What we’ve said about Psychotherapy

“I think they're probably equal in efficacy. Now, medications work a little bit faster. So we know that our standard antidepressants take about four to six weeks to work, but it takes about two weeks to kind of see an effect”

“Psychotherapy is the treatment for unipolar depression, and people ought to get trials of three different Psychotherapies before they get a first trial of an antidepressant”

“the most important, quote, medications for depression are behavioral activation, exercise, light exposure, and psychotherapy”

“They will take the medications at high doses, which is generally needed for someone with a primary anxiety disorder or a serious anxiety disorder. And then they will get good enough And then they will not do any of the psychological treatment, which is fundamentally the most important part to treating anxiety and growing for the vast majority of patients”

“the medications don't solve your problems to make it easier for you to grow and change. And so even if you're going to use medications as a first-line treatment in a GAD phenotype”

“we have to get rid of the narrative that if something's biological, then it requires a biological solution. And if something's environmental, then it requires therapy. The truth is, is that something can be biological and therapy can help it”

“we want to find the right clinical treatments for people. And if it's not a medication, that's important to prevent harm and to prevent wasting time with trying to treat a personality problem with a medication”

“If there's something fundamentally more medical, biological that will not respond to a talk therapy alone, ignoring that you're not going to get much progress”

“when someone's in such a depressed headspace that everything feels negative, everything kind of feels so difficult. Therapy kind of can stall because that negative headspace makes it so that patient's not able to have an open, flexible mind”

“anxiety can be interpreted as an activation right as a higher level of sort of psychological energy. And if you decrease it, remove it, or suppress it entirely as you would using a benzodiazepine, that will slow or stop motivation itself”

“in a psychotherapy, the patient needs to be at an optimal level of activation, not over-regulated, not under-regulated for optimal treatment”

“I do recommend that medication management actually take place separately from psychotherapy, even if you're capable of doing both”

“anything that is a named and specific psychotherapy for trauma, I would generally recommend. That includes the IP, you know, the CPTs, right? the CBT traumas, even EMDR”

“psychodynamic being more important for early onset traumas. I feel like that's an area where going pure CBT struggles. You know, there's actually a type of psychotherapy that seems to be more intended for people with multi-traumas”

“Cognitive processing therapy or written exposure therapy or even EMDR, fine, because none of those is likely to make bipolar worse and may help some”

“To me, the only difference is maybe CPTSD should focus more on trauma-focused therapy, so EMDR and trauma-focused therapies. And BPD should focus a lot more on the interpersonal dysfunctioning and the emotional regulation”

“for moderate to severe borderline conditions, they should be in weekly psychotherapy, ideally. And we know that out in the community, things are limited. Not everyone can do everything”

“I think of the minimum effective dose of therapy as once per week. I see a lot of patients that they go once every two weeks or they say, you know, they're not doing good”

“I call it throwing spaghetti at the wall. You're just throwing something at the problem to see what sticks, right? And so when you're not principled about diagnosis, you run into that type of problem quite frequently”

“any effective therapy really needs you, the patient, to understand clearly what the problem is and for that to be accurate. And for the therapist to understand and for you to both agree on how to solve that”

“Quote-unquote diagnosis that's pertinent to a therapist is surely the formulation. And then I wonder how many practicing therapists out in the community are actively formulating and then delivering that formulation to the patient within the first four to six sessions”

“in therapy, it's like it's a little laboratory for a new experience, which is something it's something you do, not something you think”

“before you do any analysis, okay, before you do any interpretation, before you do any confrontation, contain, contain, contain. Demonstrate to the patient that you have actually heard and experienced something like what they have gone through within themselves emotionally, psychologically”

“just because someone went through something doesn't mean that they can see it clearly. Try to put it into words, get those surface and depth clarifications”

“When there is a fracture, a rupture in a relationship, they have not been taught to, they are not accustomed to repairing that together with the other person, which this is an example of why the psychotherapy is so important in treatment”

“good therapy ultimately is, leads to the patient feeling more responsible for their choices in life, a greater degree of freedom in the world, a greater sense of self-responsibility. And I think therapies that sort of move the patient, if you will, in the opposite direction are potentially quite dangerous and quite harmful”

“Usually depressive patients are pretty good patients in psychotherapy because they come in believing the problem is them and they respond They're very reactive to separation. They tend to equate separation with rejection”

“In the more empty, hungry group, they respond very well just to a relationship in which the other person is interested in them. In the more self-hating versions of depressive personality, the therapist has to eventually find a way to really call their attention to how their go-to automatic self-talk is”

“If you're too supportive with the self-hating kind of depressive person, they tend to get more depressed because they think, you're a very nice person, but you don't get how bad I really am”

“What's mostly helpful to people like that is for the therapist to be very respectful, patient, not interpret at the person. because that just makes them feel dominated again or impinged on or penetrated”

“In psychotherapy, they need a therapist who can help them become more comfortable with their emotional life and really question the fact that feeling things is tantamount to loss of control”

“If the therapist appreciates that they have a schizoid psychology, you don't necessarily try to modify that, but it helps you to understand that that's the kind of patient that will do better if you give them a lot of space, rather than if you move in on them”

“you can't say to them, do you think you're projecting? You can't interpret the defenses. What the therapy has to consist of is trying to help them be more comfortable with parts of the self that they need to disown and project”

“a lot of people are already trained to expect that you're there to throw a medication at them. That's why they're seeing you. Right. And if therefore, if you don't take active steps to show that the treatment process is more than the medication, then that's the natural assumption”

“I think therapist skill has enormous variability. And when a patient says, you know, the therapy didn't work, the analogy I like to work is if someone says like, oh, I read a book and it didn't help. Well, what book did you read”

“the easiest way to tell if you are in a good therapy or not is how your therapist responds to you bringing up issues about being in the therapy itself”

“Talk therapy as we conceptualize it in the West since pretty much 1905 maybe didn't really exist properly before psychoanalysis. Psychoanalysis is the original talk therapy and all others kind of come out from that in some way or another”

“This stuff that we're talking about, about the frame and timing, you know, it's been tried and true for psychotherapy. If you've had any training, this is old news to you”

“psychotherapy is a form of surgery. It's being very invasive. You are almost playing God. You're this authority figure, and you cut into the psyche, and you go in there and move stuff around”