Share this page!

Enter URL or ID to Unroll

You can paste full URL like: https://x.com/threadreaderapp/status/1644127596119195649
or just the ID like: 1644127596119195649

How to get URL link on X (Twitter) App

  1. On the Twitter thread, click on or icon on the bottom
  2. Click again on or Share Via icon
  3. Click on Copy Link to Tweet
  4. Paste it above and click "Unroll Thread"!
  5. More info at Twitter Help
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?

• • •

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
Dec 18, 2024
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 Profile picture
Dec 12, 2024
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 Profile picture
Nov 17, 2024
1/ Possibly 90% of arguments/disagreement about "diagnosis" in MH professions would disappear if people clarified whether they mean

1️⃣trying to trace & identify the source(s) of a problem (like my auto mechanic diagnosed the rattling noise) or

2️⃣using the DSM diagnostic manual Image
2/ If you intend to offer meaningful help for any problem, then you are necessarily in the business of "diagnosis" in the former sense of the word—working to understand what's wrong so you have a realistic chance of helping

For problems we typically address via psychotherapy,
3/ this generally has little or nothing to do with the DSM diagnostic manual, which does not speak to causes

Even people who claim to be adamantly opposed to MH diagnosis and believe all problems are due to (say) capitalism or social ills are, in fact, making a diagnosis
Read 6 tweets
Jonathan Shedler Profile picture
Oct 18, 2024
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 Profile picture
Oct 11, 2024
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 Image
/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 Profile picture
Oct 3, 2024
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

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!

Send Email!

:(