1/ More snippets of real and pretend therapists.

Patient: That's insulting.
pretend therapist: I'm sorry, I didn't mean it as an insult. You know I respect you very much.
real therapist: I can see how that landed badly. Tell me how you understand it.
2/ Patient: You don't care about me at all. You're just in this for the money.
pretend therapist: I care about you a lot.
real therapist: You must have reasons for thinking that of me. Help me understand how you came to see me that way.
3/ Patient: [after boyfriend cheats on her *yet again*] I know it's my fault, I'm not meeting his needs.
pretend therapist: It's not your fault. He doesn't deserve you.
real therapist: If it's your fault, it would be in your power to make the cheating stop.
[after therapist cancels previous session]
Patient: It's ok, I know something must have come up.
Pretend therapist: Thanks for understanding.
real therapist: That's true, but you must have had thoughts & feelings about me cancelling on short notice. It couldn't have felt good

• • •

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More from @JonathanShedler

13 Jan
1. In-depth personal therapy. You cannot understand another's emotional life unless intimately familiar with your own.
2. Making discussion of therapy relationship a normal part of sessions. Recognizing pt's problematic relationship patterns are always happening *in the room*
3. Recognizing your own emotional reactions with a patient are a crucial source of clinical information about the patient and knowing how to use that information constructively (see #1)
4. Unfailing honesty & authenticity with yourself & your patients, no matter how difficult.
5. Truly understanding how and why therapy frame & boundaries are necessary for the difficult work, and how to maintain them gracefully.
6. Ongoing and absolutely ruthless willingness to examine ourselves.
7. Humility about what we can know an understand—and readiness
Read 7 tweets
13 Jan
1/ From a forthcoming book chapter, "The Personality Syndromes"

"Personality is not about what disorders you have but about who you are. It refers to a person’s characteristic patterns of thought, feeling, behavior, motivation, defense, interpersonal functioning, and ways of
2/ experiencing self and others. All people have personalities and personality styles.

While there are as many personalities as people, clinical knowledge accrued over generations has given rise to a taxonomy of familiar personality styles or types. Most people,
3/ whether healthy or troubled, fit within the taxonomy. Empirical research over the past two decades has confirmed the major personality types and their core features.

Most clinical personality theorists do not view these personality types as inherently disordered. They are
Read 5 tweets
11 Jan
1/ Therapists who endlessly soothe & validate are not doing therapy & likely don't know how. Some snippets illustrating real vs pretend therapy:

Patient: [cries] 
pretend therapist: hands pt tissues
real therapist: [when crying subsides] Can you put those tears into words?
2/ Patient: He abused me 
pretend therapist: You've suffered through so much.
real therapist: Tell me what you mean.
3/ Patient: I feet unsafe
pretend therapist: You need to protect yourself
real therapist: Help me understand what thoughts and feeling are coming up.
Read 6 tweets
30 Oct 20
Eight tips for getting the most from teletherapy*

1. The most important thing is privacy. When we meet in my office, it’s my responsibility to provide a private setting. When we meet remotely, it’s up to you.

*adapted from guidelines by @DrIsaacsRussell & @ToddEssig

Please do whatever is necessary to make certain you are in a private place where you will not be overheard or interrupted.

2. Settle into a comfortable chair but don’t lie down or recline. Try to arrange yourself as you would if we were meeting in person.

3. Leave yourself 10-15 minutes of quiet, alone time before and after sessions. You need time before sessions to set aside the activities of the day and let your thoughts transition to therapy; you need time after to reflect and absorb. If possible, take a walk by yourself

Read 8 tweets
25 Oct 20

"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
Read 9 tweets
1 Oct 20
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
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

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