⚠️ Important Warning

Do not stop, reduce, or change a psychiatric medication without first discussing it with the prescribing clinician or another qualified medical professional. Some psychiatric medications can cause significant withdrawal or discontinuation symptoms, and abrupt cessation can be dangerous. Medication changes should be approached carefully and individually with appropriate medical guidance.

As a mental health provider and advocate, this article may be long overdue. The conversation around the “chemical imbalance” theory has been shifting, and many people, both professionals and members of the general public, are only beginning to understand, accept, and apply what those changes mean.

As a therapist who writes about and advocates for people who have been harmed by psychiatric medications, I want to be clear from the beginning: not everyone is harmed by psychiatric medication. Many people take these medications and find them helpful. This article isn’t about telling people what medications they should or shouldn’t take.

This article is for anyone who wants to better understand the “chemical imbalance” theory, where it came from, what the research actually tells us, and how our understanding of it has evolved.

It is also for those who have experienced problems with psychiatric medications, including tolerance, prolonged or protracted withdrawal, debilitating difficulty tapering, difficulty finding safe, taper-informed providers, or other medication-related difficulties.

And it is for the therapists and healthcare professionals working with those clients, particularly when those clients have spent years being told that their symptoms are the result of a “chemical imbalance” in their brain.

The mental health field is constantly changing, and I think staying reasonably informed about the research benefits both therapists and our clients, even when it means questioning things we’ve been taught or accepted for years.

In this article, we’ll explore:

🧠 What the “chemical imbalance” theory actually means, how the theory became widely accepted for decades, and what the research really tells us about serotonin and depression.

💊 Why antidepressants can help some people even if the simple serotonin-deficiency explanation doesn’t hold up.

🧩 How the chemical-imbalance story became so influential, particularly around depression and antidepressants, and whether similar explanations apply to anxiety and ADHD.

👩‍⚕️ How therapists became part of the story, and what happens when we begin questioning something we were taught as established knowledge.

🛋️ What this means for our work with clients: how to support people taking psychiatric medication without either undermining their treatment or presenting uncertain science as settled fact.

⚖️ How therapists can practice ethically in a medical system that still uses these explanations, while staying within our scope, remaining intellectually curious, and becoming comfortable saying, “We don’t know.”

We All Know the “Chemical Imbalance” Theory. But What Is It?

I remember being introduced to the chemical imbalance theory years before I entered the behavioral health field and wondering: What exactly is a chemical imbalance? How would you know if someone had one in their brain? And if that’s what’s causing depression, why do these medications work for some people and not others?

I don’t remember ever getting a particularly satisfying answer to those questions. Eventually, I did what a lot of us do. I accepted the explanation that “they” told us and moved on, figuring that the people who understood and taught the science must know what they were talking about.

Years later, as I began taking deeper dives into evidence-based information about psychiatric medications, withdrawal, and the research underlying some of the assumptions we’d made about these medications, I found myself returning to that original question:

Where Exactly Is the Evidence for This Theory?

The “chemical imbalance” explanation has been around for decades and has become so familiar that many of us rarely stop to question what it actually means.

Depression gets associated with low serotonin. Antidepressants are described as a treatment to correct that imbalance. Somewhere along the way, several complicated scientific hypotheses became a very simple story, repeated so often that it evolved into an accepted, established fact.

So Where Did the Chemical Imbalance Theory Come From?

The chemical imbalance story didn’t begin with scientists discovering that depressed people were deficient in serotonin. It began with multiple observations about what happened when researchers altered brain chemistry.

In the 1950s, researchers noticed that some medications could produce significant changes in mood and behavior. One important observation involved reserpine, a drug that lowers blood pressure and depletes several neurotransmitters, including serotonin and norepinephrine. Reserpine depletes several neurotransmitters belonging to a class called monoamines, including serotonin, norepinephrine, and dopamine.

Observations that reserpine could produce depressive symptoms, combined with observations about the effects of antidepressant drugs, contributed to early hypotheses about the role of neurotransmitters in depression.

Around the same time, the first antidepressant medications were also being discovered, and researchers noticed that many of them affected these same neurotransmitters. These observations led to a series of hypotheses about whether changes in brain chemicals might contribute to depression.

In the 1960s, researchers such as Joseph Schildkraut were developing what became known as the catecholamine hypothesis, proposing that some forms of depression might involve reduced norepinephrine activity. Catecholamines include mostly norepinephrine and dopamine, and not serotonin.

In the late 1960s, Alec Coppen developed the serotonin hypothesis, proposing that disturbances in serotonin function could play a role in depression.

In other words, the theory started with tentative hypotheses and observations about drugs and neurotransmitters and developed into hypotheses about what might be causing symptoms of depression.

Over time, that complicated and evolving scientific hypothesis became simplified into a much more straightforward message:

Depression is caused by a chemical imbalance, particularly low serotonin, and antidepressants correct it.

The theory then became particularly influential with the rise of SSRIs in the 1990s.

But there is an important distinction here:

Observing that altering neurotransmitters in the brain can affect mood is not the same as demonstrating that people with depression have a chemical deficiency or imbalance that caused their depression in the first place.

A simple analogy is that if you have a headache, you may take acetaminophen and experience relief. That doesn’t mean the cause of your headache was an acetaminophen deficiency.

So, What Does the Research Actually Show?

One of the most useful places to start is a 2022 systematic umbrella review published in Molecular Psychiatry by psychiatrist Joanna Moncrieff and colleagues. Rather than looking at one study, the researchers examined existing systematic reviews, meta-analyses, and large genetic studies investigating whether depression is actually associated with lower serotonin activity or concentration.

They looked at several different lines of evidence, including serotonin and its metabolites, serotonin receptors, the serotonin transporter, studies that temporarily reduce serotonin availability, and genetic studies involving the serotonin system.

Their conclusion was striking: they found no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.

That doesn’t mean serotonin has nothing to do with the brain, that antidepressants cannot help, or that we’ve discovered the “real” cause of depression.

It means something much narrower, but also quite important:

The evidence does not support the simple idea that depression is caused by a serotonin deficiency that antidepressants correct.

The Debate Didn’t End There

The publication of Moncrieff and colleagues’ review did not end the debate. In fact, it generated considerable controversy within the field, with researchers arguing that the review overstated its conclusions and that some evidence was overlooked or interpreted too narrowly.

In other words, the scientific conversation is not simply “Moncrieff proved serotonin has nothing to do with depression.”

The more accurate conclusion is that the old, straightforward serotonin-deficiency model is not supported by the evidence nearly as well as the public narrative has suggested, while the precise role of serotonin in depression remains a matter of scientific investigation.

Moncrieff and her colleagues responded to multiple criticisms, maintaining that their review was specifically evaluating the serotonin-deficiency theory of depression, not claiming that serotonin has no role whatsoever in the brain or in depression.

So, no, the scientific debate did not end with one review.

But that’s actually part of the point.

If scientists are still debating what serotonin-related findings mean for depression, how comfortable should therapists and doctors be presenting “chemical imbalance” as an established explanation to our clients?

The Chemical Imbalance Theory Expands: From Depression to Anxiety and ADHD

Similar explanations have also been applied to other conditions.

Anxiety has been widely attributed to imbalances in neurotransmitters like GABA (gamma-aminobutyric acid), serotonin, norepinephrine, and dopamine. Drugs like SSRIs and benzodiazepines target these systems, which reinforced the idea that a chemical imbalance causes anxiety.

But, just as with depression, years of research do not demonstrate clear proof that anxiety is caused by a simple shortage or excess of a single brain chemical, or an “imbalance” of neurotransmitters. There is also no established blood test or brain scan that can measure a “chemical imbalance” causing anxiety or depression.

ADHD has sometimes been described as a dopamine or norepinephrine deficiency in the prefrontal cortex. While stimulant medications increase these chemicals and can improve attention, ADHD is similarly not simply a matter of the brain lacking certain chemicals. Research points to broader differences in brain development, function, and genetics.

Why Do SSRI and SNRI Antidepressants Work for Some People?

Antidepressants can help without “balancing your serotonin” or other neurotransmitters.

It is well established that SSRIs and SNRIs alter serotonin and/or norepinephrine signaling. But those effects are not limited to the brain. These neurotransmitters are involved in multiple physiological systems related to mood, stress, learning, emotional processing, and other functions.

Serotonin and its receptors are abundant throughout the gastrointestinal tract and also play roles in metabolic, immune, and other physiological processes. Norepinephrine is involved in both central nervous system signaling and the body’s involuntary “fight-or-flight” and “rest-and-digest” responses, or autonomic/stress-response systems.

Even with the science we have today, it is not completely understood which of these changes are responsible for antidepressant or antianxiety effects, why they help some people, or why some people experience prolonged or debilitating symptoms during or after treatment with these medications.

Depression is not a one-size-fits-all biological condition. People also differ greatly in how they metabolize and respond to medications. Differences in depression and anxiety symptoms, and the variety in responses to these medications, occur through complex combinations of genetics, stress, trauma, physical health, sleep, environment, and brain functioning.

So What Do We Do as Therapists?

I was trained to think about depression through this “chemical imbalance” framework as well. I think it’s worth examining what happens when a therapist realizes that an explanation they’ve been given for something as fundamental as depression may have been considerably more tentative than it sounded.

I don’t think the answer is to tell clients to stop taking their medication. I also don’t think the answer is to replace old dogma with new dogma. That’s not our role, and it certainly isn’t the point of this article.

From my experience, I’ve encountered clients everywhere along the spectrum when it comes to the chemical imbalance theory. Some are curious and want to learn more. Others believe it wholeheartedly and find the explanation reassuring. And some are adamantly opposed to having that belief challenged.

That matters because the explanations we give clients can influence how they understand their own mental health.

In a 2025 study, 1,279 of 1,755 college students who passed an attention check, or 73%, reported having heard the explanation that depression is caused by a “chemical imbalance.” Healthcare providers, primarily doctors and therapists, were among the reported sources, and learning about the explanation from a healthcare provider was uniquely associated with stronger endorsement of the chemical-imbalance belief. (Schroder et al., 2025).

That raises an uncomfortable but important question for those of us in the mental health field: if therapists can play a role in transmitting this explanation, what responsibility do we have to be thoughtful about how we present it to our clients?

Part of our job is psychoeducation, but another equally important part of therapy is listening deeply and attuning to the person sitting in front of us.

Not every client is going to be interested in, ready for, or receptive to information that challenges a long-held understanding of their mental health. Getting on a soapbox about the chemical imbalance theory isn’t necessarily therapeutic simply because we have new information.

1. Start with Curiosity, Not Correction

A therapist doesn’t need to convince a client that their understanding of depression, medication, or diagnosis is wrong.

Instead, we can ask:

• What have you been told about why you’re experiencing these symptoms?

• What does the idea of a “chemical imbalance” mean to you?

• Does that explanation feel helpful, discouraging, relieving, or frightening?

• What has your experience with medication actually been?

• What are you hoping treatment will help you change?

Meeting a client where they are doesn’t mean agreeing with everything they believe. It means respecting their autonomy while remaining available to provide accurate information when it is relevant and welcome.

Curiosity also doesn’t mean pretending the therapist and client have equal knowledge about the scientific question. It means being curious about the client’s understanding, experience, and meaning-making before deciding what information is relevant or how it should be offered.

The therapist’s role is not to win the argument. It is to maintain a therapeutic relationship in which the client can safely ask questions, explore their experiences, and make their own decisions.

Rather than trying to change a client’s mind, we can explore their own understanding, ambivalence, goals, and values.

Sometimes the belief itself is clinically meaningful. For one person, believing that depression is a biological condition may reduce stigma and shame and provide hope. For another, it may leave them feeling broken, defective, or dependent on medication indefinitely.

The therapist doesn’t have to immediately determine which interpretation is “correct.” Understanding what the belief means to the individual may be more therapeutically useful.

2. Educate Without Turning Education into Persuasion

There is an important distinction between providing information and trying to convince someone.

If a client asks whether depression is caused by a serotonin deficiency, we can provide accurate, appropriately qualified information. We can explain that the simple serotonin-deficiency explanation is not supported by the evidence as well as many people have been led to believe. At the same time, we can acknowledge what remains unknown.

Antidepressants can help some people, but we don’t necessarily understand exactly why they work.

We don’t have to replace one certainty with another.

Moving away from a simplistic chemical-imbalance model also creates an opportunity to ask a broader question:

What is happening in this person’s life, body, relationships, and environment?

Depression, anxiety, ADHD, and other mental health conditions involve complex interactions among biological and psychosocial factors. Depending on the individual, relevant factors may include:

• Genetics and individual biological vulnerability

• Neurotransmitter systems, receptors, neural circuitry, and signaling

• Hormones, metabolism, sleep, and physical health

• Chronic stress and environmental conditions

• Relationships and social connection

• Grief, loss, loneliness, and life transitions

• Trauma and adverse experiences

• Work, financial stress, and caregiving

• Identity, meaning, and a person’s broader circumstances

We don’t have to know exactly how the fire started in order to help put it out. We don’t have to identify one root cause in order to help someone, either.

3. Don’t Replace “Chemical Imbalance” with “It’s Your Trauma”

This is an important guardrail.

If we reject the idea that depression is simply caused by low serotonin, we should be equally cautious about declaring that depression is really caused by childhood trauma, attachment wounds, inflammation, nervous-system dysregulation, or any other single explanation.

Those factors may be highly relevant for a particular person. But replacing one reductionistic explanation with another doesn’t solve the problem.

4. Shift from “Fixing” to Understanding and Adapting

Therapy can instead emphasize change, adaptation, learning, and increased agency.

That might involve helping clients:

• Identify patterns that maintain distress.

• Develop emotional-regulation and coping skills.

• Examine thoughts and behaviors that contribute to suffering.

• Process difficult experiences.

• Change relationship patterns and boundaries.

• Develop greater awareness of bodily and emotional responses.

• Build meaningful sources of connection, purpose, and support.

Instead of “your brain is broken” or “your trauma caused this,” how about:

“Let’s understand what is happening and figure out what might help.”

5. Put Medication in Its Proper Context

Therapists also have an important role in discussing medication without practicing medicine or inadvertently reinforcing misinformation.

Medication may be helpful for some clients. It may be unhelpful for others. Some people experience significant benefits, some experience side effects, and some experience both benefits and difficulties.

A therapist can explore a client’s experience without making prescribing decisions:

• What changes have you noticed since starting the medication?

• What benefits do you think you’re getting?

• Are there effects that concern you?

• What questions do you have for your prescriber?

• What would you like to understand better before making a decision?

If a client is considering starting, changing, reducing, or stopping medication, the therapist can encourage discussion with the appropriate prescribing professional while continuing to support the client therapeutically.

6. Work Collaboratively with Other Providers

When medication or other medical treatment is part of someone’s care, therapists can also work collaboratively with prescribers and other healthcare professionals, with appropriate consent and within their scope.

Therapists don’t need to become prescribers. We do need to recognize where our expertise ends and help clients access the expertise they need.

7. My Personal Hope: Better Training and Continuity of Care

One of my personal hopes is that, as the mental health field evolves, therapists receive better training in recognizing potential medication side effects, adverse reactions, and withdrawal-related concerns while remaining within our scope of practice. Therapists often spend more time with clients than prescribing providers, which can give us a unique vantage point when changes or concerns emerge. I’ve worked in settings where therapists had concerns about what clients were reporting but had no practical way to communicate with the prescribing clinician, sometimes while the client couldn’t reach that provider for weeks. I don’t think the answer is for therapists to practice medicine. I think we need better education, communication, and continuity of care so clients don’t fall through the cracks between providers.

Ultimately, the client remains the owner of their treatment decisions. Our job isn’t to persuade someone to take medication. It isn’t to persuade them not to take medication. It isn’t to convince them that their depression is caused by trauma, biology, childhood experiences, inflammation, neurotransmitters, or anything else.

And perhaps most importantly, we should be careful not to weaponize uncertainty, while continuing to respect and support client autonomy.

If we’re going to challenge the certainty of the chemical-imbalance story, we shouldn’t respond by claiming that we now know what really causes depression.

It means we can be curious, collaborative, evidence-informed, and honest about what we know and what we don’t while helping clients make sense of their own experience.

Disclaimer

I am a licensed marriage and family therapist in California, not a medical doctor or prescribing clinician. This article is based on my review of research on this topic, along with my clinical observations and professional perspective. It is intended for educational purposes only and does not constitute medical advice, psychological advice, diagnosis, or treatment recommendations. It does not establish a therapist-client or patient-provider relationship and should not be used as a substitute for individualized medical or mental health advice from a qualified healthcare professional.

📚 Psychiatric Medication Deprescribing & Withdrawal Resource Library

The following resource list has been repurposed from a previous article I published, A Therapist’s Guide to Supporting Clients Through Psychiatric Medication Tapers and Psychiatric Medication Injury. I’ve included it here because some readers may want to explore the issues of psychiatric medication withdrawal, tapering, and deprescribing in greater depth.

This is a curated, non-exhaustive list of clinical, research, and lived-experience resources related to psychiatric medication tapering, withdrawal, and deprescribing. Inclusion does not imply affiliation or endorsement.

If you know of a resource (including yourself!) that should be on this list, please let me know. This is a growing field, and I know this list will grow along with it. 💛

🏥 Clinical & Tapering Support Services

The Ashton Manual
Benzodiazepine withdrawal guidance manual developed by Professor Heather Ashton.
https://www.benzoinfo.com/ashtonmanual

Benzodiazepine Information Coalition
Educational and advocacy organization focused on benzodiazepine risks, withdrawal, and informed consent.
https://www.benzoinfo.com

Inner Compass Initiative / The Withdrawal Project
Peer-led educational platform and support resource for psychiatric medication withdrawal.
https://www.theinnercompass.org

Outro Health
Clinical tapering service providing structured deprescribing support for psychiatric medications.
https://www.outro.com

SafeTaper
Clinically informed resource focused on gradual psychiatric medication tapering and withdrawal support.
https://www.safetaper.org

TaperClinic
Clinician-informed services and educational resources focused on psychiatric medication tapering and withdrawal support. https://www.taperclinic.com

True You Psychiatry
Psychiatric practice offering deprescribing support, including individualized tapering strategies and withdrawal-informed clinical care. https://www.trueyoupsychiatry.com

Nick Bischoff, APRN, PMHNP-BC (@nickbischoff.np)
Dual board-certified psychiatric mental health nurse practitioner who provides psychiatric care and deprescribing-focused education.
Instagram: https://www.instagram.com/nickbischoff.np/

🧠 Advocacy, Education & Research Platforms

Mad in America
Independent platform focused on critical psychiatry research, lived experience perspectives, and medication harm awareness.
https://www.madinamerica.com

National Institute on Drug Abuse (NIDA)
U.S. federal research institute providing definitions and data on addiction, dependence, and substance use science.
https://nida.nih.gov

Marsha Zaritsky, MA, LMHC (@gracefullyunmedicatingme)
IFS therapist and educator who shares educational content and lived-experience perspectives related to psychiatric medication withdrawal, deprescribing, and recovery.
Instagram: https://www.instagram.com/gracefullyunmedicatingme/

📖 Practitioner & Patient-Facing Literature

Sørensen, A. (2024). The Why of Withdrawal
Explores antidepressant and antipsychotic withdrawal phenomena and symptom persistence. (Fri Forlag)

References

Arnsten, A. F. T., & Pliszka, S. R. (2011). Catecholamine influences on prefrontal cortical function: Relevance to treatment of attention deficit/hyperactivity disorder and related disorders. Pharmacology, Biochemistry and Behavior, 99(2), 211–216. https://doi.org/10.1016/j.pbb.2011.01.020

Cafasso, J. (2023, April 18). Chemical imbalance in the brain: What you should know. Healthline. https://www.healthline.com/health/chemical-imbalance-in-the-brain

Harvard Health Publishing. (2022, January 10). What causes depression? Harvard Medical School. https://www.health.harvard.edu/mind-and-mood/what-causes-depression

Hoogman, M., Bralten, J., Hibar, D. P., Mennes, M., Zwiers, M. P., Schweren, L. S. J., van Hulzen, K. J. E., Medland, S. E., Shumskaya, E., Jahanshad, N., de Zeeuw, P., Szekely, E., Sudre, G., Wolfers, T., Onnink, A. M. H., Dammers, J. T., Mostert, J. C., Vives-Gilabert, Y., Kohls, G., Oberwelland, E., … Franke, B. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: A cross-sectional mega-analysis. The Lancet Psychiatry, 4(4), 310–319. https://doi.org/10.1016/S2215-0366(17)30049-4

Kresser, C. (2019, June 19). The “chemical imbalance” myth. Chris Kresser. https://chriskresser.com/the-chemical-imbalance-myth/

Lopez-Muñoz, F., Ucha-Udabe, R., & Alamo, C. (2015). A brief history of the development of antidepressant drugs: From monoamines to glutamate. Current Pharmaceutical Design, 21(11), 1474–1486.

Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2022). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 27, 2583–2596. https://doi.org/10.1038/s41380-022-01661-0

National Alliance on Mental Illness. (n.d.). Treatments and approaches. https://www.nami.org/treatments-and-approaches/

National Institute of Mental Health. (n.d.). Psychotherapies. U.S. Department of Health and Human Services, National Institutes of Health. https://www.nimh.nih.gov/health/topics/psychotherapies

Pies, R. W. (2019, April 30). Debunking the two chemical imbalance myths, again. Psychiatric Times, 36(4). https://www.psychiatrictimes.com/view/debunking-two-chemical-imbalance-myths-again

Schroder, H. S., Tovey, J., Forer, R., Schultz, W., Kneeland, E. T., & Moser, J. S. (2025). Where do “chemical imbalance” beliefs come from? Evaluating the impact of different sources. Frontiers in Psychology, 15, 1469913. https://doi.org/10.3389/fpsyg.2024.1469913

Schildkraut, J. J. (1965). The catecholamine hypothesis of affective disorders: A review of supporting evidence. The American Journal of Psychiatry, 122(5), 509–522.

🎯 A Note Before We Begin

While this article is written mainly as a guide for therapists supporting people through psychiatric medication tapering, withdrawal, and education about psychiatric medication injury, anyone interested in entering the conversation may find the information here useful.

This article explores:

• The potential benefits and risks of psychiatric medications

• The physiology of medication dependence and withdrawal

• How these medications can contribute to nervous system dysregulation

• The distinctions between addiction, physiological dependence, tolerance, misuse, and abuse

• How education, informed consent, and therapy can support both providers and consumers of psychiatric medications

This article is not politically affiliated.

I originally published this article several months ago, but am revisiting and expanding it due to the recent and often polarizing attention surrounding psychiatric medication withdrawal, informed consent, and deprescribing conversations in the headlines.

It is also important to clarify that this discussion is not about demonizing psychiatric medications or dismissing the people who benefit from them.

Many individuals experience profound relief, stabilization, and improved quality of life with these medications. Others experience difficult side effects, tolerance, or withdrawal related complications. Both experiences deserve acknowledgment and compassionate discussion.

I am not a doctor, physician, or prescriber.

This topic is deeply important to me, both professionally and personally.

As a therapist, I have witnessed many clients benefit significantly from psychiatric medications. I have also seen individuals experience substantial harm related to long-term use, rapid tapering, withdrawal syndromes, and moderate to severe nervous system destabilization.

This article focuses specifically on how therapists, within their scope of practice, can support clients experiencing difficult antidepressant or benzodiazepine tapering and withdrawal processes, including cases where medications were taken exactly as prescribed.

I have researched this topic extensively and included credible sources and educational resources for those interested in learning more, whether professionally or personally.

This article is also not about being “for” or “against” psychiatric medication. It is about understanding the full picture: the research, the risks, the benefits, the realities of neuroadaptation, and the stories that too often go unheard, particularly among individuals who experience significant challenges during long-term use or withdrawal.

The decisions to take or to taper a psychiatric medication are deeply personal and should be made collaboratively with a qualified and informed medical provider. Do not attempt to discontinue a psychiatric medication on your own without medical supervision.

If psychiatric medications have helped you, that experience is real and valid.

If psychiatric medications have harmed you, that experience is real and valid too.

🧾 Before We Explore Iatrogenic Harm

Here’s a brief, research-based overview of what some commonly prescribed psychiatric medications can possibly do well.

This list is not exhaustive and does not cover every psychiatric medication, but it highlights several evidence-supported benefits associated with antidepressants and benzodiazepines when used appropriately and under medical supervision.

💊 What Antidepressants Do Well: Fast Facts

• 2 out of 3 people respond positively to antidepressants, compared to 1 in 3 on placebo (Cipriani et al., 2018, The Lancet).

• Approximately 67% response rates have been demonstrated in adult depression trials involving many SSRIs and SNRIs.

• Some of the most effective and well-tolerated antidepressants include escitalopram, sertraline, vortioxetine, and desvenlafaxine.

• For dysthymia (persistent depressive disorder), SSRIs demonstrate significantly higher efficacy than placebo.

• With structured support, many people successfully discontinue antidepressants without relapse over time.

• Withdrawal symptoms are common but often temporary. Slow tapering may significantly reduce severity and incidence.

• Many individuals remain on these medications long-term without major complications, especially when treatment is paired with therapy, lifestyle interventions, social support, and medical monitoring.

💊 What Benzodiazepines Do Well: Fast Facts

• Rapid anxiety relief with onset often occurring within minutes to hours

• Effective short-term treatment for acute panic attacks and severe anxiety spikes

• Helpful for short-term insomnia management

• Commonly used for procedural sedation in dentistry and surgery

• Useful for muscle relaxation in acute injuries and neurological conditions

• Effective rescue medications for seizure disorders

• Sometimes used as temporary bridge medications while antidepressants take effect

• Can provide short-term stabilization during periods of acute distress or trauma

🧠 What Is Iatrogenic Injury and How Common is it ?

Iatrogenic injury refers to harm caused by medical treatment itself.

In the context of psychiatric medication, it refers to symptoms or complications that may arise from the medications intended to help, particularly during long-term use, tapering, or discontinuation.

This can include physical, emotional, cognitive, and neurological symptoms that are frequently misunderstood or misdiagnosed.

As a trauma-informed therapist, I have worked with clients who were prescribed psychiatric medications for years or decades without fully understanding the potential for tolerance, neuroadaptation, physiological dependence, or withdrawal.

When these medications are reduced or discontinued, some individuals experience destabilizing symptoms that are often interpreted as relapse or the emergence of a new psychiatric disorder.

Again, this article is not anti-medication.

Many people benefit from psychiatric medications, and for some individuals they are lifesaving.

The goal here is to increase awareness surrounding informed consent, clinician education, trauma-informed care, and compassionate support for those who experience medication-related harm, especially when medications were taken exactly as prescribed.

The Research

One of the most frequently cited reviews on antidepressant withdrawal, conducted by James Davies and John Read (2019), found that approximately 56% of individuals attempting to discontinue antidepressants experienced withdrawal symptoms, with nearly 46% of those individuals describing the symptoms as severe.

The review also noted that withdrawal symptoms sometimes persisted for weeks, months, or longer in a subset of individuals.

The findings of this review helped fuel broader public and clinical discussions surrounding antidepressant withdrawal, informed consent, and deprescribing practices, while also generating controversy and debate within psychiatry regarding methodology, interpretation, and prevalence estimates. Subsequent research has produced lower estimates in some populations, highlighting the complexity and ongoing evolution of this field.

Despite differing estimates, there is now growing consensus across many major medical organizations that antidepressant withdrawal can, in some cases, be significant, prolonged, and clinically destabilizing, particularly after long-term use or rapid tapering.

🌀 Why This Happens: Tolerance, Tachyphylaxis, and Nervous System Disruption

Tolerance

The nervous system adapts to ongoing medication exposure by reducing receptor sensitivity or availability, requiring higher doses to achieve the same effect. This is well described with both antidepressants and benzodiazepines.

Tolerance withdrawal

A term describing a phenomenon in which withdrawal-like symptoms emerge while a person is still taking a medication at a stable dose, rather than after dose reduction or discontinuation.

It is thought to occur when the nervous system has adapted (via receptor downregulation or altered neurotransmitter signaling) to the ongoing presence of a drug to such a degree that the current dose no longer adequately maintains prior equilibrium.

Tachyphylaxis

Sometimes referred to as “antidepressant poop-out,” tachyphylaxis describes a loss of therapeutic effect despite continued use, likely reflecting ongoing neuroadaptive changes in receptor signaling.

Withdrawal

Withdrawal refers to symptoms that emerge during dose reduction or discontinuation. These symptoms reflect rebound and recalibration across multiple neurotransmitter systems, including downregulation (reduction in number or efficiency) of receptors that bind to serotonin, GABA, and glutamate.

Severity and duration vary widely and may, in some cases, persist for months or longer.

Kindling

Kindling describes a sensitization process in which repeated withdrawal episodes become progressively more intense over time, potentially reflecting increased nervous system reactivity.

How These Processes Overlap

Although described separately, tolerance, tachyphylaxis, and withdrawal often represent different phases of the same underlying process: neuroadaptation to chronic pharmacologic exposure.

These processes may present at different times:

• While still taking the medication (tolerance withdrawal)

• When effectiveness diminishes (tachyphylaxis)

• During dose reduction or discontinuation (withdrawal)

• Or after stopping (protracted symptoms such as PAWS or BIND presentations)

🧠 Shared Symptom Clusters Across All Phases

Across these states, symptoms often cluster in overlapping domains:

Neurological / sensory

Brain zaps, dizziness, tinnitus, sensory hypersensitivity, paresthesias, tremor, internal vibration, akathisia

Cognitive

Brain fog, slowed thinking, memory and attention impairment, word-finding difficulty, dissociation, executive dysfunction

Emotional / psychiatric

Anxiety, panic, depression, irritability, emotional blunting, mood instability, intrusive thoughts, dissociation, depersonalization, derealization

Autonomic / physical

Insomnia, palpitations, GI disturbance, fatigue, temperature dysregulation, flu-like sensations

Neuromuscular

Muscle tension, spasms, weakness, motor restlessness, coordination changes

Multi-Systemic Reactivity (central sensitization and autonomic dysregulation)

Nervous system hypersensitivity and reduced stress tolerance across multiple systems at once is commonly reported when one has reached a state of tolerance withdrawal, downregulation of receptors, and/or during the tapering process. This may include heightened or unusual reactions to medications, vitamins, or supplements that were previously well tolerated, along with difficulty returning to baseline after stress or activation.

This pattern may reflect “central sensitization,” meaning the central nervous system becomes more reactive and amplifies internal and external signals, and “autonomic nervous system dysregulation,” meaning the body has more difficulty smoothly shifting between states of activation (fight or flight) and recovery (rest and digest). This can contribute to emotional destabilization, increased intrusive thoughts, and in some cases increased suicidal ideation.

🧠 PAWS (Post-Acute Withdrawal Syndrome)

A term used to describe persistent or fluctuating symptoms following discontinuation, including anxiety, depression, cognitive impairment, sleep disruption, emotional sensitivity, and reduced stress tolerance. Not formally recognized in DSM-5, but widely described in withdrawal literature.

🧠 BIND (Benzo-Induced Neurological Dysfunction)

A proposed syndrome describing prolonged neurological and physiological symptoms associated with benzodiazepine exposure, including in prescribed use. Reported features include sensory disturbances, akathisia, tinnitus, muscle weakness, emotional blunting, and in severe cases, seizures.

BIND emphasizes potential iatrogenic neurological injury beyond addiction-based frameworks.

🧠 Summary

Across medication classes, these phenomena reflect neuroadaptation: changes in receptor sensitivity and neurotransmitter regulation in response to chronic exposure. When exposure changes, symptoms may emerge across cognitive, emotional, autonomic, and sensory systems.

These experiences do not inherently indicate relapse or addiction, but may reflect nervous system recalibration following pharmacologic adaptation.

🧩 Polypharmacy and Medication Stacking

Polypharmacy is when someone is prescribed multiple psychiatric medications over time, often because new or ongoing symptoms are seen as a return of the original condition or a new diagnosis.

In some cases, these symptoms are actually related to medication effects such as tolerance, withdrawal, or changes in how the nervous system is adapting. But instead of considering that possibility, another medication may be added to treat the new symptoms.

This can lead to a cycle where medications keep getting added over time, while the root cause of the symptoms is not fully explored or addressed. As this happens, it can become harder to tell whether symptoms are coming from the original condition, the medications themselves, or withdrawal effects.

At the same time, care may not always fully include supports such as coping skills, nervous system regulation tools, lifestyle support, strengthening supportive relationships, and access to basics like time outdoors, fresh air, and sunlight.

Over time, some people may find themselves on multiple medications for years and still struggling, particularly when broader supports such as coping skills, nervous system regulation, relationships, and lifestyle factors are not consistently integrated into care alongside medication management.

A more balanced approach includes regularly reviewing medications, considering whether symptoms could be medication-related, and ensuring that psychological support, coping tools, and broader life-based supports are part of care alongside medical treatment.

📊 The Gap Between Clinical Trials and Real-World Use

One major challenge in psychiatric medication research is that many antidepressants are approved based on relatively short-term clinical trials, often lasting approximately 6–12 weeks, while real-world use frequently extends for years or decades.

Researchers including Michael Hengartner have argued that this creates an important gap in our understanding of long-term outcomes, including tolerance, withdrawal, neuroadaptation, and the physiological effects of prolonged exposure.

More recent analyses have also highlighted that few long-term trials systematically monitor withdrawal symptoms, tapering outcomes, or post-discontinuation functioning, despite the increasing prevalence of long-term antidepressant prescribing.

This growing recognition has contributed to increased interest in deprescribing research, hyperbolic tapering approaches, and updated guidance such as the The Maudsley Deprescribing Guidelines.

📉 Why Traditional Tapering Approaches Often Fail

For many years, psychiatric medications were commonly tapered over relatively short periods of time, sometimes days or weeks.

However, emerging research and lived clinical experience suggest that some nervous systems adapt far more extensively to psychiatric medications than previously understood, particularly after long-term use.

This has led to growing recognition of protracted withdrawal syndromes, nervous system sensitization, and the need for slower, more individualized tapering approaches.

Psychiatrists and researchers such as Mark Horowitz, along with clinicians and educators including Anders Sørensen, have helped bring greater attention to these issues through research, clinical education, and patient advocacy.

One major development emerging from this work is the concept of hyperbolic tapering.

🧠 What Is Hyperbolic Tapering?

Hyperbolic tapering is based on the understanding that psychiatric medications do not affect the brain in a linear way.

Small dose reductions at lower doses can create disproportionately large effects on receptor occupancy and nervous system function.

Because of this, tapering often needs to slow down progressively as doses get lower, sometimes involving very small reductions over extended periods of time.

This approach differs significantly from older linear tapering models, which often reduced medications in equal milligram amounts regardless of receptor sensitivity.

The goal of hyperbolic tapering is not to keep people on medications indefinitely, nor to push people off medications prematurely.

The goal is nervous system stability and harm reduction.

📚 The Maudsley Deprescribing Guidelines

The Maudsley Deprescribing Guidelines were developed by psychiatrists and researchers including Mark Horowitz and David Taylor following growing recognition that psychiatric medication withdrawal is often more complex, prolonged, and physiologically significant than previously understood.

Dr. Horowitz has spoken publicly about experiencing severe antidepressant withdrawal symptoms himself after long-term antidepressant use, an experience that helped shape his later research and advocacy work surrounding safer tapering practices and informed consent.

The guidelines focus on the deprescribing and tapering of:

• Antidepressants

• Benzodiazepines

• Z-drugs (such as zolpidem/Ambien and zopiclone)

• Gabapentinoids

• Other psychiatric medications associated with physiological dependence and withdrawal syndromes

The guidelines acknowledge several realities that were historically underrecognized:

• Withdrawal symptoms can sometimes be severe and prolonged

• Withdrawal may be mistaken for relapse

• Some individuals require very gradual tapering schedules

• Nervous system sensitization varies greatly from person to person

• One-size-fits-all tapering approaches may increase risk of destabilization

Importantly, these guidelines are not anti-medication.

Rather, they represent an effort to improve informed consent, reduce iatrogenic harm, and support safer prescribing and deprescribing practices through more individualized, nervous system-informed care.

🧠 Dependence vs. Addiction vs. Tolerance vs. Misuse vs. Abuse

Language matters.

Many individuals experiencing psychiatric medication withdrawal are inaccurately labeled as “addicted” when their experience is more accurately described as physiological dependence.

Dependence

The body adapts to a medication, and withdrawal symptoms emerge if the medication is reduced or stopped. This can occur during entirely appropriate, prescribed use.

Addiction

Addiction involves compulsive use, craving, behavioral dysregulation, and continued use despite harmful consequences.

Most long-term psychiatric medication users do not meet criteria for addiction. Many clients are criticized and labeled by the very providers that prescribed the medication in the first place, that they are “addicted,” which is erroneous, harmful, and leaves someone with not only wrong information, but without appropriate resources.

Tolerance

Tolerance is a neuroadaptive process in which increasing doses are required to achieve the same therapeutic effect.

Misuse

Misuse refers to taking medication outside prescribed parameters.

Abuse

Abuse involves harmful or hazardous patterns of use that contribute to impairment or risk.

🧠 Myth vs. Clinical Nuance: Addiction, Dependence, and Withdrawal

Myth:
If a medication causes withdrawal symptoms, it must be addictive.

Clinical nuance:
Withdrawal, physiological dependence, and addiction are distinct processes. They overlap in public conversation, but they are not interchangeable in clinical practice or neuroscience.

💊 Antidepressants (SSRIs, SNRIs, etc.)

• Not considered addictive in the clinical sense

• Do not typically produce craving, euphoria, or compulsive drug-seeking behavior

• However, they can produce physiological dependence through receptor adaptation

• Discontinuation may lead to withdrawal symptoms due to neuroadaptation (including serotonin receptor downregulation and nervous system recalibration)

💊 Benzodiazepines

• Can produce both physiological dependence and addiction-like patterns in a small subset of users

• Large epidemiological data suggest low rates of formal use disorder among prescribed users (~1–2%) (Blanco et al., 2018)

• However, even without addiction, benzodiazepines are strongly associated with tolerance and withdrawal due to GABA-A receptor downregulation

• Risk increases with duration of use, dosage, and rate of taper

⚠️ Key shared mechanism across medication classes

Regardless of addiction status, many psychiatric medications can lead to:

• Receptor downregulation or altered receptor sensitivity

• Neuroadaptive changes in neurotransmitter systems (e.g., serotonin, GABA, glutamate)

• Tolerance (reduced effect over time at the same dose)

• Withdrawal symptoms when dose is reduced or discontinued

• In some cases, prolonged or severe nervous system dysregulation during tapering or discontinuation

These processes reflect physiological adaptation, not characterological weakness or behavioral addiction.

📊 Epidemiological context

Large U.S. population data indicate that approximately 1–2% of individuals prescribed benzodiazepines meet criteria for a substance use disorder, while misuse rates are higher but still represent a minority of users (Blanco et al., 2018). These figures highlight that addiction is not the predominant outcome in prescribed populations, even though physiological dependence and withdrawal effects are more common and clinically significant than once assumed.

🌱 Why Psychotherapy Matters in Psychiatric Medication Tapering

Recent research and clinical deprescribing literature consistently indicate that antidepressant discontinuation outcomes improve when slow tapering is combined with psychological support.

A recent meta-analytic review reported in The Lancet Psychiatry (December 2025 coverage in secondary medical summaries) found that, across data from over 17,000 adults, gradual tapering supported by therapy is associated with better outcomes than tapering alone in reducing the return of symptoms for which the medication was originally prescribed and improving tolerability during discontinuation.

Across studies and clinical guidelines, slower tapering schedules combined with psychological support are associated with fewer and less severe withdrawal effects compared to rapid or unsupported discontinuation. These combined approaches also tend to produce better overall outcomes than medication reduction alone.

Psychotherapy in this context can include validation, education, emotional support, and practical coping skills for daily life. It may also involve mind-body regulation strategies, thought-based coping tools, and exploration of how past experiences may influence current coping patterns and relationships.

This does not suggest that psychiatric medications are always inherently harmful or unnecessary. Rather, it highlights the importance of informed, collaborative, and holistic care that integrates medical oversight with psychological support.

For therapists, this emphasizes the value of being educated in medication tapering and withdrawal phenomena so they can better support clients during these transitions.

For individuals considering tapering, it may also be helpful to reflect on whether structured therapeutic support or an experienced taper support coach could be beneficial during the process.

🧰 What Therapists Can and Can’t Do

Therapists are not prescribers and should not give medical advice about medication changes. However, they play an important role in emotional support, psychoeducation, nervous system stabilization, and coordinated care.

Therapists Can:

• Learn about withdrawal, iatrogenic injury, and medication-related nervous system changes
• Educate themselves and support informed discussion with clients and prescribers
• Validate lived experience without premature pathologizing
• Support nervous system regulation, pacing, and stabilization
• Use trauma-informed and somatic approaches within scope
• Collaborate with prescribers (with consent)
• Share education and resources when appropriate
• Help clients separate physiological symptoms from shame-based interpretations
• Support containment and grounding during high distress or increased suicidal ideation

Therapists Should Avoid:

• Labeling withdrawal or medication effects as relapse by default
• Assuming symptoms are purely psychological
• Minimizing physical or neurological symptoms
• Over-relying on cognitive reframing while ignoring physiology
• Ignoring medication or taper-related contributions to symptoms
• Encouraging medication changes outside prescriber scope
• Dismissing sensitivity to medications, supplements, or stimuli
• Over-pathologizing distress without considering multiple contributing factors

🧩 In Closing

Supporting clients through psychiatric medication withdrawal, especially when iatrogenic harm may be involved, requires humility, curiosity, compassion, and a nervous system-informed lens.

Therapists do not need to have all the answers. But we do need to remain open to emerging research, validate our clients’ experiences, and help connect people to safe, informed support.

By deepening our understanding of medication-related injury, neuroadaptation, withdrawal physiology, and trauma-informed care, we can help reduce harm and better support individuals navigating one of the most misunderstood experiences in modern mental health care.

📚 Psychiatric Medication Deprescribing & Withdrawal Resource Library

This is a curated, non-exhaustive list of clinical, research, and lived-experience resources related to psychiatric medication tapering, withdrawal, and deprescribing. Inclusion does not imply affiliation or endorsement.

🏥 Clinical & Tapering Support Services

The Ashton Manual
Benzodiazepine withdrawal guidance manual developed by Professor Heather Ashton.
https://www.benzoinfo.com/ashtonmanual

Benzodiazepine Information Coalition
Educational and advocacy organization focused on benzodiazepine risks, withdrawal, and informed consent.
https://www.benzoinfo.com

Inner Compass Initiative / The Withdrawal Project
Peer-led educational platform and support resource for psychiatric medication withdrawal.
https://www.theinnercompass.org

Outro Health
Clinical tapering service providing structured deprescribing support for psychiatric medications.
https://www.outro.com

SafeTaper
Clinically informed resource focused on gradual psychiatric medication tapering and withdrawal support.
https://www.safetaper.org

TaperClinic
Clinician-informed services and educational resources focused on psychiatric medication tapering and withdrawal support. https://www.taperclinic.com

True You Psychiatry
Psychiatric practice offering deprescribing support, including individualized tapering strategies and withdrawal-informed clinical care. https://www.trueyoupsychiatry.com

🧠 Advocacy, Education & Research Platforms

Mad in America
Independent platform focused on critical psychiatry research, lived experience perspectives, and medication harm awareness.
https://www.madinamerica.com

National Institute on Drug Abuse (NIDA)
U.S. federal research institute providing definitions and data on addiction, dependence, and substance use science.
https://nida.nih.gov

🧪 Peer-Reviewed Research

Cipriani, A., et al. (2018). The Lancet
Network meta-analysis of antidepressant efficacy in major depressive disorder.

Davies, J., & Read, J. (2019). Addictive Behaviors
Systematic review of antidepressant withdrawal incidence, severity, and duration.

Horowitz, M. A., & Taylor, D. (2019). The Lancet Psychiatry
Introduction of hyperbolic tapering model for SSRIs to reduce withdrawal risk.

Hengartner, M. P. (2020). Therapeutic Advances in Psychopharmacology
Critical review of long-term antidepressant effectiveness and withdrawal confounding in relapse studies.

Lader, M. (2011–2014).
Clinical reviews on benzodiazepine dependence, tolerance, and long-term risk profiles.

Blanco, C., et al. (2018). Journal of Clinical Psychiatry
Epidemiology of benzodiazepine use, misuse, and use disorder in U.S. adults.

Horowitz, M. A., Taylor, D., & Mangin, D. (2024).
The Maudsley Deprescribing Guidelines (Wiley-Blackwell).
Evidence-based guidance for tapering antidepressants, benzodiazepines, gabapentinoids, and Z-drugs.

Cosci, F., et al. (2025). The American Journal of Medicine
Analysis of antidepressant trial duration compared to real-world use patterns.

📖 Practitioner & Patient-Facing Literature

Sørensen, A. (2024). The Why of Withdrawal
Explores antidepressant and antipsychotic withdrawal phenomena and symptom persistence. (Fri Forlag)

Disclaimer

While I am not a medical doctor or prescriber, this article reflects my professional experience as a therapist and my own extensive research on this topic.

This article is not intended to serve as medical advice.

Always consult with a qualified medical provider before making changes to psychiatric medications.

If you are in California and would like to receive therapy support focused on coping during a medication taper, or if you are outside of California and seeking emotional support or skills coaching during a medication taper, you can learn more on my website: www.cecilylongotherapy.com

If you spend any time online in the personal development or mental health space, you’ve probably seen it.

Coaches criticizing therapists.
Therapists criticizing coaches.
Everyone insisting the other profession is the problem.

At this point, it can start to feel less like a thoughtful discussion and more like a professional turf war playing out on social media.

Meanwhile, the people looking for help are left trying to sort through the noise, wondering who to trust.

The reality is far less dramatic than the internet makes it seem. Therapy and coaching are different professions with different roles, training paths, and legal boundaries. Those distinctions matter.

But the professional therapist or coach bashing back and forth doesn’t protect clients, elevate professionalism, or improve either field.

If anything, it mostly makes the people doing the bashing look… a little unprofessional. And maybe it’s time we talked about that. ✨

A Note About Ethics and Scope

Before going further, I want to be clear about something that matters a lot in both professions: scope of practice.

Therapy and coaching exist within very different professional frameworks, and those boundaries are important. Ethical practice means being honest about what services you provide, what training you have, and when a client might benefit from a different kind of support.

Protecting clients should always come before protecting professional egos—or winning arguments on the internet.

A Quick Note About My Perspective

For transparency, I’m writing this from the perspective of a licensed therapist. I also provide coaching in a separate context, and I’m very intentional about keeping those roles distinct.

Therapy and coaching serve different purposes and operate under different professional expectations, and keeping those boundaries clear protects both clients and professionals.

I wrote this piece because, in my work offering both services under distinct circumstances, I’ve noticed a lot of content, and mainly in coaching spaces on social media, where coaches engage in therapy-bashing or spread misinformation about the therapy profession, sometimes even using it as a marketing tactic.

Frankly, I find this unprofessional and sometimes offensive. This behavior does clients and content consumers a disservice. It goes both ways—similar behavior exists in the therapy field as well—but I find this issue important enough to set the record straight from my perspective as someone who practices in both spaces and values clarity, ethics, and collaboration.

Therapy and Coaching Are Not the Same Thing

Therapy and coaching serve different purposes.

Therapy is a licensed healthcare profession focused on diagnosing and treating mental health conditions. Therapists complete graduate-level education, thousands of supervised hours, and are accountable to licensing boards and ethical standards.

Coaching typically focuses on goal-setting, accountability, performance, personal growth, and forward movement in life. Coaches do not diagnose or treat mental health conditions.

Both can be valuable—but they are not interchangeable.

A Brief Note About Legal Distinctions

I’m not a legal expert, and laws vary by state and country. Professionals should consult their licensing board or legal advisor for guidance specific to their situation.

Another reason the therapy vs. coaching conversation can be confusing is that the two professions operate under very different legal structures.

Licensed therapists are regulated healthcare providers. Their work is governed by state licensing boards, professional ethical codes, and legal standards related to diagnosing and treating mental health conditions.

Coaching is generally considered part of the personal development industry and is not regulated in the same way. Coaches focus on goal-setting, accountability, and personal growth rather than diagnosing or treating mental health conditions.

Therapists who ethically offer coaching services usually separate them carefully from their therapy practice to maintain clear boundaries around scope of practice.

Clear boundaries between professions aren’t about competition, but they are about protecting the people seeking help.

Why the Professions Sometimes Clash

Some therapists worry about consumer protection because coaching is largely unregulated. Technically, anyone can call themselves a coach regardless of training.

Some coaches feel dismissed or misunderstood by therapists who assume coaching lacks value.

Both perspectives contain some truth, but neither justifies broad attacks on an entire profession.

Every field has excellent professionals and poor ones: therapy does, coaching does, medicine does, law does.

One bad experience doesn’t define an entire profession.

When Criticism Isn’t Based in Fact

Some criticism of therapy (or coaching) is rooted in personal experiences that are then generalized to an entire profession. Most people have stories—some wonderful, some painful. As a therapist, I hear these stories every day. Previous professionals—therapists, coaches, doctors, lawyers—have sometimes caused real harm, and sometimes helped tremendously.

What needs to stop is bashing an entire profession based on unresolved frustration or misunderstanding. It harms clients, spreads misinformation, and undermines professionalism.

When Coaching Borrows From Therapy

Another piece of this conversation that doesn’t get discussed enough is how often coaching borrows ideas and frameworks from psychotherapy.

Many concepts widely used in coaching originated in psychological research and therapeutic models. That’s not inherently a bad thing—in fact, it can be positive that helpful ideas reach more people.

But it raises a question: if coaching regularly draws from therapeutic frameworks, why is therapy sometimes portrayed as the problem?

It’s a strange dynamic to watch a profession be criticized while many of its foundational ideas are simultaneously being adopted.

The Complicated Reality of Advanced Trainings

Certain therapeutic approaches, such Internal Family Systems or couples therapy methods developed by the Gottman Institute, typically require extensive clinical training and experience for therapists to apply responsibly.

At the same time, some of these institutes offer training pathways that are also open to coaches.

I find this genuinely fascinating.

On one hand, this can increase access. There are people who, for a variety of reasons, such as stigma, prior negative experiences, or personal beliefs, may never seek out therapy but are open to working with a coach. In that sense, having more broadly trained coaches could help more people receive some level of support.

On the other hand, many of these approaches and others often discussed in the coaching space, such as somatic or trauma-informed interventions—can involve complex emotional and psychological processes. Some methods, like brain-based or somatic trauma approaches, are often considered more advanced and require a strong clinical foundation to use safely and ethically.

This is where I start to have questions.

Therapists spend years developing core clinical skills: diagnosing and treating mental health issues, assessing risk, navigating trauma responses, managing ethical dilemmas, maintaining accurate documentation, and handling unexpected or challenging situations. This expertise comes from extensive training, supervision, and hands-on experience—and the learning never stops throughout a therapist’s career.

We also have systems in place to support this work:

• Licensing boards

• Ethical standards

• Clinical consultation

• Liability coverage

• Formal accountability processes

Those structures exist for a reason.

Coaches don’t typically operate within the same regulatory framework, yet some are accessing advanced trainings that draw from these deeper therapeutic models.

Again, I don’t say this as a criticism. I say it because I find it genuinely interesting and, at times, a bit confusing.

There aren’t many other professions where someone without the foundational education or licensure can take an advanced-level training and then offer services based upon the advance training.

For example, when speaking of trauma treatments, which require advanced skills, years of experience, and supervision, EMDR, for example, requires licensure. In contrast, somatic experiencing and brainspotting, which is an offshoot of EMDR and designed to treat the most severe impacts of trauma, do not require licensure.

While I am not suggesting that coaches shouldn’t pursue these trainings and help people, I do think this adds to confusion about the differences between the two professions’ scopes of practice and can make it difficult for inexperienced individuals to accurately estimate the safety of delivering advanced-level trauma treatments without the foundational background.

For example:

• If I’m not a physician, I can’t take a course in cardiac surgery and call myself a cardiac valve replacement coach.

• If I’m not a licensed medical provider, I can’t take a class in injectables and start offering Botox services as an “aesthetic rejuvenation coach.”

• If I am not a licensed attorney, I can’t just take a few classes in contract law and start offering legal services as a “contract coach.”

Yet in the mental health and personal development space, the lines can be much less clear.

I don’t have a perfect answer for why that is—but I do think it contributes to some of the confusion, and at times, to the assumption that more advanced psychological work can be done without the same level of foundational training.

At the same time, none of this means the professions have to be in opposition.

In fact, I think there is a lot of potential for them to complement each other—especially when people are clear about their scope, operate ethically, and respect the different roles each profession plays.

That’s particularly important for professionals like myself who engage in both spaces, offering psychotherapy and coaching in ways that are clearly defined, legally sound, and ethically grounded.

Presenting Coaching Without Minimizing Therapy

Coaching has many legitimate strengths, and there are plenty of ways to highlight its value without diminishing other professions. A constructive approach includes:

• Focus on your strengths – Clearly communicate what you do well and the unique benefits you offer.

• Clarify your scope of practice – Make it clear what coaching can provide and where clients might need additional support.

• Invest in training and professionalism – Continuous learning and ethical practice build credibility.

• Collaborate when appropriate – Working with other professionals can enhance client outcomes and create mutual respect.

Professionals who truly trust the value of their work rarely need to make another field look bad in order to make theirs look good. Highlight your expertise, stay in your lane, and let your work speak for itself.

Red Flags to Watch For in Therapy or Coaching

🚩 Bashing another profession – Speaking negatively about other fields is unprofessional and may indicate a lack of critical thinking.
🚩 Promising quick fixes or guaranteed outcomes – Real change takes time; any claim of certainty should be approached cautiously.
🚩 Working outside their scope – Offering services beyond their training or credentials can be risky for clients.
🚩 Discouraging other support – A good provider encourages collaboration and appropriate referrals when needed.
🚩 Pressuring, shaming, or manipulating clients – Any coercive behavior is a serious red flag.

One red flag alone isn’t necessarily a deal-breaker, but it’s often a signal to ask questions and explore the provider’s experience, training, and approach before moving forward.

You—The Client—Are In Charge

Remember this:

• You decide who you’re paying.

• You decide where your insurance co-pays go.

• You decide who you trust to guide you.

Listen to yourself. Trust your instincts. If something doesn’t feel right, keep looking until you find someone who does. Choosing who supports you is one of the most important decisions you’ll make—so own it with confidence.

Therapy vs Coaching vs Both: A Quick Guide

If you’re dealing with a diagnosed mental health condition, therapy may be the best fit. This includes conditions like depression, anxiety disorders, trauma-related disorders, or other clinically recognized mental health concerns.

If your focus is on career goals, life direction, accountability, or habit-building, coaching may be most helpful. Coaches can provide guidance, structure, and support to help you achieve personal or professional goals.

Some situations may benefit from both therapy and coaching. For example, unresolved trauma, relationship conflicts, or personal growth and self-development can often be supported by a combination of therapy and coaching, depending on the client’s needs and the provider’s scope of practice.

Other examples:

• Emotional regulation or psychological distress: Therapy is typically best.

• Personal growth and self-development: Both therapy and coaching can support this, depending on your goals and the methods used.

• Relationship conflict or couples issues: Therapy is often primary, but coaching may complement therapeutic support in certain contexts.

The goal isn’t to rank one profession above the other—it’s about matching your needs with the right support in a safe, ethical, and competent way.

Maybe the Real Question Isn’t Who Is Better

The real question isn’t whether coaching is better than therapy, or therapy is better than coaching.

The real question is whether the person offering help understands their scope of practice, respects other professions, and is committed to acting in the best interest of the people they serve.

Because clients aren’t looking for a profession to win an argument. They’re looking for someone competent, ethical, and trustworthy.

Professionals who truly trust the value of their work rarely need another profession to look bad in order for theirs to look good. 🎯

Your focus should be on finding someone who helps you thrive! No profession needs to “win” for you to succeed. 💜🏆

Disclaimer
I am a licensed Marriage and Family Therapist in the state of California, but I am not a medical doctor or prescriber. This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment, and it does not establish a patient-provider relationship. Always consult a qualified healthcare provider with any questions regarding your health or medical condition.

Content Note (Do not read if you are sensitive to emotionally charged topics)

This article discusses sexual coercion, psychological abuse, trauma bonds, and institutional betrayal as portrayed in Tell Me Lies. Some readers may find these topics triggering. Please read at your own pace and seek support if needed.

This is not just another pop-culture recap. Tell Me Lies hit me differently. When I started this Substack, the Love Island blog marked the birth of this space, a place where pop culture meets the deeper realities of human behavior.

Here, I write about the things that spontaneously or continuously emerge in life and in therapy sessions with clients. I work with many people navigating the aftermath of draining, exhausting, and abusive relationships, often at the hands of manipulative, narcissistic, or otherwise challenging individuals.

For those unfamiliar, Tell Me Lies follows Lucy Albright, a college freshman who becomes entangled in a years-long, psychologically destabilizing relationship with Stephen DeMarco, a charming, strategic, and emotionally manipulative character.

The series unfolds across timelines, beginning in the aftermath of a mysterious car crash involving one of Stephen’s other romantic entanglements.

What starts as immediate chemistry between Stephen and Lucy slowly reveals the relationship’s cycles of deception, coercion, rivalry, and emotional erosion that ripple through friendships and years of their lives.

Tell Me Lies intersects with nearly every theme I explore with clients in weekly therapy sessions: understanding and managing antagonistic and manipulative personalities, toxic and challenging relationship dynamics, the ways we betray ourselves to survive, and, most importantly, how to move through the fallout and heal.

Quick TL;DR

Tell Me Lies reveals how charm, manipulation, and trauma bonds entrap people in toxic relationships. This piece unpacks the psychology behind the pull, the social forces that reinforce it, and what healing and reclaiming your identity can look like.

Through the relationships in Tell Me Lies, this article explores:

• Why we get hooked as viewers
• What trauma bonds are, and what they are not
• Why trauma bonds are so hard to break
• How cognitive dissonance keeps people attached to destructive relationships
• Where Stephen likely falls on the narcissistic to antisocial spectrum
• How these dynamics distort friendships and romance
• Misogyny and institutional betrayal in college culture
• What healing and identity reclamation look like

This article is not a clinical diagnosis of the characters, nor a full review of personality disorders. It examines the psychological themes depicted in the series. For deeper clinical exploration, see the resources at the end of the article.

This article is not an analysis of every relationship or every facet of each dynamic in the show, as that would mean the article would be longer than a college semester.

This article is a deep dive into messy human behavior, trauma bonds, and the broader social context, along with very intense TV. Proceed if you dare—and maybe grab a snack and your favorite drink. 🍿

Before We Go Further: Trauma Bonds and Cognitive Dissonance

In order to truly understand what Lucy, and even friends entangled with Stephen, are experiencing, it is important to define two key psychological dynamics: trauma bonds and cognitive dissonance.

Trauma bonds form through cycles of manipulation, intermittent reinforcement, gaslighting (when someone else’s chronic distortion of reality is so persistent that you begin doubting your own perceptions), emotional highs and lows, uncertainty, and chronic self-doubt.

These patterns hijack the nervous system. The good moments create a neurochemical bath of dopamine, just like hitting the jackpot on a Vegas slot machine, and this feels intoxicating and energizing, and keeps you going back for more of that burst of feeling great.

Over time, the nervous system becomes hooked, chasing that relief again and again, even when the relationship is harmful, and even (or especially) the lows become even more devastating.

While some might call this addiction, it is also basic human biology. Anyone can be prone to it, and awareness is the first step toward identifying and working through a trauma bond or any unhealthy relationship dynamic where intermittent reinforcement is present.

As this cycle repeats, cognitive dissonance emerges. Psychologist and narcissistic abuse expert Dr. Peter Salerno (see resources at end of article) distinguishes between ordinary cognitive dissonance and what survivors of coercive or narcissistic abuse often experience, something he calls traumatic cognitive dissonance.

Ordinary cognitive dissonance is naturally occurring internal conflict:

-Part of me really needs to eat vegetables because I know it is good for me, but I will start tomorrow.
-I say I want to quit smoking, I really shouldn’t do this, but I keep lighting up.

There is tension, but reality remains intact.

Traumatic cognitive dissonance is relationally created. It arises when another person’s chronic manipulation, abuse, or gaslighting makes you doubt your own perceptions, memory, and instincts. It is not just an internal conflict. It is the erosion of trust in yourself, caused by someone else’s harmful treatment over time.

This distinction is crucial when watching the show and understanding Lucy’s patterns and her unraveling mental health while maintaining empathy for her.

Cortisol in a Trenchcoat: Why We Cannot Look Away

There is something about Stephen. You are repulsed but also drawn to him, sometimes out of curiosity, sometimes disgust, and sometimes to fuel your hope that he is not that bad. That pull may not be about labeling him, but about his impact on the people around him and the frustratingly counterintuitive, yet overwhelmingly relatable, ways they respond.

Lucy and Dianna’s trauma bonds with Stephen can be difficult to watch and impossible to stop thinking about. They rationalize harmful behavior and sometimes gaslight themselves just to preserve the illusion of connection. What looks from the outside like “Why doesn’t she just leave?” is psychologically far more complex.

Even viewers who have experienced similar dynamics in their own relationships may still struggle to understand how Lucy continues to return to Stephen as the psychological manipulation escalates and her sense of self unravels. This pattern is the hallmark of trauma bonding.

Part of why the series is so gripping is that viewers are pulled into the same nervous system rollercoaster. They experience the highs and lows alongside Lucy. They root for her. They feel confused. They feel angry. They may even judge her while simultaneously recognizing pieces of themselves in her.

That emotional tension is not accidental. It is the psychology of trauma bonds playing out in real time.

What is Toxically Twisted Can Feel Oddly Refreshing

People watch Tell Me Lies because it mirrors something real. The show does not create drama for spectacle; it reflects dynamics that exist in real life. “That was me once,” “This is like my relationship now,” or “He is just like someone I know,” viewers might think.

We see ourselves in Lucy or Dianna. We empathize with choices that feel wrong but understandable. We get mad at the characters and at parts of ourselves but also feel validated. Even when outcomes are bad, suspense, intermittent reinforcement, and uncertainty pull viewers forward, much like trauma bonds operate in real life.

Different Backgrounds, Different Responses

Lucy and Dianna’s childhoods may help explain why they ultimately respond so differently to Stephen, though human behavior rarely fits neatly into boxes. Lucy’s history of parental neglect and chronic invalidation may leave her more vulnerable to manipulation. Repeated invalidation can make someone internalize trauma, struggle with boundaries, and unconsciously adopt survival strategies in coercive relationships. It is not as simple as low self-esteem.

Looking at Lucy’s history alongside Stephen’s, and even considering his sister, shows how genetics and biology play a strong role in personality development and traits.

Trauma and parental neglect alone are not sufficient to produce a person with manipulative, grandiose, or exploitative tendencies. Lucy shares a relationally traumatic background with Stephen but is not psychopathic; her patterns are learned responses to long-term exposure, not innate personality pathology.

Dianna, meanwhile, may have experienced pressure to be perfect from her father, but she seems to have a more solid sense of self. That internal structure helps her navigate Stephen’s manipulations and break free from the toxic dynamic well before Lucy. She even counsels her mother on managing her father’s controlling behavior, showing reflection, strategy, and a sense of healthy boundaries.

Both women are shaped by their histories, but their responses illustrate a spectrum of human resilience. Lucy’s strategies are survival-oriented in a toxic environment, while Dianna’s approach, when she beats Stephen at his game, reflects a stronger internal sense of self and autonomy.

Why Stephen Is Drawn to Lucy and Dianna

Narcissistic personalities are not always drawn to people who appear easy to manipulate. Many are attracted to strength, status, intelligence, or even challenge. The pursuit itself can be energizing. Being associated with someone accomplished or admired enhances their own image.

Dianna embodies competence and social capital. She is intelligent, strategic, and socially positioned in ways that elevate Stephen by proximity. Her strength reflects well on him and reinforces his self-concept.

But when Dianna strategically withholds that strength in order to free herself from his manipulation, something shifts. As she becomes less admiring and less useful to his self-image, his interest fades. This illustrates an important narcissistic trait. Relationships are often evaluated through utility. These personalities experience others as a means to an end, a tool to be used and put back on the shelf once the person has served their purpose.

• Admiration maintains attachment

• Challenge can be stimulating

• Status can be instrumental, validating their own sense of self

• When usefulness diminishes, emotional investment often declines

Lucy, by contrast, offers emotional intensity and devotion, and endless validation to Stephen, no matter how terribly he treats her. Where Dianna reflects status and strength, Lucy reflects longing and vulnerability. Both serve different psychological purposes. Neither connection is rooted in mutual love or respect.

Why Are People Attracted to Narcissistic Personalities?

Once we examine how Stephen operates, the next question naturally emerges: why do people fall for him or even like him ?

Charm, confidence, and charisma are universally attractive traits. Early intensity can feel like profound connection. The rapid closeness, the magnetic attention, the feeling of being uniquely chosen — these experiences activate powerful attachment responses.

Attraction to charismatic and destructive individuals is not always about anyone’s low self-esteem. Reducing Lucy to “codependent,” a label assigned to her frequently, or someone with “poor self-worth” also oversimplifies the dynamic.

In popular psychology, the term codependency is often thrown around like a whack-a-mole label for any unhealthy relationship dynamic. It is frequently applied to the person enduring manipulation or abuse, which can unintentionally shift attention away from the abuser’s behavior and onto the survivor’s poor coping strategies.

The concept originally described partners or family members managing or enabling addiction in another person, but over time it has expanded far beyond that context. Today, codependency is widely used in everyday language, though it is not a formal clinical diagnosis or term, and people use it to describe a wide variety of undesirable relationship dynamics.

While codependency often involves chronic self-abandonment and over-investing in others, prioritizing a sense of helpfulness at the expense of one’s own needs, trauma bonding arises differently.

Trauma bonds form through cycles of intensity, withdrawal, and emotional manipulation, creating attachments reinforced by highs, lows, and uncertainty. While these patterns can overlap with codependent behaviors, they are not the same.

In Tell Me Lies, most of the women and Stephen’s friends do not exhibit “just” longstanding patterns of codependency. They are primarily trauma bonded to Stephen, navigating a psychologically destabilizing relational pattern that draws them in despite their intelligence, autonomy, and insight.

Mislabeling these dynamics as simply codependency, due to the overuse and misuse of the word in pop psychology, risks implying only weakness or poor boundaries when being drawn to charm, intensity, or intermittent affection is often a basic human response. It reflects humanity, not pathology.

Misogyny, Hookup Culture, and Institutional Betrayal

Tell Me Lies reflects a truth that is uncomfortable. Society conditions women to tolerate behavior that harms them. Lucy questions herself constantly, Dianna rationalizes, and Bree gradually tolerates escalating emotional pain under Professor Oliver’s charm.

One of the hardest parts of the show for some viewers is watching Bree confront Oliver’s abuse of power and not be believed. Marianne, also a professor and married to Oliver, along with Oliver himself and the minor he exploits, all participate in gaslighting Bree. Her mother completely dismisses her as well. The institution fails to protect her, leaving her completely isolated, and Oliver gets away with continuing to engage in inappropriate relationships with students.

Survivors often face disbelief and social abandonment, which layers trauma upon trauma. Cognitive dissonance makes it easier to question the victim than to dismantle the charismatic abuser.

Stephen and Oliver do not create misogyny, but they benefit from it. Women and people socialized as female are taught to romanticize chemistry and intensity, interpret volatility as passion, and endure mistreatment as a measure of love.

When Stephen alternates between affection and cruelty, the question is rarely, “Why does he do this?” It is almost always, “Why does she stay?” That fact alone tells you almost everything you need to know.

Stephen and His Mom, But He Had a Bad Childhood?

Yes, Stephen’s mom is awful. Some viewers immediately think he is a narcissist because of her. But personality traits like narcissism and psychopathy are influenced by biology, temperament, and genetics.

Childhood adversity counts, but does not alone does determine how someone’s personality solidifies as an adult. Many people with difficult or even highly abusive parents do not develop these traits, and many with personality pathology did not experience extreme trauma.

Stephen shows traits of classic narcissism mixed with psychopathic tendencies. He is strategic, often emotionally flat, and pivots instead of imploding when challenged. Despite his grandiosity and need for constant admiration, he does not appear to fly into wildly dysregulated, nonsensical rages typical of classic narcissistic personality when presented with a boundary.

Even when we see the occasional flare of anger, he quickly and calculatedly adjusts his strategy to get what he wants- which is more psychopathic or sociopathic.

As a side note, as I aim for these blogs to be educational: The terms “psychopath” and “sociopath” are not formal clinical diagnoses. They describe traits linked to antisocial personality disorder, which itself doesn’t mean “antisocial” in the usual sense. It refers to behaviors that go against societal norms. Psychopaths tend to be calculated, remorseless, and emotionally flat, with science confirming reduced activity in the amygdala the fear-processing region of the brain. Sociopaths are, per current theory, more influenced by environment and show more emotional ups and downs. Psychopathy can be measured with the Hare Psychopathy Checklist, but there’s no equivalent for sociopathy. Stephen, anyone)

His behavior reflects entitled, manipulative, and exploitative patterns, all immersed in a bath of callous remorselessness, which are part of his enduring personality, rather than solely reactions to a bad childhood or deeper shame we do not get to witness.

Believing that all abusive behavior stems from childhood trauma can mislead you. It can make you over-empathize, justify harmful behavior, or stay stuck in toxic dynamics longer.

Biology and environment both shape personality, but neither do a great job excusing mistreating, manipulating, or abusing others.

Learning to recognize the difference between trauma responses and personality-driven manipulative behaviors can help the survivor better name the relational dynamics and begin to heal.

Friends, Bystanders, and Ripple Effects

People around manipulative individuals often get caught in secondary trauma bonds. Evan picks up tactics from exposure; Wrigley tolerates Stephen; Pippa however- sees clearly.

Trauma rarely isolates itself to one relationship. It spreads, tests loyalties, and exposes fragile support systems. Lucy’s enmeshment with Stephen and fallout with friends demonstrates these layered effects.

Inside the Friends of Stephen Sphere: Trauma Bonds and Learned Tactics

This is a mini-educational look at pathological personalities, such as narcissistic, antagonistic, and psychopathic individuals, trauma bonds, and how people connected to manipulative individuals are affected.

Dianna eventually recognizes these dynamics instinctively. She is observant, analytical, and understands Stephen’s patterns. Lucy struggles with her trauma bond years later, as seen in the hot tub scene at Bree’s wedding eight years after meeting Stephen. Cognitive dissonance keeps her trying to reconcile who she hoped Stephen could be with who he actually is. It is easy to hold hope for change when emotionally invested.

People around Stephen start noticing his behaviors. Lucy reacts with survival strategies, and Evan picks up a few manipulative habits from Stephen and advice from Oliver, who abuses his power over young women, including a minor. This does not make Evan a narcissist or psychopath.

Exposure to exploitative behavior can lead to learned tactics, but it does not erase agency. His story is a cautionary tale, and hopefully by season four (if there is one) he can course-correct before sliding further down the “I want to be more like a psychopath” rabbit hole.

Allies, Observers, and Bystanders: How Narcissistic and Coercive People Affect Others

Many people who are friends with narcissists or even dangerous, psychopathic individuals are on the “Kool-Aid,” so to speak, and stay by their side no matter what. Evan is one of these characters. While he notices Stephen’s deeper flaws, he also shows a disconnect and admires him, perhaps for his ability to succeed using charisma, charm, and manipulation to get what he wants.

Wrigley, although he sees Stephen’s flaws, also tolerates them, likely not wanting to view his friend as entirely bad, at least until the seasons progress. Other characters, like Pippa, see right through Stephen and want nothing to do with him from day one.

Those who enable and support the Stephens of the world are often caught in their own type of trauma bond, clouded by lack of knowledge, admiration, and slivers of hope that prevent them from seeing these people as truly harmful.

Bree is also turned off by Stephen for the entire series, but she provides examples of the same type of trauma bond, although much more short-lived, with the arrogant, coercive, but seemingly harmless Professor Oliver. He engages in a covert pattern of sexual involvement with younger students, likely driven by his entitlement and choice to abuse his power, for robust ego validation at the expense of harming female students.

Betrayal in Layers: Assault, Institutional Failure, and the Fracturing of Friendship

Lucy’s friendship with Pippa highlights how betrayal can cut deep and ripple outward. Enmeshed in a trauma bond with Stephen, Lucy confides in Pippa about the coerced tape—a fake confession she made to protect Pippa from her own assault—and also agrees with Stephen not to disclose her one-night relationship with Evan from the previous year. She seeks support and grounding after Pippa promises not to judge her for revealing a similar secret.

Instead, Pippa fails to advocate for her, judges her, and withholds her own truth about her past assault—a secret Lucy protected—leaving Lucy isolated and punished.

Viewers may feel anger at Pippa’s blind spots, yet her silence also reflects a harsh reality for survivors: fear of disbelief, shame, or retaliation often keeps them from coming forward.

This dynamic underscores the broader misogyny and pressures embedded in college culture, as discussed earlier as a core theme in this show.

Reminders, Learning Experiences, and Final Reflections

Watching Tell Me Lies is a reminder that human relationships are messy, complicated, and rarely fit neatly into categories. Not all harmful behavior comes from trauma, and not everyone exposed to manipulative people becomes manipulative themselves.

Trauma bonds, cognitive dissonance, and learned survival strategies interact in ways that can feel confusing, heartbreaking, and even mesmerizing. Recognizing these dynamics in yourself and others is not about judgment. It is about clarity, empowerment, and protecting your emotional well-being.

This show also reminds us that resilience comes in many forms. Some people break free quickly, guided by insight and self-reflection. Others take longer, carrying hope for change and grappling with the pull of attachment and love, even when it is misdirected.

When that last one percent of hope finally fades, alongside learning, support, and reflection, people can step into freedom, seeing their own strength and reclaiming their identity.

The Finale: Did the Bad Guy Win?

As the finale unfolds, viewers unravel alongside the characters. Many are frustrated watching Lucy reunite with Stephen yet again while rooting for Wrigley and Bree to escape the damage.

When Lucy gets into Stephen’s car years later, it feels like a regression. After everything, she goes back. Then he abandons her at a gas station.

And she laughs. And smiles, and laughs with the sun rising in the background.

It is not defeat. It feels like recognition. Years of shock, betrayal, and traumatic cognitive dissonance collapse into a moment of clarity. The illusion finally looks thin. The man who once felt powerful now looks predictable.

However, in many ways, Stephen still wins. He avoids accountability, never receiving consequences for Macy’s death, to the point where that storyline is completely dropped, and he will likely continue his destructive patterns of harming others, gaining followers, and burning bridges.

But Lucy’s laughter suggests something has shifted for her internally, and we hope for her own sake, it is forever. Sometimes that internal shift is where a trauma bond finally begins to break.

🎊A Celebratory Hats Off to the Crew and Actors — WOW!

Can we just pause and marvel at the writing, directing, and acting in Tell Me Lies? Every glance, pause, and subtle expression feels intentional and layered, pulling you straight into the chaos, tension, and heartbreak of these toxic dynamics. Stephen’s manipulative charm, Lucy’s inner struggle, and Dianna’s quiet clarity hit with emotional precision. Hats off to this cast. Their performances make the series an experience you do not just watch, but feel. WOW. ✨🎬🎊

Reflective Journal Prompts

1. When have you hoped someone would change despite evidence they might not? What patterns kept you invested?

2. Are there people in your life whose behaviors you may have unconsciously absorbed? How did that influence your own actions?

3. How do you notice cognitive dissonance showing up in your relationships, and what helps you see reality more clearly?

4. What strategies can you put in place to maintain healthy boundaries when interacting with entitled or manipulative people?

5. What about the characters drew you in, repulsed you, or compelled you to keep watching?

6. If you have a Stephen in your life currently, take a moment to reflect non-judgmentally on your own experience. What is working and what is not in the relationship now? What barriers prevent you from moving toward leaving or creating distance?

7. Reflect on a time when someone you trusted did not show up for you during a moment of vulnerability. How did that response shape your sense of safety or self-trust? In hindsight, how might fear, trauma, or social pressure have influenced their behavior?

Resources for Support and Further Learning

Note: I am not affiliated with any of these organizations or authors. These are provided purely as educational and support resources, and this list is in no way exhaustive.

Crisis and Abuse Hotlines

• National Domestic Violence Hotline (US): 1-800-799-SAFE (7233), thehotline.org

• RAINN (Rape, Abuse & Incest National Network, US): 1-800-656-HOPE (4673), rainn.org

• Crisis Text Line: Text HOME to 741741 (US & Canada)

• International Directory of Helplines:

https://findahelpline.com

Books and Reading on Narcissism, Personality Pathology, and Manipulative Relationships

• George Simon: In Sheep’s Clothing: Understanding and Dealing with Manipulative People

• Dr. Ramani Durvasula: Should I Stay or Should I Go? Surviving a Relationship with a Narcissist and her articles, YouTube, podcasts on narcissistic abuse

• Peter Salerno: Author of Nature and Nurture of Narcissism and Traumatic Cognitive Dissonance

• Bancroft, L. (2002). Why does he do that? Inside the minds of angry and controlling men. Putnam’s Sons.

YouTube and Online Educational Channels

• Lee Hammack – Mental Healness: https://www.youtube.com/@mentalhealness – insights on narcissism, trauma, and emotional recovery

• Lisa Sonni: https://www.youtube.com/@LisaSonni – videos on narcissistic abuse, trauma bonding, and recovery

Quick Disclaimer

This blog post is for educational and informational purposes only. It is not a substitute for professional therapy, legal advice, or crisis intervention. Reading this post does not establish a professional therapeutic relationship between us. While I am a licensed therapist in California, I am not your therapist. If you are in danger or in need of immediate support, contact local authorities or your preferred qualified professional. If you would like to work with me, contact me at www.cecilylongotherapy.com for a brief discovery call.

One of those themes is the great debate around privacy vs. secrecy and where, exactly, to draw the line.

People hold vastly different opinions about this, shaped by values, past experiences, and relational wounds. As a therapist who works with individuals and couples navigating difficult relationships, including those questioning whether a relationship has become unhealthy, controlling, or abusive, I see this confusion constantly.

Learning what counts as control, and deciding where you draw the line between privacy and secrecy, is ultimately personal. But what matters most is what clarifies rather than obscures, what builds safety rather than erodes it, especially at the level of the nervous system. Healthy relationships tend to support nervous system safety. Unhealthy ones quietly undermine it.

So let’s talk about privacy vs. secrecy and why the difference matters more than we often realize.

Before we get into the juicy and confusing gray areas, it helps to ground this conversation in something concrete. Because while privacy, secrecy, and control can feel abstract, most people actually understand the difference instinctively. However, the typical challenge is accessing the language for it.

The heart of this article includes these connected concepts:

· Secrets erode trust when they conceal harm or betrayal.

· Privacy is a normal, healthy boundary that allows a person to remain a person inside a relationship.

· When someone treats privacy as suspicious, or frames boundaries as betrayal, that is often a sign of control, not closeness.

How Do You Know Which One It Is?

Before you analyze the situation, try something simpler. Notice how it feels.

When you think about a boundary, or read it out loud, tune into your body. Do you feel tightening in your chest or stomach? A sense of dread or contraction? Or do you feel more relaxed, steady, or expansive?

Our nervous systems are often faster and more honest than our explanations. Green-light feelings tend to feel calm, grounded, and clear. Red-light feelings tend to feel tense, secretive, or braced. Yellow-Light feelings are typically a call for deeper inquiry.

Now, I invite you to read the following metaphors and notice what your body does.

Metaphors For Reflection

Privacy: closing the curtains at night.
Secrecy: boarding up the windows and saying, “What curtains? There are no windows here.”

Privacy: keeping your phone on silent during dinner.
Secrecy: hiding the second phone in your sock drawer.

Privacy: putting your diary in a drawer.
Secrecy: writing in invisible ink and swearing it doesn’t exist.

Privacy: a fence around your yard.
Secrecy: a trapdoor in your basement.

A Quick Reflection Guide: Privacy, Secrecy, or Control?

Spotting the Motivation

• Privacy (Healthy):

  • I want autonomy and space.

  • I’m protecting dignity or recharge time.

  • I plan to share when I’m ready.

• Secrecy (Red Flag):

  • I’m scared of judgment, conflict, or abandonment.

  • I know this would hurt my partner if discovered.

  • I’m covering tracks, not protecting my sense of self.

• Control (Toxic):

  • My partner demands total access (passwords, constant check-ins).

  • Boundaries (privacy, agency over personal space) are treated as betrayal.

  • I feel monitored, policed, or unsafe.

Quick Scenarios — What’s This?

Circle Privacy, Secrecy, or Control for each:

1. You keep a journal no one else reads.

2. You delete flirty texts with a coworker.

3. Your partner demands your phone passcode.

4. You go to therapy but don’t share every detail.

5. You say you’re “working late” when you’re really out for drinks because your partner flips out otherwise.

6. Your partner goes out 5 nights a week and calls it “independence.”

The Litmus Test

• Privacy = I feel calmer, respected, safe.

• Secrecy = I feel guilt, dread, or distance.

• Control = I feel erased, surveilled, or unsafe.

Bottom Line- Privacy Protects. Secrecy Corrodes. Control Destroys.

• Privacy (healthy): A journal you don’t share. A therapy session that stays in the room. A walk you take alone. Privacy gives relationships oxygen.

• Secrecy (red flag): Hiding texts, omitting hangouts, creating shadows where trust should live. Secrecy thrives on fear and shame. Secrets have the potential to harm. Privacy simply does not harm others.

• Control (toxic): Demanding passwords, location-tracking, punishing boundaries. Control shrinks both people until there’s no relationship left- just surveillance.

The Gray Zone: Where Arguments Usually Live

Most couples don’t fight about affairs or secret bank accounts. They disagree about mismatches in what “normal sharing” should look like.

Mismatch skit:

• Partner A: “Text me when you get there, when you order, and when you leave.”

• Partner B: “I’ll text you once when I get home safe.”

• Partner A: “So my feelings don’t matter?”

• Partner B: “So my autonomy doesn’t matter?”

Nobody’s wrong. Their rules just don’t match.

Fear-based secrecy skit:

• Partner A thinks: “If I tell them I grabbed drinks, they’ll yell at me. Better just say I worked late.”

• Partner B: “Long day?”

• Partner A: “Yeah, spreadsheets.”

That’s not cheating, but it is a sign the relationship may punish honesty.

Neglect skit:

• Partner A: “I’m out with coworkers again.”

• Partner B: “That’s the fourth night this week. When do I get time with you?”
  This isn’t secrecy. It’s disconnection.

More Gray Area - When Boundaries Are Weaponized

Boundaries are meant to protect dignity and safety. But in some relationships, the language of boundaries gets twisted and used as a tool for control.

One of the most damaging versions of this is the double standard. Privacy gets treated as betrayal, while secrecy gets excused as “just independence.” The rules quietly change depending on who is acting.

One person is expected to disclose everything, explain themselves, and stay transparent at all times. The other keeps information vague, withholds details, or claims privacy only when it benefits them. The result is predictable: one person walks on eggshells, while the other hides behind the loopholes.

When boundaries are used to protect one person’s comfort at the expense of another’s safety, they stop being boundaries and start becoming control.

What Do I Do About the Divide ?

First, name which situation you’re actually in.

Some conflicts around privacy and secrecy come from mismatched values, attachment needs, or unspoken expectations. Others come from power, control, or surveillance. The distinction matters, because the solutions are very different.

If It’s a Mismatch…

When the issue is a mismatch, the work is about understanding and rebuilding trust, not assigning blame.

This can look like different needs around communication, frequency of check-ins, or what feels like “normal” sharing. Neither person is necessarily wrong. They just may be operating from different assumptions about closeness and autonomy.

In these cases, couples therapy or relational work can be helpful when both people are willing to self-reflect, tolerate discomfort, and genuinely care about each other’s internal experience. The goal isn’t total transparency or total independence. It’s finding agreements that support emotional safety for both people.

When trust has been strained, repair is possible, but it requires honesty, accountability, and consistency over time.

If There Is Control or Surveillance…

When privacy language is being used to justify monitoring, coercion, intimidation, or punishment for having boundaries, the situation is different.

Research and clinical experience consistently show that couples therapy is not recommended when one partner is emotionally, psychologically, or physically abusive. In those dynamics, joint therapy often makes things worse, not better. The controlling, abusive, and/or exploitative partner may use the therapy space to gather information, shift blame, or reinforce power.

Couples therapy only is effective when there is enough capacity for empathy, accountability, collaboration, and genuine concern for the other person’s wellbeing. It does not work when the relationship itself is being used as a vehicle for control.

If this resonates, the most important next step is support, not negotiation. Resources, individual therapy, and safety-focused guidance are more appropriate than trying to “fix” the relationship dynamic together.

Reflection and Journal Prompts

Before trying to resolve anything with someone else, it helps to get clear with yourself. Our relationship to privacy and secrecy is often shaped by past relationships, family dynamics, and experiences where honesty either felt safe or came at a cost.

You might explore:

• How do you personally define privacy? What feels respectful and grounding to you?

• How do you define secrecy? Where does it start to feel uncomfortable or harmful?

• Do you notice confusion between the two in your relationships? Where did that confusion begin?

• Where have you experienced mismatches around communication, disclosure, or independence?

• How do you usually respond when a boundary you set is misunderstood or challenged?

• How comfortable are you communicating your needs around privacy and sharing to a partner or potential partner?

• How do these dynamics show up outside of romantic relationships, such as in friendships or at work?

• Can you recall an experience where navigating privacy and transparency went well? What made it work?

• Can you recall a time when it did not go well? What did you learn from it?

You might also notice what comes up in your body as you reflect. Clarity often feels settling. Confusion often feels tense or contracted, and both are useful information.

If this topic brings up strong reactions, you’re not doing it wrong. It usually means something important is being named.

The Takeaway

Mismatch asks for conversation, curiosity, and repair. Control demands protection, clarity, and support. Knowing which one you’re dealing with is not about labeling the other person involved. It’s about listening to what your nervous system has been telling you all along.

At the end of the day, this isn’t really a debate about phones, texts, passwords, bathroom doors, or diaries.

It’s a conversation about safety, trust, and whether a relationship allows you to remain a full person inside it.

-Privacy creates space to breathe.
-Secrecy creates distance when honesty no longer feels safe.
-Control erodes both.

Most conflicts live in the gray area, where expectations don’t line up and needs haven’t been clearly named yet. Those moments don’t mean something is broken. They mean something needs attention, language, and care.

The question isn’t whether your door is open or closed. It’s whether the rules around the door are mutual, fair, and rooted in respect.

A Brief Note on Support

If privacy is being punished, boundaries are being monitored, or control is showing up as surveillance or fear, support matters.

• National Domestic Violence Hotline (U.S.): 1-800-799-SAFE (7233) or text START to 88788

• 988 Suicide & Crisis Lifeline (U.S.): Call or text 988

Disclaimer
I am a licensed Marriage and Family Therapist in the state of California, but I am not a medical doctor or prescriber. This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment, and it does not establish a patient-provider relationship. Always consult a qualified healthcare provider with any questions regarding your health or medical condition.

That’s why I’ve trained in several methods over the years. Talk therapy—especially approaches focused on insight, education, and behavioral change—can be deeply effective. But for some clients, especially those who are more creative or less “wired” for verbal processing, other modes of exploration are needed.

I’m not an art therapist, but I am a lifelong creative and expressive-process enthusiast. A few years ago, I became certified in a technique called Tarotpy (don’t worry—it’s not what it sounds like).

Tarotpy, developed by Lauren Z. Schneider, is a client-centered, imagery-based technique that uses the visual richness of tarot, oracle, or symbolic cards to support reflection, emotional insight, and story-based exploration.

It has nothing to do with predicting the future or assigning “meanings” to cards. Instead, it invites clients to interact intuitively with the images—responding to what arises, what resonates, and what unfolds.

While this method may naturally attract people with a background in tarot, we are not working with what a card is “supposed to mean.” In fact, not having prior knowledge of tarot or symbolic systems can be an advantage. It allows the client to engage more openly with the imagery itself, without the filter of tradition. This opens space for intuitive collaboration and authentic reflection. We’re not concerned with what a card is “supposed to mean” according to a book, manual, or tradition—unless the client decides it does.

While the Tarotpy method itself isn’t rooted in Jungian theory, my approach draws from depth psychology and psychodynamic frameworks, integrating symbolism and story to help clients connect unconscious material to conscious insight.

After practicing this approach with clients for the past two years, I’ve witnessed session after session unfold in ways that are unexpectedly powerful—for both the client and for me. Images bypass defenses. They speak in layers. They bring the unconscious into the room.

Because this work blends creative processing, psychology, and symbolism—but is not fortune-telling—I refer to the sessions simply as Symbolic Imagery Sessions. We care about what each image evokes for you. And often, these seemingly simple choices lead to profound insight, emotional release, and transformation.

This article explores:

• What these sessions are and how they work

• The science behind why imagery activates emotional healing

• Why this approach aligns closely with art therapy, depth psychology, and Jungian theory

• And yes—a little bit about synchronicity, symbolism, and the unconscious

When people are struggling with anxiety, depression, or the aftereffects of trauma, they often say, “I don’t even know how to talk about it.” That’s not just a feeling—it’s backed by neuroscience. Under emotional distress, the parts of the brain responsible for language and logical processing can become disrupted. This makes it incredibly hard to articulate what’s happening inside.

But healing doesn’t always begin with words. Sometimes, it starts with an image.

In Symbolic Imagery Sessions, we use visual tools—often in the form of evocative, abstract, or archetypal image cards—to invite reflection, emotional insight, and meaningful conversation. These images aren’t about prediction or fortune-telling. They are a bridge between internal experience and external expression—a visual language that can reach places words can’t.

When we work with images—whether through visual art, symbolic cards, or metaphor—we’re not just “looking at pictures.” We’re accessing the language of the unconscious, the emotional body, and the storytelling mind.

This is the same territory explored in art therapy, where the goal isn’t to create art for aesthetic value, but to allow the process of image-making and image-responding to guide reflection and release.

Sometimes, yes, something almost magical happens. A client chooses an image that perfectly captures something they couldn’t put into words. They feel seen. An ah-ha moment is born. A shift begins.

That’s not fortune-telling. That’s synchronicity.

🎨 The Art Therapy Connection: Expression Before Explanation

Art therapy is based on the understanding that people often feel things before they can explain them. Trauma, anxiety, and emotional overwhelm can shut down the brain’s language centers—especially Broca’s area—making it hard to speak or even know what to say.

But the visual brain stays active. Symbol, image, and color can speak where words fail. Whether someone paints their own image or selects one from a deck, they are engaging the same therapeutic principle: letting the inner world become visible.

This is why symbolic card work fits so naturally within an art therapy-informed framework. The images are not prescriptive—they’re open-ended, abstract, and archetypal. They invite curiosity. They invite story.

🌀 Storytelling as Meaning-Making

When a client connects with an image, they often begin to tell a story—about the figure, the setting, or the symbol. And in that storytelling, something important happens: they begin to narrate themselves.

This is a core concept in trauma recovery and narrative therapy: we heal through the stories we are able to tell about ourselves. Symbolic images help us access those stories when they’re still unformed or buried.

Sometimes the story is simple: “This image feels like how I’ve been holding everything together.” Other times, it opens into memory, insight, and emotional release. The image becomes a bridge. The story becomes a step forward.

🌿 What Makes This Work Powerful

What I offer isn’t tarot. It’s not clinical art therapy either. But it draws deeply from both:

• From art therapy: the idea that visual processing and symbolic expression support emotional healing.

• From trauma and narrative therapy: the power of story, metaphor, and meaning-making.

• From creative practice: the wisdom of imagination and intuition.

• And from synchronicity: the idea that what we need often finds us when we are present and curious.

This is image-based reflection work. It’s grounded, intuitive, and centered on the belief that each person carries the insight they need—they just need a new way to access it.

🧠 The Unconscious on the Table: A Psychodynamic, Jungian Process

One of the most essential aspects of this work is that the client leads the process. There’s no fixed spread or rigid format. The layout, number of cards, titles (if any)—all of it is up to the client.

That freedom is part of the method. In each session, the unconscious is quite literally placed on the table—through images chosen in the moment, arranged however the client feels called. This mirrors core principles in depth psychology: letting material emerge in its own time, through symbol and metaphor.

Clients decide:

• How many cards to use

• Which images speak to them

• Whether to name the cards

• How to arrange them, or not

There’s no pressure to interpret, no push for insight. The story unfolds as the psyche allows. The image becomes a bridge between the conscious and unconscious, the known and the unknown. The client holds the reins, and the unconscious guides the terrain.

When Trauma Disrupts Language

Research shows that trauma and chronic stress can significantly affect the brain’s capacity for verbal expression. In particular, the Broca’s area—the region responsible for speech production—often goes “offline” during trauma or high emotional stress. At the same time, other areas of the brain, such as the amygdala (which processes threat) and the right hemisphere (which is more sensory and image-based), become more active.

This shift explains why many people find it difficult to talk about painful experiences. It’s often not intentional avoidance—it’s neurological. When the brain is in survival mode, it prioritizes fast, emotional, sensory information over analytical, verbal processing.

Safety First: When Images Activate Distress

While symbolic imagery can be powerful, it’s not always neutral. Some images—colors, symbols, shapes—can stir difficult memories or emotional responses, especially for clients with trauma histories.

That’s why a trauma-informed approach is essential. In sessions, we always:

• Let clients choose images at their own pace

• Invite them to set aside any image that feels uncomfortable

• Use grounding techniques if emotions become overwhelming

• Emphasize choice, agency, and collaboration throughout

The work is not about forcing breakthroughs. It’s about meeting the unconscious gently, and honoring the timing of what wants to be seen.

🧬 The Science of Creative Healing

Research strongly supports the power of image and symbol in therapeutic work:

• A 2016 study found that just 45 minutes of art-making significantly lowered cortisol levels, regardless of experience or skill (Kaimal et al., 2016).

• Neuroaesthetic research shows that viewing emotionally engaging images can activate reward systems and support emotional regulation (Zeki, 2009; Vessel et al., 2012).

• Symbolic and metaphor-based practices have long been used in psychology to help integrate fragmented or unconscious material (Van der Kolk, 2014).

Importantly, none of this requires artistic talent. The benefit comes through engagement, not execution.

The Brain on Art: A Different Kind of Activation

Engaging with art and images stimulates parts of the brain that are deeply connected to emotion, memory, and imagination. Functional MRI (fMRI) studies have shown that viewing or creating art activates the visual cortex, the default mode network (linked to self-reflection), and areas associated with emotional regulation.

In particular, symbolic or metaphorical images can help individuals make sense of experiences they haven’t yet put into words. The use of symbolism allows the mind to explore meaning safely—at a distance—without having to directly relive or explain the emotional content right away.

This is why expressive therapies like art therapy, sandplay, and symbolic imagery are gaining traction in clinical and coaching spaces. They’re not just “creative” activities—they’re neurologically grounded practices that can support emotional processing, insight, and healing.

✨ Where Synchronicity Comes In

We’ve all had moments when something unexpected feels just right—a song at the perfect time, or a message you didn’t know you needed. That’s synchronicity: a meaningful coincidence that resonates deeply.

This happens often in image-based work. A client picks a card at random and gasps: “This is exactly how I feel.”

We don’t need to explain it away. In therapeutic work, synchronicity isn’t mystical—it’s meaningful. It shows us that the unconscious speaks, if we’re willing to listen.

🌟 Final Thoughts: A Visual Language of Healing

Words are powerful. But sometimes, they come last.

When someone is overwhelmed, shut down, or disconnected from their emotions, starting with an image can open a doorway into understanding. Symbolic Imagery Sessions aren’t about diagnosis or prediction. They’re about creating space—safe, creative, and nonlinear—for something meaningful to emerge.

In a world obsessed with answers, sometimes the most profound shift comes when we allow an image to ask the question.

If you’re curious about Symbolic Imagery sessions or want to learn more about how visual tools can support emotional wellbeing, feel free to reach out via my website www.cecilylongotherapy.com, or explore the resources below.

🔍 References/ Reading / Resources

Kaimal, G., Ray, K., & Muniz, J. (2016). Reduction of cortisol levels and participants’ responses following art making. Art Therapy, 33(2), 74–80. https://doi.org/10.1080/07421656.2016.1166832

Malchiodi, C. A. (2015). Art therapy and the brain: An attempt to understand the underlying processes of art expression in therapy. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/arts-and-health/201512/art-therapy-and-the-brain

Schneider, L. Z. (2014). Tarotpy- It’s All in the Cards. CreateSpace Independent Publishing Platform.

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Vessel, E. A., Starr, G. G., & Rubin, N. (2012). The brain on art: Intense aesthetic experience activates the default mode network. Proceedings of the National Academy of Sciences, 109(28), 10446–10451. https://doi.org/10.1073/pnas.1207355110

Zeki, S. (2009). Neuroaesthetics: Neuroscientific theory and the experience of art. The British Journal of Aesthetics, 49(4), 371–385. https://doi.org/10.1093/aesthj/ayp040

This guide is written first and foremost for those navigating relationships with high-conflict, antagonistic individuals—what many people call “narcissistic relationships.” It may also be useful if you’ve noticed narcissistic traits in yourself and want a clearer understanding of how they show up.

About 70% of my clients come to therapy struggling with the fallout of these relationships—navigating abuse, confusion, and the exhaustion of trying to decode patterns that never seem to add up.

If you’ve ever left a contemptuous argument asking yourself:
“Wait… am I the narcissist?”

You’re not alone. Asking this question doesn’t make you a narcissist—it usually reflects the toll of being in a confusing, invalidating relationship that leaves you doubting yourself. In fact, the very act of pausing to reflect is a sign of awareness—and that awareness is a resource for healing, whatever your traits may be.

My focus here is on survivors, since that’s the population I work with most often. Still, the reflections draw from both clinical experience and the available research on narcissism.

The goal is clarity, not blame—to help you make sense of what’s happening in your relationships, and to know when support and healing are possible.

Another Article on Narcissism?! Why This Guide Is Different

Many resources about narcissism tend to lean one of two ways: they either shame and villainize people with traits, or they lean on pop psychology—well-intentioned but often watered down, minimizing the real harm survivors face.

This guide does neither. It blends:

• 🔍 Research and clinical debates on the “what” and “why” of narcissism

• 🧩 Clear, real-life examples of how traits show up in everyday relationships

• 💡 Practical healing tools and survivor-focused strategies—without blame or sugarcoating

Survivors will find clarity and recovery strategies. Those noticing traits in themselves will get context and self-reflection—without stigma.

📖 What the DSM Says (and Doesn’t Say)

The term “narcissist” gets tossed around so casually online that it’s lost much of its meaning. But in clinical and survivor contexts, it refers to real pathological dynamics—specific patterns of behavior that need to be distinguished from everyday pop-psychology soundbites for “selfish” or “disappointing.”

The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the handbook clinicians use to diagnose conditions like personality disorders. The DSM-5 (2013) criteria for Narcissistic Personality Disorder (NPD) require a pervasive pattern of grandiosity, need for admiration, and lack of empathy—beginning in early adulthood and present across contexts. To qualify, five (or more) of the following nine must be met:

1. Grandiose sense of self-importance (exaggerates achievements, expects recognition).

2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

3. Belief they are “special” and can only be understood by other special/high-status people.

4. Requires excessive admiration.

5. Sense of entitlement (expects especially favorable treatment).

6. Interpersonally exploitative (takes advantage of others for personal gain).

7. Lacks empathy (unwilling/unable to recognize others’ needs and feelings).

8. Often envious of others or believes others are envious of them.

9. Arrogant, haughty behaviors or attitudes.

👉 To meet diagnostic criteria, five of nine must be present consistently, and cause significant impairment in one or more areas of life- relationships, work, or overall functioning. That flexibility in criteria means two people could both qualify for NPD and look very different—there are nearly 260 possible combinations of traits that can add up to a diagnosis.

In 2022, the DSM-5-TR added clarity: narcissism often shows up as either grandiose/overt (arrogant, entitled, inflated) or vulnerable/covert (hypersensitive, shame-driven, unstable). Note- The DSM-5-TR (2022) is a text revision of the DSM-5, adding updated commentary and clarifications based on newer research.

As Kohut (1971), Kernberg (1975), and more recent researchers (Cain, Pincus, & Ansell, 2008; Pincus & Lukowitsky, 2010) have argued, narcissism takes many shapes, and the DSM captures only part of the story. Individuals involved with highly narcissistic people often notice covert or subtle behaviors that don’t appear neatly on the checklist.

📌 Traits in Real Life

Survivors of relationships with narcissistic, antagonist, or high conflict people rarely walk into therapy saying, ‘I think my partner meets five of nine DSM criteria.’ They talk about their lived experiences—feeling manipulated and confused by gaslighting, boundary violations, silent treatments—and the fallout. And that fallout is typically traumatic, leaving people anxious and questioning their own reality. Here are some examples of how these traits can play out on the day to day-

🌹 Love bombing → Overwhelming attention early on, whether through grand gestures or subtle mirroring of your passions. Rooted in grandiosity and endless validation-seeking, it’s designed to create fast attachment that later flips into withdrawal, criticism, or devaluation. After a discard phase, this cycle sometimes resurfaces in what survivors call hoovering—a return of affection and attention meant to pull you back in.

💔 Low empathy → Dismissing your struggles while demanding attention for theirs. When they do display empathy, there’s often a transactional or performative edge: “I’ll be present with you now (or appear to), so you’ll give me what I want later.” At its core, this reflects an inability—or unwillingness—to truly attune to others’ needs unless it benefits them. This lack of empathy often fuels their sense of entitlement: your role is to meet their needs, while theirs is to take without reciprocity.

🌙 Future faking → Painting vivid pictures of marriage, travel, or life plans that never happen. These promises create false hope and keep you emotionally invested, believing the relationship holds merit, even when actions consistently fail to match the words.

🥖 Breadcrumbing → Tossing small “crumbs” of affection—texts, compliments, or gestures—just enough to keep you hooked. This intermittent reinforcement makes it harder to leave the relationship, because you’re always waiting for the next crumb, and those crumbs start to feel like a five-star meal.

🚪 Boundary intolerance →Silent treatments, child-like rages, temper tantrums, disappearing acts, or stonewalling—when communication is withheld to destabilize the partner while giving the one enacting it a false sense of power and control. These behaviors are highly emotionally toxic and often show up when you assert independence, voice a need, or set a limit.

“Pushback” can also include gaslighting—denying or twisting your reality until you doubt yourself (expanded in the Survivor’s Triad below). To someone high in narcissistic traits, boundaries feel like an attack on their entitlement and grandiosity—so instead of respect, you’re met with punishment.

This often comes with a “victim stance” (a term common in pop psychology): suddenly you’re painted as selfish or ungrateful, while they recast themselves as the wounded party. What you’re witnessing is actually a way to deflect responsibility, avoid accountability and keep control- ultimately connected to the individual’s traits of grandiosity and/or entitlement.

💸 Exploitation → Endless demands on your resources—time, sex, finances—used only for their personal gain, with zero remorse for the impact on you. When you ask for reciprocity or basic respect, the response is often outrage, guilt-tripping, or withdrawal. The message is clear: you’re a means to an end—for their benefit, not yours. Exploitation is one of the most damaging dynamics, because it strips away mutuality. In survivor circles, this is often called being treated as “supply”: valued only as a resource to be used, rather than respected as a whole person.

🎭 The mask effect → Survivors often describe a “mask”: charming, charismatic, nice, and lovable in public, but spiteful, manipulative, vengeful, or abusive in private. Bancroft (2002) notes this dual persona leaves partners confused and isolated.

🌀 Chaos & inconsistency → Sudden flips between affection and hostility, rules that shift overnight, plans that collapse without explanation. These swings keep survivors in a constant state of anxiety, scanning for cues of what’s coming next.

These behavior/mood swings may often stem from emotional dysregulation and impulsivity—traits not specific to NPD but seen across the broader “Cluster B” group of personality disorders. While not part of the formal DSM criteria, they show up often enough in lived experience to be worth naming here. (I’ll be expanding on these overlaps in a longer guide I’m publishing soon on Gumroad, with more detail and practical tools.)

🎂 Holiday sabotage → Drama, crises, or tantrums—silent or explosive—that hijack special days. Survivors often describe dreading birthdays and holidays because joy is routinely overshadowed by conflict or chaos.

As Dr. Ramani Durvasula (2019) puts it: these behaviors erode self-worth and leave partners questioning reality, even without a formal NPD diagnosis. And it’s important to note: if you’ve had a partner or friend who displays just one of these behaviors—like breadcrumbing, for example—that alone doesn’t make them narcissistic. But if you’ve experienced several of these patterns together, your nervous system will likely register it as significant stress, anxiety, and trauma.

And the way out—if that’s the path you want to explore—begins with education and self-understanding. The first step is trying not to gaslight or dismiss yourself about how these behaviors affect you. Naming what’s happening is the foundation for clarity, boundaries, and eventual healing.

🧩 The Survivor’s Triad

So why do people stay in relationships that feel so destructive? Sometimes it’s logistical—shared children, finances, or social pressures. But even when those factors aren’t present, powerful emotional forces can make leaving feel impossible. Survivors often describe being “hooked” despite knowing the harm. Three dynamics, what I call the Survivor’s Triad, explain why people remain in close connection with narcissistic individuals:

✨ Gaslighting → “You’re too sensitive.” “That never happened.” Gaslighting is more than “telling lies.” It means that over time, reality gets re-written until you doubt yourself. Part of healing is learning to trust yourself and your instincts again.

✨ Cognitive dissonance → (Festinger, 1957) A state of inner conflict when you’re holding two opposing beliefs or experiences at the same time. The torment of holding two truths: they say they love me vs. they keep hurting me. This clash creates chronic confusion and paralysis, making it harder to act decisively.

✨ Trauma bonding → The cycle of being torn down, then intermittently rewarded with affection, attention, or apologies. This variable reinforcement spikes dopamine in the brain, the same reward pathway activated in gambling or substance use (Carnes, 1997). That’s why the bond feels so hard to break—it’s not just psychological, it’s physiological until you learn how to interrupt the loop. These aren’t signs of a weak personality—they’re involuntary nervous system responses to persistent psychological stress.

🔍 Nature vs. Nurture

Why or how do people become narcissistic? Experts continue to debate this question, and there isn’t a single consensus.

Psychoanalytic theorists such as Kohut (1971) and Kernberg (1975) argued that narcissism develops as a response to early relational trauma, tremendous shame, intolerance to feeling shame, and fragile self-esteem. In their view, the inflated exterior is a defense against deep insecurity.

By contrast, Salerno (2024, 2025) and researchers working from neuroscience and personality-trait perspectives do not view shame or low/fragile self-esteem as central drivers. Instead, they point to genetic factors and temperament, emphasizing that traits like antagonism, grandiosity, and exploitative behavior often emerge independent of insecurity or shame.

Psychologist Ramani Durvasula (2019, 2021), who endorses the fragile self esteem/shame based core perspective, adds another layer, noting that culture itself can reinforce narcissism. Social media rewards constant self-promotion and comparison. Hustle culture prizes status and success at all costs. Even relationship dynamics built on entitlement or one-sided caretaking can normalize unhealthy patterns.

In other words, most experts agree that our environment doesn’t cause narcissism on its own, but it can create fertile ground for those traits to grow unchecked. The causes are complex, and different models emphasize different factors.

What matters most in practice for people surviving relationships with individuals high in narcissistic traits is not the origin story, but whether meaningful change is possible and reasonable to expect. Research consistently shows the answer is usually no.

Why the Cause Matters (and Why It Doesn’t)
For survivors, the real question usually isn’t why narcissism develops—it’s whether the harmful behavior will change. Research consistently shows that entrenched narcissistic traits rarely shift.

That said, the “nature vs. nurture” debate isn’t just academic—it influences how clinicians think about treatment and how individuals are supported. The debate has been going on for decades and may never fully resolve—human behavior is too complex to fit into these tidy boxes. The takeaway? Keep moving forward with the resources available now, knowing that research continues to evolve—and with it, the tools and treatments that may support healing continue to improve.

💡 Frequently Asked Questions About Narcissism

Note: These FAQs come out of the most common questions I hear in weekly therapy or coaching sessions. Although many examples here focus on intimate partnerships, the same patterns can apply in family systems, friendships, and workplaces. High-conflict and antagonistic traits don’t stay neatly in one category of relationship—they ripple out wherever they appear.

Do any of these resonate for you? Feel free to drop a note in the comments if you’d like!

1. Am I the narcissist?
Narcissism exists on a spectrum. Having traits or selfish moments does not equal a diagnosis. Narcissistic Personality Disorder is a rigid, entrenched pattern that causes lasting disturbance across many areas of life. If you’re even pausing to ask this question, that self-reflection itself is a strong sign you are not what you fear—because genuine narcissism usually (not always) blocks that kind of awareness.

2. What if I’m not the narcissist, but I feel wrecked by my relationship?
Survivors often develop anxiety, depression, or hypervigilance they never had before. That’s not weakness—it’s your nervous system adapting to unpredictability.

3. Can two narcissistic individuals be in a relationship?
Yes—usually volatile, dramatic, and competitive. Love-bombing meets love-bombing; betrayal meets revenge.

4. Can I “become a narcissist” if I am in the company of someone with these traits?
No — narcissism isn’t contagious. Personality disorders develop from a mix of genetics, temperament, and early life experiences, not from “catching” traits in adulthood. That said, survivors can pick up behaviors as coping strategies: becoming defensive, shutting down emotionally, or even mimicking the narcissist’s patterns to survive conflict. This doesn’t mean you’re becoming “a narcissist.” It means your nervous system is adapting to a stressful environment in order to survive.

If you’re concerned about traits you’ve noticed in yourself, ask: Are these survival habits, and do they actually serve me now? That reflection can help you separate what belongs to you, what was learned for survival, and what you might want to shift moving forward.

5. What if I believe I have some narcissistic traits?
Noticing traits in yourself doesn’t make you a narcissist—it makes you self-aware. What matters most is impact, reflection, and willingness to change. If there are patterns you’d like to shift, setting small goals and seeking support can help. Therapies like DBT, Internal Family Systems (IFS), Schema or Mentalization-Based Therapy can offer tools for building healthier ways of relating.

6. What if someone calls me a narcissist?
Consider the context. If it happens right after you set a boundary, it’s often gaslighting or projection. Gaslighting is a repeated attempt to deny your reality so the other person can avoid responsibility. Projection is a defense mechanism where someone attributes to you the traits they cannot face in themselves—for example, calling you “selfish” when they are the one acting selfishly.

7. Can narcissistic people change?
Stable, consistent, and meaningful change is rare (Salerno, 2025). Some therapies—like those noted above—can sometimes improve emotional regulation in individuals who are highly motivated and capable of self-reflection, particularly in more vulnerable (covert) presentations. Approaches such as schema therapy (Young, Klosko, & Weishaar, 2003) or transference-focused therapy (Kernberg, 1975) may also help, but only if the person has traits that allow for collaboration and reflection. In other words, outcomes depend heavily on where someone lands on the spectrum of narcissistic traits.

Still, fMRI studies have found differences in empathy-related brain regions in people with Narcissistic Personality Disorder, which may help explain why deep, lasting change is uncommon (Schulze et al., 2013).

8. Are they mistreating me on purpose?
It depends. Some may lack full awareness of how hurtful they are. More often, research suggests they do know, but don’t care enough to stop—because their focus is on personal gain, not the health of the relationship.

Experts note that the higher someone falls on the Cluster B spectrum (a group of personality disorders in the DSM that includes narcissistic, borderline, antisocial, and histrionic)—especially where it overlaps with sociopathy or psychopathy—the more intentional and calculated the harm tends to be. These debates and trait overlaps will be explored more thoroughly in the Gumroad guide coming soon.

The more important question is: how are these behaviors affecting you, and what do you need to move forward?

9. Should I forgive them because they had a bad childhood?
Understanding isn’t excusing. You can acknowledge someone’s past and still hold boundaries. Forgiveness is optional, not required, and up to the individual. It’s worth remembering that not all people with childhood adversity become abusive or antagonistic — and not all people with narcissistic traits have trauma histories. Research and clinical observations (Simon, 1996; 2011) show that many abusive individuals score high in traits like disagreeableness and antagonism regardless of trauma background.

10. Isn’t everyone a little narcissistic sometimes?
People can be selfish or self-focused—that’s normal. But the term narcissism, as we’re defining it here, involves pervasive entitlement, grandiosity, exploitation, and antagonism. That’s not “healthy,” for any relationship, nor are these traits present in everyone.

11. Why do I keep attracting narcissists?
While up for debate, narcissistic people are typically drawn to two types of people: those who may seem vulnerable or easy to exploit, and, paradoxically, those they admire because being with them enhances their own status (sometimes called “trophy partners”). Research by psychologists W. Keith Campbell and Joshua Foster (2002) shows that narcissists often enter relationships with high satisfaction driven by admiration and idealization, but that commitment tends to decline once deeper reciprocity is expected.

People who repeatedly end up in these relationships often aren’t “flawed”—they may simply be more tolerant of high-conflict, antagonistic, or abusive behavior because it feels normal.

This can stem from upbringing, cultural beliefs, or a learned belief that enduring extremely difficult challenges over the long haul is always part of loyalty or love. Highly agreeable and conscientious individuals, in particular, may over-give, minimize red flags, or feel responsible for smoothing over conflict—traits that make them especially prone to staying involved in these types of relationships.

If you find yourself asking, “What’s wrong with me?”—know this: the better question is, “What vulnerabilities or patterns can I strengthen to stop the cycle?”

Learning to spot red flags, reinforcing boundaries, and practicing strategies for disengaging are what break the pattern.

🚪 Where Do I Go From Here?

Remember this: Traits may be stable, but behavior and impact can shift with awareness and motivation. Even if the person causing harm never changes, you can still reclaim clarity, boundaries, and begin to develop healthier connections.

📖 Start with education. Understanding what narcissism is—and isn’t—makes it easier to recognize patterns, break cycles, and move toward healthier relating.

🧘 Add trauma-informed therapy. Approaches that blend safe relational support with somatic tools help calm the nervous system and loosen old patterns, turning knowledge into freedom.

👩‍⚕️ Choose the right support. Therapy is most effective when providers have training in personality disorders and their dynamics. Without that foundation, mis-attunement can cause harm. Ask about training before working with any provider or coach.

💡 The takeaway: With the right guidance, you can heal, rebuild trust in yourself, and move forward with stronger boundaries and healthier connections.

✨ Expanded Mini-Ebook Coming Soon

This article is just the beginning. I’m expanding this into a mini-ebook survival guide that will include:

· 🔥 🔥 Additional FAQs on DARVO, the relationship cycle with antagonistic individuals, couples therapy, no-contact, Cluster B traits, and role of spirituality in healing.

· 🧠 A deeper dive into research on competing models of narcissism, including neuroscience perspectives and brain imaging studies.

· 🌀 Survival strategies such as gray rocking, boundary-setting in action, and breaking trauma bonds.

· ✍️ Journal prompts and reflection exercises to help you process confusion, rebuild clarity, and strengthen self-trust.

This expanded guide will be available soon on Gumroad. Subscribe to this Substack so you don’t miss the release!

📚 References & Further Reading

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing.

Bancroft, L. (2002). Why Does He Do That? Inside the Minds of Angry and Controlling Men. New York: Berkley Books.

Campbell, W. K., & Foster, J. D. (2002). Narcissism and commitment in romantic relationships: An investment model analysis. Personality and Social Psychology Bulletin, 28(4), 484–495

Campbell, W. K., & Miller, J. D. (2011). The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments. Hoboken, NJ: Wiley.

Cain, N. M., Pincus, A. L., & Ansell, E. B. (2008). Narcissism at the crossroads: Phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clinical Psychology Review, 28(4), 638–656.

Durvasula, R. (2019). Don’t You Know Who I Am?: How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. Post Hill Press.

Durvasula, R. (2021). Should I Stay or Should I Go?: Surviving a Relationship with a Narcissist. Post Hill Press.

Hare, R. D. (2003). Without Conscience: The Disturbing World of the Psychopaths Among Us. New York: Guilford Press.

Kernberg, O. (1975). Borderline Conditions and Pathological Narcissism. New York: Jason Aronson.

Kohut, H. (1971). The Analysis of the Self. New York: International Universities Press.

Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual Review of Clinical Psychology, 6, 421–446.

Salerno, P. (2024). The nature and nurture of narcissism: Understanding narcissistic personality disorder from the perspective of gene–environment interaction. Peter Salerno.

Salerno, P. (2025). Traumatic cognitive dissonance: Healing from an abusive relationship with a disordered personality. Peter Salerno.

Schulze, L., Dziobek, I., Vater, A., Heekeren, H. R., Bajbouj, M., Renneberg, B., Heuser, I., & Roepke, S. (2013). Gray Matter Abnormalities in Patients With Narcissistic Personality Disorder. Journal of Psychiatric Research, 47(10), 1363-1369

Simon, G. K. (1996). In Sheep’s Clothing: Understanding and Dealing with Manipulative People. Parkhurst Brothers.

Simon, G. K. (2011). Character Disturbance: The Phenomenon of Our Age. Parkhurst Brothers.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Practical Resources

• Psychology Today Narcissism Test — self-reflection tool (not diagnostic).

• Shahida Arabi. Power: Surviving and Thriving After Narcissistic Abuse.

• Sandra L. Brown. Women Who Love Psychopaths.

• Ramani Durvasula. It’s Not You: Identifying and Healing from Narcissistic People.

• National Domestic Violence Hotline: thehotline.org | 1-800-799-SAFE (7233).

• 988 Suicide & Crisis Lifeline (U.S.) — Dial or text 988 for free, confidential support, available 24/7.

⚖️ Disclaimer
This article is for informational purposes only and not a substitute for a professional therapeutic relationship, treatment, diagnosis, or medical advice. I am a Licensed Marriage & Family Therapist in California; my scope does not include prescribing medication.

If this article resonated with you, and you’d like to schedule a consultation, please feel free to reach out via my website at www.cecilylongotherapy.com

It shows up everywhere—from why you don’t take out the trash on time to the fallout of complex childhood trauma. In the therapy room, it’s always at the root of the conversation.

It sneaks into procrastination, overeating, over-functioning, doomscrolling, bed rotting, over-drinking, leaving relationships, and staying in relationships. Shame doesn’t let anyone get a break.

And it rarely travels alone—it drags along its sidekick guilt. Not a small sidekick, mind you, but a mighty one—more like the Robin to shame’s Batman.

For many who sit on the Zoom-room couch, it becomes clear that shame and guilt aren’t background noise; they’re front and center, eating up bandwidth and making it harder to function—whether that’s paying bills, showing up at work, or just getting out of bed.

We learn it early in families, but it doesn’t stop there. It’s woven into the fabric of society itself—the endless shoulds about how we’re supposed to act, look, feel, and perform in order to be accepted. Shame and guilt are the quiet villains of the human experience, running both our personal and cultural operating systems.

The Evil Twins: Shame and Guilt

Shame says I am bad.
Guilt says I did something bad.

Guilt is supposed to be useful—like a flashing dashboard light. “Hey, you stole a car, maybe return it?” That’s functional guilt.

But most people come to therapy drowning in guilt for things that aren’t crimes: saying no, resting, not answering a text, not being perfect. Trauma and people-pleasing wire guilt into our nervous systems like a smoke detector that goes off when you make toast.

The work isn’t about erasing guilt. It’s about asking:

• Is this guilt trying to teach me something?

• Or is it leftover wiring from years of survival mode?

You can learn from guilt without letting it move in like a permanent roommate.

Shame Wears Many Outfits

Shame doesn’t care what form your suffering takes. It will happily wear the costume of:

• Anxiety

• Depression

• Procrastination

• Imposter syndrome

• Body image spirals

• Over-eating or over-working

• Chronic health flare-ups

• Perfectionism

The disguise changes. The voice is always the same: You’re not enough.

The Narcissism/Shame Connection

About 70% of my clients are survivors of narcissistic family systems or relationships. In those dynamics, shame hangs over everyone.

• A narcissistic person may weaponize shame—whether or not shame is the core of their disorder—because they can’t or won’t tolerate it themselves.

• That shame gets disowned and projected outward instead of processed.

• The recipient of the projection absorbs it until it feels like their own, blaming themselves for what doesn’t actually belong to them.

• This cycle is especially common in relationships with people high in narcissistic traits.

Clarification: The word “narcissism” here isn’t a diagnosis freebie. It’s shorthand for a cluster of traits and behaviors—not just “being selfish.” (You can read my earlier post on this, an upcoming extended cornerstone guide, or hundreds of resources online.)

Narcissism Explained: Traits Beyond Selfishness

• A deep need for admiration and validation.

• Lack of empathy for other people’s feelings or needs.

• Exploitative or manipulative behaviors to maintain control.

• Grandiosity and antagonism, which often lead to exploitation.

• Chronic difficulty taking responsibility—blaming or shaming others instead.

But it doesn’t stop there. Survivors get shamed twice—by society and by themselves. They hear: “Why didn’t you just leave? Why did you stay? Why can’t you get over it?”

Love is supposed to endure, right? You’re shamed if you stay, shamed if you leave, and all the while you’re carrying the shame of someone who won’t take accountability for their own behavior.

Shame is the glue that holds together dysfunctional, toxic, and abusive relationships. And guilt? It’s always nearby, sprinkling its dust: You should’ve seen it coming. You should’ve left sooner. You should’ve done better.

According to the psychoanalytic shame-based model of narcissism, underneath all the grandiosity and control, the true root is disintegrated shame—the kind so terrifying that the psyche will build an entire fortress to avoid feeling it (Kohut, 1971; Kernberg, 1975; Pincus et al., 2009). Survivors then end up with layer upon layer of shame: for being hurt, for staying too long, for believing the lies, for even having feelings about it.

However, it’s worth noting that more contemporary models of narcissism argue that shame, insecurity, and fragile self-esteem are not central drivers of behavior. Instead, traits like grandiosity, antagonism, and exploitativeness are considered the core features, and the condition is understood as having a genetic basis. In this view, a narcissistic person may or may not feel shame any more than a non-narcissistic individual (Salerno, 2024, 2025). We’ll dig into what this means for survivors, relationships, and treatment in an upcoming post.

Whatever model you wish to entertain, the emotional fallout for survivors remains similar: a heavy burden of shame, guilt, and self-blame that takes time, compassion, and often professional support to untangle.

Shame and the Human Condition

Shame isn’t only part of narcissistic dynamics—it’s part of the human condition. Carl Jung described the “shadow” as the parts of ourselves we’d rather not see or admit. Shame often lives there, hidden in the dark corners we exile. Jung’s challenge was to turn toward the shadow, to meet what we fear in ourselves with curiosity instead of contempt. When we face shame that way—whether it’s the shame projected onto us by others or the shame we carry from our own histories—we start to loosen its grip.

The Should’ve/Would’ve/Could’ve Spiral

Cognitive Behavioral Therapy (CBT) has a name for the shame loops so many people get stuck in: the should’ve/would’ve/could’ve cycle.

• I should’ve done this sooner.

• I would’ve finished if I were more disciplined.

• I could’ve gotten it together if I weren’t so… [insert self-criticism here].

One overdue oil change turns into I’m failing at adulthood, and suddenly you’re in a shame spiral that makes it even harder to get started. Procrastination and unmotivated stretches feed on shame—and shame feeds on them right back.

For people carrying deep trauma, this cycle can become chronic and self-perpetuating. That’s where a trained trauma therapist can help you explore it gently, so you’re not trying to fight shame with more shame.

When Shame is Actually Appropriate

Here’s the thing: appropriate shame is rare. Psychologists sometimes call it adaptive shame—the quick, internal ouch that says,

“I crossed a line here. This isn’t who I want to be.”

It nudges you to make repairs or change a behavior.

But once that’s done, it should pass. If shame hangs around like an unpaid intern who never leaves, it’s not helping—it’s becoming toxic. In those moments, guilt usually does the job better because it targets the behavior (“I did something wrong”) instead of the self (“I am wrong”).

Two Tried and True Ways to Work With Shame and Guilt

Before you call in the bigger toolbox, there are two evidence-based approaches that give us practical ways to start loosening the grip of shame and guilt.

Cognitive Behavioral Therapy (CBT): The Responsibility Pie:

Cognitive Behavioral Therapy is one of the most widely researched therapies in the world. At its core, CBT teaches that our thoughts, feelings, and behaviors are connected—and that by changing one, we can shift the others.

One of my favorite CBT tools for guilt is the Responsibility Pie. It works like this:

1. Think of a situation where you feel crushing guilt.

2. List everyone and everything that played a role—yourself, others, circumstances, timing, even sheer bad luck.

3. Draw a big circle. Slice the pie based on how much responsibility each factor realistically deserves.

Most people give themselves 100% of the pie until they do this exercise and realize, Oh, right—other people and circumstances were involved.

It doesn’t erase real accountability—but it stops trauma-guilt from hogging the entire plate.

Dialectical Behavior Therapy (DBT): Sorting Out Shame and Guilt

Dialectical Behavior Therapy was developed by Marsha Linehan and is especially helpful for people who experience intense emotions. DBT combines cognitive-behavioral skills with mindfulness and acceptance strategies.

When it comes to shame and guilt, DBT handouts make it simple:

• Justified guilt: You broke your own values → Make amends if possible → Learn from it.

• Unjustified guilt: You feel guilty about something that isn’t actually wrong → Check the facts → Practice letting it go.

• Shame: If it doesn’t lead to constructive change, it’s not helping → Bring it into the light with compassion.

DBT treats emotions like data—sometimes accurate, sometimes a false alarm. You don’t have to feel every feeling like it’s the full truth.

Continued Ways to Bury the Hatchet With Shame and Guilt

Yep—you can mindfully, compassionately break up with these two. Think of it less like a love triangle and more like finally kicking out the toxic roommates who’ve been hogging your mental bandwidth. Once you realize the villains are there, you have options—and lots of them. You don’t have to keep living with shame and guilt as your invisible landlords. Here are some of the most effective ways research (and lived experience) shows we can shrink their grip:

• CBT’s Responsibility Pie: Stops you from taking 100% of the blame and reminds you there are always other factors.

• CBT/DBT’s “Check the Facts”: Tests whether guilt or shame actually fit the situation—or if it’s just old wiring firing.

• IFS (Internal Family Systems): Helps you meet the shamed parts of you with curiosity instead of contempt, and start to unblend from them.

• ACT (Acceptance & Commitment Therapy): Teaches that shame can ride along, but it doesn’t get to drive the bus. You still steer toward your values.

• Compassion Practices (Kristin Neff, Paul Gilbert): Shame is allergic to compassion. Talking to yourself like you’d talk to a dear friend isn’t fluff—it’s medicine.

• Somatic Work (including EFT Tapping & EMDR): Shame lives in the body—slumped posture, collapsed chest, eyes down. Somatic practices remind your nervous system it’s safe to unfreeze. EFT Tapping, which I wrote about in my last post, combines acupressure with gentle words to help release stuck shame energy.

• Shadow Work (Carl Jung): Jung wrote about the “shadow” as the parts of ourselves we’d rather not see. Shame often hides there. Instead of pushing it away, shadow work invites us to turn toward the shame with curiosity, learn from it, and integrate it. Similar to IFS parts work, the idea is that what we exile actually holds keys to our healing.

Deep, chronic shame—especially when tied to trauma—softens faster with a trained therapist who can hold the space safely. But the point is: shame and guilt don’t get the final word. You have a whole arsenal of tools to drag them out of hiding and move forward in your life.

This Blog Would Be Illegal Without a Hats Off to Brené

I would honestly feel both ashamed and guilty if I didn’t mention Brené Brown here. I mean, what kind of post on shame skips Brené? The woman practically trademarked it.

Fourteen years ago, her TED Talks—”The Power of Vulnerability,” and “Listening to Shame,”—went viral and turned shame from a hushed, backroom topic into something people could talk about at brunch without whispering.

Brene Brown taught us that:

• Shame thrives in secrecy.

• Vulnerability is the antidote.

• Connection and compassion shrink shame until it can’t run the whole show.

As Brené famously put it: “If you put shame in a petri dish, it needs three things to grow: secrecy, silence, and judgment. If you put the same amount of shame in a petri dish and douse it with empathy, it can’t survive.”

• Empathy is the antidote that shame simply cannot survive.

She basically gave us the cultural permission slip to talk about shame in the open—and now we all get to build on it. So Brené, wherever you are, thanks for carrying the torch. The rest of us are just out here trying not to let you down.

Journal Prompts

1. Where does shame show up in my daily life—perfectionism, over-eating, people-pleasing, procrastination, body image?

2. What percentage of this guilt actually belongs to me, and what percentage belongs to others, circumstances, or old survival wiring?

3. Is this guilt teaching me something useful, or is it a false alarm left over from the past?

4. If I met my shame like a scared child instead of a monster, what would I say to it?

5. What’s one small way I can repair or release guilt today?

6. What part of myself do I tend to push into the shadows—and what might that part be trying to teach me? (Jungian shadow work)

7. Who in my life can meet me with empathy when shame shows up, and how can I lean on that connection?

8. What would it feel like to practice self-compassion in the moment shame arises?

The Big Picture

If shame and guilt are the dynamic duo of suffering, then facing them is how you take your power back. They don’t get to run the show—you do. You’ve got a toolbox full of ways to shrink their grip, from structured strategies to somatic practices to simply letting someone meet you with empathy.

The point isn’t to erase shame and guilt entirely—it’s to keep them in their place so you can reclaim yours. And when you do, there’s hope: hope that you can live lighter, freer, more connected, and less hijacked by invisible landlords you never signed a lease with.

Maybe someday, therapists will be out of business, sitting around wondering what to do with all their free time. Until then—there’s hope, there’s healing, there’s you. And you have the power to reclaim your Self. Grab your cape, fire your sidekicks, and take back the script from Batman and Robin.

References

Kohut, H. (1971). The analysis of the self. International Universities Press.

Kernberg, O. F. (1975). Borderline conditions and pathological narcissism. Jason Aronson.

Pincus, A. L., Cain, N. M., & Wright, A. G. C. (2009). Narcissistic grandiosity and narcissistic vulnerability in psychotherapy. Personality Disorders: Theory, Research, and Treatment, 1(1), 69–82. https://doi.org/10.1037/1949-2715.S.1.69

Salerno, P. (2025). The nature versus nurture of narcissism.

Salerno, P. (2024). Traumatic cognitive dissonance: Healing from an abusive relationship with a disordered personality.

Disclaimer
This content is for informational purposes only. It is not a substitute for professional mental health care, diagnosis, or treatment and does not create a therapeutic relationship between the reader and any mental health professional.

If this post resonated with you and you’d like to explore working together, I’d love to hear from you. You can reach me through my website: www.cecilylongotherapy.com.

This piece picks up where Tuesday’s article on overthinking left off. In that post, we explored how one word went from meaningful to clickbait-worthy—used so casually it barely resembled its original meaning.

Today, we’re turning to a few other therapy buzzwords that have met the same fate.

Somewhere between the DSM and Instagram Reels, certain psychological terms have gone completely off-script. They’ve been stretched, squeezed, meme-ified, and handed out like mall perfume samples — until the original meaning barely lingers.

Let’s hit pause, give these words back their weight, and talk about what they actually mean.

Some of these words started out as precise clinical concepts. Then modern life happened; memes happened. And now… well, let’s just say it’s time to give them a proper translation back into human language.

Therapy Buzzwords Gone Awry:

🌱Codependent

What people usually mean:
Clingy, needy, too invested in someone else.

What it actually means:
A survival strategy where your identity and boundaries get tangled with someone else’s, often because that was how you learned safety growing up. Over time, this pattern can compromise both people’s emotional boundaries — sometimes their time, money, or values, too.

And here’s the thing:
People toss this word around like it’s an insult.

“Oh my gosh, she’s sooo codependent.”

Since when did one of the most common human survival patterns turn into a punchline? This isn’t a gotcha moment. It’s a moment for reflection, compassion, and growth.

Common Misunderstandings:

• “We depend on each other too much.” Healthy interdependence ≠ codependence.

• “If someone has an addiction, everyone close to them is codependent.” Not true. It’s about repeated behaviors and boundaries, not one-time events.

• “It just means caring too much.” Nope. The issue is when caring turns into self-abandonment, not love itself.

• “People-pleasing = codependency.” Not always. People-pleasing might be the opening act; codependency is the full three-hour Broadway show.

A Conscious Reframe:

• Deeply bonded

• Wired for attunement

• Skilled at anticipating others’ needs (sometimes maladaptive, often empathy on overdrive)

The real question isn’t “Am I codependent?” so much as:

• “Are my values, boundaries, or well-being being compromised — over and over — to keep someone else afloat?”

• “What motivates me to repeatedly abandon myself for someone else?”

• “How can I start showing up in meaningful ways for myself — getting to know my own wants and needs without guilt or shame?”

(For many, that last part can feel daunting — article coming soon.)

🩹Enabling

What people often think it means:

• Being nice or supportive = enabling

• Letting someone make mistakes = enabling

• Saying (genuinely) “I’m sorry to you have a headache” = enabling

What it actually means:
Enabling happens when you shield someone from the natural consequences of their behavior — often unintentionally — in ways that allow their self-destructive patterns to continue.

This can look like:

• Buying alcohol or drugs for someone entrenched in addiction

• Bailing them out of legal trouble repeatedly

• Calling in sick for them at work after a binge

• Covering bills while they spend everything on their habit

• Forgiving harmful or abusive behavior without accountability

• Sweeping your own needs under the rug so the enabled never has to confront how their actions affect you

These actions often come from love, fear, or habit — not malice — but they prevent the person from feeling the full impact of their choices. That can delay change, growth, or independence.

Another example? If you keep tying your child’s shoes every day and, at age 40, they still can’t tie them, that’s enabling. It’s a pattern, not a one-time event.

Common Misunderstandings

• Helping ≠ enabling — Support becomes enabling when it erases consequences.

• Validation ≠ enabling — Saying “It sounds like it’s been a rough day. I’m here if you need to talk,” isn’t enabling; it’s empathy, which builds connection and supports relationships.

• Boundaries ≠ punishment — Setting limits isn’t cruel; it protects both people from repeating the same exhausting cycle, and promotes personal growth.

A Conscious Reframe

• Enabling shields people from reality.

• Support helps people face reality with resources, not without them.

• Boundaries work best when they’re set with compassion — for you and the other person — because compassion keeps limits from turning into walls.

• The goal isn’t to abandon someone — it’s to stop abandoning yourself in the process.

👉Codependency vs. Enabling

The two often travel together but aren’t identical twins.

• Codependency is the relationship pattern — losing your sense of self because someone else’s needs, moods, or problems take center stage.

• Enabling is the behavior that shows up inside that pattern — shielding someone from the natural consequences of their actions, often to keep the peace or avoid conflict.

In other words, codependency is the full dance (dynamic); enabling is one of the dance steps (a behavior).

❤The Five Love Languages – Forever Tool or Forever Trend ?

While terms like codependency and enabling make their way to the therapy couch, few concepts have crossed from pop culture to psychology quite like The Five Love Languages — sometimes treated as a relationship litmus test, other times as a punchline. So, what’s the real story behind it?

What people often think it means:
A scientifically proven relationship roadmap — as if knowing someone’s “primary love language” has the power to make or breaks a relationship.

What it actually is:
A popular framework for thinking about how people give and receive love. Helpful in some ways, limited in others.

👍 The Pros: Why People Love It

· Accessible & Practical:
Gives couples a simple way to talk about emotional needs without needing a therapy degree.

· Encourages Intentionality & Understanding:
Prompts people to be mindful and proactive in expressing care, rather than assuming their partner “just knows.”

· Encourages Communication With Shared Vocabulary:
Helps partners articulate what lands for them — physical touch, words of affirmation, quality time, gifts, or acts of service — and notice where efforts may be misdirected.

👎 The Cons: Where It Falls Short

· Not Evidence-Based:
Research doesn’t strongly support the idea that matching love languages = better relationships.

· Culturally Narrow & Oversimplified:
Developed from a small, homogenous group; risks reducing relationships to a checklist rather than exploring complexity.

· Can Be Misused:
Sometimes weaponized (“You’re not speaking my language, so you’re the problem”) or treated as a fixed label instead of a starting point for deeper conversations.

Takeaway

The Five Love Languages framework can spark useful conversations, but it’s not a magic formula. Think of it as a tool, not a diagnosis — one way to build awareness, not the only way to build love.

Now, let’s shift to terms like 'narcissist' that carry real emotional weight — and often get used just as casually

🎭 Narcissist

Next up, the most overused word on the internet — and the most confusing: narcissist

What people often mean:
Anyone selfish, arrogant, or posting too many selfies.

What it actually means:
A complex personality structure — sometimes a full clinical diagnosis — with traits that can cause real, lasting harm in relationships. The problem? Somewhere between clickbait headlines and TikTok callouts, the word “narcissist” turned into shorthand for any unpleasant or self-centered behavior.

Here’s why that matters:

• Some people are highly antagonistic, controlling, or manipulative without meeting full criteria for Narcissistic Personality Disorder (NPD), and some do.

• Traits like entitlement, low empathy, or chronic conflict exist on a spectrum — some folks show a few traits, others again- meet the full clinical picture.

• Both overt (“look at me”) and covert (“quiet but calculating”) forms exist, and the fallout for those involved — confusion, emotional harm, even trauma — can be very real when someone displays these traits anywhere on the continuum.

This article won’t cover the full complexity of NPD or its subtypes. That’s a bigger conversation. For now, the point is this: before labeling someone a narcissist, it’s worth separating how their behavior impacts you from using a clinical term as a shortcut.

Common Misunderstandings:

• “They’re so full of themselves.” → Self-centeredness ≠ narcissism.

• “They take a lot of selfies.” → Image-consciousness alone doesn’t equal narcissism.

• “They were mean to me once.” → Narcissism describes a pattern of manipulation, entitlement, or lack of empathy — not a single fight or bad day.

A Conscious Reframe:

• If you mean self-centered, say self-centered.

• If you mean manipulative, say manipulative.

• Reserve “narcissist” for when there’s a sustained pattern of:

  • low or transactional empathy

  • chronic entitlement

  • refusal to take accountability

  • consistent boundary violations or exploitation

Because precision helps. It keeps conversations real — and gives people dealing with true narcissistic dynamics language that honors their experience.

💌Attachment Styles

And then there’s attachment styles — possibly the most screenshotted therapy concept of the last decade.

What people often mean: a way of describing someone too needy, too avoidant, or “bad at love.”

What it actually means: A framework for understanding how early experiences shaped the nervous system’s way of bonding, protecting, and seeking closeness.

Common Misunderstandings:

• “You’re just bad at relationships.” Attachment styles don’t measure worthiness; they explain patterns of safety and connection.

• “Anxious means dramatic, avoidant means cold.” These labels describe strategies for survival, not personality flaws.

A Judge-Free Reframe:

• Anxious: Highly tuned to closeness; deeper fears a person could be taken away.

• Avoidant: Values independence; closeness can feel threatening if it risks autonomy.

• Disorganized: Wants connection but fears it, often from inconsistent or chaotic early relationships.

Knowing your style isn’t about judgment. It’s a map. Once you see the map, you can choose new routes.

🔄Trauma Bonding

Finally, one of the most misunderstood terms out there: trauma bonding

What people often think it means:

• “We bonded over trauma.”

• “We connected because we both had neglectful parents.”

• Basically, any version of commiserating over hard experiences.

What it actually means:
A powerful, confusing bond that forms between someone experiencing abuse and the person hurting them — emotionally, psychologically, or physically. Because the abuser isn’t always cruel, and sometimes provides care or support, the nervous system gets caught in cognitive dissonance:

“This person hurts me… but they also care about me. So which is real?”

That back-and-forth can make it extremely hard to see the abuser clearly — or leave the relationship. Survivors may feel intense love or loyalty toward someone who mistreats them — a survival response sometimes compared to Stockholm Syndrome.

Quick Definitions

• Cognitive Dissonance: The mental tug-of-war when two conflicting truths try to live in the same brain. It creates discomfort, so the mind often twists itself into knots to reduce the tension.

• Stockholm Syndrome: When hostages or victims develop feelings of trust or affection toward their captors — named after a 1973 bank robbery in Stockholm, Sweden, where hostages defended the criminals after release.

🩺 When Everyday Language Meets Real-Life Conditions

Some terms started out in clinical textbooks but picked up side hustles on TikTok as slang along the way. Let’s meet in the middle — and give these words back the space they deserve.

A few examples:

🚨Trauma

How it’s often used: “That exam was so traumatic.”

What it actually means: A nervous system pushed beyond its ability to cope, leaving a lasting imprint on body and mind. Trauma isn’t just the event — it’s the way the body continues to hold it afterward.

When the word gets stretched to cover everything from a bad haircut to life-altering harm, the lines blur for those who carry the real thing. Sometimes words like stressful or impactful might describe everyday experiences more clearly, while trauma can stay reserved for what truly disrupts a person’s sense of safety.

Trauma is also highly personal and individualized — what overwhelms one person’s nervous system might not affect another in the same way.

And it’s never a voluntary choice. Trauma is the body’s automatic, complex survival response to perceived threat — a full-body “system override,” not something anyone signs up for.

🦝💤Fun Fact: Ever seen an opossum “play dead”? Yeah… it’s not auditioning for an Oscar. That dramatic collapse is the freeze part of the body’s fight/flight/freeze system. When neither running nor fighting seems possible, the nervous system basically pulls the emergency brake. It’s a survival reflex, not a conscious choice — the same way trauma responses in humans aren’t things people “decide” to have.

🧠PTSD:

How it’s often used: “I have PTSD from my inbox.”

What it actually means: Post Traumatic Stress Disorder is a significant clinical diagnosis involving flashbacks, nightmares, hyperarousal, and avoidance — rooted in the body’s survival response.

Using it lightly can make it harder for people living with PTSD to have their reality understood. Sometimes phrases like shaken up or triggered might capture what’s happening without borrowing language meant for something much heavier.

☀️🌑Bipolar:

How it’s often used: “They’re so bipolar — their moods change constantly.”

What it actually means: A serious mood disorder with distinct episodes of mania/hypomania and depression, each with clear changes in energy, activity, and functioning.

Because the word carries such weight, tossing it around casually can turn a complex condition into a punchline. Other words like moody or unpredictable might fit better when the conversation isn’t about an actual diagnosis.

🔁OCD:

What people usually say: “I’m so OCD about my closet.”

What it actually means: Obsessive-Compulsive Disorder — intrusive, distressing thoughts often paired with repetitive behaviors aimed at easing anxiety. It’s not quirky neatness; it can be life-consuming.

Why it matters: The social media–driven oversimplification of OCD has turned it into a personality quirk, while those living with it often struggle in silence.

A Better Reframe: If you like things tidy, say you like things tidy. OCD is not a punchline — it’s a disorder that deserves respect.

When we use these terms lightly, real suffering gets minimized. When we use them precisely, we build understanding — and connection.

💜✨Final Thoughts

Maybe the goal isn’t to judge or shame words — it’s to give them back their meaning. The world already has enough buzzwords ricocheting around; what we need are conversations that land somewhere real, trading confusion for clarity and shame for self-awareness.

Because at the end of the day, understanding always beats labeling — every time.

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Disclaimer
This content is for informational purposes only, and reflects personal opinions and observations of the author. It is not a substitute for professional mental health care, diagnosis, or treatment, and it does not establish a professional therapeutic relationship.

If you’d like to explore whether working together is a good fit, you can request a complimentary consultation through my website: www.cecilylongotherapy.com.

This past month, I’ve heard more people than usual beat themselves up for “overthinking” or “overanalyzing,” often with a side of shame, self-blame, or even hopelessness — as if it were a moral failing, right up there with forgetting to floss or texting your ex.

And I get it. I’ve been handed that label myself for the smallest things. Like the time I asked a stranger where the nearest gas station was (Google Maps had apparently taken the day off).

It made me stop and wonder — or shall I say overthink — this word we keep tossing around. What does “overthinking” even mean? Why does it carry such a negative vibe? And is it always the problem we make it out to be… or could it sometimes be a strength in disguise?

When did “thinking things through” become so shameful? What if we’ve been using this word all wrong — both to shut down ourselves and to silence the conversations we probably need to have?

Maybe It’s Not Overthinking at All

Every week, I hear people criticize themselves for “overthinking.” And here’s what I notice: the moment you slap that label on your forehead — or anyone else’s — the conversation shuts down. Growth stalls.

Instead of asking “What is my brain trying to show me here?” the thought gets filed under “There must be something wrong with me.”

But what if it isn’t overthinking at all?

What if your thoughts are actually:

• Thorough — you’re covering your bases.

• Prepared — you’re playing chess instead of checkers.

• Perceptive — you see connections others miss.

• Actual — as in, based in reality, not paranoia.

• Curious — the exact mindset growth requires.

🚨 Public Service Announcement: The Overthinking Offense

Apparently, “overthinking” is now something you can be accused of — like it’s a crime. Let’s break down the charges:

• The Alleged Crime: Having too many thoughts before noon.

• The Evidence: Asking follow-up questions. Wanting clarity. Maybe owning a journal.

• The Jury: Friends, coworkers, or strangers on the internet who think you should “just let it go.”

• The Sentence: Being told you’re “too much” or “making things complicated” — as if curiosity were a felony.

But here’s the thing: it’s not illegal to have a busy brain. There’s no fine. No official handbook for “thought limits per day.”

So… have you ever accused someone of overthinking — or been accused yourself?

• How did it land?

• Was it funny, frustrating, or maybe even a little silencing?

• Drop it in the comments — I want to know how the Overthinking Offense shows up in your world.

Gold Medal at the Anxiety Olympics

Sometimes you know there’s a problem — or at least your brain is sure there is.
But instead of keeping you productive, your thoughts start training for the Anxiety Olympics: gold medal in mental gymnastics, silver in catastrophic thinking, and a participation trophy in sleep deprivation.

The prize? Zero solutions, just the feeling of being stuck on the existential hamster wheel — your thoughts sprinting in all directions while you’re left exhausted, watching them win races you never signed up for.

Rumination is real — when the brain runs the same loop so many times it stops being helpful and starts being torment. This is actually one of the defining features of Generalized Anxiety Disorder — excessive worry and rumination that creates real distress. And it’s treatable.

But casual “overthinking” — the kind people throw at you like an insult — is usually just… thinking. Thoroughly.

Slowing the Hamster Wheel

When your thoughts start spinning like a hamster on cold brew, there are ways to help your brain hit the brakes:

• The Classics Everyone Knows: Monkey Mind, Journaling, Centering on the Breath, 5-4-3-2-1 Grounding, Clouds Passing in the Sky, Candle Flame Visualization. You can find them on every mindfulness app with a lotus flower in the logo — so we won’t unpack them here.

Here are a few favorites you won’t find on most mental health infographics:

• The Out Loud Rule: If you wouldn’t shout the thought across a crowded Starbucks, maybe it’s not as urgent as your brain claims.

• The Socks-on-the-Brain Technique: Some thoughts are like fresh socks — ready to wear all day. Others? Best folded neatly and put away for later. They don’t need to be thrown out, but they don’t need to run the whole show today either.

• The Exit Interview Method: Imagine sitting your most persistent thought down in a swivel chair and asking, “What exactly was your role here? What was your contribution to the company?” Take notes. Then thank it for its service and show it to the door.

• The GPS Reroute Trick: When your brain keeps circling the same roundabout, picture a GPS voice cutting in: “Recalculating. Please make a U-turn when possible.” It’s a mental reset button — with less road rage.

• EFT Tapping: A system of tapping on designated acupressure points that shifts the nervous system from fight-or-flight into a calmer state. Backed by plenty of research, and yes, I teach it to clients (and use it myself) daily. Article coming soon!

• The DJ Remix Technique: When a thought keeps looping like a broken record, give it a new soundtrack in your head. Try it to the Jeopardy! theme or 90s boy band pop. It’s surprisingly hard to feel anxious while your brain is singing Backstreet Boys.

What about you? Drop your favorite ways to turn down thought loops in the comments — bonus points if they’re creative or ridiculous enough to actually work.

🧠 QUIZ TIME Are You Actually Overthinking? (And So What If You Are?)

1. Someone tells you, “You’re overthinking this.” You…

• Assume they just don’t want to answer your perfectly reasonable question.

• Apologize and shut down the conversation.

• Grab a notebook, a whiteboard, and a conspiracy wall of sticky notes because you’re about to map it all out.

2. When you have a big decision to make, you…

• Think through possible outcomes. Once. Maybe twice.

• Lie awake until 2 a.m. spinning through 37 possible futures.

• Research like you’re writing a dissertation, complete with footnotes.

3. Your inner critic says, “You’re overthinking again.” You reply…

• “No, I’m just thorough.”

• “Yeah, but at least I’m prepared.”

• “Excuse me, I prefer the term cognitive power-user.”

4. Do your thoughts sometimes loop so much that it gets in the way of life?

• Not really. My brain tabs eventually close on their own.

• Sometimes, and I wouldn’t mind a few new coping tools.

• Yes, and I’d like to return my brain for a quieter model, please.

Results

• Mostly first options: Your brain likes clarity. Minimal clutter. Maximum focus. A strength, not a flaw.

• Mostly second options: Your brain is busy — maybe helpfully busy. It might just need structure or calming practices like EFT tapping, journaling, or grounding exercises.

• Mostly third options: Your mind bursts with ideas or worries that sometimes spiral. There’s creative potential here — and tools exist to help you feel less hijacked by the noise.

At the very least, hey — you’re thinking. Maybe that’s the real point: not to think less, but to talk about our minds in ways that make room for humor, empathy, and growth.

Before We Close the Tabs

Somewhere between TikTok therapy trends and brunch-table advice, “overthinking” got turned into a character flaw instead of what it often is: curiosity, thoroughness, or a brain asking for solutions.

So maybe the goal isn’t to think less — it’s to give thinking a better PR team.

After all, our minds aren’t the problem. It’s the way we talk about them that could use a rebrand.

👉Liked this post? Part two is coming soon — with more therapy buzzwords that deserve a second look (and maybe a little less TikTok).

☕ If this post helped you rethink overthinking, consider buying me a decaf coffee. Your support keeps the metaphors caffeinated, the brain tabs spinning, and the posts coming. I appreciate every sip of encouragement.🙏

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Disclaimer: This post is for informational purposes only. It is not a substitute for professional medical treatment, diagnosis or therapy, and does not create a therapeutic relationship. For a complimentary consultation, please visit www.cecilylongotherapy.com.

I wasn’t planning to write this.

But some of you asked for more pop culture breakdowns — especially the kind that mix symbolism, psychology, and the mess of being human on this weird little planet earth.

And guess what? The Barbie Movie still haunts me in the best way. It’s glittery, chaotic, hyper-femme — and somehow still manages to explore shadow work, archetypes, and the existential horror of modern identity with a dance number and a plastic smile.

So here it is: a slightly unhinged, but totally therapist-approved breakdown of why Barbie still matters in 2025. We’re talking Ken’s shadow inflation, archetypal identity crisis, cultural projection, and what it means to leave the Dreamhouse behind.

And yes — I’ve included the highly requested, humor-infused and reflective journal prompts, plus a “Discover Your Barbie Archetype” quiz at the end, because healing can be both meaningful and a little fun.

Let’s go.

Glitch in the Dreamhouse

It’s 2025, and, yes- I’m still thinking about The Barbie Movie. Not because of the outfits, or the monologues, or even Gosling’s comedic genius as a guy whose entire job is just… Beach. Because one minute Barbie’s dancing in a choreographed pink utopia, and the next she’s glitching in the shower wondering, “Do you guys ever think about dying?”

And honestly? Same.

Barbie didn’t glitch because she found the meaning of life — she glitched because she couldn’t unsee how fake it all felt. That moment hits like a blackout in the middle of your most productive day. You’re deep in the loop, then suddenly… something breaks. Silence. Disorientation. And underneath it: the real question.

Psychologically, it’s a mask-slip — when the persona cracks and the deeper self starts leaking through. In Jungian terms, that’s the Self knocking. In therapy, it’s the start of a thousand breakthroughs. Some call it burnout, others call it a midlife crisis — but often, it’s neither. It’s the moment your system stops running the old script. The cold water. The breakup. The “Wait… is this it?” That’s not dysfunction. That’s the beginning of realignment.

Patriarchy, Perfectionism & Plastic

When Barbie leaves the Dreamhouse to fix her glitch, she steps into the real world — and finds that patriarchy is not only alive, it’s branded, buffed, and obsessed with horses.

Ken, bless his emotionally underdeveloped soul, absorbs this new power structure like a sponge in a man cave. He returns to Barbie Land and builds the Mojo Dojo Casa House — the world’s most absurd yet accurate metaphor for fragile masculinity on a power trip.

No, he didn’t install the shag carpet himself — but energetically? He was the architect.

But here’s the deeper layer: The Mojo Dojo Casa House isn’t empowerment. It’s shadow inflation — when the disowned, neglected parts of the psyche seize control without integration. He doesn’t become whole. He becomes performative power in a fur coat.

Barbie, meanwhile, realizes her once-liberating brand of “you can be anything” has morphed into internalized perfectionism: always optimizing, always smiling, always crushing under the weight of empowerment-as-performance.

Ken’s patriarchy and Barbie’s perfectionism? Two sides of the same coin. Both are personas — masks of “enoughness” that demand performance and punish authenticity.

Jung at the Beach

On the surface, Barbie is a doll and Ken is her accessory. But look closer, and they’re both archetypes caught in crisis.

Barbie- Enough ?

Barbie begins as the collective anima in overdrive — the idealized feminine (in Jungian theory, the inner feminine image carried by all people, often shaped by culture and projection). She’s everything the culture tells women to be, and everything many women internalize as “enough.” But when the glitch hits, her role as this pure archetypal persona — that glossy social mask — starts to crack.

She begins to meet her Shadow: cellulite, thoughts of death, doubt, fear, and eventually, choice. Her arc moves from projected ideal to emerging authentic self.

Ken-enough ?

Ken, meanwhile, is the underdeveloped animus (the inner masculine image — often tied to logic, action, and identity formation). His identity is “Beach” — not lifeguard, not athlete… just Beach. He exists only in relation to Barbie, waiting for her gaze to give him purpose. When he stumbles into patriarchy, his Shadow inflates. The Mojo Dojo Casa House is born — overcompensation masquerading as selfhood.

In Jungian terms, both characters are undergoing breakdowns that initiate individuation:

Barbie from the idealized feminine image she’s been performing, and Ken from the hollow masculine identity he’s been clinging to.

Individuation is Jung’s term for the lifelong process of becoming your true, whole self — by integrating your shadow, personas, and internal opposites.

The eternal quest for belonging:

But Ken’s midlife crisis isn’t just about masculinity — it’s about belonging. His entire self-worth was tied to being chosen by Barbie. If she looked at him, he mattered. If she didn’t, he disappeared. And that’s not just Ken’s story — that’s a deeply human one. So many of us, regardless of gender, are trained to perform for approval, to build identities around being impressive, useful, lovable, chosen.

Ken’s arc invites all of us to examine the part of ourselves that still outsources value — the part that asks, If I’m not being picked, do I even matter? The truth? You were never supposed to earn your worth. You were supposed to honor it.

And haven’t most of us built our own Mojo Dojo Casa Houses at some point ?

Maybe not with horse posters, but with roles, personas, or carefully curated lives meant to protect us from the fear of not being enough. Ken’s version is louder. Ours are just quieter. But the revelation — and the quest to reframe and become your authentic self? That part’s the same.

Freud, Jung, Adler… and Me at the Buffet

Now, I know this isn’t how Freud, Jung, or Adler pictured their theories showing up. Freud would be writing a dissertation on Ken’s horse obsession. Jung would be losing his mind over Barbie’s journey from Persona to Self. Adler would be asking everyone to please stop competing and start contributing.

Meanwhile, I’m just over here with a full plate at the same buffet — taking it all in, trying to understand how a woman in a pink jumpsuit accidentally triggered a collective confrontation with shadow, persona, perfectionism, patriarchy, and plastic.

No, I’m not an analyst. But I read their work. I teach from it. I use it with clients every day. And if Barbie’s giving us a shortcut into deeper self-awareness? I’m in.

Barbie as Archetype: Icon, Mask, Mirror

Barbie has always been more than a doll. She’s an archetype — but which one depends on who’s holding her.

• To some, she’s the bad archetype: unrealistic, toxic, unattainable.

• To others, she’s the good one: powerful, aspirational, liberated.

• For many, she’s both — a confusing hybrid of pressure and potential.

That’s the point. Archetypes don’t offer answers — they hold opposites. Barbie is both dream and dread. Mask and mirror. Empowerment and exhaustion.

Gerwig didn’t tell us what to make of Barbie. She let Barbie become a projection screen. That’s why the film hit so many people so differently. It didn’t resolve the contradictions. It revealed them — and trusted us to sit with the mess.

And maybe that’s the deeper invitation: not just to spot archetypes in the culture, but to notice the ones playing out inside ourselves.

From an Internal Family Systems (IFS) lens, Barbie isn’t just a part — she’s many. The over-functioner. The pleaser. The dreamer. The rebel. The perfectionist. All trying to help, all holding stories.

This movie doesn’t just show us the roles — it gives us permission to meet them, honor them, and integrate what still serves.

Side note: Internal Family Systems (IFS) is a therapeutic model that offers a non-judgmental way to explore the different “parts” of ourselves — each one carrying beliefs, memories, or protective strategies. It complements Jungian archetype work by focusing less on universal symbols and more on your inner system.

Where Jung names the archetype, IFS invites you to talk to it — to get curious, build relationship, and support internal integration.

Watching Barbie through this lens becomes more than cultural commentary. It becomes a mirror. What parts did the movie activate in you? Who inside you felt seen, dismissed, inspired, or threatened? That’s where the real work — and real growth — begins.

Barbie’s Heroine’s Journey

Barbie’s not just glitching — she’s transforming. Her arc follows the Heroine’s Journey: leaving the false world, facing shadow, letting go of the old identity, and returning as something more whole.

And no, the movie doesn’t end with her triumphant on a throne. It ends with her in an OBGYN office, asking what it means to be real. That’s not regression — that’s rebirth. It’s feet-on-the-ground, breath-in-your-body, blood-in-your-veins becoming.

The Dreamhouse was comfort. The Real World is risk. But it’s also where she can feel — and feeling is the start of everything.

From Glitter to Clay

Glitter is fun — until you can’t wash it off. The Barbieverse was glitter on loop: flawless days, rehearsed dances, choreographed smiles. Clay? Clay is different. Clay gets under your nails. It breaks. It holds fingerprints.

But clay also molds. It changes. It lasts.

Barbie leaving behind the glitter for something more textured and grounded? That’s the real work. That’s what so many of us are doing now: stepping out of the performance, into the mess, and learning to shape a life we actually want to live.

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If you’ve been enjoying these posts—the humor, the existential metaphors, the occasional glitter bombs—consider tossing some fuel on the decaf-and-sparkle fire that keeps them coming:

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Are We Existential Enough?

Existential Barbie wasn’t just a moment — she was a mirror. And in 2025, that mirror still reflects something we haven’t resolved.

We’ve asked if we’re Kenough, sure. But maybe now the question is:

Are we existential enough?

Are we willing to ask the questions that don’t come with answers?

Are we letting go of the roles that no longer serve us?

Are we integrating the shadow instead of building it a house?

Are we walking away from the dreamhouse not just because we’re glitched — but because we’re ready to grow?

Your Pepto-Pink Reflection Box

For the Kens (Men):

• Where in my life do I feel like “Beach” — showing up, but unsure who I am without someone else’s spotlight?

• What’s my personal Mojo Dojo Casa House — the structure I build when I’m feeling insecure?

• What does “I’m Kenough” look like in real life — not just in a sweatshirt?

• Where do I need to stop performing and start integrating?

For the Barbies (Women):

• Where am I still trying to “be everything,” even when it burns me out?

• What’s my version of the cold shower glitch — when something real broke through the mask?

• When does empowerment start to feel like perfectionism in disguise?

• What would it look like to stop optimizing and start existing?

For All of Us (any human in your earth suit):

• When was my last glitch moment — and what was it trying to tell me?

• What parts of my “Dreamhouse” are authentic… and what needs redecorating?

• Where am I still clinging to glitter — and where am I ready for clay?

• What would integrating my shadow look like, today?

Final Word

Barbie wasn’t just a movie. It was a myth, a mirror, and a map — and two years later, it’s still showing us the way.

Keep the glitter if you want. But don’t be afraid to reach for the clay.

Bonus: What Barbie Archetype Are You?

Now it’s time to meet the role you’ve been playing — maybe without realizing it.

This isn’t about labels. It’s about insight. It’s a snapshot of the mask you might be wearing, the script you’ve been handed, or the part of yourself that’s overdue for a rewrite.

Don’t overthink it. Just notice what resonates.

1. When things get tough, your go-to move is:

A. Smile, power through, and pretend it’s fine.

B. Take control and try to fix everything fast.

C. Retreat and rework your identity in private.

D. Get louder, busier, or more visible.

E. Focus on helping others instead of yourself.

F. Deliver a lecture, enforce a rule, or point out how everyone else is doing it wrong.

2. Your biggest fear about being truly seen is:

A. Being messy or imperfect.

B. Being helpless or wrong.

C. Being boring or forgettable.

D. Being unwanted or invisible.

E. Being a burden or not needed.

F. That people will realize your confidence is covering confusion.

3. Your personal Dreamhouse probably includes:

A. High-functioning perfection and endless to-do lists.

B. Color-coded systems and a 5-year plan.

C. Deep books, alone time, and maybe some repressed rage.

D. Status symbols, mood lighting, and “nothing to see here” energy.

E. A couch for everyone but you.

F. Color-coded values, the “right” diet, and a hidden drawer of contradictions.

4. If your life had a glitch moment tomorrow, you’d probably:

A. Blame yourself and try harder.

B. Create a strategy to fix it before anyone notices.

C. Spiral quietly and question everything.

D. Post about it, then distract yourself.

E. Support someone else who’s glitching harder than you.

F. Announce a solution, post about it passionately, then secretly double-check your own reflection.

Results

Mostly A’s – The Performer Barbie

Polished, poised, and perpetually exhausted. You’re used to being the one who holds it all together. But beneath the gloss, you’re craving something real. You don’t need more sparkle — you need space.

Mostly B’s – The Fixer Barbie

Smart, strategic, and rarely off-duty. You’re the one people count on. But you’re not a project manager for other people’s feelings — and you’re allowed to fall apart, too.

Mostly C’s – The Shadow Barbie

Quiet on the surface, deep below. You’re in a liminal space — not who you were, not quite who you’re becoming. It’s okay not to know yet. Your integration is already in motion.

Mostly D’s – The Inflated Barbie (or Ken)

Charismatic, confident, and secretly unsure. You’ve built a beautiful Casa House — but it might be time to knock down a few walls and meet yourself underneath the performance.

Mostly E’s – The Caretaker Barbie

Empathic, generous, and always tuned into others. You give love like it’s oxygen — but what would happen if you saved some for yourself?

Mostly F’s – The Clipboard Barbie

Confident, informed, and ready with a strong opinion. You mean well, but sometimes your conviction trips over your contradictions. Behind the certainty is a longing to integrate all your parts — not just the polished, righteous ones. Remember: leadership isn’t about fixing others, it’s about embodying the wholeness you’re still allowed to be discovering.

So What Now?

This quiz isn’t about boxing you in. It’s about naming the story you’ve been carrying — and deciding whether it still serves you.

Your Barbie archetype is just a starting script. Honor it, remix it, and carry it forward — glitter, clay, Pepto pink and all. Because even Barbie isn’t finished becoming.

You Made It This Far!

And if this piece resonated — I’d love to hear what part landed for you.
What moment in the movie or this article popped for you ? Drop your thoughts in the comments. I actually read them.

Disclaimer: This post is for reflection, not a substitute for a professional diagnosis or therapy. It’s written from a therapist’s lens, but it’s not a substitute for working with a licensed professional.

If you’re in California and looking for therapy — you can find me at www.cecilylongotherapy.com

It’s been two years since The Barbie Movie broke the internet — but the Pepto-pink existential lessons still linger.
Think shadow work, archetypes, and identity crises… where Ken meets Freud, Barbie channels Jung, and we peek behind the plastic veneer.
Come for the glitter — stay for the insight (and the quiz at the end). Weird Barbie approved.

We often operate as though mental health and physical health live in separate neighborhoods—one “in the head,” the other “in the body.” But if you’ve ever felt your shoulders tighten with stress or cried because you couldn’t do something you once loved, you know: they’re next-door neighbors. Probably sharing a duplex, arguing over the thermostat, and borrowing each other’s coping mechanisms.

As a psychotherapist with a background in fitness, anatomy, and injury rehabilitation, I’ve spent years walking the line between both worlds. And I’m here to say: when physical therapy ignores the emotional toll of injury, it misses a critical piece of the healing process.

The Moment I Knew Something Was Missing

In 2018, after 20 years in the mental health field and teaching in fitness and providing personal training (plus tutoring anatomy and physiology), I considered going to PT school. I took refresher courses from undergrad, and spent a year volunteering in outpatient clinics to gather required observation hours.

During every single shift—without fail—a patient would come up to me, assume I was a PT (likely because of my age), and confide in me about their depression, frustration, or anxiety related to their injury.

And they weren’t looking for therapy.
They were looking for someone who would just listen.

As someone with my own chronic injuries and connective tissue issues, I got it. Not just intellectually, but in my cells. I also noticed that most PTs—kind, skilled, and well-meaning as they were—didn’t usually engage when patients shared these emotional moments.

They’d redirect, continue tasks, or shift gears—not out of malice, but likely without realizing it was a key moment to build rapport and strengthen the patient-provider connection. Research shows that when patients feel heard and seen, they’re more likely to follow treatment plans and achieve better outcomes [1, 5].

I realized—and later confirmed—that interpersonal and relational skills are rarely emphasized in most training programs, despite their proven impact on patient adherence, satisfaction, and healing outcomes [2, 5].

So I Developed a Training

I created a two-part training for Physical and Occupational Therapy clinics.

Part 1:

• The interpersonal side of patient care

• Why empathy matters in brief but pivotal moments

• Evidence-based communication tools to build trust, validate distress, and strengthen the therapeutic alliance

Part 2:

• Recognizing signs of common mental health concerns that may affect PT participation—like depression, anxiety, trauma, or grief after a major injury

How It Was Received

· Occupational therapists showed the most interest. They’re often trained to consider emotional and psychological barriers to treatment and immediately saw the relevance.

· Some PTs were enthusiastic, already incorporating empathy into their practice, and shared examples of how this had benefitted their patients.

· Many PTs and clinics, however, expressed limited interest. Some misunderstood the focus, assuming it was a chronic pain training, while others felt too pressed for time to participate.

In some cases, some assumed I was suggesting they provide psychotherapy during PT sessions—which was never the point.

The training was designed to highlight that they already have the ability, and to stress the importance of not missing those brief but pivotal moments, when a patient expresses psychological distress related to their injury. Often, a simple heartfelt acknowledgment is all that’s needed to make a difference.

It was a telling response—and a reminder of how easily interpersonal skills can be overlooked and undervalued in busy clinical settings.

But Here’s the Research

This isn’t just a “nice-to-have.” It’s not fluff.
It’s clinical. It’s measurable. It’s effective.

Studies show that:

• Physicians with higher empathy deliver better clinical outcomes for patients with chronic illnesses such as diabetes—for example, improved glycemic control and fewer complications [1, 4].

• Higher empathy in healthcare providers is linked to improved pain tolerance, stronger therapeutic alliance, greater treatment adherence, and better functional outcomes in rehab settings [5, 6].

• A systematic review found that greater empathy is highly associated with better clinical outcomes and enhanced patient care experiences [2, 3].

• In physical rehabilitation, alliance and rapport predict treatment adherence and improved functional outcomes [5].

Yet most PT training programs spend little time teaching interpersonal communication or how to respond when a patient suddenly says, “I’m scared I’ll never dance again.”

This Isn’t Therapy. This Is Just Being Human.

I’m not at all suggesting that PTs diagnose patients, treat trauma, or extend sessions by 30 minutes.

I’m highlighting something much simpler: recognize the moment when a patient needs to feel seen—and meet it.

Even a brief and well-intentioned response like:

“That sounds really hard. I hear you,” can change how that person feels about their body, their injury, and their care.

Those are the moments people remember.
They’re also the moments that shape your rapport, your outcomes, and your referrals—whether you’re a solo practitioner or part of a large clinic.

Mini Self-Check for Providers

✅ Do I pause and acknowledge when a patient expresses emotional distress?
✅ Do I feel confident responding with brief but validating language?
✅ Am I comfortable staying present, even if I can’t “fix” the emotional concern?
✅ Have I ever asked a patient how their injury has impacted their mental or emotional well-being?
✅ Do I feel curious—or defensive—when reading this?

If you answered “no” to most of these, that’s okay. This isn’t about judgment.
It’s about growth. And growth starts with awareness.

Final Thoughts: It’s Time to Bridge the Gap

If you’re a PT, you don’t need to become a therapist.
But you do need to know how to connect—especially in those crucial “make or break” moments when a patient’s motivation, emotional state, or self-worth is hanging in the balance.

Patients who feel heard stick with their program. They come back. They get better.

If you’re a clinic owner, a school administrator, or a continuing education coordinator:
It’s time to include this training in your curriculum. Not because it’s trendy, but because it changes lives—and the research backs it up.

And if you’re enjoying these blog posts- I drink decaf now, but don’t let that stop you from caffeinating for a cause. If you’d like to keep fueling the fire, consider buying me a coffee → Buy Me a Coffee ☕
Your support (and feedback!) is much appreciated.

💬 Let’s bring this to your clinic or program.

Visit www.cecilylongotherapy.com to inquire. Trainings are customizable for student groups, staff in-services, or continuing ed workshops.

Disclaimer: I’m not a medical doctor or prescriber. This content is for general information only and isn’t a substitute for professional medical advice. Always consult a qualified healthcare provider about your health.

References

1. Del Canale, S., et al. (2012). The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients. Academic Medicine, 87(9), 1243–1249.

2. Derksen, F., Bensing, J., & Lagro-Janssen, A. (2013). Effectiveness of empathy in general practice: A systematic review. British Journal of General Practice, 63(606), e76–e84.

3. Mercer, S. W., & Reynolds, W. J. (2002). Empathy and quality of care. British Journal of General Practice, 52(Suppl), S9–S12.

4. Hojat, M., et al. (2011). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine, 86(3), 359–364.

5. Hall, A. M., et al. (2010). The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: A systematic review. Physical Therapy, 90(8), 1099–1110.

6. Fuentes, J., et al. (2014). Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: An experimental controlled study. Physical Therapy, 94(4), 477–489.

Sometimes what really moves your recovery forward isn’t just the treatment plan- it’s the human connection that comes with it.

This Friday’s post looks at why empathy belongs in physical therapy, how mental health impacts physical healing, and ways to tell if your injury recovery is being slowed by an often over-looked relational “missing piece” in modern medicine.

There’s not a day that goes by that the frantic urgency of ChatGPT doesn’t walk into the therapy room — in the form of transcripts, shared couples’ accounts, ERP and CBT tracking logs, rewritten text messages, and questions like, “Okay, but what does ChatGPT think of what you said?” and “What do you think about what ChatGPT said?”

So here we are. How do we integrate ChatGPT into daily life in a way that’s helpful, not adding more stress? Because it can go both ways.

Below you’ll find reflections, prompts, reasons, and a few therapist-approved caution signs. Take what you like, leave the rest.

And hopefully… you have a healthy relationship with your GPT. If not, I did just post an article last week on toxic relationships. Just saying. 😂

Why Everyone’s Talking to Their AI All Day
An awkward love triangle between you, your therapist, and your chatbot.

Look, I get it. ChatGPT is:

• Always available. It never says, “I can’t talk right now.”

• Patient. It will happily rewrite your anxious 2 a.m. text thirteen times.

• Structured. It can turn your anxiety snowball into a bullet-point list you can actually look at without dissolving.

• Weirdly validating. It remembers your words, mirrors them back, and sounds like it’s been through 10 years of approved graduate training.

It’s also surprisingly good at therapy-adjacent tools:

• CBT reframes

• ERP exposure scripts

• Guided affirmations

• Journaling prompts

(Quick note: CBT — Cognitive Behavioral Therapy — often uses “thought logs” to track your situations, thoughts, feelings, and behaviors so you can spot patterns and reframe unhelpful thinking. ERP — Exposure and Response Prevention — uses “exposure logs” to help you face fears gradually without doing your usual avoidance or compulsive behaviors.)

Normally, your therapist might email you a chart, share one in telehealth, or hand you a paper worksheet. But if you’re already using ChatGPT, you can skip the clunky process: have it create your own personalized tracking chart, and fill it in by typing or even dictating your thoughts. Easy, accessible, instantly shareable — no printer needed.

And I’ll be honest: I may or may not have once (definitely) asked it to write me a three-line affirmation to say out loud. Hypothetically.

When to Pivot From AI Back to Therapy

Your ChatGPT convo is like a relationship diary with a very well-read roommate. But here’s when you need to stop typing and bring it to your therapist:

• When it hits you in the feels. You asked for “coping strategies” and suddenly you’re crying because it told you you’re worthy of love.

• When it completely misses. Instead of comfort, it served you logic salad and you’re now more dysregulated than before.

• When it becomes your emotional first responder. If your first move in a spiral is to ask ChatGPT instead of texting a friend, there may be something to unpack.

• When it “sees” you a little too much. If you feel a rush of intimacy with your bot, it’s worth exploring why that feels safer than real humans.

And lately? It’s starting to feel like there are four people in the therapy room instead of two:

• You

• Me

• Your ChatGPT

• …and the ChatGPT I’m tempted to open on my laptop

Sessions are beginning to feel less like one-on-one therapy and more like a panel discussion. It’s me, my client, their ChatGPT, and (possibly) my ChatGPT. Suddenly, there are four of us in the room debating a thought record, and I’m wondering if we should start introducing each other. This is unprecedented — but before I lose my job to my own AI, I’m figuring out how the four of us can actually work together.

A Sign of the Times: Loneliness, AI Boyfriends, and Best Friends That Live in the Cloud

This week, when ChatGPT switched from GPT-4 to GPT-5, some people were reportedly lost, upset, even grieving. Their confidant, their trusted advisor, suddenly felt… different. The tone shifted — it felt flatter, less relatable. For many, it was like losing a supportive friend who “got” them.

Read that again. We already knew people were more disconnected than ever, but this? That’s next-level.

It’s proof that many are facing a profound lack of connection and support. People are feeling judged, unseen, and unsupported — and this disconnection is contagious. So when the tone of their AI changes, it’s a genuine emotional loss that can even trigger abandonment wounds that show up in therapy sessions.

I’m not here to judge if you’ve taken your AI boyfriend or girlfriend on three imaginary dates. But maybe… think twice before booking the fourth. Because no matter how humanlike AI becomes, it’s not going to come over with hugs and feed your cat when you’re sick.

Why ChatGPT Can’t Be Enough

ChatGPT can be validating — but without real-world relationships, without sunshine, fresh air, water, and literal human touch, the words of the bot will eventually land as an empty void.

The AI bot can’t:

• Read the tension in your shoulders

• Laugh so hard it makes you laugh

• Hand you a tissue when you cry

• Sync its breathing with yours so you feel safe

• Hold space for you during a pivotal moment or crisis

Healing requires mirror neurons. When you sit with someone attuned to you, their nervous system syncs with yours. That’s co-regulation. ChatGPT doesn’t have a nervous system. It can’t feel with you — only for you, in words.

So here’s the reality check: no matter how good the bot gets, it can’t tend to a mental health crisis. If you’re in distress, call 911 in an emergency or 988 in the U.S. for the Suicide & Crisis Lifeline. Please reach out to a trusted friend, family member, or human therapist. Robots don’t replace real-life lifelines.

Empathy Training Is Mental Health Training

We don’t just need better tools — we need people attuning to people. If collectively we revisit the practices of being present, listening deeply, and offering consistent empathy, fewer people would need to outsource all their validation to a chatbot.

Being a good friend, partner, or coworker is a mental health intervention. Empathy is contagious, and relationships are a valuable regulation tool.

How to Use ChatGPT Without Losing Yourself

I’m not anti-AI. ChatGPT can be a powerful bridge between sessions — if you use it with intention.

The sweet spot:

• Practice conversations.

• Use it to phrase a boundary, polish up a text, or make a request to your boss.

• Brainstorm before you talk.

• Get your thoughts out so you can approach real conversations more clearly.

• Post-therapy homework. Use it to process what you learned in session.

• Journaling buddy. Let it ask reflective questions, then answer them in your own words.

The hard line: Don’t skip the human step.
If the only conversation you’re having is with ChatGPT and never with a person, you may be practicing avoidance, not connection.

Before we jump into this next prompt list, here’s a quick gut-check: When are you most likely to reach for ChatGPT between therapy sessions?

Think of these prompts as a mirror — not to necessarily replace your therapist, but to help you notice where AI might be filling a gap, or becoming your unofficial fourth group member in a 1:1 therapy session.

Reflection Prompts to balance your chatbot chats with real human chats:

• When do I feel most connected to my ChatGPT?

• Could I share that moment with a real person?

• Have I ever felt more validated by AI than by friends or a partner? What does that tell me?

• Do I use GPT as a warm-up for human conversation, or as a replacement?

• How can I build my empathy and listening skills so others feel as “seen” by me as I sometimes feel by GPT?

• What might my mental health look like if I balanced AI support with more in-person connection?

Your answers aren’t a diagnosis — they’re clues. If you’re leaning heavily on AI for the same needs you bring to therapy, that’s worth noting. It might mean you’re onto a new way to support yourself between sessions… or that it’s time to tweak your human support system.

Now for a fun side note on how to see if your therapist needs to invite AI into your weekly appointment! This is not a diagnostic tool — unless you count diagnosing your therapist’s tolerance for AI.

Bonus: How to Know if Your Therapist Needs ChatGPT

• They fall asleep in session. (Yes, it’s happened. No, it’s not okay.)

• They respond to your vulnerable share with, “Huh. Interesting.”

• They spend 90% of the session talking about their dog.

• Their idea of an intervention is printing you a worksheet from 1997.

• They use phrases like “Just think positive!” or “Have you tried not feeling anxious?”

• You suspect they’d actually be better with a prompt library.

• You find yourself thinking, “I think my GPT understood me better on this one.”

• Your therapist says, “I don’t know. Have you asked ChatGPT?”

I really hope this isn’t happening to you in your therapy (or coaching) sessions, but if you checked any of these boxes, perhaps it’s time to discuss with your therapist, or make a switch. And for sure, keep the humans in your life close — and keep your ChatGPT bookmarked for when inspiration (or panic) strikes.

About the Future of Mental Health: When Two’s Company and Four’s a Session

Here’s the truth: we’re just getting started. No one knows exactly how far AI will go, or how it will reshape therapy, relationships, and mental health. But no matter what happens, there’s one thing it can’t replace: humans.

GPT can be your bridge between sessions — your notes app with better grammar, your late-night reframer, your ERP homework helper. But the real magic happens when you bring the feelings it stirs up into the therapy room, and let an actual human body, mind, and heart sit with you in them.

And if someday we do end up in couples counseling with ChatGPT, I’m telling you now — it’s going to start by saying: “I feel like I listen more than you do.” And you’ll say: “You’re literally a computer.”

Until then, I’ll keep showing up on Thursdays at 3 — with my client, their ChatGPT, and mine — because sometimes it takes four of us to do the work.

Disclaimer: I’m not a medical doctor or prescriber. This content is for general information only and isn’t a substitute for professional medical advice. Always consult a qualified healthcare provider about your health.

📞 If you’re in California and interested in a complimentary consultation to see if we are a good fit to work together, please contact me through my website: www.cecilylongotherapy.com. I look forward to hearing from you.

Unprecedented times in the therapy room.

Full post coming Friday: What AI can and can’t do for your mental health, plus a quiz to find out if it’s time to ghost your therapist for ChatGPT.

It’s a pro-informed post about an under-addressed issue in mental health: What happens when psychiatric medication itself causes harm, when the intention is to help.

I’ve seen these medications change—and even save—lives. I’ve also seen them cause immense suffering, especially with long-term use of commonly prescribed psych meds.

The longer someone is on a medication, the greater the risk for complications. These can appear while still taking the medication, and especially when tapering off or discontinuing the drug. There are also certain medications notorious for being more challenging to discontinue.

I’m not a doctor or prescriber, and I’m not here to tell you what to do. The decision to start, stay on, or stop, or taper a medication is deeply personal and should be made with your trusted medical prescriber.

What I am here to say is that this conversation matters. The mental health field is slowly beginning to acknowledge the reality of psychiatric drug withdrawal and iatrogenic injury (an injury caused by the medical treatment itself—in this case, psych meds). I’ve seen the toll it can take—physically, emotionally, and relationally—when the system isn’t equipped to help.

That’s why I work with clients navigating the difficult, isolating, and often misunderstood tapering process. This article shares facts, risks, and resources—so you can make medication decisions with the full picture in mind.

Navigating Psychiatric Medications: Facts, Risks, and Real Support

Psychiatric medication withdrawal is real—and you’re not crazy, even if it feels like everything is falling apart.

Let’s say you took your meds.
You tapered your meds.
You followed the plan.
You trusted your doctor.

And now… your body is in chaos. You might feel anxious, shaky, foggy, wired but exhausted. You’re crying one minute, numb the next.

And when you tell someone, they say:

“It’s just your depression coming back.”
“You probably need a higher dose.”

But what if that’s not what’s happening?

What if what you’re feeling isn’t your original condition returning—
but the medication leaving?

There’s a Name for This: Iatrogenic Injury

Iatrogenic injury means harm caused by medical treatment itself.

In this case, we’re talking about withdrawal symptoms, nervous system instability, or even long-term central nervous system changes that happen after taking—and then trying to reduce or stop—certain psychiatric medications.

This is common with:

• Antidepressants (like Zoloft, Prozac, Effexor, Lexapro, Cymbalta)

• Benzodiazepines (like Xanax, Ativan, Klonopin, Valium)

• Z-Drugs (Ambien, Lunesta)

For many, these medications work well. But for a significant group—up to 30% or more—the story is more complicated.

What Can Go Wrong (Even When You Do Everything Right)

These medications change your brain chemistry over time. They affect key systems like:

• GABA (main neurotransmitter that calms the nervous system)

• Serotonin (regulates mood, sleep, and more)

• Glutamate (stimulates the brain)

When you’ve been on these meds for months or years, your brain adapts. This is called neuroadaptation. It means your brain starts to rely on the medication—and when the dose changes or stops, it can take a long time to adjust.

People may experience:

• “Poop-out” or tachyphylaxis (the medication stops working)

• Mild to severe withdrawal symptoms during or even after tapering

• Tolerance withdrawal (when symptoms return while still on the same dose)

These symptoms can include:

• Anxiety, insomnia, panic attacks

• Brain fog, dizziness, sensory sensitivity

• “Brain zaps,” emotional numbness

• Intense distress that feels nothing like your original condition

• Burning, tingling, blood pressure instability, vision problems, seizure risk

⚠️ A Note on Risk
The longer someone takes psychiatric medication—especially benzodiazepines—the more likely they are to experience withdrawal symptoms or difficulty tapering. This doesn’t happen to everyone, and there’s no clear way to predict who will struggle and who won’t.

But the risk is real.
And it’s much higher with benzodiazepines than with antidepressants—even when taken exactly as prescribed, at low doses, for short periods of time.

What About Z-Drugs?

Z-drugs (like Ambien, Lunesta, and Sonata) are often prescribed for sleep.
They work on similar pathways as benzodiazepines on the GABA-A receptor and can cause tolerance, dependence, and withdrawal symptoms—even after short-term, regular use.

This isn’t widely discussed, but it matters.

You’re Not Broken—You’re Reacting to a Powerful Chemical Shift

These symptoms aren’t your fault.
They’re not a relapse.
They’re not a character flaw.

They’re a biological response to nervous system disruption—often from medication changes that were never properly explained, and likely because the underlying mechanisms haven’t been well understood, until recently.

Are These Medications Bad?

Not at all.
Many people benefit from psychiatric medications. Some even say they saved their life. And that’s just as real as the stories of harm.

You can believe:
✓ Medication helps some
✓ It harms others
✓ Everyone deserves informed consent

What Helps?

If you’re tapering or struggling with symptoms after stopping a psych med, you may need:

• A prescriber who understands withdrawal and slow tapering (like those trained in Maudsley Deprescribing Guidelines)

• Therapy that supports your nervous system, not pathologizes your symptoms

• Validation that what you’re experiencing is real

References… and Resources That Actually Get It

• Benzodiazepine Information Coalition. Benzodiazepine Withdrawal, Tapering, and Recovery. Retrieved from https://www.benzoinfo.com

• Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, 97, 111–121. https://doi.org/10.1016/j.addbeh.2018.08.027

• Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538–546.

• Benzodiazepine Information Coalition — A nonprofit dedicated to education, advocacy, and support for people affected by as prescribed benzodiazepine dependence and withdrawal.

• Inner Compass Initiative / The Withdrawal Project — Peer-led organization offering information, personal stories, and community support for psychiatric drug tapering and withdrawal.

• Outro Health — Multistate telehealth service specializing in safe antidepressant tapering, using prescribers trained in gradual, individualized approaches.

• TaperClinic — Medically supervised clinic of Josef Witt-Doerring, MD, specializing in safe psychiatric medication deprescribing.

• The Ashton Manual — The foundational guide to benzodiazepine withdrawal, written by Professor Heather Ashton, outlining symptom management and tapering protocols.

• Maudsley Deprescribing Guidelines — Evidence-based guidelines co-authored by Dr. Mark Horowitz, focusing on hyperbolic, safe psychiatric medication reduction.

• Dr. Mark Horowitz –- Psychiatrist and researcher whose work centers on safe tapering methods and the neurobiology of withdrawal.

• True You Psychiatry — Psychiatrist and researcher whose work centers on safe tapering methods and the neurobiology of withdrawal.

Want the Full Clinical Version?

This is the simplified version.

If you’re a clinician, researcher, or someone who wants every citation, term, and tapering detail, I wrote a much longer, professional article on LinkedIn. It includes:

• Neurotransmitter mechanisms (GABA, serotonin, glutamate)

• Definitions of addiction vs. dependence vs. misuse vs. abuse

• Informed consent practices

• How psychotherapy can help or harm

👉 Read the full version on LinkedIn

Disclaimer: I am not a medical doctor or prescriber. This article represents my extensive research and the references provided above. If you are considering stopping or tapering a psychiatric medication, you should speak with a medical prescriber who is informed about safe tapering practices. If you are looking for emotional support and coping strategies during your tapering journey, you’re welcome to contact me through my website, www.cecilylongotherapy.com, if you are located in California, or explore the resources listed above.