Allen Frances @AllenFrancesMD Twitter profile

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Allen Frances

@AllenFrancesMD

8 years

I wrote DSM criteria for Narcissistic Personality Disorder. Trump doesn't meet them. He's terrible person & classic schmuck-not mentally ill

David Frum

@davidfrum

8 years

1) Trump, a textbook case of Narcissistic Personality Disorder, will believe the lies he tells, after he tells them

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Allen Frances

@AllenFrancesMD

7 years

It is insulting to the dignity of the mentally ill to confuse their deep suffering with Trump's petulant tantrums & petty disappointments.

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Allen Frances

@AllenFrancesMD

4 years

Trump is inciting domestic terrorist/extemist/militia types to organize protests to defy #COVID19 physical distancing rules. US is suffering the most pandemic deaths because we have the most dangerous/incompetent leader. & it is about to get much worse.

The rightwing groups behind wave of protests against Covid-19 restrictions

Protesters in Michigan and other states claim to speak for ordinary citizens, but are also supported by street-fighting far-right groups

www.theguardian.com

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Allen Frances

@AllenFrancesMD

7 years

Constantly saying Trump's crazy wrong & misses point. He doesn't meet DSM Narcisssistic criteria(I wrote them). Its worse-he's bad,not mad.

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Allen Frances

@AllenFrancesMD

4 years

When asked who owned valuable patent for his polio vaccine, Jonas Salk replied: "The people I would say. There is no patent. Could you patent the sun".

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

Jonas Salk died on this date June 23 in 1995. Photo credit: SAS Scandinavian Airlines. #OTD

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Allen Frances

@AllenFrancesMD

6 years

Trump is by the most despicable man in American politics. But 2nd place is a really tough call. My candidates (not in any order): 1)Mitch McConnell 2)Lindsey Graham 3)Charles Koch 4)Rudy Giuliani 5)Paul Ryan 6)Steve Bannon 7)Sean Hannity Your suggestions?

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Allen Frances

@AllenFrancesMD

7 years

Calling Trump crazy also insults people who suffer from mental illness, most of whom are well meaning & well mannered. Trump is neither.

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Allen Frances

@AllenFrancesMD

2 years

DSM mental disorders are constructs, not diseases. Descriptive, not explanatory. Helpful in communication/treatment planning. But no claims re causality/homogeneity/clear boundaries. Clinically useful when used skeptically. We wrote all this in DSM-IV Intro- but no one read it.

Justin Garson

@justin_garson

2 years

It seems to me there's a conceptual puzzle with psychiatric diagnosis, and I’m earnestly seeking illumination, not a fight. On the one hand, I take it that in a normal clinical context, a diagnosis is meant to be explanatory. 1/6

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Allen Frances

@AllenFrancesMD

7 years

Just had to take my shoes off at airport security. Suggested bizarre public health paradox: 1 totally incompetent shoe bomber kills no-one= 15 billion people participate in this dumb ritual Vs 115,000 shot by firearms every year= no #GunControl

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Allen Frances

@AllenFrancesMD

5 years

I will be on CNN at 11 AM EST discussing whether Trump is crazy.

It doesn't matter if Donald Trump is "crazy" — what matters is whether he can be stopped

Trump's election has unleashed a deep streak of delusional denial in a large segment of U.S. society

www.salon.com

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Allen Frances

@AllenFrancesMD

3 years

R.I.P. Aaron Beck at age 100 Created CBT Helped millions of patients Trained 1000s of clinicians Most gifted therapist I ever met A joy to be with A gentleman & gentle man The glint in his eye/smile on his face Creative/productive til very end We miss you!

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Allen Frances

@AllenFrancesMD

5 years

Nice someone understands what DSM is/what it isnt. Mental disorders are constructs, not diseases. Descriptive, not explanatory. Helpful in communication/treatment planning, but no claims re causality/homogeneity/clear boundaries. We wrote this in DSM-IV Intro- no one read it.

DMS

@philosofacespin

5 years

the dsm's categorical grouping of disorders is not, nor was ever intended to be, a statement about the *nature* of those disorders. it was, and is, a pragmatic decision intended to aide practitioners in diagnosis and treatment.

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Allen Frances

@AllenFrancesMD

3 years

"We stopped looking for monsters under our bed when we realized that they were inside us." Charles Darwin

Dr. Jeffrey Guterman

@JeffreyGuterman

3 years

Charles Darwin was born on this date February 12 in 1809. Photo by Leonard Darwin, 1897. #OTD

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Allen Frances

@AllenFrancesMD

2 years

DSM-5 is making the awful mistake of turning prolonged grief into a mental disorder: 1)there is no expiration date on grief 2)insults dignity of the loss 3)stigmagizes normal emotions 4)will increase use of unneeded psych meds Further proof APA can't be trusted supervising DSM.

Joanne Cacciatoreⓥ

@dr_cacciatore

2 years

Whats your opinion about yet another “disorder” for #grief @AllenFrancesMD

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Allen Frances

@AllenFrancesMD

4 years

My 50 years experience condensed into 12 most crucial tips to avoid misdiagnosis & overdiagnosis From 'Essentials of Psychiatric Diagnosis'

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Allen Frances

@AllenFrancesMD

6 years

Most over-diagnosed mental disorders: 1) #ADHD 2)Autism 3) #Major #depression 4) #bipolardisorder 5) #anxiety disorders 6) #PTSD Most Missed 1)Substance Disorder 2)Medication Side Effect 3)Underlying medical illness 4)Delirium 5)Eating & Sleep Disorders 5) #personality disorder 6)PTSD

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Allen Frances

@AllenFrancesMD

3 years

As a psychiatrist, one of my most useful diagnostic statements was: "You are having a normal reaction to a very tough life situation."

Saurabh Jha

@RogueRad

3 years

Bad radiologists over call. Fits real life experience. “Normal” is one of the most difficult calls to make

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Allen Frances

@AllenFrancesMD

4 years

I greatly regret adding Bipolar II to DSM-IV. We had good reason- to reduce iatrogenic switches/rapid cycling in spectrum patients due to antidepressants . But led to much iatrogenic harm caused by massive bipolar overdiagnosis & antipsychotic overuse pushed by Pharma marketing.

Tyler Black, MD

@tylerblack32

4 years

Psychiatry pro tip: If you are suspicious but not certain your patient is manic, they almost certainly are not. The bleeding of "mania" leads to significant overmedication and inappropriate prescriptions of substances that (though helpful for BD) have significant SEs"

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Allen Frances

@AllenFrancesMD

6 years

My 40 yrs experience condensed into 12 tips to ensure safe/accurate diagnosis. From 'Essentials of Psychiatric Diagnosis'

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Allen Frances

@AllenFrancesMD

7 years

Completely normal emotions triggered by Christmas cheer: Loneliness Sadness Grief Annoyance Irritability Regret Guilt Shame Disappointment Envy Jealousy Anger Worry Nostalgia Be kind to yourself/realistic in your expectations/sensitive to the feelings of those around you.

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Allen Frances

@AllenFrancesMD

7 years

Instead of misdiagnosing Trump, we must analyze the societal sickness that gave someone so flawed the power to determine fate of the world.

Mr. G

@CGrothaus

7 years

@matthewherper @AllenFrancesMD @sxbegle @statnews W/no first-hand knowledge, it's a mystery. We should demand all presidents be examined.

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Allen Frances

@AllenFrancesMD

5 years

I can't imagine anything dumber than a pill for loneliness. Will this creeping medicalization of everyday life never cease?

Scientists are working on a pill for loneliness

Modern life has led to greater isolation, which can fuel an array of disorders. If there are medications for social pains like depression and anxiety, why not loneliness?

www.theguardian.com

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Allen Frances

@AllenFrancesMD

1 year

Recently recommended screening for anxiety disorders is dreadful mistake: 1)Huge false positive rate 2)Worried well massively overmedicated 3)Diverts very scarce resources away from really sick 4)Stigma 5)Turns normal/adaptive worries into mental disorder

Essay | Screening for Anxiety Will Only Make Us More Anxious

New federal guidelines set a low bar for diagnosing anxiety disorders, encouraging doctors to see a normal emotion as a medical problem.

www.wsj.com

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Allen Frances

@AllenFrancesMD

1 month

To avoid DSM reification/stigma: No patient "has schizophrenia" or "is schizophrenic"- lazy/misleading/reductionistic terms Proper usage: Patient "meets criteria for schizophrenia" Why? Mental disorders are constructs- not diseases People are so much more than their disorder

Harriet Vogt

@shvogt

1 month

@AllenFrancesMD Unfortunately, many DSM users also fallible. Instead of being treated as a conceptual tool, diagnostic guidance is often reified – the patient *has* Prolonged Grief Disorder etc. (for some a natural course of grief). Patients believe this nonsense & it undermines their recovery.

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Allen Frances

@AllenFrancesMD

1 year

My biggest DSM-IV regret: Our broadening the autism definition that has led to such masssive, careless over-diagnosis.

Doctor who helped broaden autism spectrum 'very sorry' for...

According to a Rutgers study published earlier this year, autism rates in the US have increased some 500% over the past 16 years. And “profound autism” cases — those who are likely...

nypost.com

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Allen Frances

@AllenFrancesMD

3 years

Asked who owned the patent on his polio vaccine, Jonas Salk said: "The people. There's no patent. Could you patent the sun?"

Dr. Jeffrey Guterman

@JeffreyGuterman

3 years

Dr. Jonas Salk in his lab in Pittsburgh, Pennsylvania on this date October 7 in 1954. Photo: AP. #OTD

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Allen Frances

@AllenFrancesMD

2 years

13 topics under-emphasized in psychiatric training: 1)clozapine 2)lithium 3)ECT 4)deprescribing 5)psychotherapy 6)work with families 7)medical causes of symptoms 8)substance disorders 9)prison psychiatry 10)community psychiatry 11)work with homeless 12)saving normal 13)advocacy

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Allen Frances

@AllenFrancesMD

6 years

I doubt any of following will much help psych patients in next 25yrs: 1)New wonder drugs 2)"Digital Psychiatry" 3)"Precision Psychiatry" 4)Genomics 5)Brain Imaging What we need now is simple stuff done well, not more misleading hype: 1)Easy access to treatment 2)Decent housing

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Allen Frances

@AllenFrancesMD

4 years

"Demoralization" is most missed diagnosis in psychiatry because not in DSM. Common reaction to chronic stress/psych disorder/med illness. Symptoms: Dispirited/giving up hope/lost confidence/inactivity Helped by psychotherapy/exercise/adding good minutes each day/finding meaning

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Allen Frances

@AllenFrancesMD

5 years

I summarize my career & explain why it's now ending on such a sour note. I failed, & psychiatry failed, to improve terrible neglect of people suffering severe #MentalIllness . I suggest simple solutions, but doubt things will ever get better. @PsychTimes

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Allen Frances

@AllenFrancesMD

3 years

Important traits to look for in psychiatrists/psychologists: Empathy Warmth Intelligence Genuineness Competence Common sense Tolerance Breadth of life & therapy experience Generosity of spirit Caring Morality Clarity of expression Sense of humor Friendliness Strength Persistence

“Prof” David Clark 🌈

@D_M_Clark_

3 years

What do you look for when choosing an effective psychiatrist? What attributes might you value? #Mentalhealth

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Allen Frances

@AllenFrancesMD

10 months

Psychotherapists are the luckiest people on earth. Many of the best hours of my life were spent doing therapy & many of my favorite people were patients. I couldn't be more grateful to them for teaching .me so much about life & making me a better person.

A Psychiatrist Reflects on Psychotherapy: An Interview with Allen Frances

Dr. Frances explains the rationale for tailored psychotherapy techniques for a strong patient-therapist relationship.

www.thecarlatreport.com

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Allen Frances

@AllenFrancesMD

4 years

If only this were just a joke.

The Onion

@TheOnion

4 years

American Psychiatric Association Adds ‘Obsessive Categorization Of Mental Conditions’ To ‘DSM-5’

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Allen Frances

@AllenFrancesMD

5 months

Publication of 'Deprescribing Guidelines' a turning point in history of psychiatry. Many people are on meds they dont need or doses that are too high for durations that are too long Docs are quick to prescribe/slow to deprescribe- & often don't know how. Now there's no excuse:

Mark Horowitz

@markhoro

5 months

The Maudsley Deprescribing Guidelines is available in the UK , US , Australia Canada elsewhere around the world (also at other booksellers).

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Allen Frances

@AllenFrancesMD

3 years

Freud's great contributions: 1)Our psychology is as much a product of evolution as our bodies 2)Inborn tendencies interact w experience to shape who we are 3)Most of our motivations are unconcious 4)Early patterns of behavior repeat thru life 5)No one is completely sane or crazy

Allen Frances

@AllenFrancesMD

3 years

Freud was greatly overestimated in his own time & is now greatly underestimated in ours.

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Allen Frances

@AllenFrancesMD

6 years

I have evaluated tens of thousands of patients. Never have I seen anyone who is more completely credible than #ChristineBlaseyFord . #Kavanaugh will surely commit perjury under oath. Penalty for this is 5 years.

Kavanaugh hearing: Supreme Court nominee insists on his innocence, calls process ‘national disgrace’

The hearing on a sexual assault allegation against Judge Brett M. Kavanaugh turned partisan as Republican senators lashed out at Democrats and the media. One of Kavanaugh’s accusers, Christine Blasey...

www.washingtonpost.com

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Allen Frances

@AllenFrancesMD

5 years

Things I recommend for people whose #anxiety & #depression haven't responded to #meds / #psychotherapy : 1) #exercise 2) #Nature 3) #pets 4)helping others 5)hobbies 6) #mindfulness 7)movies 8)dding more "good minutes" to each day 9)reducing stress 10)family/friend support 11)stoicism

Dr. Jeffrey Guterman

@JeffreyGuterman

5 years

One more thing about (my) depression. @AllenFrancesMD suggested that I walk at least 30 minutes a day. I now follow his advice and it helps me a lot. I walk about an hour each day. I also think an important thing is to identify what helps you cope effectively and then do it.

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Allen Frances

@AllenFrancesMD

4 years

"You're only given a little spark of madness. You mustn't lose it". Robin Williams

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

Robin Williams was born on this date July 21 in 1951. Photo by Eva Rinaldi. #OTD

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Allen Frances

@AllenFrancesMD

10 months

History of psychiatry is littered with numerous recurring/dangerous fads. Current fads include overdiagnosis of: 1)ADHD 2)Autism 3)Bipolar Disorder 4)Grief 5)Multiple Personality 5)Sexual Disorder Here's a summary of how fads get started & then spread:

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Allen Frances

@AllenFrancesMD

7 years

We shouldn't medicalize as mental disorder every behavior that is stupid, mean, destructive, selfish, cruel, shortsighted & self destructive

Erica Baker

@EricaBaker8666

7 years

Do we need to rewrite the DSM to fit Trump or just accept he missed out on the DNA bits with empathy and altruism?

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Allen Frances

@AllenFrancesMD

6 years

Someone asked: Why do you tweet so much? 1)Too lazy to write books/papers/blogs 2)Takes so ltitle time/effort/thought 3)Beats screaming 4)Chance to summarize lessons of lifetime 5)Still seems useful to some followers I do promise to stop when it feels nothing new worth saying

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Allen Frances

@AllenFrancesMD

5 years

Can any sensible person doubt Trump is a serial rapist? Franklin Graham: "Trump is God's instrument". I say: Graham/other cynical evangelical leaders who support Trump have sold their souls to the devil. Trump pollutes everyone & everything he touches.

Two women say E Jean Carroll told them about Trump alleged sexual assault

Donald Trump denies allegations he sexually assaulted columnist E. Jean Carroll in the 1990s.

www.bbc.com

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Allen Frances

@AllenFrancesMD

2 months

'Mental Health Awareness' has gotten out of hand & now contributes to national contagion of emotional hypochondria. Started as well meaning effort to reduce stigma/help people get help. But 2 unintended consequences- turning normal distress into disorder/neglect of really ill.

j.e.moyer, lpc

@jemoyer

2 months

@AllenFrancesMD

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Allen Frances

@AllenFrancesMD

4 years

This is what happens when a really smart virus meets a really stupid human:

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Allen Frances

@AllenFrancesMD

3 years

"When stupidity is considered patriotism, it's unsafe to be intelligent." Isaac Asimov

Dr. Jeffrey Guterman

@JeffreyGuterman

3 years

Isaac Asimov was born on this date January 2 in 1920. Photo by Phillip Leonian. #OTD

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Allen Frances

@AllenFrancesMD

5 years

How can real Republicans vote for this asshole?

Donald J. Trump

@realDonaldTrump

5 years

Spreading the fake and totally discredited Dossier “is unfortunately a very dark stain against John McCain.” Ken Starr, Former Independent Counsel. He had far worse “stains” than this, including thumbs down on repeal and replace after years of campaigning to repeal and replace!

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Allen Frances

@AllenFrancesMD

5 years

"No Treatment" paper written 50 yrs ago is still my best. Gives 5 lessons learned in psych residency: 1)Treatment can harm as well as help 2)People w mild problems get better on their own 3)Goal is to select those who really need help 4)Avoid piling on new meds 5) #FirstDoNoHarm

Mary O'Keeffe

@MaryOKeeffe007

6 years

A great article from 1981! No Treatment as the Prescription of Choice 👏 Worth a read+ Thank you @AllenFrancesMD I think the paragraph 👇 on the benefits of no treatment has broad implications beyond psychiatry @wiserhealthcare #backpain

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Allen Frances

@AllenFrancesMD

4 years

Whoever imagined that athletes would become the moral center of our country while the immoral center lives in the White House (fervently supported by evangelical "Christians")?

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

@WNBA Lakers and Clippers report they will boycott the remainder of the season following police shooting of Jacob Blake

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Allen Frances

@AllenFrancesMD

3 years

My 55 yrs of experience condensed into 50 tips on how best to help patients:

Advice to Young Psychiatrists From a Very Old One

Here it is-the 50 most important things Allen Frances, MD, has learned in over 50 years studying psychiatry.

www.psychiatrictimes.com

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Allen Frances

@AllenFrancesMD

4 years

Dunning–Kruger Effect: Dumb people over-estimate themselves because they're too dumb to know how dumb they are. Smart people under-estimate themselves because they know how much they dont know. Key to Trump's personality & secret of his success.

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. ~ Bertrand Russell

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Allen Frances

@AllenFrancesMD

7 years

I wrote DSM criteria for mental disorder. Trump doesn't meet them- he's bad not mad. Lumping him with patients insults them Pence even worse

Rob Reiner

@robreiner

7 years

I hear talk of invoking 25th amendment is making DT furious. Hey DT, 25th amend. 25th amend. 25th amend. #25thAmendmentNow

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Allen Frances

@AllenFrancesMD

1 month

Most robust finding in all psychiatry- supported by 32 studies on tens of millions of kids in many countries: Result: Youngest kids in class much more likely to get #ADHD diagnosis than oldest. Significance: Normal immaturity is widely mislabeled mental disorder/treated w pills.

Pam Jarvis

@Dr_Pam_Jarvis

1 month

This is a very worrying finding, which needs follow up, and if confirmed, urgent policy revision. #SummerBirthdays

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Allen Frances

@AllenFrancesMD

5 months

"Borderline Personality Disorder" is a dumb/meaningless label: 1)describes nothing 2)not clear what it borders on 3)invites stigma I fought to change name in DSM-III & DSM-IV, but lost both times. Good labels help people/foolish labels often harm. Your suggestion is better:

Jonathan Shedler

@JonathanShedler

5 months

@tylerblack32 @KarenAd89081735 @DrWinarick @KazJNelson @HiTOP_system @q_abnormalpsych @AllenFrancesMD @dawso007 @SameiHuda @jonathanstea @psychunseen My co-authors & I proposed “emotionally deregulated personality,” which is actually far more descriptive. The problem is that the *phenomenon* is disturbing, and any new term will in time take on the same stigma. Here’s Nancy McWilliams eloquent comments

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Allen Frances

@AllenFrancesMD

5 years

@HombreDeBicycle @drmlb @paulsummergrad @CyclingSurgeon @medicalaxioms @DrCorriel @RanaAwdish @arghavan_salles @DrJenGunter @raf_ideas @pedsmd2b My advice to medical students: 1)Medicine is a privilege, not a job 2)You must know your patients, not just their diseases 3)No visit is ever routine 4)Cure sometimes, comfort always 5)Dont get lost in the medical record 6)MDs in it for money do bad medicine 7)First do no harm

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Allen Frances

@AllenFrancesMD

1 month

All diagnoses in psychiatry are purely descriptive- just names for symptoms that tend to go together & help predict course & treatment. None of the psych diagnoses is the slightest bit explanatory- causes are too complex/interacting for us to understand.

A Descriptive Diagnosis or a Causal Explanation? Accuracy of Depictions of Depression on Authorit...

Abstract. Introduction: Psychiatric diagnoses are descriptive in nature, but the lay public commonly misconceives them as causal explanations. It is not known whether this logical error, a form of...

karger.com

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Allen Frances

@AllenFrancesMD

1 year

Main thing we've learned from the history of psychiatry is that we learn nothing from it & keep making same mistakes: 1)Recurrent diagnostic fads 2)Neglecting the most impaired 3)Overreacting the least impaired 4)Funding too much "cool" research & too little to really help people

Mark L. Ruffalo

@MarkLRuffalo

1 year

Why study history of psychiatry? A slide from my presentation for tomorrow's faculty development meeting at @UCF Psychiatry.

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Allen Frances

@AllenFrancesMD

3 years

"Of all the preposterous assumptions of humanity, nothing exceeds the criticisms made on the habits of the poor by the well-housed, well- warmed, & well-fed." Herman Melville

Dr. Jeffrey Guterman

@JeffreyGuterman

3 years

Herman Melville was born on this date August 1 in 1819. Photo by George G. Rockwood. #OTD 🐳

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Allen Frances

@AllenFrancesMD

6 years

You really gotta wonder how 40% Americans can still approve evil buffoon Trump. Is this just a temporary insanity or are we at the beginning of steep downward spiral for our fragile democracy. #Midterms2018 may provide the answer.

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Allen Frances

@AllenFrancesMD

5 years

"I am an extremely stable genius". Donald Trump "Tell me what you brag about & I'll tell you what you lack." Spanish Proverb

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Allen Frances

@AllenFrancesMD

3 years

"Major Depressive Disorder" is DSM's biggest mistake: 1)Too broad- lumps severe "endogenous" with mild "reactive" 2)Confuses #grief with clinical depression 3)Turns normal sadness into mental disorder 4)Encourages excess med use 5)Often not "major"/"not depressive"/"not disorder"

Jacek Debiec MD, PhD, DPhil 🌎

@DebiecJacek

3 years

Earlier versions of DSM distinguished between the so-called endogenous & reactive depression. I have recently seen a teenage girl treated for depression with 2 antidepressants and 2 antipsychotics(!). Her prescribing clinician was unaware that she was subject to serious bullying.

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Allen Frances

@AllenFrancesMD

11 months

Search for potential biomarkers of psych disorder= repeated triumph of naive hope over bitter experience. 60 yr cycle of hyped overpromising/failed replication. Psych disorders far too fuzzy/heterogeneous/complicated in causation to yield reductionist "brain medicine" answers.

Mark L. Ruffalo

@MarkLRuffalo

11 months

Recent article in Neuropsychiatry proposes psychiatry move more towards "brain medicine." Actually, psychiatry seems to be moving back in the #biopsychosocial direction in the wake of neuro- excesses of the 90s and 2000s. With good reason.

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Allen Frances

@AllenFrancesMD

4 years

"I do not wish women to have power over men; but over themselves." Mary Shelley Author of 'Frankenstein' Daughter Mary Wollstonecraft, 1st philosopher of feminism.

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

Mary Shelley was born on this date August 30 in 1797. Painting by Richard Rothwell. #OTD

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Allen Frances

@AllenFrancesMD

3 years

Patients & doctors have very different "lived experience"of illness- both viewpoints are necessary/neither is alone sufficient.

Ash Paul

@pash22

3 years

Doctor vs Patient: Who knows more?

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Allen Frances

@AllenFrancesMD

29 days

My view: Borderline Personality Disorder should never be diagnosed in teenagers. Easily confused with typical teenage rebelling/family issues/substance abuse/identity concerns. BPD requires long track record & carefully ruling out all other conceivable causes. Great article:

Keir Harding

@Keirwales

29 days

At last a national news article highlighting the harms of the BPD diagnosis. "Leading medics are now calling for an immediate ban on youngsters being classed as having BPD"

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Allen Frances

@AllenFrancesMD

1 year

Darwin had 2 best insights in history of psychiatry: 1)Our behaviors are inherited from animal ancestors 2)Our motivations are mostly unconscious. Evolutionary psychiatry still best way to understand normal & abnormal behavior. 2 great free articles at:

World Psychiatry: Vol 22, No 2

Click on the title to browse this issue

onlinelibrary.wiley.com

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Allen Frances

@AllenFrancesMD

3 years

I think exercise is best treatment for most mild psychiatric problems. Hard part is getting people started- walking is often easiest gateway. Can have remarkable impact reversing vicious cycles of anxiety & depression before they spiral.

Neuroscience News

@NeuroscienceNew

3 years

Anxiety Effectively Treated With Exercise A 12-week program of moderate to strenuous exercise significantly helps relieve anxiety symptoms, a new study reports. #anxiety #exercise #psychology #neuroscience #science

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Allen Frances

@AllenFrancesMD

3 years

5 Psychodynamic Concepts Patients Need To Know: 1) We don't see things as they are, we see things as we are 2)We often do things without knowing why we do them 3)The past is alive in the present 4)Many things that come naturally are self-destructive 5)'Know thyself' sets you free

Jayce Long

@JayceLong

3 years

Psychodynamic/analytic clinicians. What is/would be your list of top 5 concepts everyone’s mental health would benefit from knowing? Terms you psychoeducate patients on. @JonathanShedler @DrWinarick @MarkLRuffalo @psychgeist52 @KemtrupTweets @nyctherapist @dremilyanhalt @DrGipps

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Allen Frances

@AllenFrancesMD

4 years

Trump's America

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Allen Frances

@AllenFrancesMD

3 years

Vicious Cycle: Most psych disorders interfere with sleep/too little sleep harms brain & makes psych disorders worse. Every 1st interview should inquire re sleep problems & sleep hygiene often crucial part of treatment. Regular sleeping pill use makes things worse. Nice graphic:

Slava Bobrov

@slava__bobrov

3 years

When we sleep, waves of spinal fluid wash over the brain to remove waste: #neuroscience

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Allen Frances

@AllenFrancesMD

5 years

Psychiatry is about as effective as rest of medicine, but more personal & patients have more unrealistic expectations. When cancer treatments dont work, natural tendency is to blame the cancer, not the doctor. When psych treatments dont work, patients often blame psychiatry.

Dariusz Galasiński

@d_galasinski

5 years

As I read these lovely stories of choosing psychiatry, how come so many patients are, shall I say euphemistically, so severely disillusioned with it? Sorry to be a killjoy. #PsychsocTakeover

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Allen Frances

@AllenFrancesMD

5 years

Teddy Roosevelt on US foreign policy: "SPEAK SOFTLY & CARRY A BIG STICK". Donald Trump "SHOUT LOUDLY & HAVE A SMALL DICK".

Pompeo warns Iran about trigger for U.S. military action as some in administration question...

Some officials question whether pressure on Iran exceeds President Trump’s specific goal of preventing the country from acquiring a nuclear weapon.

www.washingtonpost.com

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Allen Frances

@AllenFrancesMD

5 years

ECT is by far best treatment for very severe #depression /certainly would be my 1st choice for me. I'll bet clinicians who so harshly criticize ECT dont treat severe depression/havent seen its powerful positive impact. Great piece by psychiatrist who has:

As a psychiatrist, if I had severe depression I’d choose ECT | Mariam Alexander

Electroconvulsive therapy is one of the best treatments available, says NHS psychiatrist Mariam Alexander

www.theguardian.com

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Allen Frances

@AllenFrancesMD

8 years

#ADHD is a very useful diagnosis for about 2% of kids. ADHD is a very harmful diagnosis when misapplied to 15% of kids.

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Allen Frances

@AllenFrancesMD

4 years

The Catholic Church condemned Galileo in 1633 for promoting the fake news that the earth revolves around the sun. He recanted publically to avoid being burnt at the stake, but left his Inquisition muttering: "And yet it moves". Truth is very easy to defeat, but hard to kill.

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

Galileo Galilei was born on this date February 15 in 1564. Portrait by Giusto Sustermans. #OTD

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Allen Frances

@AllenFrancesMD

3 years

1955- Edward R. Murrow: "Who owns the patent on the polio vaccine". Jonas Salk: “Well, the people, I would say. There is no patent. Could you patent the sun?" VS Now- US drug companies selfishly refuse to suspend vaccine patent rights as millions are dieing all around the world.

Dr. Jeffrey Guterman

@JeffreyGuterman

3 years

On this date May 1 in 1956, the polio vaccine, developed by Jonas Salk, was made available to the public. Photo by Yousuf Karsh. #OTD

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Allen Frances

@AllenFrancesMD

5 years

Only an insane society would allow this continuing massacre of innocent children. If there were a hell, cynical NRA leaders & their cowardly GOP lackeys would deserve its hottest flames. #GunControlNow

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Allen Frances

@AllenFrancesMD

6 years

In US, about 15% of kids will get #ADHD label by age 18. Optimal rate probably only 2-3%. Very troubling that youngest kids in class get diagnosed twice as often as the eldest This proves we're mislabeling immaturity as mental disorder- & often mistreating it with pills.

Óscar García Campos

@oscargarciacam4

6 years

@AllenFrancesMD In your opinion, how many children do really have ADHD? Thanks.

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Allen Frances

@AllenFrancesMD

11 months

Adult #ADHD is wildly over-diagnosed because: 1)it can be mimicked by many psych diagnosis & addictions 2)merges into normal inattention 3)is gateway to legal speed Instead ensure 1)history of childhood #ADHD 2)careful differential diagnosis Avoid pseudoscientific/quack tests.

Adult ADHD India

@adultADHDindia

11 months

@MarkLRuffalo @AllenFrancesMD “The process involves an infrared brain scan, an eye-tracker test and a continuous performance test – in addition to standard clinical interviews and self-report questionnaires.”

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Allen Frances

@AllenFrancesMD

4 years

I grew up 3 miles from Trump at same time. Bragging jerks like him couldn't survive 10 minutes in our schoolyard. No surprise that Trump's parents had to ship him to a disciplinary school out of the neighborhood. Only surprise now is how decent Americans can fall for his con.

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

More projection from @realDonaldTrump , the smallest man I know. cc: @AllenFrancesMD

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Allen Frances

@AllenFrancesMD

4 years

Trump does indeed stand out as the most despicable person in 245 year history of our country. My list of possible competitors- Benedict Arnold/Aaron Burr/Edwin Wilkes Booth/Father Coughlin/PT Barnum/Jeffrey Dahmer. But none are close in combined harm done/general loathsomeness.

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Allen Frances

@AllenFrancesMD

4 years

"Hatred paralyzes life; love releases it. Hatred confuses life; love harmonizes it. Hatred darkens life; love illuminates it." Martin Luther King, Jr. 'A Testament of Hope'

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

@ellymelly I am inspired by Joe Biden's call for civility. Accordingly, I intend to cease posting tweets that express hate toward those who support @realDonaldTrump and/or reject the new administration. I may have relapses occasionally, but I hope to keep trying. Peace.

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Allen Frances

@AllenFrancesMD

3 years

Most overused treatments: 1)Benzodiazepines 2)Antidepressants 3)Stimulants 4)Antipsychotics 5)Prison Most Underused: 1)Lithium 2)Clozapine 3)ECT 4)Decent housing 5)Job training/jobs 6)Internet support 7)Crisis intervention/brief hospital beds 9)Family & Group Therapy Others?

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Allen Frances

@AllenFrancesMD

2 years

3 most effective treatments in psychiatry are all underutilized because hard to do/not profitable/stigma: 1)ECT 2)Clozapine 3)Lithium Proper use would dramatically improve psych outcomes. Valuable piece on ECT @NEJM :

NEJM

@NEJM

2 years

Electroconvulsive therapy (ECT) is effective for several disorders, particularly severe or treatment-resistant depression, with a rapid response, but stigma has impeded its use. This brief review discusses current indications for ECT and recent advances.

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Allen Frances

@AllenFrancesMD

1 year

I feel great sadness & sense of defeat that so many people suffering from severe mental illness are even worse off today than 50 yrs ago when I began work as a psychiatrist. 650,000 are living in unimaginably awful conditions- either in prison dungeons or rough on the street.

Steve Ilardi

@dr_ilardi

1 year

The great @AllenFrancesMD first drew my attention to this travesty

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Allen Frances

@AllenFrancesMD

5 years

Advice to Young Psychiatrists From a Very Old One- me. I've expanded my previous short list of 5 clinical tips to a much more comprehensive list of 50. Probably also useful for all mental health clinicians of all ages. May help patients too.

Psychiatric Times

@PsychTimes

5 years

Here it is—the 50 most important things @AllenFrancesMD has learned in over 50 years studying psychiatry. #psychiatry

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Allen Frances

@AllenFrancesMD

4 years

"Although I wasn't invited to shake hands with Hitler, I wasn't invited to the White House to shake hands with the President either." Jesse Owens

Dr. Jeffrey Guterman

@JeffreyGuterman

4 years

Jesse Owens was born on this date September 12 in 1913. Photograph credit: USA Today. #OTD #SportsGuterman

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Allen Frances

@AllenFrancesMD

7 years

A life without sadness/anxiety/worry/grief/disappointment is not human. Medicalizing normal distress reduces resilience/causes too many meds

neuro.social.self

@neurosocialself

7 years

When does sadness, immaturity or grief become mental illness? at what cost? @raymoynihan interviews @AllenFrancesMD

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Allen Frances

@AllenFrancesMD

5 years

Here is the latest silly attempt to medicalize normality. Loneliness is part of the human condition. It is not a mental disorder & it can't be cured with a pill. Excellent piece summarizes the newly emerging field.

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Allen Frances

@AllenFrancesMD

4 months

This 1 picture is worth 1000 words: US closed most psych beds BUT didn't invest savings in community care & housing. Result: Criminalization of mental illness/Homelessness/Patients in US look much sicker than rest of world bec so neglected. Shame on us for cruel/dumb defunding:

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Allen Frances

@AllenFrancesMD

4 years

To become a better psychiatrist: 1)Treat lots of patients- esp toughest ones 2)Become a patient to know thyself 3)Have personal losses & failures 4)Fight for social & economic justice 5)Psychotherapy training 6)Learn by teaching 7)Fall in love 8)Raise kids 9)Great books 10)Movies

Dr Janaway

@drjanaway

4 years

As a trainee psychiatrist, there is only so much I can learn from my day job. I would like to know what you want me to know, how I can be a better doctor, advocate, and teacher. Please #retweet

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Allen Frances

@AllenFrancesMD

5 years

Most missing diagnosis in DSM is "demoralization"- due to terrible life circumstance/chronic illness. Not depression/not treatable w pills. What does sometimes work: 1)Reduced stress 2)Life changes 3)Exercise 4)Remoralizing #psychotherapy 5)Spiritual awakening 6)Love/friendship

Ash Paul

@pash22

5 years

Prescription drugs are no cure for deprivation: The burden of poverty can muddy diagnoses of depression and lead to the overprescription of antidepressants, says @ian_hamilton_ @raj_psyc @AllenFrancesMD @CoyneoftheRealm

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Allen Frances

@AllenFrancesMD

3 years

Psychiatry has routinely neglected the significant role of socioeconomic stress & demoralization in causing suicide/substance use/ODs. A society sick with greed & inequality destroys its most vulnerable individuals.

JAMA Psychiatry

@JAMAPsych

3 years

"Deaths of despair"-mortality from suicides and alcohol/drug problems-have received little attention from psychiatry. This Viewpoint discusses how psychiatry can use the deaths of despair framework and benefit from the study of deaths of despair

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Allen Frances

@AllenFrancesMD

6 years

A friend of our family died in this shootout, trying to save other people. I've been fighting for #GunControl , but the pain I felt for victims was abstract. Now it is searing. As is fury at NRA & GOP- cynical bastards sacrificing our kids for sordid political gain. Disgusting

Allen Frances

@AllenFrancesMD

6 years

12 dead in latest #MassShooting - 307th this year. We are allowing NRA & GOP to cause 1 massacre/day. Trump's disgusting "respect for the dead" statement only adds cruel insult to injury. MAKE AMERICA SAFE AGAIN #GunControlNow

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Allen Frances

@AllenFrancesMD

5 years

You don't really have to be an expert with 35 yrs experience to diagnose Donald Trump. He is a classic schmuck.

Dr. Jeffrey Guterman

@JeffreyGuterman

5 years

Please consider me as a guest to speak on Trump's mental health. I have 35 years experience in field and have studied Trump's mental health. My analysis is responsible and well supported. Thank you for your consideration. @AriMelber @MSNBC @CNN @brianstelter @Lawrence @smerconish

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Allen Frances

@AllenFrancesMD

6 years

"Evidence Based Medicine" often generalizes poorly to everyday practice because: 1)Patients in controlled studies aren't like unselected patients 2)Research settings differ from real life 3)Biases influence data analyses EBM provides necessary guide, but shouldn't be worshipped.

David Christmas

@dchristmas

6 years

Applicability of RCTs to 'real world' routine patients. Bottom line: RCTs for most mental disorders do not generalise to patients seen in routine clinical care. People in routine care have higher: comorbidity; severity; risk of suicide; previous treatment; current treatment.

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Allen Frances

@AllenFrancesMD

5 years

Medicine began as magic, evolved into an art, aspired to be a science, has decayed into a business. Needs to be all 4- but what is most missing these days is the compassionate art.

Raphaël Béné

@neuroraf

5 years

“To heal sometimes, to relieve often, to comfort always"- Ambroise Paré

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Allen Frances

@AllenFrancesMD

5 years

Advice to young psychiatrists from an old one 1)Helping the really sick is much harder but more gratifying than treating the worried well 2)Know the patient, not just the diagnosis 3)Dont be a pill pusher/avoid polypharmacy 4)Say things that change people's lives 5)1st do no harm

Dr Janaway

@drjanaway

5 years

An open question on #mentalhealth as a junior psychiatrist. What do you think that I should learn and focus on to be a better doctor and advocate for my patients? Please add your thoughts and #retweet . I will try to read all of them.

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Allen Frances

@AllenFrancesMD

3 years

“I distrust people who know so well what God wants them to do because I notice it always coincides with their own desires.” Susan B. Anthony

Dr. Jeffrey Guterman

@JeffreyGuterman

3 years

On this date June 18 in 1873, Susan B. Anthony was fined $100 for attempting to vote in the 1872 U.S. presidential election. Photo credit: Sarony & Co. #OTD

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Allen Frances

@AllenFrancesMD

1 year

Most people who worry a lot have a lot to worry about. They're not mentally ill- just responding to life in our very difficult world. Anxiety is so common now bec it provided a great evolutionary survival value & is still usually adaptive in helping us spot & respond to danger.

Allen Frances

@AllenFrancesMD

1 year

Recently recommended screening for anxiety disorders is dreadful mistake: 1)Huge false positive rate 2)Worried well massively overmedicated 3)Diverts very scarce resources away from really sick 4)Stigma 5)Turns normal/adaptive worries into mental disorder

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Allen Frances

@AllenFrancesMD

5 years

My Advice To New Therapists: 1)Have your own #psychotherapy 2)Read great novels 3)Watch many movies 4)Have deep relationships outside therapy 5)Study the literature 6)Dont worship at just 1 alter- learn all techniques 7)Remember, it's relationship that heals, not just technique

Martha Crawford

@shrinkthinks

5 years

Im actually totally weirded out by people who want to be psychotherapists without ever having been in their own therapies. Being a client should come first in my view. Its like wanting to teach yoga without ever taking a yoga class. Out. Of. Order.

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