Share this page!

Jonathan Shedler Profile picture
Twitter logo
Dec 8, 2019 • 5 tweets • 2 min read
1/ The common theme in mental health research—how to make treatment ever more impersonal, standardized, algorithmic. When they get poor results, researchers NEVER conclude "we're on the wrong track." Flawed assumptions NEVER questioned. Recommendation is always "more research"
2/ aimed at shoehorning reality to fit preexisting assumptions. But what if starting assumptions are WRONG? What if standardized, algorithmic treatment is inherently unhelpful? What if those suffering psychologically NEED to be seen, heard & responded to as individuals, not as
3/ instances of a diagnostic category? What if therapy REQUIRES a relationship of EARNED trust which does not and cannot happen on any fixed schedule? What if DSM disorders are NOT proper focus of treatment because they are only symptoms of underlying psychological conditions?
4/ What if mental health research were based on these assumptions, not assumption that standardized & algorithmic=better? Are researchers responsive to needs of patients or just journal & grant reviewers? Do they respond to feedback from reality or from researcher echo chambers?
@threadreaderapp unroll

• • •

Missing some Tweet in this thread? You can try to force a refresh
　

Keep Current with Jonathan Shedler

Jonathan Shedler Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @JonathanShedler

Jonathan Shedler Profile picture
Feb 17
"A master therapist has a feedback loop in real time. They’re interacting with the patient, doing what they do. And what they’re actually gauging is: how does the patient respond to it? The patient is teaching us how to do therapy for that specific person."
2/ Treatment manuals disrupt this feedback loop. Instead of therapy that dynamically changes & evolves based on the emerging response of the specific patient, interventions & techniques are pre-determined. If it's a research study, there are "fidelity checks" to monitor whether
3/ the therapist is adhering to the manual. This disrupts the feedback loop on which the master therapists relies. It prevents the organic unfolding of a therapy process according to the emerging psychological needs of the patient. Treatment manuals are therefore not just
Read 6 tweets
Jonathan Shedler Profile picture
Feb 16
Common sense to assume anything posted on social media can be seen by anyone (including patients). But telling therapists to "act like therapists" at all times is toxically destructive. And indicates a lack of understanding of what therapists do in actual psychotherapy sessions.
/2 Therapists have come to accept as normal a level of tone-policing & thought-policing that's far, far from normal. And have created a culture of policing one another into following ever-more self-imposed "rules" that don't exist. THIS IS NOT WHAT PSYCHOTHERAPY IS ABOUT.
3/ Real psychotherapy is about becoming more free, whole, & fully human. It's about living life fully, with meaning, passion, & pleasure. Yes, PLEASURE. Remember pleasure?

It's not about becoming cringey, inhibited, rule-bound, self-denying, self-abnegating, cardboard cutouts.
Read 6 tweets
Jonathan Shedler Profile picture
Feb 8
1/ Why diagnostic language always sounds stigmatizing

"A strikingly cyclical effort to sanitize speech has contributed to widespread misunderstanding of psychoanalytic tradition. Over time, whatever the original intentions of those people who coined any specific psychological
2/ term, labels for certain conditions ineluctably come to have a negative connotation. Language that was invented to be simply descriptive—in fact, invented to replace previous value-laden words—develops an evaluative cast and is applied, especially by lay people, in ways that
3/ pathologize. Certain topics seem inherently unsettling to human beings, and however carefully we try to talk about them in nonjudgmental language, the words we use to do so attain a pejorative tone over the years.
Today's 'antisocial personality,' as a case in point, was in
Read 7 tweets
Jonathan Shedler Profile picture
Feb 4
1/ Real psychology says our earliest attachments create the templates for our subsequent relationships. With the result that we repeat relationship patterns throughout our lives. Because they are present from beginning, our patterns may be as invisible to us as water to a fish. Image
2/ It boggles my mind that just by adding words "psychology says" or "psychology facts" to some mindless drivel, 100s of thousands follow. Result is that vast nos. of people can't tell difference between actual psychology and mindless b.s. & any huckster can represent themselves
3/ as an "expert" on a topic they know nothing about. People who actually take their advice to heart are their patsies and victims.
Effects of this are more insidious and destructive than meets the eye. I provide training & consultation to legit mental health professionals
Read 11 tweets
Jonathan Shedler Profile picture
Jan 28
I'm BAFFLED by therapists spending hours catching up on "notes." What in god's name are you writing? Who do you think they're for? Hint: Chart notes are NOT for your benefit—or your patient's (just the opposite). They should meet letter of the law & NOTHING MORE. Here's example:
2/ Chart notes are legal requirement, not part of your clinical work as a therapist. Communicate with your patient *in session*. If you're writing for your personal clinical purposes, write private process notes & never let them near patient chart. If you need to share info with
3/ a colleague, get permission & *speak to the colleague.* Chart notes are not for any of these thing. They're for regulators/health insurers/lawyers. Not—never—for clinical purposes. Nothing in chart note will ever help your patient. They can only be used against them (and you).
Read 5 tweets
Jonathan Shedler Profile picture
Jan 27
1/ Things that leave patients feeling like cogs in a machine (& lead to dropout). Let's start a list. Add your own.
1. Greeting new patients with forms, worksheets, paperwork
2. "Intake interviews" with laundry list of rote questions not relevant to patient's concerns (vs letting
/2 patient tell you in their own words what's wrong & why they've come—& *listening*)
3. Focusing on DSM diagnostic categories instead of on the patient's experience
4. Not developing a mutually-agreed, *shared* understanding of purpose & methods of therapy. "Shared* means an
/3 understanding you develop together—not decided by therapist alone)
5. Not recognizing the patient's doubts and reservations about beginning treatment & creating space to discuss them.
6. Related to above, if patient has had prior unsatisfactory experience with treatment, not
Read 4 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

Like this author's thread?

Get emails when @JonathanShedler has new unrolls!

Check out other threads from @JonathanShedler!

Read all threads by @JonathanShedler

:(