Here is a list of things to practice/work on (in sequence of which you should focus on) to become a “good enough” beginner-ish therapist. IMO. FWIW. It’s all stuff we continue to refine and master over years, but you can get the hang of it enough to be “good enough” first. 1/ 1. Be MORE curious. Each pt is like a book or a movie. What will each session reveal. What does this patient know about themselves? What might be unclear. How does this fit or not with various narratives you learn in class, from books? The scientific, philosophical, artistic 2/

Here’s a thing the internet does not seem to answer well, so maybe it’s good to discuss this for the public and other therapists:

What’s the difference btw psychoanalysis and psychoanalytic therapy?

I recently said psychoanalytic therapy is growing and psychoanalysis is “dead”*

I still believe it. Dead like DVDs or soda fountains on mink stolls. Sure some people still have them. I mean, if it turned out they still had soda fountains in Paraguay, I wouldn’t say they aren’t “dead.”

I say psychoanalysis is “dead” like DVDs or soda fountains

You can understand the problem here without knowing anything about IFS.

Without a deep respect for the principle of neutrality, a therapist WILL become a guru or a cult leader with a team of gurus.

The only question is how bad of a guru will they be.

1/7

https://twitter.com/nymag/status/1983854528115175829

A guru: “I KNOW what is wrong. I KNOW what you should do. My knowledge can save you. Who I am is an example of how you should be. I am modeling how to live. I make you feel listened to, so then you can listen to my knowledge.” 2/7

A great start to “season 2” of wtf is life. A convo on couples therapy @proud_penelope @wtf_is_life_pod



It got me thinking about how I would articulate what couples therapy is.

A brief primer, let me know what you’d disagree with. 1/22 1. Couples often begin relationships in some way idealizing each other or only focusing on the other person in more idealized ways. This doesn’t have to be as extreme as not even seeing your partner’s psych problems and how they can be harmful, but in focusing your emotions on 2/

Kinda curious what you all think of this.

1. The broadness of dimensional, spectrum based ADHD and autism diagnoses makes it easy to funnel patients into those diagnostic categories even in cases where it is unclear whether the pt fits the criteria fully. 2. The “network model” of psychological problems means that a lot of times patients don’t neatly fit into one category like GAD or MDD or this or that personality disorder, so it’s often a bit harder to assign one of those diagnoses than another.

link.springer.com/article/10.100…

The thing CBT (and Stoicism) gets right is that you can separate the content of a feeling from other parts of it, eg bodily jumpiness, and if you reflect on the content, the feeling has less control over you, seems less intense, causes less problematic acting out, etc. The related things CBT gets wrong:

1. It has a small minded view of what emotional content tends to be: cognitive “appraisals” of states of affairs in the world, which translatable to relatively simple propositions, eg “that is dangerous to me.”

This is an interesting article that makes important points, but I think it exemplifies an error that left-leaning critics of psychiatry make.

Here for ex, the author argues we need to focus on

“non-police crisis response systems…. fully funding and

newrepublic.com/article/191887… robustly staffing public schools and childcare programs that are essential for child development and parental well-being…. ensuring universal access to mental health support… psychiatry and therapy… direct provision of economic security, housing, and social connection.

Critics of psychotherapy like Shrier conflate "focusing on, thinking about, reflecting on" ones feelings and psychological problems with a sense that one's feelings justify claims like "I have been wronged and deserve redress" or "I am in the right" or "I have been victimized" or "I deserve more attention" or even "these feelings entitle me to things."

Their is a claim that therapy and parenting that work to increase, insight and self-understanding or the capacity to express things create a sense of being justified to have a kind of self-ishness,

An interesting article.

A good deal of therapy is increasing a patient’s capacity to take something unexpressed (whether you call it feeling, “raw affect,” etc.) that is creating problematic patterns of thought, feeling, and action and putting it “into” symbolic form, ie

https://twitter.com/lfeldmanbarrett/status/1879543746150490126

into thought, imagery, words, concepts, etc.

I don’t necessarily agree that emotions are constructed all the way down. Perhaps there are “core” emotions that almost all people have, (eg fear) that are in some way “innate,” even if they “grow” during development, more along the

Criticisms of psychiatry/psychotherapy seem to fall into two camps:

1. You the individual patient don’t really have a problem. Society has problems. You have differences that are being stigmatized as problems.

2. The tools used to help individuals are best seen as something

https://twitter.com/awaisaftab/status/1835668933430350228

other than “medical.” Depth Psychotherapy is a meaningful relationship. Skills training therapies (breathing, meditation, stoic advice CBT) is more like a life hack. And psych meds only modify feelings, they definitely don’t cure, and they really don’t treat mental problems.

The most pernicious idea in all of psychotherapy is the idea that psychological growth only happens or mostly happens by being given “tools.” In reality, psychological growth and personality development occur in a psychotherapy relationship over time. It’s a developmental process One reason this idea is so pernicious is that it leads to people believing they can’t change their psychological dispositions, their personality, ie they can’t change “themselves.” They can only better manage and control themselves with better tools. This is a depressing notion

This a fascinating paper (though I wish there was less philosophy jargon.)

The idea that MH research and treatment ought to be about understanding and changing “self-patterns” seems entirely right to me, and this is a good direction to go in, away from the DSM categorical system

https://twitter.com/RRitunnano/status/1811050102628221021

That said, I think one thing needs to be said. In an interview (structured or semi-structures) a patient/participant often cannot articulate their “self-patterns” very well. Rather, in clinical work that explores these patterns -in the context of a “frame,” neutrality, etc- the

Bion’s lasting contribution to psychoanalysis was emphasizing the idea that a lack of capacity to sculpt raw affect (beta elements, uncontained feeling) into thoughts, images, and describable emotions (alpha elements, contained feeling) is a major source of psychopathology, and these problem ms arising from a lack of capacity to symbolize (alpha function) require a different sort of response from a psychotherapist than problems arising from internal conflicts.

For Bion, sometimes the problem is not, as he explains, that an unconscious feeling can’t

The main, first lesson for psychotherapists is not practicing what you could or should say, but how not to say things while still being receptive and having presence. This is actually very hard and requires unlearning some of what comes naturally while making use of other authentic responses.

We could call this the art of silence, but it doesn’t always mean saying nothing at all or not making noises or facial expressions such that one becomes blank, a blank screen, or a full on “still face experiment.”

The biggest concern people tend to have about therapy is that it’s just endless listening, rehashing negative thoughts, blaming parents and partners, which will result in becoming coddled and endlessly dependent on the therapist, all for the benefit of the therapist. “Better to be self-reliant, independent, and able to “JUST get over it.” What’s the point of talking about all of this shit?”

It’s an odd fear when you think about it, because it only makes sense as something that could plausibly happen, if the person believes that they

A thread on an under discussed problem with the cognitivist/CBT model for formulating (and treating) a wide variety of cases where a patient’s behavior is in some way avoidant as being irrational anxiety. Think about why it is that some people cloister themselves at home in an extreme way, zone out in front of a screen. In many cases, there is a felt need to push the world away and thereby create a bubble of privacy, in which the person maintains a kind of total control.

My take:

1. Each person’s mental disorder is mental activity (obvious)

2. Each person’s mental activity is (identical to or entirely determined by) activity of that person’s brain. To deny this is to deny physicalism and risk violation of what Kim calls “the causal closure of

https://twitter.com/pessoabrain/status/1771202174120309112

the physical world.”

3. In that sense, mental disorders are accurately described as disorders arising from brain activity or disorders OF brain activity.

4. However, as @awaisaftab and others explained, the categories we use to describe mental disorders don’t imply that the

As Awais explains, the old Popperian idea, echoed by (the laudable!) @paulbloomatyale , that psychoanalytic interpretations are unfalsifiable (if you agree that your prob is you hate your mother, the analyst is right, and if you disagree that’s ALSO evidence the

https://twitter.com/awaisaftab/status/1768987900689928220

analyst is right,” heads I win, tails you lose) and therefore unscientific is based on a deep misunderstanding of how psychoanalysis is practiced.

I think Freud occasionally opens himself to this objection by overly focusing on the accuracy of interpretations. I’m not defending

There are lots of different things that make different people anti-psychotherapy, including bad experiences with psychotherapy.

And also some people are anti-psychotherapy cause fascism is anti-psychotherapy. That is a thing you can see today and at the origins of psychotherapy. The reason is that fascism or fascism-lite is opposed to subtlety, complexity, and above all anything that gets in the way of what we call “splitting,” ie making people or groups of people (cultures, nations, races.all good or all bad.

Some people cannot help but see psychotherapy as either a paid reassuring friend OR a teacher who teaches you self-help strategies and advises you OR a technician who performs a technique on you, gives you ketamine and asks questions. Real psychotherapy is none of these things. Real psychotherapy can be, at least in some cases, co-existent with these things, eg you’d can teach a few skills, though adding elements to psychotherapy also often gets in the way of the core function of psychotherapy.

Brief therapy is idealized for very understandable reasons. If most people can become resilient, functional, no longer fitting criteria for a dx, in fulfilling relationships by growing to therapy for a few months, life is not so scary, not so awful. And maybe we can find a magic form of brief therapy, Presto Change-o Therapy, PCT that uses what we know about neurons and the most recent psych paper on things that you can say that are associated with lower cortisol and reports of self-esteem. If we can find PCT research will show it to be so great, esp for