Clinical psychologist and clinical professor of psychiatry at UCSF. Author of the 2010 meta-analysis that established psychodynamic therapy as an evidence-based treatment, and a persistent critic of how the phrase "evidence-based therapy" is used.
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Mental modelWhat counts as evidence
Mental modelWhat counts as evidence
Their wordsNo research ever suggested that manualized CBT was more effective than psychodynamic therapy. It was just more often researched. There is a world of difference between saying a treatment is less often researched and saying it has been scientifically discredited.
Mental modelWhat counts as evidence
Their wordsThe American Psychological Association (APA) just issued guidelines for treating trauma. Patients and therapists would be wise to ignore them.
Mental modelWhat counts as evidence
Their wordsWhen patients don't get the help they need, they don't come away thinking, I didn't get good treatment. They come away thinking, I am too broken to be helped. They leave more hopeless and demoralized than when they came. That is harm.
Mental modelWhat counts as evidence
Their wordsIt takes more than 20 sessions, or about six months of weekly therapy, before 50 percent of patients show meaningful improvement. It takes more than 40 sessions for 75 percent of patients to show meaningful improvement.
Mental modelThe therapeutic alliance
Their wordsPsychotherapy cannot help if the participants cannot work together.
Mental modelThe therapeutic alliance
Their wordsIt is true that a good therapeutic alliance predicts good outcome. But anyone can develop an alliance with someone who can already form good relationships. Measures of the therapeutic alliance may simply be a proxy for the patient's preexisting capacity for healthy relationships.
Mental modelsThe therapeutic alliance, Empathy and validation
Their wordsThe phrase "your feelings are valid" does not invite curiosity or deeper self-understanding, which is the point of psychotherapy. It is the mirror image of "stop whining and get a grip." One sounds warm and one sounds harsh, but neither deepens self-awareness.
Mental modelsEarly templates, The pain beneath the symptom
Their wordsIt is the unconscious conviction that one is entitled to special compensation in proportion to suffering and victimhood.
Mental modelEarly templates
Their wordsThis expectation is a vestige of early childhood and the small child's experience of their parents as omnipotent-able to provide whatever is needed to make everything all better.
Mental modelEarly templates
Their wordsThe fantasy that suffering is a claim ticket becomes a powerful resistance to psychological change.