Episode 184 - Does Analysis Work? A Conversation with Jonathan Shedler, PhD
Oct 14, 2021
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Renowned researcher and clinician, Jonathan Shedler, joins to discuss the effectiveness of psychodynamic psychotherapy. Shedler's influential work shows that psychodynamic therapy leads to ongoing change, even after therapy ends. The podcast also explores the tension between psychoanalysis and cognitive behavioral therapy, challenges in the field of psychotherapy, and analyzes a dream about a lost sweater as a symbol of independence and a complex mother-daughter relationship.
Psychodynamic therapy is just as effective, if not more so, than cognitive behavioral therapy (CBT) and the narrative of CBT's superiority is based on alternative facts.
Psychodynamic therapy produces lasting benefits and patients continue to improve even after therapy ends, unlike other therapies that often lead to relapse patterns.
There is a divide between academic researchers and clinical practitioners in the field of psychotherapy, highlighting the need for more communication and collaboration between the two to ensure effective and meaningful therapy aligned with patient needs.
Deep dives
Challenging the Narrative of Evidence-Based Therapy
The podcast episode discusses the tension between cognitive behavioral therapy (CBT) and psychoanalysis as approaches to therapy. The speaker highlights the dominance of evidence-based therapy and the pressure for therapists to adopt manualized CBT techniques, which prioritize conscious strategies over understanding and addressing the unconscious. The podcast features an interview with Dr. Jonathan Shedler, a psychologist and researcher who champions psychodynamic theory and methods. Dr. Shedler's research challenges the prevailing narrative that CBT is superior to psychodynamic therapy. He argues that psychodynamic therapy is just as effective, if not more so, and that the narrative of CBT's superiority is based on alternative facts. He emphasizes the need for therapy to focus on achieving deeper self-understanding and transforming lives, rather than solely managing symptoms. Dr. Shedler also discusses the importance of long-term therapy, debunking the myth that CBT can yield the same results in just a few sessions. He highlights the benefits of psychodynamic therapy, including its ability to lead to lasting positive changes, continued improvement over time, and a focus on understanding the unconscious and exploring defense mechanisms and transference.
Effectiveness of Psychodynamic Therapy
Dr. Jonathan Shedler's research on the efficacy of psychodynamic therapy is discussed in the podcast episode. His research challenges the belief that psychodynamic therapy is outdated, debunked, or inferior to other forms of treatment such as CBT. Shedler's paper demonstrates that psychodynamic therapy is as effective as CBT, showing moderate to large effect sizes. He refutes the notion that therapy should focus primarily on symptom reduction, highlighting the broader goals of self-understanding, personal transformation, and living life more fully. Shedler's research also reveals that psychodynamic therapy produces lasting benefits, with patients continuing to improve even after therapy ends. This contrasts with the relapse patterns observed in other therapies. Shedler's work challenges the prevailing narrative, highlights the power of talk therapy, and emphasizes the need for a more comprehensive understanding of therapy outcomes.
The Siloed Nature of Research and Clinical Practice
The podcast addresses the divide between academic researchers and clinical practitioners in the field of psychotherapy. It discusses how academic researchers often operate in a silo, disconnected from the day-to-day experiences of clinicians and their patients. This disconnect can lead to a distorted view of therapy outcomes and the dominance of certain therapeutic approaches, such as manualized evidence-based therapies like CBT. The episode highlights the need for more communication and collaboration between researchers and clinicians, as well as a greater understanding and integration of scientific research and clinical practice. It underscores the importance of bridging the gap between these two worlds to ensure that therapy is effective, meaningful, and aligned with the needs of patients.
The Importance of Understanding the Unconscious
The podcast episode emphasizes the importance of acknowledging and working with the unconscious in therapy. It challenges the prevalent narrative that focuses solely on conscious strategies and symptom reduction, dismissing the significance of the unconscious. Dr. Jonathan Shedler argues that the unconscious plays a vital role in psychological processes and that therapies should explore defense mechanisms, resistance, and transference. Shedler's research demonstrates that psychodynamic therapy, which delves into the unconscious, is just as effective as other therapies. The episode highlights the need to embrace a more holistic and comprehensive understanding of the human psyche, recognizing the importance of unconscious processes in therapy and personal growth.
The importance of understanding the interplay between the individual and the collective
The podcast discusses the significance of recognizing the interplay between individual psychological factors and societal systems. It emphasizes the need to go beyond solely focusing on individuals and their diagnoses, to consider the impact of cultural, family, community, and systemic influences on psychological well-being. This broader perspective helps to understand the complexity of human struggles and highlights the importance of social justice in addressing societal inequities.
The potential limitations of an overemphasis on social justice in therapy
The podcast raises concerns about the potential negative consequences of an increasing emphasis on social justice in therapy. It highlights that while social justice is important, it should not overshadow the need to understand and address individual psychological struggles. The podcast suggests that some therapists who heavily prioritize social justice may struggle to provide effective therapeutic interventions, as they may primarily focus on social and cultural factors, while neglecting the emotional and psychological needs of their clients. The need for balance and a nuanced understanding of the individual and societal factors impacting mental health is emphasized.
“Talk is powerful medicine.” Renowned researcher and clinician Jonathan Shedler, Ph.D., joins us to discuss the effectiveness of psychodynamic psychotherapy. While so-called evidence-based therapies—brief treatments conducted by instruction manuals—offer benefits for some, their status as the “gold standard” of treatment for mental distress is undeserved.
Dr. Shedler’s 2010 paper, “The Efficacy of Psychodynamic Psychotherapy,” is the most widely read psychoanalytic paper of our time. It’s been downloaded more than a quarter of a million times and has been cited by thousands. He discusses this influential work with us, including the finding that those who engage in psychodynamic psychotherapy not only improve by the end of treatment but continue to make gains even years after therapy is finished. According to Shedler, “psychodynamic therapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended.” Jung tells us that we don’t solve our problems so much as grow larger than them. There is good empirical evidence that psychodynamic psychotherapy does indeed help us to grow.
Here’s the dream we analyze:
“I am in a snowy place with my mom. We are leaving one chalet to go to a different one to meet up with other family members. While packing up to leave, I am preoccupied with a lost sweater. My mom is angry at me for wasting time. I love the sweater; it’s beautiful, and I wanted it for a long time before I got it. I gradually accept that the sweater is now gone, but I’m really sad about it. Then we get into the car. We are both in the back seat of the car talking to each other, and it takes a few minutes before we realize that the car is driving itself. I am not bothered by this; I seem to intuit that the car will take us to the right place, or at least that it knows where it’s going. But my mom is once again angry at me for not driving it. I cannot drive it because my leg is injured. It is this anger--as she realizes that I’m not driving the car--that seems to make the car stop, and then we are stranded in the middle of the road.”