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

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

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