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Jonathan Shedler Profile picture
@JonathanShedler
Sep 16, 2020 • 3 tweets • 1 min read • Read on X
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

Jonathan Shedler Profile picture
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 Profile picture
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 Profile picture
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
Jonathan Shedler Profile picture
Apr 11
1/ One reason the therapy world is so polarized is that CBT made psychoanalysis part of its PR narrative & origin story

The narrative is that CBT is evidence-based & psychoanalytic treatment is not, and science (good) triumphed over darkness (evil)

But the narrative is a lie
2/ The claims that CBT is science & "CBT Works" come from Randomized Controlled Trials (RCTs). The narrative is that RCTs evidence supports CBT not psychoanalysis

The problem is that RCTs of psychoanalytic therapy show equally good results (in long run, possibly better results)
3/ But CBT’s entire origin story is that RCTs show CBT is superior

See the problem?

So what do when your origin story is that science shows your approach is better… AND SCIENCE DOES NOT SHOW THIS?

You do exactly what some prominent CBT researchers & thought leaders have been
Read 6 tweets
Jonathan Shedler Profile picture
Apr 10
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 both antidepressants & brief therapy (8-12 sessions,
2/ which is 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 Rating Scale for Depression [HAM-D] compared to controls—which
3/ is clinically trivial)

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 6 tweets
Jonathan Shedler Profile picture
Mar 31
1/ People have to understand that MH care changes when it’s provided in institutional settings—often profoundly, and rarely for the better

Institutions have administrative & financial agenda that are not necessarily aligned with patient’s interests. Usually, they’re under
2/ tremendous pressure to do more with less, the clinicians are overwhelmed, and they just cannot spend the time with patients that patients really need

In large institutions, MBAs & accountants & lawyers may call the shots in the background, in ways that seriously impact
/3 patient care. Decisions about what treatments are offered are often driven by health insurance company reimbursement schedules, which are definitely not aligned with patient needs

Then cognitive dissonance kicks in with administrators & providers. It’s incredibly hard to go
Read 14 tweets

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