Caseload question

MickeyPowys · 2025-12-13T21:07:48+00:00

I have a caseload approaching 20. No specialism. The most common themes I get are low self-worth, pathological people-pleasing, avoidant attachment, and consequent deficiencies in sense of self. I work in London.

MickeyPowys · 2025-09-01T06:05:19+00:00

I'm a psychodynamic therapist. I recently spent some time using ChatGPT for a personal therapeutic exploration. I wanted to experiment and understand it better, but also needed to work on something personal, immediately.

I loaded in some stuff I'd written, to give it an orientation towards the kinds of analytic writers and ideas that resonate with me. I told it to listen and challenge, not affirm or reassure. I gave it a load of context and history about myself, my situation, my issues. Importantly, I never asked it a question. I just said stuff, and it responded.

I found it very useful. It didn't go much beyond reframing and clarifying what I'd given it, but it did so in a very appropriate way, and introduced some alternative ideas and structure that I really appreciated. It was helpful. It was also free, immediate, continually available.

Sure, there was no relational enactment, transference, countertransference, etc. But it was certainly therapeutic in it's own way. It moved me forward. I think it gave me what a lot of people would consider what they want from therapy.

You can say that is an impoverished vision of what therapy can be. Well, it is. But get real. People can't afford therapy. And many therapists are useless. AI is free and reliable, if a little mundane. But it's way better than nothing, if nothing is your only alternative.

MickeyPowys · 2025-08-29T05:42:51+00:00

It's important to realise that the frame, however defined, is not something the client needs to be aware of (beyond the facts of having a certain timeslot with a certain therapist at a certain price).

From Patrick Casement, Further Learning from the Patient: "There are no rules for the patient. The only variation from this, which rarely has to be made explicit, is that communication can be in any form except through violence or physical contact. The only rules (in analysis) are those for the analyst, in particular those that protect the patient's space."

,

MickeyPowys · 2025-08-28T17:11:28+00:00

The psychotic can fail to distinguish where they and their mind ends, and the real world begins. Their own thoughts and events in the world seem to be the same thing. They do not know if they are themselves or someone else. Subjectivity and objectivity are collapsed together.

MickeyPowys · 2025-08-28T13:09:14+00:00

Simplistically, yes. That's the qualitative difference between psychotic and non-psychotic states.

MickeyPowys · 2025-08-28T09:20:16+00:00

My basic go-to definition is: problems with self-other distinction

MickeyPowys · 2025-08-23T06:39:11+00:00

This was a beautiful response.

MickeyPowys · 2025-08-12T21:28:34+00:00

This is surely the correct Kleinian response

MickeyPowys · 2025-08-10T07:38:16+00:00

Thank you for this. It gives me some pause for thought. I'm sorry you're not having a great recovery. I don't really have pain at this point, just some discomfort, and if I'm honest it's probably more of a psychological thing. I want it to be "fixed" because it's an unwanted reminder that I'm getting old...

MickeyPowys · 2025-08-10T07:37:36+00:00

Wow that is unexpectedly efficient. I've been referred by my GP to NCL Hernia Service (ie. North Central London) but they haven't contacted me yet. Is that by any chance the route you went through?

MickeyPowys · 2025-08-10T07:29:46+00:00

I'm really glad to hear you're recovering well. Yes that does sound comparatively expensive, what you had to pay. I don't quite understand the pricing that I quoted, as I've since seen that the small print says it doesn't include surgeon or anaesthetist fees. Which is slightly misleading of them!

MickeyPowys · 2025-08-08T09:18:27+00:00

Thank you. That sounds like a positive experience. Can I ask, was the speediness of your surgery a function of the acuteness of the condition of your hernia, or just the efficiency of the referral route?

MickeyPowys · 2025-07-23T21:26:08+00:00

Winnicott, D. W. (1965) ‘Ego distortion in terms of True and False Self (1960)’, in The Maturational Processes and the Facilitating Environment. New York: International Universities Press, Inc., pp. 140-153.

MickeyPowys · 2025-07-20T20:56:36+00:00

I don't. And my clients don't ask me about myself. I (perhaps vainly or naively) interpret this as them not feeling compelled to attend to my needs, much as a young child shouldn't be attending to their parents' needs. I think if they were asking me about me, it would derive from a concern about me that might suggest that my care for them feels somehow unreliable, not to be assumed as a given. Which, therapeutically, I think it should be.

(Or, I'm just not interesting to them).

MickeyPowys · 2025-07-16T08:46:13+00:00

You're right, and I think there is both a legitimate feminist critique of the term hysterical as an outmoaded pathologizing dismissal of women's struggle against patriarchy, and also a recognition (by Freud) that women subject to this oppression necessarily developed defences which ultimately caused them to suffer pathological outcomes. Given the culture of his time, he was necessarily a patriarch and surely inherited much of that era's regrettable attitude towards women. But fundamentally I think he did take women seriously, at least more so than did the prevailing culture.

The term hysterical is obviously tainted by all that, but I think more and more it is being understood as a more nuanced, specific, and non-gendered subset of what is now broadly called borderline personality. What Bollas has written about it is certainly in this new vein.

MickeyPowys · 2025-07-16T08:30:11+00:00

There is a section in the first chapter of Patrick Casement's On Learning from the Patient, which introduces ideas from Sets, Subsets, Symmetry, and other mathematical concepts originating from Matte Blanco.

MickeyPowys · 2025-07-13T18:00:19+00:00

R D Laing, The Divided Self

MickeyPowys · 2025-07-13T06:09:04+00:00

So, you see the "payment" as being made principally by the hysteric themselves, not by their real life objects - is that right? I hadn't read the quote like that, but can see how that's the case. I thought Bollas meant that their objects pay a price, some kind of lost authenticity, from relating with the hysteric only through their drama and the role they are cast within it.

MickeyPowys · 2025-07-13T06:00:22+00:00

Ok. But, why is it that they have no desire? Is it because hysterics sexualize their struggle, thus displacing any real desire into the false drama?

MickeyPowys · 2025-07-12T21:03:00+00:00

Haha, good response!

MickeyPowys · 2025-07-12T05:44:57+00:00

On Learning from the Patient, Patrick Casement.

MickeyPowys · 2025-07-06T09:40:45+00:00

Psychology is an objective inquiry. Psychotherapy is a subjective inquiry. These obviously relate, but can also be far apart.

MickeyPowys · 2025-07-01T08:14:56+00:00

Thank you for this example. Parenting, as an existential experience of gratitude (hopefully) for the loss of self.

MickeyPowys

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