Jonathan Shedler Profile picture
Sep 30, 2020 8 tweets 2 min read Read on X
1/ Signs of scientism vs. legitimate pursuit of truth:

-needlessly complex statistical methods
-emphasis on p-values
-emphasis on demonstrating “effects” vs. understanding mechanisms of action
-focus on hypothesis testing vs developing hypotheses worth testing
-dismissive...
2/ ...of necessary process of observation & inference that could lead to meaningful hypotheses
-deflecting criticism by championing “science” vs defending own methods/conclusions
-spinning weak findings as strong support for preferred conclusions
-arbitrary metrics without anchor
3/ or reference points meaningful to those who are supposed to rely on research
-outcome measures chosen without regard to outcomes desired by those receiving treatment
-use of sham (“intent-to-fail”) control group not designed to control for any meaningful rival hypothesis
4/
-peer review by cronies invested in promoting same conclusions & agenda
-blurring distinction between clinical vs statistical significance
-blurring distinction between research *assumptions* (eg 12 session treatment) vs research findings, discussing both as "evidence based"
5/
-using scientifically-meaningless marketing/PR language in public discourse (“evidence-based,” “gold standard,” “proven”) vs accurately describing actual results
-reporting one-time, short-term outcomes for conditions with known chronic or cyclical course (eg depression)
6/
-reporting “follow up” findings for very brief follow-up interval (eg 6 mos) for conditions with known chronic or cyclical course (eg, depression)
-failing to find significant difference between treatment & control group, then declaring (post hoc) that control treatment is
7/ also an evidence based therapy (in JAMA no less)
-unacknowledged file drawer effects
-willfully ignoring/denying existence of evidence supporting other approaches

I could go on...

Every single one of these things is happening in research on “evidence-based” therapy.
8/ scientism = trappings and methods of science bereft of its spirit and substance

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More from @JonathanShedler

May 18
1/ Therapy “outcome” is not a standardized scale a researcher, who's never met the patient, chooses in advance & superimposes on therapy process

Real outcome is a shared understanding of desired personal change that emerges organically from the therapy work—unique to each person
2/ Most therapy outcome researchers are not, in fact studying “outcome” in ways meaningful to patients or therapists. They’re making assumptions about what people they don't know want from psychotherapy, and the assumptions often have little to do with what patients actually want
3/ Then they distort the entire therapy process to orient it around their arbitrarily-imposed “outcomes”

Skilled therapists actually orient therapy around a shared understanding—developed with each individual patient—about 1) what is going on psychologically that's giving rise
Read 7 tweets
May 15
1/ Rule of thumb, part 1
Most therapy patients will begin to feel somewhat better within first weeks. Expect 6-12 months to make headway with underlying psychological causes

part 2
Add 6 additional mos. for every prior treatment with manualized, "evidence-based" therapy

more⬇️ Image
2/ what they have to unlearn:

-that there’s a quick fix
-that therapist has the answers / can tell them what to do
-that there's a bypass around the honest hard work of self-reflection and self-understanding
-that therapy isn't a procedure done to them, it’s a relationship &
3/ a collaboration
-that unpleasant thoughts & feelings can be disregarded or explained away
-that their difficulties are not encapsulated “illnesses” to address in isolation… they’re woven into the fabric of their lives & their relationships
Read 5 tweets
May 11
1/ I’m not sure, but leaning toward the view that all the research showing that therapeutic alliance predicts therapy outcome may be leading us astray. Here me out

Just about any well-intentioned therapist can develop a decent working alliance with someone at the healthier end
2/ of the spectrum of personality functioning (reasonably securely attached, good object relations, mature defenses, no serious personality pathology)

But it’s incredibly difficult to develop a working alliance with people with more severe character pathology (impaired capacity
3/ for attachment, impoverished or malevolent object relations, more primitive defenses, etc)

What if “therapeutic alliance” is really a proxy for personality health vs. personality disturbance?

If so, “therapeutic alliance” research may tell us only that people with healthier
Read 6 tweets
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
Apr 26
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
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
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

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