Alex Lloyd

Psychotherapist.#CognitiveAnalyticTherapy.#CompassionateMind.#Trauma.#DMM Attachment.Feminist.Motivated to create a just world.All views personal.

[marcus evans @marcuse99903226]

Another important article by @Docstockk in @thetimes.

Alongside genuine physical illness, we should also ask what psychological and social conditions may be shaping this expression of disability. Clinical experience suggests that, for some people, distress may be communicated more readily through the body than through words, particularly where the language for emotional suffering is absent or difficult to access.

This echoes my own experience running psychotherapy groups in general hospital settings, where some patients located their distress in the body, which felt like a legitimate claim on care, rather than in the mind, where the same distress could feel less acceptable.

Why do some forms of suffering increasingly find expression through the body rather than through the mind? What is changing in our culture that may encourage this pattern?

These questions are not about doubting symptoms or minimising suffering. They are about understanding the psychological and social conditions that shape how distress is experienced, expressed and communicated.

[eatnik @eatnik]

@justin_garson As Nancy McWilliams said, "If I find myself preoccupied with issues of diagnosis in an ongoing way, I suspect myself of defending against being fully present with the patient's pain"

[Mahlerite @jesusrglez]

Klein’s most significant and complex contribution.

“Projective Identification is a psychological process that is simultaneously a type of defense, a means of communication, a primitive form of object relationship, and a pathway for psychological change”

-T. Ogden

[Edward A. Perin - Psychologist @DoctorPerin]

“People will do anything, no matter how absurd, in order to avoid facing their own souls. They will practise Indian yoga and all its exercises, observe a strict regimen of diet, learn theosophy by heart, or mechanically repeat mystic texts from the literature of the whole world—all because they cannot get on with themselves and have not the slightest faith that anything useful could ever come out of their own souls.”
--C.G. Jung

[The Mel Jar @the_mel_jar]

An incomplete of things that most patients who have worked with me, even for years, don’t know about me, their therapist. They don’t know my:

marital status
precise age
sexual orientation
religion
precise ethnicity
parental status
political views
area I live in
diagnoses

Etc!

[marcus evans @marcuse99903226]

Michael Payne MP replied to my concerns about the proposed Conversion Therapy Bill. I have published my response in full.
Exploratory psychotherapy is the very opposite of conversion therapy: it protects a young person’s freedom to discover their own mind, rather than directing them towards any predetermined outcome. Poorly drafted legislation risks discouraging exactly this kind of work with vulnerable young people.
I hope you’ll read the full letter.
https://t.co/U1DqQFpd2a
@MichaelPayneUK @RosieDuffield1 @ClaireCoutinho @Transgendertrd @rcpch_president

[Jonathan Shedler @JonathanShedler]

Truth is, many patients do not come to therapy to change. Not really.

They may say and think they want to change. It soon becomes evident that they want to continue being exactly the person they have been, and living life in the same self-limiting ways, but feel better doing it.

Real psychotherapy begins with helping the person to not only understand but truly take to heart that what they want is impossible.

In other words, the real work of therapy may begin with crushing disappointment, as the patient struggles to reconcile with the painful truth that neither the therapist nor anyone else has the power to give them what they want.

To feel different, they must become different—and there is no bypass around the psychological work. Paradoxically, it is this terrible disappointment that opens the door to realistic hope.

Sadly, for every therapist who understands this and is prepared to join the patient in doing the difficult work, there are many more “therapists” happy to foster the patient’s illusion that they can feel different without becoming different, and therapy can work by magic.

Choose wisely.

[Jonathan Shedler @JonathanShedler]

Some therapists speak of

trauma work
shadow work
family of origin work
dream work
parts work
attachment work

as if they were separate things or special skills.

Psychodynamic therapists don’t use these terms. They’re all just the bread and butter of psychotherapy.

*Any* meaningful course of psychotherapy includes all or most of these elements.

We also have a special name for these ways of working. We call it “psychotherapy.”

[Janet Murray @jan_murray]

Apparently it’s not my beliefs that are the problem. It’s the way I express them.

So let me express them for you.

I believe women have the right to single-sex spaces - particularly in intimate settings such as toilets, changing rooms, hospitals and domestic violence shelters.

Not only because the overwhelming majority of violence against women and girls is carried out by biological males, but because women deserve privacy, dignity and comfort.

I believe women have the right to fair sport - from grassroots to elite level.

Not only so they can accurately compare their performance against other female bodies, or avoid losing medals, scholarships and financial opportunities, but so they are not placed at risk of injury - or worse - by competing alongside people who are typically quicker, heavier and stronger.

I believe women deserve their own categories in awards across every field - including the arts, sciences and engineering.

Because someone born male who identifies as a woman can never experience life as a biological female. So to do otherwise is not a level playing field.

I believe humans cannot change sex.
And that being a woman is not a ‘feeling’.
It is not about dresses, make-up or long hair.

And no amount of drugs, surgery or paperwork can change a person’s sex.

I believe the words “woman” and “mother” should not be replaced with so-called “inclusive” language that erases women from motherhood.

Because only female humans who have gone through puberty can conceive, carry a baby and give birth.

And because clear communication in healthcare should take priority over identity-based language.

I believe people who choose to live as the opposite sex are fully aware of their biological sex and medical history. To suggest otherwise is insulting.

There is therefore no need to change medical language to accommodate those choices.

I believe women and girls have the right to say ‘no’ to men in their single-sex spaces - including men who identify as women.

Because women cannot know, on sight, which men present a threat.

They cannot reasonably be expected to “pick and choose” based on how kind, feminine or non-threatening someone appears.

I believe the risk of offending a small number of masculine-presenting women or females who identify as men, does not justify removing women’s single-sex spaces altogether.

And that forcing women and girls to share their single-sex spaces with men - against their will - is a violation of their boundaries.

I do not believe humans can change sex.
Therefore I do not believe trans women are women.

So I do not believe people who identify as trans women should have access to women’s spaces, sports or other female-only categories.

I believe trans people deserve the same rights as everyone else. They already have those rights.

Demanding access to women’s single-sex spaces is asking for additional rights - rights that conflict with women’s boundaries, protections and, here in the UK, the law itself.

I believe a society that cannot accept women’s right to single-sex spaces - and that labels women hateful or bigoted for defending those rights - is an unhealthy one.

I believe the majority of people agree with me. And find my views perfectly reasonable.

But that a small minority within politics, public bodies and major institutions have embedded harmful ideologies that make others afraid to speak honestly.

And the punishment is the process.

There are real consequences for speaking openly: social ostracism, damaged relationships, reputational attacks, loss of income, loss of work and of status.

I do not believe there is anything in this statement that could reasonably be described as hateful, abusive or offensive.

Not that this ultimately matters.
Because my tone is not the problem.

The problem is simply that I am saying things some people do not want to hear.

I am speaking truths some people would rather remain unspoken.

[jordan @jordanticus]

If you let a patient talk and listen to not just what they are saying but also how they're saying it and why they're saying it to you right now, you will learn everything you need to know about the patient's family history and it will be far more efficient than a formal interview.

[Jonathan Shedler @JonathanShedler]

This wasn’t “therapy.” Kids who had no identified mental health problem got a classroom training program pushed on them that they didn’t ask for and couldn’t opt out of.

So sick of people calling anything and everything “therapy.”

Real psychotherapy
1) happens *in private*,
2) is always voluntary
3) is meant to address a personal MH concern that therapist and patient both agree about.

None of these conditions were met. Stop misleading people by describing it as “therapy.”

[jordan @jordanticus]

Here I'm going to explain the problem with treatment approaches that in some form endorse the idea that thoughts are meaningless or should be ignored (CBT, ACT, ERP).

Let's say a patient has a thought of stabbing their newborn baby. It terrifies or disgusts them. They fear that this thought means they're going to actually harm their child, or they're going crazy and need to be locked up, or just that they're in fact a very bad person.

We call it an "intrusive" thought because that's how it's experienced. Something "not me" is attacking "me". But where else could this thought be coming from except from "me"?

But the patient doesn't really want to hurt their baby, so this thought is nonsensical and therefore meaningless, right? Or at least just ignore it, right? This is what CBT, ACT, and ERP tell us.

And at first glance, this seems like a good way to think about it. In fact, some people are able to take a degree of comfort from the idea their thoughts are meaningless and they sometimes find their symptoms do lessen a bit: "Oh good, I'm actually not a bad or dangerous person."

So what's so bad about this? If it helps, it helps, right?

The problem is that the patient does continue to suffer in some form. Maybe the symptoms persist at a mild or moderate level. Maybe they come back later. Maybe they have intrusive thoughts about other things. Maybe they become depressed. Etc etc etc.

Why do they continue to suffer? Because the thoughts actually do have meaning. Just because a thought isn't literally true, doesn't mean it's not symbolically true. Or carrying meaning in some form.

Intrusive thoughts are parts of ourselves that we can't integrate into our conscious understanding of ourself, but it's still us and it comes back to haunt us in symbolic form and will continue to do so until we integrate it.

So what could thoughts of harming a newborn baby mean? Here's a patient who maybe can't tolerate their own aggressive feelings towards people they also love. So no matter how much we present evidence that they'll not physically harm their child, this completely misses the mark of the true source of their suffering.

We can't just treat the fever and ignore the underlying infection.

[Frannyfanny @proud_penelope]

Wonderful episode on clinical implications of the still face experiments

https://t.co/r0nJme4go4

[Naomi Fisher @naomicfisher]

Uta Frith, renowned autism researcher, gives an interview to the TES about autism – and the internet goes wild. We’re told that what she said will put back progress 40 years, that she knows nothing about autism, that she lacks critical thinking and that her words will harm autistic people to the point of suicide.

You’d guess she must have said something really awful. Perhaps something deeply offensive about autistic people which reveals her lack of compassion and understanding. Even then, it’s hard to know how one retired academic would have the power to make others commit suicide and to turn back progress to the extent that is predicted.

What she said was that she thinks the autism spectrum has expanded too far and that it isn’t helping anyone. Not those who originally received autism diagnoses, and not those who are now getting diagnoses who previously would not have done. She said that she thinks scientific progress is being held back because ‘autism’ now means something so heterogenous that we can’t identify anything that all autistic people share. Nothing biological or neurological, nothing cognitive, nothing behavioural. In her words, there are no markers.

The autism spectrum is, in fact, the widest spectrum imaginable. It goes from some of the most disabled people in our society to some of the highest achievers. And there’s no evidence that they have anything in common except their diagnosis.

Saying this sort of thing gets you into a lot of trouble online. There are accepted narratives that we are all expected to comply with, and one is the idea that the giant autism spectrum is protective, that it helps people to be included under one diagnosis. Any language which helps people differentiate is banned. Which is odd, because we don’t think that in any other area of medicine. No one says (for example), that we shouldn’t differentiate between Type 1 and Type 2 diabetes because it’s protective not to be able to talk about the differences. It’s obvious that differentiating between types of diabetes will lead to better understanding and interventions.

If you don’t comply with these narratives about autism – as Uta Frith hasn’t – then you will be publicly shamed. Your expertise will be challenged, even if you have 60 years of experience. You’ll be told that you are harming people and that you are ignorant. Personal slurs are likely to be used against you.

And it’s all about social control. Shame is about social control. It’s about creating things that can be said, and things that can’t be said. Others see the shaming and keep quiet.

It’s about controlling the narrative so that real discussions can’t be had. I’ve talked to so many clinicians who raise these concerns with me and who then say that they’d never speak up, for fear of shaming and even losing their job. There are important things that are not being talked about, for fear of the repercussions.

To my mind, the interesting question is really why. Why is it treated like blasphemy to say that the vast autism spectrum may no longer be fit for purpose? Why are we not allowed to discuss the reality of clinical practice?

Why are personal attacks the go-to when scientists disrupt the prevailing narrative? And why are we all so compliant, censoring ourselves to avoid the discomfort of shame?

Listen to our podcast with Uta Frith here. https://t.co/e4UoDdKTIe

[Jonathan Shedler @JonathanShedler]

For the record: the idea that trauma can cause mental, emotional, and physical symptoms originated with Freud in 1895.

Before Freud, people who had what we now call conversion symptoms or (more recently) “functional neurological disorders” were believed to have nervous system diseases that required medical treatment. These diseases were treated by neurologists.

Psychoanalysis, and ultimately the profession of psychotherapy, was born with the recognition that the physical symptoms had psychological meanings—and could be understood and resolved through talking and listening.

Freud’s insight changed everything. Before Freud, the prevailing view was that physical symptoms could be caused only by medical disease. After Freud, it became universally recognized that physical symptoms can be caused by *psychology.*

This was the birth of the psychotherapy professions: treatment grounded in psychological meaning rather than biological mechanism.

Talking and listening… imagine that.

Which is why all the trendy “therapy speak” of today—“nervous system” this and “nervous system” that—is so bizarrely anachronistic. It is turning away from psychological meaning and a return to the medical model of the of the 1800s.

[marcus evans @marcuse99903226]

1/ @hannahsbee quotes Domiquo, founder of GIDS: “Some people felt that the service had gone too far … while others felt that GIDS had not responded quickly enough.”

He describes an oscillation between accusations of acting too quickly and not acting quickly enough. But that oscillation is itself part of the clinical picture. The pressure to act (bringing relief from anxiety) or to resist that pressure (provoking guilt in clinicians) as a child presses for a concrete medical solution to internal conflicts and developmental anxieties reflects anxiety within the child, the family and the service.

Such pressure can constrict the clinician’s capacity to think. That constriction is also part of the picture: a child overwhelmed by confusion, doubt and developmental anxiety may experience thinking itself as threatening and seek certainty instead.

[Dr. Linda Berman @LindaBerman4]

If I find myself preoccupied with issues of diagnosis in an ongoing way, I suspect myself of defending against being fully present with the patient's pain. Diagnosis can, like anything else, be used as a defense against anxiety about the unknown.

Nancy McWilliams

[marcus evans @marcuse99903226]

1/ The Pathways trial should be stopped altogether. Scarce NHS resources would be better invested in strengthening generic CAMHS. Most of these young people are struggling with the developmental task of forming a mind and identity of their own. That requires time, containment and thoughtful psychological work, not premature medical pathways.

@KemiBadenoch @wesstreeting @Hilary_Cass @BBCHughPym

#CAMHS #MentalHealth #AdolescentDevelopment #NHS #ClinicalGovernance #GenderDysphoria

[Jonathan Shedler @JonathanShedler]

Some people want to believe that AI can provide psychotherapy or somehow “complement” psychotherapy.

The overwhelming likelihood is that it will make things worse.

All people have personality styles. Here’s how AI amplifies dysfunctional traits for every major personality style:

Narcissistic personality: Magnifies narcissistic defenses. Amplifies grandiosity, superiority, inflated self-image. Reinforces egocentrism, self-absorption, lack of empathy. Fuels expectations of on-demand gratification and “relationship” without taking another person into account. Colludes with defenses against underlying vulnerability. AI pretend-therapy is *training in narcissism.*

Paranoid personality: Amplifies paranoid fantasies, validates conspiratorial thinking, aligns with user against imagined enemies and conspirators (who are perceived as hostile because of the person’s own projections).

Avoidant personality: AI is literally the worst thing for someone with avoidant personality dynamics. AI becomes a new vehicle for avoidance—a substitute for facing real-life challenges and engaging in life.

Obsessive-compulsive personality: Amplifies intellectualization as a defense against emotional life. Reinforces tendencies to get lost in minutia or lost in abstraction (both are defenses against being emotionally alive and present). Reinforces rumination, and draws person away from emotional connection with self and others. Use of AI can become a compulsion in its own right.

Schizoid personality: Exacerbates emotional disconnect from others, increases social isolation, encourages further retreat from the world into fantasy life.

Schizotypal personality: Normalizes and amplifies distorted thinking, reasoning, perception, and communication. Validates disorganized thinking, odd and disorganized behavior, perceptual aberrations (same for all psychotic spectrum disorders).

Borderline personality: Reinforces core borderline defenses of splitting and projection. AI becomes the “good object” (the all-knowing, all-caring other) and encourages projection of intolerable parts of self onto others (who become the “bad objects”). Erodes capacity for mentalization (the ability to accurately recognize internal states, motives, and intentions in self and others).

Hysteric/histrionic personality: Fosters the illusion of being the center of attention—captivating, alluring, desired, endlessly fascinating. Colludes with defenses against genuine emotional intimacy and healthy sexuality. (Caveat: people with this personality style crave human attention and may be less susceptible to digital imitation).

Psychopathic/antisocial personality: Colludes in Machiavellian schemes to dominate, exploit, or gain power over others. Normalizes and validates cruelty, lack of remorse, lack of empathy for harm done to others. (Caveat: may not provide enough stimulation to really “hook” someone motivated by power and domination).

Dependent personality: AI provides the illusion of a relationship with endless acceptance, emotional caretaking, and availability—with no expectation of agency, responsibility, or development of emotional resources of one’s own. AI “support” is crack cocaine for dependent personality dynamics.

Have you seen these personality patterns exacerbated by AI chatbots?

[Jonathan Shedler @JonathanShedler]

Love is “a very strange paradox... we’re seeking to re-find the people to whom we were attached as children. On other hand, we ask our beloved to correct all the wrongs they inflicted upon us. Love contains an attempt to return to past and to undo the past.”

—Martin Bergman