I eventually believed that I knew myself well enough to challenge the ghost and drive him out. But I should have known better. Self-knowledge is not the same as a cure. From Ian McEwans’ ‘What We Can Know.’

Idealizations are built on sand. -Recurring lesson

“It is hoped that the therapist, because of greater psychological integration resulting from his own developmental experience & analysis, is less frightened of, & less prone to run from [highly charged, painful, conflict-laden] feelings than is the patient” - Ogden

Anyone whose fondest images of self reflect unrealistic notions of superiority, and who runs into evidence that he or she is only human, may attempt to restore self-esteem by exerting power. McWilliams

🧵 Drinking less in the new year. I've seen online and in my personal life that many people are setting New Year's Resolutions to drink less or quit drinking altogether. A few thoughts from a therapist's perspective:

A key moment in therapy for those who have experienced neglect & unmet developmental needs is when the therapist can bear and witness this pain, tolerate the grief that they went unmet, and facilitate the new experience of receiving care and updating one’s self-understanding.

The inner world is not the unmoved mover or uncaused cause, but part of a powerful web of reciprocal forces, as much a product of the person's way of life as the cause. Paul Wachtel, Cyclical Psychodynamics and the Contextual Self

Sure, there's virtue signaling, but there's also vice signaling, intelligent signaling, slacker signaling, nihilist signaling, educated signaling, self-taught signaling, friendly signaling, leave-me-alone signaling, etc. The list goes on...

Growth as a therapist requires the willingness to be uncomfortable. Studying theory you don’t quite understand, trying interventions you don’t know will work, going in directions where you don’t know where you’ll end up. Otherwise one’s clinicial vision and repertoire will remain limited.

The hardest, recurring psychological task of my life has been learning to accept the absurdity of existence, to see ambition and achievement for the false gods they are, and to understand, truly understand, how one can flourish in what looks, from the outside, like mediocrity.

suspecting at least part of the reason why humility is considered a “silent” virtue is because of its somewhat paradoxical nature in that the more we (truly) possess it, the less likely we are to know that and if / when we’re sure we have it, we almost certainly don’t

Rupture/repair as exposure: The worst relational fears can be survivable and one doesn’t have to shrink to prevent these fears from materializing so much in the future. The ground is more solid than anticipated & there’s more room to be oneself. There’s more room for authenticity & intimacy.

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

Anxiety can be secondary to guilt. It's hard to feel settled if there's a fear that one has always done something wrong. Understanding this inclination can help differentiate one's moral compass from a hypervigilance organized around a vague sense of badness.

🧵 1/3 Some of my favorite quotes speak to the paradoxes inherent in psychotherapy: If the analyst cannot be experienced as a new object, analysis never gets under way; if he cannot be experienced as an old one, it never ends. - Jay Greenberg

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I think these dynamics become more deeply problematic with marginalized patients. The powerful therapist, perched high atop their place of privilege and knowing, bestows wisdom upon the simple fool unable to educated themself. As Gherovici often repeats, even the poor can afford an unconscious.

Healthy groups don’t demand conformity to belong.

‘Every analytic pair is engaged from the outset in the task of creating a way of talking together that is adequate to give expression both to the patient's fear of the truth and to the patient's need to know the truth of his or her experience.’

I’m happy to share that I’ve started my own private practice. I’ll be seeing individuals virtually anywhere in CA. Feel free to check out my website for more info and to connect. www.nadeemhasanpsyd.com

Sam to Michael in The Big Chill, 1983

“A rigid allegiance to one or the other type of analytic thinking can narrow the way one listens to the patient. Worse, it can lead to a situation where the analyst does not listen at all because his theory offers him a prepackaged and formulaic understanding.” - Akhtar, S. (2012).

The foolish reject what they see, not what they think. The wise reject what they think, not what they see. Huang Po

#LRP it would be unfortunate indeed for patients if health care providers were unable to conceptualize any role for the current political climate in the etiology of whatever they were treating because of the privilege afforded them by their race, gender identity, sexuality, and/or citizenship

🧵Our clients can often tell how comfortable we are in feeling, receiving, and discussing different topics.  Whether they sense their grief might be met with empathy & understanding.

the sense in which relational trauma can be significantly remitted by a number of modalities but can only be cured by relationship

Contemporary psychoanalysis can be summed up in a single sentence: We treat ourselves as we were treated, and the only way to really learn to treat ourselves differently is to be treated differently. There’s nothing magical or unscientific about this. - Michael Karson

“In this world … sin that pays its way can travel freely and without a passport; whereas Virtue, if a pauper, is stopped at all frontiers.” - Herman Melville

Harry Stack Sullivan is purported to have said, “God keep me from a clever psychoanalyst!” Truly, humility is the beginning of wisdom. - Edgar Levenson

Most gossip is envy in disguise. Matt Haig

Visionaries see beyond the ideologies of our time.

I've told this story before; my [white cishet well-resourced] ex-therapist once made a comment that I "might be happier if I didn't talk about hot button issues" on SM like race/sexuality/gender/etc. It came across as so dismissive to me &my actual life, much as I'm sure he was trying to be useful

🧵Clinical psychology is different than other medical professions, in part, because there’s an honoring of the individual’s will & values. While these factors play apart in medicine more broadly, thoughtful therapists consider cultural, values, & agency when thinking about a patient’s mental health.

Humility does not mean thinking less of yourself than other people, nor does it mean having a low opinion of your own gifts. It means freedom from thinking about yourself at all. - William Temple (cited in Marcus, 2012)

Learn a range of theories; digest them well enough to hold them and use them lightly.

Spending time in the wilderness lends to an immersion in beauty where anywhere you look there’s something that’s interesting, beautiful, or awe inspiring. Spending longer periods of time lends to making this noticing a habit to bring into your everyday life.

I’m going to try to cross post on X and Bluesky (my handle there is @jefffine-thomas.bsky.social) so if you prefer one, you can find my account there.

Grandiosity and the practice of psychotherapy do not mix. Humility might be the most important quality in a therapist.

Psychological advice that espouses to make difficult psychological tasks easy to solve is ultimately alienating when it falls short and leaves people with the sense that they’re beyond the strategies that work for others.

Epiphanies don’t change your life but what you do with them can. Andre Agassi

If you listen quietly sometimes you can hear the theorist’s traumas, aversions, unmet needs, conflicts, resentments, etc. And how the theory itself can be riddled with pleas of being heard, getting back at an ancestral object, feeling tied up in knots, etc. The observer isn’t neutral.

Our psyches transcend the weight of the world, but sometimes that weight is colossal.

“Feeling your pain is what makes movement possible, while turning away from it ensures you will stay stuck in it. Perhaps this is what the psychoanalyst Bion was exploring when he wrote that good therapy should ‘increase the patient’s capacity for suffering’”. www.theguardian.com/lifeandstyle...

Carl Rogers on being real in groups: I can speak very personally about this because I feel that risk-taking is one of the many things I myself have learned from experience in encounter groups. Though I do not always live up to it, I have learned that there is basically nothing to be afraid of.

the sense in which, when people tell you this isn’t their first rodeo the instruction is sometimes to say “well then you need to find a way to make it your first rodeo” #BeginnersMind

He who is constituted to bear any how to live can find almost any why. -Masochism

cc: therapists

The basic units in Sullivan's interpersonal theory are the interpersonal field and the relational configurations that derive from it. The individual psyche, in this view, is a part and reflection of a larger whole, and is inconceivable outside of a social matrix. Greenberg & Mitchell

When guilt is intolerable and unacknowledged, it can be projected. The self-reproach that comes from not meeting a standard can be experienced as aggression coming from a critical other. One may hold a grudge, lash out at another, without awareness that the bully comes from within.

🧵 Corrective experiences can come in different doses, with different intensities. While the term can invoke the notion of a singular, powerful new experience, the more subtle, micro-corrective experiences can be deeply rich, paradigm shifting themselves, and worthy of clinical attention.