In bipolar I, mood stabilizers are essential to prevent mania, but for bipolar II depression therapy alone (social rhythm) may work, and in this trial reduced reduced suicidality independent of med:
pubmed.ncbi.nlm.nih.gov/41037752
Social Rhythm Guide:
amzn.to/4nYddI0
1/ One of most important things I've learned:
Severe personality problems find *camouflage.* No one thinks “I’m a sadist” or “I'm a malignant narcissist.”
They find a belief system/social group that validates their most hateful, destructive impulses & construes them as virtues.
Nancy McWilliams’ take on love in psychotherapy. It’s quite assuring to discover how the qualities of effective psychotherapy falls very closely to the therapist’s humanness… in the midst of all the hoo-hah about AI therapy.
“I absolutely do not believe in common sense. There is sense, but there is no common variety.
In all likelihood, not a single one of you hears me in the same sense as another.
Furthermore, I endeavour to make it so that access to this meaning is not so easy, which entails ...
I’ve been playing with the idea that relationships tend to fall into one of three patterns
1️⃣ Hierarchical. One person’s needs/wants take precedence over other’s
2️⃣Transactional. Each gives something to get something in return
3️⃣Mutual. Two people coming together as whole people, seeing and responding to one another as whole people—to connect and discover one another...
...with each person also becoming something else and something more by virtue of that coming together. This is a relationship continually co-created by two, mutually shaping and being shaped by one another—an experience of “we,” not just the a combination of two “I’s”
This is where genuine intimacy can develop. I believe this is what philosopher Martin Buber referred to as an “I-thou” relationship (vs. an “I-it” relationship)
Many people have never experience this kind of mutual relationship and cannot conceive of it, any more than a fish could conceive of “not water.” It is just outside their experience
When such people are dissatisfied with the subordinate role in a hierarchical relationship and seek a more satisfying one, they do not envision a mutual relationship. Instead, they envision another hierarchical one with the roles reversed
When such people are dissatisfied with a transactional relationship and seek a more satisfying one, they do not envision a mutual relationship. Instead, they envision another transactional relationship with a better deal
One distinguishing feature of psychoanalytic (or psychodynamic) psychotherapy is that it develops a capacity for more mutual relationships—specifically by exploring what occurs in the psychotherapy relationship itself
Because of the work done in the therapy relationship, mutuality and intimacy become more possible in other relationships
This is why most psychodynamic therapists are deeply unimpressed by pop-psychology notions of self-love, self-healing, self-care, etc. It’s all self self self self
But our experience of self is formed in relationship, and requires relationship to change
We become most fully ourselves in mutual relationships where we are truly seen by another
This is entirely different than the “self-care” and “self-love” promoted by pop-psychology and social media therapy “influencers”
“An apology, a real apology, is not an excuse or after-the-fact ritual. A real apology demonstrates an understanding of why the conduct was wrong, how it hurt, what produced it, and what is different now that prevents it from happening again”
—M Karson
This is what you *don’t* get growing up with a parent with severe personality problems, because it would require both empathy and self-reflection
The harm can last a lifetime
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