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It is a serious thing
Just to be alive
On this fresh morning
In this broken world
Mary Oliver
English
Chris Larson
641 posts
Chris Larson
@Chris_a_larson
Therapist-in-training. Here for the psychotherapy content.
Orlando, FL Katılım Nisan 2021
191 Takip Edilen194 Takipçiler
@yalexos In session I often simply use the word "unaware" or "compulsive" if I get the feeling that "unconscious" will take us down an at-that-moment unfruitful path.
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@awaisaftab This is well in the background but the glorification you refer to carries the strange assumption that nominalism necessarily equates to pure relativism.
Also an odd conflation of critical realism with this stance contra actual critical realists like Michael Polanyi.
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These days, I find the glorification of diagnostic validity by long-standing DSM critics very annoying because their arguments are the same ones people were making 20 years ago and there is no attempt at all to engage with, or even any indication of an awareness of, recent philosophical literature on the subject.
psychiatrymargins.com/p/psychiatric-…
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@DoctorPerin It's a category mistake.
"What does this person need to be able to manage themselves and their relationships more effectively?"
is a categorically different question from
"What needs to change such that people like this do not suffer from these problems in the first place?"
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I’m all for systemic interventions to improve mental health outcomes, but until we live in a magical utopia we also gotta talk about personal responsibility
ADHD Memes@ADHDForReal
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@AlobhaPatrick Yeah, Bipolar absolutely exists. That said, I'm finding that bipolar II is a bit of a dumping ground diagnosis, esp. in messy outpatient clinics, for "difficult pt with mood instability and aggression that I can't quite square into a personality disorder."
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Bipolar disorder exists, and is highly consequential. Even life threatening in some cases due to extreme impulsivity.
Dr. Roger McFillin@DrMcFillin
Bipolar Disorder is a clinical description voted into existence by committee, refined through consensus, and then handed to patients as if it were a diagnosis in the same category as diabetes or multiple sclerosis.
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@FeistyKittyPie If we're doing this then you need to pilot a full rebranding of all concepts unfortunately. Oedipus, Electra, Paranoid-Schizoid.
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@proud_penelope Yeah, like playing an instrument. The greatest pianists do not play with total accuracy. Persistent imperfection is part of the art.
Understanding our mind and another's is much like that. Never totally accurate or right, but when done flexibly and well, is profoundly human.
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🧵An underrated aspect of reflective functioning is the ability to respect opacity: that we will never really know the mind of the other, let alone our own
So mentalizing isn’t really “reading people well,” as it is the ability to read people “well enough” in conjunction
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🧵Ok everyone! We are going to try a little exercise together:
Months ago I posts about all the notable early psychoanalysts who slept with their patients. Sleeping with their patients was very, very bad. VERY BAD!! But much of what these people wrote was wonderful, clinically
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But if the patient shows up to a session with nothing to repair, then nothing stronger can be built. A disruption and cracking of some element of their internal world has to be revealed so that it can be repaired.
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Seems like a good example of the oscillation Akhtar describes. If a patient shows up to a session with cracks in their internal world already felt then reparation is needed to strengthen those structures.
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I just read Akhtar‘s incredible paper on oscillation. At the end, he makes a developmental connection to his technical recommendations—the two poles of technique are like the paternal and maternal modes of relating to a child.
It made me think of a diff developmental connection.
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@DoctorPerin To me, online descriptions of "masking" typically sound like either 1) disavowed/repressed/dissociated self-states or 2) healthy defenses and object relations pathologized. Almost never like a primary lack of other mentalizing capacity (ie autism).
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“High-masking” requires a sophisticated understanding of higher-order social skills to calculate effective superficial responses. The more skillful someone is at this, the less likely autism is the most accurate diagnosis.
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@Chris_a_larson As a big Merton fan, I approve this message 🙌🏻
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🧵The more I look at the graph Mel is wisely criticizing, the more I’m going nuts because it’s like “A Drunk Take on Psychoanalysis,” and I feel the masochistic urge to explain/make parallels/try to make sense of it. So here we go 😂:
The Managers is perhaps a chopped up way to
Mel@the_mel_jar
An absolute fantasy. A hopeful fairy tale for children. “I have an undamaged and natural and pure Core Self.” Guys, this stopped being true the moment you were born into the world within relationships to Others. By the time you developed language, man oh man, was it truly over.
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@FeistyKittyPie Wait hold on you’re saying that BOTH avowal of aggression AND avowal of shared vulnerability is important?
Nah….
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It's upsetting to me that after my sharing of the perspective that avowal of aggression is important for a truly empathic perspective, I have sometimes been mistaken as someone who rails against empathy as a whole. So I'm setting the record straight here. Kohut rocks. Go empathy.
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Richard Geist on empathy:
"... He (Kohut) didn’t say that it was healing. He didn’t say that it was curative. He said that it was therapeutic. The way I hear that is that he meant that the existence of empathy facilitated other things that were, in fact, healing or curative."
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Makes me think of some of my most disorganized patients who need to remain unintelligible to themselves--they are certain that to understand themselves would be to understand horrors beyond their imagination.
It is easier to be manic or psychotic than to be themselves.
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"[Patients dedicated to the avoidance of reflection] are in need of 'recognition' rather than understanding."
From Bromberg's Standing in the Spaces.
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@proud_penelope Makes me think of McWilliams comment about sexualization as a defense and her insistence that the actual primitivity of a defense is determined by its usage and flexibility, not by the defense itself.
PS may tend to cause more issues, but it itself is not pathological.
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3/ Not to mention how depressing it is to notice that “borderline” “cluster b” and “feminized” have all become interchangeable slurs on here.
This rot has been spreading for a while
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PSA: Klein never said that once we reach the depressive position, we stay there forever.
The hope is that once we achieve the depressive position, we can traverse back and forth between PS and D without too much anxiety, and find ourselves in D more often
The PS position has
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the role that therapy and therapists have come to occupy in our social imaginary, especially post-COVID.
It seems like *that* conversation never gets off the ground though.
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So I feel like this conversation never goes anywhere. It feels less like a conversation of substance and more like vapid in-group/out-group signaling.
Which is unfortunate because there are really interesting conversations to be had about
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Seeing an uptick once again in the "therapy is political" conversation so I'm adding my unasked for two cents into the X void.
I think part of the problem with this conversation is how poorly beliefs are defined. What does it mean that "therapy is political?"
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