The chronological record
Beyond the chatbot: why the psychoanalytic fixation on ai is miscalibrated
The psychoanalytic focus on whether AI will replace therapists misses the point. Chatbots may draw patients seeking quick answers, but they cannot replicate analytic depth. The real shift lies in agentic AI—systems that build and manipulate data. This move from “chatting” to “making” will transform how we interact with information, rendering current debates about AI in psychotherapy narrow and outdated.
Stephen grosz on the aim of psychoanalysis
I've always said that I don't like the idea of trying to "help" my patients. Stephen Grosz gave me some good words of encouragement in this regard.
A wiki directory for psychoanalytic training in new york - in alpha stage
I've built a wiki directory of training institutes, and it's (almost) ready for prime time!
So you want to hire a pre-licensure clinician
A colleague asked about hiring an LMSW, and I offer some thoughts about it. From the administrative 'kabuki' of payment flows to the choice between 1099s and W-2s, here is at least the start of an overview of what's involved in bringing someone on.
More on the training landscape in new york
The author documents their experiment using advanced AI search tools like Perplexity to build a comprehensive directory of New York's psychoanalytic institutes. While noting significant errors in the AI's current output, the post highlights how these tools can dramatically accelerate the process of structuring opaque institutional data.
Marketing and advertising: a practical approach to getting referrals
Most therapists approach referrals with mystical thinking, hoping clinical excellence somehow generates business. I've learned to think systematically about the practical mechanisms: throw lots of spaghetti at the wall, focus on wholesale rather than retail channels, and use authentic self-representation as both attraction and filter.
Networking: how to stop making it weird
You're already doing lots of networking, but probably don't even notice it.
Psychoanalytic training in new york - an opaque landscape
Psychoanalytic training in New York is described as a "maddeningly opaque landscape" where even practitioners struggle to name more than a few of the dozens of available institutes. This post introduces the author's mission to create a transparent, accessible wiki that maps these institutions for the benefit of prospective candidates.
Fun with ai
Using AI to improve my time-keeping experience, or, an argument against those who say AI has no place to play in psychoanalysis.
Time
Watching the clock
Process recordings
What are process recordings, really? What are they good for? (How) do we even think about them?
Handling referrals when they come
When I get a referral, I handle it quickly. I almost NEVER make anyone wait more than 24 hours. Usually, I get back much more quickly than that.
Making referrals, getting referrals
Making referrals is the best way to get referrals.
Am i a ghostwriter?
I think of myself as less of a healthcare professional and more of a literary consultant.
How to choose an analytic training institute
Choosing a psychoanalytic institute is a momentous decision, and this guide provides a comprehensive framework for evaluating potential programs. The author suggests key questions regarding curriculum, training analysis requirements, and community culture to help candidates find the right professional home.
Ai doesn't threaten psychotherapists or psychoanalysts
Better Help and its ilk don't scare me.
Artificial intelligence and psychoanalysis (and therapy, more broadly)
I find AI helpful. But. I have to use it right.
My decision to become a classically trained psychoanalyst
My personal experience of analysis as a patient - and my decision to become a psychoanalyst.
Whining
Thinking about the word "whining," and what parents mean when we use it.
Penis envy
What do you think Freud had in mind when he wrote about "penis envy"? What I think he would mean TODAY is... we always want what we haven't got. Controversial? Not so much.
Has psychoanalysis been discredited? has freud?
Many say that psychoanalysis and Freud have been "discredited." Those who believe that don't know the psychoanalysis, or the Freud, that I know.
How psychoanalysis works - a metaphor
How psychoanalysis works: a metaphor from my life
Analytic training (1): overview of the training landscape in new york - a gestural beginning
This is the first installation in a guide to prospective analytic candidates - a sort of overview of the analytic training landscape in New York. With much more to come.
Supervision
We all need constant supervision. It provides clinical insight, emotional support, ethical safeguarding, and networking benefits.
Getting referrals
Comprehensive, practical advice on generating patient referrals and handling them effectively.
A gpt weekend
I spent my weekend making GPTs, and you are the beneficiary!
Therapist letters
Should therapists write support letters for their patients? I don't do so, generally.
Child sexual abuse material and ai
I'm thinking about the relationship between AI and child sex abuse. The first in a series.
Artificial intelligence
I know I'm unusual among analysts, but I really like AI.
Freud, solms, and the psyche
In which I try, differently, to summarize my takeaways from - and my struggle with - Solms.
Mark solms and drive theory
I watched Mark Solms present on his "revision of drive theory." It was powerful, and compelling.
Finding a therapist
It's hard to find a therapist!
Ai in psychoanalysis, or, analysts at play
Q: What do you get an analyst for graduation? A: A hat!
Your own treatment
Are you a therapist? Great! Are you in therapy? No?!? And you call yourself a therapist?!? Seriously: we all should be in treatment.
How to be a therapist: a guide for thoughtful clinicians
The first page of a sort of virtual "book" called "How to be a therapist - a guide for thoughtful clinicians."
Personal inventory
Begin by taking a good look at yourself.
A monthly fee (part 1)
I have an unusual preference, when it comes to payment by my patients: I prefer to be paid a flat fee, monthly, regardless of how many sessions take place.
How come you don't like "informed consent" forms?
I don't like informed consent forms.
Cancellation
My cancellation policy is simple: regardless of whether we meet or not, my patients pay for every scheduled session.
Writing
The path to finding my voice has been long, and circuitous. But I think, maybe, I've finally got a plan.
A cold couch
Early on, I was trying to find my voice. The voice I found was purple, flowery, dramatic.
Masking
I don't wear a mask in session.
Cancellation, delinquency, collections, and more
I don't have a lot of delinquency, and don't struggle much to collect what I'm owed. I'm lucky that way.
Raising fees
I raise fees regularly. Except when I don't.
Switching back to in-person sessions
I prefer meeting in-person, and switched away from virtual sessions as soon as I could. And, I don't really work in a "hybrid" way, when I can avoid it.
Thoughts on accepting credit cards and other forms of payment
A few unstructured thoughts on various forms of payment
Seeing patients in other states (where you're not licensed)
Do you see patients in other states? How do you feel about the risks?
Estimated taxes
Estimated taxes are easy.
Giving w9s to insurance companies
I have no relationships with insurance companies, and I like it that way.
Lmsws, 1099s, and w2s
This post navigates the confusing legal landscape of employing LMSWs in New York State, where the law requires W2 employment despite the prevalence of 1099 arrangements. It offers practical insights for group practice owners and junior clinicians on licensure requirements and the financial implications of different hiring models.
Attachment styles and practice
I don't think a lot about attachment styles, or personality types.
Telling patients about other patients' pasts
I'm asked the question, "Should I tell some of my patients that others of my patients have engaged in assault or abuse?"
Hipaa rights and teletherapy by facetime
A writer asks, "Can I see my patients on FaceTime?"
Talking with adult patients' relatives
I don't talk with adult patients' relatives, except in very rare circumstances.
Returning to the office
Thoughts about going back to in-person work.
The challenge of boundaries in virtual sessions
Meeting virtually is VERY different from meeting in-person.
Paperwork and the frame
I don't ask my patients to fill in forms.
Thoughts, early in the pandemic
A few reflections, two weeks into the pandemic.
Scheduling with patients with irregular schedules
I like to match my level of commitment to my patients' levels of commitment.
Accepting checks from insurance companies
I try not to cash checks from insurance companies, but sometimes, it just feels cruel not to do so.
Antitrust?!?
This post challenges the common belief that antitrust laws prohibit clinicians from discussing their fees with colleagues, arguing that such discussions are generally permissible. The author provides current market ranges for both group and individual therapy to encourage more transparency around financial compensation in the field.
Structuring patient payments - a question
Is it ok to structure patient payments over time to (help them) manage their cash flow?
Cancellation
A question about the forms of payment I accept, and my cancellation policies.
Codependency and addiction
I don't like terms like "codependency."
Current thoughts on absences and payment
My thinking about absences, cancellations, rescheduling, and payment continues to evolve.
Sliding scale?
How I manage my sliding scale. (Hint: my practice is half low-fee.)
Last-minute cancellation by a new patient
How do you handle establishing a "missed session" policy with a patient with whom you've never met?
Zocdoc
I don't recommend ZocDoc.
"difficult patients"
Negative countertransference is a bear.
Credit cards?
The author expresses deep ambivalence about accepting credit cards, weighing the convenience of modern payment against the clinical complexity of involving a third-party financier. The post examines how "time-shifting" payments through credit can lead to transference leaks and complicate the direct economic relationship between patient and analyst.
Lmsws and insurance reimbursement (part 2)
A guide on how to issue statements that allow patients to get reimbursement, when you're (just) an LMSW.
Lmsws and insurance reimbursement
"LMSWs can't submit for insurance reimbursement" - true or false?
Early thoughts on cancellation
I think I _should_ charge for all sessions, but I can't. Yet. ?