Do you have a favorite puzzle? Like, a specific puzzle that you've done.

What is your process when creating a puzzle?

Is it available in the US?

Hello Dr. Maddox, I’m in undergrad and I hope to be a clinical psychologist one day. I wanted to ask 2 things, Is there anything that sticks out to you in clinical settings that should be widely improved upon in terms of mental illness treatment? And how do you feel about the work you do?

Edit: I actually have a third question that just occurred to me, is there anything you would recommend to any newer students that are aiming to be clinical psychologists? I am personally interested.

Hey Dr Maddox! Thank you for doing this AMA :) this is going to be a little personal, and trigger warning for those with trauma.

I've had a lot of experience recently with my partner going through multiple UK NHS services for their undiagnosed chronic pain and severe PTSD from childhood trauma they're still working through. They find the physical pain can lead to suicidal thoughts.

Each time they're suffering and a doctor speaks to them, my partner is extremely adverse to being honest about their suicidal thoughts as it leads to them being put in mental institutions that they feel have been unsafe and triggering while their physical condition goes untreated. As their partner and carer, I can understand their incredible reluctance to continue engaging with professionals who can help them, as my partner feels they do not truly understand or listen to their troubles.

My question is this; what can be done and what changes need to be put in place to overcome this block between doctor and patient, and what can we as individuals do who have suffered what we feel is a lack of compassionate care in the system?

Compassion fatigue, is that not similar to work induced trauma by proxy? ie specific to mental health care?

Btw, slightly off topic, but if you’re interested in systemic problems that interfere with clinical psychology treatment - DM me...

...I have a story that’s in the public interest, because whenever the care system cannot help a seriously ill service user, you’re looking at an SAI.

I hope you & Lucy don't mind if I jump in here with my own 2p worth! I had Compassion Focused Therapy (CFT) for several years & found it of very limited effectiveness. Some techniques e.g. imagining looking at your ideal compassionate self from the outside were actively unhelpful. Eventually I received a diagnosis of OCD and had OCD specific CBT. Made more progress in 20 sessions than in years of CFT.

My sense, from personal experience, hearing other people's experiences, studying psychology and working for a short time in mental health research is that different things work for different conditions & people. Usually there will be evidence pointing towards a particular treatment for the person's diagnosis, which is where treatment should start. If it doesn't help then need to give careful thought as to why before next steps.

By "people who have been traumatised respond to a system around them and how the trauma influences the system too" do you mean that people working in Health & Social Care have often had difficult life experiences which affect how they respond & that can also feed back into a vicious cycle?

I was wondering about a more straightforward or prosaic effect of uncaring/abusive management>systems which reward suboptimal care>having to switch off to avoid moral injury>high likelihood of being uncaring and increased likelihood of being abusive.

I worked for a while in a social care dept where the criteria for receiving social care were being revised. I was an assistant OT, trained in equipment provision only to help make tasks easier where people were struggling (not where they had stopped altogether), but would get referrals like "Due to changes Mrs X is losing her lunchtime meal prep visit, please work with her on food preparation, she hasn't done this for 5 years". I asked for supervision from a qualified OT, which was refused. Management cared mainly about throughput. I left. The only way I could have stayed and not had a breakdown would have been to disengage from caring about the people we worked with.

How do you respond if someone tells you things aren't going well? Are therapists taught how to do this? Does the response affect therapy going forward?

Trying to phrase this in a way that doesn't break Rule 7 but also clearly conveys my feelings on the matter.

I'm curious why you became a Navy SEAL in the first place when there is nothing benevolent or positive that the United States military does without ulterior motives. Was it a post-9/11 sense of naivete, or something more than that? Looking back on your accomplishments do you actually believe that the things you did for the government were beneficial to the world or do you understand how detrimental they were?

Hi!

I am looking to go into Clinical Psychology, I am doing an Undergraduate degree in Psychology. Do you have any advice? I am attempting to gain as much clinical experience as possible!

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Hi Lucy, thanks for taking the time to do this! From an aspiring clinical psychologist currently working in a CAHMS inpatient service for teenagers, I have a few questions - please feel free to answer whichever you feel like.

1. Your intervention sounds really interesting! I also hold an interest in compassionate care and compassion-focused therapy. What will your intervention comprise of, and how are you planning on evaluating it? Do you have any papers published or registered for this yet? I'm keen to have a read!
2. How do you approach self-practice and self-reflection if at all (i.e. outside of teamwork reflective practice and supervision)? Do you take a freeform approach or utilise a framework? Do you write, record, or just think? Has this changed from the early days in your professional development?
3. If you could choose one book (other than your own) to recommend to someone entering the field, what would it be? This can be as loosely or as closely related to the profession as you like.

Thanks in advance! :)

How do you deal with YOU ARE A NAVY SEAL every day? You’re revered; is it accurate? Lot to live up to.

Do you make a distinction between compassion and empathy?

For instance, compassion is an awareness of suffering and a heartfelt wish to alleviate it; while empathy is to feel as another person feels?

I ask because I think the distinction might be important. Extended periods of feeling what others feel can lead to empathy fatigue (checking out and shutting down), but extended periods of wishing to help alleviate suffering don't seem to lead to compassion fatigue.

What do you think?

Sometimes the brain does extreme things to protect us (although with nasty side-effects), for example in DID/MPD or PTSD. However in schizophrenia it's hard to see that there's any protective benefit at all. Am I missing anything? Is there any utility to it? And is it a natural response to any stimuli?

Thanks in advance

Thank you for answering!

And again, you've mentioned something super intriguing: "repeating patterns in relationships with people we have known for a long time."

I have had friends who just won't let go of what happened or what I used to do/be several years ago. Hard to tell if it is out of spite or their inability to let go of the past or what else. Should one move on/get past such people? Is there hope to make them move past these repeating patterns?

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> I produced a podcast about cognitive behavioural therapy called Let’s Talk About CBT for several years,

will psychology ever move away from having the main treatment for mental illness being based off how other people experience the patient? CBT really only teaches people how to hide symptoms. It hasn't been proven to lead to neurological changes - same for claims of that with DBT.

Full disclosure: I'm a trans woman and active in community outreach and care. I'm tired of burying my friends because of structural problems that I don't feel can be solved as long as we continue to let long standing cultural problems in for-profit medicine and methodological errors that have utterly divorced psychology from the rest of STEM. See also: the publication process for the DSM being shielded behind NDA, the DEA forcing doctors to prescribe off-label medications as first-line choices for treatment of psychiatric conditions, etc., etc.

The plain english here is that I'm tired of watching the results of a system that, when faced with a need for accommodation, tries (violently at times) to force the patient to adapt to a system that has been designed to fail everyone but young white men - a mirror of the demographic composition of psychiatry until about fifteen years ago. Psychology that roots in patriarchal attitudes is toxic as hell but here we are, in 2022, living with life expectancies in the mid-30s across a broad spectrum of my community.

It would be nice to see psychology stop screaming "self care" at people who need community care they won't provide, and instead make the solutions to minority struggles fundamentally reduce to either hiding their problems or doing less and if neither works then medicate them or call it a disability and then kill them slowly from poverty they can't escape.. When in actuality all they needed was someone to hold their hand for awhile.

It seems like an entire generation of teenagers is suffering from anxiety. Even before Covid. Is there a cause for this, or are we just noticing now?

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You know how I know you're an actual professional clinical psychologist?

You admit something isn't your area of expertise.

Take notes Jordan Peterson, you don't have to pretend to be an expert on everything.

Thank you for taking your time to speak to us!

How is someone as a parent supposed to be compassionate and caring towards a child that is a narcissist? My parents adoped a child that was diagnosed as a narcissist after adoption, and has nearly destroyed my parents 40 year marriage. How can compassionate care help in this situation?

Hi Dr Lucy, thanks for the interesting AMA! Obviously CBT has dominated as a model for quite a while, but IMO has some issues. Do you think there should be a push for prioritising Compassion Focused Therapy as first port of call over CBT? Also a second question regarding your career overall. Do you have any tips for an aspiring Clinical Psychologist? I'm just about to complete my psychology undergraduate degree but am feeling so overwhelmed as to what to do next. AP positions are limited in my country, would you have any recommendations for getting non AP clinical experience? Thanks so much!