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Comment by alfanick | Hacker News Reader

"All of our Shimmer ADHD Coaches are licensed or certified mental health professionals or have extensive experience with ADHD & undergo our Shimmer Coach Training program developed alongside our clinical advisors Dr. Amin Azzam (MD, MA), Dr. Anil Chacko (PhD), and our Head ADHD Coaching Psychologist Xenia Angevin."

What is "undergo our Shimmer Coach Training program developed alongside our clinical advisors Dr. Amin Azzam (MD, MA), Dr. Anil Chacko (PhD), and our Head ADHD Coaching Psychologist Xenia Angevi"?

Are they doctors or not? Psychologists or not? AI or not? There is so much mumbo jumbo and scams and pseudo medicine in psychology related issues, that this sentence simply reads as "yeah trust us, some of us are doctors, people who are doing the work, are not".

Also amount of usage of word "coaching" is abusive. Are coaches respectable? Do they have credentials? Why coaches and not psychologist or psychotherapist?

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Appreciate this question, it's one we've gotten a lot and quite frankly I agree we haven't nailed the best way to articulate it. To answer a few of your questions... - We don't use psychologists or psychotherapists as the front-line helper because there is a severe shortage of them and our main goal is accessibility. There is a provider shortage (psychologists, psychiatrists, therapists, etc.) in the US and most places in the world - Depending on someone's severity, helpers can include parents/teachers, peer support specialists, mentors, coaches, therapists, psychiatrists, the list goes on (I tried to broadly categorize from least to most intensive); our service does not aim to support the most severe. Anyone who screens with high degree of Mh impairment is not suggested to use Shimmer (and we have screening in the onboarding process) - Frankly, depending who you ask, you'll get a different answer for "are coaches respectable". Coaching is a modality that is "up and coming" because of (1) the need for more providers and subclinical support services, and (2) the credentialing / reimbursement models are evolving... see next point: - We align our model most closely to Health & Wellness Coaching, which is estimated to be reimbursed by next year: https://www.wellcoachesschool.com/post/medicare-moves-advanc...

Overall though, we use PhDs/psychiatrists/master-level coaches to supervise, create protocols, trainings, etc. and use coaches to deliver. (Not AI). Our coaches are either credentialed by ICF (International Coaching Federation) like BetterUp or Ginger or Lyra's coaches, NB-HWC (National Board - Health & Wellness Coaching), or have masters-level psych degree and go through our training.

Happy to expand on any of the above!

You say you haven't found a way to articulate it. You should articulate it exactly the way you do in this comment.

You are not providing licensed medical services. Just come out and say it, since it's true. Yes, saying that will cause people to distrust you, and well it should. You are right about there being a shortage, but there is no substitute for a real doctor.

That said, being upfront about it instead of trying to beat around the bush or make excuses doesn't help you. It only serves to make you even more untrustworthy. Your attempts to obscure the fact that you aren't providing real medical service only suggests that you know in your heart that what you are providing is not the same. If you believed your "coaches" were good enough, you wouldn't have to do anything at all to hide the fact that they were not real doctors. You could just come out and say it.

Shimmer is NOT clinical and we do NOT provide licensed medical services. We are most definitely not trying to substitute a real doctor. Full stop. We hope that is clear in all of our communications and website, and do NOT try to obscure that.

However, we do a lot of work to work with the right experts (which include clinicians, psychiatrists, etc.) to ensure what we do it safe, follows best practice, is science-backed, and is effective. And we definitely want to highlight this work that has been done and the importance of it.

We will update the language to better reflect this immediately.

> Shimmer is NOT clinical and we do NOT provide licensed medical services

In which case I personally find the phrase "All of our Shimmer ADHD Coaches are licensed or certified mental health professionals" to be quite deceptive.

Thank you for pinpointing this. I re-read many times, and I agree with you. I've just re-written the whole section with our Lead Coaching Psychologist, Xenia.

Your website has photos of the doctors for the "care team" and coaches buried under a link. Come on, just be uprfront with people.

please elaborate on which licenses and certifications they have. Can I confirm those credentials, how will I know if they are industry recognized and respected instead of your own in-house certification.

None of them are our own in-house certifications. We haven't designed that yet, however we are considering it. Not meant to replace incoming certifications in the short- or medium-term, but to reward coaches for their learning and work and for common language. Example credentials of our coaches are: ICF, NB-HWC, MSW, PhD, EMCC, PsyD, LCSW, LMFT. Not all coaches have all of those credentials—it'll differ by coach.

> Not all coaches have all of those credentials—it'll differ by coach.

What decides who gets what coach? Is it a triage based on symptom severity or first-come-first-serve?

Or highest paid best coach..

This was an excerpt of a longer message; we did not claim all our coaches are licensed or certified mental health professionals.

Original wording: All of our Shimmer ADHD Coaches are licensed or certified mental health professionals* or have extensive experience with ADHD & undergo our Shimmer Coach Training program

Even the full original wording doesn't align with what you later said:

> Overall though, we use PhDs/psychiatrists/master-level coaches to supervise, create protocols, trainings, etc. and use coaches to deliver. (Not AI). Our coaches are either credentialed by ICF (International Coaching Federation) like BetterUp or Ginger or Lyra's coaches, NB-HWC (National Board - Health & Wellness Coaching), or have masters-level psych degree and go through our training.

If the licensed or certified mental health professionals aren't actually hands-on with your clients, it's awfully misleading to say that all of your coaches are licensed or certified mental health professionals or blah blah blah. If you were being honest, you'd skip the nonsense about using mental health professionals as coaches and just say that your coaches go through your training program and are supported by mental health professionals--you know, the actual truth.

Just updated the language in our FAQ for this!

> quite frankly I agree we haven't nailed the best way to articulate it.

You've certainly nailed the best way to articulate "we haven't worked out how to best phrase our bullshit to fly under the radar" though.

We've just changed our language with the support of our care team and the folks in this thread! Super open to more suggestions if it can better represent what we're doing (ADHD Coaching)

Looks like the same bait and switch Dr. K (Healthy Gamer) did. Put a real MD on the poster, and once they sign up hook your customers with people with 3 weeks of "professional training".

But honestly, that can be a win. A good process (with a person you resonate with) can go further than a medical degree. Personal opinion, based on lots of experience.

Thanks for this comment—you've nailed it. The service we're providing in it's very nature is not medical and instead encompasses support functions like accountability, celebration of the member, helping the member feel "seen and heard", etc. Many of our members have not got that from their doctors, nor do they expect it given the doctors role. We advocate for layering the services you need together (e.g. I have a doctor, psychiatrist, coach, right now.) and our coaches work hard to communicate the role of a coach and the boundaries.

Providing "not a medical service" but advertising it using explicitly medical terminology appears to be the root of the problem, don't you think?

If a fitness trainer started throwing around things like "clients reported reduction of sciatica symptoms" you would of course assume they are licensed physical therapists and that you are treating sciatica. They could just as easily say "pain management through exercise" and not get caught in that kind of credential limbo.

We definitely are not trying to pass as a medical service. However, we do our due diligence to make sure we have medical staff on board to advise us on our protocols, services, train our staff, supervise our staff, and to stand in if there is any escalation needed. We hope it's clear Dr. Anil himself is not coaching and very happy to make things more clear by adding his title to the front of the card.

> We definitely are not trying to pass as a medical service.

> HSA/FSA-eligible.

Try harder?

healthcare and medicine aren't synonymous

psychologists, mental health therapists, physical therapists, occupational therapists, pharmacists, and so on, do not practice medicine - but the services they provide can be paid for with HSA and FSA money

https://en.wikipedia.org/wiki/Allied_health_professions

Technicalities don't matter, explicitly calling it out creates a false connection in readers brains. Like how some snake oil treatments say "FDA cleared" because they know consumers don't know what it means.

I disagree. This isn't about technicalities. I think it's about you assuming that others draw a "false connection" just because you saw one. Most people don't see HSA/FSA and automatically assume that a service is medical care. HSA/FSA funds are for healthcare-RELATED expenses and cover lots of things that aren't medical co-pays or medication: sunscreen, condoms, breast milk pumps, glasses or contacts, health-related home improvements (e.g., wheelchair ramps, hand rails), transportation for medical care, weight loss programs, menstrual care products, band-aids etc. All of those things are healthcare-related, but they're clearly not medical care.

There's nothing wrong with stating the objective reality that the cost of Shimmer is HSA/FSA-eligible. HSA/FSA-eligibility is directly relevant to one of Shimmer's key goals, making ADHD coaching accessible to people who can't afford traditional coaching. Using HSA/FSA funds brings down the overall cost significantly, so it's going to be a factor when budgeting. It isn't even close the same thing as snake oil treatments claiming to be "FDA cleared." Consumers may not realize that "FDA cleared" is an absolutely meaningless phrase, but I think we can agree that most adults know the difference between a condom and a licensed medical professional dispensing FDA-approved medication.

"HSA/FSA-eligible" is a legitimate, accurate phrase to describe the services Shimmer provides. Plus, anyone who has a HSA/FSA has most likely received education or literature about it through the company providing it for them (typically their employer). They're not reading this post thinking, "Since I can pay for this with the account that I use to buy sunscreen and band-aids, I will surely see a physician and get drugs." Personally, I thought, "Gee, I wish I had a HSA/FSA so I could use it to pay for this health-related service." All brains are different, especially ADHD brains. It's unhelpful to assume they'll all draw the same false conclusion as you did.

I don't think that's a particularly fair point - HSA/FSA eligibility is a billing related question. There are plenty of counseling services that aren't run by formally accredited folks that can achieve HSA/FSA eligibility. The billing arrangement isn't particularly relevant - I do agree that it'd be good to be more forward about the fact that you'll be talking to someone without formal accreditation.

Thank you for this comment, we've changed the language to reflect this last point on formal medical accreditation, and clarified that even if they do have medical credentials, in Shimmer's capacity they will be practicing ADHD coaching

It's absurd to claim that you're not trying to pass as a medical service when you're offering coaching for a neurological condition.

You can argue medical vs healthcare or whatever semantics you want but if it quacks like a duck it's a duck.

Is my golf coach a physical therapist or a physical movement coach? He's been helping me improve my swing around an injury I had dirt biking.

If your golf coach is helping you with your golf swing, I'd say that he's a golf coach.

My grandma once helped me with my math homework, was she a mathematician?

You might get lucky with your golf coach. There are people that went to medical school for that though. Your choice.

She was able to help you though. You don't need a PhD in mathematics to be able to answer some math questions.

Positive human interaction goes a long way.

A good school would provide this. Does that make them a medical service? Or is this actually educational?

It's a totally coherent position to hold that the name 'ADHD' gestures at a real thing, but also reject the medicalization of that thing (or, more weakly, that that thing can/should be addressed solely medically). The predominance of the 'medical lens' in addressing cognitive differences is reflected in the language available for naming and describing those things, whether you actually agree with it or not.

The notion that ADHD 'really is' a neurological disorder and 'really isn't' anything else misunderstands the purpose of psychiatric diagnostic categories like ADHD in the first place. Psychiatrists and psychologists aren't in the business of ontology, and clinicians especially aren't.

Take it from someone who has it: this is a stupidly narrow way to think about ADHD.

You honestly could have fooled me. The amount of preaching, unfalsifiable theories and casuistry that goes on in the ADHD space is beyond the pale.

Executive function theory, delayed rewards theory, everywhere you go, when the axioms of the presenter changes, so does the "root cause" of ADHD change.

Granted it's common for these problems to pop up every where in online media the past five years or so...

... but when Law and Order SVU episodes from the 90s have more empirical cause-and-effect rigor to their detective stories than half the opinions-masquerading-as-theories in the ADHD space, then I find his skepticism understandable and I empathize with it.

I wish it were not true. I deeply, deeply crave a scientist in a lab coat to point to a chain of chemicals that describe the problem in concrete unarguable terms. The smoking gun, if you will. Something Feynman and Einstein (so to speak) could analyze, criticize and come up sucessfully defeated in attempting to prove the theory wrong, admitting the shown evidence and resulting theory is true.

We see instead research universities pouring money and big minds into Diffusion Tensor Imaging, doing hundreds/thousands of high resolution scans on kids' brains who obviously have ADHD and not only being unable to find the root cause of the problem, but they cannot even show a difference in the data that relates to ADHD at all.

Wtf is going on...

It is probably deeply impolite for me to say this, because I'm directly challenging your livelihood and it's 'more good' if I just ignore your website and move on.

To be clear, I don't work at Shimmer or any place centered on treating ADHD or helping people with it. Idek if Shimmer's services are useful.

I just want to push back on the notion that 'this is a neurological disorder' is the only acceptable or useful way to think about ADHD.

To your point, I think it's clear that the world hasn't really figured out what ADHD is yet. That is, we haven't figured out the best way to think or talk about it, let alone treat it.

That's why I think it's important to hold onto that label with a light touch, and an understanding that our conception of the problem is likely to change a lot in the future. The 'real core' that we do know about ADHD is in the common struggles of people, situated as they are, who have ADHD-like symptoms and experiences. Those are worth addressing with anything that helps, and if you have those struggles yourself you know you can't wait for an ideal 'final answer' from scientific or other authorities to try to improve your life.

All that said it's way easier to be comfortable with non-commercial, community-oriented efforts of people sharing their experiences and trying to figure out what works for them in an ad-hoc way. Companies offering solutions to people, especially people who fear that their ADHD-ish struggles might cost them their livelihood or are destabilizing their lives, do have to prove themselves trustworthy and effective somehow and there's a lot of room for scammy bullshit with something like this. I don't disagree with the skepticism so much as the scientism and medicalism.

Just recently found about his youtube channel and have found his content to be quite beneficial. Did not know that he'd done this. Can I read about this anywhere? There seems to be a lot of folks who are critical about him.

I don't know about the details, but even simply from watching HealthyGamerGG videos (which are quite good), the way he pushes his group counseling service(?) using essentially volunteers(??) who are licensed through him does seem suspect. Guess enshittification applies even to internet individuals.

I mentioned this in the main comment but I believe if you try to sign up they make it clear it’s not professional mental health service.

That's fair. I'm not accusing him of pretending it's professional. More like it seems dubious of him trying to push his side hustle in his regular programming. It's like he's presenting a paid service as the natural progression from his free advice. And as if his trained coaches are a proxy for himself.

I think calling Dr. K a bait and switch is a bit unfair. They make it very explicit before signing up that it’s not medical care and that it’s just a coach and not a mental health professional.

Unless they changed the onboarding process, it’s made obvious to the user what it is.

You're absolutely right about the onboarding process. It's very clear that Shimmer does not provide medical care. I think some people just don't realize that doctors exist outside of medical practices. "MD" is a title earned by completing a medical degree, not a job title. There's no reason to assume someone with an MD is acting in the capacity of medication-dispensing doctor at all times. Medical expertise is clearly relevant for the position of "clinical advisor" for an ADHD-related service. Many, if not most, Shimmer users use coaching as an add-on to first line medical treatments and/or therapy. It makes perfect sense to have someone on board who's well-versed in the medical side of ADHD treatment. Operating an ADHD coaching program without someone knowledgeable in that area would be downright dangerous. I'm glad Shimmer has a MD on their team to cover all the bases.

What I've seen from most of these services is they essentially hire independent contractors with experience in a related field. They "train" them with a series of required videos then send them on their way.

Not saying that's what this is doing, but that's what this whole industry does. Unfortunately, there simply aren't enough health care providers.

I think people often forget how poor the quality of an average health care provider truly is.

I would argue that most therapist are incompetent, undertrained, and potentially more damaging than helpful. Of course, there are absolute diamonds in the roughs, but they are few and far between in my (and many others') experience.

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