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Jonathan Shedler Profile picture
@JonathanShedler
Sep 19, 2020 • 8 tweets • 2 min read • Read on X
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
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,
4/ & ideological issues. But we don't have to imagine, it's happening all around us. Otherwise sane people say out loud things that are batshit crazy. Given pressure of social conformity, people will literally say the truth is a lie & a lie is the truth, right is wrong &
5/ wrong is right, violence is peaceful and peaceful is violence. And huge numbers just jump on bandwagon.

But here's where it gets interesting.

In famous line experiment, people who gave wrong answer fell into three groups:

1. People who saw the truth and knowingly
6/ said something they didn't believe just to go along.

2. People who saw the truth but thought the others must be right and they must be mistaken about what they were looking at.

3. People who, after hearing others say wrong thing, LITERALLY COULD NOT CORRECTLY SEE what was in
7/ front of them and literally saw the longer line as short and the shorter line as long. Their actual ability to perceive reality was altered.

And of course (although not an option in this particular experiment) there are the people who see reality accurately but REMAIN SILENT
8/ when the people around them start saying things that are batshit crazy.

Which group are YOU in?

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More from @JonathanShedler

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
Jonathan Shedler Profile picture
Mar 30
1/ People’s misconceptions about psychotherapy are dismaying

In last 2 days, I've seen tweets from people who think its purpose is to calm or soothe, to forgive, feel gratitude, be in a loving state of mind, become happy

it all sounds warm & fuzzy but, NO

And while it’s true
2/ any of these things may occur in the course of a particular therapy, or may possibly follow from it, none of them can be the purpose or goal of psychotherapy

Meaningful psychotherapy has one purpose: psychological change

More specifically, it’s to change something about
3/ ourselves that is causing distress or or limitation, that we desire to change, that is realistically possible to change in psychotherapy. And, of course, to develop understanding and clarity about what does and does not fall in these categories

A skilled therapist will work
Read 6 tweets

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