Beginning the Treatment with Jonathan Shedler, PhD
Feb 16, 2024
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In this episode, Dr. Jonathan Shedler discusses the importance of the initial phase of therapy, emphasizing the need to establish a working alliance and purpose. He explores resistance and defense in psychotherapy, the psychology of depression, patient readiness, and the importance of experiential understanding. Tune in to learn how to create a firm starting foundation in clinical practice.
The initial phase of therapy is crucial in establishing a foundation for successful treatment and requires a thorough evaluation of the patient's needs and therapist-patient fit.
Therapists should develop a case formulation that examines the patient's psychological factors contributing to their difficulties, enabling hypotheses and interpretations that facilitate change and improvement.
Establishing a strong working alliance between therapist and patient, including agreement on treatment frame and boundaries, is essential for effective therapy and achieving treatment goals.
Deep dives
Establishing a Commitment to Treatment
When accepting a patient into treatment, it is important to have a solid understanding of their issues, the type of help they seek, and their commitment to participating in therapy. A brief consultation or phone intake may not provide enough information for a proper assessment. Instead, taking the time to thoroughly evaluate the patient's needs and determining if the therapist-patient fit is suitable is crucial. This initial session lays the foundation for the entire treatment process.
The Importance of Mutually Defined Treatment Goals
In therapy, it is necessary to establish a mutual agreement on the purpose of the treatment. This purpose goes beyond a mere diagnosis or symptom management. Therapists should develop a case formulation that delves into the patient's psychological factors contributing to their difficulties. By gaining a shared understanding of the patient's internal struggles, therapists can offer hypotheses and interpretations that open doors for change and improvement. This collaborative approach ensures that both the therapist and patient are actively engaged in the therapeutic process.
Creating a Treatment Frame and Establishing the Working Alliance
The working alliance between therapist and patient is essential for successful therapy. This involves agreeing on the treatment frame, which includes confidentiality, consistent meeting schedules, payment arrangements, and other set boundaries. It is vital for therapists to be clear on their own capabilities, comfort zones, and areas of expertise. Additionally, patients also have responsibilities, such as being present for sessions, paying fees, and actively participating. By establishing a strong working alliance, therapists and patients can work together effectively towards achieving the treatment goals.
The Importance of a Strong Working Alliance
A strong working alliance is crucial for successful therapy. It involves attachment between the therapist and client, a mutual understanding and agreement about the purpose of the work, and agreement on the methods used. Without a solid working alliance, therapy may hit an impasse or become directionless. It is essential to establish a mutual agreement on the purpose of therapy, focusing on aspects the client wants to change about themselves, rather than external factors. The therapist needs to help the client develop insights into their own role in the issues they're facing.
The Consultation Phase and Decision to Proceed with Therapy
The consultation phase in therapy is essential for both therapist and client. It allows for exploration, understanding, and agreement on the purpose of therapy. If there is a shared understanding and agreement on therapy goals, the foundation for effective therapy exists. However, if the therapist and client cannot establish a mutual understanding and purpose, proceeding with therapy may not be appropriate. This honest recognition is not a treatment failure but acknowledges the need for alignment in therapy. It is the therapist's responsibility to help clients recognize their contribution to their difficulties and guide them towards readiness and the desire to change.
Dr. Jonathan Shedler is well known for his work on the efficacy of psychodynamic therapy. He has highlighted the importance of the initial phase of therapy in establishing a foundation for successful treatment. Dr. Shedler strongly believes the consultation phase is crucial to developing a working alliance between client and therapist and building a treatment frame and structure. Without this foundation, there is no mutual understanding about the goal or the purpose of treatment, and psychotherapy should not move forward. Join us in this episode as Dr. Shelder discusses how to create a firm starting foundation in clinical practice.
