Psychotherapist https://nitter.gq/t.co/iPd5T9mEIX
Joined March 2026
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The return of my Substack articles! This week's topic addresses the types of criticisms that therapists face online and in media through the lens of object relations in an attempt to better understand where it comes from.
Shoutout to @NickTaber who I mention in the article. While I don't agree with all of his takes, I believe it's important for the field to have its critics, lest we lose perspective of what we're trying to address.
corygradlcsw.substack.com/p/…
In grad school, therapists in training are told about the healing power of the therapy relationships, the importance of rapport and empathy.
Their first job is at a large organization that reduces treatment a to a series of metrics. PHQ9, GAD7, MH-QoL, along with a series of scoring systems populate a various dashboards that need to be checked regularly. Clinician success is tracked with intake to follow up conversation rate, documentation completion rate, and amount of monthly completed visits.
Emails regarding progress get sent out saying things like, "Case 244011 has had persistent PHQ9 for last several months. May be beneficial to explore distressing thoughts and strengthen coping, self-soothing, and hopefulness." Further clinical development comes in the form of self taught training modules online.
Client, clinician, and treatment have all been reduced to abstracts.
Cory Grad retweeted
Imagine paying $2000 a month for a grocery membership.
Then imagine going to the supermarket, filling your cart, and discovering at checkout that you still owe $300.
Three months later, another bill arrives. Apparently, the person who stocked the produce wasn’t part of your grocery network.
And the milk? Your membership covers milk, but only if you buy it at a different store.
You call to ask why. After 45 minutes on hold, someone explains that you should have obtained prior authorization before buying the groceries.
And next year, your membership goes up to $2500 a month.
Nobody would tolerate this way of buying groceries.
But somehow, we’ve come to accept it as a reasonable way to pay for healthcare.
Cory Grad retweeted
Warnings re psych diagnosis:
1)Describe/dont explain
2)Usually impossible to make accurately in 1 visit
3)are fallible/often wrong- leading to wrong treatment
4)blend into normality/require significant distress or impairment
6)self-diagnosis is usually wrong
7)Can haunt for life
Diagnoses are tools, not destinies.
Psychology needs reliable diagnoses. Before we can determine whether a diagnosis is valid—whether it captures something meaningful—we need reasonable agreement about what we’re identifying. Reliability must come before validity, though it doesn’t guarantee it.
But what we do with a diagnosis is another matter entirely.
A diagnosis can guide treatment, advance research, help people understand themselves, and give language to experiences that have long confused them.
Or it can become a label that narrows expectations, excuses behavior, invites stigma, or convinces someone that their future has already been written.
A diagnosis should help us understand a person, not become our understanding of that person.
Cory Grad retweeted
"People plant their flags, and the flags are where they make their money, too."
- Dallas Taylor
Cory Grad retweeted
Most leadership teams do not need more trust exercises.
They need to identify which truths are expensive to say, who pays the price for saying them, and what the organization therefore remains unable to know.
Cory Grad retweeted
The disappearance of “third spaces” that are neither home nor work, coupled with stigma against married couples with kids spending evenings or weekends outside the home, has created a society of “family pods” that don’t intermingle nearly enough. Children benefit from their parents’ wide friend network. They have more possible godparents or future mentors/connections to jobs, people to take them to school when parents are sick, or many many other advantages. people in the early to mid 1900s simply had better social sense and civic/community mindedness than people now. Not everything translates to an internet analogue, including but not limited to socialization and community for your family.
I'm sorry but this is so fucking lame. Your grandparents partied. Your grandparents hosted, they went to bars, they did shit. They didnt sit around and pride themselves for spending all of their free time staring at their children and mowing the lawn. Get the fuck out of your house. Take your wife out for a drink and listen to some live music. Have a conversation with someone at the bar. Go to a hockey game with your college buddies. Youre not somehow more mature for being homebound. Get a life.
Something I've noticed with couples, married or otherwise, is a focus on external growth while internal growth remains untouched. External growth refers to things such as purchasing a house, getting married, having kids, etc and internal growth refers to the ability to tolerate and resolve conflict, understand your partner's values (especially around parenting), navigate when people have conflicting needs, etc.
This can work for a while, but eventually the external growth will draw upon the underdeveloped inner work of the relationship. The relationship will try and compensate for this, but usually a way in that does not serve the relationship well in the long term.
Cory Grad retweeted
“Most [therapists] could benefit by looking harder at why they became therapists and what types of affirmation and gratification they are seeking. From my experience, many suffer from being too passive, masochistic, and conflict-avoidant.”
—Karen Maroda
Cory Grad retweeted
No one is an expert in their life. We all have an unconscious. We all have hard to see (but can be accessed) motives and wishes. We dip in and out of awareness of our various motives, it would be absurdly costly (calories) to be perfectly consciously aware of all things (e.g., blood pressure) that motivate us
Cory Grad retweeted
DSM-6 is a grift/mistake whose only real purpose is publishing profits for Am Psychiatric Assoc.
Changing its name from 'Diagnostic & Statistical Manual' to 'Diagnostic & Scientific Manual' is putting lipstick on a pig.
Giant leaps in neuroscience during past 50 yrs have had absolutely no impact on diagnosis.
A good counterpoint to all those online therapists out there who view curiosity about the patient's inquiries as being harmful.
✍️ This week’s essay is up! (2 min read)
❝
All patients are ambivalent about starting psychotherapy. Part of us wants change; another part resists it. Ambivalence and resistance accompany psychotherapy at every step.
Read free here👇
jonathanshedler.substack.com…
Cory Grad retweeted
This may be the dividing line separating skilled and unskilled therapists. Unskilled therapists see pain and victimhood. Skilled therapists also see the hate and aggression and know how work with it.
How do we know there is hate and aggression? Because the patient is human. 👇
“It is one thing to empathize with patients’ experiences of injury and victimization but we must be able to empathize with their negative impulses as well, including sadistic or hateful wishes to attack or to wreak vengeance.”
—M. Carsky & F. Yeomans, “Overwhelming Patients and Overwhelmed Therapists”
Cory Grad retweeted
Very grateful for the chat on today’s podcast!
Thanks so much to all who came out. Including: @RyanMalphrus @DFMagee @CoryGrad_LCSW .
Clip: trans teens, hormones, athletes
Much more explanation before the clip in full episode (linked ⬇️)
Cory Grad retweeted
Good morning all.
Going Live today on YewTewb at 11:30am PST. Link in bio.
Topics:
1. Mental health Criticism and skepticism.
2. Case formulation
3. “Trans teens” and gender affirming care.
Hope to see you there! @CoryGrad_LCSW @RyanMalphrus @Careerflex @SystemicTexism @PrimalHex @angpeacock1111 @DFMagee
