Many times, the work in psychotherapy is about distinguishing between 𝘩𝘢𝘷𝘪𝘯𝘨 feelings and 𝘢𝘤𝘵𝘪𝘯𝘨 on them

It's one thing to have feelings and express them in thoughts and worlds. 𝘈𝘤𝘵𝘪𝘯𝘨 on them in ways that affects other people is something entirely different
/2 In practical clinical terms, some operate 𝘢𝘴 𝘪𝘧 thoughts and feeling could harm and so squelch them before they can come into focus
(I say "as if" because consciously they know it's not so, but still function that way)
Other's act on feelings impulsively, before there is
3/ opportunity for to consider and understand them.

These ways of responding seem opposite.

Paradoxically, they are both ways of deflecting attention from (or defending against) inner experience and emotional life.
4/ Research shows we can group personality styles into two superordinate groups, internalizing & externalizing

Internalizing personality styles internalize distress. Suffering may be very private. Externalizing styles externalize distress. It will be expressed in overt behavior.

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More from @JonathanShedler

Nov 6
1/ In Kernberg's object relations model

1️⃣pathological narcissism,
2️⃣malignant narcissism, &
3️⃣psychopathy

form a continuum. Here's my "Cliff Notes"

Pathological narcissism rests on the defense of splitting. The person identifies with the good parts of self & projects the bad
2/ parts onto others. In this way, they maintain a perception of self as good and righteous, while seeing others as bad and inferior

In malignant narcissism, the projected badness is filled with hate & aggression. Others are not just seen as lesser, but will be treated in cruel,
3/ exploitive, and hateful ways, even as the person continues to see themself as good and righteous

In psychopathy, the projected badness is completely dominated by hate and aggression. Others are seen solely as objects to be exploited, or toyed with sadistically
Read 6 tweets
Nov 5
For some people in psychotherapy, the core psychological issue is *they cannot maintain relationships*

OF COURSE they will want to end the therapy relationship before real therapy even begins, or make the clinician want to end it

This is the work. This is why they need therapy.
/2 If the therapy is going to address what's psychologically meaningful, the focus must be on what goes wrong in the person's relationships—starting with the therapy relationship itself

That's where the action is. Everything else is secondary.
3/ If the problems in the therapy relationship cannot be addressed, nothing else can be addressed. Psychotherapy does not work for people who are not there to receive it.
Read 14 tweets
Nov 3
Imagine a relationship where the other person will not exploit or take advantage of you in any way, nor let you exploit them. Imagine they say what they mean & mean what they say, no matter what. Imagine they are 💯dependable & reliable. For many, that alone is a first.

“Frame.”
2/ Imagine you can express any thought or feeling and be listened to. Imagine you can be angry & there is no retaliation. Imagine when you struggle to find words, you don’t get interrupted. Imagine the other person is truly listening, not just waiting their turn to speak

“Frame”
3/ Show me a therapist who knows no theory, has no techniques, has no worksheets or tools of any kind, who perhaps isn’t even very bright—who knows nothing except how to maintain the frame. And I will show you a therapist more helpful than the credentialed genius who does not.
Read 4 tweets
Oct 29
1/ Listening non-judgmentally is not something therapists learn from a book or class. It takes years of work. We can listen without judging because we have examined the dark corners of our own souls in personal psychotherapy. What you think shocking, we know to be simply human.
2/ Therapists who have not done the hard work of in-depth personal treatment over an extended time do not & cannot listen non-judgmentally. They can tell themselves they do, they can perform the role of what they think it is—but it is only performative, and patients can feel it.
3/ Without realizing it, they subtly recoil from certain areas of the patient's inner life, subtly signal approval & disapproval, & so close off entire territories to exploration. We simply cannot face another's demons with equanimity, curiosity & acceptance until we have learned
Read 4 tweets
Oct 25
1/ Pt: I just want you to support me. Is that too much to ask? That's what I pay you for, isn't it?
T: Well, I guess a lot depends on what you mean by support. Help me understand what that would look like for you.
Pt: You know, just support me. You're the therapist, isn't that
2/ what you're supposed to do?
T: I'm still not sure what would feel supportive for you at this moment. Perhaps you can give me an example of something I could say or do that would be supportive in the way you are looking for.
Pt: You could just start by telling me I'm right.
3/ T: ::waits for more::
Pt: You could say [other person] was wrong. They had no right to talk to me like that. I was right. They're an asshole.
T: In this instance, support would mean agreeing with you. I should say you're right and they're an asshole.
Read 9 tweets

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