John Cornelius raises an important question that many outcome studies overlook: instead of focusing on who shows improvement at the 6-month mark, he asks who remains better years later. Real change isn't something you can find in a manual. #TalkingHelps #Psyc4666 @drwilliamsharp.bsky.social
During Dr. Cornelius’s talk on the efficacy of different treatments, he explained that while the effect sizes of CBT, drug, and psychoanalysis are similar for short-term treatments, psychoanalysis outpaces the previous two types in long-term treatment outcomes. @drwilliamsharp.bsky.social #psyc4666
In “Where is the Evidence for Evidence-Based' Therapy“, Shedler is careful to note that the term ‘statistically significant’ is more of a marketing technicality than a clinically meaningful result. It can be used to bolster an otherwise underwhelming “benefit”. @drwilliamsharp.bsky.social #psyc4666
Manualized treatment might work for some people, but it typically doesn’t help most patients in real-life situations. When therapy sticks to a script, it overlooks personal differences, which can lead to unsuccessful outcomes. #TalkingHelps #Psyc4666 @drwilliamsharp.bsky.social
Shedler’s paper highlights how manualized, evidence-based therapies often fall short in real-world practice. Patients’ lived experiences and the complexity of therapy cannot be easily standardized and placed into a manual that works for all. @drwilliamsharp.bsky.social #TalkingHelps #Psyc4666
Dr. Cornelius' talk showed that framing matters. In one of the charts he showed, the CBT effect sizes looked large compared to waitlists, but compared to real treatments, the advantage decreased dramatically. @drwilliamsharp.bsky.social #psyc4666
Also, regarding "Where is the Evidence for 'Evidence-Based' Therapy“, if 75% of patients don’t get well and benefits don’t last, calling a treatment the "gold standard" is very misleading and should be investigated. @drwilliamsharp.bsky.social #psyc4666 #TalkingHelps
I found Dr. Shedler’s critique of “evidence-based” therapy very compelling. Given the ubiquity of CBT and drug regimens in popular media, policy proposals, and psychology classrooms, I think a critical look at these therapies is necessary @drwilliamsharp.bsky.social #TalkingHelps #Psyc4666
Meta analyses often demonstrate more robust data. Especially when studying therapy efficacy (a more abstract concept) it is important to view a large sum of datapoints in order to analyze the success of a specific kind of therapy.
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Shedler's 2015 paper highlights the importance of looking deeper into research studies. In an NIMH study, the CBT treatment group only saw improvement 24% of participants. Manualized treatments are not always the most effective option. @drwilliamsharp.bsky.social #TalkingHelps #Psyc4666
In #Psyc4666 today, the topic of transference love came up, referring to situations in which a client develops romantic feelings toward a clinician due to the reactivation of strong affects tied to an earlier attachment figure, or “love object.”
During class yesterday, we went over presentations on therapy methods I found really interesting -- primarily as introductions/overviews of existential therapy and play therapy (very different from each other, which I found funny yet fitting).
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In today’s discussion following the existential therapy presentations, we briefly mentioned the emerging use of AI to simulate deceased loved ones, also known as “griefbots”. This generative Ai raises many complex ethical and philosophical questions. #griefbots #Psyc4666 @drwilliamsharp.bsky.social
I read Shedler (2015), "Where is the Evidence for Evidence-Based Practice?", and while reading, I liked the question that was asked in the reading. The question from the reading asks, "How can there be such a mismatch between what we have been told versus what the study actually found?"
#Psyc4666
Neither of these studies disprove the effectiveness of psychotherapy...but they prompt us to look further at how evidence is produced, who it serves best, and what we might be missing.
Curious what others think.
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Eye-opening that CBT leaves so many still struggling. Could the real therapy be less about steps in a manual and more about the relationship of being seen + understood? #Psyc4666 @DrWilliamSharp
I can’t stop thinking—if the toughest, real-world patients are cut out of trials, how can we really call it “evidence-based”? What’s left feels less like science and more like a shortcut. #Psyc4666 @DrWilliamSharp
Shedler’s advice stuck with me: don’t just trust the claims, ask for the study + read it yourself. Significance does not equal real-world impact. #Psyc4666 @DrWilliamSharp
It was interesting to read Jonathan Shedler's article, "Where is the Evidence for 'Evidence-Based' Therapy?" and Wright's "Computerised cognitive–behavioural therapy for depression in adolescents: feasibility results..." back-to-back this week.
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OpenNotes in mental health is a double-edged sword: transparency can can empower patients and catch errors, yet it also requires careful clinician training and informed rollout to avoid harming the therapeutic relationship due to misinterpretation @drwilliamsharp.bsky.social #TalkingHelps #Psyc4666
Just read Jan Hoffman’s “What the Therapist Thinks About You”. The OpenNotes pilot shows that many patients benefit from reading therapy notes, but clinicians worry about misinterpretation and documentation changes. Interesting read for our class. @drwilliamsharp.bsky.social #TalkingHelps #Psyc4666
Just watched 'The Case for Psychoanalysis (v4)' by Dr. John Thor Cornelius. He provides a clear evidence-focused case that psychodynamic/analytic therapy can produce deep, durable change that often continues after treatment ends. Great video! @drwilliamsharp.bsky.social #TalkingHelps #Psyc4666
The fixation on immediate outcomes often overlooks the importance of long-term wellness. Even though psychoanalysis is typically slower and more intensive, it provides depth of change and lasting impact that makes psychoanalysis invaluable. #TalkingHelps #Psyc4666 @drwilliamsharp.bsky.social
It is interesting to see how evidence for CBT is often overstated, relying on statistics rather than meaningful clinical change. Psychodynamic therapies consistently show more benefits that last beyond treatment, but it is often dismissed. #Psyc4666 @drwilliamsharp.bsky.social
@drwilliamsharp.bsky.social I find it annoying that CBT and drugs have been shoehorned like this. Maybe without profit incentive, then things would be different. As I learn more, I find psychoanalysis to be more individualized. Although it takes longer, the lasting benefits are evident. #Psyc4666
@drwilliamsharp.bsky.social Moreover, the actual long-term effectiveness of CBT is moot. Research presented by Dr. Cornelius in his presentation demonstrates high relapse rate in CBT patients. Contrarily, patients treated with psychodynamic therapy showed promising improvement long-term. #Psyc4666
@drwilliamsharp.bsky.social I find the separation between broad acceptance of CBT vs. Psychodynamic Therapies to be confounding. Although CBT is easier to be tested using traditional research methods, many of these studies have small sample sizes and exclude patients w/ comorbidities. #Psyc4666
When I took Statistics, we read 10 different papers published in prestigious journals that were completely BS. Researchers had altered procedures and statistics to create virtually fake conclusions. I was astounded that nobody had caught this
@drwilliamsharp.bsky.social #talkinghelps #Psyc4666
Currently watching The Case for Psychoanalysis by Dr. Thor and I am rethinking everything...
My behavioral neuroscience education has never mentioned the large number of relapses or the drop in efficacy from SSRI's. This should be known!
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Shelder's article shows how crucial it is to understand and interpret scientific findings. Statistical significance is not enough to see if findings truly support the claims. @drwilliamsharp.bsky.social #TalkingHelps #Psyc4666
