TheDrOcker

@jesusrglez Love that.

R. Greenson is a good example of how personality and technique can sometimes take a backseat to theory in psychoanalysis (himself an Ego Psychologist). A very straightforward approach in his work enabled him to explore not only transference but phantasy👇🏻

@GrantHBrennerMD This is very well said. I don’t know about new approaches, but I would think that “seem to take too long” is important. If time is an obstacle then two paths forward could be find a faster way, and also improve ones ability to tolerate waiting.

One of the difficult things that comes up when people recognize developmental patterns and try to work on changing them is when one of the developmental patterns is when not trying or resisting direction was part of a pattern of survival in the face of an overbearing and/or absent caregiver. This becomes internalized into a very recalcitrant relationship pattern with oneself that requires not doing what would help in order to preserve a minimum sense of self-respect or preservation or something like that. This is where a lot of structured approaches will break down and wear less structured approaches may seem to take too long. Things that should help such as self-compassion based practice get pulled into the same dynamic. The problem with prescriptive approaches is because they're prescriptive. Not what they're prescribing. When these dynamics are in play. Insight is sometimes helpful but there has to be something which is different from any of the above for this pattern to actually change.

@KemtrupTweets I looked into this further and saw some literature that said 4 to 5 times per week can lead to change that may otherwise not be possible. Agree or disagree?

@drockerr That’s close to my point yeah

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

@FeistyKittyPie In psychoanalysis the patients problem over time can begin to look a lot like the analysts theories. Thats what this reminds me of.

Perhaps those of us (yes us, me included) who get too excited about brain scans as some authoritative source could learn a thing or two from a different field here.

Because in psychoanalysis we have associated the antisocial with the id and the prosocial with the superego, it has been difficult for us to see evil as superego-driven [however] the greater part of human evil is done not by ‘do-badders’ but by ‘do-gooders’ -D. Carveth

@FeistyKittyPie When i trained in ERP the first module was like “this is evidenced based everything else is trash”

When I was training in ERP, I was told to NOT help bring anxiety down even when patients were completely flooding: dissociating, dizzy, nauseous. The trainers claimed that if I lowered their anxiety it'll reinforce the idea that anxiety is dangerous. Retrospectively, fuck that.

@GrantHBrennerMD Can you give a couple examples? Ive been playing around w it too.

I am definitely doing meaningful and novel things with AI which never would have been possible before. Things I know a little bit about - enough to have workable ideas but not enough to technically implement - now become feasible. And many such things - where I would have had to pick one and take days to months, I can work on several in any given time span.

@VirgilMSW @JonathanShedler @APA Im also a SW. When I deal w NASW i’ve become entirely convinced that getting any help around depth therapy from these larger organizations is totally hopeless. I hope I’m not correct on that.

Jonathan do you have any ideas of how to reform or even reinvent these institutions? So many of us agree something is wrong, but until the system that holds our licenses and has institutional power changes, I see things continuing to devolve. All the incentives are pointed in the wrong direction in my view.

Too bad the the “experts”interviewed for this piece don’t understand unconscious mental life, displacement, and overdetermination. Skilled therapists focus on underlying psychology, not just surface complaints. Embarassing that @APA promoted it. apnews.com/article/iran-a…

@KemtrupTweets @jesusrglez Its not quite that way at my institute and im at a very old one. It used to be more that way but the older faculty who act like that get spanked for it the institute wants to stay relevant as much as they can.

@jesusrglez psychoanalytic therapy! “Gold” to use Bollas’ story is analysis, and psychoanalytic therapy is at best a sort of silver or maybe just cheap iron. That’s the attitude and the structure of the institutions, IMO.

Most analytic institutes have an option to become centers for training excellent, top-notch (forgive the term) psychoanalytic psychotherapists, centers for psychoanalytic “excellence.” But they want to build their institutions around “analysis,” a now dead thing.

@KemtrupTweets @jesusrglez Than 3 controls at 4x per week. I bet id learn more in some ways but then again a 4x per week treatment is unusual IME and a great learning opportunity…its just rare to find a willing patient.

@KemtrupTweets @jesusrglez Im at a large institute….beyond control cases there isnt much of a difference in the two types of therapy IMO. The stuff about pure gold, an analytic institute will accept anyone w a degree and a license. The admissions process is hardly challenging. 1/

@KemtrupTweets @jesusrglez No one seeks out analysis unless they are in the field or in unusual cases but i practice analytically no matter who i am treating (whatever the heck that means). 2/ Institutes do need to chill w the 4x per week control case requirement. Id rather have 6 controls at 2x per 2/

@FranArtHistory @StevenShorrock Yeah thats a problem…and common sadly.

@drockerr @StevenShorrock More like people being actively discriminatory and bullying towards others

It’s incredible to me how some psychotherapists and practicing psychologists behave. The first thing I’d do as a client or patient is look at the social media output of a therapist. This would exclude many, and not because of a difference in opinion. It’s just extraordinary.

@TimothyBCE @WillBredderman What did you replace them w ?

@WillBredderman This is the solution: you can’t just discontinue a bad habit, you have to replace it with better habit that gives you something you want more. I beat processed food and sugar addictions this way

Nearly every addiction therapy I'm aware of redirects the underlying compulsive behavior onto another activity. Even AA turns the impulse to drink into an impulse to go to a meeting. I'm not joking.

@PosthumousAlex @WillBredderman AA literally is about replacing alcohol with the spiritual connection found in meetings and a fake religion called 12 steps. Thats actually the whole point of AA. It works for many people and doesnt for even more but its sort if an insane solution.

@WillBredderman I don't know you, so no disrespect intended but that isn't how AA works at all.

@DrBradleyBoivin @JonathanShedler @evolvingwithdeb Was that example a treatment plan or a progress note? id love to see a minimal progress note.

@JonathanShedler @evolvingwithdeb I’ve been playing the game long enough to figure it out. Never had a claim denied. Passed every MCO chart/billing audit. There are ways to make the system work while still being true to the work itself and, more importantly, to the patient. Don’t sell out! #savingtalktherapy

Here's one reason we cannot assume patients can just tell us their treatment goals from the get-go. They may never have experienced another way of being, and so cannot conceive or envision what it would look like. Formulating goals may be a process—and a job for 2 minds, not 1.👇

@MGBHealthPlan hello, what is the process to file an appeal/complaint/grievance for adverse benefit determinations by the health plan?

@sbuehler Its complicated. Some people who are quite in touch w their bodies are out to lunch as are many analysts. Its all so individual regarding what ends up “working”. Ive done analysis and somatic experiencing. Both have merits.

One reason novice therapists w psychoanalytic leanings can “sound wise” by quoting writers, posting philosophical quips is b/c the discipline prioritizes mental understanding, concepts as a roadmap for direct experience Which does not add any real expertise in direct experience