SPEAKER_00 0:07

Hi, I'm Piper Harris, licensed professional counselor, and welcome to the Untangled Mind Podcast. This is a show for people who want to understand why their mind works the way it does, not just how to cope with it. Drawing from neuropsychology, neurophilosophy, and data-driven CBT, we look at how anxiety and trauma shape perception, behavior, and choice and what actually helps people change. I'm an integrative CBT therapist based in the Atlanta suburbs. Each episode is designed to teach you something concrete: how to recognize what's keeping you stuck, how to interrupt unhelpful patterns, and how to move forward with clarity and steadiness. Therapy is everywhere right now, but effective therapy is not. Last year in my Catching Flack series, I raised questions that made some people uncomfortable. I asked whether the field had drifted from measurable change into something softer, more aesthetic than effective. I questioned whether support alone had replaced skill. Those conversations didn't isolate me. They clarified something. There are other clinicians asking the same questions. One of those clinicians is my guest, Emily Ferrara, founder of Simplify Life Counseling and Coaching. Our professional dialogue grew out of shared clinical standards, shared concerns about watered-down training, and a shared belief that therapy should produce movement, not maintenance. So in this series, we're getting specific. Part one is simple but foundational. What is good therapy? Not likable therapy, not viral therapy, not therapy that feels validating but goes nowhere. Good therapy. We're going to talk about specialization, diagnosis, measurable outcomes, and why precision matters. We'll also outline what you should look for if you're seeking help for anxiety, depression, trauma, OCD, personality disorders, addiction, or eating disorders. This isn't about attacking the field, it's about raising the standard. If you've ever wondered why some people improve in therapy while others stay stuck, this is where we start. Well, hello everyone and welcome. Really excited to have Emily here. So we are going to get right into it. But Emily, I would love for you to tell everybody about you, about Simplify Life Counseling and Coaching, and really your expertise in OCD.

SPEAKER_03 2:29

Thanks. Um, I'm super stoked to be here as well. Thank you. Um yeah, so I started Simplify in 2011 and um for many of the reasons that we're gonna talk about today, and um wanted to create a place that can help destigmatize therapy, but specifically for anxiety disorders. So that's kind of our our main focus. We see those um we're highly specialized and trained in anxiety, panic, OCD, um, anything that's kind of like connected with that and co-occurring disorders, and then refer out for the rest. So we've got a great team and um just love being able to offer that. Uh, we also offer faith integration if people are wanting that. So um it just depends on what what their reference is or what they want. Um, but we can offer that as well.

SPEAKER_00 3:16

That's great. That's great. Well, and I know we'll talk more as we go through today. So this is our first part of our series. So um, for all of you, you heard in the intros, Emily and I got connected via one of her colleagues on LinkedIn. And then she and I realized we had so much in common and we have a passion for the field, obviously. Um, but we really started talking about what is this idea of what is good therapy, what is not good therapy, and how do we help those of you that are really curious about maybe where she and I differ and where we're seeing kind of this clinical drift. And we're gonna hopefully give you some tools and some tips on how to find a therapist that works well for you. Um, and again, the faith integration I think is huge too, because in our field, I mean, it is highly secular. Um, so to have um that faith integration, I think is really key for a lot of people. We know that research shows that that integration of faith is one of the key determinants of effectiveness of uh of therapy. So I love that you do that too. Excuse me. So we uh kind of started having this conversation offline and decided what the heck, why don't we have a conversation? So for a lot of you, I did the catching flack series last year. So this is great. She actually said to me, She's like, Yeah, have you read that uh Abigail Schreier book, Bad Therapy? I'm like, oh man, that was a tough book to read. Uh and so today, today, our first part is about, you know, what is good therapy? What does it actually look like? And we think it's important to give you the history behind a psychotherapy, where it actually came from. Because I think a lot of people, and I know Emily, you can speak to this when they come to us, their idea of what therapy is, is really based on what today therapy is, but it's really not where psychotherapy started. So why don't you say kind of your idea of like what this drift is, or kind of it used to be very specialist driven. Why have we gotten away from that?

SPEAKER_03 5:14

Um, I think yeah, it used to be very specialist driven. And even in grad school, um, and I'm dating myself, but in the early um 2000s when I was um in college and then went into grad school, um, it was very much like pick your lane. And if you're a psychoanalyst, like that's from Freud, who we um know a lot about, and so and um doing the psychoanalyst work and saying, like, if that's what you want to do, then you need to be a psychoanalyst and you get all this training and we understand um um you know that, and then also working with like dream theory and sexualization, like sexuality and development, all that kind of stuff, repressed um feelings, all of that. And so that's what I grew up with. And like you're saying, there's been more of a shift. Um, you know, I think that because of insurance and they're wanting to be able to see more managed care, they're wanting people to be able to see a lot of different people and see them for a short amount of time. I think that that's something as well. Um, and then we also I think see stuff on online. We see picture, uh, we see like, you know, TV shows of uh reality TV people, and they're just like, this is the most specialized I see is like couples counselor, you know. Yeah. But in that, it's like it's just general. And it's one therapist, even for some of the reality shows, it's like one therapist for all of these different people, even for couples counselors. You've got right clients, you know, you've got people on the show that have trauma or have like attachment issues and whatever, and you're like, okay, this one person can't do all these things, and yet that's kind of how people see it.

SPEAKER_00 6:54

Yeah, I agree. I love that show, by the way, couples therapy. Have you seen that one? So fabulous, yeah. And she's a psychoanalyst. That's what I love about her, how she does it. So I find her work fascinating because she is 100% psychoanalyst, and so that's a really great show for a lot of you. If you want to kind of get a peek behind the curtain, it's a great uh perspective to see that particular, you know, um, focus of therapy. And I think you're right. Right. Yeah, like and I think you're right. Like when we see even there's such a the reality TV or um, you know, these famous people are talking about therapy, but they don't, they're not even able to distinguish that there are actually experts out there, um, you know, and kind of talking about Freud. He was kind of the the grandfather, but he was the Viennese grandfather. Everybody knows about Freud. I actually read a really I'm reading a fabulous book right now that made me very angry at Freud, and I can share with that later, but um, you know, because his focus began with hysteria because they really didn't know what was happening. They and hysteria was only women, they actually used to think that it started in their uterus of all the things. Yeah, so fascinating. So obviously, we know then he went to the psychosexual work. Um, but really for us, I think for American psychology, that's William James. So he's the father, and he actually what was interesting about him is he's kind of one of the first um cognitists before Beck came on. Um my background is CBT, is that's kind of my background. Um, but it's really interesting because we see a lot of that work, Carl Young, Carl Young and Freud were in this kind of study group together, as was Alfred Adler, and we never hear about him. We never hear about Adler. Um, but it was so specialist driven. I think you and I talked about too, it was much more um medically driven, complex presentations. Yeah. So if you were, if you were to play kind of along, if um we're in the early 1850s, 1900s, and somebody came with OCD to you, what do you think? I mean, would you be like this originated in your uterus? I mean, what what do you think that would have been like?

SPEAKER_03 9:12

I don't know. And my understanding was, and and this is pulling from grad school, um, is that a lot of a lot of disorders that we know today weren't diagnosed. So they saw mostly like hysteria or people who um like schizophrenia. And so uh even like the asylums in the 19, you know, up to the 1950s, is they were um treating the most more extreme things, right? And so I think that it doesn't mean that, and I also will hear sometimes from parents who are like, Do you think this is just a fad? You know, do you think that because now it's kind of like invoked?

SPEAKER_00 9:43

There are some fads though with these kids. Like when they weren't sick, everybody had Tourette's for a while.

SPEAKER_03 9:48

Yeah, you know, and it was and then um I but I think it's also you know, if if you knew that you were gonna have to go to this scary asylum, um I'm good. I'm great. Yeah, so you know, like keep it down, shove it down. And so um, I just think that that they had it was much more of a medical model. Um, it was it was very specified to the extremes. And as, you know, psychology progressed as different theorists came out with different theories, and then also like just the the decade of the brain, you know, starting with the 80s and 90s and us understanding like what we're actually dealing with, I think it definitely helped normalize it. But um, as in the normalization, I think we watered down the treatment process.

SPEAKER_00 10:33

Yes. Oh, that's a that's a great way to put it. The normalization has watered down the actual clinical treatment process. And it's it's interesting, even talking with grad students now. I do some mentoring. I used to work in psychiatric hospitals, those are unheard of now. I mean, and unfortunately, with the closing of psychiatric hospitals, we see this on our streets, and these are the most underserved communities, lots of schizophrenia, lots of addiction, always that core comorbidity. Um, but it's fascinating. There's so very few psychiatric hospitals. And I remember walking those halls going, ooh, like this is a you just until you're there, you have no idea what it is. And it's you they glamorize it on movies and schizophrenia, for example, is just horrific. It's so awful for the individual or someone that's bipolar in a current manic manic episode. It's just awful. But again, kind of going back to what we're talking about, good therapy actually, we think should be much more specialized than the watered down version we have today.

SPEAKER_03 11:38

Yeah, yeah, yeah. It shouldn't just be generalist or you have to go to impatient, right? Um and somewhere along the lines, we've lost our way, you know.

SPEAKER_00 11:49

What do you think that where do you think that shift? I know we're kind of we have a outline everybody that we're kind of talking through, but where do you think that shift happened? What do you think societally or even politically or what maybe insurance driven? What happened with this drift?

SPEAKER_03 12:07

I think a lot of it's insurance driven, um you know, and managed care, which is helpful, but also like um I think it's also not it, the consumer's not as informed. So when you think about um where you go, uh so much of it's um word of mouth. So for our clients, so much of it's um, it's not like yellow pages or if they still even have those, you know.

SPEAKER_00 12:33

Nobody knows what a yellow page is.

SPEAKER_03 12:34

Yeah, you're like the mom group that went here, here and yes, people find us from Google, you know, find you. And but it's it's so much um it's just word of mouth, like how we met, right? Word of mouth. And if you trust the source, then you can refer out and stuff. So I think a lot of it's also not informed um kind of connectors. So yeah, think about like if you um if you're like, hey, this is a great therapist, they worked really well with me. But sometimes who works well with me is not gonna work well with you, Piper, you know, and so being able to understand like this is a really great therapist that works with X, not Y. And so sometimes, um, especially as people are talking about even influencers are like using this is what my therapist said. Well, what kind of therapist are you are using, right? And like they're effective, you know, if if you have um some sort of skin disease and I go to my endocrinologist, like it's not gonna work, not gonna work, right? Like it's not gonna be helpful, and so it will be helpful for other things, but it won't be helpful for that. And I think a lot of times people are like, well, it worked with this person. Um for this person, it's like, yeah, but you also don't know what they're dealing with necessarily. They're talking about the broader scope of it, perhaps. Yeah, not necessarily.

SPEAKER_00 13:50

Well, and I think too, like you said, just with the influence of social media with influencers and all of that, is that um in particular our attention span is so much less that we're we're driven by these like little 30-second tidbits of psychology. And again, it's about educating the public on um recognizing when there's clinical need and recognizing when you need an expert. And a generalist, I mean, we're not speaking terribly about generalists. In fact, anybody that has to go through internship has to practice as a generalist. We don't have a choice, right? Um, because a generalist does fit a certain type. But if we're really looking at what we would call clinical levels of distress, that is when you need to do your research on who's an expert in OCD, who works with trauma, who works with personality disorders. You know, it's it's really key because I think what I hear a lot of times when people come to me, they're like, Well, this therapist said they did 15 different things. Right? They look at their their profiles on psychology today, and it's very hard for them to discern what's going on. And so I think part of what good therapy is, or that we're hoping to promote, is the education of the general public. That if you really, like you just said, if you really have a need, just because Susie's therapist was great for Susie doesn't mean it's going to be great for you. And it doesn't mean the therapist is bad. It just means it's not the right fit for you. So I think that that generalist approach is and with this societal kind of quick little 30-second TikTok influencers and all of that has really caused a huge drift.

SPEAKER_03 15:29

Yeah, yeah, I think it's true.

SPEAKER_00 15:31

So, well, we're talking kind of about the origination of psychotherapy. Um, and I'll share this little tidbit for the the listeners. I'm reading this fabulous book called Trauma and Recovery. Um, I do not suggest it for listeners that are currently working in trauma. Um, this is a it's a pretty detailed book on trauma, so I don't suggest that. Interesting thing about Freud is he actually was one of the first people to study trauma. They called it hysteria. But ultimately, what he did is this is when he started listening, kind of that talk therapy started happening. Um, and the unfortunate thing that happened with Freud is he was very much influenced by the aristocracy of the time because he learned that it was really about sexual exploitation of women and children. That was the history histrionics, I guess you could say, that he was seeing. And rather than continue his studies, that's when he decided to shift to psychosexual um motivations and made it about the woman. It was very interesting. But when you read the history, I got very angry. Like, hey boys, you put us behind the ball here with trauma work, but it was it was a good book. So yeah, but so we talk about expertise. We know that you have an expertise in OCD. I have an expertise in PTSD, complex PTSD. So there's a lot of different primary ways that we work with them. Why don't you talk about how people know number one, what is OCD? And number two, what do they focus on? What would a therapist focus on so that we can kind of educate our listeners on that?

SPEAKER_03 17:06

Yeah. Um, for OCD, it's really important to make sure, and I know that both of us is what we align with is um having data-driven diagnoses. So making sure that if someone comes in and is like, I'm so OCD, um, I know it's a phrase that a lot of people use, or like um, just like we do with unfortunately people do with bipolar borderline um panic attacks, but being able to say, okay, tell me more. Um, and whatever the diagnosis is, but specifically for OCD, we'll we'll use um Y box or Psy box. It's kind of the gold standard for um for assessments. And within those 10, 11 questions, we've got a good read on the severity and if they have it or not. Um, sometimes they'll take it and we realize, oh, you are obsessing, but it's not necessarily OCD. And so that could be more of social anxiety or panic disorders or whatnot. So the Y Box is really helpful in us being able to pinpoint um what type of um severity we're looking at. Um and then also I think looking for someone who um who takes who takes those assessments seriously and is able to use them throughout the therapeutic process to make sure engaged, like, are you um are you progressing in this process? Um, another major thing to look for is ERP, which is um exposure response prevention. Um that's also gold standard. So if you have OCD and um you're not um exposing yourself, if you're not having to do um exercises in counseling outside of counseling, if there's not like a heavy amount of homework um and and action items um that would cause me to have a big um red flag with with yeah, so so that's good.

SPEAKER_00 18:57

I I actually didn't know that. So there is a pretty large um psychoeducational component to OCD treatment, is what I'm hearing you say. Yeah, okay, yeah.

SPEAKER_03 19:05

So and really helping them, I think the biggest um sometimes the biggest challenge is it's getting them to recognize that they have OCD. Some people come in and they're informed. We see two different types. We see people who have been informed, but they've had bad therapy. I think well-meaning therapists, right? Like we don't want to um bash our own community, but like they're people who are well-meaning and saying, okay, I work with general anxiety, so therefore I can work with OCD.

SPEAKER_00 19:31

Oh different.

SPEAKER_03 19:32

Right. And so they'll talk, just like with trauma, right? Like we know that talking about it for OCD and for trauma can just cause um increased distress and can actually make it worse. And so a lot of times them talking about it, it we know that that's not helpful on its own. And so um, we're trying to give reassurances, and so the therapists actually are engaging in um the rituals themselves and giving reassurances. And they so we have got we've got people who have gone to other therapists and are like, I was they're really nice, you know, like they're kind, I feel like I'm getting coffee with a friend, and like um, but I'm not like I'm not feeling this as challenging um and I'm not getting better, or people who um just think they have general anxiety or something's a little off, and then we go through it and they say, Okay, you know, maybe they're in their 20s or 30s and we realize that this has been something they've done, like little um, you know, if they're like little quirks or whatever that they've seen as quirks, they're really rituals um for their entire um but yeah.

SPEAKER_00 20:32

So with that, how do you distinguish between OCD? I mean, we've got obsessions and compulsions because that's the big and so everybody obsession and compulsion, obsession is thought, compulsion is action. Is that a good way for them to understand?

SPEAKER_03 20:45

Yeah, but um it can also be thought. So the compulsions could also be internal. So it could be mining for information, um, going through something over and over again in your head. So sometimes that's the tricky part too, and that's why the assessments are so important because it can flag, you know, is this just a worry, or are you doing something to help you not to release anxiety that you experience from the obsession?

SPEAKER_00 21:11

Okay. So then how do you distinguish between that and OCD PD or personality disorder? Like more that perfectionism.

SPEAKER_03 21:19

Um I um I'm gonna I think I've had like one OC um OCPD. So with that, and it's um it her life was like just upside down. Like it was it was very um it was really hard for her to engage in the process too. Like if she was um she couldn't well, I probably shouldn't even say this in a yeah, but anyway.

SPEAKER_00 21:48

Well, in OCDPD, um what I see it over here in this practice is it comes up very much like um and again, and this is what this is a hard time hard thing for everybody that's listening. Do I Have OCD, or is this like severe generalized anxiety? And so the OCD, I see that more of like that real perfectionist mindset, the type A, like really type A kind of person.

SPEAKER_03 22:12

Yeah.

SPEAKER_00 22:12

Um, and that is the hard thing. And I think that's where we have to educate the public on good therapy. Generalist therapy is helpful for some, but if you again are having these issues over and over and over again, that's when part of it too is as a listener, your job is to do the research. And I think that's part of it too, is we're used to just, well, every a therapist does everything. A therapist shouldn't do everything, right? Right. It's not healthy for you. And so part of your job is to don't go Dr. Google too long because you know that's not good. Yeah. Um, but to educate yourself on gosh, what could this be? What's going on? And interview therapists. It's okay for you to interview a therapist, and if they're very generalized in what they say, go to the next one. It's okay, it's fine. Yeah, I think too, one thing that you just mentioned was talk therapy. Everybody talks about talk therapy. First of all, therapy is talk, right? We don't do it through osmosis, right?

unknown 23:17

Right.

SPEAKER_00 23:18

But I think that might be what we're talking about, especially between what you and I do. You go do ERP, and I do exposure therapy too. I mean, ERP is a form of exposure therapy, EMDR, prolonged exposure. It's it's the whole thing. And the whole premise for everybody that's listening to this, the whole premise is exposures. We have to expose the person, the person's brain to the very thing that's causing that that that fear response. And then obviously all of those compulsions for you, obsession, whatever may happen. We have to expose that that brain to that thing. Um, and so I think that's the difference too. When we look at these really particular needs, clinical needs, exposure is a really important part.

SPEAKER_03 24:02

Huge, huge. Yeah. And you have to just do it, you know, like just do it, the Nike ums. And and some people just stay kind of just circling around the issues and they don't feel better. And that's where, you know, then people can leave with bad taste in a mouth saying therapy didn't work for me, you know, and it's like, man, that was such a miss and loss.

SPEAKER_00 24:25

Yeah. And and listen, anybody that's listening to that exposure therapy sucks. We're just gonna say it. I mean, it's not fun, it is highly, highly effective. It is backed by research. I mean, the exposure work that ERP, um, prolonged exposure, EMDR, those are some first line treatments for these sort of um issues that people might be um dealing with. Same with panic disorder, generalized anxiety disorder, social anxiety disorder. Exposure is 100% has got to be the part of your treatment, no matter what, because again, you're gonna circle that drain and then you're gonna say therapy is or that therapist sucked, or the therapy doesn't work for me. And really, it's just you were missing a really core component of that type of therapy. So that's helpful, I think, for the OCD. Also, it was you said um we've talked about that it's really about tolerating uncertainty.

SPEAKER_03 25:22

Yeah, yeah. It's um it's these like un unwanted intrusive thoughts um that are one other differentiator is the egodystonic. So they go against someone's values, and that's why it's so um, you know, that uh I usually see like high, highly virtuous people, very altruistic. And so usually the the um obsession is a threat to something they value uh immensely. So it's so dysregulating because it's um they're like I would hate to hurt someone's feelings or I would hate to harm ones or um relationship ones, any of that kind of stuff. So it's um and that's those are the components um that are for it. And I think it's it's challenging because just general anxiety is like just realistic concerns. Oftentimes for the OCD, it's like it's it's imaginative, it's it's magical even. Like even the person knows that it's not realistic, but can't separate themselves from it. And it focuses so much on um trying to prevent like it's avoidance-based, which you see with trauma, right? Like, I just want to avoid this. And so some people they'll come into therapy, and if it's not ERP, they'll actually feel a little bit better as they talk about it because they're talking about it's like they check the box, but their avoidance is still really high. And so they're not having to do the work. And so it's like, yeah, you're maybe their Y box is actually um is lower than it should be because they've done such a good job of like surviving in this space um to where they're not facing it, but their life is is is you know, is very much it's very limited.

SPEAKER_00 27:06

Yeah. Well, and I think that's a a a good thing to kind of pause and say to everybody is that when we when you're a clinician, if you're really choosing to um focus on data-driven work, understanding what your your primary population is, is that um a core component that we see with all of these individuals is that talk therapy releases the valve just a little bit, but there's always an avoidance component. And then inevitably what comes along with it is shame. Yeah. Shame is a huge driver for a lot of these things, and that is why that exposure component is so key, um, because it does help them expose even to the shame-based stuff. I mean, we all feel better when we speak out. I always say to people, and I think it's from AA, that um the see the secret is our sickness. Secrets are our sickness. Yeah. And so that's why talk therapy can feel good for a little bit, but you're you're missing that that component to to really work through. Do you find too when it comes to this kind of drift from a specialist-driven um approach that a lot of it is that they've gotten away from psychotherapy homework?

SPEAKER_03 28:19

Yeah, yeah. And sometimes they'll um I think that it also, as therapists, it's hard. Um, I equate it when I when I talk with people about it, and once they get the buy-in, first I have to get them to recognize that this is what you have and assess and help them with motivation, increasing motivation, right? Um, but then once they're they're doing it, it's like, okay, it's uncomfortable. You know, as therapists, we um I equate it to I had back surgery years ago, and I remember within hours, I had a PT come into the hospital room saying, okay, we're gonna get up, like we're gonna start walking. No, you know, um I say that in this realm, we're kind of we're more like PTs, you know, it's it's we are helping you have more freedom, right? And yet we have to face it. And I'd imagine it's similar for you with trauma of like um people have done such a good job of protecting themselves from the discomfort that we have to, I say like it gets worse before it gets better. Um, just so that you can understand, like, yes, it's it's gonna be uncomfortable in the session. Not only is there shame after the first one, which by the way, one research article showed that um one in three adults don't come back for a second session, be and I think a big part of it is because of that, right? Yes. They have the yeah, they have the shame, and then um it's the discomfort of it. Um, and so our job is to use our skills, our knowledge, um, and build continue to build that rapport. So we're able to say, like, hey, it's worth it. It's worth it on the other side.

SPEAKER_00 29:58

Yeah, yeah. And that's that is definitely it. I think uh psychoeducation can also be done in in the rapport building in the session. It doesn't mean that I mean, I wrote a notebook, a workbook, but they don't have to do that every single session. Right, right. But it education, I think, is a real key differentiator to good therapy. Because often I think um what we're seeing too with the um generalist approach being more out there now is universities, like they have to cover all of these components for licensure standards, but nothing is niche down. Like it's all my mentees say, Am I gonna be ready? I'm like, No, not at all. Yeah, yeah. You're gonna have to figure this out. And so the the um clinician needs to educate themselves so that they can educate, because I think that's a huge part too, with what our work, even when we come to personality disorders, is educating the person because you know, trauma and borderline, they're like this.

SPEAKER_01 30:57

So close.

SPEAKER_00 30:58

And but we have to be able, we have to be educated enough to educate them, and that decreases shame because we're like, this is this is what it is. There's no shame. We know you don't like the thoughts that you're having, we know you don't like the behaviors you're having, but I hold no shame for this. This is what's happening, this is what's happening, this is what's happening. That's why education it takes the person out of participating with the shame to stepping out of it and observing the shame and saying, But this is what's taking actual place.

SPEAKER_03 31:27

And I think that's where having such experience in something is so helpful. You know, someone knows they know the difference when someone's the first client versus someone who's been doing this for a long time, you know, and someone who specializes and goes into it. And you can also, I will not give names and stuff, but I'll say, you know, uh many times, and I'm sure it's this way for you, people are like, okay, but am I gonna get better? Right. Like for me, you know, it doesn't fully go away. It were symptom management and it reduces um significantly, but I'm able to say, hey, here's this, here's this, here's this, and they're able to hear, um, you know, you're not going to stump me, right? Like we're gonna break together, we're leaking arms together, and we're gonna work together. And and there, there have been some wonderful and there are wonderful stories that we can hold to. Of course. Yeah, it's okay. Or like one study said, it's like, no, you you're able to pull from your own experience for sure.

SPEAKER_00 32:23

Well, and I wonder if that's part of um what we're running into too, is the idea, the general public, the idea of you're going to fix me. Yeah. Right? Like we have a magic wand. And and it's really not this like it's symptom management. And I always tell my clients, you can't take away your trauma, and I don't want you to take away your anxiety because anxiety is good, it's just a matter of how high it is, right? Um, and it's so it is symptomatic, but there's no us fixing you, right? It's right, it's participation together.

SPEAKER_03 32:57

Correct, correct. And it's that's where um, yeah, it's it's it's hard because when people sometimes they'll think, okay, you're fixing me, or it's almost like going to the spa. Like, I just love coming. And I'm like, for certain disorders, it's really hard at first. And um, I hate even saying that because I don't want that to turn people off from wanting to do the work with their trauma or their OCD, but man, the freedom on the other side, right? Like it's being able to say, we're gonna like, um, we don't want to just, you know, change this sofa. We want to totally do a whole reno so that you have so much more freedom because we are dynamic people, right? Either we're getting worse or we're getting better. So it's not like you stay here and you can just stay comfortable. It's like, no, you're either like cuddling with your porcupine and you're gonna get worse, or you're making those changes to get better. And but but I think our field has done a disservice and saying, hey, let's just talk about it.

SPEAKER_00 33:58

Yeah.

SPEAKER_03 33:59

As if it's like this like conveyor belt process and it's like yes, yeah, it's and it's doing nothing.

SPEAKER_00 34:05

And I think too, talking about more of the generous versus specialized, I think in particular, too, um, what needs to be noted is a couple of different things. If you are currently in addiction, alcohol, drugs, sex, gambling, that sort of thing, you need to take care of that and find a specialist in those areas, um, or in in conjunction with a specialist, a drug and alcohol expert, or whatever it may be, as well as another therapist, because the brain cannot do this hard work until it's sober from that addiction. And so people need to understand that. And, you know, I I tell my clients if if I'm seeing that they're actively abusing drugs and alcohol, we I can't, you need a sober brain. And I won't step into the really tough stuff until that happens because I don't want to hurt you. And I'm very open about that, that is a dangerous process for me to put you through exposure therapy if if you don't have a sober brain. It's really important that people understand, and we understand there's rarely a what we call a pure diagnosis.

SPEAKER_01 35:11

Rarely.

SPEAKER_00 35:12

It's OCD and it's trauma and and so we have to kind of chunk those diagnoses down so people know that's how someone builds an effective treatment plan. Is it's okay, OCD, we got to tackle this first, and usually it generalizes to everything else. But if we've got an active addition addiction, we have to tackle that first before we can do the rest of it. Because what is addiction? Addiction is just the soothing for the very thing that they need help with. Right, right.

SPEAKER_03 35:40

And I think it's interesting, Piper, is it I think we need to also, as clinicians, embrace um referrals out to experts, experts, right? Like um, and I think that in school you're taught all these things. I felt like it was drinking out a fire hydrant and then just help treat the person. And in some ways, there's some schools of thought that say, okay, you need to stay with that person because they built rapport and you don't want to have abandonment. And so um, I think that we can actually reframe that and say, um, you're actually showing them what ethical care looks like. Well, I'm still here um for if time, finances, whatever, if you need to see somebody else and then come back, like to work on the addiction and come back, or if yes, that is um, especially if they've had any kind of attachment issues, it's like that actually shows them a healthy level of attachment of yeah, it's um is this is about you being able to be released into the world um autonomously and um and it's not all dependent on us. Um, but I think some therapists feel bad. Um, not I I feel bad still.

SPEAKER_00 36:45

Yeah, I mean, I still feel bad having to say to a client, I we have to stop here. I can't ethically continue to treat you until we we knock this thing out, and in it you do feel terrible, and then we have to hold the line, the boundary, knowing that there's an attachment, we know there's attachment fractures in their history, yes, but we have to hold that line of we we can't treat you, it's not ethical, it's not it, I I can't, I will cause you harm. And I think in the moment those clients are so hurt and they're saying they're thinking their minds, but you're causing harm right now, right? And it's kind of like with our kids, right? It's you know, you feel like I'm causing you harm by making you go put your nose in the corner, right?

SPEAKER_03 37:30

Right, right, or jumping in and swimming, and yeah, all of it.

SPEAKER_00 37:33

Yes, but it's like, but we have to do those things, and boy, that's a hard thing to refer out. And I think too, um, if you are going and you are interviewing therapists and you say, you know, I'm just not quite sure if this is a good fit, do you have a referral? Yeah, if they get butthurt, yeah, yes, that is a clear indication that this individual is not working in a clinically a clinical lens, I don't think. I mean, if you're afraid of referring out, then there's no scarcity of clients. Yeah, there's no scarcity. But if you have a clinician that says that to you, I would say that that's a definitely red flag. Yeah.

SPEAKER_03 38:16

Yeah.

SPEAKER_00 38:16

Yeah.

SPEAKER_03 38:17

Um, that's good. Yeah, to be able to, I think I can, I will also sometimes say, um, because with OCD, sometimes it's OCD and and I'm needing to do this other stuff. And so we'll say, let's focus on the OCD, um, or like you're saying, with um, with addiction. And sometimes then we'll say, like, I'll I'll say, hey, I'm here for check-ins. Um, and so that can actually help like stabilize it and but help them see like oftentimes I'll put it out there and then they'll cancel um and realize like, I actually don't need it. But it's a good just reminder, like, I'm here for a check-in, and you come back to me after you finish X. But yeah, that's um, I I think it's it's so much about the patient and what's there to help them.

SPEAKER_00 39:06

Yeah. Um, how do you handle that? Brings up as we're talking about that, um, client graduation. Yeah. That's a toughie.

SPEAKER_03 39:17

It it is. Um, I think we we start it from the beginning, even on the intake call, right? And I would imagine you do too, is um uh is being able to talk about leaving from the beginning, right? Um that we say we're doing a good job when we're out of a job. Um, there's some people who stay for longer levels of treatment. There are some clients that need um that need that like steady presence. Um, and but even with that, it's not every week, right?

SPEAKER_00 39:50

It's uh because once a month, once a quarter, yeah.

SPEAKER_03 39:53

Right, right, right. It's the check-ins and stuff. Um, and so that's normalized so that our clients are like, hey, I haven't seen you in a while. And it's like, that means it's great. How's it going? You know, and um and it's not this like I haven't been to confession in how many weeks? It's like, no, it's not that. Um, but yeah, I think it's being able to talk about like my job, like it's not about us, right? Like I think we're like balcony people. We are able to give them tools, cheer them on as they're like on the stage of life, and then being able to kind of work ourselves out and say, hey, in the perfect, like in healthy community, we link on our arms with you, and then we connect you with other people who can be um just healthy, grounded sounding boards and resources and all that kind of stuff. Um, even with the work that I give, and I'm like, and I love how you've got um prep materials and and um electronic materials where you can say, hey, here, get this, but it's not dependent on us, right? Like if yes walk off the face of the earth, it's not like oh my gosh, it was Piper, you know, and I can't without that being able to say, like, here's the tools, use this, here's a blueprint for the future, too. You know, if you state, country, whatever, like it's not dependent on, well, this was the person, and I have to be this person, you know.

SPEAKER_00 41:12

Yeah, and it's hard. I mean, I think as as clinicians too, I mean, we do love our work and we care deeply for our clients. Yeah, and it's even hard for us to say, gosh, you know what? You're doing great. You won't need me every week, you don't need me every two weeks, you don't need me every month, you don't need me every quarter. Hey, by the way, you're doing awesome. Yeah, you don't need me. Yeah.

SPEAKER_03 41:36

How does that work for you? I'm curious. I I have to do it like I see we have to bring it up like several sessions in advance, right? Because I think if you say it at that session, they're like, what is happening, right? Like that definitely can create an attachment wound. But I'm curious for you.

SPEAKER_00 41:53

Um what you know, I talk about it at intake, and you know, for the good faith estimate, I actually, based on severity banding, um, like you do with OCD, how severe are you looking at? I look at trauma levels, and I really do say this is this is the system I use. This is how many sessions I think it's going to take. And I'm constantly every month saying, This is what your scores are showing, this is what we've hit on all your goals. And so I'm it's every month. I'm like, okay, this is where we're at. What do we need to reassess? How do you feel about these things? Um, so it's from the get-go, from the very get-go. And I think it's hard for some clients where I'm like, hey, it's time to graduate. And they're like, nope, and they dig in. And I'm like, then that's when I have to be kind of like the stern one where I'm like, I'm sorry, like I can't, because I don't want the dependence to be like, it's not about me. Right, right, right. And if my relationship with you is styming you going out in the community and building relationship, that is not good. I can't be your savior, you be your savior. Yeah, yeah. I don't want to. So it's hard. Um, and I grow attachment to my clients too. I mean, I'm sure you have clients, you're like, gosh, I wonder. I mean, we can be making our eggs in the morning. We feel about someone from five years ago. Oh, I wonder how they're doing today.

SPEAKER_03 43:11

Yeah, yeah, absolutely. I think we we can be a corrective emotional experience for them and how they see relationships too, because even um, you know, it's I think most people are seasonal in life, yeah. You know, um, and so being able to say, like, hey, we were here for a season and you did really beautiful work, you were so courageous. I applaud you for that. I also applaud your ability to to reach back out if you need it in the future, or find somebody else if it's something that's a different, different um component, different specializations, but like you can trust yourself.

SPEAKER_00 43:45

Yeah. And I think it's that empowerment and autonomy. Um, I think that's a core component. If you really want a good clinician, that that's what they talk about. That it really is that that autonomy factor. We know in the beginning you're gonna need more. of us we recognize that but we we want to give you all of the field like we keep you in your little sandbox for a little bit and then we slowly work outside of it um that's a core component i think of a a really qualified um non-generalist therapist is like the whole point of this is to work myself out of a job which i think piper is so interesting because we've gone from oh my gosh they're going to therapy you know like what's wrong with them or like a kid goes to therapy and um not kid like college student or whatever and the parents are like oh what do we do what do we do to screw up you know that used to be and some sometimes in some areas um culturally it's still the stigma yeah but with um with you know better help or you know some of those resources it's I think prolonged treatment extensively right because um it's like well you can even the the frequency that they can use it or the access to it of I'm gonna text therapist with you know like I'm gonna connect with this person over text over video and I'm like you know I I've heard people are like I do it as I'm on the subway and I'm like what like how are you able to really bring your focus and focus and all that kind of stuff I feel like that'd be really hard for me as a therapist to be like is this your stop like I'm sorry I I can't focus until until that but I think it's um it's challenging because I think that just creates this um I don't know just it it it it creates a lack of one consistency of care but also being able to empower them you know we're with you everywhere you don't have to listen I think like you said earlier it's a therapy has become an aesthetic it's like going to the spa oh I have my therapist today it's like oh I went and got a facial every week right I mean it's kind of turned into therapy as an aesthetic and that is not and that's again that's part of this drift where we're saying we really need to get to a more specialized approach because it's being used inappropriately. Yeah and I think a lot of it I would venture to say the people I I actually just turned away a gal this week because it was like you're doing great like you don't need me you know and um she thanked me and said I nobody's told me I didn't need therapy. I'm like you're you're good and I think it's we need because it's so aesthetically driven in society now it's actually that empowerment saying you don't actually need therapy you need community. Yeah and that's where we inform them even books like here's some books here's some podcasts get involved with a community group get involved in your church whatever it is because what they're really needing is community not us.

SPEAKER_03 46:39

At that level right I think and that's where we we have this like over pathologizing um where and I know you've talked about this where there's a difference between like a panic attack and just I got really overspent right like I got really anxious or um you know I'm I'm very particular versus I'm OCD you know um and I I saw one um one resource that we give to to our patients is saying um for example they're like it's like saying I'm sick and I'm so I have cancer you know it's like and so um and for mental health because people don't understand that there's diagnostic criteria there are assessments that we use we are not just like shooting from the hip here like if you have a clinical anxiety disorder you hit a certain criteria for that and we can be able to use you know best practices gold standards all help you feel better and we can be able to mark the progress along the way but I think a lot of times people um will Google what they have sometimes I've even heard people call and I'm sure you have too where they I'm like are you reading the DSM right now and they're like well yeah like they memorized it or they're reading it on the suite and um and so it's it's yeah I think some people have a hard time because they're like I don't want to leave because because what if my anxiety revs up and I'm like well that's just worry.

SPEAKER_00 47:58

Yeah that makes sense right like that is words matter right words matter and the usage of words and that's what's happened in society too this drift is stealing actual psychological terminology and like you said the gold standards we have diagnostic criteria and they just flippantly say it. Years ago I'll never forget I don't know it was one of my son's friends or something said something like I'm so bipolar and I'm telling you I whipped around so fast and jumped on this kid I'm like hold on buddy and explained like number one when we use these words like I have OCD or I'm so OCD or I'm so bipolar when you flippantly use these terms you are number one demoralizing to every person that's walking around with it. Totally totally you're taking away the pain that they have and you're making fun of it it's just and that I think that's a an important thing too is as the clinicians we're not here to diagnose you with every single thing that we don't want to do that either. But we have to be careful with our language we have to be so careful with our language. And again if there's a therapist on your TikTok and they're kind of flippantly saying these things because they're trying to get clicks yeah yeah red flag. Right, right you know be careful with this one be careful with this one. So let's kind of shift to um why you and I think um good therapy really is dependent on you know um standardized care data to to be more effective. I think we talked about like the frequency of misdiagnosis. Yeah yeah is profound terrible terrible can you speak to that especially in particular like maybe with um what you've seen in your practice whether it's like I don't know if you see particularly um like bipolar and OCD or comorbidity or where do you see some of this misdiagnosis happening?

SPEAKER_03 49:57

We have seen people come in with um with bipolar and wheat through the process figured out as bipolar and we're able to recommend them to a different specialist. But um we see people who have they they believe that they have depression and so um and they will even score high on like the BDI2 which is um you know a depression assessment um but the challenge there is then sometimes the doctors if it's it just a PCP the patient's going saying I have depression so they're getting antidepressants um that are not going to help they can actually worsen that person's case. And so um research shows that it's about like 60 70% misdiagnosed for bipolar. And I believe I can't remember off the top of my head but I want to say it's like six seven years that um yeah yes to get a proper diagnosis.

SPEAKER_00 50:46

Yeah.

SPEAKER_03 50:47

Yeah and so people have been going and and you know man it's already it sucks enough to be depressed and feel out of control with your emotions. But then being able to going back and forth and being like okay why is this not working what's you know um that's where if you have a specialist specifically right with bipolar is being able to see yes CBT is incredibly helpful cognitive behavioral therapy but also doing DBT and helping them um we explain like CBT is like a house CBT is the first floor and DBT is the basement right so like if I'm working with someone and we're doing a lot of cognitive behavioral therapy but they're not able to just like regulate and they have like low insight on how they're feeling it's really hard um I'll see like hey wait you're not doing your homework or and they're it's it's not that they don't want to they can't they don't have that um that ego strength to do that. And so um I think that that unfortunately people will continue to go and they're like this therapist didn't work for me. Well they didn't know what they were dealing with. And if you have a therapist who's um very informed diagnostically they're able to say hey I'm not your person we need to go right yeah um yeah what are your what are your thoughts on that well I think too um a a key indicator of a good therapist is saying I'm not I'm not your therapist.

SPEAKER_00 52:09

I don't you know I tell my my clients all the time or even people that have called in for consults and I find it's legitimate like major depression or it's it's bipolar and I always say to them I am your worst choice. Yeah and they'll go what I thought every therapist did everything I'm like no I suck at working with depression I know that like I clinical levels of depression I'm an anxious person that's why I work in trauma and anxiety. Yeah yeah we're fear this let's you know so but I can say that and they giggle every time they're like why I've never heard a therapist say they suck at treating something I'm like it's true. So we need to stay in our lane and know where we effectively work. And again it's back to having a referral base is essential for uh if you want a good clinician they are going to have referrals for depression they're gonna have referrals for psychiatric medication management. By the way I am not a fan of PCPs and medication management because they just they don't have the schooling they don't have the bandwidth please seek actual psychiatric medication management period. But we're gonna have those heck we're gonna have referrals for your windows getting changed out. I mean like that's a good clinician is that we're trying to find referrals that's I loved finding you and your practice because I thought oh my gosh finally I have someone for this I have someone for this um a referral network is key because you I God forbid that we're part of the reason they're getting I know the incorrect diagnosis and care for seven years. Yeah yeah you know that's heart heart it just hurts my heart thinking about that.

SPEAKER_03 53:48

Right. They need to know that they need to be confident like if they already you know especially for someone with severe depression you know it it can be an Olympic sport just getting out of bed in the morning you know so they need to know that once they do get out of bed the person that's walking with them is qualified and that there's hope.

SPEAKER_00 54:05

You know yeah well and I think that kind of talks about um symptoms a word that we use a lot in our profession is functional impairment. Kind of going back to there's a difference between I'm so OCD and I'm I'm worrying about something or I'm so I'm so you know bipolar and like you cannot get out of bed. We assess as clinicians it's not just what you say we assess the whole thing including functional impairment. What that means is how is this uh affecting home? How is this affecting work? How is it affecting hygiene eating? I mean we look at functional impairment because that is a clue and it helps us target interventions. When we have a generalist approach they're like okay they said they're anxious we don't know how severe it is we don't know what to target um and you're not looking at what and here's the thing too OCD anxiety trauma it has a function and a purpose in that purpose that person's life yeah if you don't identify what that function is albeit it's not a good function right now we call it maladaptive but if you don't identify what that function is you're not gonna treat the right thing and that's again that's that generalist talking approach. Yeah you know so we talked a little bit about we touched on that book by Abigail Schreier Bad Therapy and if nobody's read it it's a doozy I mean it's um it it it was hard to read yeah it was hard to read and Abigail Schreier she's actually a journalist and so um and she's really kind of gone after the field which I I'm okay with I mean I think that if all we do is read the things that make us feel good we're gonna miss it. And so that's why I forced myself to read the whole book. But she had some really good um critiques in in her book. So if anybody's not read bad therapy it is good. And what I'll say is if a therapist just outright says I'm throwing it away then again these are some ideas to kind of listen to um we should all be willing to be criticized all of us. I mean that's how we grow. So some of the things that she talked about let's talk about some of her critiques and kind of discuss those we've talked a little bit about the overpathologizing normal distress all the time.

SPEAKER_03 56:36

Yes yes yes yeah and and also um there's a I did a presentation this week um using an old clip from um Dr. McGonagill, Kelly McGonagill I don't know if you know but she has great work on reframing anxiety and saying hey it's actually not anxiety that's the problem. It's how we respond to it and it's our response that actually can create um more maladaptive coping mechanisms. It causes us to I mean even research showing that your life expectancy can decrease not because anxiety but how you see it because how you see it is how you deal with it or don't and so um for us just noticing and even I tell clients with anxiety I have anxiety like you're saying you've got it um I tell people it's my superpower like it is what right like it's um it it helps me hustle and and do well in school it helps me do well in presentations it helps me to focus and synthesize thoughts um and so being able to instead of being scared of emotions like it's it's yes them and say oh hey it's there and it it's there because you like you care about this thing. You know I would be like you said um you we've said before like I'd be concerned if you weren't a little bit on edge like that body getting excited and your adrenaline running so I think us being able to like normalize and even celebrate um just regular emotions and say like congratulations you're human you know and let's not pathologize this let's just say what is your even like their awareness and increased insight what is your body trying to say to you yes and and how can we learn from that instead of okay we're just gonna stamp a label on it get some meds yes and get worse.

SPEAKER_00 58:29

Well and that's such a good point. I think it's like people think that they'll come to us when we'll fix them or I'm gonna go pop a pill and it's gonna go away. Right. And and again really what this is about and I say this to my clients all the time I said you know why you're here and like why I'm here to feel better. I said no you're learning how to suffer well because that's this life. Yeah yeah I mean and that's again these are uncomfortable emotions but we're gonna give you the tools to manage them. You know I was telling a client the other day your emotion lasts 60 to 90 seconds that's it is what you think of the emotion that leads to that oh you know I mean that's and so we have to give them the tools but again it's there's there's anxiety that's good anxiety is why we're successful. And then there's the really distressful anxiety that is impacting functional impact of your life and in maybe to our listeners assess yourself is this is this functionally impacting your life meaning we get you're upset and you're feeling a little distressed but overall what and and what's it costing you functional impact what's the cost um that's gonna determine hey I need help or um maybe I'm kind of pathologizing my distress a little bit.

SPEAKER_03 59:47

Yeah yeah like we um in with OCD treatment we talk about three chairs and it's like okay you're in this chair um which is kind of fun to do virtual because you're like now we're gonna get up and we're gonna move again they're like I'm I get the concept I'm like nope I want you to get up you know um but being able to say if you're in this chair and then here's the chair next to you of what six months and then 12 months, you know, if you don't get better what's what's life going to look like and we go through the the functional components you know what's your health what's your relationships your job all that kind of stuff um and they recognize I it deteriorates right but like when it's just normal emotions it comes and it goes back down right like it's it's our we're able to self-regulate. And so I think it's being able to help them see this isn't something that's going to cause deterioration and um you know chaos is just this is situational and it's appropriate. And it's even developing appropriate right for like teenagers or young adults like having um I wrote my dissertation on the quarter life crisis because that was like such a big thing during then and and I'm like this is normal like yes this is you this is really normal we've put a uh terminology on it which I think actually helps maybe normalize or call it out um but it's not a necessary diagnosis. But I think being able to see this is really normal. And it doesn't mean you know it doesn't mean that you're um severely depressed it means it's really hard when all of your best friends live on the same and you have like ample access to hang out with friends and time and then you move to maybe living in the basement of your parents' house or having to hustle and working a nine to five where you're just making copies. That's a huge shift that's huge. That's not depression that's like that's appropriate overwhelm.

SPEAKER_00 1:01:38

That is appropriate. Yeah yeah yeah and I think that's the fun part too I had a college student uh last month and I said listen has anybody told you you don't need therapy that life just is really life and you're learning to life. Yeah yeah and they looked at me like oh and guess what they never showed up again they just needed the permission to understand life is lifing right now it's distressing Piper gave me tools I'm gonna use them but I actually don't need a therapist for this this is just a really hard place that I'm in because this person was graduating like they're I mean no wonder you're feeling this way you recognize everything is changing in just a few short months.

SPEAKER_03 1:02:20

Yeah and that's why it's overwhelming yeah and that's just short you know like the therapist should not be like okay we're gonna be in this for long it's like hey let's talk through what your fears are let's talk about where you want to head you know it's almost not coaching but it's it's more like it kind of is though it's coaching them through it.

SPEAKER_00 1:02:37

Yeah yeah it kind of is what do you say to about people that um over identify with the diagnosis because diagnosis actually can be very life giving to some people yeah yeah but what do we do with the people that I mean that's like their identity that's a toughie.

SPEAKER_03 1:02:57

Sometimes you can notice that beforehand because they're the ones who might be like I'm so this I'm so this you know and so um when that happens I can be a little bit cautious. When it's kids and we work a lot with pediatrics when it's kids I really try not to use um a diagnosis before I've talked to the parents because I don't want that to be weaponized. I don't want there to be misunderstanding. I want to be able to really talk with um the adults and help them understand so then they can have conversations about it because if someone says you traumatized me because of X, you know the parents and it just makes it just muddies the water and it's not as helpful. So um when before I even go into a diagnosis and that's where we do the assessments beforehand, right? As they're coming in our intake form is about 50 pages. I think yours is pretty expensive.

SPEAKER_00 1:03:49

Mine's pretty yeah that's a big one.

SPEAKER_03 1:03:51

We want to make sure we understand and can almost like get a diagnosis just from some of the paperwork and stuff report. But as we're as we're looking through it I will tell them like hey especially the anxiety I'm saying I'm your worst case scenario like yes I have you know an else um anxiety had social anxiety of OCD you know like I I'm your worst case scenario and do I look like a a screw up you know like and with kids they'll laugh and I'll be like I mean honestly I don't look as cool as you do you know whatever but um but still saying you know this I'm sitting here and I'm thriving. I love my life right like I love the life that God's given me and and that's around me. And so um this is not especially when I work with people of faith of saying like your name like your identity is beloved child of God like that is who you are. You know if it's someone who's not um someone of faith of just being like you are precious you're an unrepeatable miracle like I'll even say like what does your name mean? Sometimes they're like I don't know my gave me like the name whatever and I'm like this is what like this is who you are and there's so much behind that and this is how I knew this is integrated and the the beauty of this I think in the redemptive part of our work is helping them say um this is so that you can be like me. Not all of our clients become counseling you know we've I've probably had about like six to seven who have become it through the process which is so cool. But being able to say you get a talk not in an office necessarily but in a coffee shop with a friend. And as they're noticing and saying these things, you get to be on you get to help hold hope for them and help encourage them to do the the really courageous thing you did. And it but I think when we when we get stuck on the labels we get right and people are not likely to use the tools that they need to um and and they're going to say like this is kind of a a cop I I think it can sometimes be a cop out you know for absconding responsibility. Totally and something where it's like hey this this is um it's not your fault but it is your responsibility and helping them steward this Well, and um, and and see how you can use this to actually create greater good in the world, too. Sure.

SPEAKER_00 1:06:08

Yeah, how about you and I wonder, and that's and that's what Schreier talked about was like this weird identity formation that's happening. And I don't even know that she was necessarily, I'm trying to remember that section. I don't know. Actually, I think it's on my bookshelf. Yeah, it's right over there. Um, I thought it was at this house or this my office. Yeah. Um, but I think part of the identity formation is when um almost like this thing that we're seeing with the therapy that's happened also culturally, is the therapist creating identity that then they help create identity in the client, right? They're cloning.

SPEAKER_03 1:06:44

Yeah.

SPEAKER_00 1:06:45

Um, and I think that was part of her her concern is that by doing this, like she says, we're reinforcing the victim narratization, right? And where you and I are saying, no, our work is empowerment. Yes. We don't want little Emily and Pipers running around. Yes, right. We don't want that. We want that empowerment and that person to go out in that world and be able to hold hope for ever other people because they know what it feels like to not have hope.

SPEAKER_03 1:07:12

Totally. And I think that's it's hard because it can be very weaponizing, I think, with families. We live in like such a culture, right? Where um people can go to therapy and and um, and I'm I mean, both of us, I think, really take this so seriously. But when it, especially when we're working with a minor, I tell the parents, I'm like, I believe I'm gonna have to answer to God for this, honestly. Like I take it very seriously, and I believe that your child, you are the best parent for this child. And so my job is to help um heal if there's been tension and to help equip you guys so that um, you know, it's not being able for someone who goes to therapy or even in college and saying, like, my parents traumatized me and I'm cutting them off. Like that, yes, we need we need boundaries, not walls, right? So like sometimes if if it's a really toxic or enmeshed relationship, you need to be able to step back some, but it's being able to learn how to be differentiated, not completely um, you know, disconnected. And so I think unfortunately, our when we do that and we overpathologize it, um it also people are looking for, if they're victims, they're looking for um a finger to point at, you know, like who can I blame? And and so not only are they helpless, but they're actually pushing away the support structures that would be there to help them. You know, I I've I've seen um, you know, I've seen where families will come in and say, hey, I'm so sorry. I I so I was doing the best I could with what I knew. That's not an excuse, right? But like when parents can identify and say, oh, yeah, that actually was not helpful, you know, saying um paying you for these or pushing you to get on a roll when you're someone who's having like true ulcers at night and you're your own worst enemy, like you know what I was I was parenting out of my own childhood, you know, like I think you needed to carry it and you don't need to carry it, you don't need us, you know. And so when parents can come in a session and be able to do that healing work, it's beautiful, it's life changing, right? Um, and and but I think sometimes when we we over pathologize it, it's like, okay, who broke you? Who screwed you, and now they have to pay. And yes, the revenge part, that's not part of therapy. That's not that's not what we do. It just keeps you stuck, right? Like it doesn't help heal. And some people do need to have, you know, if there's very again unhealthy talking.

SPEAKER_00 1:09:41

Of course, yes, yeah, we're not speaking do that, right?

SPEAKER_03 1:09:45

But but you also need to be able to see, okay, how can I engage with these people? Um, because it's not just your mom or your dad, there's other people in the world that we can't cancel everyone, you know.

SPEAKER_00 1:09:57

And it's interesting as you're talking that uh about the parents and the client. I would almost even kind of flip that over. If the clinician has not done their their work, they are working through their childhood, whatever that has not been healed, they're working it out on that client, or they're avoiding it. And again, it becomes this identity formation around a thing that they've never actually done the work on. Yeah. Um, with my mentees, I say to them, if you've not done therapy, you need to stop everything now and it's time to start. Yeah. Because you have to look under all the rocks, all especially the ones that are like, I want to work in trauma. I'm like, oh, okay. Let's hold on a second because we don't need you disassociating in the middle of a session because you've not done what you need to do. Do you ask them? I'll often ask, like, why when I'm um all the time. And usually it's from a place of, well, I went through. Yep. And I'm like, okay, that's great. And that's a starting point, but you cannot go into this per um this field if you've not worked your stuff out. It is unprofessional and it is clinically irresponsible. Yeah. If you don't do your work, I uh gal interviewed me from her school a couple weeks ago, and she said she was like, Yeah, I'm I'm uh what does she say? The word, I'm gonna use the word smorgasboard of um mental illness. And I was like, Okay, tell me more about this. And and again, she had like 15 diagnoses, which I was like, you need to go somewhere else. But she and she wanted to help people because she felt she was getting the help. But the more I talked to her, I said, honey, like I think this is great, but please here's here's a form to help you find a good therapist. These are the questions you need to ask, but you really need to do the work. And I think that's a real sign of a good therapist. That a therapist, I say to my clients all the time, what I'm putting you through is nothing that I've not been through.

SPEAKER_03 1:11:51

Totally, totally.

SPEAKER_00 1:11:53

I've been there, I've done it. I know this exposure therapy sucks. I've been there, but we're gonna do it together, you know. Um, and they'll ask questions. I don't know how open you are with your clients, but I have clients say, Well, did you kind of do this stuff? I'm like, Heck yeah. Yeah, yeah, yeah. Terrible. Yeah, or they'll ask about different anxiety attacks that I've had, and I'll full on share it with them because it's like I am a human being too. I've done the work, it's not always a hundred percent of the time that I'm on top of it because I'm human.

SPEAKER_03 1:12:22

Right, right.

SPEAKER_00 1:12:23

You know, but I I know the tools too. But I I I think that's a biggie. We have to be careful with generalist therapists that aren't doing the work. I think schools need to do a much better job at gatekeeping this.

SPEAKER_03 1:12:34

We for us, we had to do M MPI2s um where I went to, and I'm so grateful they did. Um, so for people who don't know what that is, it's um really like screening for FBI, CIA, like making sure and finding out different pathology. Um, and then we had to study our own MMPI twos. Um, but I thought that was cool. Really helpful. Yeah, and everyone had to go to therapy themselves. So like, you know, when I'm hiring people, I'm asking them, you know, are you have you gone to therapy? Are you, you know, are you doing therapy currently? I think I know we'll talk later um about um questions to ask when you're you know talking to different people who you're gonna hire as a therapist, but I think it's totally valid and and helpful to be like, hey, have you have you gone to therapy yourself? Because you're essentially saying, like, have you done the courageous work that I'm about to do? You know, you know what it's like feeling on the other side and and sitting on it.

SPEAKER_00 1:13:26

Yes, it's it's not enough to say you can kind of think about how it is on the other side. You you need to experience it. And not everybody has stuff that needs actual in-depth therapy, and that's fantastic. You're gonna be a great therapist, yeah, you know, like this is fantastic. But if you do have that deep work that haven't hasn't been done, it will be expressed onto that client, and that is the last thing you want to do. Um, so one of the other things Abigail Schreier talks about when you and I have talked about this, is that overvalidation, yeah, just as you know, the excessive like nodding and oh I see I hear what the there's no confrontation. Yes, yes, um, and that is so not what psychotherapy was at the beginning.

SPEAKER_03 1:14:08

It was not right, right. Yeah, that um you're like a human trash can, right? Like um my gosh, super validation.

SPEAKER_00 1:14:18

And I think part of it too, um, the class I was teaching the other day, one of the students raised their hand and said, Um, do you can are you pretty like abrupt with your clients? Like you you kind of like seem like that, and the actual professor's laughing because she knows me very well. I love it, I love it. When I said to him, I said, this is where the shift has happened. We are the whole point of psychotherapy is to confront the very thing that's causing distress. If all we do is sit there and validate every feeling, every single thought, therefore, we're implicitly validating those behaviors that put you in this this couch in the first place.

SPEAKER_03 1:14:55

Yeah, and it's it's not scientific either. Um being able to say, like your brain, I do again a lot of psych ed, right? And ask being able to say your brain is scanning for danger, right? Like we're not scanning for hugs, like our brains in are in survival mode or scanning for danger. And so your brain is one heck of a communicator, but it can be a horrible and misaligned dictator, right? And so um, our feelings aren't facts, and so when we are validating all the feelings is if they're factual, we are adding to their pathology, right? Yes. Yes, um, and and if you're just doing that, especially with your trauma work, you're just affirming that the world is unsafe. Yep and adding to trauma narrative, I'd imagine.

SPEAKER_00 1:15:40

And I think I hear the argument against that is that, well, then you're denying their their lived experience. And said, I'm not denying their lived experience, but I am saying, can we take a second and not believe the feeling the second it happens or the thought the second that it happens? Because again, if therapists knew the science and studied the brain, we know that they there's misfiling. There's misfiring. Like you can't, you that doesn't work anymore. Um, and I think too, what's happened is there was such a there was such a medical specialized focus in the beginning, right? That people got in, they got a bad taste in their mouth.

SPEAKER_01 1:16:15

Yeah.

SPEAKER_00 1:16:15

You know, the psychiatric units and the drugs, and then we're hearing about all the testing. So it's this giant snap or like pendulum swing to this over-affirming, this over-validation, this uh, you know, um pathologization. I can't say it, you know what I'm trying to say. Pathologizing. Thank you. I can't get the words out. But it's this huge pendulum swing. And I think what you and I are saying, hey, can we come into the middle a little bit? We're not saying over here's right or over here's right, but the pendulum has gone too far. And I think that's what uh Abigail Schreier was saying as well. It's it's gone too far.

SPEAKER_03 1:16:50

Yeah, yeah.

SPEAKER_00 1:16:50

It's too far.

SPEAKER_03 1:16:52

Totally. It's important of being able to understand your story, right? Like, and being able to see where did you come from? How did this all impact? Like that's part of our intake process, um, understanding the G frame and families, all of that, and being able to hold space and say, like, um, we're not uh the phrase hold space just drives me crazy sometimes. Yeah, I know. What the heck is that? We're we but we are holding, we're we're saying, hey, let's talk about this, and then say, hey, is that really accurate? You know, uh, because we're doing uh good work, we're able to see, hey, that was a thought, it was a form of it is helped you survive.

SPEAKER_00 1:17:29

Yeah.

SPEAKER_03 1:17:30

Now we need to deconstruct that, but if you're not being direct with it, they're gonna hold on to these mindsets, um, they're gonna hold on to these false mindsets and how they see themselves in others, and they're never gonna get well, right? So um, I think for us being able to like honor that and and talk through it and say, how did this serve you? How did that help you? And we're gonna call like we're gonna call it out going forward. At the beginning, obviously, we're not maybe as direct, but I love, I mean, I would imagine you're the same way where I'm like, where in the heck did you think that was a good idea? You know, and they'll start laughing and I'm like, I don't know. It sounds to me like you wore the wrong lenses that day, you know, and um, but they know where it comes from, but they don't just there, you know.

SPEAKER_00 1:18:17

Well, and I think that's I hate the word holding space too, because it's just it's been overused too much. But I think really what it is is um, like I always say to my clients, we're not demonizing the anxiety or or the effects of the anxiety or the trauma, but we need to hold it without participating with it because that's how we can decipher is what my brain is drumming up, is this true? Is this factual? And if the answer is no, then that's the empowerment of, oh, that means then it's not holding something true. I can therefore change and shift its focus, I can reframe, I can reteach the brain. And it is, I mean, it's hard to teach people how to hold a distressing thought, feeling, behavior, yeah, and not participate with it, whether it's shaming yourself, you know, reenacting, whatever it may be. It is a hard skill to teach people. It's a very hard skill.

SPEAKER_03 1:19:09

But I think when you can go back even in all, and this is not true for every, there's some for sure, um diagnoses where um, you know, I think of like schizophrenia, schizm, you know, other more severe diagnoses. Um but for what we're talking about, being able to say, hey, when when you came into this world, you weren't, you know, you weren't codependent, you weren't having panic attacks, you weren't whatever. That was a learned behavior to make it through and survive the system that you were in or the situation that you were in, right? And so you had to learn this, and now we're gonna unlearn it. And I think that's helpful because um we'll just talk about like a newborn, and they're not saying, oh, I'm sorry, I'm I, you know, I I don't want to take up space. It's like all they are is need. Yes, and being able to say you had that right, and then you and then it changed. And so we can go back to to unlearning this.

SPEAKER_00 1:20:10

And I think that's that's the beautiful thing about counseling. And I think this is where I've seen the generalist drift. It's this kind of become the counselor is generalist because they're gonna save everyone. Whereas as you and I are talking, the the most exciting thing for me is I sit in here and just them verbalizing and learning tools. I'm like, I can I like if I could see in your brain, I can see what you're doing. It's so life-giving and exciting because we know because of our our in-depth research and the science that we know of what we're doing, we are literally changing neural pathways by just giving them that couch to sit and learn. It's phenomenal, you know. And I think that's that's the exciting part. Like good therapy is having that excitement for that hurting person because we know without a doubt, you you can get on this other side. We believe that, and these tools will get you there. You don't need me, you're gonna learn these tools and you're out. I mean, it's just such a good it's just it's one of the most exciting things. One of the most exciting things. They can sit there and they just feel a mess. And I'm in my head going, I know it hurts right now. I know, I know, but keep going, keep going.

SPEAKER_03 1:21:19

Yeah, I sometimes I have to stop. I remember I recognized because someone reflected back there, like, you're smiling. And I'm like, I'm so sorry. I just you know, um, but even then, I was like, I'm I'm totally hearing you, and I'm so excited because there's a map, right? Like, and I I'm confident in the map, I'm not the map, right? Like there's a process that people before us have done so much research and so much studies, and so it's like I'm not Jesus, you know, I'm not your safer. We're gonna use these tools because they work, and I'm so excited because you're here. Yeah, and I am looking at the larger thing that I'm and I'm here and I'm just asking for you to to like hold on to hope here. Yeah, um, yeah, where a lot of um I think of have you seen shrinking? Have you I love that show?

SPEAKER_00 1:22:06

Harrison Ford does such a good job in that show. It is I cry every episode.

SPEAKER_03 1:22:11

You're so good. I yell every every episode. My husband's like, stop talking because I get onto is it Jason Jason? Is that the um Siegel? Seagull word, yeah, Jimmy, where he's like so enmeshed with his client. Like that is bad therapy, right? Like, and and that's why it's entertainment. Hopefully, everyone knows that, right? But like um, Jimmy at the beginning, like he needed to work through stuff, like he should never have been seeing clients. He's never working with prostitutes and doing cocaine, you know, and um his life's a mess and his family's a mess and all that kind of stuff. But you know, when we're good therapists, we've done our work, we've stepped back, we've we've in order to do no harm to them, we've done our work, and then we're able to engage and um being able to say, Here, it's about you, to where this Jimmy character, I think, is such a picture of bad therapy, where um, I forgot what his name is, um, who lived in the backhouse, like his own client.

SPEAKER_00 1:23:07

Oh, yeah, it was his client and let him live there.

SPEAKER_03 1:23:10

I was like, No, no, but then it's then is like at the kitchen table with his girlfriend now, you know, and I know that he's he's now referred at him out to a different therapist, but it's like still like so wrong. Um, you can't be friends like that. But um, but it's like now this person's just like integrated in his life, and that's so much about Jimmy and serving something for Jimmy, and that's why I think we have to be um we have to really get over ourselves, right? Um, and not get in our own way, where it's not about us. Like we get we get to do this work with them, and we get to stand in this, like I think sacred ground of beholding like such beautiful change. Yeah, we're just a tool, we're just an instrument being used. Yep. And they continue. And we aren't our our like self-worth is not caught up in it. Yes, it's rewarding, but like it cannot be our identity, or it we're I think more of a danger to our clients.

SPEAKER_00 1:24:07

Absolutely. And speaking of shrinking, I don't are you in the third season because it started. It's so good. So I love what you're speaking of because the Harrison Ford character, he's like the main guy at the the practice, yeah, and he has terrible Parkinson's. And you see him like, this is my identity, I have to do this, and then you you slowly see him go, No, this can't, this is not my identity. I love what I do, but I need to release some of this control. It was a really good example because Jimmy was been a mess the whole time, yeah, yeah. Um, or like the other therapist, I can't remember the gal's name in it. She screwed up in session. Oh, totally. She totally, yeah, and and she's like, I'm sorry. Yeah, she totally apologized. And that's a sign of a good therapist, too, that says, Whoa, I so screwed up. I screwed up with a client a while ago. We were talking about events around here, and I said, Yeah, it was like a bourbon tasting or something. And the client goes, You're saying this to an alcoholic. I was like, Oh, I just felt like such an ass. Yeah, and I just and I really I came back next session. I said, I really want to apologize to you. It was it was not on purpose, I wasn't trying to be painful or do anything wrong, but gosh, that was so insensitive of me. And as therapists, we have to be able to apologize and say, I super, I screwed up so bad. Please forgive this process. I am human. Yes, yeah, yeah. Absolutely. Well, this has been fun. So let's kind of bullet point good characteristics of or characteristics of good therapy, core characteristics. Um, and if anybody has questions, you know, we're just kind of riffing this. We've got like an outline. We hope that this helps some of you. This is a three-part series, so we're gonna work on it. Some some core um characteristics of good therapy is clear diagnosis or a working formulation, super important to have. The treatment matches the condition. If they're like, oh, we're just gonna sit here and talk, I would uh maybe go elsewhere. Um, define goals and treatment plans. We didn't talk about that a lot, um, but really key to good therapy, right? Because you are gonna just drift into the affirmational validation kind of stuff if you don't have that. Skill acquisition, not just insight. Those educational tools, right? Like insights, great, but insights only the very, very beginning. We have so much after that. Um, measurable progress. Emily and I believe very strongly in data-driven care. Because again, the part good thing about using assessments like your Y Box and the others that I use is that it keeps us out of assuming that we're doing a good job. Yeah, and we can see am I doing a good job and am I not doing a good job? It really keeps us actually accountable to the goals, not to our internal biases of oh, I'm an awesome therapist. Yeah, yeah, yeah, exactly. Um transparency about their approach, that's good. Ask them direct questions. You have to ask direct questions. Um, movement toward independence, we talked about that. Saying goodbye is hard, but we love doing it. And then time limited when appropriate. It doesn't always have to be long-term. That's not something that we always have to do. Um, anything you want to add to that? What do you think?

SPEAKER_03 1:27:20

No, I think that um I some of the um things that we've seen is just yeah, really giving them support is is is helpful, but without a strategy, it's not treatment, you know, it's not therapy. Um, it's listening. And friends do that, community do that. Um, and another thing that they is kind of taken from the bad therapy um book is um good therapy builds resilience, not for children. And so you need to feel um, you need to feel empowered knowing this is not lifelong, you know. I'm I'm being able to um learn these tools, I'm improving, and I'm able to walk into this world and help others, hopefully too, in some way. Um, but I'm not stuck, I'm not fragile, I'm not labeled, and I'm not um, I'm not a victim. That's the yeah.

SPEAKER_00 1:28:10

Yes, yeah, yeah. Um, and we've put together a list of questions to help everybody to help you find good therapy because we understand that this is just one singular podcast, but we really do want you all to have, you know, you're you're ready for these consultations. Most therapists provide at least a 15-minute free consultation. So just pull out the sheet and ask the questions, you know. So we've created that for um you all. You can download that on our individual sites. We'll have it in the show notes. Um, so this is just hopefully another tool for you all to find good therapy. Um, we are going to continue this series. So um, session two, we are really going to talk about um people that are currently in therapy and they feel maybe they're stuck and they're not quite sure what to do. So we'll speak to that. Um, and then um, and we I don't even think we got through our whole outline today, but that's okay. We've talked about a lot of stuff. Okay. Um, and then the third one, we're actually going to talk to uh to those of you that think therapy is a bunch of crap. Um, because we know you're out there too, and we understand why you feel that way. So we're gonna speak specifically to you as well. So we hope that everybody's going to stick around. Emily and I are having fun with this um series and really hope that um clinicians in the world understand that we're not trying to um speak against you. We're really just trying to raise the standard of clinical practice because the drift, the pendulum swing has just gone way too far. And we've got a re-reset course um and and really empower these clients that so desperately need the change.

SPEAKER_03 1:29:42

Yeah, we want to do better and we want to help you guys more.

SPEAKER_00 1:29:44

Yeah, yeah, that's it. All right, y'all. We'll see you next time. Thanks for joining us. Thank you. That brings us to the end of this episode. Thanks for joining me. I hope you learned some tools that can equip you to untangle your mind and untangle your life. If you're curious about working with me for your anxiety or trauma, head on over to my website at untangledmind.net to connect with me. If you enjoyed the show, please rate and review me on your podcast listening platform and share it with your friends and family. As always, thanks so much for listening to me, hyper Harris with the Untangled Mind Podcast. I'll talk to you next time.