Irrational Fears, Healthy Boundaries, and "Evidence-Based" Therapy: March Mailbag

hello and welcome to being well I'm Forest Hansen if you're new to the podcast thanks for joining us today and if you've listened before welcome back I'm joined today as usual by Dr Rick Hansen Rick is a clinical psychologist a best-selling author and he's also my dad so Dad how are you doing I'm doing well I have a little frog in my throat so I might sound a little horse uh but otherwise I'm doing really great today we're going to be answering some questions from our listeners it's always great to do this because we get really fantastic questions from people if you're interested in asking a question to be answered on the podcast you can reach us at contact at beingwell podcast.com the best way to do it is actually by signing up for our patreon that's patreon.com beingwell podcast one of the reasons that I liked the questions that we got today is because they grouped in these uh really nice and tidy ways into two different categories first we have a couple of questions having to do with working inside of the Mind including dealing with our thoughts and feelings and then the second group group of questions was more focused on our relationships of different kind with different people but particularly with family members and inside of romantic relationships and then there was just one other kind of wild card question about therapy that I thought was pretty interesting so let's get into it here's our first question I've been practicing mindfulness and the other tools you teach on the podcast and I can apply them in most situations and in general they've been really helpful but there's one situation where I just can't apply them my job is really stressful and whenever I'm corrected by my boss I get totally destabilized I'm afraid my hands Shake I think I'm incompetent and I fear that I'm going to be fired I get conceptually that it's irrational I'm competent enough to do these tasks but I'm still so afraid and stressed whenever something new comes up knowing that doesn't seem to matter how can I work with these fears in a way that is more felt than thought beautiful question and we could apply it to many situations in which on the 0 to 10 yuck scale let's say something is really just a two or a three but then on our emotional reaction scale from 0 to 10 also we get reactivated at a six or an eight or even a 10 so this is a big general question I would suggest to this person first of all to just take some time to really focus on taking in the good related to inner strengths for your need for safety and also your need for connection because those are the two needs that seem clearly challenged here you could do the practices of realizing it's basically all right right now you could build up more of an inner body memory a somatic sense of peacefulness and Tranquility you could do all these things off the playing field so that when you're on the playing field and this reactivating event occurs you would have more traits built up as inner strengths inner shock absorbers to deal with your this this threat to Safety in the sense of anxiety that arises you know we train off the field for events on the field that's full of opportunity so let's assume that a person has done some of that or is going down the road of that now when you're on the field and caboom the event happens what can you do what's interesting to me in the person's description is that they understand rationally that their body is really overreacting and that's a good place to start but that's clearly not sufficient when you are upset like this can you be aware of what's really under the surface in particular my strong hunch is there's underlying material going back in years in adulthood if not all the way back to Childhood what's that material that's getting reactivated and become more aware of it slow it down maybe simply name it to yourself um you know oh feeling sad oh feeling scared uh image of my high school football coach screaming at me when I drop the pass oh sometimes strange illogical images come up and yet they have a power and a truth to them kind of like mental poetry almost so whatever comes up try to be aware of what do you really experiencing as deeply as possible if you can't do that in the moment because you're flooded then do it afterward and then over time I would highly recommend linking do the link step in the heal process so as you get more and more aware of the underlying material that's what's not so clear here what's the underlying material then you can use linking to bring um current positive experiences that are matched in touch with that underlying material May deep maybe deep down inside is this kind of panicky fear that of annihilation catastrophe you're going to get fired it's all going to be horrible and over well knowing that knowing that what would be reassuring maybe it's you know to really have a sense of perspective there maybe you imagine other people who are with you who remind you that you're going to be okay um maybe it's the ongoing knowing in the present that you're fine you're fine you're fine whatever that is you'd be aware of both of those at the same time in the link step of the heal process that we've talked and written about a lot that so that you can gradually uproot and go all the way down to the tip of the root of this reactive pattern instability is scary to us when we're not sure we're going to land on our feet so my first question would kind of be what what's the underlying concern that is activating all of this fear content particularly related to I'm not sure what's going to happen if I were to get fired if this doesn't work out for me maybe nothing's going to work out for me am I truly a successful competent High achieving person that I think that I am you know whatever's going on for this person and also highlighting any of the uh historical material that might be present for a person because if you're getting activated in one kind of situation when you typically don't get activated by that kind of thing what matters is the situation not your not your feeling around it right you're normally fine but it's that situation that's problematic for you so to your point to D what are other situations like how has that situation showed up for you previously and that's where the real investigation is what do you think about this general question that people have all the time that I've definitely experienced in my life where you know conceptually that something is true or something is okay or you can think your way through a problem but you're just having a really hard time getting down to the feeling level like what do you think helps people with that well having had that issue a lot you know as I say I was numb from the neck down I think there's a quality of almost like listening where we are feeling down into ourselves and I I know people say I don't know how I feel well slow it down I got it you don't yet know how you feel let's kind of slow it down feelings are slower verbal thought is quick Silver Quick just like that feelings they take a while you know and we have to kind of invite them yeah yeah and just to pull out something that I I think you're kind of speaking to here Dad because this is a situation where the person knows how they feel they they're freaking out man and they also know how they think they're they're thinking all these thoughts about you know conceptually and objectively I am safe and I am okay but some kind of misalignment is happening where the thoughts aren't impacting the feelings that much and at least on a really experienced way the feelings don't seem to be impacting the thoughts that much there's this like disconnect between the two systems and I think that some of that is because of what you're saying here because the speed of the thought is faster than the feelings can kind of catch up to and vice versa um and I think a lot of the time what happens when people are like why can't my thoughts change my feelings is my first question is like well have you actually listen to those feelings yet have you let yourself experience those feelings in like a slowed down full way cuz sometimes when they actually get heard we can start to work with them more conceptually but we need to really hear them first is that part of what you're saying here yeah oh this is great that you're doing this um for some reason I'm thinking about you're inside a Corral and a bull is there and the bull starts to charge you and you can label this event till the cows come home I'm in the ranch metaphor but the bull is still charging you yeah it's much the same why would we expect being accurate in our label of the bull charging to change the bull that's charging similarly inside your being the bull is charging the reaction is fully you know happening it has a lot of momentum then there's a little part of VI that's labeling it saying irrational reactivity my boss actually loves me but that's like labeling the bull that's charging at you why would we ever expect that simply labeling it accurately would change it right so to me then the question becomes how to actually change it and a lot of it in my experience it is the truth that sets us free it's when we fully know it it's the knowing that sets us free and some of that knowing is non-verbal so if we're being reactivated by something very often it's some deep level we haven't really known the childhood decisions in the mix or the the framing of it all the the unsaid truth Underneath It All that would really free us so getting in touch with that becoming aware more of that I think is really Curative I think that it's really critical here how you're separating that kind of conceptual knowing top down from the more whatever you want to call it kind of relational emot yeah yeah yeah the the past history the whole thing of the knowing which is sort of more bottom up and also the speed that those two things are operating at and I think that just really understanding those differences can be very helpful for people here because yeah you might conceptually know something but does your body feel the same way about it does your history unpacking feel the same way about it all of that good stuff that's right I think that some of this is also relevant for our next question here so we can kind of move on to that one and uh we might backtrack to some of the things that we just said you regularly talk about having thoughts rather than being thoughts and similar techniques are taught in CBT that's cognitive behavioral therapy I've been meditating and practicing mindfulness for almost 6 years and I simply can't do this I am my thoughts and my thoughts are me I've tried all the practices visualizing thoughts like watching a movie or like leaves washing down a stream clouds passing by or whatever ever else none of it works for me could this be due to some kind of childhood trauma I also have a very hard time feeling Body Sensations other than really obvious ones like physical pain and if somebody like a therapist asks me where in my body I feel something I've just mentioned I have no idea do you have any advice or tips for me here this question really puzzled me initially and I think it's because as I have a hunch that this person is already aware of the distinction between having a thought and being the thought in that they are able to name their thoughts they know they have a thought my hunch is that the real issue is that they still believe the thought that's what they mean by being the thought they believe it but right here we have a really useful distinction so this person has already accomplished that first step of differentiating from the thought the problem is they they still they still believe it so there's a set of beliefs here maybe rooted in childhood experiences that a person still has what to do about that so I want to just name a couple things here um and I'm quite happy for this person to email us back and say thank you Dr obvious but no you did not really understand me okay fine so that's sad um one is to basically classic cognitive behavior technique or cognitive therapy technique list a thought list a belief turn it into a belief and then list three or more believable rebuttal to it and then you have to ask yourself who do you want to win do you want the old belief to win or do you want the new belief to win if you want the old belief to win then you should ask yourself deep down what's the payoff what's the function that the old belief serves what's the payoff of this belief what do I get out of it what function does it serve for me and then ask yourself if there's a better way to meet that function without paying the price of that old belief so you're starting to shift to a new way of looking in terms of your belief systems and you're helping yourself become convinced this this a key right here for us the Crux has to do with motivation do we want to get convinced and then with regard to uh trauma I mean just the question asked kind of suggests that maybe there are some very deeply held views that are even non-verbal that go all the way back and you know as a kind of point of view or perspective like the world is dangerous or I'm weak or people are unreliable getting in touch with that material and working with it that's a whole undertaking here that's a really you know significant one what I hear intuitively it's a little bit like which you which me rather do I want to identify with is it my identity that I don't know that I'm broken or bad or inap or is it my identity that I really experienced from this questioner of having a lot of Moxy being highly determined actually good at personal growth this is a person who has a lot of wonderful qualities so what's the identity right and I have a hunch that part of what's been called for here at a global level what kind of bypasses a lot of the work in the infrastructure is to actually shift the identity my first question for the questioner is is this a uh theoretical question or is this a practical question and what I mean by that is what's the value that they're trying to get from being able to increase the separation that they have from these thoughts yeah because if you're kind of in meshed with your thoughts you know I'm my thoughts my thoughts are me it's all kind of okay we're plugging along together and you're you're basically doing okay you're happy you're moving through life you've got your meditation practice that you've been doing for a long time you've engaged with some form of therapy they refer to a therapist and it's like all kind of okay then great we're we're sort of good here right but if there's something that you're trying to accomplish by doing that that's what I'm really interested in um and that's that Target that's trying to be accomplished is not like immediately apparent in the question which is kind of interesting to me in terms of what might be getting in the way with your ability you particularly feel bodily Sensations it's totally possible that some difficult experiences early on in life would impact that for a person by and large there's just a range here and there are some people who are very sensitive particularly sensitive to physical Sensations and some people who are just less sensitive and inside of that natural range you just might be on the less sensitive side of the Spectrum which again unless there is some Target that you're aiming for that is being impeded by that is not really problem in and of itself so what do you think about that Dad it's a real thing to dissociate as a result of trauma yeah and reassociating with the body can be fraught because then you start to connect sometimes with old pain so I think it's important to take your time with this and resource yourself um in various ways like deliberately internalizing repeated experiences of being connected with sensation in ways that are pleasurable and repeatedly internalizing you know the kind of bodily sense of uh strong positive emotional experiences Delight exuberance enthusiasm happiness uh lovingness I think that's good background training no I think that's a great summary of a lot of stuff here and we can probably just move on to the next question if you think that's think we're ready for that yeah good job I loved your episode on cognitive bypassing and had a question about it as a teen I would spend hours in my inner World daydreaming imagining and creating stories often because my external world was pretty difficult I enjoyed it a lot is this cognitive bypassing is all excessive cognizing bad or are there useful versions of it the real question is what's the function if we are um intellectualizing or getting into philosophical debates about something as a way to avoid something useful then that would be a bypass through cognitive means there are other bypasses like picking Corrals with people or getting stoned or hammered all right uh there are different ways to bypass something useful to experience or do some of them are cognitive so far this sounds like the function of daydreaming for this person when they were young was actually really good was necessary and I'm reminded of a kind of a haunting uh description of a psychoanalytic psychoanalytic case that I uh learned about in grad school many moons ago in which essentially the client growing up in an abusive childhood deliberately put precious parts of themselves into a kind of treasure chest and locked it away to protect them and then years later reclaimed what was in her Treasure Chest to reintegrate it into herself and I thought a lot about the ways in which sometimes we do things when we're young you know we may put on an outer mask of compliance and agreement we are burying our inner Treasures deep down inside ourselves so they won't get attacked or or poisoned there's a place place for that but then you come into adulthood and you're no longer in those environments right and then the question becomes is a person moving into the imaginal world daydreaming fantasizing spacing out as a way to bypass things here and now there's been I think a uh a well-meaning but slightly misguided movement in the last five to 10ish years in the kind of more Progressive psychology world against over cognizing of various kinds uh this is a bit of a response to kind of the classic psychoanalytic top- down very cognitive approaches there's been an attempt to incorporate the body more as part of this process I think that that is all great and uh really necessary and wonderful broadly but it's also taken us to this place where sometimes people start to think okay I'm thinking about this at all is that a problem should I just be feeling my way through this instead of thinking my way through this and that just seems obviously like an overcorrection there are plenty of great functions that cognizing has the brain is a very powerful tool broadly it is the seat of our experiences we use it to perform various functions and the question isn't like are we using the brain the question is are we using the brain well and so if you're using the brain well and you're going after a good Target and it's helping you get through life in a way that doesn't cause a lot of problems for you again we kind of go back to that question that I asked the second person like what's the problem here and if the answer is there's no problem here then like okay we can have kind of a fun time talking about this conceptually but there's no actual issue that we're trying to solve and so it sounds like you used a great tool to get through a difficult moment in time for you and that sounds all good to me all right the next one great so I loved this question I was really touched by it um so here is our fourth question I really appreciate your podcasts I'm 20 the youngest of three siblings I lost my mom at six and my father was taken to prison when I was 13 my brother is in and out of jail and my sister has struggled with addiction I do well in school I have a job I mostly like and I'm usually doing pretty stable in life but without my parents around it feels like I'm the only person responsible of taking care of everything which puts a lot of stress on me I'm exhausted from being on the roller coaster of their problems but I feel kind of guilty am I a bad person for not wanting to help them anymore given the circumstances how do I set healthy boundaries well first we can just kind of let let this land and imagine some of what that has been like this person is being pulled by the heart as I hear it to take care of their older siblings I've just known situations like this for us that's one reason I'm slowing it down U because there there's so much in it and it's easy to be glib about it yeah but obviously we don't want to do that kind of the Crux of it for me is to be able both to have a lot of love for others like your own older brother and sister let's say while also recognizing that you have your own job to do for yourself you have school to go to you have a job to work you have friends that are appropriate to develop which then leaves you and this can be helpful leaves you with an hour a week maybe it leaves you with 20 minutes a day that you can give to your brother and sister for their problems but you cannot give more than that and it might sound a little formulaic it's really not there there's something very Soulful and it's like you're surrendering to what your own life calls for your needs your schooling your work your friendships you're surrendering to the truth of that and surrendering to the fact of the limitations on which you can offer to two people you love but it's in that surrender that you can find a peace and something that's sustainable uh for yourself um and that others even if they bounce against those boundaries and don't like them can understand and expect over time that'd be part of a response and I know there's much more to it than that to be really succinct and offer some view here uh no I do not think that you are a bad person for not wanting to be on the roller coaster anymore I think that that is a rational response to challenging circumstances that you have done seemingly a phenomenal job of dealing with inside of your own life as we talk about on the podcast regularly the best way to support others is often by supporting ourselves and if you get to a place in your life where you also become destabilized based on the work that you're doing for other people you are no longer this safe secure stable Harbor for them to turn to when they really need it you yourself are now in need of a kind of support from somebody else or a broader system or whatever it is so the most important part of this process is doing what you need to do to remain that safe and secure and stable and high functioning individual that's actually the greatest service that you can offer others in some way here and to maybe be like a little bit edgy here in my experience with situations like this the best way to help people inside of the situation is often from outside of the situation because it can become a little bit of a crabs in a bucket thing where there's just so much chaos inside of the environment that everybody ends up pulling each other down into the mud of it and it's only when you get a little bit of space from that that you can actually throw a rope down from the top of the bucket and help somebody else climb out there's a great line from Elizabeth it's one of my favorite uh favorite lines from her it's boundaries are the space that I need to love you and I think that that's just like such an encapsulation of this whole thing and then we can get into some practical material here about how to do that with people particularly people who we really care about and we really love in our life um I think that that kind of matter OFA approach your dad that you laid out is a great place to start how much time and space do you actually have to perform these functions for other people and then when that's communicated to other people if it is communicated to them it becomes a practical issue it's not about how much you love them it's not about you don't really care about me anymore it's about hey look I'm I'm trying to make my way out here as a lot of people are of whatever their challenging circumstances are and this is the time that I got and you know I want to give it I'm open to giving it but that's my math and you know I'm sorry but from there I just don't have more what do you think about that dad there's something about this question that's really gotten me in a good way because you can feel the posos in it yeah totally and you can also feel that in this family system of five people wow it could be that out of the five people there's really one person who kind of has a shot at a normal range good life and wow we would just hate to see this person pulled back into the Crab Pot as it were yeah you know totally and and yet also just think about all the things that happened to the older brother and sister that were major factors in what they're dealing with themselves today and the pthos of that and the fact that sometimes it's really true that the higher functioning sibling let's say that really is significant in pulling other siblings up out of the crab poot there are also many situations where even after heroic effort from the higher functioning sibling uh the other siblings just they succumb to all the various factors that are pulling them down back into the pot so it's a lot of POS here yeah and I think it's important to not make yourself wrong for taking care of yourself I think it's important also to be realistic about how little you can do and you know being realistic about that so I just it's all in there and I find myself really really wishing this questioner well that's mostly where I am with it as well I think this is one of the more difficult things to do it's a really beautiful question maybe practically he dad to offer something there's a a concept from family systems theory that I'm sort of curious what your take on is as somebody who was working with a lot of kids and families for a long period of time where the notion is that the the healthiest member of the system often carries a lot of the uh content of the system as a whole is may be a way to put it that a lot gets put on them and uh so much so sometimes that they can even start to manifest symptomology that that's tied to that carrying of the you know pressure the trauma the burden of this unhealthy system that get then gets kind of placed onto a healthy often a child inside of it um I'm sure that you know a lot more about this idea than I do I just kind of know it from reading about it a little bit and I'm sort of wondering what your take is here I think there's a lot of truth about that it's also fed somewhat by as you know the term Survivor guilt yeah so you feel like whoa you feel guilty and it also gets to what does it mean to be high functioning which sometimes what it means is you're internally regulated so you're pushing down or you're not expressing some of your own reactions understandably to the crazy unhealthy environment you're in but then you're stuck with what you don't express and so that would be another thing here I would think about for this person who's asking the question um what might be your own undelivered Communications what might be your own underexpressed truths about what it was like growing up and what it's like for you with regard to your older brother and sister what's unsaid for you and to claim more and more of your truth about that also to get allies you're just 20 years old yeah who can you talk with that can give you counsel friends maybe older mentors maybe people who are the 10 year- old the 10 years old older the 30-year-old version of yourself today who's been through a lot of what you've been through and can help you with some perspective about it just who can you talk with who can you lean on your your parents disappeared when first when you were six and then think about what the events that led to the dad going to jail at 13 seven years later you probably didn't have a lot of great parenting you know who can you connect to now that you can lean on and and get counsel from I'm sure that you've worked with people who have come from chaotic family systems and have been looking around they've been going I just can't do this anymore I need to do some things here to establish healthy boundaries optimal distance pick your pick your language here what have you seen actually help people do that like is there process that they can go through are there some tactics that you've seen be helpful just what do you think about that part of the question I think it happens in different ways sometimes people just get so fed up they hit bottom in effect and then sometimes they'll do something that's long overdue and sometimes on the other hand they'll do things that are pretty abrupt and and ir irreparable and they look back and they regret so there's one way it happens is just yeah boom yeah it happens that's one way another way uh is to get a little space that's where sometimes this person has a very busy schedule I can imagine that you know potentially they're getting needs or messages texts calls from brother and sister they're knocking on their door whatever things can happen sometimes you just need to get a little space for a morning or an evening or a long walk by the beach just something to get your head clear so you get some perspective and step back and look at the overall truth in the aggregate it may be when you look at it that you realize that you know letting your brother sleep on your couch huh yeah you don't want that to be a permanent solution but you really could deal with it for the next few months you're right on the one on the other hand you might look at it and think man my brother in my home in my house doing drugs in my house doing deal dealing out of my house no way that's intolerable that's crazy cakes that's my childhood I'm not going to do my childhood anymore uh and so there's a Clarity based on some Detachment there depending on the particulars of the situation I think that helps um in a weird way it can this is crazy there's something called a genogram oh yeah yeah no Elizabeth did one of these yeah totally oh great it can be wild basically briefly and maybe in the show notes or patreon you can do a you know a couple pictures of them you essentially diagram your family system so you you might start out with your two biological parents if you've got that and then they're three kids in this case and then their parents their first-degree relatives their you know their brothers and sisters their cousins and then you go back a generation or two and just kind of little thumbnail description of each of the players and their background sometimes just doing that picture you know of your family system uh can be really revelatory you know you can draw connecting lines between you know different beings and you start to see patterns some sometimes and it can give you a kind of a healthy Detachment from it so that would be something also to do yeah part of that process that Elizabeth went through what they had um had her do as part of it was Mark various kinds of traumatic experiences or you know whether it was like a a poverty link or different kinds of violence that were enacted on different members of the family and so on so you're basically mapping the experiences of these people back through time and it was totally revelatory for her because she got to the end of it and like the whole thing was just it was just a map of red it it was a mess and it can help you really appreciate not in like a judgmental way but just to see what you've been through what the broader system has been through yeah and then just to be able to take a little step back from it and go like whoa all things given I am just killing it over here and that was actually really uh really helpful and really resourcing for her and also just the feeling of like seeing clearly yeah sometimes when you are that healthier member of a system you have these moments where you look around and you kind of feel like you're the crazy one you're just like am I am I going nuts over like what am I not seeing something but it turns out no you actually are the person who's seeing it all right here and so that can be very positively reinforcing for people the last thing on this yeah and then we can move on and I think it's a broad important principle is the difference between have to and want to and to know in your body what that difference is in other words for this person it would be like knowing hey I have to go to school I have to take time to study I have to have a clear head for studying I have to also I have to work I have to have time to get dressed for work I have to have time to commute I have to have time to clear my head from both work and school so I can sustain this I have to I just have to I have to and then over here is I want to I want to be a good sibling to you right I want to be helpful I want to listen to you I want to you know be emotional support for you I want to do those things but they live alongside what I just have to do and if something has to budge it's in the one to C ategory I have had a lot of bodily experiences of the difference between have to and want to while rock climbing or being in Wilderness and so I kind of just it's for me it's really binary it's really kind of straightforward like oh and I just know what I what H you know doesn't matter how I feel doesn't matter how I think doesn't matter my mood doesn't matter if I'm hungry or tired whatever boom you just got to do it you're you're totally right on here and I I love that you're closing with this because it kind of leops back to some of the stuff you were saying at the beginning about just like this very kind of clearheaded sorting of things into categories and letting yourself be guided by that a little bit inside an environment that is very chaotic and while dealing with an issue that is extremely emotional and very vulnerable and so like I mean man it's just like it's such a tug at the Heartstrings question and situation and like you're saying I just really feel for this uh for this person and so just being able to apply some of those kind of basic almost more logical principles can be really really clarifying and helpful and I love that distinction between have to and want to that you're bring to this stat because I think it just like cuts through a lot of a lot of very complicated stuff here imperative optional yeah yeah essential desirable World a difference yeah no I I I think you totally crushed it here so I want to move on I think to just one more question is what we have time for and uh dad I actually want to jump to question seven if that's okay and we can do the therapy one I want to hammer on this you want to do the therapy one okay all right I want to do the two of course do it oh man I have I'm gonna try to control myself that I don't rant yes yes yes I I do that this would be like catnip okay here we go question number five when people talk about evidence-based approaches to therapy most of the time they're referring to cognitive behavioral approaches like CBT DBT act that's acceptance and commitment therapy mbct that's mindfulness-based cognitive therapy and so on these approaches have a lot of research that backs their efficacy over say an 8-week program I've benefited from these approaches but I've also benefited from a lot of not as evidence-based approaches like longer term humanistic and existential psychology depth psychology sematic psychology or internal family systems therapy I think of you guys as pretty rational and scientific but you also talk about a lot of those not so evidence-based approaches on the show that's true so what's going on here are these approaches less good if you think they work why aren't they evidence-based wow what a question here Dad what do you think oh my God I'm my head is exploding with like I love this question and there's so much about it I'll try to stay calm and succinct I'm going to need your help here I'll do my best to to raid you in a little bit I need an auxiliary ego to control me all right first of all what is evidence the primary evidence is one person one example that's evidence on the scale of evidence we can accumulate evidence with multiple people in one study then we start accumulating evidence with multiple studies and then we start doing more and more complicated analyses of that evidence it's all evidence first of all there we might be increasing The credibility of it but to generate the binary categorical either or label evidence-based not evidence-based is enormously unscientific and ridiculous second a truly scientific attitude is that the absence of evidence is not evidence of absence we just don't know yet next point a metaphor from the great Charles sherington who coined the expression that the brain is like an enchanted Loom weaving the fabric of Consciousness he made the point that if you drop a net into the ocean made of mesh 2 in on a side you would conclude that nothing smaller than 2 in long lives in the sea so it is often the case frankly that the more superficial therapies are much easier to study because they can be procedu and manualized so that study can be very well controlled and much of what makes therapy effective is the kind of the magic between therapist and client so that even as Carl Jung puts it over time the therapy becomes successful when the client's problem becomes a problem for the therapist in other words the therapist can connect emotionally to the client's problem that's extremely difficult to turn into some kind of manual and it's also extremely difficult to to assess on a 7 point ler scale from somewhere between never to always for example so in other words the therapies that you know tend to be have the most kind of uh elaborate evidence-based for them by their very nature tend to be more procedural and kind of superficial if you will next Point much psychotherapy research uh has really tried to do these head-to-head comparison between different approaches for different things and when you step back and look at the aggregate of basically hundreds of studies that have attempted to do that you have on the whole what people call the dodo effect from the Allison Wonderland in other words everyone wins the race everyone gets a prize and it's really striking that you don't find the kind of marked differences between treatments that you might find in more of a medical setting so e so any so claims like my therapy a is evidence-based unlike therapy B is first of all usually wrong second when there is evidence about therapy a compared to therapy B usually on average they're essentially equivalent now here though if there is a statistically significant difference let's there actually is let's suppose that for condition X therapy a on average is a little better than therapy B but what does it actually mean to be on average a little better imagine two bell curves superimposed over each other the some kind of distributions the more or less the average of each of those distributions the therapy a people and the therapy B people they overlap each other mostly with a little distance between their peaks enough to get statistical significant well first of all usually the size of that difference is typically pretty darn minor in the big picture number one number two it means that for a large number of people in therapy B they got more out of the therapy than some people than a lot of people in therapy a and very often the reason why people in therapy B even if it's so-called lesser than therapy a they still got more out of treatment than many people in therapy a it was just that the average of the two distributions more or less in terms of statistics I'm simplifying uh gave a little bit of a nod to therapy a and a lot of the reason for that has to do with individual differences that are not captured in the study which is what really matters what really matters is not the type of therapy but the uh quality of the therapist and the motivation of the client those are the two variables that show up again and again and again yeah so when people say therapy a is better than therapy B I think of that's a little bit like saying that a trombone is better than a violin these are two instruments different tools what really matters is the person playing them which is more likely to make beautiful music a violin or a trombone it's the person playing them it's the musician who makes the music and that's then takes us into a lot of research that gets that therapist characteristics which find again and again it's not about education it's not even about often years of experience uh I'd rather do therapy myself I'd rather receive it from a talented beginner than you know a not talented ex you know person who's been doing it for 15 years and uh it also has to do with the ways in which the therapist is getting repeated fairly rapid cycle feedback from the client that's the key variable so we have the the variables that really matter are not the ones that people Yap about they have to do with the level of functioning of the therapist the motivation of the client and the rapid cycle time of feedback which then tends to foster a strong relationship which is kind of a proxy for these other factors and which in turn tends to be you know uh associated in a summary kind of way uh with the largest effect sizes coming out of therapy well I think you nailed it there dad there's really very little that I would add to it functionally in terms of what you're saying I guess the only little bit of a a turn I would put on one tiny aspect of it has to do with just reading a lot of studies uh over time for prep for these episodes and stuff there are some therapies that have been shown to be incrementally more effective than other therapies for particular families of problems a lot of this has to do with the history of that therapy for EXA for example DBT dialectical behavioral therapy was initially designed for working with certain populations of people and uh still these days is a bit more effective when it comes to certain families of issues kind of similarly cognitive behavioral therapy has been shown to be super effective for dealing with particular kinds of problems that people have so if you're trying to deal with one of those specific issues and you're contemplating an 8-week course of CBT or a kind of unbounded depth psychology run and you're making a a sort of cold but very rational and uh maybe even economically driven calculation about when you want to see results and what your budget is then yeah it could be totally rational for you to select one form of therapy over the other but by and large it's exactly what Rick said you know it's about the quality of the clinician and the relationship between the clinician and the client and the exact way that they're getting from point A to point B is really more about what feels good for you for you as a person you're going to have way more individual variation that huge population of people and so it's about what feels good to you not what feels good to that population of 20,000 people which we're then smashing into a chimera and saying that's the average person right you're not the average person so those returns are of value but they are not the be all and all wonderfully said and uh reflecting on this to go back to the analogy between the instrument and the musician playing the instrument right trombone or violin on the one hand I've known people whose complaint about longer term approaches that are more open-ended humanistic existential depth psychology psychoanalysis these more open-ended approaches I've known some people who would report that they just felt like they were talking about interesting things but they weren't getting anywhere they were wandering in the wilderness what was the point yeah I've known people who have done these more time bound proceded approaches particularly ones that are more cognitive let's say or behavioral variations and uh they didn't feel deeply listened to We're just trying to stay on a schedule here I feel like you're giving me homework not like you're actually paying attention to what I'm saying yeah you're not listening to my soul I I I want to feel Hur that's the most important thing so the the thing is in either one of those instruments a different kind of musician could have played the instrument better in ways that were connecting with the client that really gave them a sense of being heard uh and that we're directed this is my bias uh that are directed at the specific changes that you're trying to accomplish Inside the Mind of the person and as a client because this person's asking as a client wow therapy matters your life matters the time investment in doing it matters cost matters you ought to be getting results so you ought to have a therapist who's results oriented now maybe the result is a space in which we can unpack what's going on without trying to change anything uh in a context in which you feel deeply listened to that's a key result right beyond that what are we working on Doc you know is somebody we should do an episode on questions you ought to your therapist ought to be able to answer yeah no I would I would love to do another we did a couple of years ago we did two episodes on basically like how to find a good therapist or how to start approaching the process of therapy how to get the most out of it um but I think we should totally revisit that maybe with some of this kind of built into it as one final thing here there are essentially two reasons that something might not be considered evidence-based the first is that it just doesn't work and I do want to name that for example there's something called the great prayer study we know that intercessory prayer praying on praying on other people's behalf does not help them recover physically from ailments because we can study that there was a phenomenal study ran for about eight years involved 1200 participants and uh there's a line in that study that is my single this is the nerdiest thing I've ever said it's my single favorite line I have ever read in a study okay here's the line intercessor prayer itself had no effect on complication free recovery from cabg this particular kind of heart procedure but certainty of receiving intercessory prayer was associated with a higher incidence of complications so people actually had a harder time recovering theoretically in this sample when they knew somebody else was praying on their behalf the instance of complications during recovery actually went up that's probably just sample noise but the fact that it's in there is hilarious okay so we do know that there are some things that just like aren't that effective um that's one reason the second reason it's really hard to study depth psychology is really hard to study how are you going to get a cluster of like any reasonable sample size of people together to work with the same clinician over a long period of time who have a comparable clinical relationship with them like it's just not really practical so some of the considerations here about evidence-based versus not evidence-based are not actually about whether or not the the the instrument has a certain kind of return for you it's based on whether or not we can actually study it effectively and so that's a huge part of this question as well if I were just to finish one additional factor that I think is really Central it's related to the motivation of the client it's the process of taking in the good it's the process of helping the learning to land it's the process also we talked about earlier helping the ideas become experiences that process staying focused on that process where you're you know you're really engaging the mind of the client and the client is really helping themselves that's why gendlin's work on focusing you know I'm a big fan of because it's squarely focused focused on this particular uh aspect here that's where change happens it's like helping change happen where it happens inside so I would say say yeah level of functioning of therapist motivation of client rapid feedback and focusing on growing the good that lasts inside the person uh I think that was great we've run a little bit long during this episode I do have one more question I wanted to get through so here's what we're going to do for this one Dad this is like again just right in your wheelhouse I'm going to ask you the question you're going to give whatever bullet points you want to give and I'm going to let it kind of stand on its own because I'm I'm sure you're going to pretty much cover this uh without any assist from me here so here's the question I have three young children and I've had relationship difficulties with my husband for nearly our whole 10year marriage we get along okay but in Conflict Things become very tense and escalate very quickly I've played a role in this and I've tried to work on my anger reactivity and compassion over the past year but I think there's just too much trauma or maybe history here to really feel emotionally safe again so I'm wondering first have you seen cases like this where one partner is checked out like I kind of am although I wish I were not and things can still heal and improve second do you think divorce will harm the children more or will stay together unhappily and then third any additional advice on how to approach when a partner is being sarcastic shaming or yelling at the kids this is often the trigger of our conflicts because I don't like his tone with our kids thank you so much this is in my wheelhouse and and these people have walked to my door I want to work backwards on the questions so the last question I'll do first just advice about what to do when our parenting partner is acting in ways that we think are inappropriate or on the kids and uh with regard to that I think it's really important to sort out is your partner really acting inappropriately or are they just being a normal range parent uh in ways that um you know are just different from your own or could it be that they're being a normal range parent but you're really concerned about the impact on one or more of your kids because it's just not a good fit so you kind of clarify for yourself how significant is this occasionally it helps to take a look at a parenting book or get some kind of neutral thirdparty perspective on really how bad is this and then you're in the realm of trying to essentially make agreements with your partner so that you're both both parenting from the same page obviously in this case making that kind of agreement is going to be really challenging but at least that's what you're trying to do and you're also really weighing how much do I want to escalate around this where's the line where I actually say to my partner uh the next time you start down that road I'm going to call CPS Child Protective Services and I'm going to get a consultation right on the spot about this or I'm going to call the police that this is over the top I really am going to step in here you know these are options that are available to you you're it's the nuclear option but you have to decide for yourself where these lines are as much as you can research shows that uh arguing with your partner about the kids in front of the kids is problematic which goes to essentially research on conflict between parents what's interesting is that kids seem to be okay in Fairly High parental conflict situations as long as three conditions are met it roughly stays in bounds you know throwing televisions through Windows that's not good so conflict kind of stays in bounds maybe voices rise but you're not swearing at each other it's not vicious one two the conflict is not about the kids and three the conflict is resolved so the kids see their parents making up they see their parents being nice with each other they see their parents being able to talk with each other in a rational way if you're trying to intervene with your partner about how they're parenting in front of the kids and your partner loses it then you need to find ways obviously to talk with them you know off stage as best you can that's my first response second do I think divorce will harm the children more it's huge question I summarize it this way I think almost every child suffers the divorce of their parent and research shows that um a significant fraction are injured by the divorce so I'm distinguishing between unhappiness the hassle factor of shlepping your stuff from Dad's house to Mom's house and back again the weirdness of holidays the awkwardness the tension yeah you're suffering as a kid but are you really damaged by it are you injured by it kids who are injured by it it tends to occur if one or more conditions are met first is there a substantial change in their standard of living so first thing don't let the kids standard of living drop second kids get harmed after divorce when one of their one or both of their parents starts having significant mental health issues like depression or substance abuse issues so maintain the standard of living second maintain the mental health more or less parents are stressed or unhappy but not mental health issues and then um third uh keep both parents involved as best you can then you're into the question assuming you do that of asking yourself you know what are your rights for happiness and what are your child's rights for happiness what are the vulnerabilities of the children what can you put up with for another few years for example and you weigh you know your duty to your children who at a minimum will suffer a divorce on the other hand they might suffer less being out of the field of ongoing chronic conflict and I've known young people who basically you know wish their parents had gotten a divorce sooner because when they finally did it was peaceful on the other hand if you ask someone you know when did your problem start in your youth they would say Well when my parents divorced yeah totally that's when it All Began that was when the unraveling occurred so you can balance side finally I hope I'm not going over long here uh the first question which is now the last question uh what do you do in cases like this where one partner is checked out like I kind of am although I wish I was not and things can still heal uh if the ongoing sources of the checking out if that continues I don't see how a repair can occur and here's a key point it's really important to do your part if you are a factor in the in the extreme Fighting do everything you can to control your part so you can start to see what's left when you take your part out of the equation that's when you really know what you're dealing with and then see once you take your part out what's the learning curve of your partner what's their rate of change over time and is it fast enough to be good enough even then if they made those changes do you just want to turn the corner do you just want to turn the page and if you do Turn the Page uh for many people for most people divorce will be the single largest financial transaction of their life because so much is in the mix so if you're going to turn the page Turn the Page very skillfully get your own legal advice so that you can understand the steps that are ahead of you the pros and cons of different options different approaches you can get guidance early about not doing things that have could have irrevocable harm to your to your custodial rights or financial outcomes in a divorce you know get good legal advice be prepared and then think ahead and realize that if you do step into a divorce frame for most people they do not maintain their sense of love and connection with their partner it's War it's a adversarial context for many many people and do not kid yourself about what your partner especially an explosive partner might be prepared to do if you step into that frame so if you're going to step into that frame do so with this with a with preparation not impulsively and really building up your resources to protect your children first and foremost right and and protect yourself well I think that was a very thorough exploration of some of the issues that people have here and some of the stuff that's on the table it's an incredibly complicated question you might get really good Council and the council might still end up being wrong and that's part of the complexity of this question is that it's just so hard to say uh but I think that that was some really good advice to add so it's a great place to start and we just got so many great questions this week so uh we ended up running a little bit longer on this one I like the longer episodes I feel like it gives us the space to really dive into this stuff and yeah I just really want to close by thanking everybody for sending in such great questions like it's so awesome that we get to do this I love answering them I love talking with Rick about them and uh yeah I just really you know appreciate that we've got a group of listeners that cares this much about it so thanks again for doing that I had a great time answering questions from our listeners with Rick today we covered a number of different questions I'm going to do my best here at the end to summarize them and very quickly summarize some of the things that we talked about first we started with a question that was from somebody who is having a hard time applying the various tools that we often teach on the podcast things like self-regulation skills mindfulness practices how to deal with different kinds of difficult emotions to a particular situation where they just weren't able to manage the fears that were rising up inside of them and as Rick and I both focused on the big question there is why that situation what is it about that situation that is causing you to feel the ways that you feel CU if you can regulate yourself 99% of the time but you can't regulate yourself 1% of the time it's not that you can't regulate yourself it's that there's something about that situation that is making that process particularly difficult for you and then the second part of the question got to the difference between conceptually understanding something like conceptually understanding that I am actually okay in the situation and I can apply all these tools that I've learned and I'm more than capable of dealing with this work project functionally versus really feeling that way inside of oursel and one of the points that Rick made that's going to stick with me is the notion that Body Sensations are way slower than our thoughts are so a lot of the time when we say okay I can think this I can think this I can think this but I just can't feel it there are two questions first have you slowed down enough to actually feel the feeling have you done what you can to let the tempo of the thought and the tempo of the feeling line up with each other in your body and then the second question I would ask is have you actually felt the feeling there's a really wonderful practice in mindfulness-based cognitive therapy it's incredibly simple it's just saying I feel blank whatever you're feeling I feel sad I feel angry I feel afraid and that's okay and in that very basic practice of acceptance what most people find is the feeling itself really changes the second question asked about the distinction between having thoughts and being thoughts and uh this person said basically I am my thoughts I can't get that kind of Separation with them what can I do to get more separation and Rick went wait it actually really sounds like you understand that you aren't your thoughts but what's happening here is that you're still identified with those thoughts you understand that you're not them but you believe them anyways and then if you want to a person can go go through a deliberate process of learning how to disidentify from various beliefs get even more separation between themselves and the thoughts that they're having you know whatever is useful for them but what I really wanted to highlight with this question was what are you trying to get out of this is this sort of a theoretical process where you want to understand how to see your thoughts as being separate from yourself a little bit more or is it a practical process where you really trying to solve a problem because if there's not a real problem that you're trying to solve here you're just doing something cuz you feel like you're supposed to do it because people tell you that you know this is a useful CBT practice and other people can do this and you start going wait does that make me unhealthy if I can't do this why can't I do this is this the result of childhood trauma you know like you know whatever Rabbit Hole you find yourself going down there a really important question to ask is why do I want to do this along similar lines the third question was about cognitive bypassing and whether really all forms of excessive cognizing are problematic particularly they were asking about a form of daydreaming that they did when they were younger to protect themselves from the difficult emotions and challenging situations that they were experiencing and we both said no if this was protective if it served you great go ahead do some daydreaming the question is what's the function that this behavior is serving and is it serving a useful function or a less useful function then we got this really very touching question from somebody who was coming from very challenging circumstances and was feeling weighed down by the responsibilities the obligations uh the ways in which less functional members of the family system had really turned to them and were starting to rely on them for support and they were going wow I really don't want to do this anymore but I also feel this kind of heart obligation very understandably to my family and I I do want to support them on some level and they were asking first am I a bad person for feeling this way and we both said no your obligation here is to support yourself first at least in some part so that you can go and support other people and then second there was more of a practical question about creating healthy boundaries and I really like how Rick separated out essential and not essential necessary and optional and going through this very deliberate process of taking a step back and asking yourself hey how much time and space do I actually have here in the course of a busy life where I'm going to school I'm maintaining my own friendships I'm doing the things that I care about I'm uh doing the things that keep me that stable functional person that other people in the system can rely on after I've done all of that how much space do I really truly have then we talked about the difference between evidence-based and not so evidence-based approaches to therapy why evidence-based therapies are evidence-based and whether or not it's problematic that on the podcast with some regularity we talk about families of therapy that tend to fall into the not as evidence-based cluster Rick gave a great answer here uh it would be very difficult to kind of paraphrase it at the end but essentially a big question is what's evidence and how much evidence do you need in order for something to become evidence-based there's a lot of General evidence that psychodynamic approaches to therapy humanistic approaches to therapy work for people in part because there are a lot of happy clients so if there are a lot of happy clients but that doesn't really count as evidence what are we referring to as evidence and most of the time when people say that they're talking about a 8we program a regimented study that's done inside of a very medical model that's transferable out to wide populations of people and to be clear we are medical model people by and large on the show I really care about that stuff I really care that things have an Evidence basis I really care that we are not talking out of both sides of our mouths I really care that research supports at least on some level the things that we talk about on the show but many things are not evidence-based not because they don't work but because they're really really hard to study and it's important to distinguish between those two categories does it work can it be studied the final question was from somebody who is contemplating divorce and they asked a three-part question first have you seen situations where one partner was checked out where things really did get better then second do you think that divorce harms children more than staying together and third any additional advice on handling conflict with your partner Rick gave a very thorough answer there to quickly summarize a couple pieces of it rick started by saying that it's very uncommon for things to improve if the interactions don't improve if you're just kind of going around the same bushes with your partner over and over again and you don't like it things don't get better very often but if you're able to go through a process of mutual learning where you take the problematic behaviors that you have and most people have problematic behaviors I've certainly got problematic behaviors if you can start to take those off the table and create some more space for growth and change and development then great maybe that opens up a little bit of space for your spouse to do the same and if you look at them and go you know there's a good trajectory here they really are learning then great you know there could be enough growth for you even then maybe there's still too much water under the bridge but it could be a possibility but if nothing changing then yeah things won't improve second it is very hard to say whether or not divorce will harm your kids more or less than staying together it's almost entirely situational uh there could be some advantages to keeping things functional for a couple more years to get the kids to a place in their development these were very young kids that we were talking about here on the other hand if the marriage creates a chaotic or unsafe environment it's totally possible that getting out of it is actually really beneficial for them I hope you enjoyed en today's episode I always really like these uh in part because we get fantastic questions from people if you'd like to send us a question you can reach us at contact at beingwell podcast.com you can follow us on patreon that's patreon.com beingwell podcast or you can find me on substack uh if you search for Forest Hansen on substack docomo [Music]

Channel: Forrest Hanson

Views: 9,107

Keywords: Mental Health, Personal Growth, Self-Help, Psychology, Forrest, Forrest Hanson, Being Well, Being Well Podcast, Rick Hanson, Resilient, Self-Care, Anxiety, Psychology Facts, Self-Development

Id: zf7ILqu0rY4

Length: 74min 34sec (4474 seconds)

Published: Mon Mar 25 2024