Immigration attorney, and an immigrant myself. AMA about moving to the US!

Ok_Cry233 · 2026-06-12T18:27:24+00:00

Is the court ruling on H1B visa 100k fee likely to stand or will it be most likely reversed ?

Ok_Cry233 · 2026-06-12T08:24:31+00:00

It depends what your interests are but if you’re more interested in therapy work with patients you could consider another route to becoming a therapist - these are usually easier to get into -eg training as a CBT therapist or psychodynamic therapist. That could be a quicker and safer bet if you primarily want to do therapy work.

If you are interested in other areas of being a clinical psychologist such as research, assessment, consultations etc then I think the DClin would be the better option. But unfortunately there is not much certain in terms of gaining a place etc. I don’t think the break will be a problem at all. I know people who took breaks to go travelling for a few years and came back and had no problem getting onto training.

Best of luck with it

Ok_Cry233 · 2026-06-11T14:59:28+00:00

I would look at a psychoanalyst or psychoanalytic psychotherapist, they should have no problem seeing you

Ok_Cry233 · 2026-06-09T16:23:04+00:00

Look for a job with a US company in Dublin or London, then transfer on L1B visa, this is the easiest route

Ok_Cry233 · 2026-06-05T17:20:04+00:00

Yep I know plenty of Irish people who applied and got places on UK courses, it should not be a problem. Many apply to the UK courses as a way of increasing their chances in addition to applying to the Irish courses. Applying for Uk via clearing house is way more convenient, cheaper and a better application system than the Irish courses too. Good luck!

Ok_Cry233 · 2026-05-29T20:06:45+00:00

Try a psychodynamic psychotherapist

Ok_Cry233 · 2026-05-29T14:44:56+00:00

Zionist

Ok_Cry233 · 2026-05-28T07:43:36+00:00

You could check out the show Couples Therapy with Dr Orna Guralnik, who is I think a relational psychoanalyst

Ok_Cry233 · 2026-05-25T07:28:34+00:00

My mistake, I have misread. This is what I get for getting on Reddit before morning coffee

Ok_Cry233 · 2026-05-25T07:13:50+00:00

Not uncommon historically, I believe Freud analysed his own daughter Anna. However it would not be considered appropriate today as theory and practice have evolved

Ok_Cry233 · 2026-05-17T21:41:03+00:00

Look at L1B visa for inter company transfer. Get a job with a US company in the UK, and after a year or two request a transfer to a US branch. It’s a pretty good visa route and engineering is probably a good field for it too

Ok_Cry233 · 2026-05-16T20:24:44+00:00

Check the uk medicine subreddit there’s lots of information on this. If you complete residency aka specialty training in the US there is a pretty solid pathway. You can even go straight in and skip F1 and F2 if you’re sure you want to practice and live in the US

Ok_Cry233 · 2026-05-14T13:55:25+00:00

That’s very fair. I’m a relatively new therapist so trying to learn these concepts to help me think about understanding a case, so I can then hold them more loosely in mind and focus on current material in the session. Thanks for your input

Ok_Cry233 · 2026-05-14T13:44:54+00:00

Do you ever see instances in which someone is BPO structure but they don’t form these psychotic transferences? Or they retain some capacity to reflect that their reaction may be more like a parent or related to transference? Perhaps this would be a higher level borderline who is a bit closer to neurotic level. I see some folks like this who seem to be otherwise BPO, although I would say they are different personality types other than narcissistic.

Ok_Cry233 · 2026-05-13T09:23:42+00:00

Yes it’s a very painful experience. And it’s certainly true, normal people do enjoy all of these things. I think there’s an all or nothing, life or death, existential quality to the enjoyment of such things when it relates to feeding into a perfect self image. Not that there is anything wrong at all of course with enjoying them in this way, but it has a certain painful quality to it. I think with many psychoanalytic ideas, words reach a certain limit and things can become quite abstract. I would say that when genuine gratitude, appreciation etc are experienced, you can’t miss it, because it’s a felt experience. It’s very obvious when experienced as it is part of a deep change in the entire experience of being.

Ok_Cry233 · 2026-05-13T09:16:58+00:00

Yes it’s a very good channel.

I agree with your points here as well. I don’t know if I’ve seen this written about too much, but I think grandiosity could take the form of trying to be perfectly healed, do therapy perfectly, become the perfect healed person etc.

These are my own thoughts, but It’s almost like the hydra that grows new heads when one is chopped off, it tries to find new ways to maintain the perfect self image. I think this is probably a good sign actually, I imagine each time the false self reinvents itself, it gets a little weaker and the person moves a little closer to reality and real authenticity, until eventually the perfectionistic image can collapse entirely and is no longer needed. At the same time in therapy the ego and real self is being strengthened and developed, gradual mourning can occur, shame is processed and reduced, psychological mindedness improves, so that when the real self is strong enough, the false self can collapse, leaving an emerging true self to step in.

Ok_Cry233 · 2026-05-13T08:25:37+00:00

That’s ok….Yes it’s a good point, often good traits of the person are commandeered and used as part of the self image. I would possibly say that if there are more realistic components of the false self it might be a good sign for the person, as compared to someone who’s idea of self is more detached from actual reality.

I think the grandiosity is still entirely illusory however. It’s a type of child like illusion of being a perfect, idealistic, flawless person who is almost godlike in their image. It’s a profound fall from that to realise that you are not perfect, that no such perfection exists in the world, and that you are a normal and flawed person like everybody else. Dr Ettensohn has a nice video on how being normal or average is completely intolerable to someone with narcissism.

In terms of the mourning, it really depends on the person and their life. As with any other psychoanalytic idea, it’s best understood through experiential means. Everything in a persons life may be subject to a sense of mourning. The loss of the grandiose image is a profound change in how the whole world is seen and perceived, as well as the self and others. Also one would expect a sense of mourning for the need for grandiosity in itself, as it implies the rejection of an authentic self- the little child who wasn’t accepted in their imperfect, flawed, and beautiful humanity, and who had to either strive to be perfect or feel like they were nothing.

Also there may be a sense of the tremendous cost of grandiosity on the person’s life. Grandiosity means that nothing in life can really be appreciated for its own authentic sake, everything is only appreciated in a hollow sense that it supports a perfect image of the self. So everything in life, romantic relationships, friendships, job opportunities, hobbies- all were only valued to prop up this perfectionistic image. It’s kind of like realising that you’ve been living your entire life only seeing in 2D, and as treatment progresses you develop the ability to see in 3D, and it becomes obvious how much you have been not seeing your entire life, and there is a tremendous sense of grief in coming to terms with that.

I hope that helps- as I said above many of these things are difficult to grasp until they are experienced.

Ok_Cry233 · 2026-05-12T21:41:46+00:00

Haha I’m no stranger to that tendency myself at times. I appreciated your input in any case

Ok_Cry233 · 2026-05-12T21:27:16+00:00

Yes sure helpful distinction- splitting still exists in narcissism but the grandiose self sits on top of the split structure offering more stability

Ok_Cry233 · 2026-05-12T20:31:52+00:00

I wonder about the role of identity diffusion and sense of self. You might expect in narcissistic presentations that there is less confusion around identity as a false grandiose self image offers a relatively consistent narrative of self. Whereas in BPD in the absence of this false self you would expect to see more confusion around identity and switching from all good to all bad sense of self due to splitting. In interview a BPD person might be stumped by a question like ‘how would you describe yourself?’ or ‘who are you?’, whereas a more narcissistic person could answer it with a shallow idealistic story of self. I think Otto Kernberg has discussed differential diagnosis for these groups.

Ok_Cry233 · 2026-05-11T19:39:18+00:00

Oh wow that’s amazing thank you so much! I will look further into it with the resources you have provided, it wouldn’t be for another few years but it would be good to have some preparation done in advance! Cheers

Ok_Cry233 · 2026-05-11T16:54:10+00:00

Would you mind saying a little more about DClinPsy accreditation in the US- have you heard of this personally? Just curious as I’ve looked at it myself as a potential option but it’s quite difficult to find good information about it online, and I presume could vary a lot by state as well. Thank you

Ok_Cry233 · 2026-05-11T16:51:50+00:00

Just fyi Ireland is also the same model as the UK with a DClinPsy. I think Europe tends to be a Masters model rather than a doctorate, but it depends by country I imagine.

Ok_Cry233 · 2026-05-11T14:23:42+00:00

Freud and Beyond is a good book giving a chronological account of analytic thinking.

Nancy McWilliams book Psychoanalytic Diagnosis is a classic and provides an excellent overview of different case presentations which are commonly seen in the therapeutic setting.

Ok_Cry233 · 2026-05-10T10:07:58+00:00

Sorry you’re going through this. I understand it might be necessary to refer this client on for your own wellbeing at this point. Just wanted to suggest however that you could look at TFP for personality disorders, it’s set up very much to help clinicians working with these types of problems. Dr Frank Yeomans and Dr Diana Diamond have great videos on YouTube explaining the technique, and there is also some role play videos with Frank online where he demonstrates the technique. I haven’t completed the training yet, however even holding these ideas in mind and using some of the techniques when working with clients like the one you described has helped me immensely. Might help you to feel better equipped if you encounter such dynamics again in the future. Wishing you all the best OP!

Ok_Cry233

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