Psychotherapist https://teapawt.net/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/…
Cory Grad retweeted
A therapist loses a treatment in five ways:
-he overrides the patient’s capacities
-he only sides with one power in the patient’s life
-he brings in a third-party payer
-he is not present
-he leaves nothing behind in the patient between sessions
If you work in a Big Box Therapy place and you do couples and family therapy, be prepared for the following:
1. These are forms of therapy that can be intimidating, especially for an early-career clinician. They will probably shovel most of those cases onto you simply because you offer it, not because of fit. These places would rather grind the clinician into sawdust than refer out.
2. Be prepared for the therapy frame to be challenged before session one. One spouse or only part of the family may attend the intake session. If it's done over telehealth, don't be surprised if couples therapy is sprung on the other unwitting spouse. ("Honey, get in here! I booked us couples therapy!" … "What?!")
Other examples include family members trying to come in and out of family therapy because of work or other obligations (no session can happen in that case), or people trying to do couples therapy as they're driving to work in separate cars (again, therapy cannot happen in that instance).
One of the reasons this happens is that the intake process is nearly nonexistent in Big Box Therapy places. The only requirement to book a session is to provide your insurance info and a credit card number.
Cory Grad retweeted
PSA:
Generally speaking, acronym therapies are commodified products.
CBT, ACT, DBT, ERP, etc.
They are dumbed-down, shortened, enshittified and simplified versions of therapy designed to be sold for profit. The acronym itself is a result of this process.
Acronym therapies are born in academia because they're measurable. When it comes to the human mind, the more measurable something is the less its actually capturing something meaningful and truthful.
Then health insurers, large companies, etc. adopt these acronym therapies because they're easily marketable for the same reasons they're easily measurable.
Most people who've benefitted from acronym therapies are unaware they've simply received the best help from a line-up of inferior services with no high-quality service to compare it to.
TLDR, 'evidence-based' is functionally equivalent to a coffee shop that advertises 'the world's best cup of coffee'.
Cory Grad retweeted
Hey all. We had a spooktacular chat on today’s podcast.
Grateful to everyone in the chat: @angpeacock1111 @CoryGrad_LCSW @DFMagee @sfowler and others!
A bit of a rant on EHRs and EMRs.
(Full episode w/context ⬇️)
Cory Grad retweeted
Couples who protect their date nights like they would an important business meeting, and their sex life like a treasured thing, give their marriage a much better chance of staying warm, connected, and worth protecting.
Cory Grad retweeted
Every morning, before the first patient, consider that this may be your last session with each of them. This helps to stay present. Patients leave without warning. They may move, lose their insurance, get better, give up, die. Say what needs saying in a form they can use that day.
Cory Grad retweeted
A therapist should know where the work came from. Every rule taught in this field was paid for by a clinician who went too far or not far enough. Be careful not to worship old masters, but do study them to learn what their mastery cost.
Cory Grad retweeted
Howdy all.
Today’s UnShrink Me Halloween special will be streaming on EwwwTube at 12:30pm PST.
Spooktacular topics include:
1. The terror of EHRs.
2. Spooky therapists: fragilizing, objectifying patients.
3. Frightening future challenges for the field.
Hope to see yall there: @SystemicTexism @RyanMalphrus @PrimalHex @CoryGrad_LCSW @angpeacock1111 @sfowler
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
Mental Health Is More Than Symptom Reduction
Good therapy does more than reduce anxiety, lift depression, or quiet painful thoughts. It helps people reclaim agency, deepen relationships, and rediscover purpose. Consider someone whose anxiety has improved but who still avoids meaningful conversations, struggles to make decisions, or feels disconnected from daily life. True therapeutic progress is not simply feeling less anxious; it is finding the confidence to speak honestly with a partner, make an important choice, or reconnect with something that matters. The challenge for mental health care is clear: Are we merely helping people suffer less, or are we helping them live more fully?
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.
