, it is largely our thinking about events that leads to emotional and behavioral upset. With an emphasis on the present, individuals are taught how to examine and challenge their unhelpful thinking which creates unhealthy emotions and self-defeating/self-sabotaging behaviors.”
I assist people with challenging rigid and extreme attitudes which are commonly expressed through use of should, must, or ought statements. These irrational beliefs could manifest in one saying, “I must have an emotional support animal, otherwise I don’t think I could stand venturing into public.”
This is precisely the sort of self-disturbing content with which I assist clients—not through letter-writing. Potentially reinforcing codependence on an animal may send a different message than what I project through use of REBT. Therefore, I’m likely not an appropriate fit for issuing ESA letters.
Question: Do you provide service animal letters?
Answer: I am aware of some of the truly amazing tasks working (support) animals can perform. Having worked with disabled veterans for a number of years and realized how valuable it is to have a dog that can detect seizures, disrupt a flashback episode, and perform other necessary functions has been educational for me.
In compliance with the ADA, I support an individual’s right to secure reasonable and/or special accommodations to improve functioning and quality of life. In the state of Texas, I do not have prescribing authority and will be unable to prescribe a service animal to prospective clients.
Regarding both ESAs and support animals, I invite people to seek an appropriate source (i.e., psychologist, physician, etc.) for animal-assisted needs. I have no level of competence in this area and I am therefore not an appropriate fit for ESA or service animal therapy or documentation.
Question: Do you provide documentation for legal cases (i.e., deferred adjudication, divorce, child custody, etc.)?
Answer: From time to time, clients with whom I’ve worked for a significant amount of time have inquired about character references, proof of diagnosis, professional opinion regarding likeliness to reoffend, etc. Though each case is unique, I largely refrain from providing such letters.
Suppose a client seeks an “expert” opinion for a court case to verify that the individual is not a threat to the community. Aside from not serving as an expert in any capacity, let’s say I put on the line my licensure by affirming such an unverifiable claim.
The person then goes on to commit any number of grievous offenses. Guess who is then potentially held legally responsible, as indicated by way of signature and licensure. I’m not trying to get anyone to yes with such significant stakes on the line.
Likewise, it isn’t uncommon for prospective clients to seek mental health treatment solely for proof to an authority or governing body for a potential “hidden agenda.” Imagine going to a primary care provider (PCP), not because you’re actually ill, though seeking documentation to say you are nonetheless.
Rather than working towards an outcome with services I provide—improving one’s level of functioning and quality of life—some people seek mental health treatment for the clinical opinion of a professional, perhaps because a system of “credntialism,” “expertism,” or “scientism” creates a hierarchal dominance structure.
I approach each prospective client as unbiasedly as possible while also keeping in mind the potential for hidden agendas. It isn’t that I think there is no genuine need for professional mental health opinion in matters of legal interest.
Simply stated, I am not well-qualified to rend such supposition. Because I am not a legal professional and cannot possibly predict a person’s future behavior, and due to the fact that ulterior motives conflict with the services I offer, I invite prospective legal documentation-seeking clients to search for a more appropriate fit for this unique request.
Question: Do you provide documentation for insurance-related claims (e.g., proof of treatment) or disability claims (short- and long-term disability, workman’s compensation, veteran compensation, etc.)?
Answer: Generally speaking, I am not the mental health practitioner to seek specifically for insurance claims. For current clients, I can provide an invoice of services though there is no guarantee for fee reimbursement.
Likewise, I can provide copies of progress notes for current clients. Prospective clients who are in search of a clinician who will essentially function as a paid scribe—one who will simply draft whatever one is paid to write—likely will find dissatisfaction if mistakenly believing I am such a practitioner.
For more information as to why I do not accept insurance or work with insurance providers as a whole, I invite you to read my blog entry entitled Insurance Coverage and Lengthy Wait Times.
According to one source, “Even in some developed countries that have health insurance to pay for treatment, a meaningful proportion of the population sometimes lacks this coverage.” While I value the idea of insurance coverage, I simply do not participate in insurance-related activities for prospective clients at this time (i.e., claims, proof of treatment, etc.).
Concerning veterans, as I remain well aware of the compensation and pension (C&P) process, I understand the need to prove one’s disability to the Department of Veterans Affairs (VA)—even though evidence may be clearly indicated within one’s military record. I support veterans seeking such proof and to receive the benefits to which they are entitled.
Similarly, I understand the ethical consideration related to an allegation of “how the Veterans Administration makes veterans sicker.” This is one of those topics discussed behind doors in the VA, as I used to work within that system and was privy to many such conversations.
It would be bold and disingenuous to prose that all or most veterans are feigning injury for compensation. I certainly am not malingering in regards to my VA-connected disabilities, and I grant each veteran the charitable premise that you aren’t either.
Still, if one is willing to entertain that some or even many veterans may be doing so—and with keeping in mind that “many” can mean something as small at 5% of a number—then there’s a reasonable discussion to be had about whether or not I want to provide services as an evidence-gathering entity for C&P exams. I do not.
As well, I don’t advocate a person using a particular diagnosis as an excuse for poor behavior—something not unique to any given population—though perhaps unreasonably associated with veterans. Nonetheless, I’m well aware of how some people use diagnoses as an excuse for poor behavior.
When working with clients, I maintain a position similar to one clinician who stated, “There’s also the component of, like, blaming our missteps or wrongdoings on a mental illness, and I don’t accept that, because we all have our own ish [shit] and we’re responsible for what we do in our world.”
I use elements of personal responsibility and accountability—collectively, ownership—which doesn’t support a victimhood narrative. Not everyone appreciates this method of mental health treatment.
There are seemingly countless psychotherapists who will treat clients as injured victims, buying into subjective complaints of that which cannot be controlled by you, and I encourage prospective clients who value that approach to seek what works best for you.
Additionally, in compliance with the ADA and other pertinent policies, I support a client’s self-determination and I maintain a stance of nondiscrimination. On an individual basis, for current clients, matters related to disability may be resolved using a personal ownership approach.
My clinical approach is mostly designed to treat symptoms, not provide evidence of disability. As well, I market my style of therapy as difficult, not easy. My clients are encouraged to push through discomfort as a means of growing.
For prospective clients who specifically seek a provider to support disability claims or to blame others for one’s own behavior, I invite you to seek an appropriate professional who specializes in disability-specific matters or coddling approaches to therapy.
Question: Do you provide documentation for excused absences from social or professional responsibilities (i.e., jury duty, attendance at a wedding, etc.)?
Answer: Unlike a PCP who may issue a physician’s note for perhaps anything imaginable under the sun, I do not typically perform such a service. I’m less focused on substantiating your claimed illness and more concerned with helping you get better.
In the past, people have expressed to me that it is their perception that as a psychotherapist I am essentially a paid-for wish-granter. Perhaps a client wishes for me to write a document to counter a jury summons, I am therefore expected to make a letter appear.
Maybe a client wishes for me to draft a note, stating the person cannot attended a family reunion—largely because the individual doesn’t take ownership of the task for declining the event—and I am subsequently relied upon to let the client’s partner know the event is not in the best interest of the person.
I will get you to nope rather fast on this one. Though some may think they will “feel” better if their wishes are granted by me—having me function in a paternal role like a dad who writes an absent note for a child—this is not my responsibility as an REBT psychotherapist.
With limited exceptions, I do not perform as a rubber stamp for a person’s unreasonable expectations. I’m not in the business of granting wishes, or even helping people feel better, because it’s my aim to help people get better.
Question: (Though not expressly stated, I think this question is sometimes inferred.) Will you serve as a therapist about whom I may brag, kind of like you are my social accessory (e.g., boasting to friends, family members, coworkers, social media followers, etc. in the way of, “My therapist says, ‘[…].’)?
Answer: You’re free to conduct yourself in many ways outside of session. I have no control of you, nor do I want such power. Still, I do invite people to consider the potential motivation behind their actions or underlying their behavior.
What do you gain from using your therapy as a societal conversational piece? Are you seeking to get better or merely signal to others that you’re doing what they consider to be a moral good?
How is accessorizing the people in your life benefitting you? Is it beneficial to the people you objectify? What may life be like if you received the help you seek and didn’t share the experience with others for social clout?
Again, you may behave as you see fit. Still, the motivation for your actions may be something worth assessing. If you received therapy in a metaphorical forest and no one was privy to hearing about it, did the clinical intervention even take place?
Question: (Though not expressly stated, I think this question is sometimes inferred.) If I attend sessions with you as a help-rejecting complainer (“askhole”), challenging almost everything you have to say and discrediting any assistance you provide, will this validate the idea that I’m more intelligent than you or perhaps that I don’t actually need the help with the problem for which I’m reaching out?
Answer: Maybe. First, I’m not particularly intelligent. For those who are searching to engage in a psychological chess match of sorts, I’m uninterested. Let’s simply agree to forfeit that mental game before we begin.
Next, I don’t offer advice—thus neutralizing the askhole strategy—and I don’t want to waste the time or money of my clients. As well, I’m not the sort of psychotherapist who will offer solutions to your problems, instruction about how you should, must, or ought to live, or one who will passively sit by as a tabula rasa upon which you may project. Nope.
Lastly, for prospective clients seeking therapy so that they may challenge a professional—only to prove to themselves or others that psychotherapy is ineffective—what could I possibly say that would persuade you otherwise? If your mind is already made up, I won’t stand in your way.
Question: (Though not expressly stated, I think this question is sometimes inferred.) If I engage in services with you for data-gathering purposes, possibly regarding potential litigation or activism, how may this impact the care I receive?
Answer: It is well understood that “therapists are operating in a society that is increasingly litigious,” as I am under no illusion that some people are actively seeking their next mark. Because of such confidence tricks, I maintain an insurance policy and retained counsel—as do many other professionals.
One wishes this wasn’t a necessary element of mental health care. Additionally, while unfortunate, raiding, doxing, mobbing, brigading, review-bombing, swatting, canceling, and other forms of group bullying are common in the mental health industry.
I remain selective regarding who I treat in my practice. Therefore, a “get them to yes” strategy is not conducive to how I conduct business. My strategy doesn’t fully eliminate all would-be acts of harm, though knowing when to say “nope” is important.
Question: (Though not expressly stated, I think this question is sometimes inferred.) Will you help me collect a lengthy diagnosis chain, like Pokémon where I “gotta catch ‘em all,” so I may finally be able to prove to myself or others that I am as broken as I or others think I am?
Answer: Nope. While there may be advantages and disadvantages to mental health diagnosis, overdiagnosis can be an issue in and of itself. In 2012, I began observing a trend on Tumblr whereby people would stack various diagnoses as part of their identification.
I’m not here to say what is good, bad, right, wrong, or otherwise. I simply noticed a trend. That behavior then made its way to Twitter and elsewhere, as TikTok now appears to serve as a bastion of mental health diagnosis collection. More about TikTok in the next question.
From time to time, I’ve been contacted by prospective clients seeking additional diagnoses to the seven or eight self-reported labels they claim to have. While not intending to mock anyone, I think it’s important to demonstrate what I’m referencing.
A query may go something like, “I have major anxiety depressive manic disorder with borderline suicidal tendencies and alcoholic type II with ADD and OCD dissociation, because I’m so bipolar, and I was wondering if you see people for multiple personalities?”
It is uncertain as to whether or not the Internet, social media, multiple interactions with psychiatric or psychological providers, or some other influence may explain why a person can spout off as many diagnoses. Who’s to say?
As well, it is unclear as to how beneficial it is for a person to be diagnosed with all the conditions. Many mental health diagnoses overlap and collecting precious titles may not serve one as well as addressing reported symptoms.
If one seeks to prove a level of dysfunction, be it to yourself or others, I would invite prospective clients to think about what it is you’re seeking from a psychotherapist. I’m not one to validate perceived brokenness.
Using REBT, I won’t pity you. Rather, I seek to empower the individuals with whom I work. Whoever dies with the most diagnoses still dies. I’m here to help with your level of function and quality of life until then, diagnosis or not.
If you maintain a condition with which I’m less familiar, or I don’t maintain the level of competence necessary to treat you, I won’t get you to yes. If nothing else, the current post serves as verification of my level of comfort with simply saying, “Nope.”
Question: Do you provide therapy similar to what I see on social media, like TikTok?
Answer: Perhaps of all matters I’ve addressed herein, I can’t get you to nope quicker than I can on this one. In fact, “Hell to da naw, naw, naw […] hell naw!”
There is a growing trend for people to simulate what they experience using social media platforms, similar to the phenomenon of bodily mimicry. In some cases, people outright reflect symptoms they observe on TikTok.
For instance, some individuals bring to session psychobabble concepts they learn on these platforms. People are often highly suggestive and may remain susceptible to so-called “mental health influencers” who promote “illness appropriation”—taking on impairment one doesn’t actually exhibit.
Per one source, “Even if a therapist isn’t on social media, their clients are, and those clients are impacted by what they see on social media, and they’re bringing that directly into the session.” For some providers, all it takes is one client’s irrational belief from the idealized therapeutic process heard on TikTok, and months of progress can be erased.
For clients with whom I work, as I familiarize people with REBT techniques, this isn’t a significant problem. Prospective clients who desire popular mental health trends may be disappointed when receiving services from me.
I question when clients choose to adopt a victimhood narrative, perhaps listening to content creators who use their “platforms to talk openly about their own battles with mental health”—even though mental health is neither a war nor a battle. How helpful is this trend?
What use is there, aside from the obvious self-focus, in fixating on symptomology for the sake of sadfishing or vapid self-consciousness? I work with clients who have legitimate issues. Together, we push through discomfort as a means of increasing functioning and quality of life.
Prospective clients with imagined conditions may tie up valuable resources from others who aren’t focused on fantasy. Likewise, I will not parrot styles of therapy observed on various social media platforms.
There simply isn’t enough nope that may be expressed herein. For those yearning for a dancing psychotherapist who compartmentalizes life in a short video with overly-simplistic solutions, I invite you to look elsewhere.
I market my approach to mental health treatment using two concepts repeatedly mentioned herein:
1) I seek to help improve the level of each client’s functioning.
2) I seek to help improve the quality of life for each of my clients.
I’m not here to lie about my abilities, get a prospective client to yes through misrepresentation of my competencies, or to deceive in order to receive a payout. Likewise, I’m not practicing as a glorified administrative note-writer, to serve as conversational martial in social settings, or to be debated for one’s own ego.
Additionally, I screen clients for appropriate fit for services in contrast to litigation potential, I do not seek to stack a client’s mental health diagnoses, and I will not provide trendy social media-influenced mental health treatment. Nope, nope, nope.
If the topics addressed herein assist you in determining that the services I offer aren’t what you’re seeking—and you ultimately conclude, “You know what, that’s not for me”—I applaud your ability to use self-determination and autonomy to make the healthiest decision concerning your care.
If on the other hand you’re looking for a provider who works to help you understand how irrational beliefs impact your life in an unhelpful way, I invite you to reach out today by using the contact widget on my website.
As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.
At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
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