Scott Smith LCSW

14/11/2025

The New Yorker

12/11/2025

You may have noticed that the distortions and false beliefs of others are quite apparent, but only if they differ from our own. When they fall beneath the shadow of our own beliefs they magically morph from naive biases into obvious facts. This is a handicap from which all humans suffer.

Louis Cozolino, The Development of a Therapist

10/11/2025

“The next zeitgeist may ask us not what happened to us—but what we will make happen, together. Or maybe — in a darker scenario — with the advent of super-intelligence we will have less agency, less empowerment. Either way, I sense that this era - when psychiatric labels have become common terms for distress and trauma has become the explanation for our ills - will soon be coming to a close.”

https://open.substack.com/pub/thomasinsel352222/p/zeitgeist?selection=2cef4b94-784f-4512-bee8-60f81a2b87f2&r=32275k&utm_medium=ios

What Comes After the Trauma Era?

09/11/2025

Personality disorders, by contrast, are serious psychiatric conditions—not personality quirks or dating styles. They describe enduring patterns of thought and behavior so rigid that they cause dysfunction in nearly every area of life: work, friendships, intimacy, even a person’s sense of identity. Someone who holds down a steady job, maintains long-term relationships, and adapts to social expectations simply doesn’t meet the clinical criteria for a personality disorder. Yet online, these words get tossed around like shorthand for “someone who hurt me.”

The same happens with attachment styles. Finding out your “style” can be illuminating, but it can also become a trap. Instead of motivating change, it excuses stasis: “I’m anxious/avoidant, that’s just how I am.” What began as a framework for understanding has morphed into an identity that tells people not how to grow, but what to demand. “I have this” becomes “I can only be in a relationship that accommodates this.” It’s self-awareness turned self-entitlement, and it leaves no room for maturity, effort, or grace.

What began as a framework for understanding has morphed into an identity that tells people not how to grow, but what to demand.

https://open.substack.com/pub/eviemagazine/p/attachment-styles-how-a-childhood?selection=153d068a-d352-4453-b6cb-ce9866bbabad&r=32275k&utm_medium=ios

We used to say, “He’s just not that into you.” Now we say, “He’s avoidantly attached.”

06/11/2025

In addition to the necessary sacrifices of the role, there is the not-so-small matter of uncertainty. When therapists are being honest about the work, they will tell you that they are often wondering what to say or do next. For most, being in the dark is not a self-esteem enhancer and therapists a good bit of time fumbling around in it. If you enjoy a life of self-doubt, welcome to the practice of psychotherapy:

The neat theories that can feel reassuringly definitive when encountered in classes or textbooks give way to a messy human reality that is much more enigmatic… Any therapist who claims that he or she confidently knows what to do most of the time probably isn’t paying close enough attention to what is actually transpiring in the room (Wachtel, 2011, p. 3).

Psychotherapy is a high-stakes, high-ambiguity enterprise. This ambiguity can be disquieting, especially when we are being paid with the expectation of having answers. It is easy to overvalue our ideas because in times of doubt, we tend to cling to them. The overidentification with theories and ideas tends to be on full display in collegial forums, where clinicians get into their lanes and race each other to the last word. The humility required in the consulting room may result in a fair amount of pent up energy for collegial showboating:

… the work of therapy is so difficult, and its strains on our normal self-esteem and exhibitionism so great, that [therapists] need narcissistic stabilization more than other people do and therefore seek out-of-the-office opportunities to be bigshots (McWilliams & Lependorf, 1990, p. 438).

Exploring critical, philosophical, and scientific debates in psychiatric practice and the psy-sciences. Click to read Psychiatry at the Margins, by Awais Aftab, a Substack publication with tens of thousands of subscribers.

06/11/2025

“The simpler explanation is also the more troubling one: psychiatry didn’t uncover two overlapping epidemics. It created overlapping categories for the same behavioral and cultural phenomena.”

How Psychiatry’s Attempt to Erase Stigma Inflated a Rare Madness into a Cultural Epidemic

03/11/2025

"The evidence is clear. Lifestyle interventions — programs that support people to quit smoking, improve diet quality, increase physical activity, and restore healthy sleep — when delivered in a way that meets the needs of people living with mental illness, can reduce psychiatric symptoms, improve physical health, and extend life expectancy. The task before us is no longer to prove efficacy, but to embed these interventions into the core of mental health care."

Australians living with severe mental illness continue to die around 15 years earlier than the

02/11/2025

“If all treatments are able to achieve similar results, what is the point of learning in depth about any one of them? Rather than binning their books, however, therapists should be reading from a wide variety of theoretical perspectives. Each may have something to contribute in a given context, or at a given time.

“Equally, this is not a mandate for ‘anything goes’ quackery. A professional therapist needs to learn how to manage their own emotional responses in the consulting room; they need to become practised at noticing when and how the patient is avoiding sensitive topics, and critically they need to learn what not to say. Psychotherapy is sometimes dismissed as nothing more than a sort of paid-for friendship, but there is more to it than that. Our friends support us and listen to us, but they don’t necessarily have the same commitment to paying careful attention and challenging our assumptions; friendships have an element of mutuality – sparing someone’s feelings, or mirroring them – that therapy may need to omit. At the same time, it is an active process; the therapist can try to foster thinking but cannot do it on behalf of the patient. It comes into its own when patients are trying to work something out, and are genuinely perplexed about their mind or relationships.”

So you want to try psychotherapy. But what does it actually do? https://www.theguardian.com/books/2025/nov/02/so-you-want-to-try-psychotherapy-but-what-does-it-actually-do

From psychoanalysis to existential therapy, there’s a bewildering variety of approaches – with one thing in common

02/11/2025