1/ "Lived experience" can be loaded term. Speaking only for myself, I would never ever discount or minimize another person's experience or their efforts to describe it. However, I often encounter people who speak in ways that seem to presume their "lived experience" should trump
2/ everyone else's lived experience or their own personal experience/perception/understanding is universal truths that must apply to all. As psychologist whose work is all about listening & hearing, my ears would perk up if someone said "my lived experience is..." vs. saying "my
3/ experience is..." While the statements are objectively the same, the former locution somehow seems to be making a greater claim. Something about term "lived experience" implicitly seems to set it apart from the rest of experience & accord it a different & privileged status.

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More from @JonathanShedler

19 Sep
1/ Social psychologists long ago proved something utterly terrifying: *People will literally DISREGARD WHAT THEY SEE WITH THEIR OWN EYES to conform to what others around them say.* In classic 1951 experiment by Solomon Asch, people looked at picture of 3 lines & asked to choose Image
2/ which one was same length as "target" line—which was also right in front of them. Correct choice was OBVIOUS. Person after person gave wrong answer OUT LOUD when others before picked wrong line. WHEN THE TRUTH WAS RIGHT IN FRONT OF THEIR FACES. Watch
3/ video, see for yourself. This happened even when the truth was visibly obvious. If person after person will say something blatantly false to conform with group of strangers, imagine what happens when things are even slightly more ambiguous as with social, cultural, political,
Read 8 tweets
17 Sep
1/ A case formulation is a working hypothesis for therapist & patient to consider & reflect on together. Therapist should share it with pt, in clear, experience-near language, as a possibility for mutual consideration. Pt can revise, edit, elaborate on, or correct it. It can then
2/ be reformulated based on pt's input, and process repeats until pt & therapist can home in on a formulation that 1) fits pt's experience & 2) fits therapist's psychological understanding of what is underlying pt's difficulties. Formulation is dynamic, not static—it may evolve
3/ as therapy unfolds & new understandings emerge. A simple formulation might be:
Tx: I notice when you describe experiences where you feel rejected or excluded, you dwell on it at length & criticize yourself harshly. But when you tell me about times someone appreciated and
Read 9 tweets
2 Aug
1/5 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.
2/5 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
3/5 Discussions 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
21 Jul
1/ “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/ This is why the answer to the question of how to help cannot be known in advance and cannot be found in the pages of a treatment manual. A meaningful answer can be found only "in the room." But you have to know how to *be* in the room, in a particular way.
3/ The patient doesn't need a cheerleader, an apologist, a hired friend, an ersatz mother, or a fawning sympathizer. She does not need to be treated like a subject in a psychology experiment. She needs someone *in the room* paying attention to what is happening in the room.
Read 8 tweets
10 Jul
1/ Online therapy: I've heard therapists comment on how difficult it is for some patients to create a private/safe space for their therapy appointments. (I’ve heard same about some therapy students/trainees). They don't close door, close it but let others to intrude, let children
2/ interrupt, let pets disrupt, etc etc. I've likewise heard pf patients being relatively oblivious to therapist boundaries, for example bringing therapist with them by camera into their beds or even toilets. (To my horror, I even heard of a student therapist conducting
3/ therapy session with clients from their beds). These kinds of privacy/boundary difficulties may be sign that something is amiss in other areas of life as well, with respect to ability to set & maintain physical or emotional boundaries with others, or recognize and respect
Read 12 tweets
5 Jul
1/ This is the DSM error—conflating two different things & discussing them as if same. 1. You can assess/diagnose personality at level of multifaceted syndromes or narrow traits. Clinicians *always* think in terms of syndromes. 2. Irrespective of whether addressing syndromes or
2/ traits, you can treat phenomena as categories (present/absent) or continuaa (eg, no narcissistic personality characteristics through moderate to strong to extreme). This is what DSM-5 work groups failed to grasp. Clinicians think in terms of syndromes not traits. Severity of
3/ syndromes are continuaa, not categories. Obvious solution is to diagnose *syndromes* and treat them as continua. We DID it. It works, clinically & empirically. Academic psychology researchers (who have never seen a pt in their lives) sold DSM workgroups a bill of goods,
Read 9 tweets

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