Dr. Jonathan Shedler, an expert in psychodynamic therapy, discusses the misconceptions and importance of evidence in psychotherapy. Topics include the limitations of evidence-based therapy, therapist flexibility, psychiatric diagnoses, psychological understanding, and misunderstandings of therapy concepts.
The term 'evidence-based therapy' has been distorted and should not be limited to a specific treatment modality, promoting a more nuanced and individualized approach to therapy.
The therapeutic frame, which includes boundaries, structure, and reliability, plays a crucial role in creating a safe and secure environment for therapy to occur and facilitating meaningful insight-oriented therapy and psychological growth.
Deep dives
The Misconception of Evidence-Based Therapy
The podcast episode explores the misconception surrounding the term 'evidence-based therapy.' It highlights that the term has been distorted and used as a marketing buzzword, deviating from its original meaning in medicine. The episode emphasizes that the term should not be used to refer to a specific treatment modality that is better than others, but rather as a way to promote a particular ideology about how therapy should be conducted. The podcast argues that evidence-based therapy has become associated with a specific type of treatment, usually brief, standardized, manualized CBT sessions. However, research shows that most people who receive these evidence-based treatments do not experience meaningful improvements or relapse quickly. The episode challenges the notion that evidence-based therapy should be the gold standard, and instead advocates for a more nuanced understanding and individualized approach to therapy.
The Importance of the Therapeutic Frame
The podcast highlights the significance of the therapeutic frame in psychotherapy. It explains that the frame refers to the boundaries, structure, and reliability of the therapy relationship. The episode emphasizes that the frame creates a safe and secure environment for therapy to occur, allowing both the therapist and the client to fully engage in the work. It ensures that the therapist keeps their promises, maintains boundaries, and creates a sense of trust and security for the client. The frame also allows the exploration of difficult and intense emotions, fantasies, and patterns of behavior within a contained and supportive space. The podcast underscores the importance of the frame in facilitating meaningful insight-oriented therapy and fostering psychological growth.
Understanding Transference and Countertransference
The podcast explores the concepts of transference and countertransference in therapy. It explains that transference refers to the repetition of patterns and ways of relating that individuals have formed in their early relationships. It highlights that transference occurs in the therapy relationship, where the client projects their patterns and lenses onto the therapist. Countertransference, on the other hand, refers to the therapist's emotional and personal responses to the client's transference. The episode emphasizes that transference and countertransference are valuable sources of information in therapy and can be used constructively to deepen self-understanding and create opportunities for change. It underscores the importance of the therapist's awareness and ability to work with transference and countertransference in order to facilitate meaningful therapeutic outcomes.
The Future of Psychodynamic Therapy
The podcast concludes with a discussion on the future of psychodynamic therapy. It acknowledges that the field is undergoing shifts, with a potential swing back towards a more psychodynamic-friendly approach within psychiatry and psychotherapy. The podcast notes that a growing number of professionals recognize the limitations of certain therapy modalities and are seeking a deeper understanding of their patients. However, the episode raises concerns that misconceptions and prejudices about psychodynamic therapy may hinder its recognition and utilization. It suggests that open and thoughtful discussions, as well as a renewed understanding of psychodynamic concepts, may be necessary for the future of psychodynamic therapy.
Mark L. Ruffalo, MSW, DPsa, Jonathan Shedler, PhD, and Geneva Valeska, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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