When the patient says “I have too much insight”

[bobbysuede]

Someone posted on the residency subreddit asking which med influencer would you be confident in to take care of you and I was happy to see your name in the comments! Keep it up man

[Dragonmoon]

I love how the key to good therapy isn't pointing things out to them, but just being a sounding board until they figure it out for themselves.

[xyffypb]

Intellectualisation. Classic defence mechanism

[md]

You are going to be a fantastic psychiatrist / already are. So many people would benefit from you and these kinds of conversations. Thank you for your content!!

[danburrito]

This one hits close to home thank you for sharing your insight into mental health

[colinpierce]

I feel like this video was the key to the circles I've been running around in during my last few therapy sessions. I think I might bring this video to the next one. Thank you Preston :)

[lulu_]

Freud realized this too in his development of talk therapy. Knowledge of ones’ symptoms and their likely causes/developments doesn’t often result in permanent change. We are affective beings, not just rational. Change often comes about because of our emotions—one important one being the (libidinal) motivating energy to change our behaviors. thus we get the idea of transference yada yada

[creachiecritter]

Please keel posting! I love your videos and I am so happy when I see them come up.

[realstaf]

I think that this approach to this conversation would work with some subset of patients but not all of them, I think psychiatrists should be weary of their own inclination to constantly try undercutting their patients words by walking them into some trap that makes them see how unreasonable what they believe is, sometimes the psychoanalytical Freudian approach of mapping current pathology on to past trauma and mistaken beliefs is useful and true, but sometimes a patient is analytical and neurotic because that was part of their inborn temperament, sometimes it could be a problem related to their diet, sometimes their intuition about being curious about something that they feel like they need to figure out could be genuinely correct and they have something they should indeed spend more time thinking about, the list goes on. I obviously don’t think Preston wouldn’t pay attention to each person he seems like a very caring and attentive doctor but there is a risk associated with advice on psychotherapeutic approaches that one ought to point out

[muneeb-khan]

Psych is great sometimes. You just let people talk, give a nice simple "yes, but" or "yes, and" response and let them do their thing. The number of times I've heard a student say the patient isn't psychotic because they only asked closed questions instead of just letting them talk Or the number of times I've had patients tell me "I don't know what's wrong" when they completely know what's wrong (but just hadn't thought about it) is a lot.

[deanj]

Ironically, he lacked insight to his intellectualizations causing him harm.

[saigeethanlambotharan]

thanks for sharing! it low-key reminds of when michael scott had to do mandated therapy with toby 😂

[pablo]

As someone who is like the patient, thanks for the vid and it's insight

[happylemon]

Oh yeah I think I might use intellectualization a lot as well - I feel very aware of my emotions and likely causes and I am pretty willing to talk about them. The one time I talked to a counselor or therapist-adjacent person they said “it must be hard to talk about this stuff” or something along those lines and it frustrated me because no, it wasn’t hard and I felt like she didn’t understand me. Luckily I still got what I needed out of that session or two but eventually I’m gonna find myself a therapist, hopefully one who understands patients like this and can help me get to the bottom of my intellectualization haha

[Snuffymcgee]

Amazing. You helped solve your (albeit fictional) patient’s problems as a psychiatrist without using substances (medications). It’s almost like you’re a psychologist.

[Trexusable]

Okay but like is anyone gonna talk about how he just casually dropped an oscar performance?

[rusinoe]

What would be the utility of that patient's conclusion at the end? Would they let go of their need for control? Stop intellectualizing? Is it bad to intellectualize? Might be a bit annoying, but I dunno.

[neobyte]

So ok fine, I accept this, and I want to let myself feel the grief of my past trauma, but I don’t have the time nor inclination to allow that because I actually don’t know what that actually means. What does it mean to grieve over your past trauma? Am I meant to stamp my feet like a toddler on my tormentor’s grave? Scream at the sky?

[jonaak]

Too much insight? Someone has been playing Bloodborne lately

[DentinStar]

The brain seeks patterns either for the saving of energy, prevention of pain, or the promise of pleasure. A good mental health advocate will intercede where these motivations are erroneous and causing unnecessary suffering. You're a smart man Dr. Presto. Make sure you get that nightguard for your teeth btw.