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Jonathan Shedler

@JonathanShedler

Apr 30

1/ I made a list a while ago, about therapy🚩 that should make you think long & hard about whether you’re seeing right therapist

Starting another, please add

-agrees with nearly everything you say
-diagnoses people in your life
-gives you advice
-mawkish displays of “empathy"

2/ -defaults to calming/soothing in response to everything
-acts like cheerleader/coach
-wants to play role of hero or savior
-wants to plays role of spiritual or religious guide
-validates & affirms whatever you say
-speaks in jargon or “therapy speak” instead of plain English

3/ -jumps in with worksheets or “exercises” instead of listening
-joins you in blaming other people in your life
-seeks to indoctrinate you in politics/ideology
-talks about themselves/discusses their own life
-does most of the talking
-promises a specific result or outcome

Read 9 tweets

Jonathan Shedler

@JonathanShedler

Apr 26

https://twitter.com/SteveStuWill/status/1758276648506671283

1/ Absolutely none of these conclusions are justified

1️⃣ Patients who exercised showed some minimal improvement—but not enough to matter
2️⃣ The patients were not severely depressed to begin with
3️⃣ We already know that antidepressants & brief therapy (8-12 sessions, which is

https://twitter.com/SteveStuWill/status/1758276648506671283

2/ pretty much all that’s ever studied in research trials) are inadequate treatment for most depressed patients most of the time

(Avg effect of antidepressants in research trials is < 2 points on Hamilton Depression Rating Scale compared to controls—which is clinically trivial)

3/
4️⃣ The proper conclusion is NOT that exercise is more effective than two effective comparison treatments

The proper conclusion is that NONE of the treatments in this study are adequate treatment—and this is with patients who are not severely depressed

Read 7 tweets

Jonathan Shedler

@JonathanShedler

Apr 25

1/ “Therapists need to be oriented toward... patient’s degree of felt power to influence events.

Many people come to treatment feeling that things just ‘happen to’ them. The absence of a sense of agency is inferable when the therapist has asked a question such as, ‘Were you

2/ feeling sexual desire when you agreed to give oral sex to that guy?’ and meets a blank stare or a response like, ‘I don’t know. It seemed like the thing to do at the time.’ Patients who give such answers are often the same ones who wait passively for the therapist to tell

3/ them what to do, a stance that can flummox clinicians who know [therapy] is not a set of instructions but do not easily find their own sense of agency in the face of this non-participation.

Psychodynamic therapists want clients to feel increasing power to influence their

Read 4 tweets

Jonathan Shedler

@JonathanShedler

Apr 24

1/ I’ve never had a “noncompliant” therapy patient. I don't even find the word helpful. It implies therapist brings an agenda for patient to follow, but that’s not how good therapy works. Good therapy means a "working alliance"—a shared understanding & agreement about the purpose

2/ of therapy and the methods to be used to achieve that purpose. The initial sessions (the "consultation phase”) are devoted to developing that shared understanding. That takes two—it takes collaboration to reach a meeting of the minds about the purpose of & methods of therapy

3/ The purpose must fit the therapist’s understanding of what is going on psychologically that’s giving rise to the patient’s difficulties, that is realistically possible to change in psychotherapy, that the patient recognizes (with the therapist’s help) is causing difficulties

Read 11 tweets

Jonathan Shedler

@JonathanShedler

Apr 13

1/ Contrary to what therapists are often taught, we don’t protect patient privacy & confidentiality because it’s an ethical or legal requirement, although it’s that too. We protect privacy & confidentiality because it is the 𝘱𝘳𝘦𝘤𝘰𝘯𝘥𝘪𝘵𝘪𝘰𝘯 for honest self-exploration

2/ We are asking the patient to share their most personal and vulnerable thoughts, feelings, desires, and fears. We are asking them to share things they may have never told another soul. We are asking them to tell us things they may have never previously told 𝘵𝘩𝘦𝘮𝘴𝘦𝘭𝘷𝘦𝘴

3/ No one is going to do that if there’s even the slightest doubt that what’s said in therapy stays in therapy, or that what’s said and thought in therapy could in any way impact their lives and relationships outside of therapy

Psychotherapy must become a special & sacred space

Read 12 tweets

Jonathan Shedler

@JonathanShedler

Apr 11

1/ The goal of psychotherapy is to insert spaces for reflection where they have not previously existed—and thereby create opportunities to know ourselves more fully, connect with others more deeply, and live life more congruently

2/ Psychotherapy is about slowing things down—so we can begin to see and understand the patterns that otherwise happen quickly, automatically, without reflection or awareness

3/ Pronouncements about "optimizing" or maximizing efficiency reveal a misunderstanding of psychotherapy at the most fundamental level. We find ourselves in difficulties because we cannot slow down to reflect. The rush to optimize every facet of life is the disease, not the cure

Read 5 tweets

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