1/ Some in therapy world beat the drum about science & evidence. They point to research (RCTs) to claim their approach is superior
When you read the studies, it's clear they don't even pretend to compare the treatment to any other legit therapy. In fact, they do NOT put their
2/ claims to a scientific test
The claim is that their preferred therapy brand is more effective than other kinds of psychotherapy. But the studies don't compare their therapy to other legit therapy. They compare it to *doing nothing* (wait list) or to fake, sham therapy that
3/ is not intended to offer legit help—or even practiced by therapists in the real world
This sleight-of-hand goes on in plain site. They get away with it because few can critically read the primary sources
This is simply not "science"
It is marketing pretending to be science
4/ Slowly and reluctantly, I came to the realization that the more drum beating about "science" and "evidence," the less likely the claims are ever put to a scientific test
1/ One of most important things I've learned: Severe personality problems find *camouflage.*
No one thinks "I'm a sadist" or "I'm a malignant narcissist." They find a belief system/social group that validates their most hateful, destructive impulses & construes them as virtues.
2/ The most toxic and hateful people in the world are 100% convinced they fight on the side of all that is good and right.
3/ They find a way to give free rein to their cruelty, to attack, to treat others cruelly and viciously.
And they find *allies to cheer them on* who also believe they are on the side of all that is good and right.
1/ "The ultimate goal of therapy cannot be answered in any generic way. The goals in therapy are a collaborative effort in which therapist and patient together identify what is distressing to the patient, what the patient would like to change, and what is realistically possible
2/ to change in the course of psychotherapy. Certainly the search for the truth about oneself is an overarching goal in most dynamic psychotherapy..."
—Glen Gabbard
So different from researchers who presume therapy outcome is a PHQ-9 score or the like... and on that basis make
3/ blanket pronouncements about what "works," and what kind of therapy people (whom they've never met) should receive
This is why I've said psychotherapy researchers are not studying psychotherapy. They are studying fictions of their own invention and calling it "therapy"
Why do you think you had that particular memory the other night?
-Dr. Paul Weston
Perhaps there’s a reason you had that particular memory the other night.
-me (imagining I'm his consultant)
Two ways to invite reflection. Perhaps one is more inviting
/2 This is a matter of therapy technique. Many therapists default to question-asking as matter of course, with the goal of eliciting the patient's curiosity and reflection. But there are more refined ways to accomplish this.
3/ Questions can land like interrogation, whether intended or not, & carry a subtle implication that the patient already knows or should know the answer.
Consider the difference between "Why did you do that?" (question mark) vs. "There must a reason why you did that." (period)
1/ I'm often asked about evidence for psychodynamic therapy so I'm putting it in a tweet for whoever wants it
In 2010, I published "The efficacy of Psychodynamic Psychotherapy," which put psychoanalytic/ psychodynamic therapy on the map as evidence-based therapy. It reviewed the
2/ major meta-analyses available at the time. Here are the citations for that paper and for the major reviews and meta-analyses of psychodynamic therapy published since then.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98-109
3/ Abbass AA, Kisely SR, Town JM, Leichsenring F, Driessen E, De Maat S, Gerber A, Dekker J, Rabung S, Rusalovska S, Crowe E. Short‐term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD004687
1/ There were 3 categories of response to my tweets about having COVID 🧵
1️⃣ Answers to a specific question I asked (is a super-feint line still a pos result?) Helpful
2️⃣ Expressions of concern & good wishes to get well. Helpful
3️⃣ People making political points about whether
2/ there is a pandemic and how society/government/other people should or shouldn't respond to it. Unhelpful.
It left me feeling like my wellbeing was an irrelevancy & I was little just a prop for someone to score a point about their politics or ideology
Then it occurred to me
3/ (since the topic is never far from my mind) that there is something here relevant to psychotherapy
These online debates about whether the causes of mental/emotional distress are personal or societal, whether diagnosis is useful or a tool of oppression,
whether mental illness
I'm dumfounded when I hear people say we "need more research" to treat mental health problems effectively
In fact, we already know how to treat most m.h. problems
We're just not willing to invest the resources to make high quality care widely accessible
It's as simple as that
They mean they want a magic bullet
But we're talking about how human beings can live life with meaning, purpose, and satisfaction
Not repairing appliances
That takes time, effort, and sacrifice. And favorable circumstances, and yes, sometimes luck
There are no magic bullets
Case in point. My understanding is VA spent $10 billion on mental health in 2020. Perhaps enough to pay for individual psychotherapy w qualified clinician in the community—of the vet’s choice—for every vet who wanted it