I’ve always maintained that it was transference-focused psychotherapy (TFP) with my former psychiatrist, Dr. Lev, which saved my life and gave me a life worth living. I’ve recently been looking at posts on Instagram and TikTok about borderline personality disorder (BPD) and some mention dialectical behavior therapy (DBT) as the gold standard treatment. None mention TFP.

Before managed care, I spent 10 months in a long-term inpatient unit that treated patients diagnosed with BPD with dialectical behavior therapy. Then I was discharged to that hospital’s day program for patients with BPD. We were treated with DBT by many of the same staffers. I stayed in that program for 18 months.

TFP is a psychodynamic treatment, as opposed to DBT, which is a skills-based treatment. DBT is based in the here and now, while TFP treats BPD by focusing on the relationship — or the “transference” — between the therapist and the patient.

Transference-focused psychotherapy most often takes place twice weekly, and treatment lasts between one and three years. I worked with Dr. Lev for 11 years, with twice-weekly sessions. Before Dr. Lev and I started working together, we created a contract the purpose of which was to identify any behaviors that might interfere with treatment. The three items on my contract were:

• If I fell below a certain weight, I had to enter inpatient eating disorder treatment.
• If I cut myself, even a scratch,…

Developing self-awareness requires intentional effort and practice. Do you believe you already have self-awareness?

Tasha Eurich, PhD, researcher and organizational psychologist, has spent more than 10 years surveying people about their levels of self-awareness. She’s found that while 95% of study participants think they’re self-aware, only about 10% to 15% of them fully are.

– How to Develop Self-Awareness and Why It’s Important via PsychCentral.com

For those interested in continuing to hone their self-awareness, there are some skills you can practice over time to help develop it. Remember that it’s a process and not a destination. If you are interested in the first place, you will surely progress. Not everyone is. Consider it an ongoing journey that can unfold over your lifetime.  

Self-Awareness Suggestions

• Mindfulness Meditation: Regular mindfulness practice helps you observe your thoughts and feelings without judgment, increasing your awareness of your inner state. 
• Journaling: Writing down your thoughts and emotions can provide valuable insights into your patterns and triggers. It also can help you track your progress.   
• Feedback from Others: Seeking feedback from trusted friends, family, or therapists can offer valuable perspectives on your behavior and blind spots.  
• Self-Reflection: Take time to reflect on your experiences, asking yourself questions like, “What am I feeling right now?”, “Why did I react that way?”, “What are…

This is part two of a pair of posts. Click here to see the previous post.

Last Monday morning, while I was getting my breakfast to take up to my office, I got a call from the insurance company that manages my medications: My appeal of its decision not to reauthorize my prescription of the antidepressant Pristiq was denied. I managed to keep from spilling my coffee and headed up to my office where I closed the door, and the tears spilled.

The American Academy of Family Physicians states that “Utilization management can complicate physicians’ lives by requiring them to submit precertification paperwork, deal with the fallout of denied services, and participate in time-consuming appeals.”

What was going to happen to me? I called the insurance company immediately and asked why the appeal to the prior authorization had been denied. The representative said it was because I hadn’t had sufficient trials of duloxetine (Cymbalta) and venlafaxine (EffexorXR). I’d been on duloxetine; it was the medication that had stopped working prior to my fourth suicide attempt in 2014. I couldn’t specifically recall being on venlafaxine, but in my three-plus decades of cycling through many medication cocktails, I was almost sure I’d taken it.

Although I knew the representative wasn’t the person who made the decision and had no power in reversing the denial, I couldn’t help spilling my guts. “I’ve been stable…

Intimacy, the feeling of closeness and emotional connection with another person, is the cornerstone of healthy and fulfilling relationships, playing a vital role in relationship satisfaction, fostering trust, commitment, and overall well-being. It encompasses various aspects, including emotional, intellectual, physical, and shared experiences, though partners might have different meanings around these, so important to check in on this to assess significance to each partner. 

Cultivating intimacy involves actively engaging in behaviors that nurture these different aspects:

> Emotional Intimacy: This involves sharing feelings, thoughts, and vulnerabilities with your partner. It’s about creating a safe space (emotional safety) where both individuals feel comfortable expressing their true selves without fear of judgment.

> Intellectual Intimacy: This refers to connecting on an intellectual level, sharing ideas, values, and beliefs. Engaging in stimulating conversations, debating topics of interest, or even reading the same book and discussing it can foster intellectual intimacy.

> Physical Intimacy: Including sex but a broader range of behaviors, physical intimacy encompasses hugging, kissing, cuddling, holding hands, etc. It’s quite possible to have sex without intimacy as well as intimacy without sex. Physical touch releases oxytocin, the “love hormone,” which promotes bonding and feelings of closeness. 

Just the simple act of…

I’m terrified.

After my suicide attempt and subsequent psychiatric hospitalization in 2014, all my medication was changed. I was started on a different antidepressant (Pristiq, 100 mg.) and a different antipsychotic (Abilify, 15 mg). In 2018, following my stroke I became severely depressed and returned to therapy. My therapist, Dr. Lev, added a second antidepressant (Remeron, 45 mg.) to my cocktail. I’ve been stable on these medications ever since.

I started a new job this year. That means new insurance. When I ran out of the Pristiq, Dr. Lev had to send in a refill to the pharmacy which triggered a prior authorization request from my new insurance company. Unfortunately, by the time she got notified that prior authorization was necessary, I only had one tablet left, which I took this morning.

In an article published by the AMA, Jack Resneck, a dermatologist and immediate past president of the AMA, writes about prior authorizations, “Many years ago, health insurance plans came up with this process, and at the time it was just for brand-new, expensive medications that had just come to the market or new treatments that they wanted to limit use of.”

I can manage one or two days without the Pristiq, but more than that I start to worry. I’m anxious that I may start to go through withdrawal or what is more formally called antidepressant discontinuation syndrome which can happen if you stop taking your…

Shame, a painful emotion rooted in feelings of inadequacy and unworthiness, can cast a long shadow over our sexual lives if it gets entangled in one’s sexuality. The disgust or humiliation directed at the self can have a pervasive influence on one’s identity as a sexual being as well as relationship impact.

The term “sexual shame” is even more emotionally loaded because of the inherent discomfort associated with both of those words, let alone when used together.  The issue deserves a continued spotlight on it, to help those held back, unable to enjoy sex or simply feeling cut off from their perceived right to be sexual beings.

People will have their own unique experiences around the roots of their sexual shame but there are some common sources:

• Cultural and Religious Influences: Societal norms, religious teachings, and cultural taboos can create a climate of shame surrounding sex, particularly for women, LGBTQ+ individuals, and those engaging in sexual practices considered outside the “norm.”
• Negative Experiences (Childhood or Later): Traumatic experiences such as sexual abuse, neglect, or witnessing unhealthy sexual dynamics can lead to deep-seated shame related to sexuality.
• Internalized Messages: Negative messages about sex, bodies, and pleasure absorbed from family, peers, or media can contribute to feelings of shame and self-doubt.

Many aren’t even aware they carry sexual shame. Because the topic tends to lurk in the…