Collecting haunts: the clients who never leave your mind
Every therapist carries a specific inventory of clients who will not leave. Not the successes. The ones who left before the work finished. The ones whose …
Uncensored
Diagnosing your ex-husband in session
The training does not turn off when you go home. Every therapist with enough years behind them has done this, and almost none of them say it out loud in a …
Empathy fatigue: when compassion turns into disgust
The burnout literature describes empathy fatigue. It does not describe the stage that comes after. This episode describes that stage, names it with more …
Faking empathy for an hour
There is a thing that happens in the clinical hour that graduate training never names. Not because it is uncommon. Because naming it out loud requires admitting …
Giving up on a Borderline before the first session
The diagnosis arrives before the client does. This episode is about what happens in the therapist in the time between reading the referral note and the first …
Grieving the ones who get better
The clinical literature on termination is written from the client’s perspective. This episode is written from the therapist’s. The experience it …
I liked her better before she healed
The client who heals is not the person the therapist worked with through the crisis. That person changes when the crisis ends. What remains is healthier and …
I miss the clients who needed me too much
There is a category of clinical loss that the profession does not give therapists language for. This episode provides some. The experience it describes is not …
Keeping them in treatment for the mortgage
The financial structure of private practice creates a specific pressure on clinical judgment that the training literature does not discuss. This episode …
Lies that help more than truth
There is a category of clinical intervention that the training literature calls technique and that a more honest accounting would call something else. This …
Manipulating the spouse to leave
The profession teaches that the therapist presents options neutrally. This episode makes the case that this is a description of technique, not a description of …
My burnout looks like enlightenment
The symptoms of advanced therapist burnout and the qualities attributed to mature therapeutic practice look, from the outside, almost identical. This episode …
My favorite pathological liar
Not all clinical relationships ask the same thing of the therapist. This episode is about the client who asks for something more specific, and what the …
My favorite sociopath
The clinical literature on antisocial personality disorder describes the population almost entirely in terms of what it costs the therapist. This episode …
My inner supervisor is drunk
There is a clinical competency nobody teaches in reverse: how to stop the training from interfering with the work. This episode makes the case that the internal …
My unspoken crushes in session
The training literature on erotic transference is written almost entirely from the perspective of the client’s feelings toward the therapist. This episode …
Righteous cruelty in the name of growth
The clinical frame can be used to justify causing a client pain in ways that would not be acceptable in any other relationship. This episode examines what that …
Secretly enjoying someone's relapse
A client’s relapse after a period of stability produces something in the therapist that is not adequately described by clinical concern. This episode …
Strategic gaslighting for a good cause
There is a clinical intervention that the training literature calls reframing and that a less comfortable description would call something else. This episode …
Taking a client you know you can't help
Every honest therapist knows the intake where the answer should have been no. This episode is about what happens when the answer is yes anyway, why it happens, …
The addiction of hearing secrets
The moment a client says something they have never said to anyone else produces a specific experience in the therapist that is not adequately described by the …
The client who reminded me of my mother — and paid for it
Unresolved personal history enters the room regardless of training. Every experienced therapist has had the client who carries the specific signature of someone …
The client who taught me to manipulate better
Therapists learn from their clients in ways that the training literature does not describe accurately. This episode is about a specific category of learning, …
The confession that shouldn't have healed me
There is a category of clinical encounter that changes the therapist, not the client, or at least not only the client. The profession’s framework for that …
The day I wanted to slap a client
The clinical term countertransference covers a range of experience that includes some things it is more comfortable to name than others. This episode names one …
The dopamine hit of being needed
There is a specific reward built into the structure of a therapeutic relationship where the client depends on the therapist, and that reward shapes clinical …
The erotic thrill of ethical restraint
The ethics literature describes the therapeutic frame primarily in terms of what it prohibits. This episode describes what the frame also produces, in the …
The erotic transference you actually enjoyed
The ethics training covers what to do with erotic transference. It does not cover what it is actually like to hold the frame around it across years of practice. …
The fear of being useless when clients actually heal
The therapist’s need to be needed is a variable in the termination decision that the clinical literature does not account for. This episode makes that …
The god complex you never lose
Every experienced therapist operates from a level of confidence in their own perception that the training literature carefully avoids naming directly. This …
The guilt of enjoying transference
Positive transference makes the work easier and more enjoyable. The profession’s response to that fact is management and monitoring. This episode asks a …
The love affair that almost happened
The prohibition is clear. The experience it applies to is more common, more textured, and more clinically significant than the training literature acknowledges. …
The orgasm nobody names: saving someone
There is an experience that keeps experienced therapists in the field despite everything that works against staying. The clinical literature calls it …
The porn addicts I envy
There are clients whose central problem has pleasure at its center rather than pain. A therapist’s response to that population, when it is examined …
The power trip of being the safe one
The therapeutic relationship gives the therapist a specific kind of structural advantage that the training literature describes in clinical terms and almost …
The secret joy of a client's divorce
The profession teaches that the therapist should have no stake in what the client decides. This episode makes the case that this is not possible, and that the …
The seductive charm of damaged people
There is something that happens in the room with a certain kind of client that the clinical literature describes only in terms of the risks it creates. This …
The superiority that keeps us employed
The therapeutic relationship requires the therapist to be in a specific position relative to the client. The training literature describes that position in many …
The therapeutic use of a well-timed insult
There is an intervention that works, that experienced therapists use, and that nobody teaches. This episode makes the case for it, describes what it requires, …
Therapy for sociopaths who want to get better at it
There is a category of client who comes to therapy to become more effective at the behavior that brought them in, not less. This episode is about what happens …
Transference is just attraction we legalized
The clinical concept of transference is one of the most useful tools in the therapeutic literature and one of the most convenient places to put an experience …
Unethical fantasies at professional dinners
Every practitioner knows the difference between what gets said at the conference and what gets said at dinner afterward. This episode is about the dinner …
When holding space becomes emotional masturbation
There is a clinical stance that looks like careful, attentive practice and functions, in a significant number of cases, as an extended exercise in professional …
When silence becomes punishment
Clinical silence is the most powerful tool in the therapeutic kit and the easiest to weaponize. The pause that invites the client to go deeper and the pause …
When the couple is better off breaking up (but you need the fee)
There is a financial incentive built into couples therapy that nobody names in training. This episode names it. The specific conflict it creates between what …
When therapy becomes kink with paperwork
The structure of the therapeutic relationship is not as different from certain other structured relationships as the profession would prefer to acknowledge. …
When your client becomes more interesting than your spouse
The work creates an appetite for a quality of presence that the domestic relationship was not designed to satisfy. This is not a complaint about the marriage. …
Why CBT is for robots
The effect sizes on the gold standard of psychotherapy have been declining for forty years. Most practitioners have seen the numbers. Almost none are having the …
Why I don't send my kids to therapy
What therapists choose for their own children is a more accurate reading of their real confidence in the field than anything said at a conference. This episode …
Why the most ethical thing I ever did looked terrible on paper
There is a category of clinical decision that was right and would not have survived a review board. Most experienced practitioners have made one. The profession …