Former psychotherapist, clinical consultant, & public policy advocate exploring the intersection of AI & human psychology. Lover of free speech & Diet Coke
Joined March 2020
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I think you can do a lot of good for the world as a really friendly waitress, cashier, etc. You can make a person’s whole day just by showing them that they mattered to somebody in that moment in time.
rogue therapist ✨ retweeted
Therapy for psychosis. Many of my colleagues find the idea silly.
When I led mental health in a large jail, we had people who were grossly psychotic and incoherent and still did not meet criteria for involuntary treatment. A common response from psychiatrists was: he won’t take meds, what can I do?
A lot.
You can show up regularly and frequently. You can be kind without being naive. You can tell them where they are, what is happening, what is required to leave, and that their family has been calling. If psychosis is, in part, a retreat from a reality that feels impossible to live in, then part of the work is making reality less terrifying.
After weeks of daily visits, many of those patients accepted antipsychotics. I am often critical of psychiatric medication. Antipsychotics for impairing psychosis are still, generally, effective and humane, despite significant side effects.
Signing off because someone is psychotic and refusing pills is misunderstanding what psychiatry can be.
Psychodynamic therapy fell out of use for schizophrenia after 4 small trials found no benefit for core symptoms, but can it help functioning?
Here it did, as add-on to antipsychotics, in the first large trial to test that outcome:
psych-partners.com/psychodyn…
rogue therapist ✨ retweeted
You know why people pair up into couples? Because being a human is f*****g terrifying. But it's a hell of a lot easier if you're not doing it by yourself.
Alice Oseman
rogue therapist ✨ retweeted
Therapy research supports what is called the “Dodo bird” verdict: all mainstream therapies show equivalent benefits in research trials.
It is possible that there are no differences. But it is also possible something is very wrong with the research trials. Here are six reasons current research may hide crucial differences:
1️⃣ Research focuses on brief therapy. Meaningful psychological change begins, on average, at approximately six months. Research trials are typically 6–12 sessions. The treatments are over before real change even begins.
2️⃣ Only short-term outcomes are considered. The real effects of psychological change may reveal themselves long after therapy has ended.
3️⃣ Outcome is defined as a score on a standardized symptom scales. But the scales don’t even attempt to measure the psychological changes patients want most from therapy.
4️⃣ Only standardized treatments conducted by following instruction manuals are studied. The attempt to standardize and pre-script treatment destroys the conditions necessary for deep psychological work.
5️⃣ The studies assume that patients with the same DSM diagnosis have the same problem and will benefit from the same treatment. This is not remotely true. The studies throw patients with vastly different psychologies and treatment needs into the same hopper. They respond differently to treatment and the differences cancel out when averaged, making it impossible to detect a signal. As the data scientists say, garbage in, garbage out.
6️⃣ The effects of a therapy modality or brand cannot be isolated from the therapist, patient, and their unique relationship and interactions. Therapist and patient form a massively complex system in which all variables reciprocally influence all others, and small changes in one variable can have large and unpredictable effects on others. This violates the basic assumption of the randomized controlled trial (RCT) as a research method, which is that the effects of an independent variable can be isolated.
Any one of these factors could make it impossible to see anything clearly when viewing therapy through the lens of current research methods. The studies may be measuring noise, not signal.
It is possible that the findings of therapy research trials, as they are currently conducted, are little more than artifacts of the research methods—and teach us nothing useful about actual psychotherapy.
rogue therapist ✨ retweeted
Neither. Neither SSRI nor psychedelics should be the default first move for most depression.
Many cases are mild or time-limited; therapy, self-help, groups, and support often suffice.
A lot of therapists need to do a better job at informed consent. Patients shouldn’t feel this way — they should know exactly what the line is so they can feel comfortable being honest -and- have the autonomy to decide whether they want to cross that line.
I once refused a second date with a guy because I took him to my favorite [barely] Mexican restaurant because I loved their nachos and he said, “I don’t get it. This is just chips and cheese.”
I regret to inform you that LinkedIn influencers are trying to shoehorn Dolly’s death into clever little career lessons and they’re as painful to read as you’d expect
rogue therapist ✨ retweeted
It is a term for non-therapy professionals, such as dentists or masseuses, who want to be sensitive to the needs of customers with difficult trauma histories. Saying “trauma-informed therapist” is just redundant. It’s like saying “tooth-informed dentist” or “music-informed DJ.”
Jesus’s M.O. was welcoming sinners to heaven
So a Jesus who exists for one person solely because she was so good is not Jesus, and this is really just deifying Parton, which she would’ve hated as a devout Christian
I have been a pretty committed atheist for decades now.
But Dolly Parton is in heaven with Jesus and I will not be taking questions on this.
I don't want to hear about the vastness of the cosmos or the absence of empirical evidence or any of my own arguments that I have made confidently for years. None of that applies here. We are making an exception and the exception is Dolly.
If there is a heaven and Jesus is up there he has been waiting for her specifically and there was a whole moment when she arrived. That's just what happened. I don't know how to explain the theological mechanics of it and I'm not going to try.
Some people just live in a way that makes the universe owe them something on the other side and Dolly Parton sent books to millions of children she never met and asked doctors to use her dying body to save strangers and wrote Jolene and I Will Always Love You and funded research that helped create a Covid vaccine and just kept going like that for decades.
If heaven has any kind of selection process she didn't even have to apply.
I'm still an atheist about everything else. The rules still apply across the board.
Except Dolly.
Dolly is with Jesus now and that's just a fact and the cosmos can deal with it.
rogue therapist ✨ retweeted
The roughly 342 million people who live in the U.S. don’t seem to agree on much these days. But on at least one subject, large swaths of the country see eye to eye: Dolly Parton was a national treasure. nbcnews.com/pop-culture/pop-…
rogue therapist ✨ retweeted
Dolly Parton’s Imagination Library was the best contribution to child literacy ever made by a celebrity. Our paths crossed once, in the 90s, backstage at a talk show, and I was completely tongue-tied and starstruck. RIP Dolly. You were a complete, irreplaceable one-off.
rogue therapist ✨ retweeted
This is really sad:
When psychology professors are asked whether they'd put the truth before social equity concerns, 66.4% of male professors said yes, but fewer than half of female professors (43%) agreed.
In both groups, too many put equity before truth.
rogue therapist ✨ retweeted
The doctor who delivered Dolly Parton in a one-room Tennessee cabin in 1946 was paid with a sack of cornmeal. Her father farmed other people's land and could not read or write. Eighty years later, the reading program she built in his name has mailed more than 300 million books.
She wrote "I Will Always Love You" on the same afternoon she wrote "Jolene," as a goodbye to Porter Wagoner, and released it in 1974. Elvis wanted it. The night before the session, Colonel Tom Parker called and said Presley would only record it if they got half the publishing, meaning half of everything the song ever earned. She had been in Nashville ten years by then. She said no, and cried all night. Whitney Houston cut her version in 1992, held number one for fourteen weeks, and Forbes later put Parton's royalties from it near $10 million. She put some of that money into an office complex in Nashville and called the place the house that Whitney built.
Dollywood opened in Pigeon Forge in 1986 because she wanted paychecks in the county she came from. Around 4,000 people work there now. Three million visitors come every year. The University of Tennessee put its economic impact at $1.8 billion, and it is the largest employer in Sevier County. Since 2022 the company has paid tuition, fees, and books in full for every worker from their first day, seasonal hires included.
Wildfires tore through those mountains in November 2016, killing fourteen people and destroying more than 2,400 buildings. Her foundation was handing out money within 48 hours. Every family that lost a home got $1,000 a month for six months, regardless of income. The final check was $5,000. Total delivered: $8.9 million.
In April 2020 she sent $1 million to Vanderbilt for coronavirus research. When Moderna's vaccine results ran in the New England Journal of Medicine that November, her fund appeared in the footnotes.
Carl Dean, her husband of nearly sixty years, died in March 2025. The note she wrote to fans afterward ended with the same five words she wrote for Porter Wagoner back in 1974. She died in Nashville today. Her family asked that instead of flowers, people give to the Imagination Library, which still mails 3.4 million books a month to children who will never get to meet her.
Boycotting a company that knowingly sells products of slave labor for reasons other than that is just silly to me
Using slave labor is among the worst things humans can do
So if that isn’t the ethical line for you, you’re just taking political rage out on a random retail store
Teachers union boycotts Target, says company was silent on ICE surge startribune.com/teachers-uni…
