1/ "Clinicians need to learn from their supervisors how to foster serenity and forbearance in the face of life’s difficulties. Simply reducing overt symptoms may leave this area untouched. A man who feels less anxious but who is still holding a deep grudge is only marginally
2/ better off than when he came to treatment; a woman who feels entitled to all her advantages rather than feeling grateful for them will have an ongoingly resentful life whenever she confronts limitation.
Supervisors have a critical role in helping clinicians to bear their
3/ patient’s suffering when it involves experiences that cannot be undone. Although it never fully goes away, grief does eventually soften, and the mourning process enriches those who can tolerate going through it.
4/ Therapists who offer reassurances, reframing, behavioral goals, and other distractions are not likely to do the important work of bearing witness to a process of deep healing."
—Nancy McWilliams

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More from @JonathanShedler

11 Jun
These are the 3 necessary elements of a working alliance in therapy. Most clinicians miss #2 or #3.

1. There is attachment—both parties are invested in relationship
2. There is mutual agreement about purpose of the work
3. There is mutual agreement about the methods to be used
#2 is the tough one. The key word is "mutual." It means clinician must 1) develop a psychological understanding of the causes of the patient's difficulties (which will not be the same as patient's—if it were, clinician would be superfluous), 2) communicate this understanding to
Patient in an experience-near way that patient can regognize/resonate with emotiuonally, and 3) reach a meeting of minds w/ patient that this is what both people want to focus on. This is not a linear or sequential process. It's not a didactic process. It is a *mutal* process
Read 7 tweets
7 Jun
Nine 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. Please do whatever is necessary to make certain you are in a
1/10
private place where you will not be overheard or interrupted.

2. Settle into a comfortable chair but don’t lie down or recline. To the extent possible, try to arrange yourself as you would if we were meeting in person.
2/10
3. Leave yourself 10-15 minutes of quiet, alone time before and after sessions. You need time before sessions to set aside your activities and allow your thoughts transition to therapy; you need time after to reflect and absorb. If possible, take a walk by yourself or take
3/10
Read 10 tweets
3 Jun
1/ "Individuals who seek treatment may, understandably, just want the pain to stop. They may view clinicians as authorities who will simply fix their feelings, or fix their partner or boss or parent. They may have been told there are active strategies therapists can implement.
2/ New therapists feel acute pressure to do such magic, especially if their training has emphasized evidence based techniques or medication that, in terms of statistical averages, can reduce immediate pain. But patients who are helped to find the confidence that they
3/ can change what is making them unhappy get something much more valuable than temporary relief from a toxic mental state...
In general, clinicians need supervisory support to avoid falling into the role of fixer, which tends to be either ineffective in changing behavior or,
Read 4 tweets
3 Jun
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
Read 4 tweets
13 May
1/ "The quality of the relationship between the patient and therapist is an important contributor to outcome, far more so than the particular techniques or ’brand’ of therapy. The original term was 'working alliance,’ not 'therapeutic alliance,' and
soundcloud.com/betweenuspodca…
2/ I think the original term the more helpful term, because it reminds us that it's an alliance around the work we’re there to do. It doesn’t just mean that two people feel good about each other, or like each other. It’s much more specific than that.
3/ A working alliance has three elements. The first is that there’e a connection; the two people are invested enough in the relationship to want to continue meeting. The second is, there’s a shared agreement about the purpose of the therapy. What are we here to do?
Read 5 tweets
11 May
1/ New MDMA study provides great example of how researchers spin findings to obfuscate & mislead. It's not just this study—it's virtually all outcome research.

Fact is, the attempt to blind participants (to whether they got MDMA of placebo) didn't work.
nature.com/articles/s4159…
2/ This is important, because patients deeply invested in being part of study/wanting MDMA to work. Knowing whether they got "miracle" drug or placebo likely to make a big difference.

Accurate statement: 84% in placebo group knew or suspected they got placebo. 95% in MDMA group
3/ knew or suspected they got MDMA.

Spun version from paper: "When participants were contacted to be informed of their treatment assignment at the time of study unblinding it became apparent that at least 10% had inaccurately guessed their treatment arm."

See the difference?
Read 5 tweets

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