Musings by Patrick Turbiville, LCSW-S, IEDS

Below you will find various musings about topics related to mental health, psychotherapy, and social issues influencing both.

My hope is that readers will get a better idea of how I approach my work as a psychotherapist, and maybe some perspectives that can be usefully applied in daily life.

September 28, 2025

Anticipation Anticipation

A disappointed woman at a kitchen table stares at her partner, faced away from her doing dishes. She has a thought bubble above her head, showing that she would like a hug.

It's not a typo. Waiting for people to anticipate our needs is a recipe for disappointment.

August 29, 2025

Convergence of Deterrents

An image with inverted colors of a fat woman in yoga pants and a crop top sits cross legged with a defeated and anxious look on her face. Red arrows are surround her, represent deterrents to making change.

Accumulated challenges can combine to make desirable change exponentially more difficult.

August 19, 2025

Allostatic Load

A black man with a transparent backpack full of stones strains to climb stairs, representing the effects of allostatic load.

Allostatic load is a physiological phenomenon where persistent stressors negatively impact health.

Values Aligned Defenses

A woman with a calm and determined expression, eyes forward, with painted, impressionist arrows meeting at the center of her face, one a vibrant green and one a chaotic mixture of red and black.

Defense mechanisms can align with values in helpful ways when combined with a variety of diverse defenses.

Work-related Rumination is Free Labor

A black woman with braided hair holds her head in your heads, with closed eyes and furrowed brow. Shapes swirl around her head, symbolizing stressful thoughts about work.

Viewing work-related rumination as free labor can help reduce rumination and reclaim free time.

Codependence: A Definition

A codependent couple, wearing black and standing in front of grey clouds, look away from each other, bound together by handcuffs.

Defense mechanisms can align with values in helpful ways when combined with a variety of diverse defenses.

Repetition Compulsion

A Latino man with purple and blue hair wipes tears from his face. He has a circular arrow tattoo on his forehead, symbolizing repetition compulsion. His girlfriend, in a tank top with a chest tattoo, stands behind him with arms crossed and a stern face.

Understanding repetition compulsion can enable us to choose better relationships in the future.

Safety in Connection

Two women, an Arab woman in a hijab and an older white woman in a dress, float in the sky in a lightning storm. They reach out to each other for safety, but are reluctant for their hands to touch.

Seeking safety in connection can change how we view and experience important relationships.

Motivation: The Largest Achievable Step

A three dimensional stick figure crosses a pond by hopping from one lily pad to the next.

We can build motivation by identifying the largest achievable step toward completing a daunting task.

Implicit Memory

A bald man with a salt and pepper beard looks onto the street from the sidewalk in a city. Indistinct images float behind his head, representing implicit memories.

Understanding implicit memory helps when anxiety is bigger than the situation we're reacting to.

Well-being & Physical Environment

A young woman with headphones over pink hair sits on a green polka dot blanket in a field, under blue skies and surrounded by trees. Squirrel approaches her as she watches birds flying in the background.

Awareness of the impact of physical environment on well-being enables us to make rewarding changes.

Political Angst

A man on stage stands behind a podium screaming and waving his arms. A woman in the back of the room watches with an anxious look on her face.

The impact of political events is very real, sometimes severe, and survivable with self-care and community.

Mental Health Stigma

A man sits at a table in a dark room with his face buried in his harms. Three men look down at him with looks of judgment and disgust.

There are many sources of mental health stigma and we have the power to choose our beliefs about mental health.

Starting Psychotherapy

A Japanese American woman and an Black man with grey hair and beard sit across from each other in chairs enjoying their first psychotherapy session. There are paintings on the wall behind them.

Scheduling a first therapy session is a momentous step and patience pays off early in the therapy process.

The Central Relational Paradox

A cartoon of an anxious high school girl feeling left out as she watches a group of girls from a distance. They are having fun as they ignore her, hanging out in the hall by their lockers.

Trying to fit in can lead to more anxiety and less satisfying relationships.

A Latina woman with earrings, a necklace, and jean jacket stands in front of a brick wall screaming "You're not the boss of me!" while experiencing reactance.

Improve motivation by responding to reactance with gentle self-kindness.

Deep Breathing

A Chinese American man with short hair and a green hoodie sits in a forest, exhaling after taking a deep breath.

A simple approach to deep breathing can soothe anxiety when other coping strategies are hard to remember.

Listeners, Doers & Distractors

Two women offer emotional comfort to each other at a kitchen table, a white woman with lots of tattoos and blue hair and a black woman with green hair.

Identifying people as listeners, doers, or distractors is a useful tool when asking for or offering help.

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