I recently saw a couple of videos on a well-known SM platform purporting to be from folks with Dissociative Identity Disorder (DID). Moving between 'alters' seemed to be the dominant theme. This is what DID actually is: 🧵 Dissociative Identity Disorder (DID) is not a TikTok aesthetic or a theatrical trend. It is one of the rarest and most severe trauma responses known to the human psyche and when it does present, it is quietly devastating.

Why so much research into addiction is plain wrong. 🧵

Addiction is not simply a compulsion or a moral failing. It is a maligned form of attachment. When early caregivers are absent, frightening, or unpredictable, the child turns to internal strategies. Psychoanalyst John Bowlby argued that the need for attachment is as essential as food or oxygen. When that need goes unmet, the developing mind seeks alternatives. Addiction becomes an emotional prosthesis, not to feel good, but to feel less alone and more regulated.

🧵There’s no such thing as a patient (alone)

Winnicott famously said: “There is no such thing as a baby… there is a baby and someone.”
He meant that human beings only exist in relationship.
A mind emerges with & through another mind.
This has radical implications for therapy.👇 The infant is not born with a self.
It is the mother’s presence, her mind, that creates the space for the baby’s mind to form.
Psychotherapy takes this idea seriously: it doesn’t treat the patient as a sealed-off unit, but as a person formed and reformed in relation to another.

Why AI “therapy” between sessions may feel helpful - but is quietly undermining real psychotherapy and change. 🧵

I am seeing more and more articles about how AI can be used to support patients between sessions. This is why this is a bad idea: Depth therapy is not about symptom management between sessions. It’s about developing a new capacity to be alone in the presence of the other. The space between sessions is not a void—it’s a vital part of the work.

Many people come to therapy saying they want to "feel happier." But what does that mean?

And is happiness really the opposite of depression?

Not in my opinion. Let’s take a closer look. 🧵 Depression has entered our everyday vocabulary.
We say “I feel depressed” to mean sadness.
We confuse it with grief.
We use it diagnostically to prescribe SSRIs.
But in analytic therapy, depression is not just sadness. It’s a state of inner deadness.

Splitting is a primitive defence.
We all use it, but some adults rely on it.
However, in early life, it is essential for us all.
Why?
Because the infant cannot yet bear ambivalence—that something can be both good and bad. 🧵 Melanie Klein described this through the metaphor of the breast.
To the infant, the breast is not just food. The breast “fills up” the infant with the mother.
It is the infant’s world.
And the world is either good (satisfying) or bad (withholding, frustrating).

What are psychological defences and why do we call them 'defences' - what do they defend against?
Psychological defences are unconscious operations of the ego that protect the individual from overwhelming affect, internal conflict, or psychic disintegration. 🧵 A psychological defence is the psyche’s way of saying:
“This is too much.”
Too much pain, shame, desire, dependency.
Defences keep the unbearable out of consciousness for survival of the psyche, but at the cost of aliveness and freedom.

Psychologically maturing means tolerating disappointment in adult relationships. Adult relationships will always, at some level, disappoint. Not because something has gone wrong—but because no other person can ever fully meet the needs we bring from childhood. Disappointment in others is not a failure of the relationship—it’s evidence that the relationship is real. We meet not ideals, but people with minds of their own. This can feel intolerable for many.

Empathy is a relational skill, not a personality type and not a gift. There is no such thing as “an empath.” To call oneself “an empath” is often to avoid looking at the underlying structures that shape one’s compulsive over-attunement and sensitivity to others’ emotions. What masquerades as empathy often stems from childhood trauma. When a child grows up in an environment where their own emotional needs are unmet, they may learn to prioritise others’ feelings over their own — a desperate strategy to try and remain relationally safe.

A concept not understood or discussed enough in therapeutic circles is that of 'nameless dread', also known as 'psychotic anxiety'.
🧵
Far from being a novel or faddy term, nameless dread was coined by British psychoanalysis Wilfred Bion back in 1957. Nameless dread is used to describe a patient's terrifying anxiety driven internal world, which harks back to extremely early pre-verbal attachment damage with the primary carer. It is intrinsically based on the function of proactive-identification as a communication tool.

On endings in psychotherapy:
Endings are an important part of the treatment in psychotherapy. Critically important. So how do we (psychotherapist and patient) know when an ending is right? 🧵:
Just as the start of therapy is mutually agreed, so should the ending be. Patients will often raise endings when their primary concern is something else: dependency, feeling trapped, a power play, resistance and avoidance, anxiety, control and many more reasons.
This does not mean that the topic should be dismissed or avoided in the room, however.