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Psychologists Describe The Most Difficult Patients To Work With

This is why therapists have therapists...

There are so many people in need of assistance and we often tend to forget that the people helping us figure out our fractured psyches. They carry the burden of the patients pain and rage long after a session.

Redditor u/bondmemebond wanted to give psychologists a chance to shake it off a bit by asking.... Psychologists/psychiatrists of Reddit, what patients are usually the hardest to work with and why? [Serious]


You know, I've come to think of mental illness as being something like a person being encased in blue glass, when the outside world looks at that person they see them through the glass and so see them as being blue, but when that person looks at the outside world, everything but them is blue. In this way, most mental illnesses have an internal way for the sufferer to conceptualize them and an externalized way of conceptualizing them that projects internal qualities onto surroundings.

A paranoid person generally does not experience themselves as a paranoid person, rather they experience society as conspiratorial and dangerous. In much the same way a depressed person may not experience themselves as depressed, but will externalize that in the form of life being worthless, people being cruel, etc. Often we make a mistake in educating people about mental illness by focusing too much on what it looks like, as opposed to what it feels like from within, and perhaps that makes it harder for people to recognize signs of mental illness in themselves.

So, rather than pick a specific pathology or diagnosis and say that that is the "worst" one, I think it would be more accurate to say that people across all diagnoses who don't or can't recognize that they have a problem and can only project their condition onto their surroundings, always have worse outcomes and will benefit less from interventions. Psychiatrically often times the goal is to tip the scale just enough so that you can enable that shift in someone where they do have the increased self-awareness or objectivity to have that insight.



I know psychiatric nurses who always found the ones with personality disorder really tough. They said there was a lot of manipulation there in conversation, which made it incredibly difficult to know how much progress you were making, if any.



Personally I worked in inpatient mental health facilities and I found the patients with personality disorders the hardest to work with because they can be so manipulative- they can make you feel like you're failing them because you don't care and you're a bad person. I had the insight to recognize that I couldn't personally handle personality disorders and so left that line of work.

I never found patients with paranoia, schizophrenia, bipolar etc too hard to work with because their distrust of you is more understandable- its self preservation.

In personality disorders (e.g. EUPD), patients can make you feel like they trust you and are confiding in you only to turn around and verbally cut you down. I couldn't leave that sh!t at the door, I would go home feeling like I failed them and myself. It was tough. It's also really tough because it's hard to tell if you're making progress, and the feeling that these people will never get better stays with you.

I did a full 180° and I'm much happier cutting out organs now!



Depends on the clinician. I think depressed people with low motivation are the hardest to treat. I love working with people with OCD, but I have colleagues who feel the opposite.


I had a doctor that specialized in OCD and anxiety disorders. I saw him for general anxiety disorder and panic disorder.

I was extremely motivated and with his help (and medication), I was able to graduate from therapy in about 4 or 5 months. I owe my quality of life to him and think about him often even though he treated me 3 years ago.



Psych nurse here. Staff splitting, really getting personal in their verbal attacks on you, always looking for an edge. And often they are my favorite patients, too, because they can be great. But it's hard. If a schizophrenic calls me an ugly witch, eh well, no big deal. If someone with a personality disorder calls me an ugly witch, it's usually followed up with minute details, often something I'm self conscious about. We're human too, it's hard to ignore.



Those who benefit from their disease in my experience, for example Munchausen. They tend to get to the point where they don't like where they are in life (for example loneliness), so they get help, then realize that if their life will improve, the help will disappear. They don't want that. So they start playing a game of cat and mouse. Throwing little breadcrumbs saying things are going better, only for it to magically become worse again.

In which this pattern repeats multiple times. You usually notice somewhere halfway treatment cause no progress is made.

As opposed to my colleagues here, I do not find those with Borderline to be that particularly difficult. You just gotta be very upfront with them. One interaction with a client of mine went as followed: "stop lying to me Karen and tell me what really is up" - "yea yea... I know... I know... "



My mom had a hard time with people who had borderline personality disorder. These people are very insecure and can treat you badly in their efforts to seem superior and well-adjusted. Yet when you set limits or call them out, they get defensive and often angry. Some will even act out by harming themselves or others.

Borderline personality disorder is generally regarded among psychiatrists as very difficult to help someone with. Not recommended for inexperienced doctors.



Help Rejecters are the toughest in my opinion. They might even cognitively understand their predicament, they know you are trying to help, and they start out seeking help but then reject it. Then the cycle begins again. It requires a lot of energy and time investment to show them how genuine you are, and even then it doesn't always lead to a positive outcome.



Borderline personality disorder (though I have only worked with them as parents of my actusl patients) If you can even get them to show up to the appointments, they usually have very little capacity to reflect on their own actions and how it affects how other people react to them, usually blame everything on everyone else, take zero responsibilities for their actions and demand an awful lot of you in terms of "fixing" their kids.



A lot of people mentioned people with personality disorders- especially borderline, as patients they find difficult. I have found them much easier after attending an APA conference a couple years ago where a speaker was describing how for people with borderline everything can feel very unsure and chaotic and all their emotions feel very intense.

The speaker really liked the "emotion disregulation disorder" instead of borderline because it was actually explaining something about it. Thinking about it this way really helped me. Especially as someone who at times met enough to be diagnosed with BPD ( I don't now, it was due to a lot of attachment trauma in my childhood that lots of therapy and secure attachments have solved.

I would say I have a hard time working with patients I can't communicate with well. But it's mostly because I feel like I am being a bad doctor by not being able to connect or be able to work well with what I am able to understand of what is going on for them.



Psychopaths. They have no desire or intent to change their behavior, they don't care about you or others, and they are harmful or even dangerous. There's nothing to empathize with because they have no empathy themselves, and there's nothing to work with.

They are the predator, and everyone else, including you, is the prey.



Borderline, Narcissistic, and Antisocial personality disorders.

My reason for this opinion is that these folks have one pathway that every single stimulus follows as it enters their brain... eyes, ears, taste, all the senses. That pathway goes directly to the place where they try to figure out how to use every situation to get what they want. There is no empathy. There is no concern for others. There is no genuine humanity. There is only "I want" repeated over and over.

The impulse is virtually impossible to treat because the treatment effect goes to the same place. Some believe that Dialectic Behavior Therapy can work. I disagree. The pathway remains regardless what anyone does or says. Being held accountable for dysfunctional comments or actions doesn't make a bit of difference. In the end, they go back to their impulse. The only strategy I have seen that works even a smidgen is to teach them how to get what they want without hurting other people. Even then, it is still about getting what they want.

I am quite sure that my colleagues will disagree with this opinion. Remember it is just that... anecdotal and my opinion.

Life and relationships are about give and take, sacrifice and intimacy, love and belonging. To some degree we all want what we want. But we also give of ourselves and cry at the movies and love little children. These integral emotional parts of living aren't possible for some people. It's good to know that before you get involved.

Only my opinion.



Psych ward....

-Some girl thought she was a werewolf and would wander up and down the halls all night howling

-Another girl would walk inside of the toilet, like literally in the toilet, then complain about not being allowed to wear wet socks

-A lot of people wanting to start fights with each other

The main thing I remember was this overwhelming sense that things weren't going to get better for a lot of these people, which made me really sad.



I think the realization that a lot of the people aren't going to get better, voluntarily or not, was really bad. I know there was one kid weaning off his insomnia meds and he would just start singing in the middle of the night. Wild stuff.



This was early on in training but a mandated client had dropped acid before the session and it started coming on while we were talking - he didn't want to be there as it was and was much larger than me (5'0"). Once he got to threatening me for being the reason everything was wrong with the world I ended up needing to get up and leave my own office to get a supervisor. I definitely thought he would hit and/or strangle me if I stayed.



Used to be a therapist at a behavioral health hospital. I had some patients who genuinely scared me in theory, but nothing ever happened with them. I was significantly attacked twice at work. Both patients were young women. Neither of them "scared" me beforehand. Both were incredibly quiet, withdrawn, and unassuming. One strangled me with my keys- my lanyard was a breakaway for that very reason, but she had tried to steal them several times that shift in attempt to escape the building and run into traffic, so I stupidly knotted off the breakaway portion. We carried panic buttons on the lanyards and I was able to press it while being strangled with it.

The other attack occurred when I was fairly new and on a low-security unit, in view of other staff. I was walking away from the patient and she grabbed me by my hair, pulled me to the ground, and dragged me for several feet down the hallway where she began kicking me in the chest and stomach. She was sent to a higher security unit as a result. I guess I was afraid of her after that, but she wasn't there long. There was law enforcement intervention after she assaulted a pregnant nurse, pulled her to the ground as well, and stomped on her stomach.



The only one I have felt a little scared of was one who threatened to kill me. I knew she meant it. She had already assaulted a number of other staff. She got sent to a higher security ward and I heard she had broke staff's fingers first day she was there.

She held staff and other patients hostage in one of our rooms threatening them but circling the table as if playing with them first. I see violence and aggression regularly and it doesn't phase me but she did. I would purposely avoid eye contact and look straight ahead avoiding her and pretend I wasn't intimidated, as that's what she wanted.



My SO (mental health nurse) tells me that BPD (Borderline Personality Disorder) is very difficult to work with, because while it's a totally legitimate disorder, it often presents as someone being a brat.



I used to work with multi-disabled youth in a school. We had to sign a waiver that we wouldn't press charges or sue or anything the school, the students, or the other staff while working there. I could have sued at least two students (concussion/whiplash/bites/sexual assault...). I left after needing to be taken to the ER a 2nd time.



I am encouraged by some of the new research with psychedelics etc (disclaimer I am not advocating them for anyone, merely saying they look promising in the research) but it is nice to have something new for non-talk/behavior therapy. Metacognitive therapy is also promising as an effective variant of CBT that I have also found compelling. I wish you all the best.


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People Reveal The Weirdest Thing About Themselves

Reddit user Isitjustmedownhere asked: 'Give an example; how weird are you really?'

Let's get one thing straight: no one is normal. We're all weird in our own ways, and that is actually normal.

Of course, that doesn't mean we don't all have that one strange trait or quirk that outweighs all the other weirdness we possess.

For me, it's the fact that I'm almost 30 years old, and I still have an imaginary friend. Her name is Sarah, she has red hair and green eyes, and I strongly believe that, since I lived in India when I created her and there were no actual people with red hair around, she was based on Daphne Blake from Scooby-Doo.

I also didn't know the name Sarah when I created her, so that came later. I know she's not really there, hence the term 'imaginary friend,' but she's kind of always been around. We all have conversations in our heads; mine are with Sarah. She keeps me on task and efficient.

My mom thinks I'm crazy that I still have an imaginary friend, and writing about her like this makes me think I may actually be crazy, but I don't mind. As I said, we're all weird, and we all have that one trait that outweighs all the other weirdness.

Redditors know this all too well and are eager to share their weird traits.

It all started when Redditor Isitjustmedownhere asked:

"Give an example; how weird are you really?"

Monsters Under My Bed

"My bed doesn't touch any wall."

"Edit: I guess i should clarify im not rich."

– Practical_Eye_3600

"Gosh the monsters can get you from any angle then."

– bikergirlr7

"At first I thought this was a flex on how big your bedroom is, but then I realized you're just a psycho 😁"

– zenOFiniquity8

Can You See Why?

"I bought one of those super-powerful fans to dry a basement carpet. Afterwards, I realized that it can point straight up and that it would be amazing to use on myself post-shower. Now I squeegee my body with my hands, step out of the shower and get blasted by a wide jet of room-temp air. I barely use my towel at all. Wife thinks I'm weird."

– KingBooRadley


"In 1990 when I was 8 years old and bored on a field trip, I saw a black Oldsmobile Cutlass driving down the street on a hot day to where you could see that mirage like distortion from the heat on the road. I took a “snapshot” by blinking my eyes and told myself “I wonder how long I can remember this image” ….well."

– AquamarineCheetah

"Even before smartphones, I always take "snapshots" by blinking my eyes hoping I'll remember every detail so I can draw it when I get home. Unfortunately, I may have taken so much snapshots that I can no longer remember every detail I want to draw."

"Makes me think my "memory is full.""

– Reasonable-Pirate902

Same, Same

"I have eaten the same lunch every day for the past 4 years and I'm not bored yet."

– OhhGoood

"How f**king big was this lunch when you started?"

– notmyrealnam3

Not Sure Who Was Weirder

"Had a line cook that worked for us for 6 months never said much. My sous chef once told him with no context, "Baw wit da baw daw bang daw bang diggy diggy." The guy smiled, left, and never came back."

– Frostygrunt


"I pace around my house for hours listening to music imagining that I have done all the things I simply lack the brain capacity to do, or in some really bizarre scenarios, I can really get immersed in these imaginations sometimes I don't know if this is some form of schizophrenia or what."

– RandomSharinganUser

"I do the same exact thing, sometimes for hours. When I was young it would be a ridiculous amount of time and many years later it’s sort of trickled off into almost nothing (almost). It’s weird but I just thought it’s how my brain processes sh*t."

– Kolkeia

If Only

"Even as an adult I still think that if you are in a car that goes over a cliff; and right as you are about to hit the ground if you jump up you can avoid the damage and will land safely. I know I'm wrong. You shut up. I'm not crying."

– ShotCompetition2593

Pet Food

"As a kid I would snack on my dog's Milkbones."

– drummerskillit

"Haha, I have a clear memory of myself doing this as well. I was around 3 y/o. Needless to say no one was supervising me."

– Isitjustmedownhere

"When I was younger, one of my responsibilities was to feed the pet fish every day. Instead, I would hide under the futon in the spare bedroom and eat the fish food."

– -GateKeep-

My Favorite Subject

"I'm autistic and have always had a thing for insects. My neurotypical best friend and I used to hang out at this local bar to talk to girls, back in the late 90s. One time he claimed that my tendency to circle conversations back to insects was hurting my game. The next time we went to that bar (with a few other friends), he turned and said sternly "No talking about bugs. Or space, or statistics or other bullsh*t but mainly no bugs." I felt like he was losing his mind over nothing."

"It was summer, the bar had its windows open. Our group hit it off with a group of young ladies, We were all chatting and having a good time. I was talking to one of these girls, my buddy was behind her facing away from me talking to a few other people."

"A cloudless sulphur flies in and lands on little thing that holds coasters."

"Cue Jordan Peele sweating gif."

"The girl notices my tension, and asks if I am looking at the leaf. "Actually, that's a lepidoptera called..." I looked at the back of my friend's head, he wasn't looking, "I mean a butterfly..." I poked it and it spread its wings the girl says "oh that's a BUG?!" and I still remember my friend turning around slowly to look at me with chastisement. The ONE thing he told me not to do."

"I was 21, and was completely not aware that I already had a rep for being an oddball. It got worse from there."

– Phormicidae

*Teeth Chatter*

"I bite ice cream sometimes."


"That's how I am with popsicles. My wife shudders every single time."


Never Speak Of This

"I put ice in my milk."


"You should keep that kind of thing to yourself. Even when asked."

– We-R-Doomed

"There's some disturbing sh*t in this thread, but this one takes the cake."

– RatonaMuffin

More Than Super Hearing

"I can hear the television while it's on mute."

– Tira13e

"What does it say to you, child?"

– Mama_Skip


"I put mustard on my omelettes."

– Deleted User


– NotCrustOr-filling

Evened Up

"Whenever I say a word and feel like I used a half of my mouth more than the other half, I have to even it out by saying the word again using the other half of my mouth more. If I don't do it correctly, that can go on forever until I feel it's ok."

"I do it silently so I don't creep people out."

– LesPaltaX

"That sounds like a symptom of OCD (I have it myself). Some people with OCD feel like certain actions have to be balanced (like counting or making sure physical movements are even). You should find a therapist who specializes in OCD, because they can help you."

– MoonlightKayla

I totally have the same need for things to be balanced! Guess I'm weird and a little OCD!

Close up face of a woman in bed, staring into the camera
Photo by Jen Theodore

Experiencing death is a fascinating and frightening idea.

Who doesn't want to know what is waiting for us on the other side?

But so many of us want to know and then come back and live a little longer.

It would be so great to be sure there is something else.

But the whole dying part is not that great, so we'll have to rely on other people's accounts.

Redditor AlaskaStiletto wanted to hear from everyone who has returned to life, so they asked:

"Redditors who have 'died' and come back to life, what did you see?"


Happy Good Vibes GIF by Major League SoccerGiphy

"My dad's heart stopped when he had a heart attack and he had to be brought back to life. He kept the paper copy of the heart monitor which shows he flatlined. He said he felt an overwhelming sensation of peace, like nothing he had felt before."



"I had surgical complications in 2010 that caused a great deal of blood loss. As a result, I had extremely low blood pressure and could barely stay awake. I remember feeling like I was surrounded by loved ones who had passed. They were in a circle around me and I knew they were there to guide me onwards. I told them I was not ready to go because my kids needed me and I came back."

"My nurse later said she was afraid she’d find me dead every time she came into the room."

"It took months, and blood transfusions, but I recovered."


Take Me Back

"Overwhelming peace and happiness. A bright airy and floating feeling. I live a very stressful life. Imagine finding out the person you have had a crush on reveals they have the same feelings for you and then you win the lotto later that day - that was the feeling I had."

"I never feared death afterward and am relieved when I hear of people dying after suffering from an illness."



The Light Minnie GIF by (G)I-DLEGiphy

"I had a heart surgery with near-death experience, for me at least (well the possibility that those effects are caused by morphine is also there) I just saw black and nothing else but it was warm and I had such inner peace, its weird as I sometimes still think about it and wish this feeling of being so light and free again."


This is why I hate surgery.

You just never know.



"More of a near-death experience. I was electrocuted. I felt like I was in a deep hole looking straight up in the sky. My life flashed before me. Felt sad for my family, but I had a deep sense of peace."



"Nursing in the ICU, we’ve had people try to die on us many times during the years, some successfully. One guy stood out to me. His heart stopped. We called a code, are working on him, and suddenly he comes to. We hadn’t vented him yet, so he was able to talk, and he started screaming, 'Don’t let them take me, don’t let them take me, they are coming,' he was scared and yelling."

"Then he yelled a little more, as we tried to calm him down, he screamed, 'No, No,' and gestured towards the end of the bed, and died again. We didn’t get him back. It was seriously creepy. We called his son to tell him the news, and the son said basically, 'Good, he was an SOB.'”



"My sister died and said it was extremely peaceful. She said it was very loud like a train station and lots of talking and she was stuck in this area that was like a curtain with lots of beautiful colors (colors that you don’t see in real life according to her) a man told her 'He was sorry, but she had to go back as it wasn’t her time.'"


"I had a really similar experience except I was in an endless garden with flowers that were colors I had never seen before. It was quiet and peaceful and a woman in a dress looked at me, shook her head, and just said 'Not yet.' As I was coming back, it was extremely loud, like everyone in the world was trying to talk all at once. It was all very disorienting but it changed my perspective on life!"


The Fog

"I was in a gray fog with a girl who looked a lot like a young version of my grandmother (who was still alive) but dressed like a pioneer in the 1800s she didn't say anything but kept pulling me towards an opening in the wall. I kept refusing to go because I was so tired."

"I finally got tired of her nagging and went and that's when I came to. I had bled out during a c-section and my heart could not beat without blood. They had to deliver the baby and sew up the bleeders. refill me with blood before they could restart my heart so, like, at least 12 minutes gone."


Through the Walls

"My spouse was dead for a couple of minutes one miserable night. She maintains that she saw nothing, but only heard people talking about her like through a wall. The only thing she remembers for absolute certain was begging an ER nurse that she didn't want to die."

"She's quite alive and well today."


Well let's all be happy to be alive.

It seems to be all we have.

Man's waist line
Santhosh Vaithiyanathan/Unsplash

Trying to lose weight is a struggle understood by many people regardless of size.

The goal of reaching a healthy weight may seem unattainable, but with diet and exercise, it can pay off through persistence and discipline.

Seeing the pounds gradually drop off can also be a great motivator and incentivize people to stay the course.

Those who've achieved their respective weight goals shared their experiences when Redditor apprenti8455 asked:

"People who lost a lot of weight, what surprises you the most now?"

Redditors didn't see these coming.

Shiver Me Timbers

"I’m always cold now!"

– Telrom_1

"I had a coworker lose over 130 pounds five or six years ago. I’ve never seen him without a jacket on since."

– r7ndom

"140 lbs lost here starting just before COVID, I feel like that little old lady that's always cold, damn this top comment was on point lmao."

– mr_remy

Drawing Concern

"I lost 100 pounds over a year and a half but since I’m old(70’s) it seems few people comment on it because (I think) they think I’m wasting away from some terminal illness."

– dee-fondy

"Congrats on the weight loss! It’s honestly a real accomplishment 🙂"

"Working in oncology, I can never comment on someone’s weight loss unless I specifically know it was on purpose, regardless of their age. I think it kind of ruffles feathers at times, but like I don’t want to congratulate someone for having cancer or something. It’s a weird place to be in."

– LizardofDeath

Unleashing Insults

"I remember when I lost the first big chunk of weight (around 50 lbs) it was like it gave some people license to talk sh*t about the 'old' me. Old coworkers, friends, made a lot of not just negative, but harsh comments about what I used to look like. One person I met after the big loss saw a picture of me prior and said, 'Wow, we wouldn’t even be friends!'”

"It wasn’t extremely common, but I was a little alarmed by some of the attention. My weight has been up and down since then, but every time I gain a little it gets me a little down thinking about those things people said."

– alanamablamaspama

Not Everything Goes After Losing Weight

"The loose skin is a bit unexpected."

– KeltarCentauri

"I haven’t experienced it myself, but surgery to remove skin takes a long time to recover. Longer than bariatric surgery and usually isn’t covered by insurance unless you have both."

– KatMagic1977

"It definitely does take a long time to recover. My Dad dropped a little over 200 pounds a few years back and decided to go through with skin removal surgery to deal with the excess. His procedure was extensive, as in he had skin taken from just about every part of his body excluding his head, and he went through hell for weeks in recovery, and he was bedridden for a lot of it."

– Jaew96

These Redditors shared their pleasantly surprising experiences.


"I can buy clothes in any store I want."

– WaySavvyD

"When I lost weight I was dying to go find cute, smaller clothes and I really struggled. As someone who had always been restricted to one or two stores that catered to plus-sized clothing, a full mall of shops with items in my size was daunting. Too many options and not enough knowledge of brands that were good vs cheap. I usually went home pretty frustrated."

– ganache98012

No More Symptoms

"Lost about 80 pounds in the past year and a half, biggest thing that I’ve noticed that I haven’t seen mentioned on here yet is my acid reflux and heartburn are basically gone. I used to be popping tums every couple hours and now they just sit in the medicine cabinet collecting dust."

– colleennicole93

Expanding Capabilities

"I'm all for not judging people by their appearance and I recognise that there are unhealthy, unachievable beauty standards, but one thing that is undeniable is that I can just do stuff now. Just stamina and flexibility alone are worth it, appearance is tertiary at best."

– Ramblonius

People Change Their Tune

"How much nicer people are to you."

"My feet weren't 'wide' they were 'fat.'"

– LiZZygsu

"Have to agree. Lost 220 lbs, people make eye contact and hold open doors and stuff"

"And on the foot thing, I also lost a full shoe size numerically and also wear regular width now 😅"

– awholedamngarden

It's gonna take some getting used to.

Bones Everywhere

"Having bones. Collarbones, wrist bones, knee bones, hip bones, ribs. I have so many bones sticking out everywhere and it’s weird as hell."

– Princess-Pancake-97

"I noticed the shadow of my ribs the other day and it threw me, there’s a whole skeleton in here."

– bekastrange

Knee Pillow

"Right?! And they’re so … pointy! Now I get why people sleep with pillows between their legs - the knee bones laying on top of each other (side sleeper here) is weird and jarring."

– snic2030

"I lost only 40 pounds within the last year or so. I’m struggling to relate to most of these comments as I feel like I just 'slimmed down' rather than dropped a ton. But wow, the pillow between the knees at night. YES! I can relate to this. I think a lot of my weight was in my thighs. I never needed to do this up until recently."

– Strongbad23

More Mobility

"I’ve lost 100 lbs since 2020. It’s a collection of little things that surprise me. For at least 10 years I couldn’t put on socks, or tie my shoes. I couldn’t bend over and pick something up. I couldn’t climb a ladder to fix something. Simple things like that I can do now that fascinate me."

"Edit: Some additional little things are sitting in a chair with arms, sitting in a booth in a restaurant, being able to shop in a normal store AND not needing to buy the biggest size there, being able to easily wipe my butt, and looking down and being able to see my penis."

– dma1965

People making significant changes, whether for mental or physical health, can surely find a newfound perspective on life.

But they can also discover different issues they never saw coming.

That being said, overcoming any challenge in life is laudable, especially if it leads to gaining confidence and ditching insecurities.