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Jonathan Shedler Profile picture
@JonathanShedler
Feb 8, 2020 • 3 tweets • 2 min read • Read on X
1/ JAMA: "High nonresponse & dropout rates suggest mismatch between complex clinical reality of military-related PTSD and one size-fits-all treatment approaches in VA"
"...do not effectively manage PTSD in large % of patients" #cbtworks #somepsych #psysci
jamanetwork.com/journals/jama/…
2/ Talking point emailed from VA central office: "Disseminating [same one-size treatments] through national training initiatives is appropriate given that these treatments have the most robust evidence of effectiveness."

Someone invested in "alternative facts."
JAMA or VA?
3/ Therapies in question were NEVER tested against relationship-based talk therapy as practiced by most psychotherapists.

How can a treatment have "most robust evidence" when never compared to psychotherapy as practiced in real world by most psychotherapists?

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More from @JonathanShedler

Jonathan Shedler Profile picture
May 8
1/6 The goal of psychotherapy is to insert spaces for noticing and reflecting where space has not previously existed—and thereby create opportunities to know ourselves more fully, connect with others more deeply, and live our lives more congruentlyImage
2/6 Psychotherapy is about slowing things down—so we can begin to see and understand patterns and responses that otherwise happen quickly, automatically, without awareness or understanding
3/6 Talk about “optimizing” psychotherapy or making it more “efficient” betrays a fundamental misunderstanding

We find ourselves in difficulties specifically because we *cannot* slow down to notice and reflect. The rush to optimize every facet of life is the disease—not the cure
Read 6 tweets
Jonathan Shedler Profile picture
Apr 28
1/ This post is misleading. The research does NOT show people who get these CBT treatments get well—what people take “effective” to mean. Overwhelming majority do NOT. They do better than a control group, which is a totally different issue

People go to therapy to get well, or
2/ at least meaningfully better

Not to do better than a control group which gets no treatment that’s meant to help (or no treatment at all)

This is why people have become so skeptical of “experts.” What they get isn’t what they’re led to expect
3/ It’s really important to understand WHAT GOES WRONG when findings from therapy outcome research get reported to the public

The research yields quantitative findings. Tons and tons of them. No one without a serious (professional level) understanding of statistic AND knowledge
Read 41 tweets
Jonathan Shedler Profile picture
Apr 24
1/ The essence of real psychotherapy is exploring and understanding why things go wrong, so we don't have to keep repeating the same painful, self-defeating patterns

👉 But... many poorly-trained therapists cannot differentiate between exploring and understanding vs. BLAMING Image
2/ When they confuse exploration with blaming, they’re trapped. Psychological inquiry can lead only to (1) blaming the patient or (2) blaming the patient’s problems on someone or something else

👉They can’t blame the patient, because they’re
3/ supposed to “support” the patient

So someone or something else *must* be blamed: toxic people, parents, partner, narcissists, abusers, predators, society, the “system”

When therapists are trapped in this way of thinking, the patient is also trapped
Read 7 tweets
Jonathan Shedler Profile picture
Mar 31
1/ Why MH diagnostic language 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 term,
2/ 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
Read 7 tweets
Jonathan Shedler Profile picture
Mar 30
1/ Malignant narcissism

“Malignant narcissism is a variant of narcissistic personality that has gained public attention in recent years. It is, in fact, the intersection of narcissistic personality and antisocial-psychopathic personality, blending the characteristics of both. Image
2/ Malignant narcissism is also described by clinical theorists as narcissism suffused with sadistic aggression. It is not sufficient for the malignant narcissist to feel important and special; it is necessary for someone else to be demeaned or vanquished.
3/ The syndrome could plausibly be called ‘psychopathic narcissism’ or ‘narcissistic psychopathy,’ but malignant narcissism is the historically and clinically familiar term.

When psychopathic deception, exploitation, sadistic aggression, and externalization combine with
Read 13 tweets
Jonathan Shedler Profile picture
Feb 3
“In a large meta-analysis of 562 randomized controlled trials… we found no indication that the effects of therapies have improved over time”

—from Cuijpers et al (2023), Five Decades of Research on Psychological Treatments of DepressionImage
2/ Over time, the no. of published studies increased dramatically—but no increase in benefits to patients

Also, more & more of the research is on CBT and its endless new variants, always hyped—in name of “science”—as advances/breakthroughs

The actual evidence contradicts this
3/ But we have to ask a potentially important question

This finding is based on the therapies studied by academic researchers in randomized controlled trials

The question is whether you believe that’s representative of all psychotherapy
Read 5 tweets

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