Forensic & general psychiatrist. From fixated threat to psychotherapy. Retweets are not my opinion.

Melbourne, Australia
Joined July 2009
The benefits of psychotherapy don’t come from self-disclosure. They come from working through inner obstacles (like shame and fear of judgment) to self-disclosure. This work must happen in the therapy relationship. Take it outside the relationship and it’s no longer therapy. Psychotherapy works because there is skin in the game. In all relationships, including psychotherapy, there is vulnerability and risk. You may feel shamed. You may be judged. You may be rejected. Remove these risks and you remove the therapy. It becomes a meaningless illusion. It’s the illusion that there is such a thing as connection without vulnerability. There isn’t. It’s the illusion of understanding, without risk of misunderstanding. It’s the illusion of facing emotional risks, without actual bravery. It’s buying into a comforting lie. Real psychotherapy is never a game of pretend. It’s never about comforting illusion in place of difficult truth. It’s about facing ourselves honestly, in a real relationship that comes with real risk. This is how emotional change and growth happen. The core defining feature of real psychotherapy is facing the truth, and telling the truth, and living the truth. Not living in illusion. So many want a bypass. There is no bypass.
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“Good psychotherapy creates the conditions for its own expiration because the patient will no longer need us. As Winnicott noted, ‘We all hope our patients will finish with us and forget us, and they will find living itself to be the therapy that makes sense.’” —Nancy McWilliams
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The Ukrainian actress Tania Galakhova portrayed what it's like to live with depression 😢
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Read along with my Intro to Psychotherapy students!
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Some therapists speak of trauma work / shadow work / family of origin work / dream work / parts work / attachment work / etc. etc. as if they were separate things or special skill sets Psychodynamic therapist don’t use these terms. Frankly, they sound silly to us. They’re the bread and butter of what we do, day in day out We also have a special term for this kind of work. We call it “psychotherapy”
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Where do you think the most talented therapists are found?
2%Insurance network
11%Community Health
80%Private practice
6%Universities
731 votes • Final results
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Highly recommend getting this book or audiobook by Nancy McWilliams. Reading each chapter 3-4 times is required to really grasp the depth. This chapter on depressive personality is articulate, nuanced, and the best I have found written on it.
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I just failed a student for submitting an AI-written research paper, and she sent me an obviously AI-written email apologizing, asking if there is anything she can do to improve her grade. We are through the looking-glass, folks.
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What is the most poorly understood concept by therapists? I will go first: Reflective function
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NDIS spending will exceed defence spending and education spending by 2028-29 according to the forward estimates. $68 billion per annum.
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Jackie Rakov retweeted
Anyone with those beliefs should never be allowed to work in healthcare. Lifetime ban.
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Two nurses at Bankstown Hospital, located in Sydney's western suburbs, have been removed from their positions after declaring on video they would refuse to treat—and would kill—Israeli patients who presented for care. This marks the first time in Australian history that healthcare workers have openly declared their intent to murder patients based on nationality. Healthcare enjoys a special place in the Australian psyche. The fact that everyone—no matter who they are—can access the highest quality care through our public hospitals is a source of national pride. When you ask people why they live in Australia, healthcare is typically listed among the top five reasons why citizens stay, and migrants arrive. From the moment an Australian is born, they know that if they get sick or have an accident, they will be treated in hospital without receiving a bill. They can be confident the care will be of high quality. This is what makes the NSW Nurses Scandal such a bombshell. It rends a tear in a blanket of trust that all Australians experience as a birthright. The sight of nurses in NSW government uniform declaring murderous intent represents a fundamental break in the social compact. This social compact is grounded in a small-l liberal, egalitarian society. We pay high taxes that support our welfare system, schools, hospitals, and disability scheme. Australians accept this because our culture emphasises that "we're all in this together." This attitude was one reason why Australians were so compliant during Covid lockdowns. Because we are a small country, on a harsh, unforgiving landscape there is a much higher sense of collectivism in Australia as compared to the US. Rejecting the aristocratic class system of the Old World, Australia has a much stronger egalitarian spirit than the UK. The only comparable cultures are the high-trust nations of Scandinavia, similarly small nations with robust welfare systems. You can see the trust breaking down in real time in the faces of our health bureaucrats. In a press conference on the morning of Wednesday 12 Feb, the NSW Health Minister Ryan Park can be seen as visibly angry as he described the nurses' behaviour as "vile and disgusting," emphasising they will "never, ever, ever" work for NSW Health again. Holding back tears, the NSW Health Secretary opened her statement saying that "never in her wildest dreams" did she think she would have to address the media about staff threatening to murder patients. Yet while the emotion of these leaders is real, it is unlikely we will get complete honesty about what has happened here. The nurses responsible for bringing the NSW Health system into disrepute are from a minority group themselves. Referring to "Jahannam", the Arabic word for hell, and wearing a hijab, both of them speak the language of Islam. And the incident occurs against a backdrop of escalating antisemitism in Australia that has now entered the realm of domestic terrorism. From the mob chanting "Where's the Jews" at the Sydney Opera House less than 48 hours after the October 7 massacre, to the discovery of a caravan of explosives intended for a Sydney synagogue in January 2025, what began as street demonstrations has metastasised into organised terror. The NSW Nurses Scandal forces us to confront an uncomfortable, but urgent, question: If one group of Australians cannot safely access public healthcare—a basic right and necessity—can we still claim to be a "successful" multicultural society? That we are multicultural is a fact. The the claim we are successful is now under doubt. The reality today is that any Australian who is Jewish, appears Jewish, has a Jewish name, or simply supports Israel, may experience hesitancy when visiting a public hospital. For the first time in our history, Australians will have to consider the ethnic and political beliefs of their healthcare workers. Again, this is unprecedented. It represents a fundamental shift. The mateship ethos that defines Australian identity rests on a simple truth: we look after each other. We support Medicare because we believe in equal treatment for all. Never before have Australians had to worry about what clan, race, or political group their nurse belongs to. Such tribal considerations are alien to our culture. The shock in our health officials' faces reveals how deeply this has breached the social compact. The nurses have not just threatened individual patients—they have desecrated something that is sacred to Australians. Using the authority of our healthcare system to declare murderous intent against any group of Australians is more than a criminal act. It is a rejection of the foundational values that make Australia work. Such a problem must be named and addressed by our leaders. No bureaucratic action will be able to restore what will be lost if we fail to confront those who continue to reject Australian values while enjoying its benefits. Read my full piece for @Quillette in the next tweet 👇
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“The patient should give some indication of wanting not only change but 𝘵𝘰 𝘤𝘩𝘢𝘯𝘨𝘦, that is, of dissatisfaction with something that resides in the self” —Otto Kernberg When the patient recognizes that they are contributing to their own difficulties, it’s easy to develop a working alliance and shared treatment purpose The purpose is to understand how the patient is contributing to their difficulties and develop alternatives to that—so they don’t have to spend their lives repeating and reliving the same painful, self-defeating patterns. This becomes the shared work of psychotherapy When patients do not see that they are contributing to their own difficulties, the work of the therapy shifts. The work is now about helping the patient to recognize and understand their own role in their difficulties This is difficult work, requiring genuine therapeutic skill, sensitivity, tact, and compassion. It may take weeks or months to help the patient to truly grasp that changing their unhappy outcomes requires changing something about themselves There’s no foundation for doing any other work in therapy unless and until patient recognizes this and desires to change (Alternatively, if the patient really has no role in their difficulties, then their problems are not problems that psychotherapy can solve, and the patient has come to the wrong place. They may need help, but it’s not help that can be provided via a psychological treatment) If it becomes clear that it is impossible to create this foundation of shared purpose, treatment should not proceed. And the therapist must understand that treatment never really began. There was no working alliance and no foundation to build on
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An industrial dispute with the NSW’s hospital psychiatrists has reached a crisis with hundreds set to leave their jobs within days. 7NEWS.com.au @AngeliqueOpie7 #7NEWS
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1/10 ADHD and Sleep 🚨 Grab a ☕ (or skip it if it’s late!), and let’s discuss the intricate relationship between ADHD and Sleep ✅ AND Why Sleep in ADHD is a crucial piece of the puzzle!👇 #SleepScience
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🧵1/14 Is C-PTSD replacing BPD ? Why is BPD having to look over its shoulder ? 🚨 Let’s explore this shift 👇
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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
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“Psychological health is not merely the absence of symptoms. It is the positive presence of inner capacities and resources that allow people to live life with a greater sense of freedom and possibility" jonathanshedler.com/PDFs/She…
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1/ Listening non-judgmentally is not something therapists learn from a book or class. It takes years of work We can listen without judging because we have examined the dark corners of our own souls in personal psychotherapy. What you think shocking, we know to be simply human
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