Keith Karabin: Uncut. Uncensored. Unmasked.

I was recently honored to be spotlighted in a graduate school project by an anonymous future colleague. Aside from being humbled by her regard, I was actually inspired by her questions. As you will read, they were thoughtful and insightful and prompted me to prattle on about myself as a therapist.

I thought you would value those insights and my professional opinions since I do a great deal of exhortation on life from that perspective. Therefore, read on, and find the interview—uncut and uncensored.

If you came to the site thinking “Oh, I know Keith loves Halloween! What does he have to offer?” and found this interview, please stay for the after party. I hit Halloween hard last year, and will again, but for this year I thought I’d give you a glimpse “behind my mask.” I did leave a few treats for you in the bowl following the interview.

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In what setting do you practice? How long have you been practicing?

I am currently a Primary Therapist at Foundations Behavioral Health in Doylestown, PA. Before that I was a Primary Therapist at Today, Incorporated in Newtown, PA. I’ve been a paid mental/behavioral health therapist for going on six years but I’ve been a volunteer therapist (one time a volunteer Director of Male Counseling) for around 15 years. Unless, of course, you also count the work I did in the hallways of my High School as a student. But, let’s not count those years.

What are your specialties or areas of clinical focus?

Specialties? Hm. I’ve been told by administrators that my specialties are “living outside the box,” “making anything therapeutic” and “having a positive vision of a kid and never giving up on them.” My kids (patients) would say that my specialty is “making us cry,” “confusing me” and “being funny.”

My clinical focus is best described as tool-box, with most of those tools honed for work with trauma and psychosis. Even when I was a drug and alcohol therapist at Today, Inc, my focus was more trauma and psychosis in our drug abusing teens. Interestingly, I never consciously chose this focus—and I’m not certain someone should, especially while in school—these were just the patients allotted to me by administration and admissions. My advice (unsolicited, of course) would be to let your strengths and heart dictate your specialties and let your first few agonizing years in the field lead you to your focus.

What are the most common disorders you treat?

Pfft. No disorders are common. Really, though, what I see most often are the differing manifestations of trauma, abuse, neglect and genetic predisposition. That amounts to anything from acute Paranoid Schizophrenia with Psychotic Delusion and Hallucination or Post Traumatic Stress Disorder to Anxiety, Depression and Violence.

Do you have any special certifications or training beyond your original graduate coursework?

Yes, I do, and you will, too. It is the nifty nature of our field. Hopefully, you will always seek to increase your knowledge—my desire is based in a frank assessment of my inadequacy when faced with the enormous responsibility to help support or guide a young life. If your motivation to keep training isn’t that grandiose, you will also be required by most programs to do so. Aside from my Masters in Christian Counseling (which is like having the ability to switch-hit from Clinical Psychotherapy to Pastoral Counseling as the patient dictates) I also have certifications in Motivational Interviewing and the Stages of Change, which I use often along side supervised Trauma Focused Cognitive Behavioral Therapy. I seek out new, best-fit models for my patients, as well, and have recently added Rational Emotive Behavioral Therapy for Depression to my REBT based college education and Schema Focused Therapy methods for working with a teen who is diagnosed with Borderline Personality Traits—something unusual for that age group. I will soon be certified in (EMDR) Eye Movement Desensitization and Reprocessing to target non-verbal trauma. I’m very excited about it. I’m not as excited about the travel, but that comes with the trainings.

How do you approach therapy or treatment? Do you use specific modalities, techniques, or interventions?

Well, I answered some of that above, but I’ll also add that I’ve recently said in conversation that “Some great therapists focus on the word Therapist in our title, and that helps make them great. I focus on the word Primary and…that makes me arrogant.” Which was a joke. But, I do focus on the primary, in that I believe you must tailor even your most minor interactions—let alone your modalities and treatment plan—entirely to your patient and their goals, abilities and welfare. You must know as much as you can about your patient, including the way they see the world, themselves and their disorder to tailor the best model to suit them. If you don’t know the best model, find it, get approval from your treatment team and psychiatrist (puh-lease!) and then use it. If you are not comfortable with that then refer the patient. In short, always do the best thing for your patient and never buy into the hype that you are that best thing.

What ethical and legal issues do you think are the most challenging or common?

Working in an in-patent setting the most challenging ethical issue is achieving the collaborative balance with your funding source, the insurance company. The insurance company seeks one thing, two ways. Primarily, they want to ensure that the patient is in the “least restrictive level of care possible” (Like not have them in a hospital when they can do outpatient therapy successfully). Secondarily, they want brief stays to pay for. It’s essentially the same thing for two different reasons. As a therapist, I’m seeking one thing and that’s the holistic, long term health of my patient. The goals are the same, just the time-table differs. If a kid is doing poorly, we all agree that they need more time paid for. But, if therapy is working, the kid is giving it their all and beginning to succeed—get ‘em out the door! The ethical part of it comes in terms of practice and internalization vs. fear and the pattern of failure. These kids have a deeply entrenched pattern of failure and have just begun to counteract years worth of esteem damage. I would prefer a length of time to practice the new way of life, screw it up, try again, succeed and repeat within treatment because I think that helps lower returns to treatment shortly after a discharge without practice.

The way I resolve this is through perspective. The insurance company is my customer, they want and deserve the best quality product (therapy) at the best value. The kid is my client and they’re paying for a service (not a product) which is help and support changing their life. So, I try to achieve both goals within the framework of that perspective.

Do you have an opinion on where you think the field of psychology is heading?

Hm. I want it to head toward a comprehensive deconstruction of walls. Drug and Alcohol vs. Mental Health. Bust down the wall. Scientific Medical Research vs. Holistic Methods. Boom. Different disciplines. Smash. The best work is done collaboratively with the least ego possible.

What do you enjoy most about your work?

The moment when the kid faces what they’ve been crushed by or running from, finds in themselves the power to win and realizes that they’ve had that power all along. Gets me every time.

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That was the interview, as it happened, I hope you enjoyed. Now, here in my treat bowl I have the boilous bounty of the blog!

Maybe think of them as zombies risen from the dead…and have a fun Halloween, internet!

Behind the Red Nose Part One and Part Two from 10/28 & 29/10 – Clown Fear, exposed! With interviews from actual clowns.
I have a Halloweener from 11/11/10 – The last of my introspective pieces on the personal value of Halloween as a tradition and why Christian values should allow it.
Psychotherapy Horror Stories from 10/13/11 – What can psychotherapists learn from horror movies?
For the Love of Fear from 10/31/11 – Why do we like to be scared?!

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