Practice in Action: Beyond CBT, Integrating Different Approaches for Better Outcomes

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All right.
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Hello, and welcome to the Psych2 Practice Podcast, your one-stop for practical and useful clinical information, masterful insights from experts in the field and a guide to daily living.
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I'm your host, Paul Wagner, and joining me?
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Ray Kirstner.
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And Ray, we have an idea that you were putting out here that I thought was really interesting.
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Would you mind kind of giving a bit of an overview of what it is that we're looking to really dive into for today?
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Yeah, so it's interesting.
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This came to me really because of working with someone.
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And someone who came to me specifically for CBT and some exposure work.
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And we made progress.
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I think there were there's there were definitely some things we gained.
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But we didn't quite hit the outcomes that we were hoping for.
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And there were some things where we kind of got stuck.
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And that case got me thinking about, you know, well, you know, I am a CBT person.
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That's what I do.
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And you know, we we talk about that quite a bit.
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That the reality is, is there are limits to CBT, and there's a limit to exposure therapy, and that it's not that it fits for everyone.
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And at times, you know, maybe at times it's easy to just refer out.
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That that, you know, maybe a different type of approach might be better.
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But but it got me thinking more about the idea of integration and how before we do that, are there ways that we might integrate some other therapy approaches into the work that we do?
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Or maybe it is time to refer out.
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I think that's okay as well.
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But I so so that's really kind of where this came from was to really think about understanding the limits.
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Because I hear all the time people say things like CBT is the gold standard and all of these things.
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And and yes, there's a lot of wonderful research in CBT.
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And I do it because that's what I think works well.
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But I think professionally, we also need to understand that it's not right for everyone.
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And I would even go a step further, recognizing for some, it actually may make it worse for them.
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Um, this whole idea of iatrogenesis, right?
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Like what we do can can create problems.
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So yeah, that's that's the idea.
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And I thought maybe we could tackle and go through that a bit.
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And, you know, I I'm going to assume for the vast majority of uh, you know, you at home, CBT isn't a new concept um and it isn't something that's you know wholly unfamiliar.
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But I think it would be helpful to first starting off, like, you know, maybe we're talking about like where do we where does CBT typically get it right?
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You know, when we're talking about it being the gold standard, why is it earned that?
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And like what are the things that it does really well?
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And like I think uh for me, one of the pieces that stands out is just the how empirically based it is and how we can really look at the the the science and the research behind it, because we have we have so much of that.
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When if I'm talking, if I'm thinking about like, you know, some of the, I guess, some of the therapeutic approaches that, you know, in grad school that I really like romanticize and, you know, there's still a quite a uh you know, soft spot in my heart for that data is very, very different when I'm when we're looking and comparing to like what the evidence is that supports and backs up empirically for CBT there.
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Yeah, I think there's there's wonderful research that exists.
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And I think why I was drawn to CBT and why I think it works really well is it's it's really taking this kind of clinical theory and really put it into things that we can observe, we can test, there's teachable skills that are involved.
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So there's there's a real kind of action-oriented approach.
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And it is, as you said, measurable, really good CBT.
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We're looking at measuring outcomes.
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And I think with that, the action part of CBT, especially around exposure, uh, yeah, it it targets the maintaining factors.
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It targets things like avoidance or escape and really tries to um, you know, to put people in that moment.
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But again, we we don't want to say that that's that's that works for everybody, but we know how effective exposure is.
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We've we've had other guests on that talk about it as well.
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So I think it does that well.
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I think that just the the idea of skill building and ex and using exposure to practice skills, it it's it really is an effective approach for a lot of areas.
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And I I think it it makes it nice when we're kind of thinking of it, I guess.
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Um I'm gonna overgeneralize here a little bit, of like when there's uh metaphor came into mind of like, you know, if I call a professional for, let's say, you know, if my roof is leaking or something like that, my expectation is that by the end of it, I'm going to see this resolved.
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My roof will no longer be leaked, we're gonna see the outcome in the in the transition, the change, rather than it being modeled, or it's like, yeah, we got most of it, or hey, we're noticing a really significant change here, but it if at the end my roof is still leaking, and I think CBT does a great job of taking some of these concepts, and it is not like a perfect, it is not uh, I think a sure 100% guarantee part of the conversation we're having, but for the things it does well, I think it there's a lot of validity and reliability in what we're talking about here.
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And I think I know for me, I was there was almost a part that I again grad school wise, in learning about CBT, it it almost felt it didn't really capture, I guess, some of the maybe mysticism or some of the the just the the the soul of therapy, I guess in some ways.
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And recognizing as time has gone on that that what is it, the the art and the science can be blended.
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And really, you know, and I think CBT does a gr is a great mechanism for that that I didn't really recognize earlier on in my career.
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So no that I don't think there can be enough positive things recognized about CBT, but that's not why we're here talking for today.
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Yeah, but yeah, I I want to go on that though, because I think that's important though, because I do think that sometimes I've heard CBT talked about in this very mechanical way.
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And and I think sometimes in in grad school we hear that.
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And I I think you're right.
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The reality is is there there is the art and relationship part of CBT that is core.
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And yes, there is skill building and there are these other things, but you know, if you if you ever hear Aaron Beck talk, you know, he he would talk about relationship a lot.
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And, you know, watching somebody do therapy, there there wasn't many people that had better relationship in in how he interacted with people.
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So I I think that's an important part because I think that's also why it works.
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Yes, there there's these treatment planning and progress monitoring and repetition and data collection and all these things that sound very mechanical, but there is the art of it.
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I I want to add to that, though, the other thing I think with CBT that sometimes is why it doesn't work is people think of it in a very old school way, like exposure, especially.
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Like, you know, I think people think that exposure is just this idea that you stay in an anxious moment until it declines.
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So you're afraid of snakes.
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Let me give you a snake to hold.
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And in an hour you're gonna be cured.
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And that's not what exposure is.
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And I think contemporary models of CBT really have I think enhanced what we do, especially around exposure.
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And, you know, we see this idea of generalization and variability of responses and ways that we're we're looking at using skills in different contexts.
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And even gradually, you know, I I think back to a real early episode that we had when uh Bob Friedberg was on.
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And, you know, he talks about like using exposure with just playing games, right?
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And we've had other episodes about that.
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Um, that's not what I think some people think about of exposure.
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You know, simple role-playing or maybe doing improv are all exposure things that we do in therapy.
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And I think contemporary CBT has really gotten that right.
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I think we've done it really well.
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And so, yeah, I think that's important.
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And and with all of that, though, I I again, I think going back to the root of what we're talking about, CBT can be really effective.
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Sometimes it's poorly delivered, and that's what causes it not to be effective.
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But I think also sometimes it's just not the right match for for the individual.
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And and that's okay.
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I don't I don't like I said, that's where I think this idea of what do we do and how do we integrate something different is important.
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And so maybe barring it being delivered poorly, it let me, there's portions I think of this conversation where it being delivered poorly doesn't necessarily mean the clinician is doing a poor job with it.
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But it it can be, I think, possible, we're not talking about or we're not targeting the right thing.
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You know, what when we're kind of coming in and and what's being presented and what we're kind of really focusing on isn't really an it isn't accurate.
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And so uh similar to if you have a viral infection, if you're given an antibiotic, we're targeting the wrong thing.
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It's not going to be effective.
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And so, in the similar way, making sure there the clarity, and I know we've talked about case conceptualization.
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Probably one of my most popular episodes is talking about case conceptualization.
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I think a key component of that is making sure we have a full understanding of the person, and within that, getting a formulation, an idea of like what are the the aspects and areas that we're looking to treat and really trying to support this individual and making their life better in a way.
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And that might not always be clear as we're kind of especially early on engaging with someone, or if we've been kind of stuck for a while, being able to come back to I I think that can be one of those elements where we can still CBT can still be very viable and very valuable.
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However, we just need to make sure we need to bring that accuracy into it.
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Yeah, and and it it's you're right.
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I don't I don't think anyone does it poorly because that that I should say, there's probably somebody who does it poorly because they're just not doing it.
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But I Yeah, I think it's interesting over time and and being part of supervision.
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I think there's there's a few things.
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I think sometimes as clinicians, we're we're afraid to reach out and we're not maybe getting the supervision we need.
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And you know, I I've I've said a million times, I'm so lucky that I had the time and the supervision.
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I mean, you know, gosh, I've I've had f over 4,000 hours of supervised practice where you know that that means a lot and that helps.
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And and unfortunately, that doesn't, that's not always the option for people.
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And so I think sometimes people are doing the best that they can, but sometimes may maybe the first step, if it's not working, is consulting with someone, getting some supervision, and making sure that you know we are using those skills and really doing good CBT.
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Because again, sometimes it's it it's just not being delivered in a way that it would be effective.
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And but with some training and supervision, I think that that can help for for a lot of people, but that's that's hard to access.
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And I I I think I've shared on other episodes, I get asked to do supervision and consultation from people all over the place.
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And I've yeah, I've literally been on Zoom calls where the psychologist that I'm working with, there's not another psychologist in a hundred miles of where they're practicing.
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And so when it's tough, where do you go?
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Right.
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And luckily, these some of these people were able to reach out and we could connect, but that's not always an option.
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And I guess in that, when individuals are maybe struggling or maybe they don't have access to the support or the supervision, you know, what are some of those things that I guess from maybe a to watch out for or recognize like when some of these CBT protocols really start to start to fall short or really aren't being as effective as we would expect.
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Yeah.
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I think you you highlight a little bit, maybe we might be treating the wrong problem.
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So going back to I think case conceptualization, I think that's a good part of it.
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I think sometimes in in doing supervision with people, I find that sometimes they teach the intervention, but they themselves as clinicians are not comfortable with the exposure piece, you know, where it's so that can go wrong, where we're not generalizing it.
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We've taught a lot of good skills, and the talk part of therapy is good.
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The action part is where it falls short.
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And and so sometimes I, you know, I've worked with many early career professionals where we gotta we have to get them comfortable with setting there and being in the emotion and being in those uncomfortable times.
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It I think it gets easier.
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I don't know about maybe with you, Paula, but for me, I feel it gets easier, but it's still hard for me.
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There are times that I'm I'm with someone and it is a really, we are really pushing.
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And even 30 years later, I I want to move away from that making them uncomfortable because that's part of our our therapeutic mind.
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But I know that we need to stay in that hot moment.
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And so I think that that's part of it that that that gets in in the way.
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How about you?
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I mean, are there some areas that you kind of you think about?
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Uh well, one, I just to to piggyback, uh there's a case that's coming to mind where trying to challenge a kiddo's fear of flying and him and his family were going, and he was really looking for reassurance from me.
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He'd like, yeah, it problem is he'd gotten reassurance from everyone else.
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And he's like, what if the plane crashes?
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Like, you think what do you think is gonna happen?
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And I wanted to tell him, you're gonna be fine.
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That's really I truly thought he's probably gonna be fine.
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And having to be like, you know, your mate, your plane might crash, it might not, I don't know.
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Right.
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And the look of shock, but it was just those moments on, but then it wasn't him turning to me.
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It was, how do we then try to go and seek out better information?
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So don't just trust me.
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How do we go and look up information?
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Let's try to be better informed about that and spark this whole tangent of the the safety of airfare versus driving in a vehicle and some of those pieces and trying to make more effective comparisons rather than him just hearing you don't have anything to worry about because he hears that and feels good in the moment, but then but what if?
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Sure.
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Um and so uh, but I I think some of those other pieces one thing that I think comes up is when I really it's a version of the CBT that I use, but when there's this perfectionistic expectation, I think is also quite challenging.
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Sure.
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And it becomes this we're then falling back into these black and white expectations and thinking, and then it like when things don't go well or when they aren't being as effective, it turns into this just this garage of the negative self-talk and just really just harsh criticisms and things of that nature there.
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And when we're talking about some of these pieces and trying to challenge, they almost view themselves as a failure for not being able to be effective in it.
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And or it it sparks more of this sense of like, what's wrong with me?
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If like, you know, if they are struggling and they aren't able to overcome it, especially if they've been able to overcome quite a bit with some of those mechanisms that well, maybe not the the healthiest have served them before.
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And I think that their lived experience at times has been like, oh, if I do this, it works.
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Right.
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And it's but at what cost, or up into a certain point in some of those pieces there.
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So I think those are some of those concepts or those aspects that come up that really I think kind of challenge and like we end have to pause and we have to kind of come back and recenter versus continuing on at times.
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So like there's when to push, and then also when do we kind of call timeout and then because we're starting to go down a pathway that isn't the most effective or helpful there.
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Sure.
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Yeah, I think that perfectionist self-attack kind of mentality, I think that it's an interesting piece because like I I've had I've seen that a lot with people.
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And and again, it feels like the intervention's not going well at that point.
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I I almost reframe it that I think it that that's when it it is going well, but maybe we didn't do the right preparation.
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And in in the sense of, you know, I I oftentimes will will tell people, listen, there there are times we're going to do strategies that you're not going to be successful at.
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The first few times you try them, you're not going to get any result.
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And the bad news is it might even be a worse result.
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You actually may try this and feel worse for a while.
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And really kind of setting that up ahead of time, knowing that it's just not like, hey, I went to therapy, I learned how to challenge my thoughts, and I'm going to do them automatically.
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They may have the skill, but they may not be able to access them.
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And there's a lot of things.
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I think that perfectionism gets in the way.
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I think shame gets in the way.
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I think that our own emotional arousal sometimes gets in the way.
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Listen, I've done this for a long time.
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I can be in an emotional state and forget the same skills that I've taught thousands of times, right?
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And so we're all vulnerable to that.
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And I think that that's the part of maybe doing some self-compassion with people and say, yeah, hey, listen, you got to give yourself some grace.
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This isn't gonna go smooth.
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Change is not this linear path that goes in a straight line.
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It looks like an EKG, right?
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It bounces around and we're gonna have good days and we're gonna have bad days.
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And some days it's gonna work.
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And so the next day, for the same exact issue, it might not.
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And that's just human nature.
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And so I think talking through that and getting giving some tolerance around that, we get through that.
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But it absolutely, I think, happens.
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And one other area, and I think this comes back to just the value and importance of doing really good case conceptualization early on, is when like when the person's environment continues to reinforce kind of what's going on or their reaction there.
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And so, you know, if I'm working with someone and not, you know, maybe it wasn't initially disclosed, or we hadn't initially kind of like really focused on if it's poverty, if it's, you know, um belonging into a minority group and experiencing discrimination as a result of that, or being just in some really challenging environments that, you know, on the surface might present as a distorted cognition, or, you know, you know, they were when it's more of that their lived experience just continues to tell them no, this is accurate, this is right.
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Like in your reactions are what's on the only thing that's kind of keeping you safe or that's keeping you that that's kind of keeping you grounded.
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And I think we need to be really make sure we're recognizing some of those environmental factors that whether they contributed to the formation of it, or if it just reinforces even more so of a previous formation of it, of someone who maybe has, you know, if they like I can't trust anyone type of, you know, you know, if we're we have that belief system.
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Yet if there's been a significant betrayal from family, and then from there, maybe there has been a failing or a dismissiveness from support systems that were meant to be there to help them out, or even, you know, if it's faith-based or school-based or athletic, whatever that may be, and leaving them feeling even more vulnerable.
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And maybe again, couple that with some challenging work dynamics or infidelity in relationships.
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It's like, how am I supposed to believe anyone?
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My entire life I've had this background that's there, and you know, challenge, well, you know, that cognition that, you know, it doesn't feel accurate.
00:21:58.349 --> 00:22:00.989
Like their lived experience is like calm bullshit in a way.
00:22:01.229 --> 00:22:01.389
Right.
00:22:01.469 --> 00:22:01.869
That's right.
00:22:02.109 --> 00:22:03.469
Yeah, absolutely is.
00:22:03.549 --> 00:22:06.109
And it's yeah, and I think two thoughts on that.
00:22:06.269 --> 00:22:12.589
I think one is sometimes it it there are those, um, I guess we'll call them maintaining factors, right?
00:22:12.669 --> 00:22:18.669
That that maintain some of the challenges that are are not always malicious.
00:22:18.829 --> 00:22:21.389
Sometimes I think they're they're done with good intent.
00:22:21.469 --> 00:22:28.189
You know, and I I think just of parents who try to relieve their child's anxiety so they accommodate.
00:22:28.349 --> 00:22:30.909
So I I as you were talking, I'm thinking about past episodes.
00:22:30.989 --> 00:22:33.229
Like I'm thinking about like the bedtime battles, right?
00:22:33.309 --> 00:22:35.629
Like our child's having a hard time in bed.
00:22:35.709 --> 00:22:36.909
So we want to relieve that.
00:22:36.989 --> 00:22:40.749
So we're gonna lay in bed with them so that they can get this good night's sleep.
00:22:40.829 --> 00:22:45.149
And out of our kindness, we are actually exacerbating the problem, right?
00:22:45.229 --> 00:22:47.389
Like it's and it's it's not purposeful.
00:22:47.469 --> 00:22:49.869
Like I think parents do that because they care.
00:22:50.029 --> 00:22:53.229
And but it is a maintaining behavior.
00:22:53.469 --> 00:23:09.629
And I think on the the more malicious end of it is I I just had this young guy that I've I have been working with who um, you know, he came in and and I'm I'm seeing him because he's gone through a lot of other providers and interventions.
00:23:09.869 --> 00:23:15.709
When I talked with him, this young guy had more CBT skills than many therapists that I know.
00:23:15.869 --> 00:23:19.229
Like he, I I even told his parents he's therapized, right?
00:23:19.389 --> 00:23:22.109
He's he knows the lingo, he knows the skill.
00:23:22.269 --> 00:23:24.189
He and I could do it together.
00:23:24.509 --> 00:23:29.069
But he is a victim of very significant bullying.
00:23:29.229 --> 00:23:31.309
And that environment hasn't changed for.
00:23:31.949 --> 00:23:32.189
Him.
00:23:32.429 --> 00:23:39.709
And until we change the environment for this young guy, we could keep teaching him skills and we can keep doing one-on-one therapy.
00:23:39.789 --> 00:23:48.429
But you know, my advice to the parents were we need to have conversation with the environment that's where the bullying's occurring.
00:23:48.669 --> 00:23:50.669
And we have to address that.
00:23:50.909 --> 00:23:57.709
And we we're pathologizing in some ways his victimization.
00:23:57.869 --> 00:24:00.829
And we're saying, hey, you need to learn better skill.
00:24:01.229 --> 00:24:03.789
No, we need to provide better safety.
00:24:03.949 --> 00:24:06.029
And then your skills will emerge.
00:24:06.189 --> 00:24:15.709
And you know, so it's so yeah, I I think that's a great point because I I think we may have talked about this at other times, but I always hear terms like treatment resistance, you know, right?
00:24:15.789 --> 00:24:17.629
Like that, those terms come up.
00:24:18.189 --> 00:24:19.869
And I hate that term.
00:24:19.949 --> 00:24:26.829
Um, you know, and I always say, like, I I've not really ever met a person who's treatment resistant.
00:24:26.989 --> 00:24:31.629
I've I've met people that maybe we haven't found the right intervention at the right time for them.
00:24:31.869 --> 00:24:40.589
And so for this young guy, we keep jumping therapist thinking that he that he hasn't found the right therapist, or we haven't, no, we've given him all the skills.
00:24:40.749 --> 00:24:42.669
The environment needs to work.
00:24:42.829 --> 00:24:45.149
So I think that's a great point that you have.
00:24:45.309 --> 00:24:55.469
And and I think the whole idea of just again, we need to rethink treatment of resistance a bit as well, because don't know that it's always just the individual.
00:24:55.629 --> 00:24:56.989
There's more to the story.
00:24:57.309 --> 00:24:58.109
Absolutely.
00:24:58.269 --> 00:25:35.229
And and maybe kind of going in, and I I will say the treatment, the running into the experience of treatment resistance, or at least that label of treatment resistance, it I think thankfully isn't I'm not have meeting too many individuals that are coming in, like carrying that, like that experience of being labeled as treatment resistant, and as well as even the individuals I've worked with, you know, thankfully it uh the interventions that we're talking about and work you utilizing oftentimes work with a lot of ADHD individuals and the behavioral interventions and finding the you know supportive treatments surrounding medication and things, oftentimes they're able to experience some relief.
00:25:35.389 --> 00:25:35.549
Yeah.
00:25:35.709 --> 00:25:39.629
However, the individuals that I do, like that can be really hard to hear.
00:25:39.789 --> 00:25:44.189
Like when it's you know, this this concept of like, oh, I'm treatment resistant.
00:25:44.349 --> 00:25:45.309
What's wrong with me?
00:25:45.469 --> 00:25:46.909
It's a terrible term.
00:25:47.069 --> 00:25:48.109
Yeah, it's a yeah.
00:25:48.189 --> 00:25:56.429
Well, I'll I'll say it's a terrible term, but I'm I I'll I'll give a for those that want to read like a book that came out many years ago.
00:25:56.509 --> 00:26:10.989
I mean, I I don't think it's been in another edition, and I was probably still a doc student when it came out, but there's there's a book by Robert Leahy, who's a big name in CBT, and it's called Overcoming Resistance in Cognitive Therapy.
00:26:11.229 --> 00:26:26.669
And I think he he did it the best, where he really kind of looked at treatment resistance in in a different framework and you know looked at it as far as like what are the barriers to the impasse for therapy to work.
00:26:26.829 --> 00:26:35.629
And I think that rather than being putting that on the individual, looking at it more as these kind of these barriers that are in place.
00:26:35.709 --> 00:26:37.149
And so it's a good book.
00:26:37.309 --> 00:26:46.989
It's again, probably 25 to 30 years old, but good book to check out because I I agree with you.
00:26:47.069 --> 00:26:52.989
I think when people think they're resist that that that term resistant, not a great term.
00:26:53.389 --> 00:26:54.989
Not not a great term for us to use.
00:26:56.269 --> 00:27:01.709
You have a term that you use for for people to describe when they are having challenges?
00:27:02.029 --> 00:27:02.829
Oh gosh.
00:27:03.149 --> 00:27:29.149
It the way I describe it is uh it's far more of a paraphrase each and every time because but I it's from an earlier episode, and I'm not recalling if actually you were the one who uh kind of first presented this when talking about a diagnosis, and it was, you know, the diagnosis is the person that I'm seeing within the specific environment on this specific day at this specific point in time, like type of type of idea, and trying to make it far more conditional.
00:27:29.389 --> 00:27:38.269
And I also oftentimes will try to wrap in just understandings of the functional attribution error and how this is the current circumstance that we're in.
00:27:38.429 --> 00:27:40.669
It's not an attribute that they are carrying.
00:27:40.829 --> 00:27:44.669
And you know, they are not resistant, it's you know, we're currently experiencing resistance.
00:27:44.829 --> 00:27:48.589
And, you know, so um, and I don't think I necessarily use that language of resistance.
00:27:48.749 --> 00:27:54.109
Oftentimes it's whatever the specific focus is, is we talk about how that's not effective in this current moment.
00:27:54.269 --> 00:28:05.069
Doesn't mean it's not wouldn't be effective later on, but at that same point, it's as long as we're staying true to the interventions, it's not from a failing of of them, it's what's going on.
00:28:05.149 --> 00:28:22.749
And we try to then go through a different iteration of let's try to better understand it or let's try to make some tweaks and really pulling in even the some of the uh the core pieces of the scientific method elements of it of what are the variables that we're gonna pull on next and see what occurs in terms of how how we're observing the outcomes.
00:28:22.829 --> 00:28:30.589
And and when we view it in that way, I think there's less ownership over this concept of resistance, and we view it far more as experimentation.
00:28:30.749 --> 00:28:37.709
And so, like that there tends to be a receptiveness there when having those convoluted conversations and the way that I have them.
00:28:38.109 --> 00:28:40.349
Yeah, no, I I I but I I I like that.
00:28:40.509 --> 00:29:00.029
I for for me, I it's I I tend to talk about and I and I do this early with people, is that when we're when we think about a diagnosis, let's just say depression, people have different types of depression and different responses to intervention.
00:29:00.269 --> 00:29:03.469
And sometimes it's difficult to treat.
00:29:03.629 --> 00:29:24.989
And and I really kind of talk about the the actual diagnosis as being difficult versus that it's an internal piece that, you know, and and and I I'll I'll use the example, you know, there there could be someone who um I I have a friend who's athletic, he's a weight lifter, he does all of these things.
00:29:25.309 --> 00:29:34.029
He also happens to have diabetes, and he has diabetes that is actually very difficult to regulate his blood sugars.
00:29:34.269 --> 00:29:45.549
So he does the right diet, he does the right exercise, he does all of these things, and he still is has a type of diabetes that just happens to be difficult to treat.
00:29:45.709 --> 00:29:53.709
And depression and anxiety can have those versions as well, that it's not an internal thing, that it's just that sometimes that's difficult.
00:29:53.869 --> 00:29:59.069
And sometimes it's difficult because maybe we as clinicians are are missing something.
00:29:59.229 --> 00:30:05.869
Sometimes it's just the nature of the beast, and there's other factors that are coming into play.
00:30:06.109 --> 00:30:18.429
So I I try to reframe it around that sometimes, just to to to put it more back on the idea that our diagnostic aspect of it, there are just different levels that we have.
00:30:18.509 --> 00:30:25.789
And as with everything else, some sometimes people respond really quick to interventions, and other times we have to try different versions.
00:30:25.949 --> 00:30:28.109
And I think that works most of the time.
00:30:28.349 --> 00:30:30.669
I've had some people though that that's even a challenge.
00:30:30.829 --> 00:30:42.749
So and you know, Ray, kind of in in planning and even the early early parts of this episode, we talked about the idea of like the the integration outside of CBT and like how that is really important and really valuable.
00:30:42.829 --> 00:30:57.869
And I'm curious for you, like when you've gone through this process and when you're recognizing that the CBT, like like the true to form CBT approach doesn't seem to be effective for these in for the for an individual.
00:30:58.109 --> 00:30:59.469
Where do you start to look elsewhere?
00:30:59.629 --> 00:31:04.509
Like, what are some of those things that you might kind of start stepping outside of CBT to explore and trying to bring in?
00:31:04.829 --> 00:31:25.629
Yeah, I so you know, I I was lucky when I, I mean, although my training was primarily CBT as a doc student, I I also got exposed to to other kind of different types of CBT, like schema focused therapy that integrates object relations in with cognitive therapy, which is excellent work.
00:31:25.869 --> 00:31:29.629
And I also I trained earlier in psychodynamic theory.
00:31:29.709 --> 00:31:43.389
And then when I did my doctoral internship, uh part of my internship was actually doing both gestalt therapy and object relations therapy, just because they really wanted us to have a broad experience.
00:31:43.549 --> 00:31:49.869
So for me, I I tend to go to those comfort levels because I have some backing in those things.
00:31:49.949 --> 00:31:56.989
Uh, you know, and and I I'm gonna call out another podcast out there, but I I know Paul, you and I have talked about this.
00:31:57.149 --> 00:32:02.029
You know, one of my favorite podcasts is called Talk Therapy or Talking Therapy.
00:32:02.189 --> 00:32:05.709
And it's Alan Francis and Marvin Goldfried.
00:32:05.949 --> 00:32:13.309
So one person who is psychodynamic, uh Alan Francis and Marvin Goldfried, who is uh big in the CBT world.
00:32:13.549 --> 00:32:31.469
But what I love about it is they really talk about this integration and how we, you know, really can pull techniques and strategies from other areas and even some interpretations from other theories that will enhance our work.
00:32:31.629 --> 00:32:44.989
And you know, one of the organizations I belong to is the Society for the Integration of Psychotherapy, and which is dedicated to this idea that yes, we can have our foundational skills, but we can pull from others.
00:32:45.149 --> 00:32:56.829
So so for me, and I think this is probably just because of the the individuals that I see, I probably lean first more into that psychodynamic world.
00:32:57.149 --> 00:33:09.229
And so when I when I'm struggling and you know, trying to to to try to move past some kind of a challenge, you know, it's uh that's what I'll probably pull out first.
00:33:09.389 --> 00:33:18.349
And you know, I I was describing this to somebody the other day, and I said, I don't know if you've ever seen the movie National Treasure with Nicolas Cage.
00:33:18.509 --> 00:33:31.309
And you know, in Philadelphia, in the there's a scene, he finds Ben Franklin's glasses, and they're glasses that have lenses that you can put over, and as you switch the lenses, it changes what you see.
00:33:31.709 --> 00:33:34.989
And that's kind of how I view integration in therapy.
00:33:35.149 --> 00:33:39.629
My glasses are CBT glasses, but I have these overlays that I might put in.
00:33:39.709 --> 00:33:49.549
And so for me, I might put that psychodynamic lens on, and not that I'm kind of abandoning my CBT science behind it.
00:33:50.029 --> 00:34:09.150
But, you know, for some cases, I might try to draw a different meaning for people, maybe kind of understanding um, you know, those defense mechanisms, maybe understanding what their behavior communicates a little bit and and drawing that a little different.
00:34:09.309 --> 00:34:23.949
So kind of moving into an area where maybe I'm trying to understand the underlying functions of their behavior, different than behavioral functions, but just trying to understand the the meaning of it and why they're stuck.
00:34:24.110 --> 00:34:34.909
And yeah, I think when we look back at you know some of Freud's work and others in psychedelic, I think defense mechanisms are are just such an important part that we don't talk a lot about.
00:34:34.989 --> 00:34:36.509
So I may pull that kind of thing.
00:34:36.590 --> 00:34:39.070
So that's probably the first layer that I would pull in.
00:34:39.309 --> 00:34:39.470
Yeah.
00:34:39.710 --> 00:34:52.670
And what's funny, I I think as we were kind of preparing for this episode and kind of discussing elements of this, I was kind of questioning some of these pieces because especially when we're talking about like some of the meaning behind symptoms.
00:34:52.829 --> 00:35:05.789
I I think that's something that I just tended to integrate without even recognizing that foundation being in psychodynamic and like being able to talk about, you know, really, you know, what what purpose does it serve?
00:35:05.950 --> 00:35:07.550
How is it, how is it being shared?
00:35:07.710 --> 00:35:11.470
What are the pieces that what it was it preventative in certain ways?
00:35:11.630 --> 00:35:17.550
Or um, you know, what how was it still kind of, even if it wasn't overall in a healthy way, like is it preserving elements?
00:35:17.630 --> 00:35:32.910
And like so just kind of by the nature of getting into those conversations, and I think in part how I can at times go off on various tangents, and it it can just lead to different levels of depth or insights that might not have come up in in other ways.
00:35:33.070 --> 00:35:41.389
And so um, but I'm imagining there's some of you at home that are probably also maybe recognizing pieces of, yeah, no, I I do this too, or I I've done this.
00:35:41.550 --> 00:35:46.750
And you know, as you're saying, we're not losing the the that that foundation.
00:35:47.070 --> 00:35:49.550
We're just being able to broaden kind of the technique.
00:35:49.630 --> 00:35:55.949
And I think you have a quote, you are it's it ends with technically eclectic, but what what is the first part of that quote that you're using?
00:35:56.349 --> 00:35:58.990
Theoretically sound and technically eclectic.
00:35:59.230 --> 00:36:03.150
So yeah, I I always view again, it's my main glasses, right?
00:36:03.230 --> 00:36:11.630
Are always going to be CBT and and a lot of my interventions are, but you know, yeah, it's but it can add a really important layer.
00:36:11.789 --> 00:36:13.550
You know, it it's it's interesting.
00:36:13.710 --> 00:36:20.670
I I I have a an individual I'm seeing currently who has pretty significant depression.
00:36:20.990 --> 00:36:29.470
And we have started to engage in what I would say kind of in a gent more general term, behac behavioral activation.
00:36:29.630 --> 00:36:34.990
So we're getting, there's certain things we're getting them to do on a regular basis.
00:36:35.230 --> 00:36:38.429
And it went well, which is great, right?
00:36:38.590 --> 00:36:43.470
So this individual engaged and started feeling better.
00:36:43.710 --> 00:36:57.869
And all of a sudden, this wave of guilt kind of came over that because there was progress, it brought up a lot of other guilt that was maintaining the depression.
00:36:58.030 --> 00:37:00.670
And that was around family issues.
00:37:00.909 --> 00:37:06.670
And now it was, it could have been easy for me to ignore that and to kind of go in.
00:37:06.909 --> 00:37:21.949
But, you know, kind of going back to you know, something we were talking about earlier, like so all of a sudden the shame starts coming in and all these other really hard emotions, and then the depression emerges again, the behavioral activation decreases.
00:37:22.269 --> 00:37:25.789
To ignore that and not to go, wow, let's talk about that.
00:37:25.949 --> 00:37:46.110
What are some thoughts that you have around this idea that when you feel pleasure, when you feel that you're doing well, that also is kind of integrated with this feeling of guilt and shame, that you're doing something wrong because you're you're you're feeling good.
00:37:46.349 --> 00:37:49.230
And and we had to have discussions around that.
00:37:49.389 --> 00:38:03.230
And because again, it looked maybe like the treatment wasn't working, but there was some deeper kind of personality kind of features, I think, with this individual that we had to talk through.
00:38:03.389 --> 00:38:09.710
And CBT by itself wasn't it was it was putting it on wave.
00:38:09.869 --> 00:38:13.389
We were we were doing well and then sinking, doing well and sinking.
00:38:13.470 --> 00:38:14.829
And we weren't seeing this.
00:38:15.550 --> 00:38:21.389
While, as I mentioned, we might look like an EKG, we still want to see some upward progression.
00:38:21.630 --> 00:38:41.309
Now, too early to for me to know what the outcome is, but we've now had two sessions where we really got into some intellectual discussion around why that's happening and created a little separation from the actual activation of doing things and more.
00:38:41.550 --> 00:38:43.150
Let's sit with that a little bit.
00:38:43.309 --> 00:38:46.190
Let's kind of really kind of think through it and we'll see.
00:38:46.510 --> 00:38:52.269
So far, I feel like we're making a different progress, but then we're gonna try the behavioral activation again.
00:38:52.429 --> 00:38:53.630
We're gonna bring that back.
00:38:53.869 --> 00:39:01.630
So it it may be integrated through and we come back to to those other CBT strategies later.
00:39:02.510 --> 00:39:04.349
And I think that's such an important piece.
00:39:04.750 --> 00:39:20.829
And I'm thinking so many individuals that I work with, especially individuals who have later in life been diagnosed with ADHD, like shame is such a mechanism that it works at times to motivate, but it's inconsistent like everything else with ADHD.
00:39:20.990 --> 00:39:22.590
And then it just begets more shame.
00:39:22.670 --> 00:39:26.909
And so there becomes this process of, you know, do I not care enough?
00:39:27.070 --> 00:39:27.869
What is wrong with me?
00:39:28.030 --> 00:39:38.110
And it it can really like just erode away at some of like their own sense of value, their own sense of agency or their own, you know, sense of purpose at times.
00:39:38.269 --> 00:39:48.670
And like being able to dive into those pieces while also trying to kind of supplanting or trying to kind of uprooting elements of the shame of like, okay, where's it house?
00:39:48.829 --> 00:39:51.070
You know, what are the experiences that are there?
00:39:51.309 --> 00:39:59.070
And then once we're digging back and identifying those pieces, it's like, okay, well, now can we come in with some of this understanding of what does ADHD do and how does it present?
00:39:59.230 --> 00:40:03.630
Yeah, you you missed something that was so important and something like, how could you?
00:40:03.789 --> 00:40:07.230
Yet if we're looking at this through more of this neutral line, how can we do this?
00:40:07.309 --> 00:40:13.710
But it's really trying to, we're not just talking about the some of the behavioral elements of how do we improve follow-through and those pieces, but also how do we backwards?
00:40:13.949 --> 00:40:20.909
Let's try to reverse the lens in which we're looking at our lives through it, and how can we recognize the impact that this has had?
00:40:20.990 --> 00:40:30.190
And it, you know, they're still responsible for it, but that responsibility doesn't need to affect or influence how they view themselves as a person or their values and worth.
00:40:30.349 --> 00:40:42.909
And I again, so I think that, you know, when you brought up shame, like I think that's just such an important piece of that, and like our willingness to kind of sit with that or to the guilt that can come along with certain elements of, you know, why didn't I seek this out for earlier?
00:40:43.070 --> 00:40:44.190
Do I even deserve this now?
00:40:44.349 --> 00:40:46.110
You know, when I've already affected so many people.
00:40:46.269 --> 00:40:55.470
So really trying to, I think, tackle some of those pieces and again sitting with some of that meaning of like, what is it, what is truly and trying to better understand like what is truly occurring here.
00:40:55.869 --> 00:41:04.269
We're not just, you know, we're not just treating like, here's how we follow through, here's how we, you know, create activation, motivation, and like, you know, some of those pieces.
00:41:04.590 --> 00:41:14.990
Yeah, I I I think this is where where I think psychodynamic does a really good job is it really is asking the why about the behavior or the solution.
00:41:15.550 --> 00:41:20.269
Why has that become necessary for the person?
00:41:20.429 --> 00:41:20.670
Right.
00:41:20.829 --> 00:41:24.190
It's so the the individual I was mentioning, that that's our discussion.
00:41:24.349 --> 00:41:31.389
Like shame has been become a necessary component that counteracts success.
00:41:31.630 --> 00:41:42.190
And there is there are and and in our discussion, we've uncovered a lot of reasons why that's become a particular part of this individual's dynamic.
00:41:42.349 --> 00:41:45.150
And I again, I think that's where it's different.
00:41:45.309 --> 00:41:53.710
It's not just about the the the cognitive distortions around and the negative thoughts around shame.
00:41:53.869 --> 00:41:58.829
It's really important to understand that why is that a solution for you?
00:41:58.990 --> 00:42:04.990
Why is that when when things go well, what makes you keep going back to that?
00:42:05.230 --> 00:42:08.269
And again, we'll see how that that kind of progress goes.
00:42:08.349 --> 00:42:15.309
You know, it's um you know, so we talk about psychodynodynamic or for you, Paul, other things that you might integrate in.
00:42:15.789 --> 00:42:18.510
And I think I I've probably mentioned this before on the podcast.
00:42:18.590 --> 00:42:26.670
I think even earlier in the episode, uh mentioned really uh I have a love of Carl Rogers, of Irvin Yallum, and just uh some of those individuals.
00:42:26.750 --> 00:42:49.550
And so whether that's a person-centered background and through our conversations and even just kind of through experience, like recognizing like there's elements of person-centered that are present throughout, but but especially certain elements of like existential uh psychotherapy, which it was an area in grad school that I really like in those courses, like it just spoke to me in such a way that other courses didn't.
00:42:49.789 --> 00:42:59.389
And being able to recognize some of these really strong conflicts that we don't really, we aren't really able to rectify.
00:42:59.470 --> 00:43:05.550
So whether that's surrounding death or, you know, freedom or isolation, um, like some of those pieces.
00:43:05.630 --> 00:43:28.750
And I find especially uh probably uh most recently when I'm interacting with someone experiencing grief, and because I don't want to pathologize the grief, I don't want to target how do we reduce this because it's an important part of their experience, but it just gives a framework to recognize some of the death anxiety and some of the experiences of uh how you know some of the core pieces of like death is what gives life meaning.
00:43:29.070 --> 00:43:38.829
And I'll and without death, life doesn't have urgent, life doesn't have that that zest and that that sense of you know uh that push to go and experience more.
00:43:38.909 --> 00:43:48.909
And even so there's so much of that that I think I try to pull into when we're talking about some of those pieces that otherwise maybe would have been like, well, hey, like that's that's a normative experience.
00:43:49.309 --> 00:43:49.630
Right.
00:43:49.949 --> 00:44:11.949
And it's accurate, but it just doesn't really give the depth of the scope that I think the individual might might be looking for and sharing or discussing some of those pieces and being able to talk about their grief symptoms or their like their overall just sense of lost and just I think to validate while still trying to keep them grounded, why and rather than just that just that well these things happen type of answer.
00:44:12.269 --> 00:44:13.389
You know, it'll get easier.
00:44:13.630 --> 00:44:18.750
Like and those are true, but but again, just trying to give it a little bit more depth and breadth.
00:44:18.829 --> 00:44:33.470
And I think that to me, the existential therapy leans a little bit more on the like philosophy side of things, which I think can can at times provide a sense of comfort or connection that you know maybe more like the psychology element maybe doesn't always tap into.
00:44:34.190 --> 00:44:42.190
Yeah, I it's I think existential therapy is also a a really natural adjunct or supplement in in CBT.
00:44:42.269 --> 00:44:55.869
You know, I mean it because they both have do have that, you know, philosophical kind of background and you know, the reliance on Socratic dialogue and the those types of you know technical aspects I think merge really well.
00:44:56.030 --> 00:44:58.510
I I think existentialism, though, I think, I think you're right.
00:44:58.590 --> 00:45:13.389
I think the the value, and it's not one that I necessarily lean on first, but I think the value of how we utilize that to really help people unpack their whole perception of the of the world, right?
00:45:13.550 --> 00:45:17.150
Really, and again, deep philosophical conversations.
00:45:17.470 --> 00:45:23.869
Death is a really tough thing to talk about, or meaninglessness, this idea, all of these things.
00:45:24.030 --> 00:45:31.470
And I see those challenges, I think maybe more now, maybe just because of just world issues that are happening.
00:45:31.949 --> 00:45:36.750
Happening, people that are, you know, talking about isolation and and those types of things.
00:45:36.829 --> 00:46:01.630
And I think leaning on that existential piece, you know, when I've used it, it really helps again, kind of that unpacking piece, but then also really challenge us, challenges us to think of them in a personal growth way, which is sounds weird that we're going to talk about meaninglessness and po and and that turns into to personal growth.
00:46:01.789 --> 00:46:07.150
But but when we do it well, I think it becomes a really good conversation.
00:46:07.470 --> 00:46:12.190
My hard part with it is it moves a little slow for my brain.
00:46:12.349 --> 00:46:17.789
And sometimes these are big issues that require us to really sit with them for a while.
00:46:17.949 --> 00:46:32.190
And and I always have to catch myself, if I know I need to go there, I have to slow me down and kind of being like, oh yeah, we're not gonna, this isn't something we're gonna talk about in a session and it's gonna, we're gonna have a new meaning of life.
00:46:32.269 --> 00:46:34.110
Um, that that that changes.
00:46:34.269 --> 00:46:37.309
But yeah, but I do think it's a real nice adjunct though.
00:46:37.630 --> 00:46:39.710
And I I'm I'm curious.
00:46:39.789 --> 00:46:54.030
So the one that I don't feel as I just have as much background in utilizing, but one that you kind of brought up in with a bit of an asterisk here for today, like that for us to be able to talk about was like the the somatic approaches here.
00:46:54.110 --> 00:47:11.550
And like I'm curious, like kind of with with the time we have left, I want to make sure, like just because that's a part where I know I think I need to strengthen that background a bit more so for me, because I do think there are there are times in which some of those interventions or some of those, you know, those approaches could really benefit certain individuals.
00:47:11.630 --> 00:47:14.030
But I'm curious, like, how do you find yourself using them?
00:47:14.190 --> 00:47:22.429
Because there is kind of the we don't want to lean too heavily into like all of maybe the somatic approaches, but there's some really good content or pieces of it that are there.
00:47:22.750 --> 00:47:29.070
Yeah, and I and I think again, it's one of these things where I think we don't realize that we use them, but they're there.
00:47:29.389 --> 00:47:31.309
You know, for me it was interesting.
00:47:31.470 --> 00:47:33.869
I I wrote a book, edited a book years ago.
00:47:34.030 --> 00:47:40.510
I mean, gosh, probably we're probably getting on the maybe the almost the 20th anniversary of the book.
00:47:40.750 --> 00:47:45.869
But in the book, we had a chapter on dance and movement therapy.
00:47:46.030 --> 00:47:58.429
And and I bring it up because at that point in my career, when Romeudi, who co-edited the book with me, said, Hey, we're gonna, we're gonna do this chapter, I I think my mouth dropped, and I'm like, what?
00:47:58.510 --> 00:48:01.630
We're gonna do dance and movement therapy in our book.
00:48:01.789 --> 00:48:10.269
And I think I was really naive to the idea of body movement and all of the things that kind of come with it.
00:48:10.429 --> 00:48:28.110
It ended up being one, actually, one of my favorite chapters in the book, because it talked about things like our body language and the impact of if we're sitting erect and our shoulders are back, like think of a ballroom dancer, right?
00:48:28.510 --> 00:48:46.590
How does that change how we feel versus if we're sitting slouched over and we're are we're kind of pulled in and and all of a sudden I went, oh my gosh, yeah, I I can watch people in my office where their body language tells me their mood.
00:48:46.829 --> 00:48:47.710
It's really amazing.
00:48:47.869 --> 00:48:49.710
And then so I started researching it.
00:48:49.789 --> 00:48:53.150
So for me, like I I integrate it in a couple different ways.
00:48:53.309 --> 00:48:59.869
One, I talked to a lot about to people about, you know, how do we feel when we change our body language?
00:49:00.030 --> 00:49:03.070
Like our body naturally ties it to emotion.
00:49:03.150 --> 00:49:08.909
You know, I I won't get into a whole bunch of research because I but I do think it's interesting.
00:49:09.150 --> 00:49:14.429
There's a a research study that, and I don't even know if I want to call it a research study, but yeah, I guess it was.
00:49:14.590 --> 00:49:17.230
They they looked at blind runners.
00:49:17.550 --> 00:49:20.269
So seems like an interesting study, right?
00:49:20.429 --> 00:49:30.030
They they took people who were blind runners that ran races that have never seen people celebrate after a race.
00:49:30.190 --> 00:49:38.510
So if we think about people at in a race that cross the the finish line, what's the body movement that we think they do?
00:49:38.750 --> 00:49:39.550
What do you think?
00:49:40.190 --> 00:49:42.510
Arms over the head, arms over the head, right?
00:49:43.150 --> 00:49:48.269
People who've never observed anybody else do that do the same body movement.
00:49:48.510 --> 00:49:50.190
So why is that, right?
00:49:50.269 --> 00:49:57.869
So a runner who has never seen crosses the line, they raise their arms up in the air and do the same movement.
00:49:57.949 --> 00:49:59.389
And that fascinated me.
00:49:59.470 --> 00:50:00.990
Like I saw it and I went, what?
00:50:01.230 --> 00:50:02.909
Like that, why did we do that?
00:50:03.150 --> 00:50:06.269
Well, if we pay attention to body language, we do a lot of that, right?
00:50:06.349 --> 00:50:10.510
We look at people who are confident, they carry themselves differently.
00:50:10.670 --> 00:50:13.230
So for me, I may use it in that way.
00:50:13.470 --> 00:50:31.949
I also, though, think when we think about somatic therapies, things like paced breathing and things like grounding techniques that we see a lot in DBT, they're really based in these somatic therapy theories, deliberate movement, all of these things.
00:50:32.190 --> 00:50:38.990
Even what we think of CBT like muscle tension release strategies is somatic, right?
00:50:39.070 --> 00:50:40.590
We're body, it's a body movement.
00:50:40.750 --> 00:50:48.510
So again, I don't know that we always think of these it connecting, but it is how closely related sometimes these these things are.
00:50:48.909 --> 00:50:50.829
And I'm grateful you brought up DBT.
00:50:51.070 --> 00:50:56.190
And, you know, we've talked a couple different uh times recently on the podcast about DBT.
00:50:56.269 --> 00:51:00.510
And it's still an area that it's just it's a blind spot for me, true.
00:51:00.590 --> 00:51:02.590
I I think in terms of it's fascinating.
00:51:02.670 --> 00:51:03.789
I knew it existed.
00:51:03.949 --> 00:51:10.349
It just wasn't an intervention, a treatment focus that really I leaned into.
00:51:10.429 --> 00:51:21.230
And so there's almost that uh I feel like there's that meme of parks and recreation of like it's a it's been so long, I'm almost afraid to ask about it, or I'm almost afraid to find out, and challenging that fear and exploring more of those topics.
00:51:21.389 --> 00:51:36.190
But um there's so much in the somatic piece that I I pull and it's just I don't have that level of expertise or confidence in the DBT, but certainly, you know, as you're talking about the muscle relaxation, the pace breathing, those elements of that and how that's being utilized.
00:51:36.349 --> 00:51:56.510
But when it becomes to, you know, I guess interceptive observations, I think are quite challenging when it comes to again, individuals I'm working quite a bit with where there can at times be some of those interceptive disconnects, or uh, you know, we're not always being the most intercept have that interceptive awareness when it comes to some of the executive functioning or dysfunction or the for neurodivergent individuals.
00:51:56.590 --> 00:52:01.150
But it's something it's just an area I want to kind of strengthen and pull on quite a bit more so here.
00:52:01.550 --> 00:52:10.670
Yeah, and I and I I and I think that that that's that's awesome because I think that's what we all should be doing is exploring how they how these things integrate.
00:52:10.909 --> 00:52:17.949
But I also, you know, I I think there's like around somatic therapies, I also think that there's there's some misinformation out there.
00:52:18.110 --> 00:52:29.949
And, you know, we we hear, you know, kind of these broad statements that get made, like, you know, that trauma is literally stored in the body kind of thing.
00:52:30.110 --> 00:52:34.750
And those those kind of claims really just haven't been backed up in the research.
00:52:34.909 --> 00:52:38.909
Now, that doesn't mean that there's there's not somatic symptoms.
00:52:39.070 --> 00:52:43.470
That doesn't mean that there's not an advantage to doing some of these things.
00:52:43.710 --> 00:52:48.349
But, you know, I I just saw a I guess it was a TikTok clip.
00:52:48.429 --> 00:52:56.909
I wouldn't watch it on TikTok, but it came up on a feed that I had with a person talking about that their body never lies, that you have to listen to your body.
00:52:57.070 --> 00:52:57.949
Well, you know what?
00:52:58.030 --> 00:52:59.630
Our bodies lie all the time.
00:52:59.789 --> 00:53:01.710
You know, there's they really do.
00:53:01.949 --> 00:53:08.110
Like we have I have seen people who are hungry and think that they're having an anxiety attack.
00:53:08.349 --> 00:53:10.510
Our body gave us a symptom.
00:53:10.670 --> 00:53:12.829
Our mind, I guess, maybe distorted it.
00:53:12.990 --> 00:53:15.470
So there are lies that come with that.
00:53:15.630 --> 00:53:28.349
And so I I always like when we talk about somatic therapies, I hate that they get generalized where a lot of times then we don't use them because then we'll read research that they're not effective.
00:53:28.590 --> 00:53:32.990
I I think there are advantages of it, but we just have to not over-generalize it.
00:53:33.150 --> 00:53:35.550
It's just one piece of the puzzle, right?
00:53:35.710 --> 00:53:37.550
It's just one piece that we look at.
00:53:38.429 --> 00:53:40.190
And I think that's at its core.
00:53:40.670 --> 00:53:50.990
For all of these and for all the interventions or all the um therapeutic modalities and approaches that we didn't talk about, it it's a piece of the like it's a piece, but it's not the answer for everything.
00:53:51.070 --> 00:53:54.670
And again, kind of the the the reason for this episode.
00:53:54.750 --> 00:54:08.829
And so, you know, I I think if there's a call to action, it is, you know, being uh you're theoretically sound, but but technically eclectic in that way where it's find that system that fits well for you.
00:54:08.909 --> 00:54:28.750
And I I know right CBT is that, but for others it might be psychodynamic, but not like let's not operate in a bubble because that's really where we're going to then we're gonna become over-reliant or we're gonna over-generalize, and we're then we're not gonna seek out potential interventions or treatments that really can connect and really help us address this.
00:54:28.909 --> 00:54:34.190
And so let's not be overly restrictive, but we we do need a good foundation.
00:54:34.510 --> 00:54:39.550
And so, you know, how do we we have to find that harmony, as Michael Alsey would say.
00:54:39.869 --> 00:54:40.269
That's right.
00:54:40.349 --> 00:54:42.269
It is it is absolutely a harmony.
00:54:42.349 --> 00:54:50.349
And I think that when we see someone maybe not improving, we we start really thinking about what are the questions that we need to ask.
00:54:50.510 --> 00:54:53.230
And I think that's that's how we create that harmony.
00:54:53.389 --> 00:55:02.990
It's looking maybe at their engagement, maybe our implementation, which is hard sometimes to look and go, maybe we're not doing something well.
00:55:03.309 --> 00:55:06.670
Is it the formulation, or is it just the treatment itself?
00:55:06.750 --> 00:55:08.429
And we we need to shift gears.
00:55:08.590 --> 00:55:18.190
And you know, at the end of the day, our goal is getting an outcome, getting improvement, a quality of life, and better experience for people.
00:55:18.429 --> 00:55:21.550
So being open-minded to that, I think is important.
00:55:21.869 --> 00:55:22.750
Absolutely.
00:55:23.070 --> 00:55:26.349
And you know, you at home, we hope you enjoyed this episode for today.
00:55:26.429 --> 00:55:28.510
Uh Ray and I will be back in two weeks.
00:55:28.670 --> 00:55:30.269
But until then, be well.
00:55:30.510 --> 00:55:31.550
Stay psyched.