Hi, I'm Piper Harris, licensed professional counselor, and welcome to the Untingled 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. On today's episode, I want to talk about the moment in therapy that doesn't get discussed very often. What happens after treatment works, when symptoms resolve, functioning improves, and by every measurable standard, therapy has succeeded. Yet, for some people, something quieter and more ambiguous begins. That's the space we're going to explore today. Well, hello everyone. So this is my second time trying to record this podcast simply because I'm really excited to get into this conversation today, but it's very difficult to get into. So today, what I want to talk about is this moment in therapy that rarely gets named. And it's one of those spaces that I think is not only difficult for a clinician to traverse, but also a client. So what we're talking today, it's not about crisis, it's not about dysregulation, and it's not about the hard early work of symptom reduction, but it's what happens after treatment works. So meaning the symptoms improve, functioning stabilizes, all the measures reflect success. And from an outcomes perspective, therapy has done what it was set out to do. And yet, for some clients, this is where this quiet uncertainty, and for clinicians, uh quietly enters. So before I get into this, I want to be really clear at the outset that not every single client experiences experiences, excuse me, this phase that I'm going to discuss with you today. And honestly, most don't, and that's important to hear. They don't have to. This is a very different phase that I've seen come up in my clinical work in the last two and a half years. And I'm sure other clinicians would say this as well. So for many people and most people, symptom resolution is the appropriate endpoint for therapy. Therapy ends, life continues, and that's exactly as it should be. But what I'm speaking about today applies to a small subset of clients, often those who have done significant trauma work and they've reached this level of, we'll say, psychological stability, although I'm willing to bet they'll say they don't feel that way. But it allows for something very different to emerge in the conversation. So this isn't a failure or of therapy, and it isn't a sign that something is wrong. Um, and certainly this is not an argument for indefinite treatment. What I'm going to speak about today is a developmental moment and one that clinicians are rarely trained to talk about. So I'll kind of give some background. This weekend I was um preparing. I'm going to be speaking or teaching at Georgia State University. So I'm preparing everything for Georgia State. And then I'm also preparing to teach a clinical practice over my measure-based assessments and what that looks like to create competent clinicians. But as I'm working through it, I thought, you know, I know how to teach this untangled mind pathway. I believe in the system that I have developed 100%. But what do I say or how do I teach individuals to understand that there are a certain few people that get to this space, this new space? And what does how do I say this? And all that to be said, I went down this rabbit hole and I was just kind of digging through what how do I do this? What does this looks look like? And ultimately, what it led me to do, you can hear me clicking through, what it led me to do is I'm very interested in how to present that goal-based short-term clinical treatment. We reach our goals, symptom reduction, all of that is the gold standard. However, there is a subset of individuals that can move forward. And this is a psychological developmental stone, um, stepstone for them that some people can reach, and that as clinicians, we need to be prepared to do that because I'm seeing that in my own work. So I started writing a white paper. Why I'm doing this, I don't know. I was talking to my husband and I said, I must be wasting my time. I don't, I don't know what I'm thinking, but I did. Or I'm I'm working on it. So I'm going to read the abstract to you, and then we'll get into today's topic. So this is the abstract, and it's from symptom reduction to self-authorship. Why modern psychotherapy stalls before psychological maturity? Again, to the listeners, um, and if you're a previous client, this doesn't mean that you missed out on anything. This is just something that comes to be with a certain subset of clients. It's not the right, or it's not the wrong, or what did I miss out on? It is not that. Okay. So this is what I said here. Despite unprecedented access to psychotherapy, mental health utilization continues to rise alongside reports of stagnation, therapist shopping, and chronic dissatisfaction with care. While symptom reduction remains an essential function of clinical intervention, this paper argues that contemporary psychotherapy routinely terminates too early at functional stabilization, leaving many psychologically intact adults without a framework for integration, meaning, or self-authorship. Drawing from foundational theorists in developmental, psychodynamic, cognitive, and existential psychology, including Jean P. Piaget, Eric Erickson, Abraham Maslow, Sigmund Freud, Carl Young, Aaron Beck, and Victor Frankel, this paper proposes that psychotherapy has increasingly abandoned its role in adult psychological development. The result is a growing population of symptom-managed yet directionless individuals who continue to seek care not for relief but for clarity. This paper delineates the developmental gap within contemporary clinical practice, examines structural and theoretical factors, contributing its persistence, and argues for the ethical necessity of post-stabilization, meaning-oriented framework within psychotherapy. That's the abstract. Now, the first thing that I want to say is many people that are listening to this are probably gonna say, Well, wait a second, Piper, you're actually arguing against what you're saying. And that is not what I'm trying to do. What I'm trying to explain is this really interesting thing that's come up. And I'm seeing it in a few, a handful of clients. I would say over the last two and a half years, um, I have had maybe five or six go to this place. And again, I talked about these different psychological grades. If you look at the untangled mind pathway, how I have created the pathway, it is loosely designed based on Abraham Maslow's hierarchy of needs. This is how I built the untangled mind pathway. So the first level works on building safe connections, and this is where I'm discussing with clients their whole health. I might send them for blood work. We're discussing their different assessment scores. We're really getting to know each other. This is rapport building. Then we move up to our foundational needs. Foundational needs again, rapport building, getting to know each other. I'm understanding your trauma narrative. Um, and so then we go up to the third level, and this is regulation strategy. So this is where I'm teaching the individual how to regulate their body andor mind because we need this all as a foundation before we can enter into some of the more difficult work that's typically done through exposure. The next level is attachment, and this is where we're discussing their attachment figures, the deepest irrational belief. And this is where we start getting more into what I'm discussing. I have had some clients that reach this attachment level in the workbook. Some love it, and I ask them to step into their dib. I want them to personify their deepest irrational belief. Some people understand this task, other people say, I'm not quite sure what you mean. Now, this is not to say something about client A versus client B. What I'm saying is there's a psychological developmental task that's needed to move into the full depth of the attachment level of untangled mind pathway. Now, if they go don't go into the entire depth of the untangled mind pathway, that's not a problem at all. Um, we still get a lot about that. We're understanding attachment narratives, attachment wounds, attachment figures. But again, this is where some of this process gets a little a little more existential. It gets a little bit more on the psychoanalysis of things if an individual is prepared to do that. Then the next level we go into cognitive behavioral strategies. So this is where we'll do exposure therapy, where we're going to work on cognitive distortions and reframing. And finally, when we get to the very tip of our pyramid of the untangled mind pathway, it's goal actualization. Well, with Abraham Maslow, he very much had the very same thing, but later in his life, he talked about transcendence. Now I have a hard time with that word simply because transcendence um uh is been the word has um been bastardized. I hate to say it that way. I apologize. Um, by just different Eastern philosophies, that sort of thing. I am not stepping into Eastern philosophies. I am a loving Catholic. Um, and so that's not what I mean by transcendence. What I mean, however, is something that maybe I would see in my faith tradition of very few, and those are the saints, how they have transcended what has taken place in their life, and they're able to more um accurately, more attunedly walk out their faith. And um, what does that look like? So for my clients, goal actualization for some people, most people, I'll say 99% of my clients, they get to goal actualization, which is that symptom reduction, they've reached those goals, and it's time to graduate, which is fantastic. But then there is this certain subset of people that we get them stabilized and they say, Hold on a second, but there's something else there. And so it's this real truly developmental moment where as a clinician as myself who teaches measurement-based care, where we have goals, we we have symptom reduction, and they graduate. There's a few where we say, okay, I'm gonna help you move beyond this untangled mind pathway and symptom reduction, and we're gonna help you figure those things out. This is very developmental and it's not meant for everybody to reach it. So, for example, um, I have a client that's been with me for some time and came to me for some very significant trauma. We had uh high trauma scores, um, I think it was in the 60s, so 60 out of 80. So significant trauma scores. We're looking at complex trauma. And what we've done is the really hard work. We've done the really hard work. They were always engaged in the process, they did the homework, they stayed in touch with me in the portal. Um, we did exposure work together. We found what kind of exposure worked best for this individual because there's both EMDR or prolonged exposure. Um, we did all the hard work. And what was interesting is this client resolved the trauma. We could see throughout the scores that the trauma was resolved. It was no longer alive in this individual's mind and body. We'd also done the hard work of recognizing where the thought distortions were, how they were created by the trauma. Um, everything was just brilliant. And when I said to them, I'm really excited to let you know. I can't, I will never forget, they're sitting in my office. I said, I'm so excited to show you your trauma scores and just talk about what you've been doing and congratulations. This is astounding. This is what happens when people put their, you know, dig their feet in and they do the hard work and they don't turn away from the ugliness of our lives that hurts so bad. And you looked it straight in the face and congratulations. They were not distressed in any way. They were not symptomatic in any single way at all. And what I say, what I saw pass across their face was complete uncertainty. This idea of I think first, like, is Piper kicking me to the curb because all my clients know that I'm very much um in favor of time-bound therapy. I don't want to create a dependency with clients. Um, but there was this look that went across their face of like uncertainty. And they're, and I could tell they're trying to make sense of this current experience when they're in. So that's what I'm speaking to. When symptoms organize someone's internal world for years, especially in trauma, the urgency, the hypervigilance, it provides a structure. So that survival has shaped their identity, their decisions, and their meaning on this earth, right? Whether it's good or bad. But when that urgency recedes, there's suddenly this space. And that space can feel very, very uncomfortable if you've never had to live there before. And this is often where people misinterpret what's happening. They assume that the discomfort means there's a relapse, or maybe it's an unfinished work, like we need to go back to the workbook, we need to do more exposure work, or that the therapy needs to continue simply to manage the uncertainty. But from a developmental perspective, something else may be occurring. So, like I read you from the um abstract, as I was thinking this through, how do I teach this untangled mind pathway? I can teach this in my sleep, I understand this, but how do I describe this very small subset of clients? How do I describe how to teach a clinician to step into this space while also not look like I'm talking out of two sides of my mouth, saying on one hand I think time-bound, and on this side saying, well, but there's just people. It's a very difficult place for me to balance. So I want to look at it from a developmental lens. So most clinicians, most counselors were um introduced to developmental theory very early in our training. So that's usually Piaget and Ericsson. But we rarely apply these frameworks to adults since um or once symptoms have resolved. But here's the thing: development doesn't stop when distress stops. And we know this. And oftentimes I pull up Eric Ericsson, and I'm gonna pull it up right now. I should have had it before. Um, Eric Ericsson talks about um these different levels of development, and with the um adult population that I work in, I actually look at this very often at level seven, which is generativity versus stagnation, and level eight, which is in integration, integrity versus despair. So generativity and stagnation, um Eric Erickson says that this usually lands about 40 to 65 years old, and this focuses on creating a legacy and contributing to the next generation. And then there's level eight, which is integrity versus despair, and this is 65 plus. And this involves reflecting on life and achieving wisdom. Now, what I see when my clients have the symptom reduction, they've mastered the untangled mind pathway, and they are doing fantastic. Some of them stop and say, Okay, I've mastered the conflict, I've mastered the trauma, I am healthy, um, I have a healthy understanding of my personality, I have a healthy understanding areas of my life that I need to really uh be cautious of. But there's something there, there's something missing. And so often in this stage, people say to me, like this individual that I was talking to, wait a second, I need to know what's next. I know that there's something else that's missing, and I need your help to get there. I need to understand. And so it's it's very interesting because you know, we're we're talked about, we're told or taught developmental psychology, yet we rarely discuss it with our clients. We rarely discuss it amongst each other that this does happen with some individuals. It doesn't have to, again, it doesn't have to happen. And this is not to negate one or compare one client to another. They're not, it's not an um intellect. I want to say that very clearly. This is not uh uh intellectual level, one client versus the other. That's not at all. It's just that everybody develops at different rates and stops at different rates. So when when our distress stops with these individuals, I hear them say these questions. And at later stages of development, the psychological tasks shift. So it's no longer about us seeking safety or stable stabilization, it becomes about coherence and meaning making and self-direction. And so this client was so funny. I said, okay, we're gonna dig into this book. It's by James Hollis, it's called A Life of Meaning. And they and I have been sharing, you know, experts from the excerpts from the book and discussing it, and they've shared a real consternation with the book, a real frustration. In fact, last session, it was like, all this is is just esoteric to be esoteric. There's nothing here. And I kept saying, be patient with this. You're gonna be chewing on one paragraph for days, and it's going to click because that thing that you're saying that you're trying to find, like, who am I? What is my contribute contribution to the world in a different psychological um mindset? Who do I want to be? How do I want to show up? It's going to show up for you in this book. I share, I kept saying, I swear it's going to show up in this book. But they were very frustrated with the book, which is understandable. But sure enough, sure enough, I get a text message or in the portal saying, finally, page 90, here it is. Now it's clicking. But damn, it took the whole book to get to this. But it does. And this is where it's really important as clinicians that we look at thinkers like Maslow and Frankel. They become very relevant in this kind of, I guess you could say, level seven above the untangled mind pathway. And it's because not everyone arrives there, but because only those have sufficient stability and um have grown uh psychologically really get to this point. So Maslow, as I described, upper levels of hierarchy aren't obligations anymore, right? When we look at Maslow's hierarchy of needs, these are needs, these are tasks, these are obligations that we have. But at the upper levels, we're actually looking at possibility, right? So we turn away or we turn from obligation with the untangled mind pathway. We're gonna achieve everything that we need to do, all our goals, everything's actualized, and we move into the realm of possibility, totally different, right? And then Frankel's work reminds us, and if you know who Victor Frankel was, he um survived the concentration camps. And so um a man's search for significance, uh, his nominal work, I mean, his amazing work, um, he reminds us that meaning doesn't automatically appear when suffering ends. And in fact, these certain individuals that I'm talking about, I'm constantly teaching them that this is where we learn to suffer well. That even though when the suffering hasn't ended, it must be discovered this thing. And the discovery requires tolerance of ambiguity. And it again, not everyone reaches this terrarium, and nor do they need to. But for those who do, it can feel very unfamiliar precisely because it's developmental, not clinical. And so this is where it's really hard for me to discuss this because I believe in time-bound. I don't believe in infinite um therapy. However, for a small subset of individuals, it's something that we can help them become comfortable in, this ambiguity of like, what are the actual answers to my questions? Well, we don't actually know the question yet to find the answer. And it is a bit esoteric. It is very highly philosophical and can make your mind bend. But this is the developmental task that they require. And as clinicians, we can walk them through it for a bit. We don't want this to be infinite. So, again, this is why clinicians, I think, feel very uncertain when this happens. Not because the model, like Untangled Mind Pathway or a manualized CBT or a DBT has failed, but because. Training rarely, rarely addresses this phase explicitly. And that is what I'm having a hard time putting into words. So that the outcomes, measures look good, right? All their scores look good. The symptoms are resolved. And yet the client is asking a different kind of question. But without utilizing a developmental lens by Piaget, by Ericsson, looking at Frankel, looking at Young, we're going to miss out on things. And then those clinicians may feel pressured to reintervene unnecessarily, right? Because they're used to fixing a trauma problem. Whereas this process of seeking possibilities, there is no uh guardrails. So they might intervene in the process where it is absolutely unnecessary and in fact unwarranted. Or they may extend therapy without a clear purpose. So with this client that I'm working with, when will I know this individual is done? Well, when um the sessions become quiet, when they come to session and they don't have quite the things to dig into. And eventually, what actually happens with these clients, like I said, I've only had a handful over the years, they say, you know, I found it. I found that balance. It's not necessarily this transcendent internal piece, but it is a assuredness of I can do this and I can continue to seek these things without falling apart. Um, and then there's some clinicians that just avoid the ambiguity altogether because for them they've not done this work as well. So none of these responses really reflect their poor attention, these counselors, it's just because it reflects a gap in training. And again, we don't talk about the developmental aspect in adults after they've um resolved trauma, right? So um I how I invite clients to this approach, this space, um, is curiosity and it's not steps and it drives them nuts with this particular client. It's like, yeah, but how am I gonna know? Like, what do I need to do? And I have to keep saying it's not about what you're doing, it's about what you're you're learning. It's a what uh what you read in the book and then you apply uh this paragraph you read on, you know, page 102. Um, it's not about A plus B equals C. That is definitely not what this process is about. So when clients do enter this phase, the work is no longer about fixing at all. It's about posture. How do they welcome life? Have they learned to suffer well? What is it going to take to learn to suffer well? And I know that sounds terrible, but y'all, we're we live on this earth. There's a lot of suffering. How do you how do we do it well? So I invite curiosity rather than kind of ginning up that urgency that they might have been feeling already with their trauma that's already been resolved. So it's not, you know, what's wrong now or what do I do? It's what's different that I haven't had to tolerate before. It's inviting recognition into this space, that ambiguous space that feels different. And it's seeing self within that space, it's stepping out of self and and listening to self. Does that make sense? So it's, and I tell people this all the time, it's the ability to think about your thinking, to see yourself thinking, speaking, behaving outside of being that person thinking, speaking, and behaving. No, this is not multiple personality. I am not asking you to fragment. I'm asking you to be aware. Many people, nine out of 9.9 out of 10 people are unaware of how they think, speak, and behave. They are, they're absolutely unaware. Anybody can tell you how they feel. Most people can tell you how you they feel, but they can't tell you in what context. And this space is about recognizing those things. And again, there are not concrete answers in this space. And it's not what should I do next, but what happens if I don't rush to answer that? And this isn't about insight for insight's sake. I want to be very clear about this. This really does step more into the tradition of psychoanalysis, and that's where I talk about young. So CBT and measurement-based models, we really do excel at addressing symptoms. The psychoanalytic traditions offer this really useful insight into what follow symptom relief. Carl Jung used to say that psychological development often involved periods of uncertainty once early organizing forces are dissolved, right? So we are dissolving those old trauma mechanisms. Um, Freud even said the same thing that once symptoms are removed, it leaves behind questions that that previously were unable to be seen. So, what's the meaning in my life? How do I want to be within my life? Um, it's these very existential questions and these perspectives, they really don't oppose structured therapy, like I'm talking about, that I believe so strongly in. They actually complement it and they help clinicians recognize that not all meaningful psychological work looks like symptom reduction. And not all ambiguity requires intervention. So, again, not every individual is going to go to this more transcendent, again, don't like the word, work, but some really require it. And so this is not, again, speaking towards endless therapy, which I do not promote, but this is allowing individuals to explore post-symptom ambiguity that they were feeling. When I'm like, hey, congratulations, you graduated. This is can this is amazing, congratulations. You know, just so excited. And they look at me like, no, there's something there. Conversely, nine out of 10 clients are like, This is awesome. Thank you, Piper, and they're out, right? So clinicians have to be trained to recognize when symptom-focused treatment is complete and identify when a client has entered into this developmental transition rather than a clinical setback. And it helps that client understand that you don't want to avoid the ambiguity prematurely and like slam in another technique like or something by a clinician, but it is to help support them appropriately into that space, or it's time to end therapy. Again, um, this is what I was trying to explain. It's a very hard topic for me to explain. And so I don't think that this phase needs to be prolonged, and I don't think it needs to be filled. So for most clients, therapy ends well before this point, and that is absolute success. For a very, very, very small group, symptom resolution opens a totally different developmental question, one that requires tolerance and maturity and restraint on part of both the client and the clinician. That's not more therapy, that's learning discernment, and it's a conversation that I think needs to be able to hold without pathologizing it and without turning it into something that it isn't. So I hope that made sense. Hopefully, I will have this um white paper written. I don't know why I'm doing it. I guess it's just an exercise in articulation of what I believe in. But I do think that the whole premise of what I'm saying is if we can get a client to self-authorship, they start authoring their own lives. We see integration and meaning making making, that is um the true psychological clinical experience that is really a blessing to be a part of. And to the clients that have moved into this space, if you're there right now, currently, I know you're very, very frustrated, but you will get there. Um, and what I've said to most of them in Einstein's words is if you stop learning, you start dying. Well, this experience is about continuation of learning and observing self and self-authoring. It doesn't really end. It really doesn't really end. So thanks so much for joining me with me today. Um, I'm sure this left you with a lot more questions. That's why this was the second go-around trying to record this. 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, 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. Hiper Harris with the Untangled Mind Podcast. I'll talk to you next time.