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Therapy Modalities- Getting the Most Out of Therapy · Millennial Mental Health Channel

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Quidratu saludal. This is Millennial Mental Health Channel. I'm doctor Justin Romano,
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a child adolescent psychiatry fellow, and I'm Adi Koreo, a licensed clinical therapist.
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Our podcast is here because we wanted to start a much need to conversation
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about mental health. Our goal is to teach you as much as we can
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by sharing our own experiences and interviewing experts in the mental health field. We
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will discuss topics like mood disorders, psychotic disorders, substance use, personality disorders,
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and many more. Millennial Mental Health Channel buy Millennials for everyone. We
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hope you enjoy today's episode. MMHC is a production of Speaker from iHeartMedia.
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I heartma Ye. Welcome back to mmHg Edny Korea. What is our topic
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for today? I can't like describe it, but there's like a specific like
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SpongeBob episode that comes up with like some similar character which is on there,
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And that's like the first thing I've thought about. So I actually am not
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I forgot what our topic is today? Do we have a topic? Just
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kidding? The topic therapy the basics of therapy, therapy one on one,
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psych one fifty or maybe it's more of a graduate level, so psych five
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to ten would be like the course number. We're just going to talk about
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therapy. What to look for in a therapist, What are the modality specifically
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that some therapists do, What do they mean? What do the acronyms mean?
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Just want to give you information so that you can be the best consumer
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of therapy as possible. I think there's a ton of acronyms in probably a
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lot of medical professions, but in mental health for sure. I mean,
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my licensure is an acronym. Other licensures are an acronym. Different therapy modalities
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or acronyms. Acronyms are everywhere. So hopefully with us talking about specific motive
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today we can clear that up. We can make it a little easier.
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So if you are looking for a therapist, if you're helping someone find a
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therapist, you at least know what you're looking at. You know what these
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different acronyms mean, and it makes it a little easier. And a lot
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of the episodes that we do justin we'll add a section on like treatment options,
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like what is helpful for an eating disorder? What is helpful for ADHD,
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autism? And oftentimes he will put specific therapeutic modalities, and we thought
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about it and we're like, well, we mentioned these things, but we're
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not really sure if we've really ever talked about what those things are specifically,
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what is DBT, what is cognitive behavioral therapy. We also want to mention
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that four years ago, long time ago, one of our very early episodes
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had to I think it was a single digit episode justin I don't know if
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you remember, I can barely remember, but it was basically like how to
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find a therapist. So we did that, but we really didn't talk extra
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about the modalities. So that's what we want to talk about today. We
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want to talk about some common modality, some things to look out for,
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some thoughts that we just have professionally. Just the importance of being a good
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consumer. If you are someone that's going to look for therapeutic services, either
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now in the future, you're trying to help somebody. So that's the biggest
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thing for us. We want to make it easy for y'all to understand before
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we keep going, Before I keep rambling justin, do you have any shout
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outs, anything you want to cover before I just jump even more into it.
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I want to shout out you because on the How to Find a Therapist
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episode, you told me and our listeners about Psychologytoday dot com, which is
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a great way to find a therapist. It's not the perfect way, but
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it's something I use all the time because I have lots of patients come up
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and say like, hey, I've got try care, I need someone who
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does autism testing, and I need it for ages like six to eleven.
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And I'm like, okay, I can plug all that into psychologytoday dot com.
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It actually gives me a list of people. It's been a super helpful
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tool for me too, especially with starting my job as an attending and not
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knowing the resources a well as well in Wyoming. So yeah, Psychologytoday dot
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com is a great way to start that process for finding a therapist. How
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about you, Eddie, any shout outs for us? Well, I'm glad
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it's been helpful. First off, yea, in terms of shout outs,
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I mean this is cheesy, but just our listeners, our supporters. We're
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finishing up wrapping up another calendar year, we're going into the new year.
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We're thinking about taking a little break right after this episode, but really just
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thankful for all you who continue to listen and give us reasons to talk to
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record to give you stuff to listen to. So thank you guys again justin
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I'm glad Psychology Today has been helpful for you. One thing I'll add I've
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noticed in the years now that i've been using it more recently, they've added
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this not really a feature, more of a reminder or just a suggestion that
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if you do use Psychology Today, immediately after you email someone on the platform,
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like a therapist, it'll say like, oh, let's try to find
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you two to three more so you have options. And I think that's to
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to basically acknowledge that it can be kind of hard to find a therapist.
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Again in the Psychology Today is not perfect, but it is really helpful and
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I actually just use it today to try to help a student who needs help.
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So with all that being said, let's just start with a little definition.
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So, according to the National Institute of Mental Health, psychotherapy the term
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refers to a variety of treatments that aim to help a person identify and change
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troubling emotions, thoughts, and behaviors that I guess in a nutshell, what
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therapy is. Many types of professionals can conduct psychotherapy, so that includes psychiatrists
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like doctor justin, counselors like your boy, psychologists, and social workers.
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One thing that they didn't mention in there, but it falls under kind of
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like the same master's level clinicians. Is also like marriage and family therapists.
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If you're not in the field, you don't really pay attention too much to
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it. But one thing to just be thinking about if you're ever gonna look
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for somebody is just that different states have different titles for therapists. So like
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for me, I'm a licensed professional counselor in the state of Oregon. I
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believe the similar licensure to myself in California is an LPCC, which is a
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licensed Professional Clinical counselor. Right above me. In the state of Washington,
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literally an hour away if you cross the river past Portland into Vancouver, Washington,
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they go by a similar licensure as LMHC, so licensed mental health counselor.
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So just things I think about at the end of the day. As
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as long as either someone's license or at least registered with the board, that's
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probably a good thing in terms of finding a professional. Oftentimes, people who
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conduct therapy are licensed professionals. But in the case of master's level clinicians like
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me back in the day, professional counselors, marriage and family therapists, mental
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health counselors, and social workers, there is about a two to four period
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two to four year period where they're working towards licensure, so they are You're
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not just automatically licensed once you graduate and complete your National Board exam. It
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takes a couple of years of basically getting on the job experience that you can
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do. Like on your job, like you have a full time job,
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you're getting paid for it. What you're doing is you're accurring hours, and
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then once you have enough, once you meet the state's requirements, you're cann
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apply for license. Here. You can have the fancy license, you can
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have the nice little piece of paper in your office that says I am.
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It's going to be the wrong one because if I say I'm duly licensed,
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that means I'm licensed twice. That's not what I mean. But I'm licensed
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by the state of So and so I've met the requirements. I am legit,
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I do my continuing education, I do my whatever it is. So
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that's a little bit on that of therapists and like the basic bare bones information
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before we really jump into it. Yeah, and we bring up that last
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point because oftentimes when you're searching for a therapist, you may see people who
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include the world word associate in their title, and this means that they're registered
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with their state board and are working towards that license. Yeah, and like
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I mentioned today, there's a number of different approaches, but for today,
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we're going to focus on I think the main three. People will call it
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the third wave of behavioral therapy. You're just kind of the third wave,
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the newer wave. There are some newer modalities that I'll mention at the end,
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but this is kind of like the one that a lot of people will
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mention, So very first one. Cognitive behavioral therapy CBT. This is the
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one. This is like the one that everybody will say they know, because
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most likely they do. This is the main one that's talked about in school.
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This is like modalities one oh one, Like this is the first You're
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the first thing you're writing on your notebook or you're typing into your computer or
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whatever is CBT. It's probably the most intuitive. It really just makes sense.
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Really the basic premise of it is trying to find, discuss, and
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make changes to the connection that we have with our thoughts, feelings, and
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behavior. So think of it as a triangle. You have this imaginary triangle
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in front of you. I'm picturing it. I hope you're picturing it too.
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On one corner you have thoughts, On the other ones you have feeling,
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and on the last corner you have behaviors. In CBT, this is
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where you see a number of therapists use a lot utilizing worksheets, So oftentimes
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we have a lot of homework and assignments. So say you're in therapy for
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a type of anxiety, say you have some social anxiety, some of that
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homework might be okay, what's one step you want to work in the direction
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of being in public forcing yourself to work on these things, to expose yourself
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to the things that make you anxious with the hope of that them not making
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you more anxious in the future. So the goal of CBT is to take
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the understanding of how those three pillars that Eddie mentioned are intertwined and then learn
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how to best manage stressors so that now be your reaction of behaviors, emotions,
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and thoughts will impact the other. Yeah, like you're just more aware,
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Like you know that if I have these certain thoughts, this can impact
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my emotions and this way, if my emotions are this way, this,
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what could this is? What could happen to my behaviors? Some common disorders
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that are treated with CBT, if you ask, like if you if you
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ask insurance, everything is treated by CBT, but insurance. We don't really
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care what insurance says sometimes, but really the most common ones that are studied
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a lot depression, anxiety phobias, PTSD, and substance use disorders. There's
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more, but I think those are the ones that come up often that are
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just like CBT. BAM, It's like the one size fits all, even
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if it doesn't necessarily always fit all. With like all types of things that
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we tell you about, we at least want to give you both sides of
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it, the pros and cons. So I'll start with the pros. CBT
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is something that's highly studied and backed up. There's just if you go to
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Google scholar which is a great free resource to try to find articles and just
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things to read if you want to learn more. CBT has a lot of
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articles that kind of will replicate studies and be able to have some strong evidence
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for it. A lot of studies show it to be highly effective in the
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disorders that I can treat. It's versatile. It can be used in different
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settings like groups. I teach about group therapy every summer to master's level students.
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I enjoy group therapy, so CBT is definitely something that can be used.
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Another really good pro is that it can be used as a short term
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intervention. So it's something that like some people, if you say you work
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somewhere where you have this benefit of eight free sessions of therapy, oftentimes you're
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going to get someone that practices CBT. Hopefully in those eight sessions they do
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a good enough job to help, like in the interrom and help you learn
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and be able to really take some good information home. So it's able to
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make a positive impact on your life. But oftentimes it could be used as
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a short term intervention, and early evidence shows that it can be effective for
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Internet and social media addiction, which Justin has a great Ted talk on,
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so yes, go check out that Ted talk. I was doing some research
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recently, and there's not a lot about social media and internet addiction because it
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is such a new addiction, but there is some good evidence showing that yes,
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this can be applied to internet, cell phone, smartphone, social media
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addiction, so that's a major plus. Some of the cons of CBT is
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that it can be difficult if your readiness for change is not there and it's
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not able to shift towards action. So you have to be ready for therapy.
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You have to like if you're forced to do it, if your court
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ordered to do it, if your parents are forcing you to do it,
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it won't be quite as effective. And that might be true for most therapies
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too. Yeah, there is a lot of homework and worksheets, so if
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you're the kind of person who says like, hey, that's not my jam,
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might not be the right therapy for you. And sometimes because it is
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the tried and true, it is the one that tries to appeal to everyone.
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Sometimes it doesn't appeal to everyone, and sometimes it can be too rigid
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for some clients that need a little bit more flexibility and can't stick to the
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exact program. When you said tried and true just made me think of like
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a bald eagle, like flying across the screen, and just like, yeah,
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if you need a truck that can handle whatever life throws at it.
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Pick for tough. I don't know why. Just the CBT is the Ford
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f worn fifty of the world. That's pretty good. It's the tried and
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true. Okay. So now that you say that, I have to throw
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this in here. Okay, it's super off topic. Holy shit. Okay.
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Back in fifth grade it was part of like the California Standards that you
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had to learn about, like US history and obviously like not all the like
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the facts of US history, but just like the basic like oh the British
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and Paul Revere and blah blah blah. So at the end of the year,
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the fifth graders did this big performance where they would do like a skit
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or a play that took you through the the years of America basically, and
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we had to sing in it. One of the songs we had to sing
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was the Hannah brow to Be, So that' gon that back from the tangent
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before we continue. One thing I wanted to mention. I told myself,
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say this before you even talk about CBT, But of course I messed it
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up. But that's okay. One thing that I do want to mention,
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Yes, modality expertise in modality, being like an expert and DBT. Whatever
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modality is great, It can be really helpful, it can be really impactful,
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and it can really make or break, you know, if you're able
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to get better or not. I personally think and professionally think the thing that
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takes that thing that is more important than specific modality is being able to connect
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with the therapist and being able to make a connection with a random human that
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you were meeting for the first time, that you were reaching now too,
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for support at potentially your lowest and going from there. I have told my
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students this. The very last day of class this last summer semester, someone
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had mentioned that one of their professors had said, basically, they said,
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you have to like pick a modality and stick to it, and like you
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can't say that you're eclectic and you do multiply blah blah, And I said,
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fuck that. Do whatever you want, do whatever you're comfortable with ethically,
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make sure you know what you're doing and you're like you're read up on
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it and you're competent in it. But really the most important thing is being
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able to connect with somebody, Like I tell students, is all the time.
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You could fucking buy whatever manual you want, you could take whatever training.
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But if you can't meet someone for the first time and make a connection
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with them within three minutes two minutes, that makes them say like, yeah,
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I can work with this person, or I can tell them some of
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my most difficult thoughts and feelings, then the modality is out the window.
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It doesn't matter what the hell you do. Yeah, And that's actually a
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great point, and that's actually backed up with studies and evidence, is that
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that ability to connect, that connection you have with your therapist changes the outcome
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more than anything else. So, yes, modality is an important and it's
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important to do the right type of modality in the right situations, but that
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connection is pinnacle. Yeah, absolutely, what got next? Up? Next,
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we have dialectical behavioral therapy, which is one of my favorite types of
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therapy. This was created by the og Miss Marshall Liahan to help with borderline
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personality disorder and suicidality. We do have episodes on borderline personality disorder. If
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you are in suicide, I believe actually, if you are so interested.
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So this is a highly structured and manualized approach. According to Elective Clinic the
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term dialectical refers to working with opposing forces, so die meaning to electical,
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apparently meaning forces. So the aim is to accept yourself as you are and
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at the same time embrace the power that you have to change. So one
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of my favorite lines in this is I'm perfect just the way I am,
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but I still have room for improvement. It's important to give yourself that grace
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and say like, I'm okay with who I am, but there's always something
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I could be working on. So DBT has four pillars mindfulness, distress management,
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emotional regulation, and interpersonal effectiveness. DBT is some good shit. I
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have been on this like kick of just being so intrigued by it since the
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summer. My students were doing their final projects and one week is about DVT
17:49
and group and group therapy. And there was something about one of the presentations
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where I was like, man, I've known about DBT since I've been in
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school, but maybe it took me until I was thirty years old in the
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summer and been in the field long enough to be like, Wow, this
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really clicks for me. This is so cool. And I think I told
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you about this. I probably mentioned that in one of our episodes around the
18:14
same time. But that same night I checked out Marsha Lenihan's book Building Life
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Worth Living. It's her memoir and I read that thing in like a week
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because it was just so good and it talked about like her journey of struggling
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so hard. And I didn't put this in the note, and I know
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Justin knows this, but yeah, it was made for She created it to
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help with borderline personnel disorder and suicidality. But she made it to help in
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those things with her ye, because those are things that she was struggling with
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and she was having a hard time with. And she was in and out
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of long term treatment, not any of that like outpatient once a week,
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so like she was in residential. So she had it tough and she worked
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through a lot. And it's really too. It's really cool too because a
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lot of the components of it come from they're not Western culture. It's like
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more of an Eastern culture. I think she even stayed with like Buddhist monks
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for a while. Like it's really cool stuff. It inspired me to take
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a DBT and a nutshell training maybe like a month later. I'll be the
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first to say I will never do the Marshall Lenehan DBT certified thing that's just
19:22
not an interest to me, but being a DBT, being informed by DBT
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and knowing like some basic skills and stuff that stuff that I think is really
19:33
cool and really resonate with. And one thing that I've actually because of the
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book and the training this summer, one thing that I've actually really focused on
19:41
with my kids who are in crisis with either like anxiety, a panic attack,
19:45
or just feeling like they're just so overwhelmed is doing one of the techniques
19:49
of kind of temperature control and either giving them a cup of ice or getting
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them to like splash their face with water to try and bring the overall body
20:00
temperature down, which then brings down their heart rate helps them calm down.
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So DBT is some good stuff. We'll tell we'll talk about like what's kind
20:07
of hard about it, but it's it's really good. So I hope you
20:11
can hear from my like it's just been so like interesting for me, like
20:17
this little like DBT intrigue journey that I've had the last six months totally.
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And yeah, it sounds like Eddie and I are both big fans of DBT
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because those four pillars that we mentioned can apply to everyone's mindfulness, being aware
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of your thoughts, feelings, and emotions and how that impacts your life.
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Distress management how to be able to calm yourself down if you're really worked up,
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emotional regulation, how to make sure your emotions don't get in the way
20:47
of your life, and interpersonal effectiveness, communication, conflict resolution. All of
20:52
this stuff everyone could benefit from, and that's one of the reasons why DBT
20:56
is such an impactful therapy. There is a large importance on using coping skills
21:03
to deal with these stressors, so it teaches you specific skills, it gives
21:07
you a ton of suggestions of how to actually use this stuff to make your
21:10
life better. And DBT itself can be used to treat things like borderline personality
21:17
disorder, which four percent of the population has, substance use disorders, eating
21:22
eating disorders, and suicidality. So it's a little bit of the opposite coin
21:27
of CBT. It's a little bit more specific for specific disorders, but man
21:32
in those things it can be super effective and really change people's lives. I
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think one of the cool things about DBT and I think what really makes a
21:47
stick out compared to the other two that we're talking about today, is the
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other two give you like almost like some thoughts. So you have like mental
21:56
tools, like you have a mental toolbox to use, whereas DBT almost feels
22:03
like you get more of like physical tools with the coping skills that it teaches
22:07
you. So it almost feels like you're like actually leaving with something, like
22:11
even though it's not physical, but you're leaving with something, whereas the other
22:15
two you're almost kind of just not just but you're trying to restructure the way
22:19
you're thinking about things. So I think that's another cool thing about it.
22:23
Yeah, it's a little more tangible m in terms of pros and cons.
22:29
I told you we're going to talk about both today. Pros So it's it's
22:33
evidence based, very evidence based when done to fidelity, so when done to
22:38
the way it's supposed to, when it's reaching all the requirements that have been
22:42
set forth by the National Institute of Marshall Lenihan or whatever it's called. For
22:48
DBT, the client has access to the clinician outside of therapy sessions, so
22:52
that could be really helpful. There is a texting component with like legit DBT
22:57
certified clinicians where they know that they might be on call with certain clients,
23:03
and it's highly effective in groups. It's another really great one that you can
23:07
teach a group of people some coping skills, and now you just have a
23:10
group of people that left your group room that all just learned a skill that'll
23:14
help them in the near future in their life. The idea of being able
23:18
to connect with your provider even outside of sessions kind of scares the graph out
23:22
of me, Like, I know, I couldn't do that because I need
23:26
to separate from work when I'm done. But for those people, one thing
23:30
I noticed, the people who need DBT the most, the people with borderline
23:33
personality disorder oftentimes are the types of people who don't feel like they have someone
23:37
to reach out to in in a big suicidal episode, anger episode, So
23:44
it's really useful for them to have someone or the people in their life are
23:47
very invalidating if they have one of these episodes too, So being able to
23:51
access a therapist in a crisis can be very useful for them and help prevent
23:56
a lot of negative outcomes. Some of the cons of DBT is that it
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can be hard to find someone who is certified. That's the biggest con for
24:06
me is just getting people to a DVT therapist and making sure they have openings
24:11
and taking new clients. It can be hard because I want to get everyone
24:15
DBT, but it is a limited resource. It is also a significant time
24:18
commitment. I usually tell my patients like, we're going to start this therapy
24:22
and it is going to help, but it will take months two years to
24:29
really see the full effects of it, so I want you to stick with
24:32
it as much as possible. And it is very structured and usually has a
24:34
lot of homework, so again, if you're not a homework person, this
24:37
might not be for you. Yeah. And our last of the main three
24:41
that we want to talk about, and I think this one is the newer
24:44
or newest of the three, is Acceptance and Commitment Therapy or ACT. ACT
24:48
aims to develop and expand psychological flexibility. So psychological flexibility encompasses emotional openness and
24:56
the ability to adapt your thoughts and behaviors to better align with your values and
25:00
goals. And I want to share like a way to think of the three
25:03
when we're done with this one. So if I forget, just to remind
25:06
me, but I have a thing that I've thought about, and I think
25:08
it works similar to DBT. With ACT, you're paying attention to the present
25:14
moment, but instead of turning to a specific coping skill, you turn to
25:17
your own cognitive flexibility and work through accepting the present moment. ACT also has
25:22
its own pillars, but they call them the six core processes, which includes
25:26
stay in present, diffusion, committed action, personal values, self as context,
25:33
and acceptance, all of which are centered around the idea of psychological flexibility.
25:40
And I remember I had an attending ones that explained it to me a
25:41
little bit and correct me if I'm wrong, because acceptance and commitment therapy is
25:45
probably the one I'm the weakest on. But he said, it's like,
25:49
you have to accept the things in the world that suck and get to a
25:56
point where you can accept it and then move on and folkocus on the things
26:00
that you actually enjoy, focus on the things that you can control, which
26:03
is a really healthy thing because, especially in our world of social media twenty
26:07
four hour news cycles, we are constantly faced with bad news and bad stuff
26:15
that we have no control over. And I see how it affects a lot
26:18
of people and they let it get them so down. So it seems like
26:22
ACT might be something that is really important for this next generation because they are
26:26
just bombarded with bad news twenty four to seven. Did every tell you about
26:30
the book The Subtle Art of Not giving a fuck? Yeah, the guy
26:33
is not a clinician at all that wrote it or the person that wrote it,
26:37
But a lot of the principles in there are kind of ACT based,
26:41
where it's basically like, both things can be true. This fucking sucks,
26:45
and this is what I can do to not let it impact me. Yeah,
26:51
exactly. So. ACT can be helpful in treating anxiety, depression,
26:56
substance use disorders, and chronic pain, which is fascinating. A lot of
27:00
therapies can help with chronic pain issues too, and it's oftentimes an overlooked aspect
27:06
of mental health that can be really useful. Some of the pros of ACT
27:11
are that it promotes psychological flexibility and mindfulness. It is evidence based, A
27:17
lot of studies have shown that it is useful and effective, and it takes
27:22
a holistic approach, which I know a lot of people are looking for.
27:25
They want that holistic approach. Some cons it requires active participation, which I
27:30
think we could honestly put, for for any type of modality, you got
27:33
to you gotta be, you gotta participate. I mean, there's no other
27:36
way around it. We can't really fix it for you without that. There's
27:40
a limited emphasis on the paths. Some people don't like that. Some people
27:44
feel like if you're not going to focus on the past, then you're really
27:47
just like braining it down. But it depends on who you ask. There's
27:51
a lack of standardized protocols, which for someone like me, hell yeah,
27:55
that's pretty cool. Uh, but so for some people they don't like that.
27:59
And the last part is it's not a quick fix. So trying to
28:02
teach yourself this ability to be like, wow, that really sucks and I
28:07
need to move forward from it so that the rest does not suck. Where
28:12
with like therapy, it that it can be that thing that helps you build
28:18
new pathways in your brain where when something negative happens, you're able to choose
28:22
a different way to react. Similarly, it's it's like it can take a
28:27
while to do that. Everything takes practice, right, So it's just something
28:30
to think about, Okay, cbt dbt act right. The three of them
28:36
have a sort of basis in the act of maybe not being not mindfulness per
28:42
se, but being present and being able to acknowledge the present moment. CBT
28:49
is all about being present and being able to see how the present moment has
28:53
impacted the three pillars right, emotions, thoughts, behaviors. DBT is all
29:00
about being present in the moment and being able to decide this is the coping
29:04
skill I'm gonna use right now to help deal with these stressors. ACT is
29:11
all about being present in the moment and saying, fuck it, I'm gonna
29:15
go ahead and move forward and not let this hold me back. It's a
29:19
very very simplified way of thinking about it, but that's how I explain it
29:23
to students, and that's what helps me remember, like how they're they're all
29:29
a little different from each other. I like it. I am okay,
29:34
so now the rant okay so modality is to be aware of E M d
29:38
R I movement, desensitization, reprocessing, reprocessing. I was gonna say reciprocity,
29:48
not reciprocity. That's one that's very popular with trauma PTSD. There's a
29:52
whole component about it with like moving your eyes and tapping noises and stuff can
29:57
be really helpful if heard good thing about it. That's one to know.
30:02
Another one is trauma focused CBT. There's like a specific branch of CBT that's
30:06
all about focusing on trauma. Really, I literally just stated like I said,
30:10
trauma focused CBT, and then I basically said it backwards, saying,
30:14
yeah, trauma focused CBT, it's CBT, this's focus on trauma. That's
30:17
terrible. Uh, it's just a specific branch that that is the main component
30:22
to it. And then the last two these are the interesting ones. And
30:25
I don't know if you're familiar with these, justin internal family systems or IFS
30:30
and then Polyvagel theory. I tried to read into both of these to give
30:33
them a simplified thing or simplified like description, but it was a little hard
30:40
to do. So, so really what I want to say with that with
30:41
both of these is this, these are ones, the last two internal family
30:47
systems and Polyvagel theory that have really blown up in popularity recently. If you
30:51
go on the subreddit therapist, there's a lot of posts about it. A
30:53
lot of people are interested in it, a lot of people want to be
30:57
trained in it. Specifically, if a lot of people have questions about it,
31:02
and I bring them up because both of them have mixed reviews, and
31:04
I just think it's important that you are a knowledgeable consumer. That's kind of
31:07
the point of today's episode. In the simplest of terms, IFS first it
31:12
takes a look at the whole person and it basically says they are made up
31:17
of different parts. A lot of therapists have found this approach to be helpful
31:21
with their clients and in their own work, basically helping them compartmentalize who they
31:26
are as a person. And somehow for some people that just helps them,
31:30
I think, feel more in control and have a better understanding of them and
31:34
how they react with the world. As a clinician. One of the biggest
31:38
criticisms that I've heard about IFS is the cost of becoming certified and how difficult
31:45
it is to find certification programs. So for them, some people have complained
31:49
that it feels a little gatekeepy and it feels a little hard to access.
31:52
And because of that, is it really something that's helpful if you're going to
31:56
make the access point to it so difficult to think about. As far as
32:00
polyvagel theory, there are some concerns that it is an oversimplified approach of how
32:07
it describes our nervous system. So that's that's the most I could get as
32:13
far as giving you a simple description. And one final thought about it.
32:16
I was talking to a colleague and asking if they could share spread the word
32:21
on our Oregon Counseling Association conference that we had in October, yeah, a
32:27
couple months ago, And when I told her about it, they said they
32:30
asked if there was going to be any presentations that were that were not evidence
32:35
based, such as internal family systems and polyvagel theory. So take that information
32:40
however you want it. That's what some people in the field think about it.
32:45
At the end of the day, Really what's important is that you find
32:47
what works for you, you find what fits your budget, and you find
32:51
a clinician that can meet your needs and that you feel comfortable working with.
32:54
I know we talked a little bit about those types of trauma therapy and the
32:59
two most popul o the ones right now are EMDR and Trauma focused CBT,
33:02
and I think that's really important. Like if you do have a diagnosis of
33:08
PTSD, if you have been through traumatic events and you're just doing regular CBT,
33:15
you're not really digging in and processing the traumas that you have went through.
33:20
So I always try and recommend, and I see patients who come in
33:23
they're like, oh, yeah, I've been doing CBT for years. I
33:25
don't feel like it's really helping that much, not digging a little bit deeper.
33:29
Finally have PTSD, and I say, Okay, I know you love
33:30
your therapist, you've been with them for so long, but I think you
33:35
need something more. I think you need to work on this trauma. I
33:37
think you need to overcome that trauma. So that's preemptively saying, like,
33:43
if there's one take home point from me for today is that if you do
33:46
have trauma, try and get into a specific trauma therapist. That is the
33:51
best way to overcome that trauma. And again, it takes months to years.
33:54
It is a process. And sometimes trauma therapy makes you a little bit
33:59
worse before things get better because you're having to dig up these difficult memories,
34:04
you're having to relive your traumatic experiences. It sucks, but if you want
34:09
to get better, it is so important and that's the best way we know.
34:14
How I love it well said, how important is it to be in
34:17
the right type of therapy. We've talked about a little bit. I think
34:22
the right therapy is important. I'm not going to say very or not that
34:28
important. It is important. I think the most important thing is finding the
34:31
right therapist, the one that you can connect with, the one that you're
34:36
able to go to certain places with in terms of like difficult areas of your
34:40
mind and of your being. So I think that's really important. What do
34:45
you think? It kind of depends on the diagnosis. Sometimes that's a good
34:50
point. If you're dealing with bread and butter, psyic and mental health stuff,
34:53
depression, anxiety. Yeah, the connection is the most important thing.
34:58
But if you have borderline personality disorder, you should be in DBT. If
35:04
you have trauma, you should be in trauma therapy. That is the best
35:07
way to address the elephant in the room, to work on the things that's
35:12
going to make you better the most. What about changing therapists? Is that
35:17
allowed? Yes? This is the question I get all the time from patients.
35:22
Yeah, And usually my answer is the relationship fixable or repairable with the
35:29
therapist, Like what happened? Why are you upset with therapists? Why do
35:31
you want to change? Can you talk to therapists because your relationship with your
35:37
therapist is like a trial, a free trial. You can try different things
35:43
with them. That's what they are there for. You should be contrary or
35:46
be a little bit. You should advocate for yourself. You should tell them
35:52
when things aren't going well, tell them when things bother you or you don't
35:55
like a certain part of the therapy. So I'd say, if there's some
36:00
thing about your therapist you don't like, try and fix it with them,
36:02
because that in and of itself. Learning how to fix relationships instead of just
36:07
bombing them and moving on to the next relationship is a really important life skill
36:12
that you can translate to your friends and family. I know a lot of
36:15
people who do that when things start going south in a relationship, they bomb
36:19
it and get the hell out instead of fixing it and moving forward. So
36:22
I think using that with your therapist is a really important thing and something I
36:27
always advocate my patients do. I try to remind myself that I'm not everybody's
36:31
cup of tea. As much as I want to be as helpful as possible,
36:35
and that's totally fine. I see on the subreddit a lot of the
36:37
therapists. One that newer clinicians will be like, am I doing something wrong?
36:40
Like you know, this happens to me. People keep leaving, whatever
36:45
it is, and it's just important to remember it's not necessarily about us.
36:49
It's about being a potential component to someone's getting better, and it's their right
36:53
to choose who is going to be part of that process. And then I'm
36:58
curious, what do you think about what's a sign that you maybe need to
37:01
change therapists or you're not doing good solid therapy. Yeah, I think if
37:05
the therapist is just talking about themselves the whole time, I've heard a whore
37:08
stories like that. If the therapist is not using your input, like Justin
37:15
said, like, if you're a client that's trying to make things better and
37:17
the therapist is just not taking your input at all, that's an issue.
37:22
Logistical things like shitty communication, showing up late, especially if it's virtual.
37:29
If you have a therapist, I can't even get on time to a virtual
37:30
appointment, that's a big problem. Yeah, I think those would be my
37:35
main my main ones, I would say. The only thing I would add
37:38
to is, you know, I've had some people who have got like a
37:42
significant trauma therapy or you know, bad relationships with their parents, and they
37:47
they've been doing like with a therapist for a year, and I'll ask them
37:51
like, hey, have you ever talked about this with your therapist? And'll
37:52
be like no, Like you've been a therapy for a year and you never
37:57
talked about your relationship with your parents or your trauma. Like Okay, what
38:00
are you doing? You're like, Oh, he just asked me about my
38:01
day, and I just kind of tell him and then I leave. It's
38:05
like, that is not therapy. You shouldn't just go in and vent or
38:09
tell me about your day. You need to be working on stuff. You
38:14
need to be digging into this stuff. So if it's really superficial and you're
38:19
just passing the time for an hour and then getting out of there, that's
38:22
not therapy. Facts. Yeah. Yeah, we got some celebrities that have
38:30
been big proponents of therapy. Number one is one of my favorite artists from
38:36
my college years, Kesha, and I didn't put the dollar sign instead of
38:42
the S in the show notes, Uh so you wrote it wrong. I
38:45
misspelled it to Kesha had a really good quote that says, I feel like
38:50
part of my job was to be as skinny as possible, and to make
38:53
that happen, I had been abusing my body. I just wasn't giving it
38:58
the energy it needed to keep me healthy and strong. My brain told me
39:02
to just suck it up and press on, but my heart knew that something
39:07
had to change. So I made a decision to practice what I preach.
39:09
I put my career on hold and sought treatment. I had to learn to
39:13
treat my body with respect. I think that is a very good message for
39:15
young women in this country. Yeah, you know what song was my shit
39:20
back in the day, It was your Love is My Drug. Yeah,
39:22
that's a great That's a banger still to this day as a good song.
39:29
Oh yeah, she had some real bangers back in the early twenty tens.
39:34
Her Katie Perry, Like, some of these people were fucking running running our
39:39
mixtape CDs that we would make. Oh yeah. Next up is Kerrie Washington.
39:46
She's an actress. She's got a good quote, so a good quote
39:52
saying and I quote. Learning how to love myself and my body is a
39:57
lifelong process, but I definitely don't struggle. The way that I used to
40:00
therapy helped me realize that maybe it's okay for me to communicate my feelings instead
40:05
of literally stuffing them down with food. Maybe it's okay for me to express
40:08
myself. That's pretty cool. In that article, she was talking about how
40:13
she used to struggle with binge eating, and so that's kind of what she
40:16
was doing. She was trying to stuff herself or stuff her emotions down with
40:21
food, which a lot of people do. And then the last celeb we
40:25
have on the list is Charlemagne the God. He's a big proponent of therapy,
40:30
especially for the African American community and especially men in the African American community.
40:36
But he also talked about how if you're still experiencing trauma, if you're
40:40
still in the hood, if you're still in the ghetto and constantly being traumatized
40:46
every day about how rough that environment is, it can seem like a ridiculous
40:51
thing to go to therapy, but it still helps you. It's still an
40:53
important thing. So I really liked that quote. And he just recently guest
40:59
hosted The Daily Show and did such a good job. It was hilarious.
41:05
Oh yeah, I used to randomly when I would drive to work really early
41:08
and I had like a long commute, and I listened to the radio.
41:12
I'd switch between two and his show was is it Cyndy Cast? Is that
41:15
the right word? It was the Breakfast Club too, yeah, yea yeah,
41:21
is the Breakfast Club? And it would it would play on the local
41:22
station, but it was like his live show. I think they were doing
41:25
on like the East Coast. So I used to listen to him a lot
41:29
actually in the morning. That's pretty good, thoughtful guy. Yeah. Well,
41:34
with that, thank you all for making it this far. I think
41:37
we're going to lean into letting this be our last one for the calendar year.
41:42
We appreciate you all. We hope you have a wonderful holiday, great
41:45
new year. We'll see you early January twenty twenty four. Let me run
41:49
through our final things that we finished every episode with that being. You can
41:53
find us everywhere Apple Podcasts, Spotify, whatever podcast app. Do you use
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YouTube music? Now? You can see our show on there, which is
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pretty cool. I think YouTube music is a new thing. Maybe it's not,
42:05
but I heard about it for the first time recently, so that's why
42:07
I'm mentioning it. But we're on there. If you use Apple Podcasts,
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feel free to leave us a five star review. You can leave us a
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on social media at Millennial MHC. Thank you, happy end to twenty twenty
42:25
three, hoping for an even better twenty twenty four and as always, take
42:31
care of y'all. Mentals quia tu salud meal, Let's go.