BiteSize Therapy

As this article wonderfully illustrates, the spurning of psychoanalytic thought has led to serious deficiencies in training programs.

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“Shouldn’t a therapist be excellent at understanding symptoms, wise about people, and extraordinary at relationship maintenance?”
- Michael Karson (2018)

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“This is, of course, exactly what it means, but clinicians hear it in a pathologizing context, as if you just said that you want to be the best member of a family. When Tom Brady discusses his pursuit of excellence, no one chides him for making the other quarterbacks feel bad…”

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“The whole idea of a treatment manual or a programmed approach is that therapeutic expertise is not needed to implement it. Some colleagues treat the desire to become excellent as if you were trying to surpass both them and your patients….”

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“In much of contemporary psychotherapy, 𝑒𝑥𝑐𝑒𝑙𝑙𝑒𝑛𝑐𝑒 is a dirty word. In many programs focused on so-called evidence based treatment - which has become a synonym for manualized or at least simplified treatments - excellence is relevant only to writing the manual…”

An AI therapist will know you about as well as Spotify Wrapped.

a man in a suit and tie is screaming and says i want the truth ALT: a man in a suit and tie is screaming and says i want the truth

Rascal’s neighborly discussions be like… 🤣

“Psychotherapy is no simple life hack. In our age of the quick fix, therapy is a long-term commitment that requires patience and nuance on both sides.”
- Aaron Balick

The practice of psychotherapy 𝑙𝑜𝑜𝑘𝑠 much easier than it is. Once trainees get in the chair, illusions of ease fall away.

This is a niche post for therapists 😅👏🏻

Don’t forget about turn signaling

If we’re fighting about validation, does that mean we’re not fighting about neutrality? 🤣

𝐸𝑥𝑖𝑠𝑡𝑒𝑛𝑡𝑖𝑎𝑙 𝑛𝑜𝑡𝑎𝑟𝑦 𝑝𝑢𝑏𝑙𝑖𝑐…my fanciful term for perhaps one of the most frequent and fundamental of all transferences: the need to share life experiences with someone else…Our experiences need to be shared, confirmed, ratified…after which we somehow feel different about them.
- James S. Grotstein

A joke tells of two analysts who meet on the street. One says to the other, “Hello, how are you?” The other wonders darkly to himself, “I wonder what he means by that?”
- Herbert Schlesinger, 𝘌𝘯𝘥𝘪𝘯𝘨𝘴 & 𝘉𝘦𝘨𝘪𝘯𝘯𝘪𝘯𝘨𝘴

Was buying this book an ACT of faith? 🤣

The Age of Acronyms "Little by little and letter by letter, acronyms obscure the essence of psychotherapy." Stephanie Foster

A therapeutic brand for every human nook and cranny is the profession chasing its own tail. Rather than collecting tools for every situation, we should focus on fundamentals that work in most situations.

www.psychiatrymargins.com/p/the-age-of...

“We don’t refer to people based on their theoretical allegiances. We refer to people based on our sense of their character.”
- Lee Grossman (2023)

We are all more human than otherwise and, in the consulting room, we are probably more ourselves than otherwise.

I have referred to the importance of economy in making interpretations…Most things that we think of to say, even quite complicated things, can be pruned.
- Nina Coltart

This is the most elegant account. Don’t tell @rascality.bsky.social I said that 🤣

It is always important that we leave room for a patient to do something with an interpretation beyond just agreeing with it or disagreeing.
- Patrick Casement

Insights occur when a person feels safe to have them.
- Alan Rappoport (1997)

Defenses, even when they have painful consequences, are comfortable in the sense that they lower anxiety. Forgoing the defenses raises anxiety, so there is discomfort inherent in therapeutic progress.
- Nat Kuhn

The supply of interpretations far exceeds the demand.
- Harry Stack Sullivan

It is much easier to talk about psychotherapy than it is to do it.

www.psychiatrymargins.com/p/from-here-...

I have double-checked the spelling of “accommodation” a million times in my life 😂

Salman Akhtar’s definition of humility:

Akhtar (2019) lists the silent virtues as: Patience, Curiosity, Privacy, Intimacy, Humility, and Dignity.
I don’t see “Rascality” on there - time for a second edition 🤣

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Rascal’s consult live shot

I wonder if some of the problem is definitional. “Validation” is part of both the everyday and clinical vocabulary (a bit like the word ‘neutrality’). I find when clinicians have a real conversation, off social media, there is a much more reasonable consensus.

In the collegial sphere, the majority of eye-rolling events can be traced back to the nearest better-knower. This is the person who travels with a portable lectern so that they can speechify on-the-go.

www.psychiatrymargins.com/p/from-here-...