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
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
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

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!

:(