Episode 145 - Patreon Selects: Book Review - All Therapy Books

All therapy books have an oddly similar message: *This* form of therapy is the one that truly matters, and *this* science/philosophy/whatever is the key to understanding how human psychology actually works. These narratives can’t all be true, so are they all simply bullshit instead? We read through Scott Alexander’s legendary blog post, Book Review: All Therapy Books, and discuss whether therapy gurus really believe the answers they are selling.

Introduction: 0:00 – 10:36

Part One: 10:36 – 1:29:35

Part Two: 1:29:35 – 1:31:55

Show Notes:

• ‘The Body Keeps the Score’ offers uncertain science in the name of self-help. It’s not alone.

• Book Review: All Therapy Books 

• Astral Codex Ten 

• Slate Star Codex 

• An Investigation of Self-Assessment Bias in Mental Health Providers 

• Transcript

  Carrie Wiita [00:00:00]:

  Welcome to Very Bad Therapy, a closer look at what goes wrong in the counseling room and how it could go better as told by the clients who survived. From Los Angeles, I'm Caroline Wiita.

  Ben Fineman [00:00:11]:

  And I'm Ben Fineman legally encouraged to say that this podcast does not constitute therapeutic advice.

  Carrie Wiita [00:00:16]:

  But it will get interesting.

  Ben Fineman [00:00:18]:

  Let's get started. Alright, Carrie. So So my audio sounds pretty good right now, doesn't

  Carrie Wiita [00:00:29]:

  it? It does. It sounds really good.

  Ben Fineman [00:00:32]:

  And and this has come after us recording The intro to this episode and then the listener mail at the end, with you, I guess, compassionately Not wanting to tell me that my audio sounded strange until after we finished recording?

  Carrie Wiita [00:00:47]:

  I I didn't realize it until, like, the very end, And I deeply regret saying

  Ben Fineman [00:00:53]:

  anything. So we're just gonna play the intro and the listener mail because what was your what was your, line that you just said, Carrie, that you'd rather

  Carrie Wiita [00:01:01]:

  I said, I am not recording it again. We're not sacrificing the magic of a live performance for Audio quality.

  Ben Fineman [00:01:09]:

  Is this your your subtle way of saying that if I am trying to pretend to recreate our conversation, it'll just be An unmitigated disaster, and you'd rather sacrifice the audio quality for the the content quality?

  Carrie Wiita [00:01:22]:

  I I think that I think neither of us can capture the lightning In a bottle. That was what we just

  Ben Fineman [00:01:29]:

  recorded. Oh, yeah. So is it better than if we just awkwardly So what we just recorded, like, right after these words, or do we replay the the little 25 second intro right now?

  Carrie Wiita [00:01:41]:

  Oh god. That's

  Ben Fineman [00:01:42]:

  Or that little, like, mid segment jingle. What's the best

  Carrie Wiita [00:01:45]:

  way to transfer? No. Do that. Put something in between because then it maybe won't be so noticeable, The difference in your audio quality.

  Ben Fineman [00:01:53]:

  We are a tightly run ship here,

  Carrie Wiita [00:01:54]:

  aren't we?

  Ben Fineman [00:02:03]:

  Harry, I have a I think this is a really great article, At least from my perspective from The Washington Post, this is from, early August of of this year, 2023. And before I tell you what it's about and read the title of the article and few key quotes. I'm curious to get your perspective on just the overall vibe you feel like of the feedback that we've gotten From our recent episodes on things like trauma EMDR and how people have responded to us kinda looking under the hood At the research that supports these themes of trauma informed care.

  Carrie Wiita [00:02:37]:

  You know, I think as we anticipated, it has been The whole spectrum from folks being like, oh my god. Thank you. I have also been confused, or I have been not wanting to take that EMDR training, and now I'm not gonna. All the way up to, You guys are idiots, and you don't know what you're talking about. And you should shut the fuck up and never say the word trauma ever again because you're gonna cause harm. So, and everything in between, which appreciate all the feedback.

  Ben Fineman [00:03:10]:

  I think my favorite my favorite aspect to those critical emails is when it's The 2 of you don't have enough experience to be saying negative things about people like Bessel van der Kolk or about Our field stands on treating trauma. Yes. When much of what we did in those episodes was cite people

  Carrie Wiita [00:03:31]:

  Other people.

  Ben Fineman [00:03:31]:

  Not Putting out brand new material that you and I have created. Yeah. So that's why I was a big fan of this article, and the title this is from The Washington Post. The title is, The body keeps the score, offers uncertain science in the name of self help. It's not alone.

  Carrie Wiita [00:03:49]:

  See? It's not just us, And we're not being, like, snot nosed upstart brats.

  Ben Fineman [00:03:55]:

  Well, maybe.

  Carrie Wiita [00:03:56]:

  Just saying the truth. Okay.

  Ben Fineman [00:03:57]:

  Those 2 things aren't mutually exclusive.

  Carrie Wiita [00:03:59]:

  That's true. Good points.

  Ben Fineman [00:04:01]:

  And this article is by Kristin Martin. And I wanna read, a key quote here that I think sums up what this article is trying to present. And I think it reflects a lot of what you and I have been kinda touching on in some of these recent episodes. Okay. Neuroscientific Self help books scratch the same itch as labeling everything a trauma response, self diagnosing ADHD, and treating mental health diagnosis like a giant BuzzFeed quiz. They superimposed order on the messiness of emotions telling us that looking inside the brain can explain why we feel so out of control. With neat answers come neat solutions as though we can life hack some of the hardest parts of being a person, grieving our loved ones, Grappling with the long effects of trauma. But there's no remedy for the human condition, and implying that it's all in our heads make our pain seem like a glitch Instead of a feature.

  Carrie Wiita [00:04:52]:

  Oh my god. That's so good. You know what that makes me think of? Actually, it's so funny, because something that Brian, my my fiancee, has said a couple times, you know, just related to, like, Like, self help kind of stuff. Like, you know, we're talking about things that we wanna do or get better at or whatever. He'll often use the phrase, I wanna hack myself, And I'm always like, what? Like, what is that even but, apparently, like, this is and once he started saying it, then I started becoming aware of it like in pop literature. But this is absolutely a way that I think a lot of people think about, like, psychology or or their their, So, yeah, self help. Like, when they wanna, like, improve or get better or something, that's the phrase. It's like, I'm gonna hack myself.

  Carrie Wiita [00:05:38]:

  And it that's such a great connection That this whole, you know, trauma informed, trauma treatment, the narratives around that Have something to do or connected somehow to this idea that you can, in fact, hack yourself.

  Ben Fineman [00:05:55]:

  Yeah. Or or fix or even explain with Some level of certainty, and I think that's what these books offer more than anything else. And this gets to the Patreon episode of Rabouts of Re Air That the books in our field so often ease our anxieties, whether you're a client or a therapist, because they give some kind of certainty around why things are the way they are and do about it. And in reality, it just is never and can never be that simple. And I think what feels so striking to me is that I don't know if you can go back in the history of our field, say the last 100 years, and find any study, any book, Anything that was once considered to be groundbreaking and, quote, unquote, true from that era, Maybe even 90, 80, 70, 60, 50 years ago, how far back do you have to go before every single thing that was published has at least been Dated, modified, disproven, etcetera. What makes our knowledge now any different than the knowledge we had 50 years ago in that There's any reason to believe it's not going to be disproven or, you know, evolve in some helpful useful way within decades, It's not yours.

  Carrie Wiita [00:07:07]:

  You're so right. The reality is that, like, you know, all of these things that that come out, the new theories, the new approaches, You know, I and we and and you and I were never saying these are bad. I mean, like, the rebirthing therapy where they put the girl in the bag and then beat her to death or suffocated. I mean, like, that was bad, objectively bad. Right? But, like, that's not what we're saying EMDR is or, you know, somatic experiencing or whatever. We're just saying, like, you know, it heads up that they have hypotheses about how they work, but the actual science that we have has not entirely caught up. And, also, you know, there's a lot of, like, buzz about this being the way to treat trauma when the research is actually showing, like, bunch of ways to kind of kind of come out that problem. And something that it reminded me of that I I realized that we didn't even touch on in that episode, on trauma informed care, Ben, was how exactly similar the situation, with trauma stuff is to, when, antidepressants came out, the neurotransmitter hypothesis of antidepressant The present medication.

  Carrie Wiita [00:08:20]:

  You know how, like, when when they came out in, like, the eighties nineties, the pharmaceutical companies were all like, well, these work, and here's how we think they work because you have, like, an imbalance of neurotransmitters. You have, like, a you don't have enough. You don't your body doesn't naturally make enough, so You take the Prozac, and that, like, fixes the problem. Right? And it's like it's like a diabetic. You wouldn't tell a diabetic not to take their insulin. And And so we all, like, bought into this and believed this idea of the neurotransmitter hypothesis. And then, like, you know, in the past few years, we've realized I I think our field the the the medical community knew this for a long time, but, like, our field kind of came to the realization that, wait a minute. That wasn't entirely true.

  Carrie Wiita [00:09:00]:

  That was a myth. That was a story. That was a hypothesis that they came up with, and they told us that this is how it works. But turns out, that's not at all how it worked, And we have found that that is in fact not true. Every test they've done to try to detect levels of neurotransmitters has nothing no connection to depression whatsoever. And I'm sorry, but I know quite a lot of therapists who are, like, up in arms and pissed about that and then, like, decide because of that, Or we should not use any psychiatric medication. Therefore, we shouldn't be trying to treat mental illness with pills, blah blah blah. And yet and yet you say the exact same thing about theories of how, quote, unquote, trauma is stored in the body.

  Carrie Wiita [00:09:41]:

  And And you say, no. No. It's like a story that describes a hypothesis, and it turns out there's no evidence yet. And in fact, when you try to test it, you can't test it. There's no evidence for this. Then the same therapists who are like, throw out psychiatry, are like, you should not be talking about what you don't know anything about. It's very interesting to me.

  Ben Fineman [00:10:04]:

  Well, speaking of very bold claims, That I think more than anything are about just finding certainty in an uncertain world. Yeah. This was a fun Patreon episode that we put out a while back. Should we get into it? Should we re air it?

  Carrie Wiita [00:10:20]:

  This is one of the greatest things you have ever sent me. Now not this episode, the the the thing that we talk about in the episode is one of the greatest greatest pieces of artwork You have ever introduced me to, and I will be endlessly grateful to you for doing that.

  Ben Fineman [00:10:41]:

  Alright, Carrie. I think this this Patreon episode is long overdue, and we didn't think to do this until recently. But I can't wait to have this conversation with you.

  Carrie Wiita [00:10:49]:

  I know. We bring up you bring up this article fair like, fairly often on the I mean, relatively often on the show. And I'm so excited that, like, if anyone hasn't, like, gone and looked it up or clicked the link and has had it in the back of their mind, I should read that. We're gonna bring it to you now.

  Ben Fineman [00:11:08]:

  Yeah. I don't know if we've ever done an episode like this where we go through an article or a blog post Kinda select certain parts to read or even the whole thing and then talk about it as we go. One of my favorite podcast does this a lot, and I enjoy it. So I figured, Why not give it a try? But, also, I just need to talk about this article because it might be my favorite thing that's ever been written about therapy.

  Carrie Wiita [00:11:31]:

  Should we share what what it is, where it's from, how you came across

  Ben Fineman [00:11:35]:

  it? Yeah. So the the title of the blog post, it's a blog post. It's called book review, all therapy books. And this was written by Scott Alexander in November of 2019. So, Carrie, you and I would've Already met. And I don't know if I had already started reading his blog. At the time, it was called Slight Star Codex, very popular blog. Now he is on Substack Under the the blog name AstralCodex 10, and we'll put links to all that.

  Ben Fineman [00:12:01]:

  But he's a writer that I really like, and he's a psychiatrist. So a lot of what he writes about is mental health related, and I don't wanna say he's cynical. I think he's very honest In his review of things and how he looks at things, I'm very curious without without letting his biases get in the way, I think, as much as any human can. He's very honest about trying to take As objective a look as possible about mental health related things. And he, like you and I, have some, I think, Justified cynicism about our field, specifically how people talk about and write about modalities when they are trying to sell them to the general public and to therapists. So I read this at some point. I imagine I sent it to you immediately, and I've been recommending it to people ever

  Carrie Wiita [00:12:47]:

  since. Yes. And I feel like I it it kind of captures the sense of betrayal, I think, that we all felt, when you realized that the certitude conveyed in a lot of the, you know, media or or, in this case, books, in this field is maybe a little overconfident. And, you know, I I think that I I personally before getting into this field, When I would read, like, you know, because I didn't read a lot of, like, mental health books, say, or, like, self help books before I got into this field. I think that my reading of, like, mental health things largely came by way of magazine articles or newspaper articles, prep blog posts, something. But I I didn't think twice about the certainty of things like, you know, trauma comes from blah blah blah very of the day. You know? I was like, oh, that's neat. I didn't know that.

  Carrie Wiita [00:13:47]:

  Yeah. And now I went

  Ben Fineman [00:13:49]:

  over there. Time you read a book like this, A therapy book. You go, holy shit. So this is what this is the truth. Right. And then you read another book, and you're like, oh, well, maybe there's another truth. And then you read a few more, and you realize they're all telling you that their way is right and that all other ways and we'll get into the article. I there's something he writes.

  Ben Fineman [00:14:10]:

  The the only reason other therapies have worked to date is that they accidentally were doing our therapy. At some point, you read enough of these books, and you go, wait a minute. They can't all be true because they're mutually exclusive in how they describe the correct answer. And so he has such a a wonderful, like, Satirical voice describing this. And I think we should just read the article and talk about it as we go because it is maybe my favorite thing on the whole Internet.

  Carrie Wiita [00:14:33]:

  I think we should, but I have 1 question for you before we dive in. What was the therapy book that you read that made you that you think of most often when you read this article.

  Ben Fineman [00:14:50]:

  Well, see, I know you know what I'm gonna say.

  Carrie Wiita [00:14:53]:

  I don't, actually. I don't. I don't know which one you're gonna say. I just can't wait to hear.

  Ben Fineman [00:14:57]:

  It might be recency bias Because we were just talking about EMDR on this podcast. Right. Or because EMDR seems so much more explicit about there. This is the actual way To treat demi trauma specifically, but in general. Mhmm. But I don't know if that was the 1st book I read where I started going, wait a minute. This can't be right, then these other books are also right because they're saying things that contradict each other. So I don't have a, like, a single book, but I've read dozens of these kinds of books, and at some point, I stopped.

  Ben Fineman [00:15:25]:

  I just, like, stopped reading these kinds of books because I realized they could be 15 page pamphlets and everything else is filler.

  Carrie Wiita [00:15:32]:

  Were you reading these books because they were assigned, or were you reading them because you wanted to learn the method? You were searching for the truth. Like, why were you reading all these books?

  Ben Fineman [00:15:41]:

  Both. And I think that maybe that's that's a good thing that I was reading some because I was genuinely interested in the approach, and others I had to read because I I was able to see the same book template whether it was something I was interested in or not. So it wasn't just, oh, well, I'm being assigned this book on DBT or ACT in my class, like mindfulness based cognitive therapy. And so I can I can be a bit skeptical because this wasn't something I was that excited about? There there were books I was really excited about, and I'd be like, wait a minute. This sounds great, but in a vacuum, it sounds great compared to the other dozen books. This feels weird.

  Carrie Wiita [00:16:17]:

  Yeah. Yeah. Well, I'm excited. I I wanna share this with everybody. I can't wait.

  Ben Fineman [00:16:22]:

  Will you be, given your acting background, will you be the dramatic voice reading through, parts of this Blog post, and then we can have our fun talking about it.

  Carrie Wiita [00:16:33]:

  I love it. I can't wait. This is and now I give you the dramatic reading of Book review, all therapy books. All therapy books start with a claim that their form of therapy will change everything. Previous forms of therapy have required years or even decades to produce ambiguous results. Our form of therapy can produce total transformation in 5 to 10 sessions. Previous forms of therapy have only helped ameliorate the stress of symptoms. Our form of therapy destroys symptoms at the root.

  Ben Fineman [00:17:07]:

  So I wanna I I wanna talk about this opening paragraph because I was thinking to myself, like, who are the biggest offenders?

  Carrie Wiita [00:17:14]:

  Mhmm.

  Ben Fineman [00:17:16]:

  And the more I thought about it, the more I realized I think every single therapy book I've ever read is like this, Where they are saying they have the right approach, and the other approaches just haven't been as effective. And I'm curious if that's been your vibe as well Or if you feel like there are some books you read or some modalities that when you read about it, they seem like bigger offenders in terms of Talking about their way as the

  Carrie Wiita [00:17:41]:

  way. I'll be honest. I haven't read that many therapy books that, like, our the book whole book is about the specific thing. I am more of a read articles or read textbooks kind of person, But it doesn't it almost doesn't matter what format it is. It because when you once you start talking about it, you have to fall into the language of This is how it works. Otherwise, you're starting every sentence with people who believe in cognitive behavioral therapy believe that. Interesting. You know? So they have to I mean, like, especially with a book.

  Carrie Wiita [00:18:17]:

  Right? My brother, psychiatrist Patrick Weta, Had mentioned he he told me pointed something out to me at one point that blew my mind because he was I was crowing to him about some psychotherapy Conclusion, and he's like, I don't believe that. And I was like, it's in a published book. And he was like, published books aren't peer reviewed. And I was like, oh god. That's true.

  Ben Fineman [00:18:43]:

  Even the peer reviewed stuff, you

  Carrie Wiita [00:18:45]:

  I know. Kinda look at. Yeah.

  Ben Fineman [00:18:47]:

  Right.

  Carrie Wiita [00:18:47]:

  But but, like, specifically, books when you're thinking about by the time it's made it to its own book. Right? Mhmm. It's a it's it's gotta sell. It has to sell. And you can't sell a book by starting off with, we have some ideas that that might be helpful.

  Ben Fineman [00:19:03]:

  Yeah. Yeah. I think you're spot on that without that certainty, you're you're writing a book that isn't gonna sell because you're saying, maybe. Like, we're not sure. But I I think something else I was considering here in terms of, like, which are the biggest offenders, which approaches, is in my experience, The more grounded in science an approach tries to be. So EMDR, as we've talked about at length, big on neuroscience. CBT, tons of research on it. Yeah.

  Ben Fineman [00:19:28]:

  I think those modalities tend to compare themselves to other approaches more and say that those other approaches just kind of, Like Scott Alexander writes, they only help ameliorate the stress of symptoms, but ours destroys it at the root because they wanna tie that to science and stay with the studies to prove it. I think every book I've read does this general thing, even the narrative books. But in in my experience, the ones that are More overt with it and annoying are the ones that are more grounded in science or try to be more grounded in science because it gives them a sense of superiority compared to the more Postmodern or, like, existential approaches where they can't just say, look at all these studies because Right. They're not studied as much or at all.

  Carrie Wiita [00:20:10]:

  Do you think it would be more okay if these scientific studies they were referring to were, like, actual actually demonstrating trading the effectiveness of the of the therapy instead of just kind of pointing at these scientific studies and saying, Well, we can't prove it yet, but because of this study, look at all the science, science, MRI, CAT scan results, blah blah blah. Like, do you think that that's do you think it's worse when they do that than say your run of the mill narrative therapy book, which is like, well, Facot said this.

  Ben Fineman [00:20:42]:

  Yeah. So It's it's worse to me because they're trying to claim Some objectivity based on things that simply are not.

  Carrie Wiita [00:20:50]:

  Yeah. I I I tend to agree with you. I think that's true. Okay. Shall I continue?

  Ben Fineman [00:20:55]:

  Yeah.

  Carrie Wiita [00:20:56]:

  All therapy books bring up the dodo bird verdict. The observation confirmed in study after study that all psychotherapies are about equally good, and the only things that matter are nonspecific factors, like how much patients like their therapist. Some people might think this suggests our form of therapy will only be about as good as other forms. This, all therapy books agree, would be a foolish and perverse interpretation of these findings. The correct interpretation is that all previous forms of therapy must be equally wrong. The only reason they ever produce good results at all is because sometimes therapists accidentally stumble into using our form of therapy without even knowing it. Since every form of therapy is about equally likely to stumble into using our form of therapy, every other form is equally good. But Now that our form of therapy has been formalized and written up, there is no longer any need to stumble blindly.

  Carrie Wiita [00:21:55]:

  Everyone can just use our form of therapy all the time for everything. Nobody has ever done a study of our form of therapy, but When they do, it's going to be amazing. Nobody has even invented numbers high enough to express how big the effect size of our form of therapy is going to be.

  Ben Fineman [00:22:13]:

  Can we point out that what he's saying is that in every therapy book and I appreciate this. Well, first, the fact that Scott is writing about the dodo bird verdict Right. And things like the common factors and the therapeutic alliance makes me immediately just trust everything he's gonna say because he's, like, speaking my language here. So that's my bias. Right. But he's pointing out that every therapy book acknowledges that all other therapies to date are equally effective. And then they're saying that their approach is going to be more effective or is more effective, which is saying that the entire research base Does not apply to them because they have stumbled across what actually works. So they're ignoring decades decades of research in favor of Optimism and just pure faith that their approach is somehow different.

  Ben Fineman [00:23:00]:

  And I am pretty sure that this is a cognitive distortion. This is magical thinking.

  Carrie Wiita [00:23:05]:

  Yes.

  Ben Fineman [00:23:05]:

  This is it's an it's so unrealistic. I don't know if they realize how absurd it is to make these claims back to back, But it's just crazy.

  Carrie Wiita [00:23:16]:

  That's that's the question I I desperately wanna know the answer to. I would love to be like, in in my In my perfect world, I would, be able to sit down in a in a private conversation with, like, Francine Shapiro or, like, Sue Johnson or, who's the IFS guy?

  Ben Fineman [00:23:37]:

  Richard Schwartz.

  Carrie Wiita [00:23:38]:

  Richard Schwartz

  Ben Fineman [00:23:39]:

  Stephen Hayes for ACT, he has authored or coauthored so many books where I mean, ACT very much carries this kind of We have now combined cognitive behavioral therapy with mindfulness and holy shit, you guys. Like, this is all you need.

  Carrie Wiita [00:23:53]:

  Right. Right. And I want and and I'm I'm picking on these people in particular because there are now entire industries around this approach to therapy. Right? And I really want to sit down privately and look these people in the eye and be like, okay. Which is it? Like, do you really think that you found the key? Like, you do you do you really believe this, or do you feel strongly about your approach and know that to get people to do it, you have to double down into, like, a 100% certainty. Like, which is it?

  Ben Fineman [00:24:25]:

  Oh, I would I would bet all the money I have on the former that they Genuinely believe that they have the answer.

  Carrie Wiita [00:24:31]:

  My god. That's crazy, though. Yeah. It's straight up Crazy. How can you do you do you want like, the amount of hubris that that takes to be able to stand up and be like, Listen, guys. But is it Listen.

  Ben Fineman [00:24:47]:

  So when you and I first discovered feedback and form treatment

  Carrie Wiita [00:24:49]:

  Right.

  Ben Fineman [00:24:50]:

  And I Later in in our review here, I had a note about this because you and I just, like, jumped in. We're like, this makes so much sense. This speaks my language, and I believe this to actually make the difference. And we'll talk later about the fact that it doesn't necessarily make the difference, but you and I followed the exact same path of seeing those early studies and being Like, holy shit. This really does

  Carrie Wiita [00:25:14]:

  matter. I'm gonna argue that that's different, though, because feedback informed treatment you apply to any approach the

  Ben Fineman [00:25:21]:

  therapy. Sure.

  Carrie Wiita [00:25:22]:

  I mean, I I'm talking about the amount of hubris that it takes to come up with a new form of doing therapy, be able to understand the evidence base that says pretty much everything works exactly the same. We don't know why things work, and to stand up and genuinely believe that no. No. No. No. I Created the one that actually that's what I that's what I'm like I I can't I can't believe it's got it has to be on some level disingenuous. It has to be on some level understanding that, like, it works because you believe it works. You know? Like, I kind of feel this way sometimes about, like, Tarot card readers or, like, mediums who connect who who talk to the dead people.

  Carrie Wiita [00:26:00]:

  Right? They do they really, like, do they really believe that that's happening? Or do they kinda know that for it to be helpful and beneficial in any way, they've really gotta communicate that, like, they believe it a 100 Like, which is

  Ben Fineman [00:26:14]:

  it? I don't know. I I I know who I know who I could ask.

  Carrie Wiita [00:26:19]:

  Who? Who?

  Ben Fineman [00:26:20]:

  Doctor Alex Bosch. He spent so much time, like, going to conferences, really getting to know a lot of people who are, like, in these these frameworks, these models. And it's something that he's very passionate about and very interested in, and I feel like he, more than anybody I know, because he's Been exposed to so many different approaches and gotten to know so many people within those models and those hierarchies of who is the the person in the next Line of, you know, deputies. Mhmm. I'm gonna ask Alex.

  Carrie Wiita [00:26:51]:

  Oh my god. Please.

  Ben Fineman [00:26:52]:

  I'll report back.

  Carrie Wiita [00:26:53]:

  Please do. Okay. Good. But loved

  Ben Fineman [00:26:56]:

  Can we talk about the case of Bob?

  Carrie Wiita [00:26:58]:

  Yeah. Here's the here's I'd like you to consider the case of Bob. Bob has some standard issue psychological problem. He had been in and out of therapy for years, tried dozens of different medications. None of them had helped at all. Then he decided to try our form of therapy. In his 1st session, the therapist asked him, have you ever considered that your problems might be because of, brackets, The kind of thing our form of therapy says all problems are because of, end brackets. Bob started laughing and crying simultaneously, eventually breaking into a convulsive fit.

  Carrie Wiita [00:27:32]:

  After 3 minutes, he recovered and proceeded to tell a story of how, brackets, everything in his life was exactly in accordance with our form of therapy's predictions, end brackets, And he had always reacted by brackets, doing exactly the kind of thing our form of therapy predicts that he would, end brackets. Now that all of this was out in consciousness, he no longer felt any desire to have psychological problems. In a follow-up session 2 weeks later, the therapist confirmed that he no longer had any psychological problems and had become the CEO of a Fortune 500 company and a renowned pentathlete.

  Ben Fineman [00:28:08]:

  Can I tell you how much I love this? Because the the vignettes, like the case studies in all of these books Good. Are not that much more absurd than this.

  Carrie Wiita [00:28:18]:

  Nope. I know. I know. And you come across these, like, Every I I read these in almost every therapy thing I've ever read, always has some kind of vignette, And I find myself getting obsessed with I wonder, like, what parts of the like, you know, they always say, like, these are conglomerates, aggregates of of actual patients. And I'm I always wonder, like, what was that process like coming up with this imaginary, like, to protect Confidentiality patient

  Ben Fineman [00:28:52]:

  person. So instead of CEO of a Fortune 500 company, what happened in real life Is is there a fortune 1,000?

  Carrie Wiita [00:28:59]:

  I'm sure. I'm not sure there is.

  Ben Fineman [00:29:02]:

  Yeah. It's crazy. These books I think every single one I've ever read has case studies. It's just the natural progression of how these books are written, and they're not I don't think they serve a purpose. I think they just fill out a book to get it close to, like, 200 pages so you can sell it as a real book and not some 30 page pamphlet. Because I don't think you need I don't think there's a single therapy book that actually needs to be longer than, say, 50 to a 100 pages at most, if not just 10 pages, And that so much of the stuff in these books is really filler, and I think these case studies are that.

  Carrie Wiita [00:29:37]:

  I'm so glad you just said that Because I'm telling you, when I read these case

  Ben Fineman [00:29:41]:

  studies skip over them?

  Carrie Wiita [00:29:42]:

  I skip them. I do. I I've tried. I've tried multiple times to, like, read them and be like, What am I supposed to be getting out of this? Like, what am I I'm supposed to be analyzing? Oh, wait. With that sentence, I guess he used that technique, and then, look, it worked Because the client said so they think but it happens. And it even happens in the material that, like, honestly, that I'm not making like, this this stuff I love, like, the the approaches that I really love, even they have the case studies or the transcripts. I remember there was a book I read on narrative therapy with, like, children and families. And, honestly, pages and pages of, like, thing like, conversations, Like, what happened with the family in session, I felt like such a bad student because I really wanted to understand it, and I was reading it specifically for work with a client.

  Carrie Wiita [00:30:34]:

  And so I felt doubly guilty because I was just skimming through. I was like, I don't care. Oh my god. This can't this makes no sense. I don't like, what is this doing for me?

  Ben Fineman [00:30:42]:

  And then you take it into session with your clients, and they they are rude enough to not have cathartic convulsive fits of awakening.

  Carrie Wiita [00:30:48]:

  Yeah. And

  Ben Fineman [00:30:49]:

  you're like, well, shit. True. Study wasn't true at all.

  Carrie Wiita [00:30:52]:

  No. No. It's that I didn't do the model right.

  Ben Fineman [00:30:54]:

  So you have to buy the next book.

  Carrie Wiita [00:30:56]:

  Yeah. Exactly. I have to go to the live training and do the certification.

  Ben Fineman [00:31:00]:

  Yeah. Oh, I wish I wish, Scott had written blogs about these kinds of trainings, Although I doubt he goes to the and if he did, he would probably be miserable.

  Carrie Wiita [00:31:08]:

  Oh, that'd be really good. Shall I continue with would you like to hear more about About our case studies? Yeah. Not every case goes this smoothly. Consider the case of Sarah. Sarah also has some standard issue psychological problem. She'd also been in and out of therapy for years, tried dozens of different medications, and none of them had helped at all. Then she decided to try our form of therapy. In her 1st session, the therapist asked her, have you ever considered that your problems might be because of brackets, The kind of thing our form of therapy says all problems are because of, end brackets.

  Carrie Wiita [00:31:44]:

  Sarah said, no. I don't think they are. The therapist asked, Are you sure you're not just repressing the fact that they totally definitely are for sure? As soon as Sarah heard this, She gasped, and her eyes seemed to light up with an inner fire. Then she proceeded to tell a story of how, brackets, everything in her life was exactly in accordance with our form of therapy's predictions, And she had always reacted brackets doing exactly the kind of thing or form of therapy it predicts that she would and brackets. Now only when she was repressing this because she was scared of how powerful she would be if she recovered. Now that all of this was out in consciousness, she no longer felt any desire to have psychological problems. In a follow-up session 2 weeks later, the therapist Confirmed that she no longer had any psychological problems and had become the handpicked successor to the Dalai Lama and the mother of 5 healthy children.

  Ben Fineman [00:32:39]:

  I I appreciate, this example because I it could just be One thing to remember it being exactly like this, but I do feel like a lot of these books. The first case study is not that intense, and then you get into at 1st, the client didn't believe it. Mhmm. And then they opened up to it, and then everything changed. Mhmm. And it's also clients who have been to therapy for decades and tried a number of different things, and this suddenly works.

  Carrie Wiita [00:33:03]:

  This is the thing that

  Ben Fineman [00:33:05]:

  No therapist has had a client like this. It doesn't exist where a client goes to therapy for 20 years And just because they see, like this is why EMDR drives me crazy. Is the narrative in EMDR is you just need this, And then all the failed attempts at therapy will be in the past. It's just I don't think human psychology can possibly work that way. It can't be that straightforward and simple.

  Carrie Wiita [00:33:29]:

  No. And I love the deliberateness of of including the case study of, like, look. Look. Look. We're not cherry picking our results. You know, sometimes it's hard. Sometimes it almost doesn't work, but then it does.

  Ben Fineman [00:33:41]:

  Right. Right. That's like the the later case study is it didn't work for the 1st 3 sessions, so we tried this skill, which was written about in the middle of the

  Carrie Wiita [00:33:49]:

  book. Right.

  Ben Fineman [00:33:49]:

  It's an advanced skill, and then

  Carrie Wiita [00:33:51]:

  it worked. Previous forms of therapy have failed because they were ungrounded. They were ridiculous mental castles built in the clouds by armchair speculators. But our form of therapy is based on hard science. For example, it probably acts on synapses or the hippocampus or something. Here are 3 neuroscience papers which vaguely remind us of our form of therapy. One day, neuroscience will catch up to us and realize that the principles of our form of therapy are the principles that govern the organization of the entire brain, if not all of multicellular life.

  Ben Fineman [00:34:29]:

  I love it probably acts on the synapses of the hippocampus or something.

  Carrie Wiita [00:34:33]:

  Or something. Like, they're definitely talking about EMDR now. Right? Like, definitely.

  Ben Fineman [00:34:39]:

  Yeah. I think this is basically EMDR, except I think EMDR feels it seems like the EMDR people, at least based on what we talked about with Angela in our last So feel like the neuroscience is already true as opposed to these books which say that neuroscience will prove our model to be true eventually. EMDR just kinda jumped in and said, no. We already claim it as a truth about our

  Carrie Wiita [00:35:02]:

  field. And it's I'm struggling because, like, on the one hand, look, I always argue that our field should be, incorporating understanding and advances from other fields. I think that we shouldn't be siloing ourselves off and ignoring it. Where how do you how do you how do you walk that line between, like, in like, doing that, like, being open to what neuroscience has to offer, but also, like, recognizing that you may that you can't just make up a therapy based on these things that these Hypotheses, these, you know, guesses that we have.

  Ben Fineman [00:35:40]:

  I don't think any theory of therapy has emerged from neuroscience that I'm aware of. Think it's the opposite, and that's what Scott's writing about. Yeah. That somebody or some people will come up with a theory that sounds really great. And then they'll take that theory and say, okay. What neuroscience can we find that supports our

  Carrie Wiita [00:35:58]:

  claims?

  Ben Fineman [00:35:59]:

  Right. But nobody I don't think anybody has ever studied the brain To then come up with a theory of therapy after they've found their conclusions about how the brain

  Carrie Wiita [00:36:08]:

  works Yeah.

  Ben Fineman [00:36:10]:

  Which kinda Makes cynicism very healthy here because Yeah. Yeah. The theory comes before the science, and then the science is retrofitted to support Right. The theory. Here are 3 papers that vaguely remind us of our form of

  Carrie Wiita [00:36:26]:

  therapy. Which, to be fair, is sometimes what we do on this show.

  Ben Fineman [00:36:30]:

  Yeah. Very fair.

  Carrie Wiita [00:36:33]:

  Okay. So now we're now we're going into section 2 of this article. Maybe I'm being unfair here. I'm basing this off a Small sample of therapy books, 5 textbooks I can think of plus scattered papers on psychodynamic and psychedelic therapies, and only a subset are quite this bad.

  Ben Fineman [00:36:50]:

  So I would contend that they are all quite this bad.

  Carrie Wiita [00:36:53]:

  I think you would.

  Ben Fineman [00:36:55]:

  Not like, You know, the cases of Sarah and Bob that are so obviously satire. But I think they all do this, and I don't read therapy books much anymore. And I have a theory, Carrie, and I wanna float it by you, which is that you can learn 90% Of what you need to know about a theory in at least, say, 3 to 5 hours and no more than 10 hours That you can Google, you can watch videos, and you can learn just about everything you need to know about some specific theory you could teach yourself in a day.

  Carrie Wiita [00:37:29]:

  I'm gonna disagree with that simply because of everything that we talked about in our theoretical orientations episode. I actually think that you need Fucking years of study with, scholars in the field before you can, like, really understand any theory. I hear what you're saying, need to know, like, that you can learn 90% of what you need to know. I don't even I wouldn't even say it's, like, need to know. I would say In that amount of time, in, like, a few hours, you can and and will learn The the most that you are gonna be able to incorporate in your own actual clinical practice on the thing.

  Ben Fineman [00:38:09]:

  Yeah. So maybe it's not what you need to know. It's If you had a client come to you and say, I really like therapists who work from a blank

  Carrie Wiita [00:38:17]:

  framework Mhmm.

  Ben Fineman [00:38:18]:

  That in 10 hours or less, You as a therapist can go learn about that framework enough to happily meet that client's needs unless they are themselves that kind of therapist And will recognize that you're not following, like, strict adherence to the

  Carrie Wiita [00:38:33]:

  model. Yeah. Or if they are, like, a super fan of a particular of a particular model. Right. So, like, if if I were in that situation as therapist, I would hedge it with my client by saying, like, yeah. Absolutely. I will go learn about Internal family systems. But I need you to understand that, like, I am not a trained IFS therapist.

  Carrie Wiita [00:38:52]:

  I'm happy to incorporate the principles into our work together, But would you like referral to an actual IFS therapist? You know, that's I feel like that's the way I would hedge it.

  Ben Fineman [00:39:01]:

  Oh, I wouldn't do that at all.

  Carrie Wiita [00:39:02]:

  Oh my god. Are you serious?

  Ben Fineman [00:39:03]:

  Yeah. I've done this with clients. They've said, I want x, and I've gone and learned it. And my clients had convulsive fits of joy because within 2 sessions Stop The 2 sessions, their problems were were all

  Carrie Wiita [00:39:17]:

  better. Shall I continue? Please. Okay. But my basic confusion is this. I work in a clinic with about 10 therapists. Some are better than others, but all of them are competent. I send my patients to them. In a few 100 patients I worked with, 0 have had the sudden, extraordinary, long lasting change that the therapy books promised.

  Carrie Wiita [00:39:39]:

  Many have benefited a little. A few would say that over the course of years, their lives have been turned around, but sudden complete transformations, Not that

  Ben Fineman [00:39:49]:

  much. I think that's a very good point here that these books sell that transformation. Yeah. It's not just that this is the way, but this is the way, and it will lead to these huge changes. And I think I'm more optimistic than Scott is in terms of how many people benefit from therapy. And is it just a tiny bit or is it significant, but I would agree that I've never really seen these, like, huge complete transformations that these books Cellulon. And I think it's an unrealistic expectation for clients to have and for therapists to have. For the most part, when Clients get better.

  Ben Fineman [00:40:20]:

  It's it is subtle. It's like changes changes around the edges of who they are as opposed to some drastic shift in how they experience the world.

  Carrie Wiita [00:40:28]:

  You know, I think I think that question depends on who you're asking. If you're asking therapists, I think that that's probably accurate. If we're being honest with ourselves, that's how we would describe But as we all know, I've done a lot of reading of BuzzFeed articles, where, you know, clients of therapy are polled about things that their therapist said that, like, rocked their world or whatever. And I actually think that there are plenty of clients of therapy who would endorse having had a dramatic transformation in therapy, either their you know, the therapist said something that Shifted their perspective wildly and that opened up all these possibilities to them, or they gave them permission to, like, You know, be a certain way or do a thing. I think that so I'm gonna say that I think sudden complete transformations are definitely possible in therapy, but I don't think it has anything to do with what the therapist thinks is Transformative. I think it's entirely up to the client whether they would agree that that has happened, and I think most therapists would be shocked and be like, I never I never said that. Or or, like, I I didn't I didn't mean it that way. Yeah.

  Carrie Wiita [00:41:35]:

  But the client has, like, taken it and walked away and been like, life changing formation.

  Ben Fineman [00:41:40]:

  Agreed. That I'll agree

  Carrie Wiita [00:41:42]:

  with. Alright. Continuing on. Of course, this fits with the therapy book's perspective. My colleagues practice normal therapy. Sometimes it's from a boring old school like CBT. Other times it's eclectic or supportive or any of the other words we use to describe what we're doing when we don't know what we're doing. So maybe there are 2 sets of therapies, boring old therapies that ordinary people practice And exciting new therapies that people write glowing books about.

  Carrie Wiita [00:42:12]:

  And maybe the 1st set really don't work or work only a little, And the 2nd set really is that good.

  Ben Fineman [00:42:20]:

  So the the spoiler is that in the next paragraph, Scott ex he He says it's it's not that simple. It's not that new therapies are better than old therapies, but I find it so impossibly strange that Our field doesn't seem to catch on that new therapies don't fundamentally make a difference. They haven't for 50 years. Why do we think That we're just 1 groundbreaking discovery away. Like, is that not is it just me?

  Carrie Wiita [00:42:48]:

  No. I don't think it's you, but I'm thinking back. Like right? Like, what if all we had was psychodynamic therapy and, You know, the postmodern like, Michael White and David Ebsen never came out with narrative therapy. Right? What if all we had to go on was psychodynamic? I would argue that The the new perspectives that are brought up by these new therapies, Fun oftentimes, fundamentally change how we do the old therapies based on, like, the new perspectives. Don't you think? I mean, I think like, I think it's a good thing that new therapies come out. Otherwise, we're just stuck with the same old thing.

  Ben Fineman [00:43:34]:

  Agreed. And I I I think The new therapies do change how we do things. I don't know if they make it more effective. And this maybe this goes back to our our long standing, Not argument, but conversation where you go, Ben, do you just think that everybody who's doing a PhD in every article and every paper It's just a waste of everybody's time. If the field's not getting any more effective, should we just not be doing this research? And maybe. Yeah. Maybe. It's very strange to say.

  Ben Fineman [00:44:04]:

  Should we as a field be just looking in other spending more of our collective efforts and resources as a field, looking in other areas if reinventing the wheel over and over again is really all we're doing. And that question doesn't seem to be being asked enough because, clearly, our field is still focused on creating new models, researching the old models. Right. Researching old models for new things. Right. I I have a Google a Google Scholar not Google Scholar, A Google alert on my phone for existential therapy. Uh-huh. And yesterday, I got, an email from Google Scholar alerts.

  Ben Fineman [00:44:42]:

  Okay. The title of the article that was sent to my inbox is being resolute in being a voluntarily childless woman living in Ireland, a hermeneutic phenomenological study. Now you tell me, Carrie, how does that make the field of psychotherapy even the slightest bit more effective. Or is that study just like an interesting philosophical paper that has value, but a total waste of time from a Let's make psychotherapy more effective.

  Carrie Wiita [00:45:10]:

  I don't know. I don't think I know enough to say it's, like, a waste of time. Somebody ops many somebodies obviously didn't think it was a total waste of time. A few people signed off on that article.

  Ben Fineman [00:45:22]:

  I I'm not sure I'm not sure that that reinforces anything knowing how papers get written and how academia works.

  Carrie Wiita [00:45:29]:

  You know, I'm just saying There has to be something of value in there. I I, like, I struggle to think there's, like, Nothing interesting to come out of that.

  Ben Fineman [00:45:41]:

  Well, you read

  Carrie Wiita [00:45:41]:

  it. Okay.

  Ben Fineman [00:45:42]:

  And you tell me how your life has been changed, Carrie.

  Carrie Wiita [00:45:46]:

  Right. I will. I will. Actually, that'd be good. We'll do that. Okay. Alright. Shall I continue?

  Ben Fineman [00:45:52]:

  Please. Alright.

  Carrie Wiita [00:45:55]:

  The problem is the boring old therapies that everybody uses nowadays inspired equal equal excitement when they first arose. This is the point that I make in CBT in the water supply, the name of another blog post, and that Oliver Bergman cogently in why CBT is falling out of favor. Look at therapy books from the 19 nineties, and they were all about how CBT was a numerical therapy that would Cure your anxiety forever in a few sessions. From a cognitive therapy book. When I first learned about cognitive behavioral therapy, I thought Depression and anxiety seemed far too serious and severe for such a simplistic approach. But when I tried these methods with some of my more difficult patients, my perceptions changed. Patient oh, no. Patients who'd felt hopeless, worthless, and desperate beg and desperate began to recover.

  Carrie Wiita [00:46:44]:

  At first, it was hard to believe that the techniques were working, but I could not deny the fact that when my patients learned to put the lie to their negative thoughts, they began to improve. Oh, no. Sometimes Sometimes they recovered right before my eyes during sessions. Patients who'd felt demoralized and hopeless for years suddenly turned the corner on their problems. Oh, no.

  Ben Fineman [00:47:13]:

  It's it's incredible how you read Scott's satire, and you're like, but none of these books are this ridiculous.

  Carrie Wiita [00:47:20]:

  I am now he I'm literally quoting. He's he is quoting from an actual CBT book. Okay.

  Ben Fineman [00:47:30]:

  Do you want me to finish the quote? I can still recall an elderly French woman who'd been bitterly depressed for more than 50 years With 3 nearly successful suicide attempts who started shouting is it? Is that right? Yep. Which means joy of living one day in my office. These experiences made such a strong impact on me that I decided my calling was in clinical work rather than brain research. After considerable soul searching, I decided to give up my research career and become a full time clinician. Over the years, I've had more than 35,000 psychotherapy sessions with depressed and anxious patients, and I'm every bit as enthusiastic as about CDT That's when I first began learning about it. This is from a real CBT book.

  Carrie Wiita [00:48:21]:

  Oh my god. That is So funny. I've it's been a while since I read this, and I forgot that that was in there. Yeah. That is so funny and Pressing. Oh my god.

  Ben Fineman [00:48:37]:

  You wanna keep going?

  Carrie Wiita [00:48:39]:

  Yeah.

  Ben Fineman [00:48:39]:

  Okay. But look

  Carrie Wiita [00:48:41]:

  at therapy books now, and they're all people saying, sure, CBT barely outperforms placebo, but what about this exciting new therapy which blows CBT Tea out of the water. Studies reflect this decline with the average studied effect size of CBT shrinking from 2.5 to 1.0 over the course of a generation. People have come up with various explanations for this. Maybe therapist quality is falling. When CBT was the hot new thing, you had to be a really plugged in, up to date therapist who have heard about it and to make the effort to retrain in it. So only the best therapist would practice it, But now it's the default therapy used by everyone who's just clocking it in. Maybe placebo effect is falling. When people viewed it as an astounding miracle therapy, it got astounding miracle results.

  Carrie Wiita [00:49:29]:

  But now that it's lost its luster, nobody takes it seriously anymore. Maybe its ideas are spreading so that patients come into their 1st session already aware of CBT Insights and inoculated against them. Or maybe it's like all science where the first studies are done quickly by true believers and the later studies are done carefully by the Cochrane Collaboration, and so the level of hype naturally goes

  Ben Fineman [00:49:53]:

  down. This is what I was referring to about feedback and form treatment. And Yeah. I didn't go back and look for this, but I I am so impressed, with Scott Miller, who is, like, the the feedback informed treatment guru. You know, we've had him on the podcast. Great researcher. Great work that he's done. Yeah.

  Ben Fineman [00:50:08]:

  I think the 1st study on feedback informed treatment one of these incredible effect sizes, and so there was a lot of hype. And depending on which article you go to, you can use, quote, unquote, the research base To prove that feedback informed treatment dramatically increases the effectiveness of therapy.

  Carrie Wiita [00:50:24]:

  Right.

  Ben Fineman [00:50:25]:

  But when Scott writes about it, now he talks about how in large part, this This is just how studies go, and I don't wanna misquote him. But, essentially, that feedback and forth treatment had the same pathway in a sense That it was researched at first by the people who were really invested in it, who were working on it. And then as more objective people started studying feedback and form treatment, the effect size dropped. And this is what happens with all the theories, with all the modalities. And, Carrie, this is what I was talking about earlier that Researcher biases are largely unavoidable in our field. And if you are the person who believes that this is going to work, you're gonna see it work In the study, more so than other people doing studies simply because it's almost unavoidable Apparently, for these biases to filter through and show greater effect sizes. And so I love that Scott acknowledges this. And to my knowledge, his message now is feedback and form treatment isn't going to make more effective by itself.

  Ben Fineman [00:51:22]:

  Mhmm. But feedback informed treatment combined with deliberate practice very well could, and the research is very promising on that Because you can use what you learn from feedback and from treatment to identify what to deliberately practice, thus improving your overall Skill level. Most researchers in these modalities do not ever go back and say, oh, these later studies done by people that weren't fully affiliated with our approach show that it's actually just as effective as everything else. They just don't really put those studies to the forefront of, you know, their their public facing presence. So I admire Scott Miller for doing that, but I think it just goes to show that, at least in my opinion, you know, Scott Alexander has a few of these hypotheses about, like, Why does the effect size drop? Why did it drop for CBT? Why does it drop in general? And he talks a bit more about them next in the article, but I fully believe it's just about researcher bias and not that there were, like, bad faith researchers trying to pump up their own numbers. This Stuff just happens as a function of all of this being somewhat subjective and biases filtering into the, you know, the conclusions of the research.

  Carrie Wiita [00:52:29]:

  I have there's no question that that's true. I would push back on that is, like, the majority thing. Because I think when he talks about maybe the ideas are spreading so people come in, like, already having these insights, I feel like that has a lot to do with Because think about so CBT kind of hit hit the ground running, like, what, eighties, really into the nineties?

  Ben Fineman [00:52:54]:

  Mhmm.

  Carrie Wiita [00:52:55]:

  Yeah. Some are in there. Right? So I remember as a child in elementary school, like, in the nineties, getting, like, we would have, like, I forget what they those, like, in health class or they were like I don't know. We have, like, the school counselor come in and teach us lessons on, like, stuff. But, like, looking back now, I know that a lot of it is, like, you know, thoughts. What kind of thought are you having about this thing? And it was, like, for conflict resolution or, you know, who knows, all kinds of things. But, like, it wasn't it it I grew up, like, with this standing, and I think a lot of us did, this awareness that, like, is this thing so bad, or am I making a mountain out of molehill? If I if I change how I'm thinking about it, will it be easier to deal with? I think that that's more part of, like, our common parlance, which is then what I think When when somebody brings up something like and, again, I keep coming back to internal family systems because, like, I've watched how this has idea has Spread, like, through social media and on TikTok in particular, people, like, endorsing this, like, Oh my god. Can you believe it isn't just about, like, you know, me changing my thinking.

  Carrie Wiita [00:54:08]:

  I have a protector, And I have an inner child who's stuck at this age, and that's what's been going on this whole time. You know? And I I struggle because, like, I I'm equally torn because I know that's that's a Story that is a that is therapeutic story about what's going on, and and this dude, Richard Schwartz, Richard Schwartz, It's, you know, making a lot of money certifying a lot of therapists to do this thing, but then I cannot deny that this has been like, like, it's Change shifted things fundamentally for this person who's, like, crowing about it on social media. You know? What what if that is a big part of it? That, like, it's it's when the old kind of ways of looking at things well, I don't wanna pay somebody $150 an hour to go sit in their Tell me what I already know, which is you could be thinking about this differently. How good is like, what good is it doing you to think about Your problems in this way. I don't I don't wanna go I know. I know what I should be thinking. But if I go spend $150 an hour to have somebody, Wave a stick in front of my face face back and forth to, like, solve my trauma. I mean, now that sounds like modern science.

  Carrie Wiita [00:55:24]:

  You know?

  Ben Fineman [00:55:25]:

  So did, animal magnetism from back in the 1800.

  Carrie Wiita [00:55:30]:

  Exactly. Exactly. I think we're always Looking for, like, the moment, I guess, humans. Shall I continue?

  Ben Fineman [00:55:38]:

  Mhmm.

  Carrie Wiita [00:55:38]:

  Okay. These explanations have different practical implications. If it's all about therapist quality and placebo expectations, Then you should go get the exciting new therapies described in therapy books since their unusually qualified therapists and unusually high Expectations will deliver you the miracle cure you're looking for. It's it's just that study quality gets better and better until we realize how crappy the exciting new therapies really are. You might as well get the boring old therapies. At least insurance probably covers them. This reminds

  Ben Fineman [00:56:09]:

  me of 2 things that you and I have talked One is if a client really wants a certain kind of therapy because they buy into the hype Mhmm. Then why not give it to them? It'll probably be more effective because they're expecting it to

  Carrie Wiita [00:56:19]:

  work. Right.

  Ben Fineman [00:56:20]:

  But also your long standing, campaign that even though everything's equally effective probably or something like that, Therapists should still be starting with the research base when deciding what to do with a client because at least it's been studied as opposed to something that is an

  Carrie Wiita [00:56:37]:

  unknown. I Yes. I and I'll beat that drum till the day I die because I I I genuinely think If if there is a common thread among clients of therapy, it's that they come to therapy because for some whatever reason, they think therapy can solve their problems because it's a professional mental health, like, practitioner, and they must know the official mental health thing to do. Right? And so I feel like, yeah, ethically, to some extent, we we owe that to them. But, seriously, like, at the end of the day, I mean, what good does it Do any of us as clinicians to disabuse clients of the notion that this thing they just heard of is, like, the thing that's gonna help them. It doesn't do us any good. Right? So then if if it's helpful, Then is Richard Schwartz and Francine Shapiro and everyone else, are they doing a service?

  Ben Fineman [00:57:37]:

  I think it's the the short versus long term perspective. Short term for the the 1 client in front of you who really wants IFS. Yeah. Right? A 100%. But long term, we're reinforcing this idea that it's the model that matters. Right. And that hype is Justified. And so it it really is a tension between do we want To focus on helping the people right in front of us right now, or do we wanna maybe risk taking a step back to fundamentally change how our field operates For future generations, and we've kind of been spinning our wheels for decades now.

  Ben Fineman [00:58:10]:

  I think that is where our field has planted its feet is we're just gonna keep doing this Same thing, but I don't know if therapy is ever gonna really move forward until we can collectively say we need to all just stop doing this in favor of Something else. And what that something else is, we don't know yet because we're writing papers about the hermeneutic lived experience of childless women in Ireland, which, again, Not against writing that, like, super interesting and great, but is it making our feel better? I will very confidently say no.

  Carrie Wiita [00:58:40]:

  You're not wrong. I absolutely agree with what you're saying. Okay. Let's move on. And they also have different philosophical implications. If it's all about therapist quality and placebo expectations, Then even if it's hard to deliver high quality therapy consistently at scale, it means high quality therapy is a thing. It means that if enough factors go right at once, therapy can be the kind of powerful tool that cures someone's lifelong psychiatric issues in a few sessions with a high If this is true, it would be fascinating. It would be like saying that bananas cure cancer, but only if they're really fresh bananas.

  Carrie Wiita [00:59:20]:

  Even if there are practical issues in getting every cancer patient a banana that's fresh enough, you still might wanna take a step back and think, woah. What's up with this?

  Ben Fineman [00:59:28]:

  Yeah. The the the really fresh bananas are the super strengths. Yeah. Like, we know from outcome research some therapists are way better than other therapists. We don't know why. We don't know what makes them better because therapy is impossible to figure out. And maybe that's oh, this is a a great way to Extend my frustration that the field is studying things that don't make it more effective is why aren't we spending more of our research efforts looking in this direction? Yeah. Are some people super shrinks, and why is that not the thing that our field is studying to figure out how can we make other therapists better Rather than keep writing about Right.

  Ben Fineman [01:00:04]:

  ACT for yet another disorder in the DSM and showing that, yes, it is just as effective as everything

  Carrie Wiita [01:00:09]:

  Why aren't we? Why do you think that is?

  Ben Fineman [01:00:13]:

  I have no idea. Is it about funding? Like, you're not

  Carrie Wiita [01:00:17]:

  gonna

  Ben Fineman [01:00:18]:

  get grants To do this research because something or other?

  Carrie Wiita [01:00:22]:

  Well, I mean, that's what I was thinking in the back of my head. I was like, it's gotta be capitalism's fault. How is this capitalism's fault? I mean, that's what genuinely, I'm thinking, like, it's gotta be the money. Follow the money. Right? But, like, think about it. So people are make a ton of money Off of saying, like, this is the new therapy and getting everybody trained in the therapy, there's no difference between doing research that says, you know, the best therapists do this one thing, so come get trained in my come to my therapy school, And I'll teach you how to do the thing really good. You know? Like, there's it's there's gotta be the same financial incentive.

  Ben Fineman [01:00:56]:

  So I think the solution Is everybody should be monitoring outcomes in some standardized

  Carrie Wiita [01:01:04]:

  way Mhmm.

  Ben Fineman [01:01:05]:

  So that, collectively, the field can identify who are the most effective therapists, And that could even be within certain contexts. So the most effective therapist in this clinic or in this Yeah. Because it's impossible to compare the most effective therapist in, like, A crisis center community mental health to private practice in Beverly Hills Yeah. Where you're you're just dealing with different client populations. Yeah. But if you can identify who is more effective than their peers, you can do very important research studying Why are they more effective? And the research like that has been done, and it's just turned up a bunch of question marks because, again, therapy is some bizarre magic and alchemy Various things that we don't know. But, like, one study of that to me is worth a 100 studies of, I don't wanna pick on this Google alert I got.

  Carrie Wiita [01:01:55]:

  No. But it's funny.

  Ben Fineman [01:01:56]:

  Yeah. Fair.

  Carrie Wiita [01:01:59]:

  Now wait. Like, is it just that people don't want to track their outcomes? Is that why we don't do it?

  Ben Fineman [01:02:08]:

  It's it's extremely imperfect. So I get the like, this isn't gonna tell us anything, but it tells us something, and it's better than nothing. And I don't wanna make perfect The enemy of good or whatever that

  Carrie Wiita [01:02:20]:

  sentence is. Yeah.

  Ben Fineman [01:02:20]:

  Yeah. Like, it is a very imprecise way to evaluate effectiveness because How do you quantify mental health? But it's coming from the client. It's reliable and valid if you're using something like the OQ or the RS and RS. So it's kinda nuts that this isn't standard

  Carrie Wiita [01:02:39]:

  practice. We're doing it again. What? Saying everyone should do feedback informed

  Ben Fineman [01:02:46]:

  treatment. Yes. But our our thought This is, like, ignore all of the other research. Our ideas will definitely be the thing that makes the field more effective, Carrie. That's the whole point, you know, podcast is to tell everybody how Pure your our perspective is to everybody else.

  Carrie Wiita [01:03:00]:

  And it must be true because we still have a podcast.

  Ben Fineman [01:03:03]:

  Yeah. And we've had a few people email us telling us how impactful it's been. Therefore, that's what everybody's experiences even even if they'd they have sent us hate mail.

  Carrie Wiita [01:03:12]:

  Even if then, yes, they just didn't know yet.

  Ben Fineman [01:03:15]:

  To have that, you know, come to Jesus moment when they listen to episode 150 or whatever. Should we, should we keep chugging along here? Yeah.

  Carrie Wiita [01:03:26]:

  I can only say that I've had a few patients try the exciting new therapies, and none of them have reported miracle cures. They've all maybe gotten a little better over long periods, same as the boring old therapies. This makes me think it's more likely that early results from the exciting new therapies get oversold, Not that some combination of therapist skill and excitement makes them go shockingly well. And the efficient market agrees with my low estimation, given that Therapists aren't rushing to learn these new strategies, and patients aren't rushing to use them. But the therapy books still confuse me. They're full of stories of incredible instinctures with the authors assuring us that these are all real and typical of their experience. How can you get this from merely, quote, unquote, stretching the truth as opposed to outright data falsification? Are therapy book authors blatantly lying? I try to have a really low prior on this sort of thing, but I'm not sure. Therapy books are often written by the researcher who invented the therapy.

  Carrie Wiita [01:04:21]:

  I imagine if you invent a therapy yourself, then it perfectly fits your personality and communication style. You believe in it wholeheartedly, and you understand every Piece of it from the ground up. You're also probably a really exceptional and talented person who's obsessed with psychotherapy and how to make it better. So maybe they get results nobody else can replicate, but that still raises the philosophical implication of it being possible For somebody to consistently produce dramatic change through therapy, this still bothers me a lot.

  Ben Fineman [01:04:54]:

  What what What's writing here is I think implied here is that the therapist described in these ridiculous case studies where people drop to the floor and their life has changed. Yeah. Those therapists consistently have that result because they're using this approach, that their outcomes are great for most, if not all clients, And that this case study isn't just a one off. Right. But the authors who write these books, I am pretty confident that they don't measure their outcomes. Because if they did and they were really good, they'd talk about

  Carrie Wiita [01:05:24]:

  it. And people who are at the point that they come up with it. Like, I think by the time they start doing therapy, studies on it, Then they're they're measuring outcomes because they have to for the study, but by that point, you're the researcher bias you're talking about has already kicked

  Ben Fineman [01:05:37]:

  in. Yeah. And and the Fair like, the the writers, the the founders of these modalities.

  Carrie Wiita [01:05:44]:

  No. You were saying that they didn't that they didn't That they they you'd highly doubt that they're tracking their outcomes. But that's, that's what I'm saying is, like, I I think that that's true in the beginning, like, when they're coming up with these things. So, of course, like,

  Ben Fineman [01:05:56]:

  Yeah.

  Carrie Wiita [01:05:57]:

  Confirmation bias. Do they they probably, to some extent, like any human, just kind of, like, forget the clients that it didn't Oregon.

  Ben Fineman [01:06:05]:

  Yeah. And I guess that's thank you for rescuing my my derailed train of thought there.

  Carrie Wiita [01:06:10]:

  Totally. I

  Ben Fineman [01:06:11]:

  think we

  Carrie Wiita [01:06:11]:

  did. So

  Ben Fineman [01:06:12]:

  What these books are actually doing is taking, like, one very, you know, extreme case, multiple standard deviations above Any therapist average where things went great and they write it in the book as if it's because of the modality and it happens with all of their clients. And, of course, that's not the case. And nobody is saying, because I use this modality, my outcomes are so much better. I have the data to show it. All of this is just being assumed that they are actually more effective therapists than anybody who has The privilege to read the book, but nobody's actually doing the work to show that this is the case. And I think just about every therapist after enough time will have Some client where it goes incredibly well. And if you wanna take that client and write a theory around why your way of doing therapy is the best, every therapist theoretically to do that, and we just gravitate towards the ones who are really good at selling a

  Carrie Wiita [01:07:08]:

  narrative. I completely agree with you. I this Brings up something that I was thinking about the other day, how pretty much any therapist could come up with their own way of doing therapy. And it will work for some people, and it won't work for others. And I I thought of this because, one of my favorite TikTokers, Elise Myers, she's America's favorite TikToker, was describing the name of her album that she had released a few years back, and it was called Wallwork. And she described how it came about because she was in therapy with this therapist who she she'd been in therapy for what? This is so funny, actually. I'm just thinking of this now. She'd been in therapy for a very long time, with really, really difficult depression, and the therapist Her therapist got to the point where she was like, I don't know what to do.

  Carrie Wiita [01:07:57]:

  We need to bring in the big guns. And so the that therapist And Elise and this other therapist worked for, like, a week together. This was a specialist therapist who did this thing called wall work. I've never heard of this before. He had her write out every memory of her life she could remember on a Post it and put it on the wall. And so the and she said it took, like, a week to do, but so this whole wall was just full of Post its of memories of her life. And she didn't, in the TikTok, explain how this changed things, but it did. It, like, did something really Significant for her to the point where, like, she credits it with, like, you know, a huge breakthrough in helping her get over things, And she wrote this whole album of music, and it was inspired by this wall work or whatever, and it was very meaningful to her.

  Carrie Wiita [01:08:49]:

  And I'm sitting here thinking, isn't it funny? Like, none of us have Ever heard of this? But this is absolutely a book I could imagine coming out. That therapist, like, publishes a book on how to do wall work with your clients.

  Ben Fineman [01:09:00]:

  Sounds no different than Stuts, which I still haven't seen. Yes. But is like, something gets publicity, and all of a sudden you have a new modality.

  Carrie Wiita [01:09:09]:

  So what's. So there's no difference. What we're saying is there's probably no meaningful difference between any of these gurus who come out with new therapies and every other therapist who's had an idea and comes up with their own, like like, decision about this their own story about what what they do in therapy and how they do it. The only difference is the gurus, like, went out and got funding for a book

  Ben Fineman [01:09:31]:

  deal. Or they're really skilled at selling a narrative, Or they can tap into a certain cultural moment. Or Yeah. You know? I I don't think their ideas are marketing. Yeah. I I I maintain that if you and I, like, quit all of our jobs and had nothing but free time, then we said our goal by the time we die is to get a new approach to therapy to be considered as, like, mainstream and popular. And we had unlimited resources to get certain researchers on our side And certain, like, you know, New York Times authors on our side, like, columnists. I I am very confident that you and I could Get an approach to therapy out into the world because it isn't about having some brilliant idea.

  Ben Fineman [01:10:18]:

  It isn't about, like, Hacking what really matters in the world and in

  Carrie Wiita [01:10:22]:

  psychology Right.

  Ben Fineman [01:10:23]:

  Is a lot of it is luck, a lot of it is skill, but none of it is finding some truth. And once you kinda see behind the curtain and you know what people are looking for, you just need the next IFS or EMDR, and you latch it on to trauma or whatever the equivalent of trauma will be in 10 or 20 years. Right. Where the field only wants to focus on this because it's so important, and you come up with a very different type of theory that maps on like, I'm certain we could do this.

  Carrie Wiita [01:10:46]:

  Okay. So wait. Are you are you saying then that we are encouraging therapists to not pursue $1,000, multi $1,000 certifications. No. No. No. And instead Come up with their own theory of therapy and do that.

  Ben Fineman [01:11:06]:

  I feel like a separate Patreon episode.

  Carrie Wiita [01:11:13]:

  Okay. Put a pin in that because I really have questions about that. That might be in a whole other episode. Alright. Are you ready to move on? Yes. Section 3. Most therapy books share some assumptions so deep as to be unspoken. Current problems serve some purpose related to past traumas.

  Carrie Wiita [01:11:33]:

  Different therapies take this in different directions. Some view problems as a passive residue of past traumas. For example, you were abused as a child that filled you with stress and rage, and Now you take that out on other people and yourself. Others view them as maladaptive learning from past trauma. For example, you were abused as a child. That taught you that other people would hurt you if you opened up to them so you never open up to anybody. I don't know the official name for this, but let's call it historicism, Symptoms are the result of something that happened in a patient's life history. Some weak forms of historicism are obviously true.

  Carrie Wiita [01:12:07]:

  Many, though not all, phobias began with clear incident where the patient was endangered by the phobic object. Someone mauled by a dog as a child who then has cynophobia as an adult is hardly a medical mystery. Many, though not all, depressions are precipitated by some depressing event, and post traumatic stress disorder has the historical perspective They're in the name. At the very least, going through trauma dysregulates something inside you. But it's a long way from there to saying that a patient's psychosomatic blindness is caused by persistent shame at having seen their parents having sex 30 years earlier or something like that.

  Ben Fineman [01:12:44]:

  So The the historicism he's talking about, these, like, choose your own adventure ways of looking at therapy where if you go to a different therapist, you're gonna get a different explanation for how your past impacts your present is a real sticking point in my not frustration, my endless uncertainty about how our field works. Because if any of them can be true, none of them can be singularly true. My therapist is a psychodynamic therapist. And so not too long ago, we were talking about some things related to my mom and me in the present, And I was like, yeah. Like, I guess. Like, sure. My mom being depressed when I was younger could impact my Strong desire to take care of others in the present. That makes total sense.

  Ben Fineman [01:13:29]:

  Sure. But I could, on the spot, give you 10 other narratives that could fit just as well. So I I I I think I apologize. I was like, yeah. Like, that sounds great, but I I What am I supposed to do with this? Because it's just one of any number of stories we could create that makes

  Carrie Wiita [01:13:47]:

  sense. So so Ben Feynman.

  Ben Fineman [01:13:49]:

  Yeah. I know. I feel like I'm a tough client. Sorry. But I I really like what he's saying about, for example, phobias that some presenting problems very clearly

  Carrie Wiita [01:13:57]:

  Totally.

  Ben Fineman [01:13:58]:

  Are traced to the past in a way that is less ambiguous. And I wonder if that means that there are some diagnoses that really Should be treated with a specific approach as opposed to a just do the common factors and then tack on whatever approach fits your client's goals and your framework. And I if I'm not mistaken, I think exposure therapy

  Carrie Wiita [01:14:17]:

  Mhmm.

  Ben Fineman [01:14:18]:

  For specific phobia is known to be More effectively treated by, exposure therapy than any other approach.

  Carrie Wiita [01:14:26]:

  And Yes.

  Ben Fineman [01:14:28]:

  Based on what Scott is writing here, I get why that's true. There isn't, like, a bunch of different narratives for why you have a phobia of dogs if you were mauled by a dog when you were 6. Like, that just makes Since.

  Carrie Wiita [01:14:40]:

  Exactly. We've had this conversation. I can't remember when on the show before, but, like, I I really do believe that they're They are going to find that there are some mental, quote, unquote, illness. We don't wanna call it illness. We don't wanna call it psychological issue, whatever, that is more, biologically based. And we know that things that are biologically biologically based lend themselves to our gold standard, like clinical trials. Right? We can figure out, like, whether we're right or wrong about our hypotheses about them to a better extent than we can with Your run of the mill adjustment what we call now adjustment disorder, which is just like you feel bummed about something. And I could not agree with you more.

  Carrie Wiita [01:15:22]:

  There are a 100,000,000 different interpretations of any sorry. My dog was just, like, having a problem. Of of any given, connection. Right? Any given, like, set of symptoms and a supposed, like, inciting incident. And I this has been my frustration with therapies that Say, this is what happened. Yeah. Yeah. It's like

  Ben Fineman [01:15:50]:

  It's so interesting to me.

  Carrie Wiita [01:15:52]:

  Okay. Should I keep going? Yeah. And some therapy books go beyond historicism into purposefulism. Symptoms serve some quasi logical purpose relating to the life history. I recently read a therapy book that included a case like this. Bob had a history of failing at work. He would go from job to job, making various mistakes, doing work until he got fired. He went to a therapist for help.

  Carrie Wiita [01:16:16]:

  During the therapy, it came out that Bob's abusive father had always pushed him really hard to succeed. The therapist suggested that maybe Bob failed at work to send a message to his father, I e, to prove that his father's abusive parenting had been a bad idea and would not make Bob The therapist asked Bob to imagine confronting his father about this. After he worked through his anger at his father, Bob was able to succeed at work. In this Story, the apparently dysfunctional symptom, failing at work, ended up having a legible purpose within Bob's life history. It helped him send a message to his father. Only by teasing out the purpose and finding some other way to achieve it could the dysfunctional behavior be prevented. Historical, nonpurposeful account might argue that Bob failed at work because he was bad at work. Maybe he was bad at the specific jobs he was holding, in which case he should get more training.

  Carrie Wiita [01:17:08]:

  Maybe he was bad at social skills, in which case he should get treatment for ADHD. In any case, him being bad at work isn't related to any past traumas or serving any hidden purposes. It's just an unfortunate

  Ben Fineman [01:17:27]:

  fact. Yeah. I think this is another way to make the argument that, Yes. Everything works equally the same on average, but should Bob be getting a different type of therapy depending on if it's about his dad or ADHD or social skills? And And it it really does seem like the answer is yes Mhmm. That you can make the case, prove that one treatment is better for ADHD than another or for working on social skills. But Mhmm. Clearly, there needs to be some focus that changes based on why Bob is struggling at work, I think.

  Carrie Wiita [01:17:58]:

  Right? Yeah. I mean, no. This is exactly what we're talking about. Right? And this is where again, I know I know this is my lens. This is I've I've picked postmodern approaches because it the logic adds up and makes sense to me. But, like, I read this paragraph, and I Couldn't agree more, and it makes me conclude the only thing that matters the only thing that matters is Bob himself. What which of these suggestions resonates for Bob and gets him to change and get, like, in a way that he wants to change too. Yeah.

  Carrie Wiita [01:18:31]:

  And

  Ben Fineman [01:18:31]:

  how can your approach to therapy give Bob that?

  Carrie Wiita [01:18:35]:

  Yeah. Yeah. Because you're right. Any you could argue anything, but if you are, like, a hardcore psychodynamic or psychoanalytic therapist and You are gonna argue either historicism or purposefulism. Right? I don't unless Unless you, like, really have a very open mind and hold your orientation loosely, you are gonna have a vested interest in convincing the client convincing Bob that no. No. No. You're trying to send a message to your father.

  Carrie Wiita [01:19:04]:

  Right? Am I wrong?

  Ben Fineman [01:19:06]:

  No. No.

  Carrie Wiita [01:19:07]:

  No. Right?

  Ben Fineman [01:19:07]:

  You're wrong at all.

  Carrie Wiita [01:19:09]:

  Because that's what that's the the the I don't know what the the double thing. That's what the the tautology of of those theories says that this is the explanation. If the client rejects the explanation, then the client is being resistant. He's having unconscious things that are preventing the the truth of what you're saying as a therapist to enter into his unconscious, and so you have to work harder to overcome the defenses. Right? It's this, like, circular fucking

  Ben Fineman [01:19:34]:

  Amen. Amen. We got we got 1 page left. Should we keep going?

  Carrie Wiita [01:19:38]:

  Yeah. Yeah. Yeah. Yeah. Okay. I am constantly worried by the history of how many things we historically applied historical purposeful reasoning to. Totally confident at the time that our explanations made sense, which we now know are not historical purposeful at all. Psychologists Knew that autism was caused by distant mothers and schizophrenia by overbearing mothers right up until we discovered both conditions are about 80% genetic.

  Carrie Wiita [01:20:05]:

  And when they knew these things, they were able to come up long lists of how exactly each individual patient fit the mold and reported great progress by helping patients overcome their maternal attachment issues back when homosexuality was considered a disorder. Historical purposeful therapists would tell gay people Patients would tell gay gay people patients

  Ben Fineman [01:20:26]:

  Gay patients, I think, is probably

  Carrie Wiita [01:20:28]:

  kids. Yeah. Historical purposeful therapists would tell gay patients that they must be so angry at their mother that they had sworn off all female companionship and switched to men instead as a way of sending her a giant fuck you message. While homosexuality is mostly not genetic, few people today think this is a plausible Explanation. I sometimes see if I can come up with these kinds of historical purposeful accounts of my patient's symptoms. These always fit into place freakishly well, So well that either the historical purposeful perspective is completely true, or there is some very strong bias that makes it were convincing despite its falsehood. But we already know there's some very strong bias that makes it extra convincing despite its falsehood. That bias must have been at work In all the therapists who applied historical purposeful narratives to autistics, schizophrenics, and gays, at Some point, I noticed the road I'm on is littered with skulls and start wondering if I should

  Ben Fineman [01:21:26]:

  reconsider. Yeah. It's Therapy or, like, how you view mental health through a therapeutic lens. To me, it's just like a horoscope where if you're going in believing in a certain idea about The horoscope or, like, astrology where Yeah. Yeah. I'm a Virgo, therefore, blank. You will Right. Interpret your life through that lens, and you will be right.

  Ben Fineman [01:21:45]:

  Even if you interpret it through a different lens, you will still be right because you can see what you wanna see in yourself. And I think therapy is just like that where your confirmation bias will make you see exactly what you want or expect to see in almost every single client you have. And if you're certain that your approach is right, You will confirm that truth every time you see a client, and nothing will shake the foundation, especially if you think that if it's not working, you You do it more or do it differently, or the client's not ready? It's such a dangerous way of thinking because you get locked into the idea that you are right, And mental health and therapy is ambiguous enough that you will always find something to confirm your existing belief.

  Carrie Wiita [01:22:23]:

  I completely agree with you. You are a 100% right.

  Ben Fineman [01:22:26]:

  Thank you. You're welcome. Should we bring it home?

  Carrie Wiita [01:22:29]:

  Alright. All therapy books propose An answer, the proof is that the patients get better, but my patients do not get better. When I tell them the historical purposeful accounts I have devised for their symptoms, They usually shrug and say, it sounds plausible, and they've thought along those lines before, but what are they gonna do? When I try all the exciting new therapies on them, they just Sort of nod, say that sounds like an interesting perspective, and then go off and keep having symptoms. It's very rude. I've told this story before. When I was a teenager, I got really into pseudo history for a while. What snapped me out of it wasn't the sober historians who Totally went AWOL on their job of explaining why they were right and the wackos were wrong. It was that a bunch of mutually exclusive pseudo histories all sounded equally plausible.

  Carrie Wiita [01:23:16]:

  The pyramids couldn't have been built by Atlanteans and Lemurians and mole people. At that point, I was able to halt, Melt, catch fire, and realize there was something really wrong with my reasoning processes, which I continue to worry about and work on 20 years later. I bring this up because I'm going to be reviewing some specific psychotherapy books. Each of them on their own can be convincing, but they should be taken in the context of All therapy books, which as a category are pretty

  Ben Fineman [01:23:46]:

  worrying. Well done. Thank you for your dramatic reading.

  Carrie Wiita [01:23:48]:

  You are welcome. I enjoyed that.

  Ben Fineman [01:23:51]:

  So the last question I have based on what Scott is saying here at the end because earlier you were asking, so what is it about the people who write these books? Yeah. Do they really believe it, or do they know some of it is a grift? And I wanna ask the same question or similar question about therapists, not the ones who write these books, but the ones who read these books. Do therapists simply not realize that there is such a logical flaw in the fact that all of these Can't be mutually exclusive, but they're all talking with certainty? Or do they realize it, but there really is no incentive within the field to do anything about it Because therapists get paid by being able to confidently describe why what they're doing is effective both to clients, to students, to supervisees. So do therapists know that this is kind of fucked up, or do Actually, no.

  Carrie Wiita [01:24:42]:

  I think they don't actually know, and I'll tell you why. I think first of all, our field is not incentivized to tell them, particularly supervisors. Right? A supervisor isn't isn't inclined to tell a a a trainee that, you know, I I I'm teaching you this method of doing therapy, but it, like, might not be it might not be it. You know? But I'm I'm I bring I come back to, the moment there was 1 moment in a discussion that we were having on the show where you shared the Study if you remember the exact one, you shared the study where, 80% of therapists polled, Believed they were in the top, like, 1% or 5% of something. Top they were in the top level of performing top level performing therapists. And that can't be true because a a a standard distribution would mean that they can't. A very tiny percentage are in the upper percentages. Yeah.

  Ben Fineman [01:25:50]:

  Yeah. It wasn't quite that dramatic, but this was a study where, I think it was a I've talked about this so much that I know the numbers. It was and I'll put a a link to this in the show notes. It was a study of a 129 licensed mental health professionals. 100% of them said that they were average or above average. Mhmm. And I think it was 80% of them said they were in the top 25%. Everybody thinks they're above average.

  Ben Fineman [01:26:17]:

  Right. And most therapists think they're, like, significantly above average.

  Carrie Wiita [01:26:21]:

  But it wasn't until you said mathematically that can't be true that I went, oh my god. Totally. You're absolutely right. But it's absolutely changed. You explaining that changed how I think when people ask me, like, how well do you think you did that? Like, I I am inclined to be like, pretty good. I feel pretty good about myself right now, but then I remember somebody's gotta be bad at it. Maybe it is me. You know? Well, I mean which is, I think, a good thing, though.

  Carrie Wiita [01:26:50]:

  This is what I'm saying. It took you saying that in from me to understand the ramifications of that for what it meant for how I analyze my own performance. I can't trust myself because I am inclined to be optimistic or I'm inclined to believe I'm exceptional when the math simply that math ain't mathing. Right?

  Ben Fineman [01:27:16]:

  You know? Did you just make that up?

  Carrie Wiita [01:27:18]:

  No. No. No. No. That's a thing. That's a maybe it's a TikTok thing. The math ain't mathing. Oh my god.

  Carrie Wiita [01:27:22]:

  I love it. But, you know, so I think that that's what I think most therapists fall into that. It just hasn't occurred to them. I think it genuinely hasn't occurred to them that all of these approaches can't all be right. Francine Shapiro can't be right a 100%. Richard Schwartz, All of them who have these, trauma, you know, approaches, they can't all have the answer. But we don't think about it that way. We think that that sounds like the right answer.

  Ben Fineman [01:27:52]:

  Oh, okay. New plan. Instead of coming up with our own modality, Carrie Yeah. You wanna get rich?

  Carrie Wiita [01:27:57]:

  Yes. I do.

  Ben Fineman [01:27:58]:

  Let's figure out a way to integrate IFS and EMDR and sell trainings for, like, $10,000, and we will just, like, ride off into the sunset.

  Carrie Wiita [01:28:07]:

  We Could make so much money.

  Ben Fineman [01:28:10]:

  Mhmm. Oh, you do bilateral stimulation first Yes. With your, firefighters To help them know that it's okay, then you do it with your managers, and then the final stage in the sequence. And the training for this, by the way, is super exclusive and cost $50,000 and the rights to your firstborn child.

  Carrie Wiita [01:28:29]:

  Oh, good. Good. Good.

  Ben Fineman [01:28:30]:

  Yes. Is doing bilateral stimulation with your exiles because you really need hyper advanced Training. Otherwise, you don't you don't even know what you're

  Carrie Wiita [01:28:38]:

  doing. Otherwise, you're you'll damage your client. What are we gonna do with all those children? The firstborns that we

  Ben Fineman [01:28:44]:

  have. Hashtag save the children. We'll we'll give them EMDR IFS from from, like, age 3 to Repair their trauma in utero.

  Carrie Wiita [01:28:55]:

  They they will be the healthiest. You just had another money Making idea, didn't you?

  Ben Fineman [01:29:02]:

  Damn my sense of ethics.

  Carrie Wiita [01:29:05]:

  You know what's gonna happen now, Ben? We're gonna have Somebody email us and tell us, oh, that that exists. That exists. Yeah. Somebody's integrating IFS and EMT. There's no question about it. Somebody is.

  Ben Fineman [01:29:20]:

  Well, thanks to everybody for listening, and thanks, of course, to Scott Alexander for writing such A fantastic blog post, which, of course, I will be linking.

  Carrie Wiita [01:29:29]:

  So good.

  Ben Fineman [01:29:30]:

  Carrie, thanks for going on this journey with me.

  Carrie Wiita [01:29:31]:

  Thank you, Ben. This was an absolute pleasure.

  Ben Fineman [01:29:40]:

  Alright, Carrie. How about some listener mail to finish this episode up?

  Carrie Wiita [01:29:44]:

  I cannot wait.

  Ben Fineman [01:29:46]:

  Well, nothing can top the the brilliance of the every therapy book ever, review that we just combed through. This is a pretty great email for different reasons. This comes from Caitlin Ware, and she's writing in response to our episode number 131 Where, Carrie, you and I were talking about what to ask clients in the 1st session, what to do in the 1st session.

  Carrie Wiita [01:30:06]:

  Right. Right.

  Ben Fineman [01:30:07]:

  And so Caitlin writes in, Hi, Ben and Carey. Longtime listener, big time fan of the show from a newly registered psychologist in Australia. I'm currently listening to episode 131, VVT study hall first sessions and felt compelled to share some brief input about how I feel I swiftly and seamlessly collect information about traumatic brain injuries As part of my standard biopsychosocial assessment during intake sessions, my interviews go a little something like this. With everything going on for you, how's your appetite been? How's your sleep? Do you exercise? In terms of your physical health, have you ever suffered any significant illnesses, injuries, or accidents? And if yes, how has this affected you? Hope this helps. Keep up the great work. Your content has been fantastic while completing my master's in clinical psychology over the past 2 years.

  Carrie Wiita [01:30:53]:

  Oh, that is so great.

  Ben Fineman [01:30:55]:

  Yeah. It's just like it's like a 10 second way of assessing for something that is unlikely, but if relevant to therapy, would completely change the trajectory of treatment.

  Carrie Wiita [01:31:06]:

  A 100%. Oh my god. I love it.

  Ben Fineman [01:31:10]:

  And then she added, and upon asking my clients this, they they convulsed into a fit and said that they had magically cured 50 years of depression and Just

  Carrie Wiita [01:31:22]:

  kidding. Well done. Thank you for listening to Very Bad Therapy. The views and opinions expressed do not constitute therapeutic or legal advice, nor do they represent any entity other than ourselves or our guests.

  Ben Fineman [01:31:40]:

  Visit us at very bad therapy.com for more content, ways to support the podcast, Or to let us know if you have a story you'd like to share on the show. If you'd like to join our Patreon community and get access to our monthly bonus episodes, Check us out at patreon.com/verybadtherapy.