How do I make therapy better?

[The man The only man]

Honestly OP, you sound like a massive faggot.

 

[Tram Fan]

The only way to make therapy better is if every therapist killed themselves. Lead by example, faggot.

In Poland we say if you go to a private shrink you will get a decent care. But if you go to a universal healthcare shrink he will just hand you a rope.

It will have to be on a case by case basis.

Yessss hard agree on that. Most shrinks think they will learn 1 type of a patient or 1 per mental disease and they are good to go and when you don't fit in the mold they meltdown.

A therapist is someone you can just rant to but you could probably get the same experience with an LLM/painted vollyball/guides on /x/ for summoning a demon gf for a fraction of the price.

Well in theory a therapist is trained to talk to you in a constructive matter so you can vent but after some sessions you should know how to unfuck your life.

using chatgpt as a shrink must be one of the worst things one can do, maybe one step below giving money to a jew for shrinking you

It's better to going to a blue-haired girl who cheated her way through her psychologist degree.

Therapy can be made better by simply finding someone close to you to use as a sounding board. This is often your chosen partner, a best friend, or a close family member (mother, father, favorite cousin or uncle, for example). Someone who understands your own complexities enough to be able to give you sound advice but is removed enough from the situation you're worried about is what you need, not some person who knows nothing about you, at all, and who psychoanalyzes every sentence you speak.

The problem is if you need a shrink for real for more than a few venting sessions you probably don't have good relationships your girlfriend is a psycho your parents abuse you and you hardly got anyone to talk to.


Alright time to get useful.
1. Don't fuckin tell your patients that weigh 150 kilos that they are fine and shouldn't lose weight. And don't tell trannies they are normal. No. If you meet a tranny u gotta tell them nicely that they arent the opposite gender.
2. For fucks sake understand your patients. Know what you're working with. Yes you can't understand it al but you can understand a lot. Don't lead people the wrong way. If they are abused don't tell them they have a victim mentality and if they are the abusers don't tell them they just need to set up their boundaries better.

If you understand this ur gonna be better than like 90% shrinks out there.

 

[Not 6 Foot]

The problem is if you need a shrink for real for more than a few venting sessions you probably don't have good relationships your girlfriend is a psycho your parents abuse you and you hardly got anyone to talk to.

I mean, yeah, that's why I made sure to say that I don't deny therapy can work for some, it's just not an ideal thing to ever do.

 

[Heckler1]

I am a humanistic and Gestalt therapist

I like the confrontational nature of Gestalt therapy. What separates a therapist from just a good listener is that you are helping a person highlight the problems/dilemmas they are describing, and taking accountability for their actions/next steps. I would say make sure that clients know they are the ones who need to make the choices if they want to see change, and don't be afraid to call out patients that just want to sit in their misery.

 

[Ravioli Chandler]

I do incorporate other therapies. If it's something outside humanistic/Gestalt but the client is responding well to it, or they request it, then I'll use it (within my scope of practice). I chose Gestalt because it works well and I feel most at home in it. Also, I think it is especially effective for our generation, who has been raised on logic, bureaucracy, corporatization, and structure in all the wrong places (not in family, fewer "third spaces" for kids and adolescents).

Therapies I avoid... conversion therapy I guess? I avoid flooding and exposure therapy if the client is not ready for something like that. It's not that they don't work at some point for some clients, but doing that right out of the gate can retraumatize someone. I think sometimes clients expect to have to share their whole story in the first session. When they start telling me about something traumatic, I will often stop them. I'll reassure them that they don't have to go into it if it's distressing, and warn them that it can be retraumatizing. You can do some trauma therapies, like EMDR, without even talking about the trauma.

How dependent is the therapy's success on the patients doing the homework, following the advice and mechanisms they learn from you in therapy? Do therapists need their own therapists, like doctors need their own doctors?

 

[ZombiesRwankster]

In Poland we say if you go to a private shrink you will get a decent care. But if you go to a universal healthcare shrink he will just hand you a rope.

What do you mean by hand you a rope? Will the universal healthcare shrink typically just throw up his hands and say there's nothing to be done?

Most shrinks think they will learn 1 type of a patient or 1 per mental disease and they are good to go and when you don't fit in the mold they meltdown.

If it was you or a friend, what were the key parts that did not fit in the mold?

The problem is if you need a shrink for real for more than a few venting sessions you probably don't have good relationships your girlfriend is a psycho your parents abuse you and you hardly got anyone to talk to.

What does the venting do for you? Not a rhetorical question.

I like the confrontational nature of Gestalt therapy. What separates a therapist from just a good listener is that you are helping a person highlight the problems/dilemmas they are describing, and taking accountability for their actions/next steps. I would say make sure that clients know they are the ones who need to make the choices if they want to see change, and don't be afraid to call out patients that just want to sit in their misery.

What I get from your message is "Don't be an enabler."

Do you think there is any use for shame in therapy?

How dependent is the therapy's success on the patients doing the homework, following the advice and mechanisms they learn from you in therapy?

It also depends on your theoretical orientation. Being humanistic, I don't give homework or teach mechanisms (psychoeducate) as much as, say, a cognitive-behavioral or solution-focused therapist. I think what clients often come for is problems they cannot solve, will not solve, or do not realize that there is no perfect solution for. I would rather do in-the-moment, experiential stuff so they can unstick themselves.

It also depends on the client. Some like homework and get benefit out of homework, so I give them more homework. There's no reason to deny a client progress or something they ask for in order to "preserve the purity" of my theoretical model.

Do therapists need their own therapists, like doctors need their own doctors?

It might seem cultish or self-propagating, but I think it's a good idea. I've been in therapy on and off for around 6 years now. I've gotten mostly lucky with my pairings. Had a really good one for 3 years, made unreal progress, and a lot of stupid decisions in my life in that same period. Had one that I did not feel heard by, stopped after one session. Had one from my old uni that helped me realize I was autistic when no one in my family did, or told me. Had one in my new uni that helped me through some relationship stuff. And I have one right now, also from new uni, who is pretty cool, but he does this one thing that bugs the shit out of me. He says "we" when referring to me. Just say "you" dude! There is no "we" in my problems! Yes, I did tell him that it bugs the shit out of me. He tries to say "you" now but is still kind of in the habit.

I think everyone can benefit from good therapy. (Caveats: Being therapy-fatigued, being over-treated, being retraumatized, being exploited, being harmed in any other way by a therapist.)

 

[Heckler1]

What I get from your message is "Don't be an enabler."

Do you think there is any use for shame in therapy?

Broadly yes, but also being comfortable being uncomfortable with clients. Good therapy is sort of like having a license to kill, where we should be asking the tough questions/observations to prevent ourselves as much as the client from falling into comfortable complacency.

Shame and guilt, when properly explored are very valid in therapy. If a client feels shame, then they should explore why and come to terms with what they want to do about it. Inversely if a client is describing an activity/thought that would cause shame in society, it may be worth exploring why they feel that way. Negative emotions are not bad.

 

[Tram Fan]

What do you mean by hand you a rope? Will the universal healthcare shrink typically just throw up his hands and say there's nothing to be done?

Handing a rope aka telling the patient to end themselves.
They just gonna bully you cuz u came at 5 pm and it's their 9th hour of work this day and they are tired and in general you're a problem to them. They won't say like "you will never get better" but they will say that you are very stupid terrible and whatever.

If it was you or a friend, what were the key parts that did not fit in the mold?

I didn't fit the mold. I'm used to hiding my powerlevel so when somebody wants me to go deep after meeting me 10 minutes ago I'm not okay with that.
Also I say stuff that is probably completely predictable but other patients wouldn't say it. You might teach me something that is very useful for others but it will be annoying for me.

What does the venting do for you? Not a rhetorical question.

First thing it's releasing built up emotions but more importantly when I vent and somebody validates that I stop feeling like I'm crazy.

It also depends on your theoretical orientation. Being humanistic, I don't give homework or teach mechanisms (psychoeducate) as much as, say, a cognitive-behavioral or solution-focused therapist. I think what clients often come for is problems they cannot solve, will not solve, or do not realize that there is no perfect solution for. I would rather do in-the-moment, experiential stuff so they can unstick themselves.

Do I understand it well that you're this type of a shrink that I should go when I need to come to terms with stuff that is horrible for me?

Broadly yes, but also being comfortable being uncomfortable with clients. Good therapy is sort of like having a license to kill, where we should be asking the tough questions/observations to prevent ourselves as much as the client from falling into comfortable complacency.

Yeah and to do that you need a very fuckin good skillset. You can't just make somebody talk about hard shit and then your time is up and you just leave the client crying bc you didn't plan it out well. And you have to be fair. If your client is a freshly widowed woman maybe you shouldn't tell her to cry less. But if you have a BPD patient who is unstable maybe you should tell them to stabilize their emotions. You have to make them feel safe when talking to you. They shouldn't question if you're a friend or an enemy.

 

[Ravioli Chandler]

Had one from my old uni that helped me realize I was autistic when no one in my family did, or told me.

Your responses are very enlightening.

What is it like being an autistic therapist? Does it help you relate better to autistic clients? Do you take autistic clients? How do you feel about therapy telehealth? Do you do your sessions in-person only or online?

 

[Super Mario Brothers]

Therapies I avoid... conversion therapy I guess?

What's your opinion on gender affirming care?

 

[ZombiesRwankster]

Broadly yes, but also being comfortable being uncomfortable with clients. Good therapy is sort of like having a license to kill, where we should be asking the tough questions/observations to prevent ourselves as much as the client from falling into comfortable complacency.

I'd agree with that. I tend to get impatient, which is a different problem.

Shame and guilt, when properly explored are very valid in therapy. If a client feels shame, then they should explore why and come to terms with what they want to do about it. Inversely if a client is describing an activity/thought that would cause shame in society, it may be worth exploring why they feel that way. Negative emotions are not bad.

This too.

Handing a rope aka telling the patient to end themselves.
They just gonna bully you cuz u came at 5 pm and it's their 9th hour of work this day and they are tired and in general you're a problem to them. They won't say like "you will never get better" but they will say that you are very stupid terrible and whatever.

Damn, that's horrible.

I didn't fit the mold. I'm used to hiding my powerlevel so when somebody wants me to go deep after meeting me 10 minutes ago I'm not okay with that.
Also I say stuff that is probably completely predictable but other patients wouldn't say it. You might teach me something that is very useful for others but it will be annoying for me.

So you only reveal your power level to people who earn your trust, that's fair, and perhaps wise of you.

I have also been told things that were annoying and 'captain obvious' in therapy. No doubt they were revolutionary for other people, but not for me. And then I have also been told things that were revolutionary for me that were probably tired and obvious for other people.

Do I understand it well that you're this type of a shrink that I should go when I need to come to terms with stuff that is horrible for me?

I could help with that, yeah. We call it "unfinished business". The event is over, the person is dead or gone, that time in your life has passed, yet you are still suffering. There is no undoing or retrying the past, at least not in the same way. But, we can get closer to coming to terms with it and feeling all of what needs to be felt.

You have to make them feel safe when talking to you. They shouldn't question if you're a friend or an enemy.

Big yes to that.

What is it like being an autistic therapist? Does it help you relate better to autistic clients? Do you take autistic clients? How do you feel about therapy telehealth? Do you do your sessions in-person only or online?

It helps me relate, yes. It also helps them trust me and what I'm doing. I see a handful of autistic clients, probably more soon.

As far as what it's like being an autistic therapist, there are advantages and disadvantages. I'm pretty organized in my brain, but this means I go too much into thinking mode sometimes rather than emotionally attuning. I have had to train my empathy a lot. I have had to put myself outside of what I think is logical or what emotionally makes sense to me. This has helped me in my personal life a lot, too. It's been a win-win.

Telehealth is not as powerful as being in person. In telehealth, everything we see, hear, smell, etc. is through a filter. There are many more barriers. However, it is some clients' only option, and it is others' preference. About half my clients I see online because they live far or don't have transportation. Ideally I would like to see everyone in person.

What's your opinion on gender affirming care?

You mean whether I think it's conversion therapy? Depends whether the person is being forced into it or chooses it. There is definitely cultural and systemic influence on people seeking out gender-affirming care, especially in the West. This could be coercion (unwanted pressure) or visibility (positive inspiration and camaraderie), or somewhere in between...

 

[Super Mario Brothers]

You mean whether I think it's conversion therapy? Depends whether the person is being forced into it or chooses it. There is definitely cultural and systemic influence on people seeking out gender-affirming care, especially in the West. This could be coercion (unwanted pressure) or visibility (positive inspiration and camaraderie), or somewhere in between...

I was actually wondering whether you thought therapists who want to treat gender dysphoria WITHOUT affirmation is conversion therapy.

 

[Tram Fan]

I have also been told things that were annoying and 'captain obvious' in therapy. No doubt they were revolutionary for other people, but not for me. And then I have also been told things that were revolutionary for me that were probably tired and obvious for other people.

I meant like wrong advice. For example I hate toxic positivity and forcing positivity onto me just annoys me and I don't react well when somebody trains me to just be more optimistic or whatever bullshit. But many people benefit from being trained to be slightly more optimistic/positive so the shrink would keep forcing this onto me just cuz.

As far as what it's like being an autistic therapist, there are advantages and disadvantages.

There should be shrinks with different backgrounds. I had a few problems because my shrinks were privileged women who didn't understand why I was struggling. Just ask your rich parents for money or connections.

Depends whether the person is being forced into it or chooses it.

Have you actually met a real trans person? Like their symptoms could only be explained by gender dysphoria and not other disorders or cultural influence?

 

[Ravioli Chandler]

I'm pretty organized in my brain, but this means I go too much into thinking mode sometimes rather than emotionally attuning. I have had to train my empathy a lot. I have had to put myself outside of what I think is logical or what emotionally makes sense to me. This has helped me in my personal life a lot, too. It's been a win-win.

Do you have any books you would recommend on that topic or in general that are psychology or therapy related.

 

[ZombiesRwankster]

I was actually wondering whether you thought therapists who want to treat gender dysphoria WITHOUT affirmation is conversion therapy.

Treating gender dysphoria without affirmation... do you mean treating it without gender-affirming care, i.e., without hormone replacement therapy? It depends how you approach treating it. If you are trying to convince someone who thinks they are trans or gay that they are not trans or gay because you think it is inherently morally wrong, inherently maladaptive, or inherently mental illness, then I would call that conversion therapy. If someone who is unsure whether they are trans or gay is pushed by a mental health professional to transition rather than not, I would also call that conversion therapy. Ethically, we should go where the client wants to go, while taking our clinical judgment into account.

Gender dysphoria causes distress, disability, and has duration; therefore, it is a mental illness. Gender dysphoria, however, is not an inherent part of the trans experience. Dysphoria—the distress—can be managed with gender-affirming care. Conversely, you cannot treat someone out of an identity. You can only influence them to suppress it, and suppression is misery. I don't believe in forcing anyone to live a miserable existence if they are not hurting anyone by doing so.

Have you actually met a real trans person? Like their symptoms could only be explained by gender dysphoria and not other disorders or cultural influence?

There is always cultural influence on our conceptions of mental health.

The question of who is a "real" trans person is up for debate. If you're worried that cultural influence is harming people by causing them to transition, that's possible, but I also know several trans people who felt something inexplicable from a very, very early age. There's the classic trying on mom's or sister's clothes, but often it's an existential feeling inside where transitioning just feels right. I wouldn't know, never felt it for myself, but there are a lot of things I don't feel that other people do.

There should be shrinks with different backgrounds. I had a few problems because my shrinks were privileged women who didn't understand why I was struggling. Just ask your rich parents for money or connections.

There is a huge problem with clinician (and client) diversity. It is mostly white and mostly middle-upper class. And mostly frickin normie too.

I meant like wrong advice. For example I hate toxic positivity and forcing positivity onto me just annoys me and I don't react well when somebody trains me to just be more optimistic or whatever bullshit. But many people benefit from being trained to be slightly more optimistic/positive so the shrink would keep forcing this onto me just cuz.

So you clearly weren't responding well to the toxic positivity/ "optimism training" yet the shrink kept bringing you back to that. Giving the wrong advice is excusable. I get it wrong all the time and I always encourage my clients to tell me when I'm off the mark or they want to try something different. Insisting on an intervention even when you say it's not working for you is inexcusable on that shrink's part. It's arrogant and uncaring.

Do you have any books you would recommend on that topic or in general that are psychology or therapy related.

As far as getting out of thinking/robot mode and into feeling and present awareness, I really like Joe Hudson's videos. He does a lot of Gestalt-inspired talks and experiments.

I also really like Dr. K / HealthyGamerGG. He focuses on helping young men in the Internet age, so a lot of his stuff is relevant to my problems.

You asked for books though: Rick Carson's "Taming Your Gremlin", Marcus Aurelius' "Meditations" and "In the Buddha's Words".

 

[Super Mario Brothers]

Treating gender dysphoria without affirmation... do you mean treating it without gender-affirming care, i.e., without hormone replacement therapy? It depends how you approach treating it. If you are trying to convince someone who thinks they are trans or gay that they are not trans or gay because you think it is inherently morally wrong, inherently maladaptive, or inherently mental illness, then I would call that conversion therapy. If someone who is unsure whether they are trans or gay is pushed by a mental health professional to transition rather than not, I would also call that conversion therapy. Ethically, we should go where the client wants to go, while taking our clinical judgment into account.

Gender dysphoria causes distress, disability, and has duration; therefore, it is a mental illness. Gender dysphoria, however, is not an inherent part of the trans experience. Dysphoria—the distress—can be managed with gender-affirming care. Conversely, you cannot treat someone out of an identity. You can only influence them to suppress it, and suppression is misery. I don't believe in forcing anyone to live a miserable existence if they are not hurting anyone by doing so.

There is always cultural influence on our conceptions of mental health.

The question of who is a "real" trans person is up for debate. If you're worried that cultural influence is harming people by causing them to transition, that's possible, but I also know several trans people who felt something inexplicable from a very, very early age. There's the classic trying on mom's or sister's clothes, but often it's an existential feeling inside where transitioning just feels right. I wouldn't know, never felt it for myself, but there are a lot of things I don't feel that other people do.

Until recent years a trans person was defined by their inability to cope with their birth sex, ie. dysphoria. It's only until the cultural factors you mention that being trans suddenly didn't mean having dysphoria. If someone had no dysphoria, why else would they transition? Hormone replacement therapy and sexual reassignment surgery was gatekept heavily for good reason, and even getting a gender dysphoria diagnosis was much more difficult. Now it's too easy to get diagnosed and given hormones and surgery.

I suppose "what is gender dysphoria?" is a better question. You did mention that trans people you talked to "always knew," which seemed to have been the narrative for a while. But what does "always knowing" mean? I've heard stories stretch like saying they "always knew" because they liked something stereotypical to the opposite sex. (Like in your example.) I haven't heard many stories with discomfort of their birth sex itself. Shouldn't these be ruled out as gender non-conforming, and not some type of sex discomfort? And even historical cases, like Christine/George Jorgenson, didn't "always know" but they're treated as actually having been trans.

Other mental illnesses overlap with the symptoms of gender dysphoria a lot. For example, PTSD, especially in the cases of sexual assault, can cause people to be uncomfortable with their body and their genitals. Similarly, people with DID can develop dissociated parts that believe they're the opposite sex to cope with childhood sexual abuse. People with body dysmorphia and eating disorders usually have body image issues. Shouldn't these disorders be heavily screened out before any trans treatment?

And I guess the most relevant question: should "affirmation" actually be the way to treat dysphoria? The reason why gender affirming care was brought up not because of research, but because activists made it so. "Trans" people (or people with GD) have lived in the past without being referred to as their desired sex, let alone medical transition. Why is it only recently that "we must affirm them or they will be miserable" has become the narrative? Why can't most learn to accept their body? Because in truth-- the real world acknowledges people by their birth sex, not their identity. Even modern medicine can't change sex, only give features of the opposite sex or modify existing genitals. Shouldn't gender transition be reserved for the extreme cases, like it used to be? (If, at all?)

(Sorry if this is a lot, I'm sure some people here have already heard all these arguments and this is the only place where you can really ask about it without being censored.)

 

[Baron Reginald]

Treating gender dysphoria without affirmation... do you mean treating it without gender-affirming care, i.e., without hormone replacement therapy? It depends how you approach treating it. If you are trying to convince someone who thinks they are trans or gay that they are not trans or gay because you think it is inherently morally wrong, inherently maladaptive, or inherently mental illness, then I would call that conversion therapy.

that is the entire point of therapy; to solve or minimize a maladaptive issue. The entire prospect of therapy is 'conversion therapy' To convert a mentally distressed or retard into a functioning person as much as possible. The term for conversion therapy is basically just a label specifically tailored from orientation conversion initially and has now slowly just been an expanding term for any of the conditions that are being considered academically taboo to critically approach, like trannies.

You don't affirm suicidal thoughts. You don't affirm phobias. You. Do. Not. Affirm. It has nothing at all to do with personal beliefs, dysphoria is recognized as a symptom of something. Could be caused by actual hormone levels being out of whack (I find low Testosterone in men being an actual cause a lot more than some people like to admit) or Trauma or whatever, it's part of your job to find out and take the appropriate steps. Not. To. Affirm.

Any affirmative care is simply building upon a leaking dam. You might make it look better, and it might even function for a while. But the leak will turn into a crack, and then it'll burst. It's no different than outright suppression the end result is the same.
If the patient does not want to accept treatment from it, then you can't work with them. No different than any other patient that refuses your advice.

I work in a mental hospital, and these people who get affirmative care are basically the part of the "Permanent residents" because they always come back within weeks or a few months. I fucking hate them and hacks like you for always leading them back here because everyone has their thumbs up their fucking ass about affirming it constantly. We unironically rehabilitate more dementia patients with assistance coping for themselves and family to return home than with these people.

 

[Ravioli Chandler]

I also really like Dr. K / HealthyGamerGG. He focuses on helping young men in the Internet age, so a lot of his stuff is relevant to my problems.

Speaking about Dr K, the Reckful situation was horrible.

How does gestalt therapy address depression and suicidal ideation? Also, at what point do you refer patients to psychiatrists? What is it like to be a mandatory reporter (in terms of responsibility)?

I work in a mental hospital, and these people who get affirmative care are basically the part of the "Permanent residents" because they always come back within weeks or a few months.

What's your workplace environment like? How do you keep yourself safe there?

 

[ZombiesRwankster]

I suppose "what is gender dysphoria?" is a better question. You did mention that trans people you talked to "always knew," which seemed to have been the narrative for a while. But what does "always knowing" mean? I've heard stories stretch like saying they "always knew" because they liked something stereotypical to the opposite sex. (Like in your example.)

Having "always known" something is hard to measure. Self-concept doesn't emerge fully formed. However, there are signs, and people can follow them or not. Being drawn to stereotypical elements of the opposite sex is one example. In this case, what it is to be a woman and what it is to be a man are culturally encapsulated.

I haven't heard many stories with discomfort of their birth sex itself. Shouldn't these be ruled out as gender non-conforming, and not some type of sex discomfort?

I'm not sure I understand this part. How would you compare discomfort with birth sex and gender dysphoria? And when would you be gender-non-conforming vs uncomfortable with your birth sex?

And even historical cases, like Christine/George Jorgenson, didn't "always know" but they're treated as actually having been trans.

I don't think you have to know from a young age--indeed, no one who transitions comes to an identical realization at an identical time--but it does help justify getting approved for HRT. How much "justifying" of oneself someone should need to do is also up for debate.

It has nothing at all to do with personal beliefs, dysphoria is recognized as a symptom of something. Could be caused by actual hormone levels being out of whack (I find low Testosterone in men being an actual cause a lot more than some people like to admit) or Trauma or whatever, it's part of your job to find out and take the appropriate steps. Not. To. Affirm.

I feel like I would be missing a big part of the puzzle if we did trauma work, ego and self-esteem work, helped them not feel misfit in other ways, but then ignored the elephant in the room of them wondering if they're trans. Even if gender dysphoria is only 10% of their total pain, I would be remiss to tell them to set aside the idea for now and ask them to do everything else first.

And of course, transitioning alone is not sufficient to resolve gender dysphoria and mental illness.

Any affirmative care is simply building upon a leaking dam. You might make it look better, and it might even function for a while. But the leak will turn into a crack, and then it'll burst. It's no different than outright suppression the end result is the same.

So the question is, how do you not suppress? And who are you when you don't suppress?

I work in a mental hospital, and these people who get affirmative care are basically the part of the "Permanent residents" because they always come back within weeks or a few months. I fucking hate them and hacks like you for always leading them back here because everyone has their thumbs up their fucking ass about affirming it constantly.

Inpatient is rough. Thank you for what you do.

How much of them coming back can you attribute to them being trans or getting "affirmative care" (not sure what this entails)? Does their suicidality stem directly from gender dysphoria?

How does gestalt therapy address depression and suicidal ideation? Also, at what point do you refer patients to psychiatrists? What is it like to be a mandatory reporter (in terms of responsibility)?

To treat depression, I'd describe it like CBT and the layers of beliefs, where negative core beliefs are things like "I'm unlovable", "I'm a bad person", "I will forever be a loser". Gestalt therapy peels back the layers to dispute those beliefs. Obviously, this doesn't happen overnight, or with a single affirmation or piece of evidence. These beliefs are deeply entrenched and you can take a long time to truly feel and realize your worth.

The above being said, I refer clients to psychiatrists when I can see they might benefit from concurrent medication and psychotherapy. There are symptom patterns and levels of severity that it is a good idea to refer someone for medication. Psychotherapy will not work as well if there are debilitating symptoms in the way.

Regarding suicidal ideation, I'm CAMS-trained but not certified. I love CAMS. I do assess for suicidality and I only make a report when I have reasonable suspicion of imminent death or serious injury. I have not yet had to make a report. It's traumatic to get called on, so I really hope that when I inevitably do have to call, I am saving a life, and not making things worse for someone unnecessarily.