Nora

AMFT, Family Clinician. MA in Community Mental Health. Views are my own. (she/her)

[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.”

[5hahem @shaTIRED]

btw they’re capping how much federal loans a person can take out for graduate school to $20k a year. that doesn’t even cover the average tuition. they really don’t want the average americans to access education and that’s so wild to me.

[The Mel Jar @the_mel_jar]

They say that child therapy is parent work for a reason. Often, what we child therapists are attempting to do is to help parents better understand the child’s perspective, and to learn to tolerate the idea that the child may be experiencing things differently than the parents. 🧵

[Edward A. Perin - Psychologist @DoctorPerin]

Of all the therapy techniques and peripheral skills I’ve studied and practiced over the years I still find “listening” and “giving a shit” to be the most useful when sitting with someone in pain.

[Nora @abolishDSM]

I chuckle when the quality assurance manager writes to clinician to correct their notes and say that she needs this info asap so she can let the billing department know. The billing department is me. I am billing department. I am also a clinician with a higher caseload than them.

[Massimo @Rainmaker1973]

🚨 Confirmed: Schizophrenia’s “voices” are the brain mishearing its own thoughts.

For decades, neuroscientists have theorized that the "voices" heard by individuals with schizophrenia stem from the brain mistaking its own inner dialogue for external sounds. A groundbreaking study from the University of New South Wales has now provided direct evidence supporting this hypothesis through brainwave analysis.

Using electroencephalography (EEG) to monitor the brain’s electrical activity, researchers examined how individuals process their internal speech. Typically, when we speak—aloud or silently—the brain anticipates the sound of our voice and temporarily suppresses activity in the auditory cortex, the area responsible for processing external sounds, to differentiate self-generated thoughts from external stimuli.

However, in people experiencing auditory hallucinations, this predictive mechanism malfunctions. The study involved 142 participants, including those with schizophrenia who recently experienced hallucinations, others with the condition but no recent hallucinations, and a control group without a diagnosis.

Participants were instructed to mentally say “bah” or “bih” while hearing these sounds through headphones. In those who heard voices, a striking pattern emerged: their brains showed heightened activity in the auditory cortex when their imagined speech matched the external sound, rather than suppressing it as expected. This suggests the brain was processing internal thoughts as if they were external voices.

This sensory misclassification sheds light on why hallucinated voices feel vividly real, revealing them as a neurological error rather than mere imagination. The findings not only deepen our understanding of schizophrenia but also pave the way for earlier detection of psychosis, potentially enabling more timely and effective treatments.

["Corollary Discharge Dysfunction to Inner Speech and its Relationship to Auditory Verbal Hallucinations in Patients with Schizophrenia Spectrum Disorders." Schizophrenia Bulletin, 21 October 2025]

[Dr James Davies (PhD) 💭 @JDaviesPhD]

Maria A Oquendo, the new Chair of DSM-6 (yes it's coming) has received unrestricted educational grants and/or lecture fees form AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Otsuka, Pfizer, Sanofi-Aventis, and Shire. She receives royalties from the commercial use of....

[Jonathan Shedler @JonathanShedler]

The best therapists are not concerned with “modalities” when working with a patient

[Jonathan Shedler @JonathanShedler]

“A basic premise of psychodynamic thinking is that internal object relations* etched in neural networks from early childhood development tend to repeat themselves again and again in adult relationships”
—Glen Gabbard

*perceptions/expectations/mental representations of others

[Sigmund Freud ✍️ @SigmundFrrreud]

Neurosis is the inability to tolerate ambiguity.

[based pariah @_Trapitalism]

i don't even understand what "depression" is anymore it feels like every diagnosis they ever came up with were excuses for how capitalism brutalizes you. you're actually responding humanely to violence, capitalism calls it depression to pathologize us for not feeling like working

[Jonathan Shedler @JonathanShedler]

“We don't see the world as it is, we see it as we are”

―Anaïs Nin (and earlier sources, likely dating back to the Talmud)

[Princess @themultiplemom]

‘Good behavior’ is not always a sign of good parenting. Often, overly compliant children are not self-regulated; they are overwhelmed and people-pleasing out of fear.

[Christine Forner @assoc1counsell]

We are an alloparenting species. This means 4-6 adults are needed to raise one human infant. All of our scientific investigation into early life stress responses confirm this. It takes this many to tame our wild stress response systems and affective circuity. This is where we 1/2

[Jonathan Shedler @JonathanShedler]

There are two kind of therapists. Those who think they already know how to help you, and those who come to discover, with you, how to help you. Choose wisely.*

[Jonathan Shedler @JonathanShedler]

1/ As a therapist, your job is not to push an agenda on patients, create converts to a worldview, persuade, dissuade, approve, disapprove, affirm or disaffirm

It’s to help them know themselves more fully and so become more whole and live life more freely—on their terms not yours

[Jonathan Shedler @JonathanShedler]

1/ Most therapists would do well to focus less on “what to say” & more on “how to listen”

And if a patient expects us to have something to say or have an answer, it’s perfectly alright to say “I don't know” or “I don't understand yet, let's keep talking & see what else comes up”