Hello new followers! I am a psychologist in the great state of Ohio. I learned to be a therapist treating Vietnam Veterans. My dissertation is on positive change after trauma. My clients are Veterans, police officers, emergency care workers, and first-responders. And I make memes

Each theorist saw something true and missed something else. The field is not finished. Your patients will show you things none of them saw, if you let them, and one day, you will have to find words for what you have seen that are not borrowed from anyone.

I read your last process note. It was full of quotations. “As Winnicott says.” “In Bion’s terms.” “This felt like a paranoid-schizoid moment.” Each was apt. None of them helped me understand what was going on in the room. Here is what I would like instead: Tell me what you saw. Tell me what the patient said, in their words, and what you felt while they said it, in yours. Tell me what you said back and not what happened next. Only after that, if the theory fits, let it come and sit next to the material. Let it arrive as a guest.

The quickest way for a patient to lose power, choice, and privacy in therapy is for someone else to pay for it.

I regret to inform you that the best Mental Health program is getting comfortable with not knowing over and over again until you die.

In 1952 Winnicott wrote to Melanie Klein, who he admired, warning that her followers were turning her discoveries into a private language that had to be spoken correctly. Her ideas, he told her, would stay alive only if people rediscovered them in their own way and described them in their own words. He was more right than he knew.

Take your vacations, all of them. Do not confuse conferences and work trips with rest. Go somewhere beautiful and do nothing useful. The point of a vacation is not to escape yourself. That cannot actually be done.

The fee, by the way, is not separate from the treatment. A patient’s relation to paying you is as much a part of their inner life as their dreams. So is yours to being paid.

When a patient cancels, do not rush to fill the hour. Sit in the room for a while. Notice what comes up. Some therapists feel worthless when the hour is empty. Some feel relieved, then guilty for the relief. Some feel abandoned, which is interesting, because they would never say a patient abandoned them. Whatever comes up is yours to know, so that you do not discover it later in the middle of someone else’s session.

Seriously. Seeing or hearing death in real time changes you.

✍️ This week’s essay is up (3 min read) ❝ Seven distinctive features reliably distinguish psychodynamic psychotherapy from other forms of therapy. These differences are empirically observable in recordings and transcripts of therapy sessions. Read free here👇 jonathanshedler.substack.com…

After the First World War, inflation in Vienna wiped out Freud’s savings. He was in his sixties with a large family depending on him. He knew what it was like to need the next patient. It was when he wrote that an analyst should treat money matters with the same frankness as sexual ones, since people are hypocritical about both. Our training has mostly ignored that advice, and young practices pay for it. The fear of empty hours makes therapists do things they later regret.

Don’t stop being afraid. Sort fears into signals and fantasies. A rough rule: fantasies are mostly about you. Signals are mostly about the patient or the frame.