1/ WHY PSYCHOANALYSIS WORKS

"This is what we make conscious—
the patterns that disable and limit
people—the ones that give ulcers either to
the individuals themselves or to recipients in
their orbit.
2/ We understand these patterns and with
painstaking effort help the afflicted come to
understand them in themselves and others.
We help them respond strategically instead of
reacting impulsively or holding back endlessly.
3/ We help people separate the wheat from the
chaff, see the forest through the trees, find
the leading edge, sort through competing
priorities, and make rightful claims and necessary
renunciations. We help them develop an
ethical flexibility of mind and attitude, knowing
4/ when to be a stickler and when to give a wink
and a nod, when to finesse a situation and
when to play strictly by the rules, when to
speak up and when to suck it up.
5/ We help people navigate power dynamics, make adaptive
distinctions and discriminations, and pick
their battles. A psychoanalytic 'read' can 'pull'
for good outcomes and help avoid blunders or
traps. We help tame our baser instincts and
6/ harness optimal aggression, assertion, competition,
intimacy, and sexuality instead of ending
up mired in destructive, cut-throat aggression,
impotent rage, or dehumanizing sexuality.
We help people be patient or impatient as
circumstances dictate, suffer appropriately but
7/ not excessively, and rejoice to the utmost
when warranted. We help people grow,
change, integrate, modulate, decrease self-absorption,
regard themselves accurately, take
themselves seriously but not too seriously,
free up emotional energy in the service of
8/ creativity and mastery—in short, become their
best selves.

The reverberations go well beyond the individual,
fostering richer and fuller family life, as
well as functional and productive organizations,
all with enormous ripple effect. Our
9/ work can help break the kinds of destructive
cycles which, if left untreated, keep echoing
through the generations."

-Wendy Jacobson (Why Bother? A Psychoanalytic Graduation Speech)

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More from @JonathanShedler

1 Oct
1/ The PHQ-2 & PHQ-9 are those ubiquitous depression screening questions in medical offices. New article tells us they're "validated" against structured interviews used in research. But... what are those interviews validated against?
It's not the snarky
jamanetwork.com/journals/jama/…
2/ question it may appear to be. Seriously, what were they validated against? The PHQ screeners were designed so non-experts without training in psych could make psych diagnoses by following the instructions. But here's the kicker... the "gold standard" structured interviews
3/ (like SCID) are also nearly always administered by non-experts, typically research assistant or students—not by psychiatrists or psychologists. So the interviews were *also* designed so non-experts could make psych diagnoses by following paint-by-number instructions.
Read 6 tweets
30 Sep
1/ Key sentence: "Clinicians would know which interventions had evidence-based efficacy for treating specific conditions."
The basic assumption underlying these recommendations in @TheLancetPsych is false. A DSM diagnosis does not identify homogenous group of people with same
2/ specific condition. It's not like aa diagnosis of influenza or diabetes which identifies a common condition likely to respond to same treatments. Ppl who meet DSM diagnostic criteria for a mental heath diagnosis, say depression, do not have same "specific" condition w/ common
3/ underlying cause that responds to same treatments. Developers of past editions of the DSM went to pains to make this clear. It was stated in DSM itself, in the preamble. DSM classification—based exclusively on overt, surface-level, readily-observable signs & symptoms (vs.
Read 7 tweets
30 Sep
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
Read 8 tweets
28 Sep
Plain English summary: people who don’t know how to talk about painful emotions are more likely to act on them.
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 anchors
Read 8 tweets
27 Sep
An antidote to the prevailing moral masochism of the psychotherapy professions:

"Several months after our final sessions, I reread the story of the Good Samaritan in the Gospel of Luke. The parable, well known, concerns a man set upon by thieves and left for dead:
2/ '[The Samaritan] bound up his wounds... and set him on his own beast & brought him to an inn & took care of him. And on the morrow when he departed, he took out two coins and gave then to the innkeeper and said unto him, "Take care of him; and whatsoever thou spendest more,
3/ when I come again, I will repay thee."'

'Take care of him," says the Samaritan. He delegates the caretaking of the victim to another! The story of the Good Samaritan is not, as I had vaguely recalled, one of selfless endless availability 'like the 24-hour store.' The biblical
Read 4 tweets
25 Sep
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.
Read 8 tweets

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