Term "empathy" rampantly misused in therapy professions to refer only to patient's nicer, needier feelings—so therapist can play caretaker role.

Empathy has to apply to full spectrum of emotional experience including aggression, hostility, competitiveness, selfishness, etc. /1
Therapists who have empathy only for patients "nice" feelings signal that other parts of patient are unwelcome in therapy relationship and must go unheard/unacknowledged.

That's not therapy & it's ultimately destructive. For many patients, it simply reenacts early patterns /2
with caretakers that required child to distort himself to fit their image, negated & disavowed huge swaths of child's experience, & demanded self-estrangement as a condition of love and care. That's what did damage in the first place & set the stage for pt's current problems. /3
Therapists who do this are not helping their pts. They are using them to shore up their own defenses against their own "not nice" feelings. Instead of helping patients become more whole, they cementing their psychological difficulties. /4
*they are cementing

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More from @JonathanShedler

22 Jul
1/ Younger therapists are often highly sensitized to issues of power dynamics. This is constructive when it helps therapists hold in mind the fundamental truth (central to all psychoanalytic therapies) that therapy is a partnership & collaboration, and something done *with*
2/ patients & never *to* them. Fostering agency, autonomy, & freedom of choice are central goals of the work.
But the same sensitization to power dynamics leads other therapists down the path of denial, which is not at all constructive. The denial takes the form of refusal to
3/ acknowledge the reality of the power imbalance & pretending it's a symmetric relationship between equals, which is factually false, & a flagrant abdication of therapist's professional responsibilities to the patient. Denial cannot be the foundation of a therapy relationship.
Read 7 tweets
21 Jul
The sad truth is that most of what ppl "know" about psychoanalytic therapy amounts to caricatures & stereotypes of things psychoanalysis left behind half a century ago, or longer. College courses/textbooks routinely present falsehoods/caricatures as if they were current & factual
2/ For those interested in an accurate/ contemporary understanding of psychoanalytic therapy, I humbly recommend my article "That was then, This is Now."
Followed by Debra Luepnitz's book of engrossing/ enthralling book of 5 stories (case studies) that bring you right inside the
3/ therapy room with a master therapist, titled "Schopenhauer's Porcupines: Intimacy and its Dilemmas"
Here's my article (free download):
Here's link to Luepnitz book on Amazon:
Read 4 tweets
19 Jul
1/ "Beginning in the mid-1990s, [depression] screening tools were developed specifically for primary care, and research projects (generally funded by pharmaceutical companies marketing antidepressants) were conducted with the aim of promoting their routine use. The results of
2/ these research projects were nearly always the same: reports in prestigious medical journals documented the validity of the screening tools but failed to mention that medical providers used the screening tools only for the duration of the research projects, while they
3/ received external support and incentives. When external support and incentives ended, providers stopped using the tools, essentially 'voting with their feet' regarding their perceived utility in day-to-day practice."
—J Shedler, 2017
Read 7 tweets
18 Jul
1/ "Psychotherapist, psychoanalyst, therapist, hypnotherapist & counsellor are unprotected terms in the UK where there is no regulation. You can legally call yourself any of these titles without training."
"Anyone can call themselves a psychologist."
2/ So let's see... there are people with mental health problems, many desperate for help. And there are people with titles that sound legitimate/professional—that in fact mean *nothing.*
What could possibly go wrong?
Things are little better in the U.S.
3/ There are *huge* differences in training between mental health "professionals." There are ppl w doctorate degrees & decades of rigorous training, ppl with correspondence school degrees, ppl w mail-order degrees, & people w no legitimate training whatever. Public has no clue.
Read 5 tweets
15 Jul
1/ The term psychoanalytic (or psychodynamic) refers to three things: 1) a body of knowledge 2) a way of thinking about & understanding mind & behavior 3) a range of therapies (plural) based on this knowledge and understanding.
To speak of "psychodynamic" as if it were only a
2/ a modality of therapy betrays a profound misunderstanding of what it is & offers.
As an attending doctor in a psychiatry dept., I supervised psychiatry residents providing CBT, DBT, schema therapy, hospital C/L, ER crisis intervention, psychopharm, etc. When they got
3/ overwhelmed or stuck, it was virtually always a psychoanalytic lens that helped them navigate the impasse and find a way to be helpful to the patient.
Transference & countertransference, defense, rupture & repair in the therapy relationship, working alliance, & unconscious
Read 7 tweets
11 Jul
Narcissism is a thief of
-capacity to accept realities that can't be changed
-capacity to apologize
2/ Let's unpack this and consider why.
-There's little gratitude because there's a chronic gap between grandiose expectations vs. what reality affords. Rewards that come the person's way fall short of what they feel entitled and are therefore devalued. Instead of satisfaction
3/ and pleasure, the person ends up feeling disappointed and aggrieved.*
-There's little acceptance, because the person cannot relinquish their insistence on how things *should* be (vs. how they are). Reality should bend to the person's will, not vice versa. Acceptance would
Read 5 tweets

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