Daniel Sousa

[Daniel Sousa @danielfesousa]

@BioavailableNd @hmillerdev How do you adress it?

[Jonathan Shedler @JonathanShedler]

“The patient should give some indication of wanting not only change but 𝘵𝘰 𝘤𝘩𝘢𝘯𝘨𝘦, that is, of dissatisfaction with something that resides in the self”
—Otto Kernberg

When the patient recognizes that they are contributing to their own difficulties, it’s easy to develop a working alliance and shared treatment purpose

The purpose is to understand how the patient is contributing to their difficulties and develop alternatives to that—so they don’t have to spend their lives repeating and reliving the same painful, self-defeating patterns. This becomes the shared work of psychotherapy

When patients do not see that they are contributing to their own difficulties, the work of the therapy shifts. The work is now about helping the patient to recognize and understand their own role in their difficulties

This is difficult work, requiring genuine therapeutic skill, sensitivity, tact, and compassion. It may take weeks or months to help the patient to truly grasp that changing their unhappy outcomes requires changing something about themselves

There’s no foundation for doing any other work in therapy unless and until patient recognizes this and desires to change

(Alternatively, if the patient really has no role in their difficulties, then their problems are not problems that psychotherapy can solve, and the patient has come to the wrong place. They may need help, but it’s not help that can be provided via a psychological treatment)

If it becomes clear that it is impossible to create this foundation of shared purpose, treatment should not proceed. And the therapist must understand that treatment never really began. There was no working alliance and no foundation to build on

[Daniel Sousa @danielfesousa]

@AdamMGrant Can you eventually (with training) switch to a different silent reading method?

[Daniel Sousa @danielfesousa]

@sanilrege @dr_kevinlee @psycheureka Interesting. Btw what is your approach on hyperarousal??

[Jonathan Shedler @JonathanShedler]

✅Narcissistic personality
✅Borderline personality
✅Histrionic personality

Want to know what they’re really about?

Here’s my chapter, “The Personality Syndromes” (Oxford University Press, 2022)

It’s written for professionals but readable by anyone https://t.co/lsj0R9DH54

[Brandon Luu, MD @BrandonLuuMD]

Exercise blunts the cortisol response from an acute psychosocial stressor

Here’s how to use exercise to help manage stressful situations 👇
🧵1/8

[Daniel Sousa @danielfesousa]

@NTFabiano There are no real placebo studies with ketamine. People that are on ketamine know they are on it because of its acute effect (psychedelic experience) and the ones that don't get it know they aren't. How did they minimize this?

[Jonathan Shedler @JonathanShedler]

1/ Truth is, many patients do not come to therapy to change. Not really.

They may say & think they want to change. It soon becomes evident they want to continue being exactly the person they have been, and living life in the same self-limiting ways, but 𝑓𝑒𝑒𝑙 better doing it.