#initially posted on Twitter

[lassify]

Is Twilight a good therapist?

[Spoilers for SxF Ch.77 if you haven't already read it!!]

I am a huge fan of seeing representation of what it's like to be in the therapy room, but there are always soooo many things that the media get wrong, and I really wanted to draw attention to Twilight's portrayal as a therapist. (This is coming from the POV of someone who works in a clinical setting in the UK/Scotland).

Before I get stuck in, I also want to make it clear that Psychiatrists and Psychologists are VERY different, and in this scene Twilight is very much acting as a Psychologist.

("What's the difference?" you may ask.

WELL:

It's easy. A Psychiatrist is trained as a medical doctor, specialising in mental disorders largely from a biology perspective, and they are qualified to prescribe drugs and medication.

A Psychologist on the other hand delivers talking therapies, and is trained to see mental health from multiple perspectives. Basically, exactly what we see Twilight doing in this scene!)

So, we have a spy who has received next to zero medical training and, as far as I can tell, has whizzed through textbooks in his spare time - no placements, no clinical training, no assessments or exams, no clinical supervisor to assist in reflection or case management.

So, how does he do?

Normalising responses to traumatic events ✅

Mr Austin has done the brave thing and turned up looking for help, and Twilight/Dr Forger responds by putting his problems into context, and normalising the experience for him. We love to see it. This is SO important to trauma-informed working.

2. Providing reassurance and expectations for recovery ✅

I love this even more because what Twilight is saying is true. Only 10% of people who experience a potentially traumatic event actually develop PTSD symptoms, and of those, 70% will recover within the year. Twilight is reiterating the message that acute trauma is absolutely recoverable.

3. Teaching and demonstrating coping skills ✅

It's not enough for clinicians to simply tell their patients about coping skills, it is essential to demonstrate them too. Bringing the practice of coping skills into the therapy room is so important for helping the patient to build their skills, and to build the therapeutic alliance as well.

Here, Twilight is teaching a simple breathing technique, but I would also commend him for teaching other coping skills: grounding, distraction, progressive muscle relaxation, visualisation, and more - although all/most of these rely on breath control as a foundation.

4. Encouraging guided self-help and making medical reccommendations ✅✅

Just trying a breathing exercise once does not make recovery easy. Twilight knows it's important to encourage patients to do this in their own time.

And, finally, we see him acting as a psychiatrist, and reccommending medication. (Although, let's temporarily ignore that as a spy he has NO TRAINING in psychopharmaceuticals).

5. Breaching confidentiality ❌ Confrontational approach ❌

Oh, Twilight... You have fucked up. Big time. This is the biggest fuck up of the entire session.

It's his SECOND session with this patient, and not only does he take a confrontational approach (putting Mr Austin on the defensive, definitely not conducive to a good therapeutic relationship), but he has BREACHED CONFIDENTIALITY. Depending on severity this is A FIREABLE OFFENCE (even in the UK!).

6. Positioning oneself as the 'expert' ❌ Telling the patient to confront their abuser❌ Not taking into account patient's readiness for change ❌

Oh HELL no. Absolutely not. Confronting fear is a delicate and lengthy process requiring many steps, and always checking in with the patient at every step of the way. It cannot go too fast.

The therapeutic relationship is an alliance, and it's important to empower the patient to make their own choices in therapy, especially if it's something that is a source of fear.

Not only that, but telling anyone to confront their abuser is straight up the worst advice ever. It's not safe.

6.5 Providing rationale and reassurance✅

Okay, I'll concede on this point. Twilight's rationale is sound: in the 'Cycle of Anxiety', Avoidance is a key factor in maintaining one's fear of something, and it is a core criterion in PTSD. Learning how to face a fear is really important to PTSD recovery.

And it's good that Twilight attempts to reassure Mr Austin's concerns.

7. Giving unsolicited relationship advice ❌

This is NOT your role, Twilight. You are outside the bounds of your job description. It's an admirable effort to connect with the patient, but, alas, not appropriate at this time.

8. Not taking risk into account ❌❌❌

This is a BIG one. It is not normal for a person to be so afraid of their spouse to be showing all the typical symptoms of a fight-or-flight fear response (sweating, shaking, racing thoughts, muscle tension, pupil dilation, etc.), and Twilight is missing some pretty obvious cues to indicate that Mr Austin is in a clearly unsafe situation.

HE IS LITERALLY TELLING YOU TO YOUR FACE!!

AND if its bad enough that Mr Austin can't even speak, that means his fear is bad enough to completely shut off his pre-frontal cortex (the centre of executive function, rational thought and decision making), which means that his fear is THAT bad. Add this up with the insomnia, chronic fatigue, frequent dissociation, irritability and mood swings, and suddenly it is bad enough to be considered a trauma response - and Twilight still doesn't question the source of this trauma.

Also, Twilight, you can afford to put the judgement aside. Please.

9. Facilitating an unsafe exercise ❌ Risking psychological safety ❌

Here Twilight is attempting a basic exercise inspired by exposure therapy (which Twilight is NOT trained in because he is a spy). While it is a therapy that has a decent evidence base, you don't to therapy to a patient, you do it with them, i.e. it's a process that needs to have a clear goal with informed consent.

In this instance, Twilight didn't prepare Mr Austin for the exercise, and he ended up in an actual flashback with very high levels of emotional distress. Unsafe.

And, again, psychiatrists do not typically deliver talk therapy - that is the job of psychologists.

Conclusion

Why did I make this thread?

I'm really happy that Endo put in the effort to illustrate a really interesting therapy session, bringing psychology and trauma into the forefront. These are sensitive topics and I applaud Endo for giving a really complex topic airtime, and doing the research into what a proper therapy session looks like - because, for all my criticisms here, it is a pretty decent represention of what therapy can look like. [Especially the good bits!]

I also think this scene/chapter alone does a great job of reducing the stigma of seeking help for mental illness. It's great to see in mainstream media, especially something as popular as Spy x Family, since Japan does have a high suicide rate and intense stigma for those suffering from mental illness.

However, I still felt the criticisms of Twilight's therapy session were important to voice.

We cannot forget that he is not a trained clinician. He is there to gather information on his patients and their families and connect him to the upper classes, which explains his confrontational approach and disregard to psychological safety.

As much as Twilight has truly absorbed the psychiatry textbooks and committed their content to memory, the effects of the lack of training is obvious, showing up as major errors in his clinical practice - some of which could get him fired in today's system.

TL;DR Twilight is a GREAT spy. But a therapist? Not your calling, my friend.

[incredubious]

MODERN AU ACESAN !!!! first impressions with a guy who barely passes the No Shoes No Shirt No Service rule

[ca-3]

RIP CHAIR-KUN 💔

(I got my persona mini figures the other day but Joker's chair was the only one that broke ..)

[akiacia]

post-credit domestics (⚠️ mildly saucy doodles below the cut)

[kimodraw]

yet ANOTHER op dump ive been drawing them so much to keep away from the horrors (waiting for an answer abt a dream internship)

[rouxboo]

yall ever have a breakup so messy that you start hunting each other's offspring in asymmetrical multiplayer horror action games

[midosune]

I've missed drawing dick....

[krazieka2]

older secret santa Lorenz/Lysithea comic drawn for Hotzo Thotzo on twitter! I still think it's cute!

[paperleef]

Hey it’s pride month you know what that means—based on @pridemonthpromptfest’s Sherlock & co

Here’s Red and Orange!

I did them by color instead of individual prompts so I tried incorporating more than one prompt based on its color

[crowrrupt]

It's like I'm drowning, as if I've lost the way

[birichardswift]

This was very cool. The shop was great too, and I was able to fill in some of the gaps in my Infinity Inc. collection.

[tinyfuh]

clownpiece eating a burger

[fumblemoon]

Long time, no Shadowgast 💕

[poepill]

happy belated valentines day quodo upon thee! originally posted on ao3 for the quodo minifest, this was my valentines for @chacusha, who organized the event! i had a ton of fun drawing them and im definitely looking forward to next year <333

+ bonus art based on the comic by Kate Beaton, Javert is in Slash Fiction:

[chemical-misfit-maiden]

Tama and the aiber

[vanmarkus]

Wip Wednesday 🎄

I was tagged by the ever so lovely @daffi-990 @thewolvesof1998 @jamespearce9-1-1 @hippolotamus @exhuastedpigeon and @rainbow-nerdss mwuah 💛

Welp a little later than usual but here I am! And uh apparently I added another Christmas fic to the pile because why not lmao but it's just a real short one and I'm aiming for it to be posted this week. 🫡

He was just about to decide what kind of disgustingly greasy takeout food to order, when the door clicked open behind his back.

He turned to see— Eddie. Because of course it was Eddie.

“Hey,” he said gently, shutting the door behind himself and Buck knew it was a little irrational right now, but it still warmed his heart that Eddie came and went like this; that he knew no matter what, he was always welcome here.

“Hi.” Buck gave him a weak smile over the brim of his beer bottle, unsure of what to expect.

“I just wanted to see if you were okay.”

“Why, did uh did I not seem okay?” Buck scoffed, just falling short of casual.

Eddie averted his gaze almost guiltily before pinning Buck with a knowing look. “No.”

“Yeah, I guess that’s fair.” Buck took a long swig of his beer with a grimace.

“You know it doesn’t change anything, right?”

“Uh no, Eddie, I really don’t know that.” Buck drawled and put the bottle down on the counter top with a loud clink.

“Bu—”

“Eddie, you’re leaving the 118. That- that literally changes everything!” He spread his arms widely, as if he could indicate just how much of that everything covered.

✨no pressure tagging: @malewifediaz @spagheddiediaz @jeeyuns @ladydorian05 @disasterbuckdiaz @jesuisici33 @steadfastsaturnsrings @eowon @heartshapedvows @nmcggg @watchyourbuck @eddiebabygirldiaz @theotherbuckley @fortheloveofbuddie