What creates real change in psychotherapy?

In this episode, Dr. Eric Spiegel and Dr. David Alter speak with Dr. Mary Jo Peebles, clinical psychologist and psychoanalyst, about the deeper processes that drive transformation in therapy.

Moving beyond technique-driven and manualized approaches, Dr. Peebles explores psychotherapy as a dynamic, relational process—one shaped by uncertainty, mutual influence, and the evolving interaction between therapist and patient.

The conversation examines how therapeutic change emerges over time through moments of connection, rupture and repair, and shifts in perception and expectation. It also highlights the importance of "scaffolding" in early treatment, the role of relational safety, and the neurobiological foundations of lasting psychological change.

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Topics include:

• The limits of manualized and protocol-driven therapy
• Psychotherapy as a relational, emergent process
• The role of uncertainty and ambiguity in clinical work
• Rupture, repair, and the development of trust
• Scaffolding and early therapeutic structure
• Perception, expectation, and psychological change
• Neurobiological perspectives on transformation

This episode offers a nuanced exploration of psychotherapy for clinicians, students, and anyone interested in how meaningful change unfolds within human relationships.

Timestamps:

00:00 Introduction to Dr. Mary Jo Peebles

02:54 The Complexity of Psychotherapy

05:54 Trans-Theoretical Approaches in Therapy

08:47 Siloed Practices in Psychology

11:55 The Role of Identity in Therapy

15:07 Understanding Patient Experiences

18:07 Role Play: Navigating Panic Attacks

20:54 Exploring Uniqueness vs. Commonality in Therapy

24:11 Role Play: Attachment and Connection

27:06 The Therapeutic Alliance and Patient Engagement

36:05 The Emergence of Change

39:02 Navigating Emotional Spaces

43:51 Understanding the Therapeutic Process

46:17 The Role of Ambiguity in Therapy

48:09 Scaffolding in Early Sessions

52:51 Duality of Experience in Therapy

55:05 Rupture and Repair in Therapeutic Relationships

01:01:52 The Challenge of Change

01:06:57 Structural Changes for Lasting Impact

Follow Dr. David Alter:

General Info: www.drdavidalter.com For Couples: www.partnersatcrossroads.com Follow Dr. Eric Spiegel:

General Info: www.ericspiegelphd.com Group Practice: www.therapistsinphiladelphia.com