#236 – The Efficacy of Psychodynamic Therapies with Jonathan Shedler

photo of Dr. Jonathan Shedler

Transcript

Jonathan Shedler, PhD is Associate Professor of Psychiatry at the University of Colorado School of Medicine, Director of Psychology at the University of Colorado Hospital Outpatient Psychiatry Service, and Founder of Digital Diagnostics Inc. He is co-author of the Shedler-Westen Assessment Procedure (SWAP) for personality diagnosis and author of the Quick PsychoDiagnostics Panel (QPD Panel) for mental health assessment in primary care. Dr. Shedler lectures to professional audiences nationally and internationally and consults to health care organizations and government agencies. He is also a certified professional ski instructor and, in a former life, taught skiing in Aspen, Colorado. Click here to go to his website!

A psychology podcast by David Van Nuys, Ph.D.

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16 Comments

  1. Michael
    Posted May 7, 2010 at 8:55 pm | Permalink

    Hello, Dr. Dave:

    I want to commend you for your excellent interview with Dr. Shedler. Your discussion of academic politics and special corporate interests cloaked in the presumed objectivity of science was illuminating. The points you made do not get stressed enough. It’s truly impressive that your podcast provides a forum for such unmitigated insights.
    The other excellent observation was with regard to the importance of a therapist’s expertise and adaptability in determining the success of his or her approach–regardless of philosophical orientation.
    Human beings cannot be reduced to quantifiable symptoms. We live in an age where humans are treated as machines. Everything is about the so-called “evidence” of clinical studies that are still open to interpretation. This paradigm needs to change if we are to appreciate the full scope of our human experience. The “scientific” seal of approval carries more weight than it deserves. In the spirit of science itself, we should be skeptical of those who further certain claims because of vested financial interests.
    A similar thing occurs in secondary education. It’s not unusual to find theoreticians who prescribe all sorts of “solutions” to classroom challenges. Unfortunately, many of these individuals have abandoned the classroom for lucrative seminar opportunities. Their research is often muddled with ambiguous terminology and so-called “research.” Teachers still at their jobs are often bludgeoned with the recommendations of these disingenuous “experts,” but one fact remains: those educators who utilize their experience and maintain the flexibility to understand different learning styles are the ones who are respected by all. There is no one solution to anything. A willingness to keep learning about ourselves and others is far more rewarding than merely accepting a scientific result as a fact. Each person deserves respect for his or her uniqueness; a symptom is one of many contingencies. There can never be a one-size-fits-all manual.
    Thanks again, Dr. Dave, for providing such a sophisticated discussion to your listeners. Your podcasts are always genuine learning experiences.

    Mike

  2. Russ
    Posted May 7, 2010 at 10:04 pm | Permalink

    This is such a great episode. Jonathan Shedler\’s description of what exactly psychodynamic therapy is is incredibly accurate, and so important.

    In my opinion – based on my own experience – part of why psychodynamic therapy has gotten such a bad rap is simply because it is really, really, really hard work. It can also take a long time and cost a lot of money. And it’s true that finding the right therapist can also be very difficult.

    Working through and examining things like transference, resistance and defences, dreamwork, fantasy, the unconscious – and coming to terms with extremely unpleasant feelings, thoughts, desires and beliefs – this is all really difficult work and requires that the client engage in looking at him/herself in ways that can be extremely uncomfortable.

    Who in the world wants to sign up for this? I sure as hell didn\’t, and after two years of therapy, I still struggle with taking responsibility for my own progress and doing the work involved with getting to the root of what it is that brought me to therapy in the first place. But, for me, this is how I get there. A dozen sessions of some kind of brief, CBT-type therapy would be a total waste of time in my own case.

    One could say that analysis is about looking at the truly ugly side(s) of who we are, and accepting it. Or exposing maladaptive beliefs about ourselves that are unconscious yet are causing the kind of internal conflicts that result in horrific symptoms of anxiety, depression, or a hundred other manifestations.

    And here\’s the hard part…the patient has to do the work. The therapist can only guide the way.

    So here\’s the problem in my opinion. Success in analysis requires the kind of work, patience, commitment and diligence that has become antithetical in American culture; a shallow, superficial culture that now strives for comfort and convenience at all costs. And presenting a rosy, external image of our lives as being wonderful and in control requires that we repress and deny the things that actually make our lives hellish and out of control.

    We want our problems to go away RIGHT NOW, and we don\’t want to have to put much effort into it, either. So it makes sense that these new, brief therapies are so popular now.

    I\’m not saying that psychodynamic analysis is the only one, true way of realising true wellness. I\’m saying that it represents an approach (and a depth) to self-examination that seems out of step with the quick-fix shallowness of our culture these days. So it makes sense that there’s a lot of “evidence” that it’s not effective.

  3. Posted May 7, 2010 at 10:18 pm | Permalink

    Thank you both Mike and Russ. I’m humbled to have such articulate and thoughtful listeners! You’ve both made such good observations. Thanks for sharing them here!

  4. Posted May 12, 2010 at 1:16 pm | Permalink

    Dr. Shedler provides a wealth of stimulating information, including important points about the commercialization of mental health treatment and dangerously rampant marketing of psychotropics.

    But here are a couple of sites for comic relief:

    HAVIDOL – “for the treatment of Dysphoric Social Attention Consumption Deficit Anxiety Disorder (DSACDAD).”
    http://www.havidol.com/index.php

    FDA Approves Depressant Drug For The Annoyingly Cheerful. “Despondex – the first drug designed to treat the symptoms of excessive perkiness.” Onion News video
    http://www.youtube.com/watch?v=jd4tugPM83c

  5. John Knight
    Posted May 18, 2010 at 7:57 am | Permalink

    Just wanted to say I second Michael and Russ\’s opinions, good reading.

  6. Peter B. Todd
    Posted May 20, 2010 at 11:36 pm | Permalink

    I have read Dr Jonathan Shedler’s timely and courageous paper on the efficacy of psychodynamic psychotherapy. As I have communicated to him by email, my reaction was that this seminal article was that it represented a significant “evidence based” contribution to the rehabilitation of psychoanalysis, especially in Australia.

    Where psychoanalytic theoretical frameworks and therapies have been ritually debunked as pseudoscientific while being ousted from mainstream academic psychology in favour of the dominant CBT paradigm. In Australia, CBT, DBT and IPT (interpersonal therapy) have been represented as the only empirically supported or “evidence based” approaches to psychotherapy, with a monopoly upon medicare rebates for treatment and research funding alike.

    In fact the “resistance to psychoanalysis has been so extreme as to preclude research which would be considered for doctoral degrees. Psychoanalytically oriented psychologists have been compelled until recently to conduct post-graduate research outside of academic psychology, for instance, in medical faculties or departments of sociology and anthropology.

    I believe that there are two primary components to the empirical evaluation of psychoanalysis. One is the verification of hypotheses derived from various psychoanalytic explanatory theories in such fields as psychosomatic research and neuropsychoanalysis. This is simply the empirical testing of robust and useful scientific predictions from theory.

    The other component and the subject of Jonathan Shedler’s paper, is the ongoing evaluation of the efficacy of psychodynamic approaches to therapeutic intervention for the personality and emotional disorders outlined in such sources as DSM-IV and the outcome of immunologically mediated and resisted diseases in which unconscious mental factors have already been shown to be predictors of prognosis or outcome. Examples include cancer and infections such as HIV/AIDS.

    I have published research in peer-reviewed scientific journals relevant to these issues. One was on the operational analysis and measurement of unconscious ego-defences and affects in women with symptoms of breast cancer in the British Journal of Medical Psychology (1978), 51(2), 177-189. Another more recent paper was published in the “Mind and Matter” journal, (2009), 6(2), 193-206. It was titled, “Unconscious Mental Factors in HIV Infection”. The methodology in the 1978 paper involved the rating of video-tape recorded, psychoanalytically oriented interviews and would be applicable to studies evaluating therapeutic process and outcome.

    Jonathan Shedler’s provocative paper has generated not only a renaissance of interest in psychodynamic psychotherapies. It has certainly created considerable controversy in psychological circles especially “downunder” in Australia where CBT doctrine has continued to preclude observation and dissident research!

  7. John Knight
    Posted May 24, 2010 at 8:02 am | Permalink

    Thanks for that Peter!

    As an Aussie with an interest in a psychodynamic approach – especially Jungian – I’ve been shocked to see that our educational structures barely even touch upon it. I’ve talked to Aussie psych students about various psychodynamic concepts only to get a blank stare! I’m interested in becoming a certified, studied, piece-of-official-papered psychologist, but not in the current courses available here in Perth!

  8. JR
    Posted May 27, 2010 at 3:18 pm | Permalink

    Dear Dr. Dave,

    I just wanted to say thank you for your Shrink Rap Radio and Wise Counsel podcasts and interviews! I discovered them today and have been listening for the past few hours.

    As a patient for over 20 years in the mental health system, I have a lot of experience with the many different aspects of the field of psychology. I have also done so much reading and research on my own to try to find help for my issues. Considering all that, I have to say that your podcast interviews are the most helpful resource I have ever found. You have made these psychology and mental health experts accessible to the layperson interested in learning more about the field without diluting the information. Your interview style really gets to the heart of what’s most important and useful for people like me who need this information urgently.

    Specifically your interview with Jonathan Shedler was very helpful to me because of my long-term involvement in psychodynamic therapy. To understand what it is and why it helps is difficult enough to explain to myself let alone others who have not had the experience. Your interview clarified my thinking about psychodynamic therapy and allayed my doubts about its efficacy. It was just what I was (unconsciously) looking for.

    Thank you again for sharing this information in such a great way. I really appreciate that you have given a forum for those in the field of psychology to share what they know directly with us listeners.

    Keep up the good work! I look forward to listening to your future podcasts and past archives.

  9. iamhbc
    Posted October 28, 2010 at 9:52 am | Permalink

    Thanks for the great interview. And thank goodness for Jonathan Shedler\’s masochism, hanging in to have published The Efficacy of Psychodynamic Psychotherapy.
    Like Peter B Todd I\’m in Australia.
    I\’ve been in psychodynamic psychotherapy for 10 years now resulting in recovery from a personality disorder. Currently in therapy I am dealing with what I call the \’legacy of the pathology\’. I agree with Russ that it is really hard work though for me every agonising nano second has been worth it. I\’m ever so grateful that the first place I sought help happened to be an ethical psychiatrist who is not interested in contributing to pharmaceutical company coffers nor does he do \’holding pattern\’ symptom relief preferring rather psychodynamic psychotherapy. Describing to others what happens in psychodynamic psychotherapy & the efficacy of it can be fraught & I was thrilled when my therapist told me about Jonathan Shedler\’s paper & I read it. His piece \’That Was Then This is Now\’ is also well worth taking the time to read.

    It seems to me that schools of psychiatry have abdicated their role in patient care to social workers and mental health nurses. Perhaps it is some sort of existential crisis that has them preferring to be the pawns of pharmaceutical companies. I understand psychotherapy isn\’t for everyone however I fear if the current climate continues psychodynamic psychotherapy won\’t even be part of the curriculum soon having been discarded for what are erroneously seen to be more cost & time effective treatments. Papers such as Dr Shedler\’s add critically to the debate that may result in long term psychotherapy continuing to be an option for patients such as me.

  10. Posted November 22, 2010 at 5:03 pm | Permalink

    Hello Dr. Dave,

    Just a quick note to let you know how much I enjoy and appreciate your excellent interviews. I commute to work and the CD’s I burn off of the programs make the trip so much more enjoyable and informative. We have put up a link to your site, and made a contribution (more to come soon), and encouraged others to do the same. I noticed that the links to interviews 224 to 238 are broken and no longer available.
    Keep up the fabulous work.
    With much appreciation and thanks,
    Catherine Cosgrove
    President,
    Heritage Home Foundation

  11. Erin Frawley
    Posted October 15, 2011 at 6:09 pm | Permalink

    Beautifully executed interview. The information presented and the graceful dialogue added to the potency of my experience listening. I am currently applying to clinical psychology graduate programs and this information is going to heavily inform my personal statement. I have been searching for explicit language to describe the relationship psychodynamic theory has with the field of clinical psychology and I am happy to have finally found this source! Thank you both.

    Erin

  12. Rick
    Posted June 11, 2012 at 7:12 pm | Permalink

    Well duh!

  13. Rick
    Posted June 11, 2012 at 7:19 pm | Permalink

    Well duh! It’s astounding to me how resistant many are to giving credit where credit is do. While we may see further than the giant’s shoulders upon which we stand we might only rise to the level of their knees had men like Freud not blazed the well worn trail those of us dedicated to helping travel. No wonder APA is so strict about proper citing.

  14. Rick
    Posted June 11, 2012 at 7:20 pm | Permalink

    Well duh! It\’s astounding to me how resistant many are to giving credit where credit is do. While we may see further than the giant\’s shoulders upon which we stand we might only rise to the level of their knees had men like Freud not blazed the well worn trail those of us dedicated to helping travel. No wonder APA is so strict about proper citing…

  15. Rick
    Posted April 23, 2013 at 2:16 pm | Permalink

    I’m currently writing a proposal for a new measure that attempts to tap into a psychodynamic construct which finds its etiology in Freud. The professor overseeing my work comes from a cognitive behavioral background and thus is having difficulty buying into the underlying variables that support my criterion. The hell we go through to provide the “evidence base” causes me to question my own sanity daily.

    When I was in my early twenties I saw a CBT therapist for severe panic disorder. While the techniques he taught me to manage symptoms were indispensable I still carry a bit of a resentment towards him for not helping me attack the underlying problems that caused my anxiety. You can train a smart monkey to do CBT, it takes natural talent to be a psychodynamic therapist. Talent that I am still trying to determine if I have.

    Psychoanalytic thought is the soul of psychology!

  16. Posted April 1, 2014 at 7:13 pm | Permalink

    I have been advocating modern psychoanalysis for years through youtube. I have received many comments from beginning and experienced therapists as to the importance of these videos. I am proud to continue to popularize Dr. Hyman Spotnitz\’s view of what makes psychoanalysis effective with all patients.

    Mark Sehl on youtube marksehl.com

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