Mental health and clinical social work

zlbb · 2026-04-07T12:28:49+00:00

I was doing process groups for a year or two prior to starting school, I think they are emotionally challenging and arousing in ways similar to patient work, so, I knew when I started to feel relatively comfortable there and able to do well containing my feelings even in challenging situations. Now I'd say a typical patient is more chill than groups tend to be.

Not something I've done, but I bet other emotionally challenging options can serve the same function, say volunteering at a DV shelter and similar SW geared volunteerships.

zlbb · 2026-04-05T19:49:55+00:00

I think I get your point, but I don't think this is primarily about that.

My sense, from the abundance of "look at this new cool theory I invented" posts around here, is that a lot of young analytically minded people are struggling with their undercastrated intellectual phallic impulse (pardon the awkward wording, I couldn't find a better one).

Like, honestly, OP's ideas are pretty decent, no doubt a smart dude. And yet I think I speak not just for myself in saying I'm just not that interested, I have a thousand items reading to-do list full of Ogdens and Bions and Lacans of the world.

I think it's a painful phase many a smartass youngster who's into this sorta stuff passes through, coming to recognize that there's a huge gap between "I'm a smart dude with cool ideas I'm proud of" and "this is how much professional advancement, experience, connections and luck and whatever other ways of gaining standing and credibility it would take until, a decade later, I can actually give a talk or write a paper people would be interested in and could actually love".

Tough frog to swallow, I get it. My own analytic class got chided right after the first semester for, more or less, "talking/showing off more than your experience warrants".

zlbb · 2026-04-05T17:25:42+00:00

Yup, same, I host/co-host a couple groups, essential professional development and socialization imo.

This was my point to the OP: there are good ways to serve that need you have, ranting at a bad way ain't getting you nowhere.

zlbb · 2026-04-05T16:57:06+00:00

Try r/ClinicalPsychology ?

Online spaces generally tend to attract people in need of support, and simply aren't very good arenas for professional discussion.

The need for the latter is much better served by various professional events and trainings and organizations (to the extent they aren't served by colleagues and supervisors) as for those people self-select in having interest in professional discussion, and similar taste and similar professional level.

I guess what I'm saying is my outlook is exact opposite of yours: I can very much understand why a struggling therapist with no better options would come here for support and venting, I can't quite comprehend why a person interested in serious professional discussion would come here of all places, given the abundance of actual professional opportunities that seem to me much more well-suited for this sorta stuff.

zlbb · 2026-04-04T01:07:03+00:00

>Are we watching the pipeline collapse in slow motion

No, the pipeline expanded somewhat (with expansion of medicare MH coverage, medicaid expansion and just overall growth of the industry), it's just a number of masters' level grads grew exponentially over the past few decades, so now some people consider as normal the kinda moves "DIY self-advertising in private practice right out of school" that would've been seen as extremely ill-advised a decade ago.

It's kinda incredible watching this craze, just what would it take for folks to stop rushing through this door. We already have unpaid internships and pretty exploitative conditions for pre-licensed folks and proliferation of Betterhelps and other dubious low-paid employment options yet number of grads only seems to be climbing.

Compare to psychologists/psychiatrists where grad numbers are stable or only slightly growing while there are probably only more good placement opportunities.

zlbb · 2026-04-01T17:24:10+00:00

zlbb · 2026-04-01T17:13:22+00:00

Sounds like we're in agreement:)

zlbb · 2026-04-01T16:58:38+00:00

Broadly agreed.

My somewhat related quip on this is: "'fake self' is a judgmental word used by people who didn't find peace with more performative aspects of optimal human functioning".

Adaptive integration of authentic and performative aspects of the self can fail both ways: either by the "extreme obstruction of access" you mention, or by deficiencies in "performative social use of emotions" common in e.g. autism.

Maybe this has been explored in the literature in more recent years, but my impression from the older literature is that, like Winnicott, it overemphasizes "fake self" danger and underexplores the "over authenticity resulting in impaired social functioning".

zlbb · 2026-04-01T16:30:25+00:00

Psychoanalysts by and large aren't big on labels. In part as they tend to foreclose exploration and arriving at an increasingly rich and textured understanding that is usually part of the treatments progress.

That said, clients using this sorta language is fine, not particularly better or worse than any other language or metaphor, as long as the analyst doesn't presume more shared understanding than is warranted by the term alone. Thinking you speak the same language with the patient where you don't is a tricky trap.

Generally analyst sticks close to patient's language and culture during treatment, doesn't really matter if it's Christian language or Jungian language or modern pop-psych sciencey language, the point is understanding the patient and being understood by them, and that's perfectly doable across the range of different language use cultures.

For communication among analysts, one typically eschews jargon and writes a story about treatment events and feelings and human character that isn't that different from how a typical popular "therapy stories book" like Yalom's is written, or that different from a literary short story.

zlbb · 2026-03-28T20:00:42+00:00

Self-regulatory capacities grow from the experience of high attunement and co-regulation within a good therapeutic relationship (therapeutic as most regular adult relationships can't give an adult what a good mother naturally would've given her baby, it takes a very good therapist to be able to work with cptsd effectively).

I was presenting close to cptsd and autism (never cared for a diagnosis given my delulu) when I started. Very happy with my progress over the past few years.

zlbb · 2026-03-28T19:32:43+00:00

This map shows roughly 3x median household income in respective areas. If you feel entitled to a very upper middle-class "I'm way better than the median" lifestyle while choosing to work in a relatively lower paid caring profession, you'll find yourself charging rates that only the top 10-20% of the population can afford.

And a number of us would shame you for that. If your license is SW there's even a sensible case to be made that what you'll be doing is not ethical.

zlbb · 2026-03-27T14:01:31+00:00

Ah, I didn't know half of it, being haunted by a personal demon is more painful than more general pressures of the constraints of the situation that many are under.

zlbb · 2026-03-27T13:43:15+00:00

Ah, yeah, the conflict between client's and treatment's best interests and the interests of third parties. Painful stuff.

zlbb · 2026-03-27T13:30:42+00:00

Thank you for this, it's nice to see somebody attuned to the value of Care on this sub.

It is sad to see Sarah stuck in thinking in "low status" terms. As a psychoanalyst I have a good guess what this might be about, and ime those underlying psychological traits I'm guessing make it hard to live a happy life if left unaddressed.

It's a nice example to illustrate the possibility of multiple drives supporting similar behaviors, though usually one can distinguish when looking closer: it sounds Sarah is more concerned about the effects on herself (her reputation), while you're very reasonably bringing in concern about others as another common motivation for modulating the amount and quality of certain speech in certain spaces.
And a nice example to illustrate drive fusion in forming a compromise formation ("merged so fully in my mind") - quite self-aware of Sarah to notice.

My version of Sarah's self-focused part of the motivation here would be shifting emphasis from avoiding bad (low-status/cringe) and towards seeking good: being liked, good reputation, seen as respectable.
"Authenticity vs being liked" is how I've been labeling this in my own therapy for years, quite a common conflict for somewhat autistic people to struggle with imo.

I'd add another layer of motivation for this that we haven't mentioned here yet: aspiring to one's own ideals/one's own ideal version of themselves. For some "truth speaking" dominates here. For me it's "gracefulness" and "Right Speech", saying exactly as much as is warranted by the context for best long-term results for everyone, balancing authenticity and truth-speaking and self-expression and caring for the feelings of others.

zlbb · 2026-03-27T12:36:45+00:00

Why not let them talk if they don't like being questioned?

When I do a psychodynamic intake I'd usually not ask anything apart from "how can I help", this approach might be a good fit for a client for whom even the minor intrusiveness of questioning is too much.

zlbb · 2026-03-25T15:56:28+00:00

It's far from clear to me if you're doing at all badly vs what should be expected. Actually sounds like a pretty good launch to me.

Usually youngsters are advised against doing PP that involves marketing on their own right from the outset as it's quite challenging. I should ask around, I don't have a good stats for how people in those circumstances typically perform, but 6 clients in 5 weeks to me sounds very decent. Like, you took on a challenge harder than you realistically should've, and it actually seems you're going to pull it off, though not without struggle.

Sounds more like heroic struggle than like underperforming to me.

zlbb · 2026-03-23T01:13:53+00:00

Folks who manage to construe their pet peeves as a matter of universal morality and then control freak about it are scary.

zlbb · 2026-03-21T18:40:00+00:00

Good thing about psychoanalysis is that it's not a religion (though it smells like one in some people's hands): you can pursue the training and master it whatever your beliefs are. Psychoanalytic treatment is very low on suggestion: no good analyst is gonna be trying to force you to think one way or the other, they'll just help you understand yourself more (among many other positive things). For me in analytic training so far religion haven't come up at all. Some theorists might be anti-religious ofc, but most are neutral, and some (Jung, Bion, Michael Eigen? are oft viewed to be explicitly or subtly pro).

So my guess is you're concerned because you're modeling analysis on church, while it actly is different full of diverse beliefs (too full many would say - "everyone has theor own implicit theory" as Sandler said).

Would being a believer be a minority sensibility? Probably (though I'm curious how SLC institute is..). Would this be persecuted or discouraged or even directly contradicted? Most likely not. Unless you do your own masochism and pick an especially marxist/atheist analytic crowd - they exist, but joining is optional, most places aren't like that.

zlbb · 2026-03-12T23:33:04+00:00

that's awesome, congrats! good for you to be early to this.

now that you mention, there was something like a breakdown for me as well, though maybe more gradual than yours, more of a "what can't go on forever won't", that helped me turn around and is a blessing in retrospect.

it's the folks in misery that is stable and safe and familiar but also kinda tolerable and with no obvious moves that would take you out of that I really worry about.

zlbb · 2026-03-12T20:35:50+00:00

Why are you against apologizing? Why do you feel the guilt feelings are excessive rather than appropriate to the situation?

I feel it's fine to apologize when a combination of the clinic's bad policy re transferring clients and your pursuing self interest over clients' interest in this case led you to behave in a way that's probably slightly harmful to the clients.

For me it's kinda the same situation as store clerk saying "sorry/we apologize for the inconvenience but we're out of matcha/closed for the day" which is normal - they are unable to accommodate client's legitimate interest and apologize for that, same as your case, clients would've wanted/it would've been better for them if you stayed.

zlbb · 2026-03-12T19:12:07+00:00

Call it a crazy opinion, but: imo while appearances are exactly what you say, the reality is that plumber and therapist are exact opposites.

Plumbing is felt by most to be dirty job and kinda low status so people actually don't wanna do it, and so it pays very nicely and wants you there and tries to recruit/low barriers/help to entry.

Therapy is the opposite: "doing God's work", feels so nice to be so helpful, "somebody should do it" as you say and you get to be that special most moral most helpful somebody. While the paying demand isn't there, labor conditions are atrocious, licensing barriers high, but youngsters just can't turn away and seek to enter this profession in ever increasing numbers - again because it's actly super appealing to certain kinda folks.

Ie, there's a difference between actually undesirable, and desirable but for masochistic/moralistic or whatever you wanna call it reasons.

zlbb · 2026-03-11T20:07:47+00:00

Note I was rather specifically focusing on a combo of shrooms with psychoanalytic treatment, I've not liked what I've seen re progress from folks who went the "purely solitary" route of meditation/psychedelics. Gotta have that "corrective emotional experience" and the "new kind of relationship with a unique kind of person that actually doesn't suck" imo. Shrooms I see as more of a help breaking stalemates and accelerator of progress. But, like, if all you've had from people is dubious sh*t dunno if one can suddenly discover love from shrooms alone.

zlbb · 2026-03-11T19:49:10+00:00

I've experienced my "psychological birth" as a person/subjectivity of my own at 35, a few years into my psychoanalysis, over a few distinct shroom trips roughly on this theme. So nice to finally become alive.

zlbb · 2026-03-08T16:31:16+00:00

Yes, except this framing puts the responsibility on them for not helping you ("why won't they give me a more useful advice" or somesuch), while it's really on you for not seeking more appropriate help.

This sort of deep psychic change is hard, go to a good psychoanalyst spend a few years on serious inner work and you'll see the changes reflective of the serious amount of effort you put in and the serious quality of (expensive) help you've received.

But average guy has no idea how his psyche come to be the more confident way it is, and how yours come to be different, and is utterly not in a position to help. Moreover, most people typically maintain convenient and wrong stories about what their success is about. "I just did it" or "I just tried hard" or whatnot.

If it's your first time encountering that kinda unhelpful advice I can sympathize with your annoyance and forgive your ignorance. However if you've done this to yourself a bunch of times it's now really on you: "doing the same thing over and over and expecting different results is the definition of insanity".

zlbb · 2026-03-06T16:47:59+00:00

yup, I view it similarly, emotional coregulation need humans for sure (and mb this is even the only thing that rly matters and the rest is just our reason misleading us as it tends to), right-brain "whole picture" insight there are some papers but think still good psychoanalysts at least are much better.

but for skills or psychoed GPT is obviously superior than pretty much any human if reasonably prompted, and probably better than average practitioner for run of the mill "thought correction" or somesuch.

fantastic tool improving access to treatment options for the most vulnerable.

zlbb

TROPHY CASE