1/ Meaningful psychotherapy is a unique, absolutely private, intensely personal relationship between two individuals—one of whom is in need of help and one of whom has committed to trying to provide it—that must unfold in its own way in its own time. It has the sole agenda of https://twitter.com/JonathanShedler/status/1381318483116355591

2/ helping the patient become more fully themselves, live more fully and freely, & and alleviating their mental and emotional suffering to the extent possible given their inner resources and life circumstances.

3/ Any external intrusion into this private relationship, or any externally imposed agenda, can only distort and corrupt it. To use a theoretical term, these intrusions into the therapist-patient relationship compromise the therapy "frame"which is essential for a meaningful

4/ therapy process to develop.

Some (very few) agencies and organizations protect the sanctity of the therapy relationship and provide a supportive context in which meaningful psychotherapy can flourish. But this is exceedingly rare.

5/ Meaningful therapy is difficult if not impossible in most public agencies & institutions. Their priorities are shaped by external pressures and agenda unrelated to the needs of individual patients. They intrude on the therapy relationship with bureaucratic demands and

6/ superimpose agenda based on revenues, costs, and metrics. They are accountable to external overseers and payers—not their patients.

In most public institutions, it is simply *impossible* for a therapist to provide meaningful psychotherapy.

7/ This is true regardless of the wishes of individual patients or the capabilities of individual therapist. The necessary conditions do not exist. Therapists are constantly pressured to see more patients in less time, pressured to utilize specific techniques that may have

8/ nothing to do with the needs of an individual patients, & are burdened with soul-sucking administrative & bureaucratic demands. Instead of facilitating the private and intensely-personal relationships psychotherapy requires, the institutions become dehumanizing assembly lines.

9/ This is why therapists with integrity, and who actually know what meaningful psychotherapy is, *do not stay in these institutions.* Young therapists who are early in their careers and not yet professionally established may work in such institutions temporarily, to meet various

10/ professional requirements (e.g., supervised practice hours). Their goal is to leave as soon as possible. More experienced and established therapists burn out quickly and leave, or would never consider working in such an environment in the first place.

11/ By and large, the therapists who remain in such institutions are hacks who are merely going through the motions.

As with all rules, there are exceptions. But real psychotherapy rarely takes place in public agencies and institutions.

12/ Never mistake their assembly-line interventions for psychotherapy relationship.

Psychotherapy does not happen on an assembly line.