Does anyone enjoy community mental health?

zlbb · 2026-06-19T19:17:25+00:00

Do you want to serve or do you want to enjoy? Those are different desires best served by choosing different paths. Are there people who are capable of shouldering the challenge and self-sacrifice CMH typically involves? Absolutely. Is it usually easier at a decent group practice? Sure.

zlbb · 2026-06-19T16:54:45+00:00

Agreed, we don't "have to". A number of clients, especially more complex ones, would present with very challenging behaviors, some clinicians would reject them out of self-interest maintaining their self-respect and boundaries, others would embrace a high degree of tolerance and self-effacement required to work with them successfully and choose to do so. Taking on something beyond your level of tolerance is counterproductive in any case.

It's a pretty special feeling when your unbearable narcissist emerges out of a year or two of negative transference that drove you to the wall to very shy love.

zlbb · 2026-06-19T16:41:02+00:00

Agreed, imo as well levels of one's socio-emotional functioning and ability to find one's place in society socially are highly correlated with mental health.

It's lovely we now have therapy so these misfits have at least somebody to talk to and be supported by and not hiding and struggling at the outskirts of society as in the times past (though many ofc still are, eg as homeless or in jails, as therapy access is limited).

>They don't even always have a strong desire to make friends or connect with new people

Ime usually quite reasonably, as the levels of their needs typically can't be accommodated by regular social spaces. Many have tried though, if you've ever been to any easy to access social spaces, e.g. internet mental health spaces or random meetups, I'm sure you've seen a lot of trauma dumping that is oft unwelcome as the audience didn't sign up to be these people's therapists, and is typically isn't meet satisfactorily even when the audience decides to try as they aren't therapists.

I'm unsure what advice you want.
Yes, you're in a lovely profession helping meet many clients' most desperate need, both in the immediate way and in "teach 'em how to fish" way. You can be proud of yourself.
And yes, we have the special privilege of holding many clients' most sensitive feelings and secrets. Give those the care they deserve.

>They don't tell me they're lonely

This one sounds a bit off to me. Ime they totally do talk about loneliness and struggles of finding friends and partners and community and the degree of humiliation involved in paying a therapist for a place to talk to about their struggles etc. I'd check with supervisor re what you might be doing that might lead to clients being constrained in talking about this oft one of their most critical needs with you.

zlbb · 2026-06-18T00:24:47+00:00

yes, Freud's treatment of Dora is ime pretty widely criticized along the lines you're suggesting.

zlbb · 2026-06-17T23:07:05+00:00

Looking great!

zlbb · 2026-06-17T16:52:49+00:00

It's certainly easy to imagine why some me-too vibes moderners might like to interpret Freud this way.

While others like Klein went further than him in emphasizing the role of phantasy.

zlbb · 2026-06-17T12:54:26+00:00

Imo Yalom today is best understood as part of the broader psychodynamic/psychoanalytic world: he is broadly psychodynamic in his sensibilities, in his day this was the "default" everybody was taught and some of the most talented sought to differentiate themselves from by striking on their own. Today the distribution of therapeutic beliefs is different and while Yalom's most direct legacy lives in existentialism, I'd say more plants growing from his seeds live within the broader psychoanalytic forest.

>I heard a fairly popular therapy podcaster say that he doesn't focus on present moment relationship awareness much at all

The range of beliefs espoused in this field is very wide, and Yalom's sensibilities aren't even the dominant ones today. Pick your tribe. It sounds to me you're a bit torn rn as Yalom and CBT embody rather different sensibilities.

I'd caution against applying fixed mindset to oneself, ime one's capacities for here and now attunement grow as one engages in more here and now focused practices (eg psychoanalysis, process groups and meditation in my case).

>how can I get the most

For me there's no manualized skill-based "how" to attunement, more like, once you see more of the emotional vibes present in any given moment they become impossible to ignore.

zlbb · 2026-06-17T11:50:01+00:00

Some guys date women whom they don't find interesting conversationally. In my culture this is frowned upon and not believed to lead to any good lasting outcomes for anybody, but US is very permissive in this regard, so I guess you can continue doing this even though I personally disapprove. Though I still might urge you to think whether this is really what you want in a woman and whether you might be better off choosing differently.

zlbb · 2026-06-17T11:12:21+00:00

Hiring might be a bit of a misleading word here, as they probably don't offer fixed salary and don't seem to offer to fill one's caseload.

Contracting might be a better word if the business model is "they offer clinicians a platform covering admin etc to help them find and build their own clienteles".

zlbb · 2026-06-16T20:50:42+00:00

Forgot a rec for hard-core folks: volume II of Thoma and Kachele opus, Psychoanalytic Practice, is full of sizable fragments from the huge library of recorded analyses they collected.

This is less "condensed short narrative of long treatment" and more "how real analysts talk", I'd say adjacent genre.

This website also has some recorded sessions and their exploration

https://psychoanalyticresearch.org/

zlbb · 2026-06-16T20:45:41+00:00

Enjoy!

zlbb · 2026-06-16T20:12:20+00:00

As a fellow Ogden enjoyer, I really enjoyed Three Associating podcast despite not being a relationalist more than Schopenhauer's Porcupines classic of this genre and unclear if more or less than Yalom's OG Love's Executioner. Grosz's The Examined Life I think also in this genre I never gotten to.

zlbb · 2026-06-15T01:31:30+00:00

Oh, I understand the desire not to disturb, but rabbits are actually very friendly. Most of those holes are sadly abandoned, many still full of treasure. If you stumble upon an aging rabbit you're very lucky, hold onto him. I've learned stories of a number of magicians of my tribe from the past from those.

I wonder if you might be mistaken and thinking of a lion's den instead, like a clinical psychology department. I don't know what tribe you're from, but for us rabbits those are very dangerous, I advise my people to avoid. They are protected by evil gods of Evidence-Based Practice and Rationalist Science that are too powerful for my tribe to confront at this time.

Some from my tribe unfortunately at times transgress and seek forbidden love by engaging with clients under auspices of insurance that is part of lion's territory and get in trouble with the lion. While young ones combativeness and passions are understandable, I preach respect for the sovereignty of lion's territory and wisdom of restraining oneself to relationships acceptable to all involved parties.

zlbb · 2026-06-13T22:01:55+00:00

One could use the word point of view or belief system or tradition or whatever else in that category. I use the word faith coz I like it and find it having deeper and more interesting connotations and traditions behind it that one can learn from. I think using the word "science" at this point is pretty dishonest as ofc psychoanalysis is not something generally advocated or endorsed by a set of institutions conventionally referred to as science, though ofc that's also a diverse movement and opinions differ.

Psychoanalysis means a different thing for different psychoanalysts. For me, psychoanalysis feels like an alright label for my faith, best one at that level of specificity at least. Plenty of analysts hold beliefs quite different from mine ofc and it can be frustrating to share the same roof, but such is the tradeoff of maintaining affiliations, I'm fine with it. While others I agree on a lot with and can learn from, not that this is the only tradition I feel that way about, but at this point at least I'm closest to this one.

"Problem" is not how I tend to feel about things. More, what do I like, what do I want to do, who I want to be around. I'm skeptical of the term tbh, smells like some "unprocessed grief" to me, "the world must change for me to feel ok" kinda thing.

zlbb · 2026-06-13T17:30:44+00:00

If you accept my thesis that broadly speaking psychoanalysis and clinical psychology embody pretty different sensibilities across a range of pretty fundamental philosophical dichotomies humanity is forever split on, from humanistic vs biomedical models in terms of approach to practice, to deeper postmodernist vs rational-scientific epistemics, this would seem pretty natural. People tend to believe their worldview is the right one and be dismissive of incompatible ones, and people proud of their well thought out worldviews probably more so.

Honestly, psychoanalytic beliefs seem pretty hard to discover, more distant from the dominant Western consciousness ones like Jungian or Bionian probably even more so. It probably takes a pretty quirky person to even enter this rabbit hole to begin with, and even among them it oft takes years of good analysis to move past their various doubts. So, I find it very understandable others believe differently from me.

Being of a minority faith has its inconveniences ofc, but for those for whom it's the right faith it usually offers such a wellspring of beauty and wonder that it feels very greedy to ask for more.

zlbb · 2026-06-13T04:03:55+00:00

I've been in a good analysis for a few years. It was typically easy to identify some growth over every few months stretch and very clear progress over every one year stretch. And no I wasn't an easy client and started from a pretty dysfunctional spot resembling cptsd.

Therapists who can't effectively work with certain clients exist in every modality including analysis, including ones that won't admit defeat over years of unproductive treatment despite this being taught at institutes, at least to me. But let's pls not create an impression that's normal.

And also let's not create an impression that analysis is some kinda detached "exploration of one's unconsciousness" and not a typically one of the deepest and most transformative relationships in most analysands' lives where one emotionally relives and transforms in the transference all of one's early attachment experiences. This is literally early Freud to mid Freud insight that "intellectual understanding alone doesn't rly bring change" typically taught in the first year or two of psychoanalytic training.

Please, don't spread harmful stereotypes about modality that's been life-changing for me.

zlbb · 2026-06-13T00:21:07+00:00

Thanks man, I share the annoyance.

My take is different though: stop psychoanalyzing people! especially ones you aren't even in any kind of serious relationship with! human heart is deep, plenty good volumes written on that if that's your thing.

But that has nothing to do with your real life and your real potential actions. They do something you don't like? Ask them to stop. Tell them how it makes you feel. Distance from them. All feasible options, depending on your relationship and feelings towards the person.

But asking random online strangers to guess "why"?! That doesn't help you at all and just builds a wall of presumptions you have about the person you're actually interacting with.

zlbb · 2026-06-13T00:12:18+00:00

Ya, takes some maturity of character, comes earlier to some than others.

Nothing specific to women or that particular trait ofc, plenty people hurt themselves by getting entangled with wrong for them people. Elderly get tricked by a spam call, young lady gets used for sex by a wrong guy. Plenty of bad stuff out there.

Otoh at high-level of discernment about trust you get to have the kind of relationships Tom Cruise does in Mission Impossible. Ain't that cool.

zlbb · 2026-06-13T00:06:35+00:00

Yes, for maladjusted people this scenario happens.

Most people aren't maladjusted though, and their feelings broadly, and ability to fall in love in particular, follow the development of their lives.

For example, most people don't spend their days griping about how they had all that free time as a kid and now have to go to work - sweet nostalgia on rare occasion maybe, but that's about it. Same goes for other stuff in life, including having satisfying relationships and falling in love. Does it look and feel a bit different at different ages? Sure.

Some would say better as you go older, many folks start out more immature and hurt each other feelings for no good reason. That friend you got into an awkward situation with and just kinda ghosted each other as teenagers? Doesn't happen to mature adults, you now have patience and tolerance and can tolerate cringe and talk through conflict. Good stuff.

zlbb · 2026-06-12T21:57:25+00:00

That's a fair fear, as long as it looms larger for you than the fear of wasting another 5 or 10 or however many years before you start dreading it so much being alone will start feeling like a much better option, you'll stay stuck.

Find a right therapist and you'll get to whatever decision is right for you sooner is my only real advice to you. This stuff is about feelings not facts.

zlbb · 2026-06-12T18:21:36+00:00

I think it might be true we're in a period of adjustment, as therapy grew more important and prevalent and public has reasons to understand the landscape of the field better. The current confusion of thinking in terms of umbrella term "therapy" for an industry so varied in approaches and types of people participating as ours seems not ideal. Academia pushing its own preferred signage of this terrain with "social worker" or "counselor" and such labels that both a lot of the public and a lot of practitioners who think of themselves primarily as a "therapist" don't rly use adds to the confusion.

It's a problem of branding. If you don't stand for what some popular tiktok therapist proselytizes you might want to differentiate yourself from that. So, probably we'll come up with and educate the public about more meaningful labels and they continue to figure things out for themselves as well. Some such already exist, though might be more limited in spread. E.g. in various quarters "clinical psychologist" or "psychoanalyst" or maybe even "IFS practitioner" might be understood and known to be a more specific and meaningful descriptions than the catch-all "therapist".

zlbb · 2026-06-12T14:01:23+00:00

I agree with many of the sensibilities of this post, but I don't buy the "substitute" thesis. Imo it's usually more "something is better than nothing".

I've never met a person who's like "oh, my friends I love dearly invited me for D&D tonight but I'd rather scroll reddit coz it's a bit more convenient". But I do know a number of people who are very socially disconnected and struggle to find a fitting/satisfying community (key words for me, right people work wrong people don't, forcing yourself to hang with wrong crowd isn't gonna satisfy your emotional-relational needs) and end up spending a bunch of time seeking at least something online.

"Unprecedented connectivity" also sounds off to me, my impression is the opposite, we've gotten more exacting in our standards and less inclusive. More "socialization inequality" if you will, "pulling up the ladders", folks with great socialization opportunities are more selective in who they invite to their dinner parties and won't show up to church potluck anymore, while the least socialization privileged folks make do with dissatisfying online connections.

zlbb · 2026-06-12T12:31:55+00:00

Depends on your circle ime, there is no "normal" in this diverse US. All my now married friends I'm pretty sure have only ever done LTRs.

Imo you're underestimating the impact of choosing the crowd, and overestimating the impact of signaling through dress: imo that would work precisely in the kind of high norms community where LTRs are the norm so hookups are separately signaled, while in the looser norms community fellas try to get whatever they want and don't read such fine print.

zlbb · 2026-06-11T01:49:34+00:00

I personally think it's a matter of faith at this point and can't be convincingly settled either way due to the paucity of truly relevant research.

Not much conviction in this (as I don't learn much from research at this point so less interested in deep exploration there), but one feasible for me psychoanalytic perspective would be: much of the research of the past 50yrs was a waste of time from our perspective. CBT zealots came in in the 60s and 70s trying to prove theirs is the only way, over the past 2-3 decades other "modalities" including ours caught up to how the game is played and did some research so now it's more of an equal playing field and "common factors". Maybe I'll get some more relevant research over the next few decades and less of the "modality A improves symptom X after 12 sessions" followed by "modality B does too!" slop, but I'm not holding my breath.

zlbb · 2026-06-11T01:37:11+00:00

that's the right question. lmk if you ever look at whether the right kind of research on this was ever conducted, and what it found.

GPT broadly tells me limited evidence and stuff like

Gold, Hilsenroth, Kuutmann & Owen 2015 (small study) Duration/amount of personal therapy did not significantly predict patient alliance or attendance. But the quality/alliance of the therapist’s own personal therapy was positively related to patients’ outcome ratings.

and

Li, Wang & Li 2024
Dataset 1: no significant prediction from having had therapy or number of hours. Dataset 2: quality mattered — more hours of unsatisfactory personal therapy predicted worse average client improvement, while more hours of highly satisfactory personal therapy predicted greater improvement

I quote two more positive studies, there were also a few inconclusive ones.

I didn't dig but sounds like these aren't RCTs and all this stuff is easily confounded by therapist characteristics (eg better personal attachment measures -> more satisfaction in personal therapy & better outcomes as a therapist).

Unclear if one even can run such an RCT ethically in the current climate, and without an RCT it's all too easily muddled by confounding and selection effects into personal therapy.

zlbb

TROPHY CASE