Psychotherapist https://teapaw.org/t.co/iPd5T9mEIX
Joined March 2026
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The return of my Substack articles! This week's topic addresses the types of criticisms that therapists face online and in media through the lens of object relations in an attempt to better understand where it comes from.
Shoutout to @NickTaber who I mention in the article. While I don't agree with all of his takes, I believe it's important for the field to have its critics, lest we lose perspective of what we're trying to address.
corygradlcsw.substack.com/p/…
Cory Grad retweeted
The transmission of clinical wisdom to the next generation of therapists isn’t really happening and it’s so important you acknowledge that, because I’m aging and when I die, I need to be reassured that nothing new or good will outlast me or be born independent of me
Around the time of COVID, when telehealth restrictions relaxed and there was a spike in demand for mental health services, private equity viewed the field as a “fragmented market.” In financial terms, this meant there was no dominant business, only a series of scattered small to midsize businesses.
This is considered a market error that must be corrected, and whoever could correct it would make a ridiculous amount of money. Of course, what these “corrections” bring usually has little to no value for therapy. Instead, clinicians are turned into cogs in the Corporate Profit Engine.
Parasites come in many shapes and forms. Sometimes it’s Big Box Therapy places that pay peanuts while the therapist sees 35+ patients a week. Then there are online platforms that ultimately want your independent practice to be dependent on their infrastructure. In addition, there are billing services, EHR systems, and credentialing programs with a similar objective: getting you to surrender significant control to these platforms. All of these entities are good at finding the pain points of being a therapist, and pain points are the first things targeted when making a sale.
In the eyes of these businesses, an independent clinician is an under-optimized asset. Keep this in mind whenever you think about entering some type of arrangement with these entities: a bunch of tech and finance bros, who have never been in therapy and don’t give a shit about it, drummed up a business model designed to get the maximum ROI out of you.
Cory Grad retweeted
All 4 of these problems have contributed to the decline of psychotherapy.
Cory Grad retweeted
Many of us are trying to get the mainstream world to see the difference between quality therapy vs. basically pleasant bureaucrat management sessions.
Jonathan is trying.
Cory Grad retweeted
There is a theory that knowledge that must be transmitted generationally is lost permanently if not transmitted for (I think) two generations. It can’t be brought back because no one knows how to do it anymore. I think the therapy professions may have crossed that point.
Cory Grad retweeted
Howdy.
Going Live today on EweTewb at 12:30pm PST. Link in bio.
Topics:
1. pain + therapy
2. “validation” in therapy
3. ADHD engagement bait online
4. Are Mental illnesses merely responses to societal stressors or constraints?
5. Boredom in marriages in couples therapy.
See yall soon! @SystemicTexism @RyanMalphrus @CoryGrad_LCSW @sfowler @Careerflex @AMHPUSA @psychodynamobs @angpeacock1111 @PrimalHex
Cory Grad retweeted
Constantly and desperately seeking certainty will probably cause you more suffering than just embracing the fact that you live in an uncertain world.
You don’t know what’s coming next… And? All the more reason to live now to the fullest.
Be as good as you can be, to yourself and others. Work with what you’ve got. This is the lemonade we’ve been speaking of.
Cory Grad retweeted
I may say something controversial.
You can't run mental health services that are overstretched and overwhelmed for years, where clinicians are forced to prioritise high risk, raise the bar for entry and cut anything seen as a "luxury", and then expect junior doctors to develop a high standard of knowledge and skill.
What they learn instead is how to manage risk and reject referrals.
In a system like this, a lot is treated as a “luxury”:
• the therapeutic value of the relationship itself, and of contact with a team (before, it was the status quo. Now patients are not kept open without a clear “intervention”, while the relationship itself can be the intervention)
• psychotherapy skills integrated in practice
• a psychiatrist seeing a patient when there is no medication need
One of the most frustrating phrases I heard in my NHS consultant years was: "I'm not going to prescribe for this patient, so there's no point in seeing them."
At first I thought this came from more biologically oriented colleagues. But when resources are this limited, even caring, formulation-focused psychiatrists end up working the same way.
Trainees learn that this is normal. Few people have time to add: "It shouldn't be like this. It's because of a lack of resources."
So, as generations change, expertise narrows to risk and caseload management.
The RCPsych is clearly aware of this, and the push to bring formulation into training is a good step against the current. My worry is that it becomes another tick-box: something to evidence during training, before trainees go back to copying what they see consultants do on a daily basis.
Psychotherapy training is often treated the same way: do your two cases, attend Balint, get signed off, move on.
For five years I taught psychiatrists in the West Midlands how to integrate psychotherapy and lifestyle skills into everyday practice. The idea is that these skills are not a box to tick, but tools to use in every clinical encounter. Not something to have signed off and forget about. But courses won't change much.
What's needed is less pressure on the system, so that the people who care still have the space to pass on what good care looks like.
P.S. This isn't about any specific trust. It's about a trend across mental health services.
Cory Grad retweeted
It is a tragedy that a Pfizer-owned, nine-question questionnaire is all it takes for a primary care doctor to prescribe drugs they do not understand to treat a condition they do not understand.
And it is a long-overdue relief to have RFK bringing attention to this tragedy.
Robert F Kennedy Jr on the dangers of SSRIs:
"I’ve watched people come off SSRIs....I watched a family member get off them after a couple of years, and she was suicidal literally every day. She woke up every morning and said, ‘I don’t want to live.’ She said, ‘The only reason I’m staying alive is for you guys, for the family.’
That’s heartbreaking to hear from a family member. And I’ve heard that from hundreds and hundreds of people, the same story again and again. It can be prolonged, and for many patients it’s completely unexpected.
Physicians often handle this by saying, ‘This is your original symptoms reasserting themselves, get back on the SSRIs,’ and they get locked into a lifetime cycle that, for many patients, is cataclysmic. It’s a system failure."
RFJ Jr at the MAHA Institute at the Mental Health & Overmedicalization Summit May 4, 2026
@MikhailaFuller @_innercompass @MAHA_Institute
Cory Grad retweeted
PHQ-9, depression screener, even worse than you think.
Not only do we inappropriately use this 9-question generic questionnaire made by pharma to diagnose depression, but also:
• It is wrong (false positive) 2/3 of the time.
• 1/2 (almost) of those who test negative still get the meds.
I am glad that we are finally looking into overprescribing and overdiagnosing more seriously.
REF: 2/3 false positive DOI - 10.1186/1471-244X-12-73
42% get meds with negative PHQ-9 DOI - 10.1136/bmj.b750
Cory Grad retweeted
Therapists on the internet are neither your therapist nor your parent, yes — but tell that to your unconscious!
Who are therapists on the internet?
Answer 1: total strangers to you.
Answer 2: whatever you want us to be.
Perhaps you want to feel disappointment, and alienation?
Cory Grad retweeted
Also stoicism was invented by Ancient Greeks. What they meant by emotionality and what a modern neurotic WASP means by emotionality is… different
They mean “don’t feel like you /must/ murder the guy cuckolding you and drink his blood in front of your wife. This too shall pass”
Cory Grad retweeted
Therapists on the internet are like priests, but who elicit even bigger reactions by their very existence. To some, therapy is reviled as a dangerous "grift," and to others, therapy is good in theory but failed them. Also, some people find it disgusting or unsettling to imagine therapists have personal lives, and are not omnipotent monoliths of meditative wholeness. It is unnerving to consider that the kind of professional person who helps you may also have their own needs and personal existence, which is quite telling as transference.
Cory Grad retweeted
Depressive personalities tend to suffer under the misconception that to have good self-esteem, you must only ever think "nice" thoughts and have "nice" feelings.
Excerpt below from Nancy Mcwilliams, Psychoanalytic Case Formulations, p. 175
Cory Grad retweeted
Activities that promote psychological flexibility and resilience:
1. Sleeping enough.
2. Eating enough.
3. Moving enough.
4. Laughing enough.
5. Hugging enough.
6. Fucking enough.
7. Playing enough.
Find a way to do enough.
Cory Grad retweeted
This is the attitude to adopt.
Patrick will be demure as I say this, but his cup overfloweth with wisdom.
He is worth a follow for TherapiX.
Sex and money, very important topics.
We live with too much societal shame about both.
Sex is amazing. I love it. I’m grateful it’s part of my life, I’m grateful I have people to connect with and get nasty with.
Similarly, money is awesome. I make enough by helping people to be able to eat well, donate, make sure my friends and family are supported. Saving up for a new toy (fun car).
I hope yall get the sex and money you need. We can help you figure out how!