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Jonathan Shedler

@JonathanShedler

Dec 18

1/ “The patient in psychotherapy, like the young child, may have an impossible time knowing his internal states—or even knowing that he has internal states that can be known—until these are recognized by another”
—David Wallin

This is why therapists who respond to patients only

2/ as hurt, vulnerable victims do them a disservice. Yes, we must recognize our patients’ hurt, vulnerable states so they can come to know these states. But we must also recognize and respond to their states of rage, spite, hate, envy, cruelty, destructiveness—and the entire rest

3/ of the spectrum of human emotional life

This is meaningful psychotherapy: helping the patient come to know themselves more fully, and so become more whole

This is very different from responding only to internal states that are comfortable for *the therapist* or bolster the

Read 9 tweets

Jonathan Shedler

@JonathanShedler

Dec 12

What expert therapists understand that others do not:

“What the patient does with the therapist in the room always holds a key to what caused her problem, what has kept it going, and what has made it difficult for her to benefit from previous efforts to treat it”
—Mary Jo Peebles

2/ Another way of saying it: expert psychotherapists do not rely on patients to *tell* us what is wrong. They do not know and cannot tell us (because unconscious mental life is real). We know they will *show* us

They have just entered a new relationship with a new and unknown

3/ person (the therapist). How do they perceive us, or misperceive us? What do they expect? How do they treat us? How do they react to us? What do they *do* with us in this us in this newly-created relationship?

In everything they do with us in the session, they are giving us

Read 4 tweets

Jonathan Shedler

@JonathanShedler

Oct 18

1/ In Kernberg’s object relations model

1️⃣pathological narcissism
2️⃣malignant narcissism &
3️⃣psychopathy

form a continuum. Here’s my “Cliffs notes”

Pathological narcissism rests on the defense of splitting. The person identifies with the good parts of self and projects the bad

2/ parts onto others. In this way, they maintain a perception of self as good and righteous while seeing others as bad and inferior

In malignant narcissism, the projected badness is infused with hate & aggression. Others are not just seen as lesser but will be treated in cruel,

3/ exploitative, and hateful ways, even as the person continues to see themself as good and righteous

In psychopathy, relations with others are completely dominated by hate & aggression. Others are seen solely as objects to be exploited, or toyed with sadistically, for pleasure

Read 8 tweets

Jonathan Shedler

@JonathanShedler

Oct 11

1/ from In Treatment season 1

Why do you think you had that particular memory the other night?
-Dr Paul Weston

Perhaps there’s a reason you had that particular memory the other night
-me (imagining I'm his consultant)

Two ways to invite reflection. Perhaps one is more inviting

/2 This is a matter of therapy technique

Many therapists default to question-asking, intending to elicit the patient’s curiosity and self-reflection

But there are more refined ways to accomplish this

3/ Questions can land like interrogation, whether intended or not, and carry a subtle implication that the patient already has or should have the answer

Consider the difference between “Why did you do that?” (question mark) vs “Perhaps there’s a reason why you did that” (period)

Read 22 tweets

Jonathan Shedler

@JonathanShedler

Oct 3

1/ Here's a two-question test to determine if you're getting meaningful, in-depth psychotherapy (part 1)

1️⃣ Think of a time you were upset with your therapist. Did you tell them? y/n

no = you are not working in depth
yes = you may be working in depth

2/ (part 2)

2️⃣ Did your therapist respond with non-defensive curiosity and genuine interest in hearing and further exploring your thoughts, feelings, and experience of them? y/n

no = you are not working in depth
yes = you may be working in depth

3/ Here's a chance at redemption

If you did *not* tell your therapist you were upset with them...

3️⃣ Is your therapy relationship on a trajectory where you will be more likely to tell them in the future? y/n

no = you are not working in depth
yes= you may be working in depth

Read 5 tweets

Jonathan Shedler

@JonathanShedler

Sep 28

1/ A sure sign of bad therapy is that the client or patient leaves therapy sessions feeling better—but continues living their life the same way, repeating the same self-defeating patterns and getting the same unhappy outcomes

Real psychotherapy is not meant to be a feel-good

2/ balm or salve. It’s purpose is not to leave sessions in a better mood, or feeling calmer. It’s purpose is to help us understand how we unknowingly contribute to our own difficulties—and change that

Make no mistake, this entails difficult, painful work

3/ There will of course be times when you leave sessions feeling calmer, or in a better mood. But there will also be many times that you leave filled with pain, having recognized something deeply troubling in yourself. You will feel the pain of opportunities missed, and the pain

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