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Jonathan Shedler Profile picture
@JonathanShedler
Jan 28, 2022 • 5 tweets • 2 min read • Read on X
I'm BAFFLED by therapists spending hours catching up on "notes." What in god's name are you writing? Who do you think they're for? Hint: Chart notes are NOT for your benefit—or your patient's (just the opposite). They should meet letter of the law & NOTHING MORE. Here's example:
2/ Chart notes are legal requirement, not part of your clinical work as a therapist. Communicate with your patient *in session*. If you're writing for your personal clinical purposes, write private process notes & never let them near patient chart. If you need to share info with
3/ a colleague, get permission & *speak to the colleague.* Chart notes are not for any of these thing. They're for regulators/health insurers/lawyers. Not—never—for clinical purposes. Nothing in chart note will ever help your patient. They can only be used against them (and you).
4/ And on a purely personal note, it would give me a special kind of yucky feeling if I thought my own therapist or analyst was writing extensive, detailed notes about what I said in sessions. Among other things, I’d wonder who he was writing to, or imagined he was writing to…
5/ and how and why this imaginary other had intruded into our relationship and had come to take up so much space. Is he really in the relationship with me? Or is the relationship really with his notepad, keyboard, or imaginary interlocutor?

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More from @JonathanShedler

Jonathan Shedler Profile picture
Jun 16
Your grad school professors likely had no idea what “neutrality” means. Most never learned and just parrot the misinformation they were taught

It means *ultimate respect for client’s autonomy and self-determination*

You are in favor of that, aren’t you? In Freud’s own words👇
2/ In historic usage, it referred to taking a position (as a matter of *technique,* aimed at self-knowledge) equidistant from id, ego, & superego—terms that no longer hold currency in contemporary psychoanalytic theory, and that are now meaningless to most

So here’s an update:
3/ The term is a recognition that we humans are of many minds about many things, there is inner contradiction, and the contradictions can be at any level of conscious awareness

“Neutrality” means helping the person become aware of all of the inner facets and contraductions,
Read 4 tweets
Jonathan Shedler Profile picture
Jun 5
My first major research article showed it’s impossible to measure mental health by self-report data (eg, a survey). Data are uninterpretable

If people *report* good mental health, it MAY mean good MH. But it’s at least as likely to mean defensiveness and self-deception

source👇
2/ This is called “Illusory Mental Health”

Published in American Psychologist (premier/flagship journal of the American Psychological Association) jonathanshedler.com/PDFs/Shedler%2…Image
/3 Did I mention that illusory mental health is linked to objective physiological measures of stress and increased risk of medical illness and death?
Read 4 tweets
Jonathan Shedler Profile picture
May 12
1/ Depressive Personality Style
“Despite its omission from the DSM, depressive personality is the most common personality syndrome seen in clinical practice. It is a personality syndrome in every sense of the term: an enduring pattern of psychological functioning evident byImage
2/ adolescence and encompassing the full spectrum of personality processes.

People with depressive personalities are chronically vulnerable to painful affect, especially feelings of inadequacy, sadness, guilt, and shame. They have difficulty recognizing their needs, and when
3/ they do recognize them, they have difficulty expressing them. They are often conflicted about allowing themselves pleasure. They may seem driven by an unconscious wish to punish themselves, either by getting into situations destined to cause pain or depriving themselves of
Read 16 tweets
Jonathan Shedler Profile picture
May 8
1/6 The goal of psychotherapy is to insert spaces for noticing and reflecting where space has not previously existed—and thereby create opportunities to know ourselves more fully, connect with others more deeply, and live our lives more congruentlyImage
2/6 Psychotherapy is about slowing things down—so we can begin to see and understand patterns and responses that otherwise happen quickly, automatically, without awareness or understanding
3/6 Talk about “optimizing” psychotherapy or making it more “efficient” betrays a fundamental misunderstanding

We find ourselves in difficulties specifically because we *cannot* slow down to notice and reflect. The rush to optimize every facet of life is the disease—not the cure
Read 6 tweets
Jonathan Shedler Profile picture
Apr 28
1/ This post is misleading. The research does NOT show people who get these CBT treatments get well—what people take “effective” to mean. Overwhelming majority do NOT. They do better than a control group, which is a totally different issue

People go to therapy to get well, or
2/ at least meaningfully better

Not to do better than a control group which gets no treatment that’s meant to help (or no treatment at all)

This is why people have become so skeptical of “experts.” What they get isn’t what they’re led to expect
3/ It’s really important to understand WHAT GOES WRONG when findings from therapy outcome research get reported to the public

The research yields quantitative findings. Tons and tons of them. No one without a serious (professional level) understanding of statistic AND knowledge
Read 41 tweets
Jonathan Shedler Profile picture
Apr 24
1/ The essence of real psychotherapy is exploring and understanding why things go wrong, so we don't have to keep repeating the same painful, self-defeating patterns

👉 But... many poorly-trained therapists cannot differentiate between exploring and understanding vs. BLAMING Image
2/ When they confuse exploration with blaming, they’re trapped. Psychological inquiry can lead only to (1) blaming the patient or (2) blaming the patient’s problems on someone or something else

👉They can’t blame the patient, because they’re
3/ supposed to “support” the patient

So someone or something else *must* be blamed: toxic people, parents, partner, narcissists, abusers, predators, society, the “system”

When therapists are trapped in this way of thinking, the patient is also trapped
Read 7 tweets

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