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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
Oct 21
1/ Highlights from this crucially important paper:

About 7 out of 10 patients who get “evidence-based therapy” for depression are still depressed after treatment

Of the 3 that get well, about half would have gotten well without treatment

No significant differences between types of therapy (the “dodo bird verdict”)

“Third wave” therapies (eg, ACT) no better than plain old CBT, or any other form of treatment

From the paper: “Most patients do not respond or remit after therapy, and more effective treatments are clearly needed”

So… can someone please explain to me again why these treatments are routinely called “evidence-based therapy?”Image
2/ When the benchmark is “getting better”—not just doing better than a control group—this is what research shows

Most patients get little or no benefit from brief therapy. This is what research has has shown for 40-50 years. The findings have been consistent for half a century
3/ Someone here offered and analogy:🙏
Imagine if the benchmark for evaluating a plumber was not doing the job right, but how they compared to not trying to do the job at all? Pipes could be leaking everywhere, the pluming fixtures could be falling off—and researchers would be
Read 15 tweets
Jonathan Shedler Profile picture
Jul 22
1/ This quotation needs more psychological nuance. In fact, it’s in our human nature to take pleasure in others’ downfall, for many reasons—often unconscious

It’s not so much that we “make monsters of ourselves,” because the monster is already within. In the words of Aleksandr
2/ Solzhenitsyn, “The line dividing good and evil cuts through the heart of every human being”

It is that *acting* on these impulses—publicly reveling in sadistic glee, joining in the pile-on, inciting others to pile on—feeds that inner monster. It grows larger and uglier, and
3/ the rest of us is diminished. In time, we become an empty husk of the person we could have become

We can’t reason away our feelings and impulses (sorry, cognitive therapists). We may feel that twinge of pleasure in another’s ruination, we may feel feel that inner impulse to
Read 4 tweets
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

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