Jonathan Shedler Profile picture
Sep 25, 2020 8 tweets 2 min read Read on X
1/ It's not just 'helpful' to view the world from patient's/client's perspective, it's a basic requirement for doing therapy & goes without saying (if it must be said, something is already seriously amiss—unless therapist is a beginning student). Therapists strive to enter their
2/ patient's subjective world, see from their perspective, know their desires & fears & understand their experience of self & others "from the inside"—keeping in mind that something about how they are viewing & experiencing the world, self, & others has become a source of pain or
3/ distress. But—and this is key—we enter our patient's subjective world NOT in order to conform the therapy to the experience they are already having of the world, or to duplicate their existing patterns of experiencing self, other & the world in the therapy relationship.
4/ We do so to help them to be able to have DIFFERENT experiences, to create opportunities for other ways of seeing & experiencing that they cannot readily envision, or cannot envision at all. We keep in mind that their current ways of seeing & experiencing the world are
5/ intertwined with their difficulties.
So when a pt cannot conceive of being with another person & allowing themselves to be immersed in experience of the relationship—without monitoring their phone throughout, allowing it it impinge on their experience, allowing it repeatedly
6/ direct & redirect the focus of their attention—we should NOT address it by declaring it to be "an invaluable component of therapy," & couch that as if that were somehow a testament to our therapeutic skill & flexibility. We might instead become curious with our patient, and
7/ invite our patient to become curious with us, about the function the phone may be serving for them, how it may be altering or influencing our respective experiences of ourselves & of one another, and of our relationship in the room—and how it may be doing so in ways that
8/ can all too easily escape our notice & that we may or may not desire. That is therapy.
And why I find it highly problematic when author says, "Eventually I 'surrendered to machines & began viewing technology as... an invaluable component of therapy."

No. A thousand times no.

• • •

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

Sep 21
1/ There’s a world of difference between sharing painful personal experiences in a close, ongoing personal relationship vs. broadcasting them to strangers on the internet

Sharing a painful emotional experience in a meaningful personal relationship builds emotional intimacy and
2/ connection. Sharing it with unseen strangers *takes the place* of connection—and is often a defense against connection

It reminds me of a case one of my professors described, early in my graduate training. It involved a quite disturbed child, maybe 6 or 7 years old. One of
3/ his weird behaviors was kissing random people in school—teachers, classmates, whomever

The professor said one thing that has stayed with me all these years:

If you go around kissing random strangers, what does it mean when you kiss your mother?
Read 4 tweets
Sep 18
1/ Sixteen psychoanalytic concepts for our time (updated) 🧵

Splitting: Perceiving others in black-and-white categories; seeing them as one-dimensional, as good or bad
2/ Denial: Refusal to acknowledge or accept reality when it does not fit your wishes & preferences
3/ Omnipotent Control: Seeking to control others’ behavior, speech, and even thoughts; insisting that others should think your thoughts instead of their own
Read 17 tweets
Sep 16
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 methods 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 minds about the purpose and the 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
Sep 15
1/ “The available data suggest that the majority of carefully selected patients who undergo 16 sessions of cognitive or interpersonal therapy for depression (the treatment length prescribed in the manuals) administered by highly trained and supervised therapists in clinical
2/ trials fails to improve, remains symptomatic at termination, and relapses or seeks further treatment within 18 months. In light of these dismal outcome statistics, and the fact that no one has ever compared these treatments with treatment in the community by expert
3/ practitioners, the assertion that clinicians should start with one of these manuals seems [indefensible]. It is unfortunate that researchers made the collective decision over the last 20 years to study only brief trials of only two treatments for a subset of poorly
Read 4 tweets
Sep 11
1/ Ten “vital signs” of psychotherapy progress* 🧵

1️⃣Greater attachment security / sense of safety in relationships
2️⃣More integrated & coherent experience of self & others
3️⃣Increased sense of personal agency
4️⃣More realistically-grounded & reliable self-esteem

(video at end)
2/ “vital signs” cont'd

5️⃣Greater emotional resilience & capacity for affect regulation
6️⃣Greater ability to reflect on & understand own and others' inner experience (“mentalization”)
7️⃣Increased comfort functioning both independently and interdependently (communally)
3/ “vital signs” cont'd

8️⃣ More robust sense of vitality and aliveness
9️⃣ Enhanced capacity for acceptance, forgiveness, gratitude
🔟 Movement toward more mature and flexible defenses

*adapted from Nancy McWilliams, “Psychoanalytic Supervision,” chapt. 3
Read 4 tweets
Sep 9
1/ Pro tips for therapists🧵

At first appointment with a new patient/client, there are three things you want to find out

1️⃣ What's wrong?
2️⃣ How are they hoping therapy can help?
3️⃣ Why now?

Some elaboration on these 3 things...

➡️ People don't come to therapy for sport. They
2/ come because they’re in pain. Something is wrong. An understanding of what’s wrong is the starting point for any work you will do

➡️ It's crucial to find out their ideas/hopes about how therapy can help them. This is an invitation to start to think together about how things
3/ could be different, what that might look like, and their initial ideas about how therapy might help them get there

The patient’s/client’s ideas about how therapy can help may be realistic or unrealistic. They may be vague or specific. They may have trouble even imagining how
Read 14 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!

:(