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 and her background
(02:39) The impact of systemic thinking across therapeutic approaches
(08:08) The influence of turf and competition on silos in the field
(11:15) The power of therapeutic alliance beyond theoretical allegiance
(14:08) Navigating uniqueness and shared human experience in therapy
(20:00) Role play on integrating the client's sense of self in therapeutic process
(33:26) Emotional inside-outside connection and the importance of feeling understood
(44:20) Opportunities for emergent potential and the fluidity of change
(55:13) Managing rupture and repair in early sessions
(64:07) Shifting focus from beginnings to the process of change
(66:55) The rarity and layers of transformative epiphanies
(68:18) The biological 'bones' of psychological structure and neuroplasticity
(72:16) The role of perception and reality testing in building relational confidence
(78:37) Dr. Herb Benson's perspective on the doors to change

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

What Creates Change in Psychotherapy? | Dr. Mary Jo Peebles