I have heard Nancy McWilliams speak a few times, including earlier this month. She engaged an audience of mostly non-psychodynamic clinicians all day. How did she do this? By leading with sense and accessibility. She’s a smart clinician first. guilfordjournals.com/doi/10.1521/...

I fear that we are two weeks away from protein infused CBT.

This is an AI summary of Gabbard’s “The Exit Line.” It is completely wrong and interprets the meaning of the paper backwards; Gabbard’s work states the exact opposite. AI is not an expert, it’s more like a con artist. “Artificial” Intelligence indeed.

For me, the crucial queries are: “What’s going on around here?” and “How did it come to happen?” - Edgar Levenson

Psychoanalysts can be arrogant. By interacting only with each other, they become increasingly certain of the correctness of their ideas. Consequently, each challenge from outside the discipline results in an ever-tighter “circling of the wagons” and an increase in defensive denial. - R. Bornstein

“When I came out to the waiting room, he [the patient] looked deeply shocked and said, “You don’t look like Glen Gabbard!” I told him I hoped he could go on with our consultation despite his disappointment.” - Glen Gabbard

I doubt that anyone will look back on this era of social media and say that it appealed to our better nature. For all the benefits these tools provide, we have to call them what they are: A splitting accelerant.

Although in plain English the word 𝑐𝑜𝑛𝑓𝑟𝑜𝑛𝑡𝑎𝑡𝑖𝑜𝑛 has a connotation of adversarial belligerence, confrontation as a therapeutic technique should be carried out with courtesy and tact and, above all, with genuine curiosity. - Frank Yeomans

“I’ve sometimes jokingly said that your functioning as a therapist could improve 31.6% if you would just substitute one word for another…’Both, and’ is one way, or ‘also’ vs. ‘really.’” Saying or thinking, ‘What you’re really feeling is…’ implies what you’re thinking is false. - Paul Wachtel

1/2 “Where analysts talk about unconscious processes, nonpsychoanalytic branches of psychological science employ a different label, 𝑖𝑚𝑝𝑙𝑖𝑐𝑖𝑡, in the belief that this term is more value neutral, scientific, and empirical…”

Many intuitively resonant ideas and common cultural notions come from the psychoanalytic tradition (e.g, identity crisis, inferiority complex, defense, projection) but are often not seen as psychoanalytic. There is an idea that if it makes sense, it isn’t psychoanalysis. - Nancy McWilliams

Alpha function acts on the data from a person’s total emotional experience…it renders this emotional experience comprehensible and meaningful…By naming it alpha function, Bion hoped to be able to keep the concept open to avoid the premature imposition of meaning. - Joan & Neville Symington

“My clinical experience with treatments that seemed to founder…because conflict and psychic pain that should have been verbalized were instead being expressed largely through somatic discharge.” - Joyce McDougall

Surprisingly, “One Battle After Another” is not about Therapy Twitter.

A patient communicates on three channels (verbal, non-verbal, reactions evoked in others). The therapist communicates this way, too. Thus, it’s vital for a therapist to believe in their approach. If the therapist speaks inauthentically, 2 out of 3 channels will be playing something different.

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

🧵 “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.

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

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

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

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-...

Salman Akhtar’s definition of humility:

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-...

Humility is often mentioned as 𝘢𝘯 important quality in a therapist, but given its impact on the other virtues, it might be 𝘵𝘩𝘦 most important quality in a therapist.

There is a difference between sharing knowledge and being a know-it-all; the first is a bid for connection, the second is a barrier to it.

Psychotherapy is an ongoing education in humility. -Nancy McWilliams

I knew I had been reading too much psychoanalytic literature when I said the clocks regressed by one hour.

Truly humble people, I suspect, never describe themselves as such; rather, they worry about their own pride, arrogance, and hubris. - Donna Orange

I was super excited to get a “Firefighters 2026 Calendar” but it turned out to be an IFS thing.

The seven primary emotional systems: SEEKING, RAGE, FEAR, LUST, CARE, GRIEF, PLAY - Jaak Panksepp

If only this were a cardigan, he could be “Therapist Batman”

This conversation captures what psychoanalytic thought has to offer, which is an understanding beyond the seemingly rational. youtu.be/a4b6XBVG034

Psychoanalysis is the disciplined study of whatever it is the patient does not want to know about himself. - Warren Poland

🧵 1/2 The envious person, instead of being aware of his envy, tries, usually unconsciously, to stir it up in other people, making others aware of his particular qualities and capacities…Of course, it creates further problems…

How people think psychotherapists look vs. how they actually look

The crucial element for becoming competent at any complicated endeavor is to experience feedback as desirable - feedback from supervisors, clients, colleagues, students, from reality. A pitch you cannot hit is itself a master teacher, not a humiliation. - Michael Karson

Accessible writing opens the door. It extends the reach of psychoanalytic theory to non-analytic clinicians. From there, people can seek out what fits with their interests and taste. Now kick back and relax with a copy of Bion’s “The Grid and Caesura”

There is always in our work a dimension that is beyond words…In all of us there are some things which will never be within our reach; there is always a mystery at the heart of every person, and therefore in our job as analysts. - Nina Coltart